HEARING LOSS IN PARANOID AND AFFECTIVE PSYCHOSES OF THE ELDERLY

doi:10.1016/S0140-6736(74)91197-0

The Lancet

Volume 304, Issue 7885, 12 October 1974, Pages 851-854

https://doi.org/10.1016/S0140-6736(74)91197-0 Get rights and content

Abstract

The reported association between acquired deafness and paranoid illness in the elderly was re-examined. Social deafness and its probable duration was assessed by clinical interviews with patients and relatives and by information from hospital records in sixty-five patients with paranoid psychosis and sixty-seven patients with primary affective disorder. A hundred and eleven of these hundred and thirty-two patients were also tested audiometrically after recovery from the acute phase of the illness, and all those with abnormal audiograms or with evidence of social deafness were examined aurally and an otological diagnosis made. After taking into consideration age and possible selective factors, it was concluded that patients with paranoid psychosis have a more severe degree of hearing loss and are more often socially deaf than patients with affective illness, who probably resemble the general population. The differences seem to be due to a significantly higher proportion of paranoid patients having longstanding, usually severe, bilateral deafness, which is most commonly caused by chronic middle-ear disease. The long interval between the onset of deafness and the onset of psychosis seems to offer opportunities for prevention.

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Cited by (80)

Increased risk of psychosis in patients with hearing impairment: Review and meta-analyses
2016, Neuroscience and Biobehavioral Reviews
Citation Excerpt :
Nine studies compared the mean audiometric threshold between the affected and non-affected groups. The study by Cooper et al. (1974) measured hearing thresholds that were significantly higher in the paranoid psychotic group than in the affective psychotic group. Yet, the other eight studies did not show significant differences between groups with and without hallucinations (Cole et al., 2002; Teunisse and Olde Rikkert, 2012), delusions (Kalayam et al., 1995) or psychotic disorders (Bull and Venables, 1974; Callison et al., 1971; Prager and Jeste, 1993; Viertiö et al., 2014; Watt, 1985).
Several studies suggest hearing impairment as a risk factor for psychosis. Hearing impairment is highly prevalent and potentially reversible, as it can be easily diagnosed and sometimes improved. Insight in the association between hearing impairment and psychosis can therefore contribute to prevention of psychosis. This paper provides meta-analyses of all epidemiologic evidence on the association between hearing impairment and psychosis and summarizes mechanisms that potentially underlie this relationship.
Meta-analyses showed an increased risk of hearing impairment on all psychosis outcomes, such as hallucinations (OR 1.40(95%CI 1.18–1.65; n = 227,005)), delusions (OR 1.55(95%CI 1.36–1.78; n = 250,470)), psychotic symptoms (OR 2.23(95%CI 1.83–2.72; n = 229,647) and delirium (OR 2.67(95%CI 2.05–3.48; n = 12,432). Early exposure to hearing impairment elevated the risk of later development of schizophrenia (OR 3.15(95%CI 1.25–7.95; n = 50,490)).
Potential mechanisms underlying this association include loneliness, diminished theory of mind, disturbances of source monitoring and top-down processing and deafferentiation. Early assessment and treatment of hearing impairment in patients with (high risk of) psychosis may be essential in psychosis treatment and prevention.
Empirical redefinition of delusional disorder and its phenomenology: The DELIREMP study
2013, Comprehensive Psychiatry
Citation Excerpt :
The latter findings are in line with our findings of significantly poorer treatment adherence, poorer functionality, and lower perception of social support, which could be related to the lack of insight into the disease, and to a greater degree of paranoidism. By contrast, no relationship was found with immigration or premorbid sensory-perception deficits — two risk factors for paranoid psychosis documented in previous studies [14,92,93]. Finally, multiple regression analyses revealed that the clinical variables that most strongly associated with PD were legal problems resulting from violent behavior, chronic course, lower global functioning, and poorer treatment adherence.
Since Kraepelin, the controversy has persisted surrounding the nature of delusional disorder (DD) as a separate nosological entity or its clinical subtypes. Nevertheless, there has been no systematic study of its psychopathological structure based on patient interviews. Our goal was to empirically explore syndromic subentities in DD.
A cross-sectional study was conducted in 86 outpatients with DSM-IV-confirmed DD using SCID-I. Psychopathological factors were identified by factor analysis of PANSS scores. The association between these factors and clinical variables (as per standardized instruments) was analyzed using uni- and multivariate techniques.
