Delusional Disorder Patients Research Articles

Is the Caudate, Putamen, and Globus Pallidus the Delusional Disorder's Trio? A Texture Analysis Study.

The neurobiological basis of delusional disorder is less explored through neuroimaging techniques than in other psychotic disorders. This study aims to provide information about the neural origins of delusional disorder (DD) by examining the neuroanatomical features of some basal nuclei with magnetic resonance imaging (MRI) texture analysis. Twenty DD patients and 20 healthy individuals were included in the study. Globus pallidus, putamen, and caudate nuclei were selected individually with a region of interest (ROI) on the axial MRI images. The entire texture analysis algorithm applied to all selected ROIs was done with an in-house software. Nuclei on both sides were taken as separate samples. There were no significant differences between groups in terms of age and gender. The average "mean, median and maximum" values of all three nuclei were decreased in DD patients. The small putamen area and the differences detected in different tissue parameters for all three nuclei in delusional disorder patients indicate that they differ in delusional disorder from normal controls (p < 0.05). The differences detected in the texture parameters for all three nuclei indicate that there is something different in the DD from in the normal controls. Neuroimaging studies with larger samples and different techniques in the future may shed light on the etiology of delusional disorder.

Differences in adherence to treatment, relapses and healthcare costs between delusional disorder and paranoid personality disorder

IntroductionLimited information is available regarding the clinical features, optimal treatment and prognosis of Paranoid Personality Disorder (PPD) and Delusional Disorder (DD). This is partly due to the low prevalence of cases and poor patient insight. The difference between DD and PPD has been questioned in the literature, as some studies have described them as a continuum, highlighting the role of specific personality traits in the transition to clinical delusions.Nonadherence to pharmacological treatment is one of the most challenging aspects. This further leads to relapses, increased use of emergency psychiatric services, psychiatric admissions, longer periods of hospitalization, and an increased cost of illness to healthcare systems.ObjectivesThe primary goal of this study is to compare the differences between DD and PPD in terms of medication adherence, relapses, lost to follow-up, and costs. Other aims of this study are to analyze the differences in these variables between patients who are adequately adherent and patients who are notMethodsAn observational, retrospective, and multicenter descriptive epidemiological study was conducted. Patients were selected from four public departments of psychiatry in Madrid, providing an area of roughly one million people. All patients were older than 18 years-old, diagnosed with DD or PPD from 2005 to 2022. Data were extracted from electronic medical records and from electronic prescribing program used in the public health system.The study was approved by the Hospital Fundación Jiménez Díaz Ethics Committee.Results1227 individuals diagnosed with DD (974 patients,79,3%) or PPD (253 patients, 20.61%). 23.81% (232 patients) of the DD-group did not take out the prescribed medication of the pharmacy, and 16.6% (42 patients) of the PPD-group were considered non-adherent.Adherent patients had greater follow-up (4.02 vs 2.89 years) and shorter hospital stays (5.15 vs 8.6 days, p&lt;0.05) compared to non-adherent patients. DD patients doubled the average hospitalization stay compared to the PPD group (6.7 vs 2.96 days, p&lt;0.01).Regarding costs: DD had higher hospitalization costs than PDD (1164 vs 488 euros per year) and higher total costs than PDD (2180 vs 1528 euros per year, p&lt;0.05). The costs were also higher in non-adherent than in adherent patients (2570 vs 1895 euros per year, p&lt;0.05)ConclusionsOur sample of 1227 DD and PPD patients followed from 2005-2022 is, to our knowledge, one of the largest collected to date. We found sociodemographic and clinical differences between the DD and the PPD group. We also found differences between adherent and non-adherent patients, highlighting that non-adherence is associated with longer mean stay of hospitalization and more costs, both hospitalization and total direct healthcare costs. We have also found association between non-adherence and risk of psychotic relapse.Disclosure of InterestNone Declared

Functional and clinical outcomes of delusional disorder and schizophrenia patients after first episode psychosis: a 4-year follow-up study

BackgroundLiterature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years.Methods71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years.ResultsAt four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients.ConclusionsResults indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.

Statistical shape analysis of corpus callosum in delusional disorder.

