Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-28T12:25:58.228Z Has data issue: false hasContentIssue false

The Natural History of Neurotic Disorder in an Elderly Urban Population

Findings from the Liverpool Longitudinal Study of Continuing Health in the Community

Published online by Cambridge University Press:  02 January 2018

Bernadette A. Larkin*
Affiliation:
Withington Hospital, West Didsbury, Manchester M20 8LR, University Department of Psychiatry, Royal Liverpool Hospital, PO Box 147, Liverpool L69 3BX
John R. M. Copeland
Affiliation:
University Department of Psychiatry, Liverpool
Michael E. Dewey
Affiliation:
University Department of Psychiatry, Liverpool
Ian A. Davidson
Affiliation:
Department of Psychiatry, Royal Liverpool Hospital, Liverpool
Paul A. Saunders
Affiliation:
University Department of Psychiatry, Liverpool
Vimal K. Sharma
Affiliation:
Walton Hospital, Liverpool
Christopher McWilliam
Affiliation:
Leighton Hospital, Crewe
Caroline Sullivan
Affiliation:
Mapperley Hospital, Nottingham
*
Correspondence

Abstract

A random community sample of 1070 subjects aged 65 years and over was interviewed at home using the GMS-agecat package and followed up three years later. Neurotic symptoms were common, but symptoms sufficient to reach ‘case’ level were much less frequent. The overall prevalence of neurotic ‘cases' was 2.4% in year 0 and 1.4% in year 3. The incidence was estimated as a minimum of 4.4 per 1000 per year over the age of 65. Women were more likely to be ‘cases' than men but not ‘subcases', and there was a general decline in prevalence with increasing age, particularly for ‘subcases'. Anxiety was the commonest neurotic subtype. After three years, ‘cases' were shown not to persist, but this did not reflect wellness. There was a tendency still to have some symptoms, but the predominant symptom appeared to change, suggesting a possible chronic neurotic disorder with changing presentation over time. Depressive symptoms were closely associated with this presentation, suggesting that depression may be an important and integral part of a general, changing neurotic disorder.

