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- Roth - "well organised system of paranoid delusions with or without
auditory hallucinations in setting of well preserved personality and
affective response"
- Grahame - form of schizophrenia attenuated and modified characterised by
prominent paranoid delusions with or without hallucinations
- ICD 10 - persistent delusional disorders
Clinical features
- Systematised paranoid delusional state
- elderly single woman, living alone, socially isolated
- substandard housing, low income
- physically robust
- 40% have impaired hearing
- Onset insidious
- Schneiderian first rank symptoms may be present
- 60 % have depressive symptoms
- Life expectancy near normal
- prognosis poor
- neuroleptics moderately effective - but frequent relapse
- premorbid personality often abnormal
- few social contacts
- unmarried
- married late
- separate
- divorced
Pathogenesis
- Inherited predisposition to develop psychosis
- Social isolation may be protective in early life, but disadvantage in old
age
Epidemiology
- 10% of all psych admissions over 60 years
- Female 7:1 male
- 8.7 /100,00 in 65-74 year old
Treatment
- Physical
- treat medical disorders
- attend to sensory impairment
- antipsychotic drugs
- Psychosocial
- engage in day care, services
- multidisciplinary approach important
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