Neurobiological foundations of delusional disorder (DD) have been studied less with neuroimaging techniques when compared to other psychotic disorders. The present study aimed to delineate the neural substrates of DD by investigating neuroanatomical characteristics of the corpus callosum (CC) with statistical shape analysis (SSA) conducted on magnetic resonance images (MRI). Twenty (female:male=1:1) DSM-5 DD patients and 20 age- and gender-matched healthy individuals were included. High-resolution 3D T1 Turbo Field Echo MRI images were scanned with a 1.5 T MR device. The landmarks that were selected to determine the shape differences in CC were identified based on previous studies. Furthermore, constructed landmarks were determined and employed to better assess regional shape differences. There was no significant difference in the CC area in the mid-sagittal images between the DD patients and controls. However, DD patients exhibited a pattern of structural CC changes in various regions. The study findings emphasizes the variable subregional nature of CC in DD patients. Future SSA studies with larger samples could shed further light on DD etiology, diagnosis, classification and treatment options.

A phenomenological approach to the affective core of Delusional Disorder.

Introduction According to current diagnostic systems, affective symptoms do not represent a fundamental criterion for the diagnosis of DD. However, numerous studies have highlighted frequent comorbidity between DD and Mood Disorders and have elucidated the importance of the affective state in the development and persistence of delusions. Thus, some factor analysis studies have identified the existence of a depressive dimension in DD, suggesting a substantial psychopathological heterogeneity in DD. However, these important affective features have not evaluated from a phenomenological point of view and in their relationship with delusions.ObjectivesThe aim of the present study is to investigate the relationship between personality, trait affectivity and severity of delusions in patients with Delusional Disorder (DD).MethodsThirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (NPI), the Positive and Negative Affect Schedule (PANAS) and the Psychotic Symptom Rating Scale (PSYRATS). Next, we analysed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions.ResultsThe severity of delusions was directly associated with “Grandiose Fantasy” item of narcissistic personality and inversely related with the feelings of shame, fear and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of the delusions, that, in in DD patients, would lie on an affective core of shame.Table 2.Pearson correlation coefficientVARIABLESDRS total scoreGRANDIOSE FANTASYp = 0.045SHAMEp = 0.048GUILTp = 0.016AGITATIONp = 0.049FEARp = 0.041Table 3.Standardized coefficients in linear standard regression (DRS)DRS: total scoreR²βtpStep 10.157---GRANDIOSE FANTASY-0.3961.890.048Step 20.460---GRANDIOSE FANTASY-0.2911.650.116SHAME--0.560-3.170.005ConclusionsThe severity of delusional beliefs in DD patients would lie on an affective core of shame upon predisposing personality traits. These findings could help to develop a psychotherapeutic approach for delusional patients focused in the feeling of shame.Disclosure of InterestNone Declared

The impact of the COVID-19 pandemic on health outcomes in delusional disorder: A systematic review

Introduction The health impact of the COVID-19 pandemic has been widely recognized in both physical and mental health. Relatively little attention has been paid to patients with delusional disorder (DD).ObjectivesOur goal was to synthesize the known mental and physical health consequences of the COVID-19 pandemic in patients diagnosed with DD.MethodsA systematic review was carried out using the PubMed and Scopus database (2019-October 2022) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Search terms: “delusional disorder” or “delusional disorder” AND “COVID-19 OR SARS-CoV2.” Inclusion criteria: 1)DD according to DSM/ICD, 2)languages: English, French, German and Spanish, 3)studies reporting health consequences of COVID-19 pandemic. From a total of 615 records, 6 were included: meta-analysis (n=1), cross-sectional studies (n=2), retrospective study (n=1), case reports (n=2).ResultsA full third of patients with psychosis (including DD) presented with increased psychiatric symptom severity, reportedly activated by increased daily life stress. Suicidal behavior was reported in a previously undiagnosed DD patient in association with a worsening clinical picture. Perhaps surprisingly, admissions for DD in 2020 were lower than in 2019. The duration of hospitalization was, however, longer. There was a report of new onset DD with delusional material centred on COVID. There was also a report of COVID-19 symptoms being more severe in DD patients than in the larger community.ConclusionsHealth emergencies affect the seriously mentally ill more than other community members. Awareness and outreach can help to maintain treatment adherence and minimize risk of psychotic exacerbation.Disclosure of InterestNone Declared

