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Asian Journal of Psychiatry Aug 2023We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N = 236) with onset of...
We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N = 236) with onset of illness before the age of 30 years. Gender differences in marital and employment status were significant (p-0.001). Delusion of infidelity and erotomania were more common in females, while males had more body dysmorphic and persecutory delusions (X-20.45, p-0.009). Males had more substance dependence (X-21.31, p < 0.001), as well as a family history of substance abuse and PDD (X-18.5, p < 0.01). To conclude, gender differences in PDD comprised some psychopathology, co-morbidity, and family history among those with young onset PDD.
Topics: Male; Female; Humans; Adult; Delusions; Schizophrenia, Paranoid; Sex Factors; Retrospective Studies; Comorbidity; Substance-Related Disorders
PubMed: 37270876
DOI: 10.1016/j.ajp.2023.103653 -
Australasian Psychiatry : Bulletin of... Aug 2020Delusional disorder (DD) is well recognised, but its treatment is controversial. This article presents a case study that highlights the therapeutic benefits associated... (Review)
Review
OBJECTIVE
Delusional disorder (DD) is well recognised, but its treatment is controversial. This article presents a case study that highlights the therapeutic benefits associated with assertive biopsychosocial treatment of DD.
METHOD
The literature on pharmacological and psychological treatments for DD is briefly reviewed, and a case example from the Queensland Fixated Threat Assessment Centre is given to illustrate a comprehensive biopsychosocial treatment framework.
RESULTS
Combined pharmacological and psychosocial intervention resulted in stabilisation and improvement in mental state for the case described.
CONCLUSIONS
There is an emergent evidence base for an assertive biopsychosocial approach to treating DD. The case study demonstrates that a range of therapeutic goals is achievable.
Topics: Aged; Humans; Male; Models, Biopsychosocial; Psychotherapy; Queensland; Schizophrenia, Paranoid
PubMed: 32019353
DOI: 10.1177/1039856220901463 -
Canadian Journal of Psychiatry. Revue... Feb 2006Often considered difficult to treat in the past, even treatment-resistant, delusional disorder is now regarded as a treatable condition that responds to medication in... (Review)
Review
OBJECTIVE
Often considered difficult to treat in the past, even treatment-resistant, delusional disorder is now regarded as a treatable condition that responds to medication in many instances. Munro and Mok previously reviewed the published record of its treatment to 1994. This review aims to update and extend their observations and to examine the impact of new second-generation antipsychotic agents on the treatment of this condition.
METHOD
We attempted to gather all published reports of delusional disorder from 1994 to 2004, using various database strategies. We then assessed the reports for clarity and completeness, treatment, and outcome descriptions, thereby selecting a patient sample for analysis.
RESULTS
Of 224 cases identified as delusional disorder, only 134 case descriptions provided sufficient treatment and outcome data to inform this review. The demographics of this sample were similar to those of the earlier review. Depression as a comorbid condition was more frequent than before. Adherence to medication regimens was seldom explicitly addressed. Most cases showed improvement regardless of which antipsychotic medication the patients received. Pimozide and other conventional antipsychotics, as well as second-generation antipsychotics, and even clozapine, were used in many of the case reports. Family history of delusional disorder was seldom recorded.
CONCLUSIONS
A positive response to medication treatment occurred in nearly 50% of the cases in our review, which is consistent with the earlier review.
Topics: Adult; Aged; Antipsychotic Agents; Demography; Depressive Disorder; Female; Humans; Male; Middle Aged; Patient Compliance; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 16989110
DOI: 10.1177/070674370605100207 -
Rivista Di Psichiatria 2021The fact that delusional disorder (DD) received minimal research attention indicates the need for descriptive studies that will better delineate the clinical and...
The fact that delusional disorder (DD) received minimal research attention indicates the need for descriptive studies that will better delineate the clinical and socio-demographic characteristics of DD. We conducted a chart review descriptive study in a tertiary hospital from Turkey. A total of 99 cases of DD were identified through hospital registry system. 57 were male (57.6%), and mean age at first admission was 49.34±13.49. The most common type of DD was persecutory (36.4%), followed by jealous type (28.3%), mixed type (18.2%), and somatic type (16.2%). Jealous type DD patients were more likely to be married, and mixed type DD patients were more likely to be divorced. The presence of hallucinations was significantly associated with history of hospitalization. About one-tenth of the patients had a family history of psychotic spectrum disorder. Comorbid depressive disorder was present in 42.9% of the patients, whereas only 9.2% had comorbid anxiety disorder. Depressive disorder comorbidity in DD seems to be associated with continued treatment for longer periods of time in psychiatry services. While most of our data were comparable with the literature on DD, our divergent findings like higher rates of male patients and jealous type of the disorder might be attributed to the cultural and geographical factors. This situation points out that future research with larger populations and from different regions would contribute to better understanding of clinical and socio-demographical characteristics of delusional disorder.
