Abstract
Delusional disorder is a difficult-to-treat clinical condition with health needs that are often undertreated. Although individuals with delusional disorder may be high functioning in daily life, they suffer from serious health complaints that may be sex-specific. The main aim of this narrative review is to address these sex-specific health needs and to find ways of integrating their management into service programs. Age is an important issue. Delusional disorder most often first occurs in middle to late adult life, a time that corresponds to menopause in women, and menopausal age correlates with increased development of both somatic and psychological health problems in women. It is associated with a rise in the prevalence of depression and a worsening of prior psychotic symptoms. Importantly, women with delusional disorder show low compliance rates with both psychiatric treatment and with medical/surgical referrals. Intervention at the patient, provider, and systems levels are needed to address these ongoing problems.
Highlights
For several decades, epidemiological studies have consistently reported gender differences in the expression of mental disorders [1]
This study found that cognitive-behavioral therapy (CBT) added to the effectiveness of medication in terms of reducing the strength of conviction and preoccupation with delusional material, increasing insight, and a weakening of the tendency to maintenance and systematization of the delusion
Postmenopausal loss of estrogens leads to an increase in the prevalence of cognitive dysfunction, cerebrovascular events and extrapyramidal effects [22]
Summary
Epidemiological studies have consistently reported gender differences in the expression of mental disorders [1]. The prevalence of some common mental disorders such as mood disorders, anxiety and somatoform disorders are reported to be substantially higher in women than in men while substance use disorders are higher in men [1,2]. Male/female ratios in the frequency and severity of psychiatric problems vary with age [2]. The prevalence of depressive and anxiety disorders remains higher in women than in men, while the number of men with substance use disorders substantially outstrips that of women. In schizophrenia and bipolar disorder, no consistent gender differences in prevalence have been noted [3,4]. Psychotic symptoms, on average, start a few years later in women than in men [6]
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