Paraphrenia is a fairly rare paranoid delirium, without cognitive impairment, where the delusional world is superimposed on the real world. It’s a light version of schizophrenia. Paraphrenia remains very little studied and very little diagnosed in recent decades. If it is not associated with a neurological disease, behavioral therapy can reduce delusions and improve the psychological daily life of the patient.

Definition of paraphrenia

Paraphrenia is a fairly rare paranoid delirium, without cognitive impairment, where the delusional world is superimposed on the real world. Paraphrenia is distinguished from schizophrenia by having a lower occurrence and slower disease progression.

The patient’s life is little affected, he does not suffer from social handicap, hence the very low demand for patient care. However, this should in no way reduce the reality and the consequences of this disease.

Types of paraphrenias

According to the classification established in 1913 by the German psychiatrist Emil Kraepelin, there are four types of paraphrenia:

• Systematic paraphrenia is the most common. The delirium is chronic there and affects the five senses;
• Expansive paraphrenia, where the patient – often women – has delusions of grandeur, or a sort of exuberant megalomania;
• Confabulatory paraphrenia, i.e. with the presence of pseudo-memories or false memories – such as inventing a historical character while really ensuring that he did exist – while keeping more or less linked imaginative creations between them. It begins earlier than other paraphrenias, between 20 and 40 years old;
• Fantastic paraphrenia often begins with anxiety and a feeling of hostility towards one’s environment. The development of megalomaniacal ideas follows and becomes, over time, more disproportionate and extravagant. The delirium has an eccentric and incoherent structure.

But since then, not all psychiatrists agree with this classification. And several of them, like Ey, Nodet or Kleist, offer, in addition or modification, other types of paraphrenia:

• Melancholic paraphrenia approaches an ordinary psychosis, without however linking paraphrenia to disorders of psychic activity, painful emotions or melancholic behaviors;
• Hypochondriac paraphrenia, the expression of which is mainly paranoid. This type of paraphrenia often progresses to absurd and acoustico-verbal bodily hallucinations, with moderate functional impairment;
• Inconsistent paraphrenia is associated with inconsistent delusions and irreversible personality changes;
• Phonemic paraphrenia involves delirious acoustico-verbal hallucinations.

There are also combined forms where two or more types of paraphrenias coexist.

Causes of paraphrenia

Very little research on the subject has been carried out over the past 70 years, arguably justifying the little knowledge regarding the causes of paraphrenia.

Paraphrenia can nevertheless be associated with:

• A neurodegenerative disorder;
• A tumor ;
• A cerebral vascular accident.

Diagnosis of paraphrenia

Paraphrenia, like many delusional disorders, is underdiagnosed. For example, it is neither listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) nor in the International Classification of Diseases (ICD-10).

Thus, in most cases, psychiatrists recognize this condition as “atypical psychosis”, “schizoaffective disorder” or “delusional disorder” due to the lack of a better diagnostic category.

People affected by paraphrenia

Between 2 and 4% the population would be affected by paraphrenia, most often it is people between 30 and 45 years.

And only 10% of people hospitalized for delusional disorders would have paraphrenia.

Factors favoring paraphrenia

Factors that can promote paraphrenia are:

• Sensory impairment;
• Social isolation;
• Stressful and important events, such as discriminating, humiliating and threatening experiences, the death of loved ones or mental disorders experienced in relatives.

Other factors suspected, but lacking in evidence, should be considered:

• A neglected education;
• Loneliness or celibacy.

Paranoid delusions

A person suffering from paraphrenia presents phases of delusions whose themes are generally fanciful, paradoxical, but which remain organized in relation to each other with consistency. The patient is often in firm agreement with his ideas, but not as much as in paranoia.

Hallucinations

Paraphrenia causes hallucinations. For two thirds of them, they are auditory hallucinations: the person hears voices.

Integrity of the person’s relationship to reality

The intellectual, mnemonic or pragmatic faculties – academic, professional, social – of the paraphrenic person are preserved.

Behavioral and cognitive therapy acts very quickly on delusions linked to paraphrenia. However, this effectiveness tends to decrease with the progression of the disease.

Antipsychotics and other neuroleptic treatments remain ineffective. However, they make it possible to control hallucinatory phenomena.

There is no real prevention for paraphrenia, apart from conscientiously following its treatment in order to reduce relapses.