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Psychological Medicine Oct 2015Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in... (Comparative Study)
Comparative Study
BACKGROUND
Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in ascertaining a representative sample size. Existing knowledge has been mostly generated from inpatient cohorts, which may be biased towards a more severe sample.
METHOD
We compared the demographic, clinical and cognitive differences between 71 patients with first-episode DD and 71 age-matched patients with first-episode SZ. Participants were consecutively recruited from a population-based territory-wide study of early psychosis in Hong Kong targeting first-episode psychosis. Basic demographic information, premorbid functioning, duration of untreated psychosis, pathways to care, symptomatology, social, occupational, and cognitive functioning were comprehensively assessed using standardized measurements.
RESULTS
Patients with DD had less premorbid schizoid and schizotypal traits compared to patients with SZ. More patients with DD were married compared to patients with SZ. However, at first episode, there were no significant differences between the two groups in regards to the duration of untreated psychosis, pathways to care, symptom severity, neurocognitive performance, treatment, and functioning.
CONCLUSIONS
Our findings challenge previous thinking that patients with DD had better functioning than patients with SZ. This study not only provides an updated perspective into conceptualizing the clinical differences between DD and SZ, but also expands the descriptive account of the two disorders to include the neurocognitive dimension.
Topics: Adult; Cognition; Cross-Sectional Studies; Delusions; Female; Help-Seeking Behavior; Humans; Jealousy; Male; Middle Aged; Neuropsychological Tests; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenia, Paranoid
PubMed: 26036591
DOI: 10.1017/S0033291715001051 -
La Revue Du Praticien Feb 2015Delusional disorders are divided in French nosography into three clinical disease entities: paranoid delusions, psychose hallucinatoire chronique, and paraphrenia. Their...
Delusional disorders are divided in French nosography into three clinical disease entities: paranoid delusions, psychose hallucinatoire chronique, and paraphrenia. Their common characteristics are a late start, a chronic evolution, no cognitive impairment and no dissociation. Delusio- nal syndrome is often at the forefront with a predominant mechanism characterizing each disorder (interpretation for paranoid delusions, hallucination for psychose hallucinatoire chronique and imagination for paraphrenia). Although these disorders are less sensitive to the medication than schizophrenia, care is based on second generation antipsychotic treatment, in association with psychotherapy and social care. The aim of treatment is to alleviate delusion intensity to improve global functioning and to prevent violent incidents or suicide attempt.
Topics: Antipsychotic Agents; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychotherapy; Schizophrenia, Paranoid
PubMed: 25939234
DOI: No ID Found -
International Psychogeriatrics Jun 2014Previous use of heterogeneous diagnostic criteria and insensitive cognitive measures has impeded clarification of the extent and type of cognitive impairment specific to...
BACKGROUND
Previous use of heterogeneous diagnostic criteria and insensitive cognitive measures has impeded clarification of the extent and type of cognitive impairment specific to late-onset delusional disorder. We examined whether clinical presentations of late-onset delusional disorder are associated with prodromal or established dementia, and whether it might be a discrete clinical syndrome characterized by its own profile of cognitive impairment.
METHOD
Nineteen patients with late-onset delusional disorder from a hospital psychiatric service and 20 patients with dementia of the Alzheimer's type (AD) from an outpatient memory clinic were recruited in a consecutive case series. All patients underwent comprehensive neuropsychological assessment that included general intellectual function, executive function, new learning and delayed memory, language, processing speed, and visuo-perceptual skills.
RESULTS
Late-onset delusional disorder patients showed moderate impairment to conceptual reasoning, visual object recognition, processing speed, and confrontation naming. Severe impairment appeared in visuo-perceptual planning and organization, and divided attention. Compared with the Alzheimer's disease (AD) group, the late-onset delusional disorder group demonstrated significantly poorer visuo-perceptual skills but a significantly better capacity to consolidate information into delayed memory.
CONCLUSIONS
A high rate of marked cognitive impairment occurs in late-onset delusional disorder. There was evidence of a conceptual reasoning deficit, plus the presence of a visuo-perceptual impairment affecting object recognition. This impairment profile can explain the genesis and maintenance of the observed delusions. Understanding late-onset delusional disorder as other than a purely psychiatric phenomenon or a precursor to AD will lead to better assessment and management approaches.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Case-Control Studies; Cognition Disorders; Executive Function; Female; Humans; Male; Memory; Neuropsychological Tests; Schizophrenia, Paranoid; Space Perception
PubMed: 24524668
DOI: 10.1017/S1041610214000106 -
The British Journal of Psychiatry : the... Feb 2016Delusional disorder has been the subject of very little investigation using brain imaging.
BACKGROUND
Delusional disorder has been the subject of very little investigation using brain imaging.
AIMS
To examine potential structural and/or functional brain abnormalities in this disorder.
