Mohammed T. Abou-Saleh

500 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYCONCLUSIONMost patients with late-onset schizophrenia or primary delusionaldisorders will be adequately and preferably managed fromhome 12,63 . The need to admit to hospital seems to be declining 64and may be determined as much by social and physical factors ortreatment compliance as degree of psychopathology. For thepatient requiring more than outpatient treatment, a day hospitalcan provide the necessary facilities for more intensive assessmentof mental state, physical health and functional level.The multifactorial contributions from ageing, physical disability,sensory impairment and social factors demand a multiprofessionalapproach and all relevant disciplines must beavailable and involved 8 . The evaluation of these conditionsrequires clinical skill, rigorous attention to detail and an holisticapproach. The accuracy of diagnosis and success of managementwill depend on the quality of initial assessment and if diagnosticdoubts exist, treatment should be postponed until the situationbecomes clear. Occasionally a diagnostic trial of treatment will bejustified.The paranoid disorders of old age are stimulating, complex,challenging clinical problems that encompass the breadth ofpsychiatry, medicine and social sciences and their assessment andmanagement will continue to appeal to the enquiring clinicalmind.REFERENCES1. Roth M. The natural history of mental disorder in old age. J Ment Sci1955; 101: 281–301.2. Kay DWK, Roth M. Environmental and hereditary factors in theschizophrenias of old age (late paraphrenia) and their bearing on thegeneral problems of causation in schizophrenia. J Ment Sci 1961; 107:649–86.3. Herbert ME, Jacobson S. Late paraphrenia. Br J Psychiat 1967; 113:461–9.4. Tanna VL. Paranoid states: a selected review. Comp Psychiat 1974;15: 452–70.5. Bridge TP, Wyatt RJ. 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