Late-onset schizophrenia and very late-onset schizophrenia-like psychosis

Abstract

The classification of schizophrenia-like and paranoid disorders in elderly people has a long and somewhat confusing history which can largely be blamed for the currently uncertain nosological position of such patients. To Kraepelin, dementia praecox was fundamentally a disorder of emotion and volition, while paraphrenia was characterized by hallucinations and delusions without deterioration or disturbance of affective response, and paranoia involved the insidious development of a permanent delusional system which resulted from internal causes and was accompanied by perfect preservation of orderly thinking, acting and will. However, by the eighth edition of his textbook in 1913, Kraepelin was expressing serious doubts about the assumptions on which his conception of dementia praecox had been based. In some cases, a complete and lasting recovery was seen and the relationship between onset and early adult life was not absolute. Indeed, Bleuler had introduced the term ‘schizophrenia’ in order to get away from the concept of the disorder as an adolescent mental deterioration.