Somatic delusional disorder in a patient with idiopathic normal pressure hydrocephalus

Abstract

Background: The delusional disorder represents one of the most difficult psychiatric disorders in terms of treatment and management because of the beliefs and convictions presented by the patient, the absence of insight and also the treatment-resistance. Of these, the somatic delusion or the hypochondriac delusion represent that situation in which the patient presents the conviction that certain parts of his body doesn`t work properly and that some parts of its have exaggerated or diminished dimensions or they present various unpleasant olfactory and tasteful features. One of the specificities of this disorder is represented by the non-bizarre character of the delusion in contrast to the others bizarre delusions specific to schizophrenia but which the patient supports without a doubt in contrast to the somatoform disorder. (1) Purpose and methods: The purpose of the presentation is to highlight the evolution of such a somatic delusion disorder and the challenges met throughout the diagnosis and investigation processes corroborating the brain changes we found with the prognosis of the current disorder. Description of the case: D.E. is a 64 years old woman presenting in our clinic having in her psychiatric antecedents only one admission until now and which presents a delusion somatic disorder consisting of T8-T10 located vertebral-thoracic hyperalgesia accompanied by depressive mood with anhedonia, high-intensity anxiety and abulia. The patient argues that she suffered a thoracic-lumbar trauma by falling from the same level 8 years ago and since then the somatic complaints appeared. All this time the patient underwent three surgeries located at the vertebra-thoracic level, without a consistent improvement of the symptoms. At the cerebral computerized tomography performed in our clinic is highlighted a normal pressure hydrocephalus. Following psychotropic treatment and various inter-clinical consultations the patient exits our service with an improved affective status and a still maintained but low-intensity somatic delusion. Conclusions: It is necessary that the somatic delusion disorder be strictly differentiated by the somatoform disorder and the major depressive disorder with somatic complaints. Also, the differential diagnosis of the possible somatic etiologies must be taken into account. In this regard the psychiatric interview and the brain changes highlighted paraclinically may be essential in the diagnosis and the future evolution of the psychiatric disorder.