J Hepple1. 1. Department of Mental Health, Peninsula Medical School, Somerset BA20 2BN, UK. Jason.hepple@sompar.nhs.uk
Abstract
METHODS: This paper reports a case series of ten patients collected over a 12-year period of clinical work in old age psychiatry in the UK by the author. RESULTS: The core features of the syndrome are: apparent cognitive impairment, regression and increasing physical dependency beginning in late middle or early old age, without evidence for an organic dementia from investigations or from taking into account the course of the illness. The syndrome is more common in women from a higher socio-economic background with past psychiatric histories dominated by depressive symptoms. The syndrome usually progresses to the point where long term institutional care is needed although the mean survival from onset is 13 years. CONCLUSIONS: The author suggests that conversion pseudodementia in older people is caused by a catastrophic reaction to cumulative loss in later life in individuals who have predisposing borderline and narcissistic personality traits. Treatment using psychotherapeutic approaches may limit the progression of the syndrome if it is recognised at an early stage.
METHODS: This paper reports a case series of ten patients collected over a 12-year period of clinical work in old age psychiatry in the UK by the author. RESULTS: The core features of the syndrome are: apparent cognitive impairment, regression and increasing physical dependency beginning in late middle or early old age, without evidence for an organic dementia from investigations or from taking into account the course of the illness. The syndrome is more common in women from a higher socio-economic background with past psychiatric histories dominated by depressive symptoms. The syndrome usually progresses to the point where long term institutional care is needed although the mean survival from onset is 13 years. CONCLUSIONS: The author suggests that conversion pseudodementia in older people is caused by a catastrophic reaction to cumulative loss in later life in individuals who have predisposing borderline and narcissistic personality traits. Treatment using psychotherapeutic approaches may limit the progression of the syndrome if it is recognised at an early stage.