Neurosciences

G.E. Berrios BA (Oxon); MD; FRCPsych; FBPsS; FMedSci, Consultant Neuropsychiatrist, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Box 189, Hills Rd, Cambridge, CB2 2QQ; Tel: 01223 336965; Fax 01223 336968; geb11@cam.ac.uk

Abstract: In 1863, Kahlbaum used the term 'paraphrenia' to refer to insanities related to transitional periods life (there were adolescent and senile forms); Kraepelin used paraphrenia to refer to a form of paranoid psychosis with attenuated hallucinatory disturbances; and Leonhard named with it at least seven types of insanities. Since the turn of the 20th century the population hit by 'old age' has grown larger and cases of 'late-onset' insanity seem to be on the increase. Some of these insanities have different clinical features and respond differently to treatment and it is unclear whether this is due to pathoplastic effects, organic factors or social expectation. In the 1950s, the Newcastle school introduced 'late-paraphrenia'. The problem of how to classify the insanities of old age remains parasitical upon beliefs about the insanities affecting people. Historians see science and medicine as examples of social narrative and practice; clinicians see science and medicine as purveyors of absolute truth and as the only way to understand the insanities. This lack of convergence is hampering the understanding and management of elderly people suffering from insanity and must be resolved.