Paraphrenia

PARAPHRENIA, a form of mental disorder, conditionally distinguished by Kraepelin from the composition of paranoid schizophrenia. It has not yet been established whether paraphrenia represents an independent disease or an atypical form of schizophrenia. The disease is characterized by the development of chronic delusions, prone to systematization, with hallucinations, but without personality disintegration, and without the phenomena of splitting and catatonic symptoms characteristic of schizophrenia. However, at the end of the disease, slowly progressive dementia sets in, which brings this form closer to schizophrenia and distinguishes it from paranoia (in which, moreover, there are almost no hallucinations). The pathogenesis of paraphrenia has not been clarified. Mixed hereditary burden (schizophrenia and manic-depressive psychosis) is often noted. The onset of the disease is usually in mature age. There are apparently no cases of recovery. Treatment is unknown. Pathoanatomically, diffuse parenchymal changes have been noted, mainly in the frontal, temporal, and lower parietal lobes of the cortex, predominantly in the III and V layers. The following forms of paraphrenia are described: 1) Systematized paraphrenia (paraphrenia systematica), corresponding to the "chronic delusion with systematic development" (delire chronique a revolution systematique) previously described by Magnan. The disease develops gradually—from a period of distrust and irritability; the patient sees hints everywhere, takes casual conversations, notes in newspapers, etc., personally. Hallucinations begin, mostly auditory. Delusional ideas gradually form into a system of persecution. Later, ideas of grandeur are added, which are linked to the delusion of persecution, and the content of the delusion is often enriched by hallucinations. The mood at the beginning of the disease is tense, later—self-satisfied. At the same time, the patient remains rational, their work capacity is usually preserved, and their behavior in everything not related to the delusion is correct. However, the patient strives to protect themselves from persecution, often goes on the offensive against their "enemies," and becomes very dangerous; in other cases, they appeal to public opinion or to the court and other authorities to defend their rights. After many years, the delusion becomes confused and absurd, and behavior becomes incorrect and strange. Placement in a hospital is rather harmful to the patient, increasing their suspiciousness, but it is sometimes necessary as a measure of social protection. 2) Expansive paraphrenia (paraphrenia expansiva) is characterized by the development of florid delusions of grandeur with an elevated mood, mild psychomotor agitation, and often the presence of visual hallucinations. 3) Confabulatory paraphrenia (paraphrenia confabulatoria) is distinguished by the fact that the development of the delusion is associated with numerous false memories. 4) Fantastic paraphrenia (paraphrenia phantastica) is characterized by the development of strange, changeable, and contradictory delusional ideas, often against a background of a general depressive mood and in the presence of hallucinations of general sensation.