PARAPHRENIA: SYMPTOMS, TYPES AND TREATMENT - ECONOMÍA - 2025

The parafrenia is a mental disorder characterized by chronic delirium, which consists of ideas unsound or unrealistic that the patient holds firmly, and that cause suffering. Delusions may or may not be accompanied by hallucinations.

Paraphrenia generally appears late, evolves slowly and presents a relative preservation of personality. In addition, these delusions are characterized by having a fantastic tonality and an exuberant presentation. However, cognitive functions and intelligence remain intact.

Except for the delusional theme, the patient with paraphrenia appears to have no problems and seems to carry out his daily tasks without difficulty. They have been observed to tend to be suspicious and / or arrogant.

Therefore, the origin of a delusion of persecution could be due to an extreme amplification of mistrust towards others. While the delusion of grandeur would come from the arrogance caused by an obsession with the "I".

History and concept

The term "paraphrenia" was described by the German psychiatrist Karl Kahlbaum in the second half of the 19th century. He used it to explain certain psychoses. Specifically, those that appeared very early in life he called hebephrenias. While those late ones he called dementias (currently, this term has another meaning).

On the other hand, Emil Kraepelin, the founder of modern psychiatry, spoke of paraphrenia in his work Lehrbuch der Psychiatrie (1913).

It is important to know that the concept of paraphrenia has been incorrectly defined. On some occasions it has been used as a synonym for paranoid schizophrenia. It has also been used to describe a psychotic picture of progressive evolution, with a well-systematized delusion that causes great discomfort.

Currently, paraphrenia is not included in the most common diagnostic manuals (such as DSM-V or ICD-10). However, some authors defend the psychopathological validity of the concept.

As it is not well determined, its causes are not exactly known, as is its prevalence in the population. For now there are no updated and reliable statistics.

Symptoms of paraphrenia

As mentioned above, paraphrenia is characterized by the presence of a delirium that arises abruptly in late life. When the delusional topic is not discussed, it seems that the person acts completely normal. These delusions can be of different types:

Delusion of persecution

The person feels that they are being persecuted, and may think that they are looking for them to harm them, and that they are watching their every move. This type of delirium is the most consistent and frequent, and seems to be found in 90% of patients.

Reference delusion

It is found in approximately 33% of patients with paraphrenia. It consists in believing that unimportant events, details or statements are directed to him or have a special meaning.

In this way, these individuals may think, for example, that television is talking about them or sending hidden messages.

Delusions of greatness

In this case, the patient thinks that he has special qualities or is a superior being, for which he deserves recognition.

Erotic delusion

The person firmly maintains that he arouses passions, that he has fans who pursue him, or that a certain person is in love with him / her. However, there is no evidence to show that this is true.

Hypochondriacal delirium

The individual believes he suffers from a variety of diseases, constantly turning to medical services.

Delusions of sin or guilt

The patient feels that everything that happens around him is caused by himself, especially negative events.

Hallucinations

They consist of the perception of elements such as voices, people, objects or smells that are not really present in the environment. Three out of four people with paraphrenia typically have auditory-type hallucinations.

Hallucinations can also be visual, occurring in 60% of these patients. The olfactory, tactile and somatic are less common, but they can appear.

Schneider's first-order symptoms

These symptoms were delimited to describe schizophrenia, and consist of auditory hallucinations such as: hearing voices talking to each other, hearing voices commenting on what one is doing, or hearing one's own thoughts aloud.

Another symptom is believing that the mind or body itself is being controlled by some kind of external force (which is called a control delusion).

They may also think that thoughts are being drawn out of your mind, introducing new ones, or that others can read your thoughts (called thought diffusion). This last type of delirium is in approximately 17% of patients.

Finally, it has been found that these patients tend to manifest delusional perceptions such as relating normal experiences to a strange and unreasonable conclusion. For example, they may believe that the presence of a red car indicates that they are being watched.

Differences with schizophrenia

Despite resembling schizophrenia, they are two different concepts. The main difference is the preservation of personality, and the lack of impairment of intelligence and cognitive functions.

In addition, they maintain their habits, have a relatively normal life and are self-sufficient; They are connected to reality in other areas that are not related to the subject of their delusion.

Types of paraphrenia

Kraepelin determined four different types of paraphrenia that are listed below:

Systematic paraphrenia

It is more common in men than women. It begins between the ages of 30 and 40 in half of the cases, and between the ages of 40 and 50 in 20% of the cases.

Kraepelin described it as "the extraordinarily slow and insidious development of a fatally progressive delusion of persecution, to which ideas of greatness are ultimately added without destruction of the psychic personality."

In the first phase of systematic paraphrenia, the person feels restless, distrustful, and threatened by a hostile environment. Her interpretation of reality leads her to experience auditory and visual hallucinations on some occasions.

