The Psychopathological Study of Late-onset Endogenous Psychosis

1998 Fiscal Year Final Research Report Summary

• Project/Area Number: 08671107
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Psychiatric science
• Research Institution: Keio University
• Principal Investigator: ASAI Masahiro Keio University, School of Medicine, Department of Neuro-Psychiatry, Professor, 医学部, 教授 (80051374)
• Co-Investigator(Kenkyū-buntansha): HAMADA Hidemichi Keio University, School of Medicine, Department of Neuro-Psychiatry, Assistant P, 医学部・精神神経科, 講師 (70101897)
• Project Period (FY): 1996 – 1998
• Keywords: late-onset schizophrenia / late paraphrenia / late catatonia / atypical psychosis / electroconvulsive therapy

Research Abstract

This study deals with late-onset schizophrenia in terms of historical background and clinical psychopathological aspect. Some important historical reports which seem to have relation to late-onset schizophrenia are summerized. Late-onset schizophrenia is not a single clinical entity, but rather than the heterogenous syndromes. It seems to be divided into three major groups or syndromes. The first is late paraphrenic group whose clinical features are hallucino-delusional states without serious deteriolaton of personality and with intact affectivity. It is further subdivided into two subtypes. The chronic delusional type is similar to delusional disorder in DSM-4. The hallucino-delusional type has more typical schizophrenic features including "Schneider's first rank symptoms" and is found to be the later onset of delusional type of schizophrenia. The second major group is late catatonic group whose clinical features are initial depression, schizophrenic negative symptoms, charcteristic s ymptomatic progression and often poor prognosis compared with the first group. In typical cases which should be called "the complete type", late catatonia develops some characteristic progressive stages in the following order Stage 1 (primary depression), Stage 2 (anxiety and agitation), Stage3 (hallucination and delusion), Stage4 (catatonic syndrome) and the residual stage. Transition to the residual stage may occur at any point. In practice, there are three other subtypes, which are called "the abortive types" (anxious/irritated type, depressive/delusinal type, residual type). The third group named atypical psychosis is much less frequent than the other two. It features recurrent confusional states. Each confusional episode is acute-onset, delirium-like but having some typical schizophrenic symtoms. At least a few intial episodes end up with complete remission.
Sixteen clinical cases are presented and discussed carefully in psychopathological viewpoint. As for treatment, a small dose of high potential neuroleptic agents is usually effective to the paraphrenic patients. On the other hand, the catatonic patients are often resistant to any drug therapies, especially those at Stage4. However, electroconvulsive therapy was obsereved to be effective in some cases.