New insights into cerebellar dysfunction in patients with delusional disorder: A systematic review

IntroductionThe cerebellum has been implicated in cognitive, affective and motor functions, including emotion regulation, executive control and sensorimotor processing. In schizophrenia, cerebellar dysfunction has been associated with treatment resistance and clinical features. However, few studies have been focused on delusional disorder (DD).ObjectivesOur main purpose was to review the evidence available on cerebellum abnormalities and dysfunctions in patients with DD.MethodsA systematic review was conducted through PubMed, Scopus and ClinicalTrials.gov (inception-June 2022) according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) directives. The following search terms were used: cerebellum OR cerebellar AND (“delusional disorder” AND paranoia). Reference lists from included studies were hand-checked to find other potential relevant papers.ResultsSix studies were included from a total of 119 retrieved records (PubMed: 52, Scopus: 66, ClinicalTrials.gov: 1). Study 1:Patients with DD somatic type (n=14) presented a decreased gray matter volume in cerebellar lobules compared to healthy controls (HC) (n=32, left lobule VIIIa) and non-somatic DD (n=18, lobule V). Cerebellar volumes did not seem to differ between HC and non-somatic DD. Study 2:Abnormalities of voluntary saccadic eye movements, linking frontal and cerebellar functions, were found in DD patients (n=34) compared to HC (n=40). Study 3: Abnormal smooth pursuit eye movements in DD (n=15) compared with HC (n=40) and similar to schizophrenia (n=40). Case reports (n=3): DD associated with Dandy-Walker variant (partial vermian hypoplasia), unruptured intracerebral aneurysm of basilar artery, and megacisterna magna.ConclusionsCerebellar deficits in patients with DD has been reported, particularly in those presenting somatic delusional contents.Disclosure of InterestNone Declared

Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders.

Background: There is increasing evidence that individuals with psychosis are at increased risk for cardiovascular disease, diabetes, metabolic syndrome, and several other medical comorbidities. In delusional disorder (DD), this is particularly so because of the relatively late onset age. Aims: The aim of this narrative review is to synthesize the literature on the necessity for medical collaboration between psychiatrists and other specialists. Methods: A non-systematic narrative review was carried out of papers addressing referrals and cooperation among specialists in the care of DD patients. Results: Psychiatrists, the primary care providers for DD patients, depend on neurology to assess cognitive defects and rule out organic sources of delusions. Neurologists rely on psychiatry to help with patient adherence to treatment and the management of psychotropic drug side effects. Psychiatrists require ophthalmology/otolaryngology to treat sensory deficits that often precede delusions; reciprocally, psychiatric consults can help in instances of functional sensory impairment. Close collaboration with dermatologists is essential for treating delusional parasitosis and dysmorphophobia to ensure timely referrals to psychiatry. Conclusions: This review offers many other examples from the literature of the extent of overlap among medical specialties in the evaluation and effective treatment of DD. Optimal patient care requires close collaboration among specialties.

Striatal dopamine synthesis capacity and its association with negative symptoms upon resolution of positive symptoms in first-episode schizophrenia and delusional disorder.

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. A longitudinal study was conducted to examine whether baseline striatal DSC would be related to negative symptoms at 3months in first-episode SZ and DD patients. 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 3months. All patients received an 18F-DOPA PET/MR scan at baseline. Baseline striatal DSC (Kocc;30-60) was inversely associated with negative symptoms at 3months in first-episode SZ patients (rs = - 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 3months was associated with more positive symptoms in DD patients (rs = 0.74, p = 0.010) and not in SZ patients. 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.

Comparison of the sociodemographic, clinical and offense-related data of delusional disorder patients with and without a criminal history

This study investigates the relationship of delusional disorder and its subtypes to criminal and violent behavior by comparing the sociodemographic and clinical characteristics of patients with and without a criminal history and identifying predictors of crime. The records of 346 patients with a delusional disorder diagnosis were retrospectively evaluated using a sociodemographic data form, a crime violence rating scale and the Overt Aggression Scale (OAS). The results show that homicide and attempted homicide were committed more frequently by patients with jealous delusions, whereas verbal assault and crimes against the public were committed more frequently by patients with persecutory and other delusions. Patients with a criminal history had more hospital admissions and longer stays. Marital status, persecutory delusions, a high OAS score and older age were found to be associated with higher risk of crime. Clinical subtypes and sociodemographic characteristics seem to discriminate delusional disorder patients’ risk of crime.

