Diagnosis Of Delusional Disorder Research Articles

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

To the problem of somatic-hypochondriac paranoia

To unite within the framework of a single clinical entity (based on the model of hypochondriacal paranoia) phenomena of the somatopsychotic and hypochondriacal range, which, in accordance with modern systematics, are classified as various categories of psychosomatic, affective disorders and personality disorders. The sample for analysis consisted of 29 patients (with the diagnosis of delusional disorder (ICD-10; F22.0 in ICD-10), 10 men (34.5%) and 19 women (64.5%), the average age was 42.9±19.9 years; men - 10 nab. (34.5%), women - 19 nab. (64.5%). The average duration of the disease iswas 9.4±8.5 years. The psychopathological method was used as the main one. The article forms an alternative concept of somatic paranoia based on the model of hypochondriacal paranoia. The fundamental difference between the construct of somatic paranoia is an obligate connection between somatopsychic and ideational disorders. Somatopsychic (coenesthesiopathic) symptoms do not exist as an independent (equivalent to the structure of somatic clinical syndromes) dimensions and are formed exclusively with the participation of ideational phenomena. In accordance with the presented concept, coenesthesiopathic symptoms within the framework of somatic paranoia act as a somatic equivalent of delusional disorders.

Clinical Factors Associated with Violence Behavior in Persons with Schizophrenia Spectrum Disorders: A Case Control Study

IntroductionStudy of clinical risk factors of violent behavior in persons with schizophrenia still remains actual in research literature. This is especially important for Georgia as ongoing mental health reform aims to shift from institutional care to community based services, which in turn requires better understanmding and management of risk of aggressive behavior in the community.ObjectivesTo study clinical risk factors for violence in persons with schizophrenia spectrum disorders (SSD) who have committed a violent act in the past and in persons with SSD who have not committed a violent act.MethodsThe survey design was retrospective case-control study. Case-control groups were defined according to the outcome (violent act in the past). We studied the impact of clinical symptoms on each person using standardized scales for assessment of the positive and negative symptoms and global level of functioning. Data were collected through patient interviews and medical records.ResultsStudy results showed that diagnosis of delusional disorder and ideas of persecution were associated with increased risk of violence (28.7% cases versus 7.5% controls); Hallucinations if presented were less severe compared with controls (2.1% vs. 7.5%). Negative symptoms were marked in cases but more severe in controls. Of cases 43,6% showed serious impairment of global functioning (vs 25,5% controls).ConclusionsStudy findings confirmed that a focus on improving controllable clinical factors, including global level of functioning, might help to prevent aggressive behavior. It is discussed that developments and implementation needs-specific services to reduce risk of violence behavior should be prioritized by mental health national strategy plan.DisclosureNo significant relationships.

Voyages pathologiques : actualités du concept et caractérisation d’une cohorte dans un service d’urgences psychiatriques