Expansive paraphrenia

It generally occurs in women, beginning between the ages of 30 and 50. It is characterized by a delirium of exuberant grandeur, although it may also have mystical-religious and erotic delusions. He seems to believe in these phenomena, although he sometimes assumes they are fantasy.

This is accompanied by mild intellectual arousal, which makes you talkative and oscillates between irritability and euphoria. In addition, they present confused language and mood swings, although they maintain their mental capacity.

Confabulatory paraphrenia

It is less frequent, and in most cases it presents without sex predilection. Like the others, it begins between the ages of 30 and 50.

It is characterized by a falsification of memories and strange stories (conspiracies). However, lucid consciousness remains. Progressively the delusions become more absurd until generating a psychic collapse.

Fantastic paraphrenia

It occurs more in men, and generally appears between 30 or 40 years. It evolves rapidly and in 4 or 5 years leads to dementia. It is very similar to schizophrenia; first it presents as dysthymia, and later fantastic persecution ideas, or delusions of grandeur, appear.

Initially, the patient has derogatory interpretations that cause the persecutory ideas to consolidate. Thus, you think you are being harassed. Later, auditory hallucinations appear, mainly voices that comment on their actions or belief that their thought is heard aloud.

They have an indifferent mood and slight excitement. Kinesthetic (movement) pseudoperceptions can also occur. While, in chronic cases, neologisms (invention of own words) are observed during a conversation.

In treating this paraphrenia, Kraepelin wonders whether these people might have an atypical form of dementia praecox (schizophrenia). Despite everything, these people can adapt to their everyday life.

Diagnosis

Although the diagnosis of paraphrenia is not found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or ICD-10, certain diagnostic criteria have been developed based on the latest research (Ravidran, Yatham & Munro, 1999):

There must be a delusional disorder with a minimum duration of 6 months, characterized by:

- Preoccupation with one or more delusions, usually accompanied by auditory hallucinations. These delusions are not part of the rest of the personality as in delusional disorder.

- The affectivity is preserved. In fact, in the acute phases, the ability to maintain an adequate relationship with the interviewer has been observed.

- You must not present any of the following symptoms during the acute episode: intellectual impairment, visual hallucinations, incoherence, flat or inappropriate affectivity, or seriously disorganized behavior.

- Alteration of behavior in accordance with the content of delusions and hallucinations. For example, the conduct of moving to another city to prevent further persecution.

- Criterion A is only partially met for schizophrenia. This consists of delusions, hallucinations, disorganized speech and behavior, negative symptoms such as lack of emotional expression or apathy).

- There is no significant organic brain disorder.

Treatment

Patients with paraphrenia rarely ask for help spontaneously. Generally the treatment comes at the request of their families or action of the authorities.

If you must go to the doctor, the success of the treatment depends largely on the good relationship between therapist and patient. This would achieve good adherence to treatment, which means that the patient would be more committed to their improvement and would collaborate in their recovery.

In fact, many people with paraphrenia can lead normal lives with the proper support of family, friends, and professionals.

It has been suggested that paraphrenia, like paranoid schizophrenia, can be treated with neuroleptic medications. However, this treatment would be chronic and could not be stopped.

According to Almeida (1995), an investigation examined the reaction of these patients to treatment with trifluoperazine and thioridazine. They found that 9% were unresponsive, 31% showed some improvement, and 60% reacted effectively to treatment.

However, other authors have not had such good results, since finding an adequate treatment for this type of symptoms continues to be a challenge for professionals; since each individual can react differently to drugs.

That is why it may be more appropriate to focus on other types of therapies, such as cognitive behavioral therapy, which would have the objective of reducing delusional worry.

References

1. Almeida, O. (1998). 10 Late paraphrenia. In Seminars in Old Age Psychiatry (p. 148). Springer Science & Business.
2. American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).
3. Kraepelin, E. (1905). Introduction to the psychiatric clinic: thirty-two lessons (Vol. 15). Saturnino Calleja-Fernández.
4. Ravindran, AV, Yatham, LN, & Munro, A. (1999). Paraphrenia redefined. The Canadian Journal of Psychiatry, 44 (2), 133-137.
5. Rendón-Luna, BS, Molón, LR, Aurrecoechea, JF, Toledo, SR, García-Andrade, RF, & Sáez, RY (2013). Late paraphrenia. About a clinical experience. Galician journal of psychiatry and neurosciences, (12), 165-168.
6. Sarró, S. (2005). In defense of paraphrenia. Journal of Psychiatry of the Faculty of Medicine of Barcelona, ​​32 (1), 24-29.
7. Serrano, CJP (2006). Paraphrenias: historical review and presentation of a case. Galician journal of psychiatry and neurosciences, (8), 87-91.
8. Widakowich, C. (2014). Paraphrenias: nosography and clinical presentation. Journal of the Spanish Association of Neuropsychiatry, 34 (124), 683-694.