Type
Papers
Copyright
Copyright © The Royal College of Psychiatrists, 1992 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Andrews, G., Stewart, G., Morris-Yate, A., et al (1990) Evidence for a general neurotic syndrome. British Journal of Psychiatry, 157, 612.Google Scholar
Ben-Arie, O., Swartz, L. & Dickman, B. J. (1987) Depression in the elderly living in the community: its presentation and features. British Journal of Psychiatry, 150, 169174.Google Scholar
Bergmann, K. (1971) The neurosis of old age. In Recent Developments in Psychogeriatrics (eds Kay, D. W. K. & Walker, A.), pp. 3956. Kent: Headley Bros.Google Scholar
Busse, E. W. & Blazer, G. D. (eds) (1980) Handbook of Geriatric Psychiatry. New York: Van Nostrand Reinhold.Google Scholar
Copeland, J. R. M., Kelleher, M. J., Kellett, J. M., et al (1976) A semistructured clinical interview for the assessment of diagnosis and mental state in the elderly. The Geriatric Mental State Schedule. 1. Development and reliability. Psychological Medicine, 6, 439449.CrossRefGoogle Scholar
Copeland, J. R. M., Dewey, M. E. & Griffiths-Jones, H. M. (1986) Computerised psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychological Medicine, 16, 8999.CrossRefGoogle ScholarPubMed
Copeland, J. R. M., Dewey, M. E., Wood, N., et al (1987) Range of mental illness among the elderly in the community: prevalence in Liverpool using the GMS–AGECAT package. British Journal of Psychiatry, 150, 815823.Google Scholar
Copeland, J. R. M., Gurland, B. J., Dewey, M. E., et al (1987) The distribution of dementia, depression and neurosis in elderly men and women in an urban community: assessed using the GMS–AGECAT package. International Journal of Geriatric Psychiatry, 2, 177184.Google Scholar
Copeland, J. R. M., Gurland, B. J., Dewey, M. E., et al (1987) Is there more dementia, depression and neurosis in New York? A comparative study of the elderly in New York and London using the computer diagnosis AGECAT. British Journal of Psychiatry, 151, 466473.Google Scholar
Copeland, J. R. M., Gurland, B. J., Henderson, A. S., et al (1988) The Geriatric Mental State (GMS) used in the community: replication studies of the computerised diagnosis AGECAT. Psychological Medicine, 18, 219233.CrossRefGoogle ScholarPubMed
Copeland, J. R. M., Davidson, I. A., Dewey, M. E., et al (1992) Alzheimer's disease, other dementias, depression and pseudo-dementia. Prevalence, incidence and three-year outcome in Liverpool: GMS-HAS AGECAT. British Journal of Psychiatry (in press).Google Scholar
Davidson, I. A., Dewey, M. E. & Copeland, J. R. M. (1988) The relationship between mortality and mental disorder: evidence from the Liverpool longitudinal study. International Journal of Geriatric Psychiatry, 3, 9598.Google Scholar
Dewey, M. E. & Copeland, J. R. M. (1986) Computerised psychiatric diagnosis in the elderly: AGECAT. Journal of Microcomputer Application, 9, 135140.Google Scholar
Eagles, J. M. & Alexander, D. A. (1988) Which neurotic patients do psychiatrists treat? British Journal of Psychiatry, 152, 222228.CrossRefGoogle ScholarPubMed
Gelder, M. G. (1986) Neurosis: another tough old word. British Medical Journal, 292, 972973.CrossRefGoogle ScholarPubMed
Lindsay, J., Briogs, K. & Murphy, E. (1989) The Guy's/Age Concern Survey. Prevalence rates of cognitive impairment, depression and anxiety in an urban elderly community. British Journal of Psychiatry, 155, 317329.CrossRefGoogle Scholar
Kay, D. W. K., Beamish, P. & Roth, M. (1964) Old age mental disorders in Newcastle-upon-Tyne. Part 1: A study of prevalence. British Journal of Psychiatry, 110, 146158.CrossRefGoogle Scholar
Kay, D. W. K. & Bergmann, K. (1980) Epidemiology of mental disorders among the aged in the community. In Handbook of Mental Health and Ageing (eds Birren, J. E. & Sloane, R. B.), pp. 3456. Englewood Cliffs: Prentice Hall.Google Scholar
Kerr, T. A., Roth, M., Schapira, K., et al (1972) The assessment and prediction of outcome in affective disorders. British Journal of Psychiatry, 121, 167174.Google Scholar
Kessel, N. & Shepherd, M. (1962) Neurosis in hospital and general practice. Journal of Mental Science, 108, 159166.CrossRefGoogle ScholarPubMed
Klein, D. F. (1964) Delineation of two drug-responsive anxiety syndromes. Psychopharmacologia, 5, 397408.Google Scholar
Lancet (1982) Goodbye neurosis? Lancet, 2, 2930.Google Scholar
McDonald, C. (1973) An age-specific analysis of the neuroses. British Journal of Psychiatry, 122, 477480.Google Scholar
Myers, J. K., Wiessman, M. M. & Tischler, G. L. (1984) Six months' prevalence of psychiatric disorder in three communities: 1980–1982. Archives of General Psychiatry, 41, 959967.Google Scholar
Nilsson, L. V. & Persson, G. (1984) Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age. Acta Psychiatrica Scandinavica, 69, 519527.CrossRefGoogle Scholar
Primrose, E. J. R. (1962) Psychological Illness: A Community Study. London: Tavistock.Google Scholar
Robinson, J. (1989) Natural history of mental disorder in old age. British Journal of Psychiatry, 154, 783789.Google Scholar
Roth, M. (1955) The natural history of mental disorder in old age. Journal of Mental Science, 101, 281301.CrossRefGoogle ScholarPubMed
Roth, M. (1975) Perspectives in the diagnosis and treatment of mental disorder in old age. Age and Ageing, 4 (suppl.)Google Scholar
Roth, M., Gurney, C., Garside, R. F., et al (1972) Studies in the classification of affective disorders: the relationship between anxiety states and depressive illnesses. 1. British Journal of Psychiatry, 121, 147161.Google Scholar
Sims, A. C. P. (1985) Neurotic illness: Conserving a threatened concept. British Journal of Clinical Pharmacology, 19, 95155.CrossRefGoogle ScholarPubMed
Spitzer, R. L. & Fleiss, J. L. (1974) Re-analysis of the reliability of psychiatric diagnosis. British Journal of Psychiatry, 125, 341347.Google Scholar
Tyrer, P. (1985) Neurosis divisible. Lancet, i, 685688.CrossRefGoogle Scholar
Tyrer, P. (1987) Outcome of neurotic disorders after outpatient and day hospital care. British Journal of Psychiatry, 151, 5762.CrossRefGoogle ScholarPubMed
Tyrer, P. (1989) Classification of Neurosis. Bristol: Wiley.Google Scholar
Tyrer, P., Setvewrioht, N., Murphy, S. et al (1988) The Nottingham Study of Neurotic Disorder: Comparison of drug and psychological treatments. Lancet, 2, 235240.Google Scholar
Williamson, J., Stokoe, I. H., Gray, S., et al (1964) Old people at home – their unreported needs. Lancet, i, 11171180.Google Scholar
World Health Organization (1989) ICD–10, Draft of Chapter V. Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.