Topics: Humans; Male; Marriage; Schizophrenia, Paranoid; Turkey
PubMed: 34927628
DOI: 10.1708/3713.37047 -
CNS Spectrums Aug 2016The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group... (Review)
Review
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group on the Classification of Psychotic disorders (WGPD), installed by the World Health Organization (WHO), is expected to publish the new chapter about schizophrenia and other primary psychotic disorders in 2017. We reviewed the available literature to summarize the major changes, innovations, and developments of both manuals. If available and possible, we outline the theoretical background behind these changes. Due to the fact that the development of ICD-11 has not yet been completed, the details about ICD-11 are still proposals under ongoing revision. In this ongoing process, they may be revised and therefore have to be seen as proposals. DSM-5 has eliminated schizophrenia subtypes and replaced them with a dimensional approach based on symptom assessments. ICD-11 will most likely go in a similar direction, as both manuals are planned to be more harmonized, although some differences will remain in details and the conceptual orientation. Next to these modifications, ICD-11 will provide a transsectional diagnostic criterion for schizoaffective disorders and a reorganization of acute and transient psychotic and delusional disorders. In this manuscript, we will compare the 2 classification systems.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Psychotic Disorders; Schizophrenia; Schizophrenia, Paranoid; Schizotypal Personality Disorder
PubMed: 27418328
DOI: 10.1017/S1092852916000316 -
Psychological Medicine Oct 2016Delusional disorder (DD) is an under-researched condition and its relationship to schizophrenia (SZ) controversial. This study aimed to further characterize DD and to... (Comparative Study)
Comparative Study
BACKGROUND
Delusional disorder (DD) is an under-researched condition and its relationship to schizophrenia (SZ) controversial. This study aimed to further characterize DD and to examine multi-domain evidence for the distinction between DD and SZ.
METHOD
Using univariate analyses we examined 146 subjects with DD, 114 subjects with paranoid SZ and 244 subjects with non-paranoid SZ on 52 characteristics from several domains including demographics, risk factors, premorbid features, illness characteristics, index episode features, delusional-related features, response to treatment and outcome. In a further step, we searched for independent associations of the examined characteristics with DD v. SZ.
RESULTS
Univariate analyses showed that DD differed from either form of SZ in 40 characteristics, the pattern of findings indicated that paranoid SZ was much more similar to non-paranoid SZ than DD. Relative to subjects with SZ, those with DD were more likely to have drug abuse before illness onset, better premorbid sexual adjustment, later age at illness onset, higher levels of affective symptoms and lack of insight, poorer response to antipsychotic medication, better functioning in the domains of personal care, paid work and social functioning; last, subjects with DD had fewer but more severe delusions and higher ratings of conviction of delusional experience than those with SZ. Predominance of jealousy and somatic delusions was confined to subjects with DD.
CONCLUSIONS
DD and SZ represent two distinct classes of disorders, the differential features of DD being of nosological, aetiological and therapeutic relevance.
Topics: Adult; Delusions; Female; Humans; Male; Middle Aged; Schizophrenia; Schizophrenia, Paranoid
PubMed: 27468631
DOI: 10.1017/S0033291716001501 -
Psychiatry Research. Neuroimaging Sep 2023Neurobiological foundations of delusional disorder (DD) have been studied less with neuroimaging techniques when compared to other psychotic disorders. The present study...
Neurobiological foundations of delusional disorder (DD) have been studied less with neuroimaging techniques when compared to other psychotic disorders. The present study aimed to delineate the neural substrates of DD by investigating neuroanatomical characteristics of the corpus callosum (CC) with statistical shape analysis (SSA) conducted on magnetic resonance images (MRI). Twenty (female:male=1:1) DSM-5 DD patients and 20 age- and gender-matched healthy individuals were included. High-resolution 3D T1 Turbo Field Echo MRI images were scanned with a 1.5 T MR device. The landmarks that were selected to determine the shape differences in CC were identified based on previous studies. Furthermore, constructed landmarks were determined and employed to better assess regional shape differences. There was no significant difference in the CC area in the mid-sagittal images between the DD patients and controls. However, DD patients exhibited a pattern of structural CC changes in various regions. The study findings emphasizes the variable subregional nature of CC in DD patients. Future SSA studies with larger samples could shed further light on DD etiology, diagnosis, classification and treatment options.
