SENILE PSYCHOSIS (PARANOID TYPE)

This is the most clearly defined type of senile psychosis, characterized by the gradual appearance of delusions with hallucinations, but not accompanied by impairment of intellectual functions in the early stages. The delusions are usually of the persecutory type. The patient may, for example, insist that his relatives have conspired to “put him away.” A delusion of this kind may be supported by the hallucination that he has been served poisoned food or that he has been sprayed with poison gas. About 30 per cent of senile psychoses take a paranoid form.Paranoid patients do not suffer from the marked memory loss, disorientation, or confusion that afflict other senile patients. Their attitudes toward others, however, are deeply affected, and they are typically quarrelsome, complaining, and demanding. These symptoms usually occur in individuals who have shown similar personality traits all their lives. They appear in exaggerated form during senility because the patient has an unconscious need to use them as defensive measures.The delusions are a more extreme form of defensive action and develop when the elderly person can no longer cope with problems posed by physical deterioration and emotional isolation. It is not surprising, therefore, that the delusions are sometimes grandiose and erotic as well as persecutory. They occur in increasing severity as these patients deteriorate for, as Noyes and Kolb (1963) point out, “As memory defect appears, delusional extension and further defensive emotional reaction may take place in an attempt to repair the additional psychobiological deficit. Similarly, as judgment fails the delusions become more absurd, partly because beliefs are no longer subject to any critical scrutiny, and partly because the damaged personality requires more fantastic beliefs for its support.”Illustrative Case:The patient, a woman of seventy-four, had been referred to a hospital after the death of her husband because she became uncooperative and was convinced that her relatives were trying to steal the insurance money which her husband had left her. In the hospital she complained that the other women had joined together against her and were trying to steal her belongings. She frequently refused to eat, on the grounds that the food tasted funny and had probably been poisoned. She grew increasingly irritable and disoriented for time and person. She avidly scanned magazines in the ward reading room but could not remember anything that she had looked at. The following conversation reveals some of her symptoms:DR: Do you find that magazine interesting?PT: Why do you care? Can’t you see I’m busy?DR: Would you mind telling me something about what you are reading?PT: It’s none of your business ... I am reading about my relatives. They want me to die so that they can steal my money.DR. Do you have any evidence of this?PT: Yes, plenty. They poison my food and they have turned the other women against me. They are all out to get my money. They even stole my sweaterDR: Can you tell me what you had for breakfast?PT: . . . (pause) I didn’t eat breakfast ... it was poisoned and I refused to eat it They are all against me. (Coleman, 1964)