ObjectivesPathological Journey or Pathological Trip is a concept often used but defined imprecisely in the recent scientific literature and usual classifications. After a brief history of this concept, appeared in France in the 19th century [5], we suggest a definition to differentiate pathological journey from other clinic entities, such as fugue or wandering. The pathological journey would be a departure to a specific destination, induced by delusional ideas or by a state of disorganization. MethodsWe led a retrospective study from patients in the biggest French psychiatric emergencies unit, in Paris, admitted for a pathological journey in 2019. Socio-demographics data (gender, age, professional activity, financial resources, place of life, marital status, family and friendly entourage), medical history, clinical features (such as delusional or suicidal ideas, hallucinations, diagnostic hypothesis), trip characteristics (such as place of departure, final wanted destination, duration of the trip) and orientation at the end of the consultation (hospitalization or not) have been notified. A comparative study between patients according to the reason of departure (to run away from something or to look for something) has been led too. ResultsA total of 217 patients are included. Men are majority, with an average age of 40 years, with psychiatric history (89%) and diagnosis of delusional disorder (F20-29 according to the ICD-10, 87%) or mood disorder (10%). They are still followed by a psychiatrist and still take their medication for the most part. They often haven’t hotel or other place to live at the destination or during the trip (62%) and the trip has often begin recently, less than 10 days for 75%. 95% of patients require an hospitalization, without the patient consent in the most part, and only 5% needed a physical restraint in the unit. The comparative study between patients by the reason of departure finds no significant result. DiscussionWe don’t find here specific characteristics by the motivation of departure, but these patients are often homeless and without ressources during the pathological trip. A particular care of these vulnerable and at-risk patients should be accentuated by the care teams and physicians. Complementary studies are necessary to identify specific characteristics and to improve the patient care management, and maybe to avoid departures of these vulnerable patients in the future. ConclusionsPathological trip is a still-used concept, described for more a century, and is frequently observed in general and psychiatric emergencies units. Its definition is not precise and is not mentioned by the actual references (ICD-10, DSM-5), and it could make the identification of this behavior more difficult. These units are often the first to meet and identify this behavior and to guide to offer adequate care to these vulnerable patients.

CLINICAL AND SOCIAL FACTORS ASSOCIATED WITH VIOLENT BEHAVIOR IN PERSONS WITH SCHIZOPHRENIA SPECTRUM DISORDERS

Study of the relationship between mental disorder and violent behavior is critical both from a public health perspective and for the proper planning and development of mental health services.However, the complex contribution of clinical, historical and environmental risk factors for violence in persons with schizophrenia remains unclear. The aim of the study was to identify clinical and social risk factors for violence in patients with schizophrenia and schizophrenia spectrum disorders (SSD) using a case-control design. Cases were defined as patients with SSD who had committed at least one act of offence in the past (94 patients wereenrolled from forensic psychiatricward). Controls were genderand age matched patients with SSD who had never committed violent acts (106 patients from general psychiatric services).A standard set of instruments was used to assess patients exposure to a variety of risk factors. Data were collected through patient interviews and medical records.Study results showed, that increased risk of violence was associated with severity of positive psychotic symptoms, diagnosis of delusional disorder, irregular or no contacts with mental health services. Significant risk factors for serious violent acts were associated with comorbid alcohol misuse, impulsivity,persecutory delusions,decreased emotional responseand unsatisfactory living environment. Study confirmed that the interaction of social andclinicalfactorswith treatment related factors played an important role as determinants of violence. These factors should be the focus of treatment and management of patients with SSD to prevent violent behavior.

Comparison of hospitalizations in patients on first generation versus second generation long acting injectable (LAI) antipsychotics

AimsThere is limited data on the comparison of efficacy between first and second antipsychotic LAIs. One good indicator of efficacy is the rates of hospitalization. Some studies have shown that second generation depot antipsychotics, significantly reduce hospitalizations as compared to conventional depots.Our aim was to compare hospitalizations in patients on first and second generation LAI antipsychotics.MethodA retrospective observational study was done by reviewing the records of all the depot clinics in South Essex, United Kingdom. A list of patients enrolled and receiving LAI antipsychotics was obtained from the 6 depot clinics. Data were collected by going through the electronic records of the patients on the depot clinic lists and taking down the demographics, diagnosis and the hospital admissions. Other variables like comorbid drug abuse were also recorded.ResultAmongst a total of 346 patients 223 (64 %) were males and 123 (36%) were females. Average age was 50.3 (range 21 to 88 years) and 290 (83%) patients were single. An overwhelming majority of patients 299 (87 %) were not in employment. Regarding the diagnosis, the majority, 237 patients were diagnosed with Paranoid Schizophrenia, 49 patients were diagnosed with Schizoaffective disorder, 38 patients were diagnosed with Bipolar affective disorder, 20 patients had a diagnosis of Delusional disorder and only 2 patients had a primary diagnosis of Mental and Behavioral disorders due to substance abuse. Of the total 346 only 17 patients were on a Community treatment Order.Risperidone was the most commonly used second generation LAI at 26%,Aripiprazole in 10% and Paliperidone was used in 5% patients. Olanzapine LAI was only used in 2 patients. Amongst first generation LAIs Zuclopenthixol, Fluclopentixol were both used in 24%, and Haloperidol in 10% patients. 21 % of patients were reported to be actively abusing drugs.65 (32.6%) of the total 200 patients on Ist Generation LAIs had hospital admissions55 (39.8%) of the total 138 patients on 2nd Generation LAIs had hospital admissionsThis difference was not statistically significant (Z test)- P value of 0.082427ConclusionThe results in our observational study are equivocal, both LAIs providing equitable decrease in the hospital admissions albeit with a slightly favourable outcome (not statistically significant though) attributable to the first generation LAIs. There was a high incidence of unemployment and drug abuse in our cohort of patients, thus targeted interventions can be established in rehabilitation of such individuals.

