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Psychotic Symptoms and Paranoid Ideation in a Nondemented Population–Based Sample of the Very Old
Svante Östling, MD;
Ingmar Skoog, MD, PhD
Arch Gen Psychiatry. 2002;59:53-59.
Background Psychotic symptoms are reported to be uncommon in the elderly, and may
be underrated in traditional epidemiological studies.
Methods Psychotic symptoms, physical disorders, disability in daily life, and
sensory impairments were assessed using results of psychiatric and physical
examinations, key-informant interviews, and medical record reviews in a representative
sample of nondemented individuals aged 85 years living in the community or
in institutions in Göteborg, Sweden (n = 347). The sample was observed
for 3 years regarding psychotic symptoms, mortality, and incident dementia.
Results The prevalence of any psychotic symptom was 10.1% (95% confidence interval
[CI], 7.1%-13.7%); hallucinations, 6.9% (95% CI, 4.5%-10.1%); and delusions,
5.5% (95% CI, 3.3%-8.4%). The prevalence of paranoid ideation was 6.9% (95%
CI, 4.5%-10.1%). Stepwise logistic regression analyses showed that hallucinations
were associated with major depressive syndrome (odds ratio [OR], 3.9; 95%
CI, 1.3-11.9), disability in daily life (OR, 5.2; 95% CI, 1.8-14.9), and visual
deficits (OR, 3.4; 95% CI, 1.0-11.1). Delusions were associated with disability
in daily life (OR, 4.9; 95% CI, 1.8-13.3). Paranoid ideation was associated
with visual deficits (OR, 3.6; 95% CI, 1.2-10.5) and myocardial infarction
(OR, 4.6; 95% CI, 1.7-12.6). Hallucinations (OR, 3.1; 95% CI, 1.4-6.8), delusions
(OR, 2.9; 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7; 95% CI, 1.2-6.2)
were each related to increased incidence of dementia from 85 to 88 years of
age. Hallucinations and paranoid ideation were associated with increased 3-year
mortality in women but not in men.
Conclusions We found a higher prevalence of psychotic symptoms and paranoid ideation
in the elderly than previously reported, and these symptoms were associated
with a poor prognosis.
From the Institute of Clinical Neuroscience, Psychiatry Section, Sahlgrenska
University Hospital, Göteborg University, Göteborg, Sweden.
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