Loneliness and the Paranoid Syndrome.

PARANOID reactions of various types are commonly found in women of late middle age or early senility. Baugh 1 described the prognosis of such cases as hopeless. He found that the patients had previously been indecisive, anxious, impressionable, touchy, scrupulous, introspective, self-satisfied and reticent before the first and final attack of insanity, and he believed that heredity was present in all. They were described as a special group of completely chronic cases by Smith, Macalister and Grimsdale,2 while Goodall and Craig 3 had previously commented on their incidence and poor prognosis. More recently Jones and-Minogue 4 had 6 per cent. discharges in this group, which they described as consisting of paraphrenia, paranoia and severe delusional states, while Riddoch 5 considered the prognosis very grave. It is as yet impossible to divide these cases into completely separate groups. Riddoch describes them generally as marked by persistent ideas of reference, sexual discord and persecutory delusions with some mental deterioration. Maranon 6 states that such psychoses vary and are not particular to the age, but that they appear in women with previous morbid nervous predisposition, even if only expressed as suspicious psychic peculiarities , and that heredity is often manifest. Jacobi 7 believes that involution leads to increased observation of one's own body, to an inclination to anxiety, melancholy, suspicion and a general paranoic state of mind, that clinmacteric and involution are not the cause of disease, but only favourable soil for the development of disease. Farrar and Franks 8 describe the group as includinig several varieties, such as cases with aggravationl of constitutional personality trends, involutional paranoids, late cases of dementia praecox, and they remark on the difficulty of separating the involutional forms from those due to senescence, pointing out that other psychoses may be coloured by involu-tional and senile changes as well as the psychoses of this group. Funfgeld 9 has described organic psychoses in two women of 60 and 61 respectivel y with symptoms strongly resembling those of late schizophrenic disease. Stevenson and Montgomery 10 have attempted to describe as a clinical subentity a paranoid reaction occurring in women of middle age, with persecutory delusions but without intellectual deterioration, the psychosis becoming gradually apparent during the fifth and sixth decades and having 318