PANSS symptoms were consistent with four factors (Paranoid, Cognitive, Schizoid, and Affective dimensions), accounting for 59.4% of the total variance. The Paranoid Dimension was associated with premorbid paranoid personality disorder, more adverse childhood experiences, chronic course, legal problems, worse global functioning, and poorer treatment adherence and response. The Cognitive Dimension was associated with poorer cognitive functioning, premorbid substance abuse, comorbid somatic diseases, mainly non-prominent visual hallucinations, fewer comorbid depressive disorders, and poorer global functioning. The Schizoid Dimension was associated with being single, a family history of schizophrenia, premorbid personality disorders (largely schizoid and schizotypal), non-prominent auditory hallucinations, and dysthymia. Finally, the Affective Dimension was associated with a family history of depression, premorbid obsessive personality, somatic delusions, absence of reference delusions, tactile and olfactory hallucinations, depressive and anxiety disorders, risk of suicide, and higher perceived stress.
The identification and clinical validation of four separate psychopathological dimensions in DD provide evidence toward a more accurate conceptualization of DD and its types.
An empirical study of psychosocial and clinical correlates of delusional disorder: The DELIREMP study
2009, Revista de Psiquiatria y Salud Mental
La finalidad de este estudio es describir los correlatos psicosociales y clínicos del trastorno delirante (TD) y sus tipos. Este enfoque es importante porque la mayor parte del conocimiento existente sobre el TD no procede de datos empíricos obtenidos con el empleo de un método de investigación sistemático validado.
Se llevó a cabo un estudio transversal en una muestra de 86 pacientes que cumplían los criterios del DSM-IV para el TD según lo determinado con la aplicación del SCID-I. Las variables estudiadas se evaluaron con una metodología sistemática y con instrumentos estandarizados, e incluyeron los posibles factores de riesgo psicosocial (bajo nivel socioeconómico o aislamiento social, inmigración, deficiencias sensoriales, edad avanzada al inicio), los antecedentes psiquiátricos familiares y personalidad premórbida (SAP), la psicopatología psicótica (PANSS), el síndrome depresivo (MADRS), la función cognitiva general (MMSE), la comorbilidad de eje I (MINI) y otros aspectos clínicos, como el funcionamiento general (GAF) y la discapacidad (SDI). Se completó también un cuestionario sociodemográfico y clínico.
La media de edad al inicio del TD era 39,6 años y un 61,6% de los pacientes eran mujeres. Los tipos más frecuentes de TD fueron el persecutorio (59,3%) y el celotípico (22,1%). Casi un 21% de los pacientes tenían antecedentes familiares de esquizofrenia y el 17,4%, de TD (en un porcentaje significativamente mayor en el tipo celotípico). El 64% de los pacientes tenían trastorno de la personalidad premórbido (el 38,4%, paranoide, y el 12,8%, esquizoide). El tipo de TD de grandiosidad se relacionaba de manera significativa con unas puntuaciones más altas de la subescala positiva de la PANSS, y el tipo mixto, con puntuaciones más bajas de la subescala negativa de la PANSS. La depresión afectaba al 45,3% de los pacientes (principalmente, depresión leve) y un 45,3% tenía alucinaciones (el 20,9%, táctiles, y el 16,3%, olfatorias), que eran más frecuentes en los casos de tipo somático. La media ± desviación estándar de la MMSE era 27,6 ± 2,5, lo cual indicaba una función cognitiva preservada. La media de GAF era 63,9 ± 11,3, que corresponde a un grado moderado de discapacidad; este aspecto era significativamente peor en los casos del tipo de grandiosidad.
Este estudio aporta una evidencia única, de carácter empírico y fiable, sobre los correlatos psicosociales, clínicos y psicopatológicos reales del TD y sus tipos.
We aim to describe psychosocial and clinical correlates of delusional disorder (DD) and its types. This approach is important because most knowledge on DD does not come from empirical data collected using a validated systematic research method.
A cross-sectional study was conducted in a sample of 86 patients fulfilling DSM-IV criteria for DD as established using the SCID-I. Variables were evaluated using a systematic methodology and standardized instruments, and included possible psychosocial risk factors (low socioeconomic status or social isolation, immigration, sensory deficits, older age at onset), family history of psychiatric disorders and premorbid personality (SAP), psychotic psychopathology (PANSS), depressive syndrome (MADRS), global cognitive functioning (MMSE), axis I comorbidity (MINI) and other clinical aspects such as global functionality (GAF), and disability (SDI). A sociodemographic and clinical questionnaire was also completed.
The mean age at onset was 39.6 years and 61.6% of the cases were female. The most frequent DD types were persecutory (59.3%) and jealous (22.1%). Nearly 21% had a family history of schizophrenia and 17.4% had DD (significantly higher among those with the jealous subtype). Sixty-four percent had a premorbid personality disorder (38.4% paranoid, 12.8% schizoid). The grandiose type was significantly associated with higher scores on the PANSS positive subscale and the mixed type with lower scores on the PANSS negative subscale. Depression affected 45.3% of subjects (mainly mild depression) and 45.3% had hallucinations (20.9% tactile, 16.3% olfactory), which were more common among somatic cases. The mean MMSE was 27.6 ± 2.5 suggesting a preserved cognitive function. Mean GAF was 63.9 ± 11.3 indicating a moderate degree of disability, which was significantly worse amongst grandiose cases.
