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Psychiatria Polska Oct 2023We present a case study of a patient who was hospitalized with the initial diagnosis of psychotic depression with predominant delusions of poverty. During his hospital... (Review)
Review
We present a case study of a patient who was hospitalized with the initial diagnosis of psychotic depression with predominant delusions of poverty. During his hospital stay despite antidepressant and antipsychotic treatment with 150 mg of sertraline and 20 mg of olanzapine per day, no symptomatic improvement was achieved. Besides, the psychotic features have risen to the fore along with inadequately vaguely expressed affective component. What drew attention was the coherence and permanence of delusional judgements, which, albeit variable in expression, always concerned one theme - the belief of an inevitable bankruptcy. The whole clinical picture, both with the objectifying interview defining the order of emerging symptoms, was suggestive and the verification of diagnosis was made. Persistent delusional disorder with delusions of poverty with subsequent mood disorder was diagnosed. The treatment with 275 mg of clozapine per day was started and we observed a slow gradual withdrawal of psychosis as well as a total normalization of the affective range. The case illustrates the importance of differential diagnosis of mental states in which psychotic features coexist with affective symptoms. It is helpful to determine the sequence of the symptoms development. It should be noted that although the ICD-10 classification distinguishes exclusively 7 subtypes of persistent delusional disorder, in the clinical practice we can encounter other thematic areas of psychosis. It brings substantial therapeutic and prognostic implications.
Topics: Humans; Delusions; Schizophrenia, Paranoid; Psychotic Disorders; Antipsychotic Agents; Poverty
PubMed: 36370381
DOI: 10.12740/PP/OnlineFirst/143044 -
Cureus Jan 2023Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a...
Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a disorder associated with paranoid dementia and paranoia, but with less personality deterioration than schizophrenia and without fulfilling the clinical features of a delusional disorder. This classic diagnostic entity is not currently listed in main diagnostic systems, rendering delusional disorders difficult to classify in cases that resemble the concept of paraphrenia. We revisit the concept of paraphrenia through a critical review based on a clinical vignette of a patient followed at the psychiatry department of the University Hospital Center of São João.
PubMed: 36726768
DOI: 10.7759/cureus.34391 -
Canadian Journal of Psychiatry. Revue... Jan 2018To contribute to a better differential clinical categorisation of delusional disorder (DD) versus schizophrenia (SZ) and to add and complete evidence from previous... (Comparative Study)
Comparative Study
OBJECTIVE
To contribute to a better differential clinical categorisation of delusional disorder (DD) versus schizophrenia (SZ) and to add and complete evidence from previous clinical studies of DD compared to schizophrenia.
METHODS
A cross-sectional study using a clinical sample of 275 patients (132 patients with DD) was studied. Patients were consecutively attending public clinics located in urban and rural areas in both Andalusia and Catalonia (Spain). All participants met DSM-IV diagnostic criteria for either DD or SZ. Data were gathered on sociodemographics, illness duration, Barona-Index estimation of intelligence quotient (IQ), and global functioning, along with a thorough psychopathological assessment using the Positive and Negative Syndrome Scale (PANSS). Comparisons between both groups were calculated using χ, Student t, and multivariate analysis of covariance tests.
RESULTS
Patients with DD were older (mean [SD], 50.3 [14.6] years vs. 36.6 [11.1] years; t = 8.597; P ≤ 0.0001), were more frequently married (45.4% vs. 10.8%; χ = 38.569; P ≤ 0.0001), and had a higher mean estimated premorbid IQ (111.4 vs. 105.4; t = 2.609; P ≤ 0.01). On the other hand, SZ patients were predominantly male (71.4% vs. 48.9%; χ = 14.433; P ≤ 0.0001) and had greater work-related disability than DD patients (20.5% vs. 50.3%; χ = 19.564; P ≤ 0.001). Overall, the DD group showed a less severe PANSS psychopathology than SZ group. Thus, total mean (SD) PANSS scores for schizophrenia and delusional disorder, respectively, were 76.2 (22.4) versus 54.1 (18.4) ( t = -8.762; P ≤ 0.0001). Moreover, patients with DD showed a better global functioning than those with SZ (62.7 [13.2] vs. 51.9 [16.9]; F = 44.114; P ≤ 0.0001).
CONCLUSIONS
DD is a milder and distinct disorder compared to SZ in terms of psychopathology and global functionality.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Schizophrenia; Schizophrenia, Paranoid; Spain; Young Adult
PubMed: 28595494
DOI: 10.1177/0706743717706347 -
Focus (American Psychiatric Publishing) Oct 2021Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly...
Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly poor quality of life and high rates of suicidality. Onset of BDD is usually in childhood or adolescence and, unless appropriately treated, tends to be chronic. The first-line pharmacologic approach for both delusional and non-delusional BDD is serotonin reuptake inhibitors (SRIs), often at high doses. SRI augmentation and switching strategies can be effective. The first-line psychotherapy is cognitive-behavioral therapy (CBT) tailored to BDD's unique clinical features. Cosmetic treatment (such as surgery or dermatologic treatment), although received by a majority of patients with BDD, is not recommended. BDD has many similarities to obsessive-compulsive disorder (OCD) and appears closely related to OCD but also has some important differences. This article, which updates a 2015 article on BDD that we published in this journal, provides a clinically focused overview of BDD and its relationship to OCD.
PubMed: 35747292
DOI: 10.1176/appi.focus.20210012 -
Frontiers in Psychiatry 2021Global communities are currently confronted with a number of complex problems and threats, the reality of which is amplified by the media. These environmental and...
Global communities are currently confronted with a number of complex problems and threats, the reality of which is amplified by the media. These environmental and socio-political stressors have been accompanied by the spread of problematic psychological and behavioural tendencies, such as the growing polarisation of opinions and values, online radicalisation and extremism, deepening xenophobia and nationalism, the proliferation of irrational beliefs and conspiracy theories, and resistance to rational public policy measures. Here we argue that although they fall outside the scope of psychopathology, they nevertheless currently constitute a major challenge for psychiatry as a research domain and a clinical practise. To substantiate this claim, we outline the mechanisms by which media-transmitted stressors impact mental well-being and possibly psychopathology. The common denominator of these global problems and the media's construction of reality is the increase in uncertainty, unpredictability, and uncontrollability, which prompts defensive responding and, in predisposed individuals, functions as a potent source of chronic stress. These contribute to cognitive inflexibility, a strong predisposing factor for the development of rigid beliefs and attitudes, which to varying degrees underlie the adverse psychological and behavioural tendencies mentioned above. We suggest that the tightening of beliefs and ideas that is the result of cognitive rigidity may correspond to the clinical characteristics of induced delusional disorder. This can be seen as a (ultimately maladaptive) defensive strategy for coping with a high degree of uncertainty and unpredictability. We conclude by briefly outlining the possible ways in which psychiatry can face this challenge.
PubMed: 35082704
DOI: 10.3389/fpsyt.2021.809239 -
BMC Psychiatry Sep 2023Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the...
BACKGROUND
Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years.
METHODS
71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years.
RESULTS
At four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients.
CONCLUSIONS
Results indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.
Topics: Humans; Child, Preschool; Follow-Up Studies; Quality of Life; Schizophrenia, Paranoid; Psychotic Disorders; Age Factors
PubMed: 37723482
DOI: 10.1186/s12888-023-05175-z -
Clinical, Cosmetic and Investigational... 2018Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the... (Review)
Review
Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. Further studies of the genetics, pathogenesis, and treatment of MD are warranted.
PubMed: 29467580
DOI: 10.2147/CCID.S152343 -
International Journal of Environmental... Jun 2020Delusional disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this... (Review)
Review
Delusional disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this narrative review is to select from the clinical literature the psychosocial interventions that appear to work best for these conditions and to see whether similar strategies can be modeled or taught to family members so that tensions at home are reduced. Because the content of men's and women's delusions sometimes differ, it has been suggested that optimal interventions for the two sexes may also differ. This review explores three areas: (a) specific treatments for men and women; (b) recommended psychological approaches by health professionals, especially in early encounters with patients with DD; and (c) recommended psychoeducation for families. Findings are that there is no evidence for differentiated psychosocial treatment for men and women with delusional disorder. What is recommended in the literature is to empathically elicit the details of the content of delusions, to address the accompanying emotions rather than the logic of the presented argument, to teach self-soothing techniques, and to monitor behavior with respect to its safety. These recommendations have only been validated in individual patients and families. More rigorous clinical trials need to be conducted.
Topics: Delusions; Emotions; Family; Female; Humans; Male; Schizophrenia, Paranoid
PubMed: 32630566
DOI: 10.3390/ijerph17124583 -
Psychiatrike = Psychiatriki 2018The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are...