Impact of day hospital care on adherence to psychiatric follow-up appointments and medications in patients with delusional disorder

IntroductionDay care programs have been extensively used to treat people with acute psychiatric disorders. Day hospitals (DH) can act as an alternative to admission in patients with acute symptoms, shorten the duration of admission, be useful for rehabilitation and maintenance care or enhance treatment in patients with poor adherence to outpatient care. Few research has been conducted in delusional disorder (DD).ObjectivesTo investigate whether DH care increases adherence with psychiatric appointments in patients with DD. To describe functions of partial hospitalization in DD.MethodsComparative study including DD patients who attended a DH (Group 1:n=12) versus patients who did not receive DH care (Group 2;n=7). Patients attending DH were classified into 3 groups according to the program function at referral. Adherence with outpatient follow-up appointments (primary outcome) and pharmacy refill data (secondary outcome) were assessed after discharge over a 6-month period (DH) and compared with group 2. For statistical analyses, non-parametric tests were performed.ResultsProgram function (DH): alternative to admission (n=4); shortening of admission (n=5) and enhancing outpatient treatment (n=3). Patients receiving DH care were more frequently referred from the inpatient unit or emergency department compared to those who did not attend DH (commonly referred from primary care services). No statistically significant differences were found between both groups in adherence to psychiatric appointments. Patients who attended DH showed higher compliance with antipsychotics (89.29% vs.72.62, p&lt;0.05).ConclusionsDH care may be a useful alternative to increase adherence with antipsychotics in DD patients with poor awareness of illness.Conflict of interestAGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

Follow-up of patients with delusional disorder in a specialized outpatient clinic over a 2-year period

IntroductionIn order to prevent relapse and increase medication adherence, primary care physicians and psychiatric inpatient units should consider referring patients with delusional disorder (DD) to specialized outpatient clinics for treatment and follow-up.ObjectivesThis poster describes a sample of DD patients referred to a specialized unit for DD and documents rates of follow-up care.MethodsOver a 2-year period, 29 individuals were consecutively referred to the Parc Tauli -Delusional Syndrome Working Group, which provides treatment and clinical care for patients with delusional disorders for a catchment area of nearly 450.000 inhabitants in Sabadell (Barcelona, Spain). Criteria for inclusion in the program are relatively flexible. Referred patients are evaluated at baseline and at 6 months following their first appointment. Treatment and case management are offered by a multidisciplinary team consisting of psychiatric, nursing, and social work personnel. Psychological interventions are also offered.ResultsOf the 29 persons initially referred, 27 attended at least one scheduled appointment. Twenty-one out of the 27 patients received a confirmed diagnosis of DD (14 women,7 men), 2 suffered from schizophrenia and 4 were diagnosed with other psychiatric disorders and referred to other programs: primary care (n=2), affective program (n=1) and addictions unit (n=1). A breakdown of DD subtypes follows: persecutory (n=10,47.6%), jealous (n=4,19%), somatic (n=5,23.81%), mixed (n=2,9.5%). Three patients with DD (14.3%) were lost to follow-up. Attendance rates of the 21 DD patients: 80.4% (Women:77.67%, Men:100%).ConclusionsFor a traditionally difficult-to-engage population, adherence to multidisciplinary clinic appointments was relatively high. Loss to follow-up was lower than would have been expected.Conflict of interestAGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

