Raymond Levy and paranoid states of late life

✍ Scribed by Robert Howard

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 623 KB
• Volume: 11
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/(sici)1099-1166(199604)11:4<355::aid-gps443>3.0.co;2-g

✦ Synopsis

It is sometimes said that if you can remember the 1960s you were probably not there, and while many of those of us who have worked with Raymond do not remember the decade clearly because we were only just there, we can appreciate that this was a boom time for late paraphrenia research. in their seminal paper provided excellent clinical descriptions of late paraphrenic patients together with established risk factors for the condition (female sex, deafness, abnormal premorbid personality and social isolation). Believing late paraphrenia to be the expression of schizophrenia in old age they nevertheless recognized heterogeneity within patients which they postulated reflected the differing aetiological contributions of personality, social isolation, sensory impairment and genetic factors.

While Kay and Roth believed that organic cerebral disease was present in only a small minority of patients with the late paraphrenia syndrome and observed that fewer than 12% of patients had developed dementia after 10-year follow-up, Felix Post (1966) regarded such organic cerebral change as aetiologically important. Post believed that patients with late paraphrenia represented a heterogeneous mixture of diagnoses and preferred to avoid diagnostic controversy by terming such cases 'persistent persecutory states'. Within this broad category, he recognized three clinical syndromes: true schizophrenia, a schizophreniform syndrome and a paranoid hallucinosis group. Proven organic factors were present in 16 of Post's 93 patients and he believed that in such cases, disturbed memory and concentration could clearly have been seen to precede the first emergence of persecutory delusions.