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Ugeskrift For Laeger Oct 2007Paranoia (delusional disorder) is an uncommon chronic condition, characterized by the presence of delusions and the relative absence of other psychopathology. Unlike in... (Review)
Review
Paranoia (delusional disorder) is an uncommon chronic condition, characterized by the presence of delusions and the relative absence of other psychopathology. Unlike in schizophrenia, the paranoiac delusions are nonbizarre and concern experiences that can conceivably occur, and the evidence mostly supports the hypothesis that paranoia is a distinct nosologic entity. The article reviews the epidemiology, pathogenesis, diagnosis, clinical manifestations and management of paranoia. It is concluded that further exploration is required and greater diagnostic and therapeutic attention needs to be given to the non-schizophrenic, non-affective, non-organic delusional psychoses.
Topics: Diagnosis, Differential; Humans; International Classification of Diseases; Paranoid Disorders; Schizophrenia, Paranoid
PubMed: 18031667
DOI: No ID Found -
Acta Medica Portuguesa Jun 2021Metabolic, toxic or structural brain changes may present as psychotic symptoms. Organic delusional disorders are characterized by the presence of delusional ideas with...
Metabolic, toxic or structural brain changes may present as psychotic symptoms. Organic delusional disorders are characterized by the presence of delusional ideas with evidence of brain dysfunction. Iatrogenesis may be a cause of this dysfunction. We present a case of neuropsychiatric symptoms, including delusional disorder, secondary to the use of herbal products. The patient's perception regarding the safety of natural products might result in an omission to report their use during clinical history taking, and thus its use should be actively questioned.
Topics: Brain; Delusions; Humans; Iatrogenic Disease; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 32425153
DOI: 10.20344/amp.13135 -
Psychopharmacology Jul 2022How striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has...
Striatal dopamine synthesis capacity and its association with negative symptoms upon resolution of positive symptoms in first-episode schizophrenia and delusional disorder.
RATIONALE
How striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has seldom been explored. As negative symptoms during active psychotic episodes can be complicated by secondary influences, such as positive symptoms, longitudinal investigations may help to clarify the relationship between striatal DSC and negative symptoms and differentiate between primary and secondary negative symptoms.
OBJECTIVE
A longitudinal study was conducted to examine whether baseline striatal DSC would be related to negative symptoms at 3 months in first-episode SZ and DD patients.
METHODS
Twenty-three first-episode age- and gender-matched patients (11 DD and 12 SZ) were consecutively recruited through an early intervention service for psychosis in Hong Kong. Among them, 19 (82.6%) patients (9 DD and 10 SZ) were followed up at 3 months. All patients received an F-DOPA PET/MR scan at baseline.
RESULTS
Baseline striatal DSC (K) was inversely associated with negative symptoms at 3 months in first-episode SZ patients (r = - 0.80, p = 0.010). This association remained in SZ patients even when controlling for baseline negative, positive, and depressive symptoms, as well as cumulative antipsychotic dosage (β = - 0.69, p = 0.012). Such associations were not observed in first-episode DD patients. Meanwhile, the severity of negative symptoms at 3 months was associated with more positive symptoms in DD patients (r = 0.74, p = 0.010) and not in SZ patients.
CONCLUSIONS
These findings highlight the role of striatal DSC in negative symptoms upon resolution of active psychotic episodes among first-episode SZ patients. Baseline striatal dopamine activity may inform future symptom expression with important treatment implications.
Topics: Corpus Striatum; Dopamine; Humans; Longitudinal Studies; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 35211769
DOI: 10.1007/s00213-022-06088-7 -
L'Encephale Apr 2019Currently, all of the studies that focus on the relationship between paranoia and criminal offenses exclusively concern subjects suffering from a delusional paranoid...
BACKGROUND
Currently, all of the studies that focus on the relationship between paranoia and criminal offenses exclusively concern subjects suffering from a delusional paranoid disorder. However, subjects with single paranoid personality disorder, without any associated delusional disorder, are not uncommon in forensic practice.
OBJECTIVES
This study aims to describe the offenses committed by subjects suffering from a single paranoid personality disorder and to compare them with the offenses committed by the subjects affected by a paranoid delusional disorder associated with paranoid personality disorder. Our initial hypothesis is that both populations have a comparable criminological profile.
METHODS
Based on a 17 year-long experience carried out in the framework of a forensic assessment, we have selected all subjects presenting a paranoid personality disorder, whether single or associated with paranoid delusional disorder. The selected individuals were divided into two groups according to whether they presented paranoid delusional disorder or not. The offenses were grouped into criminal categories. The alpha risk was fixed at 1%. Data analysis is done by SAS software version 9.4.
