Case 18: A man who has accused his neighbours for years

Case 18: A man who has accused his neighbours for years

A 70-year-old man who for years has accused his neighbours of making noise, stealing from him and cutting his power, and has taken them to court.

  • 2 min read
  • Checked 01 Nov 2026

The case

For years a 70-year-old man has accused his neighbours of making noise on purpose while he sleeps, moving the noise to whichever room he is sleeping in. He has written many complaints about them and has taken them to court for coming into his home, stealing or swapping his belongings, dirtying the place, and cutting the electricity or lowering the voltage so that he cannot read. All of this, he says, is meant to drive him out so that they can take his flat.

Summary

Diagnosis

Delusional disorder, persecutory type, with litigious (querulous) behaviour.

What points to it

  • An organised system of delusions that the neighbours are harming him, damaging his home and doing things with him in mind, partly woven into his day (the noise follows him from room to room).
  • A single, coherent theme held for years, far beyond the three months ICD-11 asks for, with a motive he can explain: they want his flat.
  • He fights for his rights through complaints and lawsuits, driven by the delusion.
  • No hallucinations, disorganisation or mood disorder are described, and he seems to have kept his everyday functioning.

What else it could be

A delusion that starts late in life needs a search for a cause. Belongings that go missing or seem moved are a common theme in dementia, so test his memory and cognition. Deafness raises the risk of late-life paranoid psychosis and can make him mishear noises, so check his hearing (and sight). Also consider depression with delusions, delirium, drugs and alcohol, and a late-onset schizophrenia-like psychosis if hallucinations appear. Blood tests and, where cognition is impaired, brain imaging.

Management

  • A therapeutic alliance built on trust and respect, which everything else depends on: do not argue with the belief and do not confirm it; talk about his distress, sleep and the toll of the dispute.
  • If he will accept it, a low dose of an antipsychotic, lower than in younger adults, watching for falls, parkinsonism and sedation.
  • Correct what can be corrected: hearing aids, glasses, social isolation.
  • Assess the risk to the neighbours and to himself; outpatient care unless the risk is high.

Outlook

Usually chronic. Some patients improve with treatment, but long-held litigious delusions seldom go away completely.