Manic-depressive patients with delusions. Clinical and diagnostic course

A study was made of the hospital records of 114 first admission patients under 60 years with a diagnosis of manic-depressive psychosis and coexisting paranoid symptoms. The male/female ratio was 1/1.4, and the females were significantly older. Symptomatology and treatment are presented. Seventy per cent disclosed delusions of reference and misinterpretation and 50% had synthymic delusions. During 11-15 years of admission 75% of the patients were re-admitted. The diagnostic concept was changed in 33%. Significantly more females were diagnosed unipolar manic-depressive. According to the general practitioners and hospital records psychotic traits were still present in 50% of the patients at follow-up. Significantly more patients diagnosed as unipolar manic-depressive had no relapse and no remaining psychotic traits. And significantly more patients with changed diagnosis had remaining psychotic traits. The need for prospective studies of patients with coexisting affective and paranoid symptomatology is stressed.