It is ironical, therefore, that his four varieties have figured in most classifications of schizophrenia ever since. Bleuler also said that, although he assumed schizophrenia to be a group of allied conditions rather than a single disease, he regarded these subdivisions as purely provisional. Kraepelin recognised three varieties of schizophrenia – hebephrenic, catatonic and paranoid – and Bleuler added a fourth – simple schizophrenia. Eve C Johnstone, in Companion to Psychiatric Studies (Eighth Edition), 2010 Varieties of schizophrenia The cumulative incidence of hallucinations and delusions for patients with probable Alzheimer's disease is reported to be more than 50% at 4 years. However, psychotic symptoms frequently accompany dementia disorders and are regarded to be more common late in the course of the disease. In Lewy body dementia, early visual hallucinations are even part of the criteria. Psychotic symptoms may also be a prodrome of dementia.

Psychotic symptoms, like most other psychiatric conditions in the elderly, are related to an increased mortality independent of physical disorders. Individuals with late-onset schizophrenia perform significantly worse than age-matched controls on a variety of cognitive tests, although the difference is not as accentuated as for younger age groups. Basal ganglia calcifications have also been reported in elderly individuals with psychotic symptoms.Īmong the consequences of psychotic symptoms are impairment and disability in daily life, dependence on community care, and cognitive dysfunction. Also, ischemic white matter lesions have been reported in late-onset schizophrenia. Some studies report a higher ventricle-to-brain ratio, larger third ventricle volume, and volume reductions of the left temporal lobe or superior temporal gyrus. Studies on the relationship between psychotic symptoms and structural brain changes in the elderly report disparate results.

Other causes are alcohol and benzodiazepine withdrawal. Furthermore, many drugs, such as anticholinergics, antiparkinsons, psychostimulants, steroids, and beta-blockers can produce psychotic symptoms in the elderly. Psychosis and psychotic symptoms in elderly populations have been associated with a variety of psychiatric and somatic disorders, such as depression, hypothyroidism, cancer, cerebral tumors, epilepsy, and cerebrovascular disease. Thirdly, as for other psychiatric disorders, diagnostic criteria are developed in young or middle-aged patient samples.įactors related to late-life psychosis include female sex, previous schizoid and paranoid personality traits, being divorced, living alone, lower education, poor social network and isolation, low social functioning, sensory impairments, especially deafness, and more dependence on community care. Second, individuals with psychotic symptoms are likely to refuse participation in population studies more often than other elderly. Recent studies have reported that up to 10% of nondemented elderly above age 85 have psychotic symptoms if information from other sources than self-report (especially close informants) is used in the assessments. First, there might be underreporting because the elderly are reluctant to report psychotic symptoms. There are several methodological factors that might explain the low prevalence of psychotic symptoms and syndromes in elderly populations. According to currently used criteria, psychotic disorders are even less common, with reported prevalence ranging from 0% to 5%. Population studies in nondemented elderly are generally based only on self-report and give prevalence figures for psychotic symptoms from 2% to 3% in populations above the age of 65 years. The prevalence of psychotic symptoms is high among the demented elderly, ranging from 45% to 50%, while psychotic symptoms and disorders such as schizophrenia are supposed to be rare in the nondemented elderly. Compared to early-onset psychosis, late-onset cases have better preserved personality, less affective blunting, less formal thought disorder, more insight and less excess of focal structural brain abnormalities and cognitive dysfunction compared to age-matched controls. Currently used terms are late-onset schizophrenia or late-life psychosis, encompassing delusions and visual and auditory hallucinations arising in late life. The term paraphrenia was previously used to describe psychotic syndromes in the elderly. Ingmar Skoog, in International Encyclopedia of Public Health (Second Edition), 2017 Psychosis

Paranoid schizophrenic