A systematic review of cognition and functionality in delusional disorder

IntroductionCurrent definitions for delusional disorder (DD) state that no cognitive or functional impairment is present. However, this assumption lacks empirical validation and has been questioned by numerous authors over the years. Through systematic search we collected articles that compare patients with DD with either healthy controls or patients with schizophrenia on the basis of their cognitive symptoms and their functional outcomes.ObjectivesOur aim is to draw conclusions from the available evidence on neurocognitive and functional affectation of DD.MethodsSystematic electronic search was performed using Pubmed and Embase databases. Inclusion criteria included that selected articles must be original studies, must be published in peer-reviewed journals, must contain a sample of DD patients that is compared with a sample of healthy controls and/or patients with schizophrenia and that samples must be compared on the basis of cognitive and/or functionality parameters. A qualitative synthesis was performed due to heterogeneity in data.ResultsAccording to the information collected through our systematic review, DD patients tend to perform worse than healthy control in tests assessing cognitive functions. Results are not as conclusive regarding comparison between DD and schizophrenia, with mixed outcomes. When it comes to functionality, results are not conclusive either, with some degree of evidence pointing towards a better functioning in patients with DD in comparison to patients with schizophrenia.ConclusionsResults agree with many authors who consider both conditions as part of a psychosis spectrum. Cognitive interventions, such as cognitive remediation, must be studied for their potential role in the treatment of patients with DD.

Are anxiety disorders a prelude to delusional disorder? A systematic review

IntroductionPrevalence rates of panic attacks have been reported to be around 24-63% in psychotic patients. Common underlying biological substrates for panic and paranoia have been proposed, suggesting that delusional disorder (DD) may be preceded by the development of anxiety disorders.ObjectivesThe main objective of this study was to investigate anxiety comorbidity in DD. As a second objective, we set ourselves to know prescription rates for the use of antidepressants and benzodiazepines in anxiety disorders in the context of DD.MethodsA systematic literature search was performed using PubMed (1980- September 2020) according to the PRISMA guidelines. The following search terms were used: (delusional disorder) AND (anxiety OR anxiety disorder OR anxi*). Research studies and case reports were included if they met the following criteria: DD diagnosis (DSM, ICD), publication in peer-review journal and investigations containing information on anxiety comorbidity in DD.ResultsFour studies fulfilled our criteria, including 155 patients: 65 (42%) women, mean age 42.7 years (SD:14.96). Thirty-three of the 155 patients (21.29%) presented at least one comorbid anxiety disorder: 14 specific phobias, 9 panic attacks, 5 social phobias and 2 agoraphobias. Treatment was not reported for many patients (n= 28). Four patients received fluoxetine and 1 patient benzodiazepines. All of them showed partial improvement of symptoms.ConclusionsLess than a third of DD patients showed an anxiety disorder. The effectiveness of antidepressant and benzodiazepine treatment has been poorly described. Future studies may be focused on the investigation of preceding comorbid anxiety disorders in patients with DD.

Clinical profile of delusional disorder and its subtypes: a descriptive study from Turkey.

The fact that delusional disorder (DD) received minimal research attention indicates the need for descriptive studies that will better delineate the clinical and socio-demographic characteristics of DD. We conducted a chart review descriptive study in a tertiary hospital from Turkey. A total of 99 cases of DD were identified through hospital registry system. 57 were male (57.6%), and mean age at first admission was 49.34±13.49. The most common type of DD was persecutory (36.4%), followed by jealous type (28.3%), mixed type (18.2%), and somatic type (16.2%). Jealous type DD patients were more likely to be married, and mixed type DD patients were more likely to be divorced. The presence of hallucinations was significantly associated with history of hospitalization. About one-tenth of the patients had a family history of psychotic spectrum disorder. Comorbid depressive disorder was present in 42.9% of the patients, whereas only 9.2% had comorbid anxiety disorder. Depressive disorder comorbidity in DD seems to be associated with continued treatment for longer periods of time in psychiatry services. While most of our data were comparable with the literature on DD, our divergent findings like higher rates of male patients and jealous type of the disorder might be attributed to the cultural and geographical factors. This situation points out that future research with larger populations and from different regions would contribute to better understanding of clinical and socio-demographical characteristics of delusional disorder.