RESULTS
In a sample of 106 subjects presenting a paranoid personality disorder, including 4 women and 102 men, we found 79 subjects with a single paranoid personality and 27 with an associated paranoid delusional disorder. The average age at the time of the offense was 41 for those with single personality disorders and 49 for those with paranoid delusional disorders. Both groups had forensic antecedents (41%, 11/27 of paranoid delusional disorder and 51%, 40/79 of single paranoid personality disorder). Psychiatric history was more frequent in the paranoid delusional disorder group (59%, 16/27) than in the single paranoid personality disorder group (13%, 10/79). History of addiction was comparable in terms of alcohol abuse (26% in both groups) and other substances (7.5%, 2/27 of paranoid delusional disorder and 9%, 7/79 of single paranoid personality disorder). Comparison of the two groups highlighted significant differences in the type of criminal offenses committed (Fisher's exact test: P=0.0003, alpha risk <0.0001). The offenses committed by delusional authors essentially came down to verbal or physical violence, including homicide (44%, 12/27), and were usually focused on a designated persecutor. Sexual violence was rare. On the other hand, paranoid personality disorder was associated with a wider variety of offenses. Sexual offenses (including 28 rapes, 35%, 28/79) were thus almost as frequent as murder, and attempted murder (38%, 30/79). This diversity of committed offenses was found in their forensic antecedents. In these subjects, the logic of omnipotence may had over ruled the logic of revenge.
CONCLUSION
We conducted a retrospective study on 106 subjects with paranoid personality disorder, including 27 subjects with associated paranoid delusional disorder. The comparison of the two groups demonstrated significant differences in offenses. Verbal and physical but non-sexual violence, committed in a delusional logic, was found among delusional subjects, while the forms of violence were more multiform in the single paranoid personality disorder group, frequently including sexual violence. This is, as far as we know, the first study describing the medico-legal acting-out of paranoid personalities. These results, which will need to be confirmed by future studies, point out the importance of the criminological risk that may be associated with paranoid personality disorder, without any associated delusional disorder.
Topics: Adult; Alcoholism; Crime; Criminals; Female; France; Homicide; Humans; Male; Middle Aged; Paranoid Personality Disorder; Personality Disorders; Retrospective Studies; Schizophrenia, Paranoid; Sex Offenses; Violence
PubMed: 30309614
DOI: 10.1016/j.encep.2018.07.005 -
Psychological Reports Feb 2010Previous research has demonstrated that patients with Delusional Disorder are impaired in executive functioning that affects performance on social cognitive tasks. In...
Previous research has demonstrated that patients with Delusional Disorder are impaired in executive functioning that affects performance on social cognitive tasks. In patients with Parkinson's disease, poor executive control induces an increase in "Machiavellianism," a term that refers to opportunistic behaviors that aim at exploiting and manipulating others. Accordingly, the association between Machiavellianism in Delusional Disorder and executive functioning deficits was examined. Machiavellianism and executive functioning were measured in 22 patients with Delusional Disorder and compared with a group of 22 healthy controls matched for sex, (premorbid) intelligence, and education. Patients and controls did not differ regarding Machiavellianism scores, education level, or intelligence. However, patients with Delusional Disorder performed more poorly on an executive functioning task. Impaired executive functioning was associated with greater Machiavellianism, particularly cynical views on human nature, but not with intelligence or illness duration. Similar to findings in patients with Parkinson's disease, Machiavellianism in Delusional Disorder was associated with poorer executive functioning. This finding indicates that frontal lobe dysfunction may influence interpersonal attitudes and personality in Delusional Disorder.
Topics: Adult; Aged; Executive Function; Female; Humans; Machiavellianism; Male; Middle Aged; Neuropsychological Tests; Parkinson Disease; Psychiatric Status Rating Scales; Schizophrenia, Paranoid
PubMed: 20402445
DOI: 10.2466/PR0.106.1.205-215 -
Actas Espanolas de Psiquiatria Jul 2016Scientific evidence focused on the treatment response in delusional disorder (DD) patients is scarce, and the findings are controversial. Our goal was to compare the... (Observational Study)
Observational Study
INTRODUCTION
Scientific evidence focused on the treatment response in delusional disorder (DD) patients is scarce, and the findings are controversial. Our goal was to compare the antipsychotic response at the 12-week followup between patients diagnosed with DD and patients diagnosed with schizophrenia and to identify potential response dimensions.
METHODS
A prospective, observational, cohort study with 12-week follow-up was conducted with DD and schizophrenia patients matched for sex, age and cumulative years of disease. The following scales were assessed: Positive and Negative Syndrome Scale (PANSS; 5-factors), Personal and Social Performance Scale (PSP), Clinical Global Impression Scale (CGI), and Columbia-Suicide Severity Rating Scale (C-SSRS). Treatment response was defined as a ≥30% reduction in the total PANSS score. Linear and logistic regression models were used to investigate the potential predictive value of psychopathological variables for the antipsychotic response.
RESULTS
Response percentages in DD and schizophrenia were 61.5% and 69.2%, respectively. The duration of untreated psychosis, antipsychotic dosage, and diagnosis did not predict antipsychotic response. In the whole sample, improvement in positive symptoms was significantly associated with the clinical global improvement (p=0.006), explaining almost 20% of the variance in the model. Within the DD group, improvement in cognitive symptoms explained 30% of the variance in clinical global improvement.