Adherence to treatment in patients with delusional disorder - study of acute inpatient population in psychiatry ward between 2007-2017

IntroductionDelusional disorder is a mental illness in which delusions are the dominant symptom. Delusional disorder is not well studied relative to other psychotic disorders - it is poorly understood in practically every aspect of its nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis.ObjectivesTo study the clinical and sociodemographic characteristics of individuals admitted for inpatient treatment with the diagnosis of delusional disorder, in particular the adherence to treatment.MethodsRetrospective observational study of inpatient treatment of patients with delusional disorder diagnosis between january 1st2007 and 31th december of 2017 in the Psychiatry Service of CHUSJ. Follow up of 2 years from discharge. Data collected included sociodemographic characteristics and clinical features. Descriptive analysis of the results was performed using SPSS (v.26).ResultsIn the period of time analyzed, 152 hospitalizations were identified, corresponding to 114 patients: 38.2% male and 62.8% female. The average age was 58 years. 3 months after discharge: 65% of patients were going to the medical appointments, which dropped to 60% in 6 months, 55% in 12 months, 53% in 12 and 24 months. Regarding adherence to the treatment: 65% of patients were still adherent to medication in 3 months time, 55% in 6 months, dropping to 50% in a year and to 48% in 2 years. There is a relation between involuntary discharge and adherence to consultations and medication.ConclusionsA cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship.

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.

Pacjent z rozpoznaniem organicznych zaburzeń urojeniowych z odczynem depresyjnym — podejście interdyscyplinarne oraz postępowanie w przypadku dodatniego wyniku COVID-19

In this paper we share clinical observations and insights regarding the management and treatment of an uncooperative patient requiring an interdisciplinary approach due to diagnosis of delusional disorder, depressive symptoms, alcohol dependence syndrome, numerous complaints related to concomitant somatic diseases, and coronavirus infection (COVID-19). Our aim was to highlight the significance of a holistic approach to the patient, and scrupulous documentation of existing somatic diseases in psychiatric hospital discharge summary reports. Due to the common lack of compliance on the part of psychiatric patients, it proves utterly important to establish cooperation between healthcare providers and families of the mentally ill. Coronavirus infection (COVID-19) becomes another, additional complication in the management of psychiatric inpatients. We believe that the discussed interdisciplinary approach, together with increased family or institutional supervision can contribute to the improvement of psychiatric patients’ physical and mental health status as well as general functioning.

