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The Cochrane Database of Systematic... May 2015Delusional disorder is commonly considered to be difficult to treat. Antipsychotic medications are frequently used and there is growing interest in a potential role for... (Review)
Review
BACKGROUND
Delusional disorder is commonly considered to be difficult to treat. Antipsychotic medications are frequently used and there is growing interest in a potential role for psychological therapies such as cognitive behavioural therapy (CBT) in the treatment of delusional disorder.
OBJECTIVES
To evaluate the effectiveness of medication (antipsychotic medication, antidepressants, mood stabilisers) and psychotherapy, in comparison with placebo in delusional disorder.
SEARCH METHODS
We searched the Cochrane Schizophrenia Group's Trials Register (28 February 2012).
SELECTION CRITERIA
Relevant randomised controlled trials (RCTs) investigating treatments in delusional disorder.
DATA COLLECTION AND ANALYSIS
All review authors extracted data independently for the one eligible trial. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis with a fixed-effect model. Where possible, we calculated illustrative comparative risks for primary outcomes. For continuous data, we calculated mean differences (MD), again with a fixed-effect model. We assessed the risk of bias of the included study and used the GRADE approach to rate the quality of the evidence.
MAIN RESULTS
Only one randomised trial met our inclusion criteria, despite our initial search yielding 141 citations. This was a small study, with 17 people completing a trial comparing CBT to an attention placebo (supportive psychotherapy) for people with delusional disorder. Most participants were already taking medication and this was continued during the trial. We were not able to include any randomised trials on medications of any type due to poor data reporting, which left us with no usable data for these trials. For the included study, usable data were limited, risk of bias varied and the numbers involved were small, making interpretation of data difficult. In particular there were no data on outcomes such as global state and behaviour, nor any information on possible adverse effects.A positive effect for CBT was found for social self esteem using the Social Self-Esteem Inventory (1 RCT, n = 17, MD 30.5, CI 7.51 to 53.49, very low quality evidence), however this is only a measure of self worth in social situations and may thus not be well correlated to social function. More people left the study early if they were in the supportive psychotherapy group with 6/12 leaving early compared to 1/6 from the CBT group, but the difference was not significant (1 RCT, n = 17, RR 0.17, CI 0.02 to 1.18, moderate quality evidence). For mental state outcomes the results were skewed making interpretation difficult, especially given the small sample.
AUTHORS' CONCLUSIONS
Despite international recognition of this disorder in psychiatric classification systems such as ICD-10 and DSM-5, there is a paucity of high quality randomised trials on delusional disorder. There is currently insufficient evidence to make evidence-based recommendations for treatments of any type for people with delusional disorder. The limited evidence that we found is not generalisable to the population of people with delusional disorder. Until further evidence is found, it seems reasonable to offer treatments which have efficacy in other psychotic disorders. Further research is needed in this area and could be enhanced in two ways: firstly, by conducting randomised trials specifically for people with delusional disorder and, secondly, by high quality reporting of results for people with delusional disorder who are often recruited into larger studies for people with a variety of psychoses.
Topics: Cognitive Behavioral Therapy; Humans; Psychotherapy; Randomized Controlled Trials as Topic; Schizophrenia, Paranoid; Self Concept
PubMed: 25997589
DOI: 10.1002/14651858.CD009785.pub2 -
Revista Brasileira de Psiquiatria (Sao... 2015To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients. (Review)
Review
OBJECTIVE
To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients.
METHODS
PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia.
RESULTS
The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2%) had at least one comorbid PD. Among them, we found 87 (23.1%) in cluster B, 55 (14.6%) in cluster C, and 25 (6.6%) in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%); histrionic, 29 (7.7%); obsessive-compulsive, 28 (7.4%); dependent, 19 (5%); narcissistic, 17 (4.5%); schizoid, schizotypal, and avoidant, 11 patients each (2.95%); paranoid, five (1.3%); and antisocial, three (0.79%).
CONCLUSION
The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive.