CONCLUSIONS
Both response percentages and required antipsychotic doses were similar between DD and schizophrenia. Changes in positive symptoms were associated with clinical global improvement in the entire sample, and improvement in cognitive symptoms was correlated with global improvement exclusively in DD.
Topics: Antipsychotic Agents; Cohort Studies; Female; Humans; Male; Middle Aged; Prospective Studies; Schizophrenia; Schizophrenia, Paranoid; Treatment Outcome
PubMed: 27388104
DOI: No ID Found -
Journal of Clinical Psychopharmacology
Topics: Humans; Phenytoin; Schizophrenia, Paranoid; Cerebellar Diseases; Mood Disorders; Cognition
PubMed: 36825870
DOI: 10.1097/JCP.0000000000001667 -
International Clinical... May 2020To collect the best available evidence and to compare the first-generation antipsychotics (FGAs) vs. the second-generation antipsychotics (SGAs) in the treatment of...
To collect the best available evidence and to compare the first-generation antipsychotics (FGAs) vs. the second-generation antipsychotics (SGAs) in the treatment of delusional disorder (DD). Systematic review including studies evaluating treatment response in DD using clinician-rated scales appearing in PubMed and Web of Science databases from inception till September 2019. Those studies meeting inclusion criteria were selected. Outcomes were summarized into two response categories: (1) response to treatment equal to or greater than 50% and (2) response less than 50%. Biases and quality of the studies were evaluated, and relevant data were extracted. Finally, both narrative review and quantitative synthesis were performed. The final sample included six studies (437 patients, 318 on treatment with SGAs). Antipsychotics achieved a good response in 32.3% of patients. Effectiveness differences between FGA and SGA were only marginal favouring the former. Among the most used antipsychotics, risperidone and olanzapine showed, respectively, 34.3 and 33.7% good response. Pimozide (n = 35) demonstrated a higher response rates compared with other antipsychotics. Inpatients showed the best treatment outcomes. Antipsychotics appeared to be an effective treatment in patients with DD. FGA were slightly superior to SGA. Pimozide does not seem to provide any advantage in most DD subtypes.
Topics: Antipsychotic Agents; Humans; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Treatment Outcome
PubMed: 32097136
DOI: 10.1097/YIC.0000000000000306 -
Neuropsychobiology 2020Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are...
INTRODUCTION
Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are unclear. Recent research suggests that specific delusional content may be associated with distinct neural substrates.
OBJECTIVE
Here, we used structural magnetic resonance imaging to investigate multiple parameters of brain morphology in patients presenting with paranoid type delusional disorder (pt-DD, n = 14) compared to those of healthy controls (HC, n = 25).
METHODS
Voxel- and surface-based morphometry for structural data was used to investigate gray matter volume (GMV), cortical thickness (CT) and gyrification.
RESULTS
Compared to HC, patients with pt-DD showed reduced GMV in bilateral amygdala and right inferior frontal gyrus. Higher GMV in patients was found in bilateral orbitofrontal and in left superior frontal cortices. Patients also had lower CT in frontal and temporal regions. Abnormal gyrification in patients was evident in frontal and temporal areas, as well as in bilateral insula.
CONCLUSIONS
The data suggest the presence of aberrant GMV in a right prefrontal region associated with belief evaluation, as well as distinct structural abnormalities in areas that essentially subserve processing of fear, anxiety and threat in patients with pt-DD. It is possible that cortical features of distinct evolutionary and genetic origin, i.e. CT and gyrification, contribute differently to the pathogenesis of pt-DD.
Topics: Adult; Aged; Amygdala; Cerebral Cortex; Female; Gray Matter; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prefrontal Cortex; Schizophrenia, Paranoid; Temporal Lobe
PubMed: 32160619
DOI: 10.1159/000505601 -
Journal Der Deutschen Dermatologischen... Apr 2010Delusional parasitosis (DP) is the most frequent delusional disorder in dermatology. In DP there is a fixed belief of a usually skin-related invasion or infestation by a... (Review)
Review
Delusional parasitosis (DP) is the most frequent delusional disorder in dermatology. In DP there is a fixed belief of a usually skin-related invasion or infestation by a number of alleged infectious species (usually parasites and bacteria), whose identity has varied over the decades. Since 2002 worldwide an increasing number of patients have complained of unverifiable fibers and filaments in or on the skin, associated with numerous nonspecific complaints (arthralgias, altered cognitive function and extreme fatigue). This entity has been named "Morgellons disease" by the patients themselves, although medical evidence for its existence is lacking. As an example, we discuss a 55-year-old woman who complained of Morgellons disease and was treated as if she had DP. Currently the delusional assumption of infestation with Morgellons should be considered as a new type of DP with some kind of inanimate material. We therefore recommend in case of DP including Morgellons the use of the broader term "delusional infestation".
Topics: Female; Humans; Morgellons Disease; Schizophrenia, Paranoid; Skin Diseases, Parasitic; Terminology as Topic
PubMed: 19878403
DOI: 10.1111/j.1610-0387.2009.07219.x