45歲 以後에 初發한 偏執症候群의 特徵

The Characteristics of the Paranoid Syndrome Beginning after Age of 45; Is It Valid to Exclude So-Called Late Paraphrenia from Schizophrenia in DSM-III

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The 25 patients, in whom paranoid symptoms had occurred after age 45, and who had been admitted to Kyung Hee University Hospital from May 1979 to June 1984, were compared with 40 paranoid schizophrenics who had fitted to the- DSM-III diagnostic criteria, to clarify whether such syndrome should be classified to schizophrenia, or a separate entity. The results were as following； 1. The male to female ratio was 0.92 : 1 in late paraphrenics, in contrast with 2.33 : 1 in control (p > 0 .05). 2. The age at onset was 53.6 ±8.0 year in late paraphrenics, in contrast with 28.1 ±7.6 year ln control (p < 0 .001). 3. Majority of late paraphrenics had been ill for 2 weeks to below 6 months(48.0% ), while for above 2 years in control(60.096)(p < 0 .0005). 4. The late paraphrenics had been in hospital for 32.1±18.6 days on the average, in contrast with 53.4±31.3 days (p < 0 .01). 5. At time of admission, majority of late paraphrenics had married (68.096) (p < 0 .005), in contrast with being single in control (62.596) (p < 0 .0005). But divorced, separated or deceased were more ’ in late paraphrenics (32.096) than control (p < 0 .05). 6. The numbers of children of late paraphrenics were 3.8±2.0, and of control 0 .8± 1 .4 (p< 0.001). 7. Upon sociosconomic classes, majority of both patients belonged to middle class (p > 0 .5), and -control(42.596) belonged to lower class more than late paraphrenics(20.0%) (p > 0 .05). 8. The control had been admitted more frequently (2 .9 土 2.1 times) than late paraphrenics(1.4 ± *0.9 times) (p<0. 01). 9. Both patients had schizophrenic family members most of all (each other 12.0^ and 7.5%) (p > 0 .5)，二the late paraphrenics had somewhat more paranoid disorder(8.0%) than control(2.5%) (P>0.3). 10. Majority of late paraphrenics had paranoid personality trait(89.096) (p < 0 .0005), in contrast with schizo d one in control(55.096) (p < 0 .025). 11. Precipitating factors were present in 92.0% of late paraphrenics and 60.0% of control(p<0.01). Among the contents, family problem was anost predominant(56.096) (p < 0 .0005) in late par-aphrenics and marital and financial problems (each other 28.0%) (p < 0 .05) in next order, while work (30.096) and interpersonal problem(17.5%) were more prominent in control (p > 0 .5). 12. Among the contents of delusions, majority of both patients had persecutory ones (80.096) (p > 0.5) and idea of reference (each other 40.0% and 62.5 % )(p > 0 .05). Otherwise, late paraphrenics had infidelity(36.0%) and hypochondriacal(32.096) ones(p>0.05), while delusion of being controlled (55. 096) (p < 0 .01) and other Schneiderian ones (30.096) were more common in control(p<0.05). In addition, affective symptoms(72.096) (p < 0 .05) and cognitive deficit(40. 0%) (p < 0 .0005) were more common in late paraphrenics, while hallucination (60.096) (p > 0 .3) and loosening of association (67.5%)(P>0.05) in control. 13. The responses to physical treatment mainlycomposed of antipsychotics were fair (each other 92.0% and 100.0%)(p > 0 .05). Otherwise, late paraphrenics administered antidepressants (24.0%) more than the control (p < 0 .01), while electroconvulsive therapy was used more in control(20.096) (P>0.1). 14. Most of the clinical diagnoses at discharge Were established as paranoid disorder (56.0%), and in next order, paranoid schizophrenia(20.0%). Based on the above results, we concluded that late paraphrenia should be classified to paranoid disorder rather than atypical psychosis in addition to the agreement with the validity of separating this syndrome from schizophrenia in DSM-III.