Hallucinatory-delusional states in the elderly: treatment classification.

This paper describes a multi-dimensional study of non-organic hallucinatory states in the over-sixties. The subjects totalled 43 with no signs of obvious dementia or sustained confusion. Eleven biological, socio-psychological factors and 15 aspects of the clinical picture were assessed at the initial interview. Clinical symptoms were followed under medical treatment. Thirty eight subjects were followed for a further one year. One month later these subjects were classified into three groups. Group I, Complete Recovery Group (18 subjects). The characteristics of this group were: same sex ratio, good previous adaptation, high educational level, normal marital state, high rate of precipitating events, good response to treatment, acute onset, vividness and concreteness of the hallucination, fragmentariness of the delusion, high rate of anxiety and psychomotor excitement and good rapport. The course resembled "psychogenic reaction" and at the same time it resembled "organic brain syndrome" in symptoms. A possible interpretation is that under the influence of precipitating factors, "subclinical" cerebral hypofunction due to senility lapsed transiently into "apparent" cerebral hypofunction, leading to acute hallucinatory-delusional state. Group II, Partial Recovery Group (22 subjects). The characteristics of this group were: predominance of females, presence of precipitating events, fair response to treatment and subacute onset. This group was similar to Roth's "late paraphrenia" and Janzarik's Altersschizophrenie. Group III, Refractory Group (3 subjects). The characteristics of this group were: poor response to treatment and chronic onset. Two fell into dementia within one year. The symptoms of two subjects in the refractory group could be interpreted as prodromal symptoms of dementia. Aging reduces the redundancy of cerebral function to cope with the environmental changes. Among the elderly, events in daily life may often become precipitating factors of hallucinatory-delusional states. For the prophylaxis of hallucinatory-delusional states in elderly, serious attention should be paid to the psychological and somatic conditions which precede to these precipitating factors.