T208. EFFECTIVENESS OF PHARMACOLOGICAL THERAPIES FOR DELUSIONAL DISORDER

BackgroundVery little is known about the effectiveness of pharmacotherapies for delusional disorders.MethodsWe aimed to study the comparative effectiveness of pharmacological agents for delusional disorder using Swedish national registries to observe a national cohort of patients with delusional disorder (n = 9,076). We studied the risk of hospitalization due to psychosis and work disability among all patients who had received a diagnosis of delusional disorder (ICD-10: F22, equates to DSM-V: 297.1) in Sweden during the years 2005 – 2016 in either inpatient or specialized outpatient care (N=9,076; 53.3% men, mean age 44.1 years [std 12.5 years], mean follow-up time 4.9 years) using prospectively gathered nationwide databases for specialized outpatient care, hospitalization, work disability (sickness absence and disability pension) and dispensed medications. Persons with previous diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder (F20, F25, F30-31) were excluded and the follow-up censored if any study subject received any of these diagnoses during follow up. Individuals with a hospitalization due to psychosis during the follow-up period (n = 2074) were analyzed for rehospitalization risk. Patients not already on disability pension at start of follow-up (n = 5025) were analyzed for risk of work disability. The primary analysis was a within-individual Cox proportional hazards model in order to eliminate selection bias. Analyses were adjusted for the effects of time since cohort entry, order of treatments, and current use of other treatments. Long-acting injectables were pooled into a single therapeutic group. Results are reported as hazard ratios (HRs) with 95 % confidence intervals (95% CI).ResultsIn comparison between use and no use among specific pharmacological agents reaching statistical significance, use of clozapine (HR 0.24, 95% CI 0.07–0.77, p = 0.016), any long-acting injectable (HR 0.28, 95% CI 0.16–0.49, p < 0.0001), olanzapine (HR 0.36, 95% CI 0.20–0.67, p = 0.001) or polytherapy with any two or more antipsychotics (0.53, 95% CI 0.34–0.83, p = 0.005) was associated with a reduced risk of hospitalization due to psychosis. Almost half (n= 4051, 45%) of the patients were already on disability pension at the time of cohort entry. Among those who were not, in comparison between use and no use among specific pharmacological agents reaching statistical significance, use of clozapine (HR 0.04, 95% CI 0.01–0.23, p = 0.0004), any LAI (HR 0.33, 95% CI 0.14–0.82, p = 0.017), antipsychotic polytherapy (HR 0.47, 95% CI 0.28–0.79, p = 0.004), aripiprazole (HR 0.49, 95% CI 0.29–0.83, p = 0.009) or risperidone (HR 0.55, 95% CI 0.36–0.86, p = 0.031) was associated with a decreased risk of work disability.DiscussionAlthough delusional disorder has been thought to be a disorder affecting mainly the dopaminergic system, use of clozapine was associated with a reduced risk of hospitalization due to psychosis and work disability in this cohort of Swedish patients with delusional disorder. Also long-acting injectables were associated with a reduced risk of hospitalization due to psychosis, which might be due to better adherence and more regular follow ups required by the injectables being only administered by healthcare staff. Nevertheless, these results indicate that clozapine and long-acting injectables might be effective in the treatment of delusional disorder patients at high risk for work disability or hospitalization due to psychosis.

P.405 Assessment of white matter abnormalities in delusional disorder patients

P.405 Assessment of white matter abnormalities in delusional disorder patients

Clinical and Demographical Profiles of the Patients with Delusional Disorder: a Retrospective Study

Objective: We aimed to investigate demographic, environmental, psychosocial and clinical characteristics in a group of patients with delusional disorder (DD).Method: In a retrospective descriptive study design, cases with DD registered at Psychiatry Clinic of Xxxxxxx XxxxxxxResearch Hospital was conducted. We obtained a sample of 320 DD patients who met the inclusion criteria according to DSM-IV. Socio-demographic and general data, risk factors, clinical picture and diagnosis were collected.Results: Proportion of males versus females was of 1.12. Only 31.25% of patients were illiterate. Of the patients, 56.56% were married and about half of them shared home. About 16,9% of patients had a past history of alcohol consumption, and 2,3% consumed other drugs. The most frequent subtype with the persecutory with 158 cases (49.38%). Ideas of reference and of persecution were found in 83.75% and 81.88% respectively.Conclusions: We found a male preponderance and persecutory subtype with the mean age at onset in the fourth decade in our DD sample. Education level was moderate and low in most of the patients. Reference and persecutory ideation and auditive hallucinations were the most prevalent delusional symptomatology in patients groups.

