Schizophrenia see Chapter 4 and paranoid disorders see Chapter

A small proportion of psychotic illnesses (probably less than 10 per cent) start after the age of 65. This is usually the paranoid form with good preservation of general personality. (The term paraphrenia may be used.) It is important to check for sensory impairment, which may be contributing to the problem by increasing the patient's isolation and reinforcing any paranoid tendency. Social activity, as through a day centre or residential home, may be helpful if the patient will accept it. Antipsychotic drugs are used, but results are sometimes disappointing.

Case example

A widower aged 73 had lived an increasingly isolated life since retirement. His GP was called to see him as an emergency by the police, to whom he had made frequent 999 calls alleging that his neighbours were trying to murder him with gas. Apart from his obvious delusions, he was otherwise in good health. He did not believe that he was in any way unwell. He was compulsorily admitted, after a domiciliary visit from the duty psychiatrist, to a psychiatric ward under the Mental Health Act 1983. He was unwilling to take oral medication, but his symptoms partially resolved with a small dose of a depot antipsychotic injection. Although he could be discharged, he remained isolated and generally suspicious, and his community psychiatric nurse frequently had difficulty in persuading him to have his injection.

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