Topics: Comorbidity; Humans; Obsessive-Compulsive Disorder; Personality Disorders
PubMed: 25946399
DOI: 10.1590/1516-4446-2014-1459 -
Actas Espanolas de Psiquiatria 2012Cocaine consumption can induce transient psychotic symptoms expressed as paranoia or hallucinations. This work reviews that evidence and tries to obtain data regarding... (Review)
Review
OBJECTIVES
Cocaine consumption can induce transient psychotic symptoms expressed as paranoia or hallucinations. This work reviews that evidence and tries to obtain data regarding frequency of psychotic symptoms or cocaine induced psychosis (CIP), risks or associated factors.
METHOD
Systematic review of studies found in PubMed database published until January 2011 where cocaine induced paranoia was present.
RESULTS
Cocaine induced paranoia has a particular clinical presentation. It needs to be clearly identified due to its harmful consequences. The prevalence is between 12% in clinical studies and 100% in experimental studies. The following are considered potential risk factors: age of first use and length, amount of substance, route of administration, body mass index, genetic factors, personal vulnerability and comorbidity with AXIS I (psychosis, ADHD) and AXIS II disorders (antisocial personality disorder).
CONCLUSIONS
It is needed to research with larger samples of cocaine users of different countries and contexts, in order to identify and detail what variables are closely related in the development of cocaine induced paranoia, so the population at risk can be treated earlier.
Topics: Cocaine-Related Disorders; Humans; Prevalence; Psychotic Disorders; Risk Factors
PubMed: 22851479
DOI: No ID Found -
The Cochrane Database of Systematic... Jan 2009Chronic amphetamine users may have experience of paranoia and hallucination. It has long been believed that dopamine antagonists, such as chlorpromazine, haloperidol,... (Review)
Review
BACKGROUND
Chronic amphetamine users may have experience of paranoia and hallucination. It has long been believed that dopamine antagonists, such as chlorpromazine, haloperidol, and thioridazine, are effective for the treatment of amphetamine psychosis.
OBJECTIVES
To evaluate risks, benefits, costs of treatments for amphetamine psychosis.
SEARCH STRATEGY
MEDLINE (1966-2007), EMBASE (1980-2007), CINAHL (1982-2007), PsychINFO (1806-2007), CENTRAL (Cochrane Library 2008 issue 1), references of obtained articles.
SELECTION CRITERIA
All randomised controlled and clinical trials (RCTs, CCTs) evaluating treatments (alone or combined) for people with amphetamine psychosis
DATA COLLECTION AND ANALYSIS
Two authors evaluated and extracted the data independently. Dichotomous data were extracted on an intention-to-treat basis in which the dropouts were assigned as participants with the worst outcomes. The Relative Risk (RR) with the 95% confidence interval (95% CI) was used to assess the dichotomous data. The Weighted Mean Difference (WMD) with 95% CI was used to assess the continuous data.
MAIN RESULTS
The comprehensive searches found one randomised controlled trial of treatment for amphetamine psychosis meeting the criteria for considering studies. The study involved 58 participants and compared the efficacy and tolerability of two antipsychotic drugs, olanzapine (a newer antipsychotic) and haloperidol (a commonly used antipsychotic medication used as a control condition), in treating amphetamine-induced psychosis. The results show that both olanzapine and haloperidol at clinically relevant doses were efficacious in resolving psychotic symptoms, with the olanzapine condition showing significantly greater safety and tolerability than the haloperidol control as measured by frequency and severity of extrapyramidal symptoms.
