Semiological differences between late-life schizophrenia and senile dementia.

It is sometimes difficult to distinguish late-life schizophrenia from senile dementia because elderly patients with schizophrenia can present in chronic remission and show gradual cognitive decline with aging. We aimed to elucidate the semiological characteristics of late-life chronic schizophrenia. Three patients aged between 60 and 66 years who were admitted to our hospital were included in this study. Detailed history taking and psychiatric interviews were performed and reviewed in the light of psychopathological semiology. Although the three patients with late-life schizophrenia showed significant cognitive decline on the Hasegawa dementia rating scale and their negative symptoms mimicked dementia, the following psychopathological characteristics clearly differentiated them from patients with senile dementia: (1) a shift of temporal organization toward the future with intact memory, (2) hypersensitivity, (3) ambivalent personal relationships, (4) systematic bodily delusions, and (5) an ante festum mindset. Identifying such clinical features of patients with late-life schizophrenia could be important for developing more effective pharmacotherapy and for providing appropriate psychotherapy.

Symptom changes in episodic and recurrent psychosis.

Changes in symptoms along the course of episodic and recurrent psychosis have yet to be fully elucidated. We investigated the long-term course, at least 5 years, of 40 patients suffering from episodic and recurrent psychosis. A total of 324 episodes observed in these patients were categorized, on the basis of their principal symptom, into three types; episodes of confusion, episodes with hallucinations and delusions, and those with affective symptoms. We divided the 40 patients into the favorable outcome group and the poor outcome group and compared the characteristics of the two groups. In the favorable outcome group, affective episodes were found to be more frequent in later episodes whereas in the poor outcome group, confusion episodes continued to be the most frequent throughout the course. We discuss diagnostic issues concerning episodic-recurrent psychosis and try to locate it within the domain of schizophrenia.

Musical hallucinations in schizophrenia. 2. Relations with verbal hallucinations.

The musical hallucinations reported by 33 schizophrenics who fulfilled ICD-10 diagnostic criteria were assessed semiologically. The subjects were 24 men and 9 women. The duration of 48 episodes of musical hallucinations varied. They occurred at all times during the course of schizophrenia, and 9 of them (18.8%) occurred before the diagnosis was made. All of the episodes could be divided into three stages: 17 (35.4%) were first stage, close to obsession, 5 (10.4%) were second stage, close to Schneiderian first-rank symptoms, and 26 (54.2%) were third stage, which is the autochthonous experience. The sounds were in a subjective space in 38 episodes and in the majority of cases, their content was familiar. The second stage was associated with xenopathic experience ("gemachtes Erlebnis") and audition of thought, and words were added to melodies that normally had no lyrics. Musical hallucinations in schizophrenia are pseudohallucinations that originate in memory representations, and they may undergo a transition to true hallucinations. The authors think that the three stages are related to the severity of the disease.