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.
A simple visual hallucination is an amorphous figure that may have a similar shape or color to a giraffe (looks like a giraffe), while a complex visual hallucination is a discrete, lifelike image that is, unmistakably, a giraffe. Command
Command hallucinations are hallucinations in the form of commands; they appear to be from an external source, or can appear coming from the subjects head. The contents of the hallucinations can range from the innocuous to commands to cause harm to the self or others. Command hallucinations are often associated with schizophrenia. People experiencing command hallucinations may or may not comply with the hallucinated commands, depending on the circumstances. Compliance is more common for non-violent commands.Command hallucinations are sometimes used to defend a crime that has been committed, often homicides. In essence, it is a voice that one hears and it tells the listener what to do. Sometimes the commands are quite benign directives such as "Stand up" or "Shut the door." Whether it is a command for something simple or something that is a threat, it is still considered a "command hallucination." Some helpful questions that can assist one in determining if they may have this includes: "What are the voices telling you to do? ", "When did your voices first start telling you to do things? ", "Do you recognize the person who is telling you to harm yourself (or others)? ", "Do you think you can resist doing what the voices are telling you to do?"