Recovery from the psychotic symptoms seems to be rare, and in most cases paraphrenia results in in-patient status for the remainder of the life of the patient. Patients experience a slow deterioration of cognitive functions and the disorder can lead to dementia in some cases, but this development is no greater than the normal population. Epidemiology
Studies suggest that the prevalence of paraphrenia in the elderly population is around 2–4%. Sex differences
While paraphrenia can occur in both men and women, it is more common in women, even after the difference has been adjusted for life expectancies. The ratio of women with paraphrenia to men with paraphrenia is anywhere from 3:1 to 45:2. Age
It is seen mainly in patients over the age of 60, but has been known to occur in patients in their 40s and 50s. Personality type and living situation
It is suggested that individuals who develop paraphrenia later in life have premorbid personalities, and can be described as “quarrelsome, religious, suspicious or sensitive, unsociable and cold-hearted.” Many patients were also described as being solitary, eccentric, isolated and difficult individuals; these characteristics were also long-standing rather than introduced by the disorder. Most of the traits recognized prior to the onset of paraphrenia in individuals can be grouped as either paranoid or schizoid. Patients presenting with paraphrenia were most often found to be living by themselves (either single, widowed, or divorced). There have also been reports of low marriage rate among paraphrenics and these individuals also have few or no children (possibly because of this premorbid personality).
Diagnosis
While the diagnosis of paraphrenia is absent from recent revisions of the DSM and the ICD, many studies have recognized the condition as "a viable diagnostic entity that is distinct from schizophrenia, with organic factors playing a role in a significant portion of patients." As such, paraphrenia is seen as being distinct from both schizophrenia and progressive dementia in old age. Ravindran (1999) developed a list of criteria for the diagnosis of paraphrenia, which agrees with much of the research done up to the time it was published. 1. A delusional disorder of at least six months duration characterized by the following:
a. Preoccupation with one or more semisystematized delusions, often accompanied by auditory hallucinations. b. Affect notably well-preserved and appropriate. Ability to maintain rapport with others. c.  None of
i. Intellectual deterioration
ii. Visual hallucinations
iii. Incoherence
iv. Flat or grossly inappropriate affect
v. Grossly disorganized behavior at times other than during the acute episode. d.  Disturbance of behavior understandable in relation to the content of the delusions and hallucinations. e. Only partly meets criterion A for schizophrenia. No significant organic brain disorder. Management
Research suggests that paraphrenics respond well to antipsychotic drug therapy if doctors can successfully achieve sufficient compliance. Herbert found that Stelazine combined with Disipal was an effective treatment. It promoted the discharging of patients and kept discharged patients from being readmitted later. While behavior therapy may help patients reduce their preoccupation with delusions, psychotherapy is not currently of primary value. Prognosis
Individuals who develop paraphrenia have a life expectancy similar to the normal population.