SENILE PSYCHOSIS (DELIRIOUS AND CONFUSED TYPE)

This syndrome occurs in either acute or chronic form and comprises about 10 per cent of senile psychoses.The acute and usually transient form may be due to hypoglycemia (low blood sugar), urinary infection, overuse of bromides or barbiturates, surgery requiring general anesthesia, trauma such as a broken hip or leg, and, less frequently, vitamin deficiency. In milder cases the patient is bewildered, disoriented, insomniac, and has frequent hallucinations. In severe cases he becomes restless, resistive, combative, incoherent, and completely confused. These reactions usually subside within a few hours or days. In some instances, especially in terminal cases, they may become chronic. Illustrative Case:Mrs. S., aged sixty-eight, had a public- school education, was of average intelligence; married, no children; had no real marital difficulties; and had had no serious illnesses or operations during her life. She had an attack of influenza from which she did not seem to recover. Physically there were no outstanding symptoms, but she became mentally deranged. She became irrational, assaultive, and untidy, so that it was impossible to manage her at home. When brought to the hospital she was resistive and confused, she cried easily, and complained of many delusions concerning her health. She was incoherent, irrelevant, and rambling. She was disoriented as to time, place, and person, and her memory impairment was pronounced.When asked what was the matter with her, she replied, “Injected you see, that spinal nerve which has to do with—what—hypnotize—I said they started so fact that. I remember my mother, grandmother and grandfather, they keep telling it to you till I find death. Gee, what she gave me that back. You have completely done that. Father had the same thing done to him that I have done to me. Uncle Abe was perfectly healthy, so that proves nothing was hereditary, that proves that, which the sick wards injected into my head, in my thinking head, in the head that does the controlling. Take me out, if you will take me out. I know didn’t anybody put me in here. I’m talking about my life and health right now. My Aunt Hattie talked to me most My mother is a very jealous person.”Her mental confusion gradually cleared up. Emotionally she remained very unstable, having frequent crying spells and complaining about small events or imaginary happenings. After six weeks in the hospital she returned to her home. Six months later her behavior again became such that home care was impossible. She was returned to the hospital, where she died after several months. (Landis and Bolles, 1948)