METHOD
We used structural imaging (voxel-based morphometry, VBM) and functional imaging (during performance of the n-back task and whole-brain resting connectivity analysis) to examine 22 patients meeting DSM-IV criteria for delusional disorder and 44 matched healthy controls.
RESULTS
The patients showed grey matter reductions in the medial frontal/anterior cingulate cortex and bilateral insula on unmodulated (but not on modulated) VBM analysis, failure of de-activation in the medial frontal/anterior cingulate cortex during performance of the n-back task, and decreased resting-state connectivity in the bilateral insula.
CONCLUSIONS
The findings provide evidence of brain abnormality in the medial frontal/anterior cingulate cortex and insula in delusional disorder. A role for the former region in the pathogenesis of delusions is consistent with several other lines of evidence.
Topics: Adult; Brain Mapping; Case-Control Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Gray Matter; Gyrus Cinguli; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Regression Analysis; Schizophrenia, Paranoid
PubMed: 26382955
DOI: 10.1192/bjp.bp.114.159087 -
Delusional disorder: no gender differences in age at onset, suicidal ideation, or suicidal behavior.Revista Brasileira de Psiquiatria (Sao... 2014To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD).
OBJECTIVE
To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD).
METHODS
We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates.
RESULTS
Seventy-six percent of the patients were women. The average age at onset was 48.76 ± 12.67 years, mean age at first psychiatric consultation was 54.13 ± 13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up.
CONCLUSIONS
Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders.
Topics: Age of Onset; Aged; Analysis of Variance; Appointments and Schedules; Comorbidity; Depressive Disorder; Female; Humans; Male; Middle Aged; Prospective Studies; Schizophrenia, Paranoid; Schizophrenic Psychology; Sex Factors; Socioeconomic Factors; Suicidal Ideation; Suicide, Attempted
PubMed: 24554277
DOI: 10.1590/1516-4446-2013-1205 -
Schizophrenia Research Jul 2019The diagnosis of paranoia/delusional disorder has been significantly modified and redefined from DSM-III to DSM-5, which in turn also meaningfully differ from the ICD-10...
BACKGROUND
The diagnosis of paranoia/delusional disorder has been significantly modified and redefined from DSM-III to DSM-5, which in turn also meaningfully differ from the ICD-10 criteria. In this study we examined the degree to which these diagnostic systems differ on external variables.
METHOD
Two-hundred and eighty-six subjects diagnosed of paranoia/delusional disorder according to DSM-III, DSM-III-R, DSM-IV, DSM-5 or ICD-10 criteria were examined for a number of validators including risk factors, premorbid features, illness-related variables and psychosocial functioning. The prevalence rates of the diagnostic criteria and their concordance level were examined, such as the degree to which the criteria sets and their main diagnostic features were differentially related to the validators.
RESULTS
Diagnostic criteria showed poor to fair concordance. The most inclusive system was the DSM-5 (n = 274) and the most restrictive the DSM-III (n = 187). Compared with subjects fulfilling other diagnostic criteria, those with a DSM-III diagnosis showed more and stronger associations with the validators: presence of cluster A personality disorders, insidious illness onset, poor response to treatment, chronic illness course and poor psychosocial functioning. This association pattern was mainly due to the 6-month duration criterion. Stability of delusions, type of delusions and the ICD-10 3-month duration criterion were poorly related to the validators.
CONCLUSIONS
Diagnostic criteria for delusional disorder are not interchangeable. DSM-III criteria for paranoia may identify a more severe disorder mainly because the 6-month duration criterion. Type of delusions had a small impact on the validators across diagnostic systems. These findings have implications for future classifications of delusional disorder.
Topics: Adult; Aged; Diagnostic and Statistical Manual of Mental Disorders; Female; Follow-Up Studies; Humans; International Classification of Diseases; Male; Middle Aged; Paranoid Disorders; Schizophrenia, Paranoid
PubMed: 31080154
DOI: 10.1016/j.schres.2019.04.027 -
The Cochrane Database of Systematic... Dec 2019Primary delusional infestation (DI) is a primary psychiatric disorder characterised by delusions and abnormal tactile sensations. The pathophysiology is undecided and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Primary delusional infestation (DI) is a primary psychiatric disorder characterised by delusions and abnormal tactile sensations. The pathophysiology is undecided and treatment includes both pharmacological and non-pharmacological options. There is currently no Cochrane Review of the treatments used. Primary DI is a diagnosis often encountered by both dermatologists and psychiatrists, with a large associated disease burden.
OBJECTIVES
To evaluate the effectiveness of different treatments in primary delusional infestation (DI).
SEARCH METHODS
On 24 December 2014 and 19 March 2019, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including registries of clinical trials.
SELECTION CRITERIA
Randomised controlled trials involving the treatment of adults with primary DI.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened and assessed studies for inclusion using pre-specified inclusion criteria.
