Eur Arch Psychiatry Clin Neurosci (1994) 244:126-130 9 Springer-Veflag 1994 Thomas Fuchs Uprooting and late-life psychosis Received: 2 March I994 / Accepted: 27 April 1994 Abstract Biographical information was collected on 60 patients suffering from late-onset (> 50 years) paranoid psychosis (with and without hallucinations), 38 by chart review and 22 by personal examination. Of the patients 28 (47%) had been war refugees expelled from the eastern territories that Germany lost after World War II. This is more than twice the rate of the Bavarian general popula- tion. The onset of paranoid symptoms was usually 3 or 4 decades after immigration into western Germany. Among patients with Alzheimer's disease and with endogenous depression the proportion of former war refugees was sig- nificantly lower (22% each). The possible relevance of early uprooting and expulsion to the development of late- life paranoid psychosis is examined. Key words Late paraphrenia 9 Early-life trauma Uprooting 9 Expulsion Introduction Paranoid psychoses of later life have been variably classi- fied as late-onset schizophrenia (Bleuler 1943; Harris and Jeste 1988), late paraphrenia (Kraepelin 1913; Kay and Roth 1961), and paranoia or delusional disorder (Flint et al. 1991; Kendler 1980, 1982). Regardless of nosological questions research into the causes of these paranoid states has established certain risk factors and triggering condi- tions such as genetic influences (although weaker than in early-onset schizophrenia), paranoid or schizoid personal- ity traits, female, social isolation, sensory impairment (es- pecially hearing loss) and mild cognitive deterioration (Kay and Roth 1961; Naguib and Levy 1991; Almeida et al. 1992; Fuchs 1993; Lacro et al. 1993). Thomas Fuchs Psychiatrische Klinik der Technischen Universit~it, Ismaninger Strasse 22, D-81675 Mtinchen, Germany The question of whether life events also may contribute to the origin of late-life psychosis has not been studied systematically. Only recently Gurian et al. (1992), on the basis of nine elderly paranoid patients, four of whom were former war refugees, have speculated on a possible con- nection between early-life trauma, infertility and a higher risk of delusional disorder in late life. In this context Busuttil et al. (1993) also pointed to the possibility that these patients could suffer from lifelong post-traumatic stress disorder. Since Oedegaard's (1932) classical study on the increased incidence of schizophrenic psychoses among Norwegian immigrants in Minnesota the connec- tion between migration and paranoid states has been re- peatedly confirmed (Eitinger 1960, 1965; Mezey 1960; Sanua 1969). Especially forced migration caused by war events or expulsion was found to constitute a major trauma that often gave rise to feelings of distress, anxiety, threat or resentment, and thus favoured paranoid reactions (Murphy 1977). However, because this refers to the more immediate effects of resettlement during the following years, speculations on a possible impact of stressful bio- graphical events on late-life paranoid states are not based on sufficient empirical data. The present study on a large sample of patients with late-life psychosis for the first time shows clear evidence of a connection between the origin of these disorders and a past history of flight or expulsion caused by war events decades before. The early trauma of uprooting and home- lessness seems to contribute to a lifelong vulnerability that serves as a matrix for delusions of persecution, harm or expulsion in old age. Patients and methods Between 1980 and 1993 60 patients admitted to the Psychiatric Clinic of the Technical University, Munich, with a diagnosis of schizophrenic or paranoid psychosis (295.x or 297.x according to ICD-8 or ICD-9) and onset of symptonas after the age of 50 years were included in the investigation. In 38 of these cases demo- graphic, biographical and psychopathological information was col- lected retrospectively by case records. The author personally ex- amined 22 patients in the course of an ongoing sudy on late para-