Elderly Graduates

Finally, the very term `late paraphrenia' was

championed by Roth and Kay in the 1950s,

apparently because they appreciated that there are

di€erences between early- and late-onset non-

a€ective functional psychotic disorders. They now

claim that, after all, it is one disorder, though

acknowledge di€erences in phenomenology, gender

ratio and aetiological parameters. Our assertion

(Castle et al., 1997), quoted by Roth and Kay, that

it is premature to consider early- and late-onset

disorder to be the same illness, grows out of our

belief that the current `schizophrenia' concept

re¯ects a set of symptoms and encompasses an

array of disorders with di€ering aetiologies;

furthermore, some of these aetiological factors

are more likely to exert an e€ect in late life than in

youth. An analogy with heart failure is apposite.

The data reviewed by Roth and Kay are perfectly

consonant with this view, and in our opinion

lumping all such disorders together under the

schizophrenia label detracts from the lessons to be

learned about the disparate aetiological factors and

how they interact to produce the set of symptoms

which we recognize as belonging to the `group of

schizophrenias' (to use Bleuler's term).

DAVID CASTLE

Fremantle Hospital and Health Service

Perth, Western Australia

REFERENCES

Castle, D. J. and Murray, R. M. (1991) The neuro-

developmental basis of sex di€erences in schizo-

phrenia. Psychol. Med. 21, 565±575.

Castle, D. J. and Murray, R. M. (1993) The epidemiol-

ogy of late onset schizophrenia. Schizophren. Bull. 19,

691±700.

Castle, D. J.,Wessely, S., Howard, R. and Murray, R. M.

(1997) Schizophrenia with onset at the extremes of

adult life. Int. Geriatr. Psychiat. 12, 712±717.

Castle, D., Sham, P. and Murray, R. (1998) Di€erences

in distribution of ages of onset in males and females

with schizophrenia. Schizophren. Res. 33, 179±183.

The Needs of Elderly Graduates

Dear Editor

The needs of elderly graduates for services is an

important though neglected area of research

(Campbell, 1997; Abdul-Hamid et al., 1998). We

would like to report the ®ndings of an analysis of

the service needs of elderly graduates from a survey

of a representative sample of people with psychosis

in two de®ned geographic areas. This survey was

conducted by the Psychiatric Research in Service

Measurement (PriSM) group at The Institute of

Psychiatry (Thornicroft et al., 1998). The survey

was carried out in two south London sectors:

Nunhead (1991 population 38 545, of whom 5742

were aged 65 and over) and Norwood (1991 popu-

lation 41 740, of whom 6926 were aged 65 and

over).

In this survey, data was collected on needs for

services using the Camberwell Assessment of

Needs (CAN) (Phelan et al., 1995). The needs of

23 elderly graduates (those who were at or over

the age of 65) were compared with those of

160 patients younger adult mentally ill patients

(under 65 years of age).

The elderly graduates had signi®cantly higher

needs for accommodation (p ˆ 0.01), food

(p ˆ 0.03), looking after home (p ˆ 0.004), tele-

phone (p ˆ 0.04) and transport (p ˆ 0.0006).

A high proportion of the elderly graduates

reported thoughts of harming themselves which

were not detected by their care sta€ (17% com-

pared with only 5%