Practical Guidelines For Caring For The Person With Paraphrenia (Late Onset Psychosis)

People with late onset psychosis often develop strange ideas and delusions. For example the person may believe that their neighbours are persecuting them and that they can hear the neighbours talking about them throught the walls. The ideas can be quite bizarre e.g. an elderly lady may believe that there are people living in her loft and that they are sending messages down her telephone line.

The symptoms of late onset psychosis can be particularly distressing for both the older person and the carer. It is important to first of all check out whether there is any truth in what the person is saying. Very often it will be very obvious that what they think is happening could not possibly be occurring. However, it may be that they are misinterpreting something or in fact the situation is true. It is not unknown for an older person to live in a flat with very thin walls where they can hear music being played by neighbours at all hours of the day and night! Reassure the person that they are not going mad and that you do believe them. However, try not to get caught up in their beliefs and do not collude with them.

Encourage them to visit their GP and if possible go along with them to explain the situation. If they have no insight into their illness and refuse to visit the GP it may be necessary to arrange a home visit. People with this condition are usually referred to the Community Mental Health Team for Older People. They will probably be prescribed medication and a Community Psychiatric Nurse will visit to monitor this and to support the person and yourself.

The person may not believe that they are ill and may refuse to take the medication. If possible try and persuade them to try the medication. However, if they adamantly refuse do not get into a battle with them.

They may be quite socially isolated. It can help to encourage them to go out with you e.g. for a cup of coffee in a local café and they may benefit from attending day hospital or day care.

People with this type of illness may believe that their problems will go away if they move, especially if their delusions relate to their neighbours. This rarely works and very often the problems transfer with them.

If the person is very distressed by their delusions they may put themselves at risk at home by trying to do something to make the delusions go away e.g. refusing to have the heating on in the depth of winter. If this happens it may be necessary for the person to be admitted to hospital to receive treatment and careful monitoring. The person may be very relieved at the suggestion of a hospital admission. However, in some cases it is necessary for them to be admitted to hospital under a Section of the Mental Health Act for their own safety.

This condition can be successfully treated with medication. However, what sometimes happens is that the person begins to feel well and so stops taking their medication and then the symptoms reoccur. It is very helpful if carers can keep an eye on whether medication is being taken as prescribed and encourage the person to keep taking their medication.

Keeping yourself well

Seeing the person so distressed by their delusions can be very stressful for the carer. It can also be very difficult for the carer when the person who is clearly very unwell refuses to accept that there is anything wrong with them and instead accuses the carer of turning against them. It is important to have a break from caring and you should talk with the community team member who visits to discuss what support there is available e.g. it may be possible for some care in the home or for the person to attend day-care. You may also find it helpful to attend a carers’ group or have one to one support either face to face or over the phone.