MAIN RESULTS
We did not identify any studies for inclusion.
AUTHORS' CONCLUSIONS
Currently there is no evidence from RCTs available to compare treatment of primary DI with placebo. We cannot, therefore, make any conclusions regarding the effects of treatments (pharmacological or non-pharmacological) for primary DI. This lack of evidence for treatment of primary DI has implications for research and practice. Robust randomised trials are indicated.
Topics: Antipsychotic Agents; Humans; Psychotherapy; Randomized Controlled Trials as Topic; Schizophrenia, Paranoid; Self Concept
PubMed: 31821546
DOI: 10.1002/14651858.CD011326.pub2 -
Canadian Journal of Psychiatry. Revue... Mar 1999Paraphrenia is a disorder similar to paranoid schizophrenia but with better-preserved affect and rapport and much less personality deterioration. It is now diagnosed...
BACKGROUND
Paraphrenia is a disorder similar to paranoid schizophrenia but with better-preserved affect and rapport and much less personality deterioration. It is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it "atypical psychosis," "schizoaffective disorder," or "delusional disorder" for lack of a better diagnostic category. Virtually no systematic research on paraphrenia has been conducted in the past 60 years.
METHOD
The authors distinguish paraphrenia from "late paraphrenia," a diagnosis used mainly in the United Kingdom, and provide a neo-Kraepelinian description of paraphrenia that would be compatible with the formats of DSM-IV and ICD-10. Using a questionnaire adapted from this description, intake cases in 2 Canadian psychiatric centres (Ottawa [Ontario] and Dartmouth [Nova Scotia]) were surveyed. Cases of paraphrenia were distinguished from those of schizophrenia and delusional disorder and were examined at the time of intake and immediately prior to discharge.
RESULTS
For logistical reasons, collecting a totally consecutive series was not possible. However, during an 18-month period, investigators in both centres identified 33 cases closely fitting paraphrenia. The outstanding features of these cases are enumerated, and an outline description of paraphrenia is derived.
CONCLUSION
It is possible to define and recognize paraphrenia; it is a viable diagnostic entity. Further research would benefit paraphrenia and schizophrenia patients. Cases in this study have been coded to permit follow-up investigations.
Topics: Adult; Affective Symptoms; Age of Onset; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Nova Scotia; Ontario; Paranoid Disorders; Personality; Reproducibility of Results; Schizophrenia; Schizophrenia, Paranoid; Terminology as Topic
PubMed: 10097832
DOI: 10.1177/070674379904400202 -
Psychiatry and Clinical Neurosciences Dec 1999Patients who visited the psychiatric outpatient service of Chang Gung Medical Centre, Tao-Yuan, Taiwan during an 8-year period were studied retrospectively. Among the... (Clinical Trial)
Clinical Trial
Patients who visited the psychiatric outpatient service of Chang Gung Medical Centre, Tao-Yuan, Taiwan during an 8-year period were studied retrospectively. Among the 10,418 outpatients, 86 (0.83%) were diagnosed as having DSM-IV delusional disorder (DD), including 61 (70.9%) with persecutory type, 12 (14.0%) with the mixed type, seven (8.1%) with jealous type, two (2.3%) with somatic type, two (2.1%) with unspecified type, one (1.2%) with erotomanic type, and another one with grandiose type. The ratio of women to men was 0.86. The mean age at onset was 42.4 +/- 15.41 years, with women being older than men. Thirty-seven cases (43.0%) presented with depressive symptoms at their first visit. Subjects were divided into four groups: persecutory type, jealous type, mixed type and others. There were no significant differences between the four groups in terms of gender, age at onset, time-lapse before seeking psychiatric help, the presence of hallucination or the presence of depression.
Topics: Adult; Age of Onset; Depression; Female; Hallucinations; Humans; Male; Middle Aged; Outpatients; Psychiatric Status Rating Scales; Retrospective Studies; Schizophrenia, Paranoid; Taiwan
PubMed: 10687749
DOI: 10.1046/j.1440-1819.1999.00624.x -
African Journal of Psychiatry Mar 2010With regard to delusional disorder-somatic subtype there may be a relationship with body dysmorphic disorder. There are reports that some delusional disorders can evolve...
With regard to delusional disorder-somatic subtype there may be a relationship with body dysmorphic disorder. There are reports that some delusional disorders can evolve to become schizophrenia. Similarly, the treatment of such disorders with antipsychotics has been documented. This report describes a case of delusional disorder - somatic type - preceding a psychotic episode and its successful treatment with an antipsychotic drug, thus contributing to what has been documented on the subject.
Topics: Adult; Antipsychotic Agents; Body Dysmorphic Disorders; Comorbidity; Humans; Male; Schizophrenia, Paranoid; Thumb; Treatment Outcome; Trifluoperazine; Young Adult
PubMed: 20454749
DOI: 10.4314/ajpsy.v13i1.53432