This study provides unique empirical and reliable evidence on the real psychosocial, clinical, and psychopathological correlates of DD and its types.
A descriptive case-register study of delusional disorder
2008, European Psychiatry
Citation Excerpt :
As mentioned earlier, sensory deficits have also been reported as a risk factor for paranoia. Cooper et al. found that 21% of deaf people tend to develop delusions and other psychotic symptoms, whilst other studies have related deafness to late paraphrenia or schizophrenia [5,6,8,26]. Deafness can more likely be seen as a correlate of psychosis rather than a specific risk factor for DD.
A few empirically based studies' data on delusional disorder (DD) exist. We aim to describe sociodemographic and clinical correlates of DD and to identify clinical profiles associated to DD and its subtypes.
This is a case-register study based on all those subjects attending community mental health services within a geographically well-defined area. Four hundred and sixty-seven patients had been diagnosed as DD cases at psychiatric services serving a catchment area of some 607,494 inhabitants living in South Barcelona (Spain) during a three-year period (2001–2003). A thorough systematic review of computerised medical records was used to establish DSM-IV diagnosis, rendering a valid sample of 370 patients who fulfilled DSM-IV criteria for DD. Independent variables gathered include sociodemographic data, family and personal psychiatric history, and comorbid diagnoses on all DSM-IV axes (including GAF). We used descriptive and univariate statistical methods to explore sample frequencies and correlates across DD types.
The mean age of the patients was 55 years and the sample had a mean GAF score of 51 suggesting a poor functionality; 56.5% of the patients were female. The most frequent DD types were persecutory (48%), jealous (11%), mixed (11%) and somatic (5%), whilst 23% qualified for the NOS type. Most frequent symptoms identified were self-reference (40%), irritability (30%), depressive mood (20%) and aggressiveness (15%). Hallucinations were present in 16% of the patients (6% tactile; 4% olfactory). Nearly 9% had a family history of schizophrenia (higher among those with the jealous subtype) and 42% had a comorbid axis II diagnosis (mostly paranoid personality disorder). Depression was significantly more frequent among the persecutory and jealous types. Finally, global functioning was significantly better among jealous and mixed types and worse amongst erotomanic and grandiose cases (p = 0.008).
In the absence of other similar empirical data, this modest study provides unique empirical evidence of some clinical and risk correlates of DD and its subtypes.
Hearing impairment and psychosis: A replication in a cohort of young adults
2006, Schizophrenia Research
Previous work has demonstrated an association between hearing impairment and psychosis. In the current study, this association was studied in a cohort of young people. In addition, it was studied to what degree duration of hearing problems (i.e. onset earlier in life) impacted on risk. Data were derived from the Greek National Perinatal Survey, a prospective birth cohort study of 11,048 neonates at baseline, 6594 seven-year olds at T1 and 3500 nineteen-year olds at T2. A significant association was found at age 19 years between the presence of hearing impairment and the presence of self-reported positive psychotic-like experiences (β = 0.18, S.E. = 0.02, p < 0.000). In addition, this association was conditional on the duration of hearing problems, in that the association at age 19 years was stronger if hearing impairment had already been reported at age 7 years (test for interaction: p = 0.022). These results replicate previous findings of an association between hearing impairment and psychosis, extend it to the age range of late adolescence, and suggest that longer duration is associated with stronger risk.
Hearing impairment and psychosis revisited
2005, Schizophrenia Research
The previously reported but still poorly investigated link between deafness or hearing impairment (DHI) and the onset of positive psychotic experiences was investigated prospectively in a general population sample. Of the 109 DHI subjects at baseline, 11 (10.1%) displayed psychotic experiences at T₂ versus 137 (2.9%) of the non-DHI subjects (OR=3.8, 95% CI: 2.0, 7.2). This effect size was only slightly attenuated after adjustment for baseline psychotic experiences (OR=3.2, 95% CI: 1.6, 6.5) and after adjustment for T₀ psychotic experiences and a range of other confounders (OR=3.0, 95% CI: 1.4, 6.2) These results confirm previous findings of an association between hearing impairments and psychosis and show that this association can also be found prospectively in a nonclinical population.

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HEARING LOSS IN PARANOID AND AFFECTIVE PSYCHOSES OF THE ELDERLY

Abstract

Comp. Psychiat.

J. ment. Sci.

J. ment. Sci.