Short-term outcome of first episode delusional disorder in an early intervention population

BackgroundPrevious evidence suggests that delusional disorder has a later onset and better functional outcomes compared to schizophrenia. However, studies have not examined longitudinal outcomes in a first episode population, where confounding factors may be adjusted for. MethodsA nested case control study was designed within the National EDEN study; a cohort of 1027 first episode psychosis patients. Patients with a baseline diagnosis of delusional disorder (n = 48) were compared with schizophrenia (n = 262) at 6 and 12 months with respect to symptomatic and functional outcomes. Regression analysis was used to adjust for possible confounders. ResultsDelusional disorder patients had a shorter duration of untreated psychosis compared to schizophrenia but were similar in other baseline characteristics. At baseline, delusional disorder patients had lower symptom scores but higher function scores compared to those with schizophrenia. At 12 months the differences persisted for symptoms scores but not overall function scores. After adjusting for baseline score, age and duration of untreated psychosis, differences between the groups remained significant only for Positive and Negative Syndrome Scale (PANNS) negative, general and total scores and recovery rates. There were no differences in changes in outcomes scores. ConclusionsDelusional disorder in a first episode psychosis population presents with less severe symptoms, higher recovery rates and better functioning than schizophrenia, but at 12 months differences are ameliorated when adjusting for baseline differences.

F229. THE BIOLOGICAL UNDERPINNINGS OF TREATMENT RESPONSE IN DELUSIONAL DISORDER: A SYSTEMATIC REVIEW OF QUALITATIVE EVIDENCE-TO-DATE

BackgroundThe dopamine hypothesis of schizophrenia has been extensively proposed as a neurobiological mechanism that explains the relationship between schizophrenic symptoms and hyperdopaminergic states. This hypothesis is supported by direct and indirect evidence, and it mainly postulates that antipsychotics act blocking dopamine receptors. When focusing on delusional disorder patients, especially delusional disorder somatic type, a great effort towards the search for a biological basis of treatment response has been recently demonstrated. Thus, the main goal of this systematic review was to examine the evidence explaining the biological underpinnings of treatment response in delusional disorder.MethodsA systematic review was performed using Pubmed, Scopus and PsycINFO databases (from 1990 to October 2017), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The following search terms were used: [(‘treat*’ OR ‘therap*’ OR ‘biol*’) AND (‘delusional disorder’)]. This systematic computerized search was completed by additional studies hand-checked through reference lists from the included studies and review articles. Studies were only included if the met our inclusion criteria: (a) the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis for delusional disorder, (b) be published in peer-reviewed journals, (c) in English, German or Spanish, (d) and reporting a hypothesis for the biological basis of treatment response in delusional disorder, irrespective of method and study design. Exclusion criteria were: (a) studies including organic delusional disorder or (b) somatic delusions secondary to other psychiatric diagnoses. The literature search strategy, data extraction and synthesis was conducted independently by two authors (A.G.R, F.E.). When disagreement, it was solved by consensus.ResultsA total of 59 articles were identified, of which 12 met our inclusion criteria. Four hypotheses were addressed: (1) Dopaminergic dysfunction (n=4): ziprasidone-induced supersensitivity psychosis by chronic blockade of D2 Dopamine Receptor (DRD2) (n=1); pretreatment levels of plasma homovallinic acid (pHVA) (n=1); dopamine transporter (DAT) dysfunction (n=1) and effectiveness of aripiprazole (DRD2 agonist) (n=1). (2) Serotonergic dysfunction (n=6): drug occupancy in 5-HT1A and 5-HT2A receptors (n=3) and efficacy of 5-HT2 antagonists (n=3). Brain dysfunction (n=7): hypoperfusion in cerebral blood flow in temporal and parietal lobes, left side (n=5), right side (n=1) and lack of basal ganglia and subcortical gray matter lesions (n=1). Genetic evidence (n=1): implications of DRD2 Ser311Cys, DRD3 Ser9Gly and TH VNTR polymorphisms.DiscussionThe strongests biological contributors for treatment response in delusional disorder seem to be those implicating monoaminergic systems, particularly dopamine and serotonergic neurotransmitters. Although the low level of evidence, the serotonergic dysfunction may be associated with response rates, especially in delusional disorder somatic type. The link between genetic variants of dopamine receptors and neuroimaging findings in delusional disorder may open new avenues for the search of the biological underpinnings of treatment response. The evidence for an integrated model involving dopamine and serotonin systems bears further investigations.