Paranoia mit spätem Beginn Psychopathologie und Psychodynamik

Abstract

We report on a 70-year-old man who suffered from persecutory delusions during the last 20 years. During first visits, he showed neither cognitive impairment nor Schneiderian first rank symptoms. Inpatient and day clinic treatment as well as further outpatient therapy led to reintegration into social life and trusting relationships between the patient and the therapeutic team, although the persecutory delusions still persisted. During following years, symptoms of cognitive impairment increased gradually and neurological symptoms could be observed. We present a psychodynamic hypothesis regarding the reported psychopathology and discuss alternative diagnoses and pharmacological treatment.

Delusional Misidentification Syndromes and Dementia

“…9–11 More recently, Mulholland and O’Hara have reported a new variant of DMS named “delusional hermaphroditism.” 12 Finally, nurturing syndrome is an increasingly recognized delusion, clustering with phenomena of misidentification, in which the patient believes a dead family member to be alive. 13 These patients often request the police to search for their missing relatives and feed and sleep with pictures of the dead family members. 14 In many cases, 2 or more misidentification syndromes and related phenomena are present in the same patient, 15–17 which may indicate similar underlying pathophysiological mechanisms.…”

Cognitive neuroscience of delusions in aging

“…At 7-year follow up, LOS patients were no more likely to progress to dementia than was a group of elderly persons with depression (Rabins and Lavrisha 2003) and have comparable life-expectancies to nondemented elderly at 5- to 10-year follow up. A case study by Schlimme et al (2002) and others suggests normal cognition at first symptom onset with moderate cognitive decline over the 20-year span of study in a nondemented elderly man.…”

“…Mirror sign (3%) (Mendez et al 1992) and tv sign (5%–7%) (Mendez et al 1992; Leroi et al 2003) are phenomena in which the patient misidentifies his or her own mirror image or treats television characters and events as reality. Finally, nurturing syndrome is an increasingly recognized (Schlimme et al 2002) delusion, clustering with phenomena of misidentification, in which the patient believes a dead family member to be alive. These patients often request the police to search for their missing relatives and feed and sleep with pictures of the dead family members.…”

“…Overall, it appears the risk for paranoid or delusional ideation increases linearly with age after age 65 (Schlimme et al 2002), delusional patients in both groups are generally older than nondelusional controls (Bassiony et al 2000) or patients suffering from hallucinations only (Devanand et al 1992; Bassiony et al 2000). Predominant symptom onset is usually in the seventies.…”