The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally fused functions of perception and recognition. The classical sub-types are: the syndromes of Capgras, Fregoli,Intermetamorphosis (mentioned in 3) and Subjective doubles. These syndromes occur in a clear sensorium and shouldbe differentiated from the banal transient misidentifications occurring in confusional states and in mania and from thenon-delusional misidentifications (e.g. prosopagnosia). Joseph Capgras, who described the best-known sub-type, was indecisive on its pathogenesis. In his original report he defined the syndrome as "agnosia of identification" produced by a conflict between affective accompaniments ofsensory and mnemonic images. In his subsequent two publications, he considered the syndrome as a restitution delusionand as a psychopathological mechanism to hide incestuous desires. For more details see the chapter by J.P. Luaute in avolume on DMS. Psychodynamic approaches are, essentially, variants of the formulation that DMSs result from ambivalent feelings resolvedby directing hate feelings onto an imagined double in order to retain the original intact (and thus avoid guilt).These views have been voiced by David Enoch [relevant chapter in (3)] and with variations by many other investigatorsreviewed by Oyebode. Regression to archaic modes of thought (like thinking in terms of doubles and dualisms) due to personality disintegrationproduced by psychotic illness is a fascinating hypothesis by John Todd [mentioned in (1)]. However, if this was thecase, DMS should be much more frequent. Mayer-Gross and Ackner (mentioned in 9) had observed that when there is a delusional development, depersonalization-derealization experiences tend to be included within the delusional system. Such experiences usually precede orcoincide with the onset of DMS. In view of this, Christodoulou suggested that DMSs may represent delusional evolutions of depersonalization-derealization experiences. Similar mechanisms were proposed for false memories of familiarity,reduplicative paramnesia and autoscopy. Cerebral "dysrhythmia" has also been noted in patients with DMS. In view of clinical and prognostic similarities of DMSpatients with patients suffering from psychotic states occurring in an epileptic setting, many of these patients have beenconsidered as suffering from broadly speaking "epileptic" psychoses. Joseph [mentioned in (6)] suggested that organiccauses produce disconnection between right and left cortical areas that decode afferent sensory information. This resultsin the creation of a separate image in each hemisphere leading to an awareness of two, physically identical images. Ellis and Young [mentioned in (1) and (6)] have maintained that DMS may result from defects at different stages of aninformation processing chain. More specifically, the Capgras Syndrome appears when the route for unconscious recognitionis damaged. Similar mechanisms have been proposed for the rest of the subtypes. Margariti and Kontaxakis8 have considered that in DMS there is disruption of the ability to recognize identities ratherthan superficial appearance. Others have maintained that DMSs are multimodal neuropathologies and cannot be linkedto a single cognitive defect. Lastly, in view of the marked organic abnormalities detected in all DMS subtypes, DMSs have been linked with a greatnumber of organic conditions [reviewed in detail by Oyebode (5)]. According to Greek mythology, Procrustes was a bandit who stretched or amputated the limbs of his guests to fit hisiron bed. The DMSs do not deserve such treatment. Submitting them to the procrustean bed of uniformity should be avoided. People develop DMS for a variety of reasons. Most subjects have right hemisphere dysfunction but not exclusively.Their condition is associated not with one but with diverse phenomena (depersonalization - derealization, prosopagnosia,false memories of familiarity, autoscopy, reduplicative paramnesia etc.) similarities with psychotic phenomena associatedwith epilepsy have been suggested but this refers to some patients only. Additionally, the charged emotionalrelationship of the patient with the misidentified person(s) is neither necessary nor sufficient. Diagnostically speaking, many roads lead to DMS, ranging from the monosymptomatic and monothematic one (consideredas par excellence DMS) to that associated with disorders mainly of the schizophrenic or organic spectrum. DMScan also be reached by a more "superficial" road, the one of depression, in which the delusion is secondary and often dependenton the self-depreciation ideation. Speculating on these syndromes is a fascinating journey in psychopathologybut, although in most cases an organic contributor is present, yet the great diversity of conditions in the setting of whichDMSs occur renders the possibility of a unifying hypothesis unlikely.
Topics: Cognition Disorders; Delusions; Humans; Neuropsychological Tests; Psychotherapy, Psychodynamic; Schizophrenia, Paranoid
PubMed: 29754115
DOI: 10.22365/jpsych.2018.291.15 -
Healthcare (Basel, Switzerland) Feb 2023Compared to other psychotic disorders, there is little information about staging care in delusional disorder (DD). Unlike schizophrenia, this is a disorder that begins... (Review)
Review
Compared to other psychotic disorders, there is little information about staging care in delusional disorder (DD). Unlike schizophrenia, this is a disorder that begins in middle age, a time at which chronic medical comorbidities have already begun to impact global functioning. With age, the combination of psychological and somatic conditions leads to new behaviours, e.g., agitation, aggression, and behaviours that require specific preventive and interventive measures. With further age, knowledgeable end-of-life care becomes necessary for this population. : The aim of this article was to review existing evidence on the management of these successive phases. : We conducted a narrative review using PubMed and ClinicalTrials.gov and searched for the following terms: (agitation OR aggressivity OR aggression OR palliative OR "end-of-life") AND ("delusional disorder"). : We found that the literature was sparse. Existing evidence suggests that medical causes are frequently at the root of agitation and aggression. With respect to management, de-escalation strategies are generally preferred over pharmacotherapy. Specific delusional syndromes, e.g., de Clérambault, Othello, Capgras, Fregoli, as well as folie à deux, are associated with aggression. The somatic subtype of DD is the one most often requiring palliative care at the end of life. : We conclude that insufficient attention has been given to the care needs of the accelerated aging process in DD.
PubMed: 36832992
DOI: 10.3390/healthcare11040458