As part of a field study of the latest draft of WHO'S ICD 10 classification, two clinicians, one familiar with ICD 9 and one with DSM-111, rated 36 cases previously diagnosed as 'late paraphrenia' using ICD 9. When raters adhered closely to the diagnostic guidelines issued with the new classification, complete agreement was achieved and most cases received a diagnosis of paranoid schizophrenia. However, both raters were uncomfortable with the low threshold for this diagnosis and when freed from the need to give primacy to schizophrenia preferred a much wider range of diagnoses which included a number of subcategories of delusional disorder. 'Persistent delusional disorder' and 'other persistent delusional disorder' produced the best fit but up to eight cases were given two diagnoses. Levels of confidence in the diagnosis and ease of achieving this are also given. There was an acceptable level of agreement (kappa = 0.756) when this procedure was employed. It is argued that retrieval of such cases would be facilitated either by providing a code for age of onset or by restoring a separate category for late onset schizophrenia or late paraphrenia.
KEY wows-Classification, ICD 10, paraphrenia. Kraepelin ( 1919) is generally credited with having established the diagnosis of paraphrenia as a disorder characterized by paranoid delusions, hallucinations and a lack of progressive deterioration. The concept is in fact much older and figures largely in French psychiatry where the term de'lire hallucinatoire chronique persists in current classifications (Pichot, 1982). Mayer-Gross (1932), however, in a follow-up of Kraepelin's original cases, found that in the majority the diagnosis had been changed to schizophrenia and that it was difficult to predict in which patients this could happen.
After Kraepelin's time, the term fell into decline and only reentered the psychiatric vocabulary when Roth (1955) described a group of conditions occurring after the age of 60 in which there was 'a well organized system of paranoid delusions with or without auditory hallucinations existing in the setting of a well-preserved personality and affective response'. This terminology was not easily accepted, opposition arising on the one hand from those who regarded all non-affective paranoid illnesses in old age as early forms of dementia and on the other from those like Frank Fish (1960), who, summarizing the early German literature, claimed to show that what was being described was Requests for reprints to Professor Raymond Levy.