SENILE PSYCHOSIS (SIMPLE DETERIORATION TYPE)

This is the most common form of senile psychosis, comprising about 50 per cent of the entire group. The symptoms are for the most part an exaggeration of the usual changes that occur with advancing age. These include memory defect for recent and, later, remote events, a narrow range of interest, apathy, intolerance of change, tendency to reminisce, loss of judgment, restlessness and irritability. As the condition progresses, the patient loses contact with his environment, becomes neglectful of personal care and appearance, confused and disoriented, and may develop a mildly stuporous state.The following case illustrates many of the features of simple senile dementia, but also shows that other types of reaction—in this case, paranoid and presbyophrenic—may be combined with it.Illustrative Case: H. S. was admitted to a public hospital for mental disorders when seventy-two years of age. When six years old she sustained a fracture of the hip. Four years later an operation was performed in an effort to correct the deformity and disability. It was necessary to strap her to the bed for six months following the operation. The functional results of this operation were disappointing, and the patient was always self- conscious concerning the considerable degree of disability that persisted. She always felt that people did not wish to mingle with her because of this infirmity and did not seem comfortable in the presence of others. It is quite possible that the few paranoid features accompanying the patient's senile dementia may have had their origin in this defensive characteristic.Five years before the patient’s admission her adopted son with whom she resided noted that she was becoming forgetful, especially concerning her usual household duties and recent incidents. She hoarded articles and sometimes said that someone had stolen them. She remembered events of her childhood quite well and at times was somewhat boresome in her accounts of early experiences. Her adopted son noted that she became increasingly neglectful of her personal appearance. For many months prior to her admission she would not bathe unless reminded to do so. Recently she often went to bed without removing either clothing or shoes. At times she put on her clothing “inside out.” For four years prior to admission she seemed to find it difficult to prepare meals at accustomed times.On many occasions she completed the preparation of the midday meal at 8 A.M. and insisted that the family should eat at that time. In preparing coffee she often put sugar instead of coffee in the coffee pot but failed to recognize her error. In a few instances she wished to pay bills she had already paid. She was restless at night but often slept during the day. The patient became increasingly confused in surroundings with which she had formerly been quite familiar. Often, when crossing the street, she paid no attention to approaching automobiles. At times she wandered away from home.There were periods during which she constantly packed and unpacked her clothing. During recent months she had often failed to recognize friends. She became increasingly suspicious, said that neighbors were talking about her, spoke of them in extremely derogatory terms, maintained that her son had lied to her and had tried to poison her, and that her neighbors had threatened to kill her. She claimed that her son and an elderly woman who had been employed to give her protective care had been secretly married. She complained that everyone was trying to control her activities and threatened to commit suicide if not permitted to do as she wished.When the patient was brought to the mental hospital, she rose to meet the admitting physician, shook his hand, asked him where he was and if there was anything she could do for him. She knew her name but could not give her address or other identifying data. She claimed that her son, who had really been extremely devoted to her, had ejected her in order to secure possession of her house, which was located “down the hill.” At the time of this writing she has been in the hospital for eighteen months. Affectless and placid, she sits in a rocking chair all day, paying little or no heed to her environment. Her existence is now but little above a vegetative level. (Noyes and Kolb, 1963)