AUTHORS' CONCLUSIONS
Only one RCT of treatment for amphetamine psychosis has been published. Outcomes from this trial indicate that antipsychotic medications effectively reduce symptoms of amphetamine psychosis, the newer generation and more expensive antipsychotic medication, olanzapine, demonstrates significantly better tolerability than the more affordable and commonly used medication, haloperidol.There are other two studies that did not meet the inclusion criteria for this review. The results of these two studies show that agitation and some psychotic symptoms may be abated within an hour after antipsychotic injection.Whether this limited evidence can be applied for amphetamine psychotic patients is not yet known.The medications that should be further investigate are conventional antipsychotics, newer antipsychotics and benzodiazepines. However, naturalistic studies of amphetamine psychotic symptoms and the prevalence of relapse to psychosis in the presence of amphetamine, are also crucial for advising the development of study designs appropriate for further treatment studies of amphetamine psychosis.
Topics: Amphetamine-Related Disorders; Antipsychotic Agents; Benzodiazepines; Haloperidol; Humans; Olanzapine; Psychoses, Substance-Induced
PubMed: 19160215
DOI: 10.1002/14651858.CD003026.pub3 -
Critical Care (London, England) Feb 2006Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome... (Review)
Review
Traditional teaching suggests that corticosteroids should be avoided during acute infectious episodes for fear of compromising the immune response. However, the outcome benefit shown through steroid administration in early septic shock implies this paranoia may be misplaced. We therefore performed a systematic review of the literature to identify the current strength of evidence for the use of corticosteroids in specified infections, and to make appropriate graded recommendations.
Topics: Adrenal Cortex Hormones; Communicable Diseases; Humans; Practice Guidelines as Topic; Randomized Controlled Trials as Topic
PubMed: 16356204
DOI: 10.1186/cc3904 -
BMJ (Clinical Research Ed.) Jul 2001To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy. (Review)
Review
OBJECTIVE
To quantify the antiemetic efficacy and adverse effects of cannabis used for sickness induced by chemotherapy.
DESIGN
Systematic review.
DATA SOURCES
Systematic search (Medline, Embase, Cochrane library, bibliographies), any language, to August 2000.
STUDIES
30 randomised comparisons of cannabis with placebo or antiemetics from which dichotomous data on efficacy and harm were available (1366 patients). Oral nabilone, oral dronabinol (tetrahydrocannabinol), and intramuscular levonantradol were tested. No cannabis was smoked. Follow up lasted 24 hours.
RESULTS
Cannabinoids were more effective antiemetics than prochlorperazine, metoclopramide, chlorpromazine, thiethylperazine, haloperidol, domperidone, or alizapride: relative risk 1.38 (95% confidence interval 1.18 to 1.62), number needed to treat 6 for complete control of nausea; 1.28 (1.08 to 1.51), NNT 8 for complete control of vomiting. Cannabinoids were not more effective in patients receiving very low or very high emetogenic chemotherapy. In crossover trials, patients preferred cannabinoids for future chemotherapy cycles: 2.39 (2.05 to 2.78), NNT 3. Some potentially beneficial side effects occurred more often with cannabinoids: "high" 10.6 (6.86 to 16.5), NNT 3; sedation or drowsiness 1.66 (1.46 to 1.89), NNT 5; euphoria 12.5 (3.00 to 52.1), NNT 7. Harmful side effects also occurred more often with cannabinoids: dizziness 2.97 (2.31 to 3.83), NNT 3; dysphoria or depression 8.06 (3.38 to 19.2), NNT 8; hallucinations 6.10 (2.41 to 15.4), NNT 17; paranoia 8.58 (6.38 to 11.5), NNT 20; and arterial hypotension 2.23 (1.75 to 2.83), NNT 7. Patients given cannabinoids were more likely to withdraw due to side effects 4.67 (3.07 to 7.09), NNT 11.
CONCLUSIONS
In selected patients, the cannabinoids tested in these trials may be useful as mood enhancing adjuvants for controlling chemotherapy related sickness. Potentially serious adverse effects, even when taken short term orally or intramuscularly, are likely to limit their widespread use.
Topics: Antiemetics; Antineoplastic Agents; Cannabinoids; Humans; Nausea; Patient Satisfaction; Randomized Controlled Trials as Topic; Treatment Outcome; Vomiting
PubMed: 11440936
DOI: 10.1136/bmj.323.7303.16