Paranoid Symptoms Among Older Adults

Muzumel A. Chaudhary, MD; Kiran Rabheru, MD, CCFP, FRCP, ABPN


Geriatrics and Aging. 2008;11(3):143-149. 

In This Article

Primary Psychotic Disorders

The essential feature of a delusional disorder is a nonbizarre delusion without prominent auditory or visual hallucinations. Symptoms must be present for a least 1 month. When symptoms arise late in life, basic personality features are typically intact, and intellectual performance and functioning outside the delusional sphere are preserved.[15]

A controversial diagnosis for consideration is that of very-late-onset schizophrenia-like psychosis. Various terms such as late-onset schizophrenia, paraphrenia, and late paraphrenia have been used to describe chronic persecutory states beginning after age 60 years that are not secondary to an affective disorder or focal or progressive structural brain abnormality.[19,22] Its cardinal features include its pattern of development over several years and the absence of dementia. As per a recent international consensus statement, there exists an overrepresentation of women among very-late-onset cases, and the presence of sensory impairment and social isolation contributes to the illness.[22] While presenting symptoms largely overlap with those of late adolescence or early adult-onset schizophrenia, very-late-onset schizophrenia-like psychosis has a lower prevalence of formal thought disorder and affective flattening and a higher prevalence of visual hallucinations.[22] Further evidence in support of this diagnosis include the increased rates of very-late-onset schizophrenia-like psychosis in patients with a family history of schizophrenia and common risk factors to that seen in schizophrenia with onset in the second or third decade of life.[19,23]


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