Topics: Humans; Male; Female; Corpus Callosum; Schizophrenia, Paranoid; Magnetic Resonance Imaging; Neuroimaging; Image Processing, Computer-Assisted
PubMed: 37567087
DOI: 10.1016/j.pscychresns.2023.111695 -
Schizophrenia Research Feb 2021Little is known on the effective pharmacological treatment of delusional disorder.
BACKGROUND
Little is known on the effective pharmacological treatment of delusional disorder.
AIMS
Study the comparative effectiveness of pharmacotherapies in the prevention of hospitalization due to psychosis and work disability in delusional disorder.
METHODS
Observational registry based cohort study including everyone in Sweden diagnosed with delusional disorder (N = 9076;mean follow-up time 4.9 years). The primary analysis was Cox Proportional Hazards within-individual analysis. Results are reported as adjusted hazard ratios (HRs).
RESULTS
Among the cohort (4835 males/4241 females;mean [SD] age 44.1 [12.5] years), 2074 persons had at least one hospitalization due to psychosis. Risk for hospitalization due to psychosis was 46% lower when any antipsychotic was used (HR 0.54, 95%CI 0.38-0.77, p < 0.001). Use of clozapine (HR 0.24, 95%CI 0.07-0.77, p = 0.016), any long-acting injectable (LAI; HR 0.28, 95%CI 0.16-0.49, p < 0.0001) and oral olanzapine (HR 0.36, 95%CI 0.20-0.67, p = 0.001) were associated with lowest risk. Among those not on disability pension at start of follow-up (n = 5025), in comparison to no use of antipsychotics, use of clozapine (HR 0.08, 95%CI 0.01-0.52, p = 0.008), any LAI (HR 0.44, 95%CI 0.25-0.79, p = 0.006) and oral aripiprazole (HR 0.52, 95%CI 0.31-0.85, p = 0.009) were associated with lowest risk of work disability.
CONCLUSIONS
Use of antipsychotics was associated with a reduced risk of hospitalization due to psychosis and work disability in delusional disorder, with use of clozapine and long-acting injectables being associated with the lowest risk for these very relevant end-points for both individual suffering and costs to society. Clinical trials with these treatments are urgently needed to make informed clinical treatment recommendations.
Topics: Adult; Antipsychotic Agents; Clozapine; Cohort Studies; Female; Humans; Male; Schizophrenia, Paranoid; Sweden
PubMed: 33548837
DOI: 10.1016/j.schres.2021.01.015 -
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 -
International Psychogeriatrics Apr 2020There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic...
OBJECTIVES
There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic use and treatment outcomes in patients with DD aged 65 years and older. Secondarily, we sought to examine associated clinical features and socio-demographic variables.
DESIGN AND SETTING
This descriptive study reviewed all consecutive cases of DD referred to an Australian old age psychiatry service over a 12-year period. Fifty-five patients were assessed in the inpatient and/or community setting, with data verified from a review of all individual medical records.
MEASUREMENTS
Data were collected with respect to antipsychotic use, outcomes, and clinical features. Socio-demographic variables of DD cases were compared to a non-matched comparison group (n=278) and an age and gender matched comparison group with a 1:1 ratio (n=55).
RESULTS
The predominant type of DD was persecutory (87%). Non-prominent hallucinations were experienced by 18%, and depressive symptoms occurred in 22%. There was a statistically significant association between having DD and social isolation (χ2= 11.04 (DF=1) p<0.001; McNemar's test p<0.001). Atypical antipsychotic medication was prescribed in 32 cases, with follow-up permitted in 51 of the 55 cases (mean duration 36.6 months). Sustained recovery occurred in 20%, and improvement in an additional 35% of the study sample. Four patients subsequently developed dementia, and two developed mild cognitive impairment.
CONCLUSIONS
Clinical improvement, including sustained recovery, occurred in more than half of those with late life DD. The majority of those who improved (96%) received atypical antipsychotics.
Topics: Aged; Aged, 80 and over; Aging; Antipsychotic Agents; Australia; Dementia; Female; Humans; Male; Schizophrenia, Paranoid; Treatment Outcome
PubMed: 31354123
DOI: 10.1017/S1041610219000966