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

Medical Investigations

The history-taking and physical examination should guide the subsequent laboratory workup and include a complete blood count with differential, electrolytes, blood glucose, calcium and magnesium, thyroid-stimulating hormone, serum folate, and B12 levels and hepatic and renal functions. Screening for syphilis and testing for human immunodeficiency virus infection should also be considered as they may mimic numerous neuropsychiatric disorders, including paranoia.

Plasma levels of any medications that require regular blood monitoring should be completed to rule out toxicity. Additionally, if there is any suspicion of substance misuse, serum levels of common over-the-counter medications such as acetaminophen and salicylates should be requested, a serum alcohol level drawn, and a urine toxicology screen completed.

A urinalysis, chest radiography, blood cultures, or a lumbar puncture could be completed if there is suspicion of an infectious process. A baseline electrocardiogram is beneficial even in the absence of a significant cardiovascular history or symptoms. Neuroimaging with computed tomography or a magnetic resonance imaging brain scan is particularly relevant if cognitive impairment or focal neurological signs are present. Electroencephalography is most useful in a suspected case of seizure disorder.

Sensory impairment can often be mistakenly classified as paranoia or suspiciousness. Thus, it is also prudent to consider audiometrical and visual testings as part of a comprehensive workup.

After the search for underlying medical causes has been exhausted, other mental illness should be considered.


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