S80. CHILDHOOD TRAUMA AND SOCIAL COGNITION IN DELUSIONAL PSYCHOSES

BackgroundDeficits in social cognition could be involved in the pathogenesis of delusions in psychotic disorders (Bentall et al., 2009). Childhood trauma (CT) has been associated with an increased risk for psychosis (Varese et al., 2012). Neurocognitive and social cognition deficits could mediate in the association between CT and psychosis (Mansueto et al., 2019). Social cognition and childhood trauma have been understudied so far in delusional disorder (DD). We aimed to assess social cognition in a sample of patients with delusional psychoses (i.e., DD and schizophrenia) and healthy controls (HC) and to explore the potential effect of childhood trauma on social cognition and delusion.MethodsThis cross-sectional, transdiagnostic study included 69 patients with a DSM-IV-TR-confirmed diagnosis of DD (mean age 44.06 ± 11.39 years, 53.6% female), 77 with DSM-IV-TR-confirmed schizophrenia (mean age 38.12 ± 9.27 years, 27.3% female), and 63 HC (mean age 43.6 ± 13.0 years, 68.3% female). Attributional bias was assessed with the “Internal, Personal, and Situational Attributions Questionnaire.” Theory of Mind (ToM) performance was assessed with the “Reading the Mind in the Eyes Test” and the “Faux Pas Recognition Test.” Childhood trauma was measured with the “Childhood Trauma Questionnaire.” Neuropsychological functioning was measured with a comprehensive battery assessing attention, verbal learning, working memory, and executive function. We used ANCOVAs and linear regression analyses to assess the association between the three measures of social cognition and i) diagnosis, ii) dimensional measures of delusion proneness (Peters Delusion Inventory, PDI) and intensity (Maudsley Assessment of Delusion Schedule, MADS), and iii) childhood trauma; after controlling for potential confounders (age, sex, socioeconomic status, and estimated premorbid intelligence quotient).ResultsPatients with DD showed significantly poorer performance on the “Eyes Test” than HC (Cohen’s d=-0.44, p=0.037), after controlling for potential confounding variables. The difference was no longer significant after controlling for verbal memory. Patients with schizophrenia (d=-1.54, p<0.001) and DD (Cohen’s d=-0.60, p=0.002) showed significantly poorer performance than HC on the “Faux Pas Test,” after controlling for potential confounders. The difference between patients with schizophrenia and HC remained significant after controlling for neuropsychological functioning (Cohen’s d=-1.09, p<0.001), while differences between patients with DD and HC were no longer significant after controlling for executive function and working memory performance (Cohen’s d=-0.23, p=0.596). No significant differences were found between diagnostic groups in externalizing or personalizing attributional bias. In the fully adjusted models, intensity of the delusional idea was significantly associated with performance in the “Faux Pas Test” in DD, and with externalizing and personalizing attributional bias in schizophrenia. A positive history of CT was significantly associated with lower performance on the “Faux Pas Test” (Cohen’s d=-0.40, p=.022) and higher delusional proneness scores in the delusional psychosis samples (Cohen’s d=-0.49, p=.006), but not in HC.DiscussionSocial cognition deficits are associated with delusional intensity in delusional psychoses. Childhood trauma could increase the risk of psychosis through its effect on social cognition.

Clinical profile, treatment received, follow up and current status of individuals treated for delusional disorder at a tertiary care centre

Background Delusional disorder presents with a stable and well-defined delusional system. Many are unwilling to accept that they have a mental disorder or that they require psychiatric treatment. The condition responds to treatment in most cases. This study aims to assess the clinical profile, treatment pattern and response to it, frequency of follow-up and current status of patients previously diagnosed as delusional disorder. Method The case records of all patients who had come to Psychiatry OPD for 3 years with diagnosis of Delusional Disorder according to ICD 10 criteria were taken and data collected. Forty eight patients were enrolled for the study. The current status was assessed from relatives through telephone calls. Results The sample consisted more of males, majority were married. The most common delusion was infidelity followed by persecution. Co-morbidity was present in 43.8% of subjects. Best response was with risperidone. At follow up, all were reported to be doing a job or engaging in household work and majority maintained improvement. Eight had delusions and six were troublesome. Less than half of responders were continuing their treatment. Conclusion Male preponderance and married status were noticeable. Delusion of infidelity was the most common. Delusional disorder has much co-morbidity. Non-compliance with treatment is common. But the level of functioning is found to be reasonably fair irrespective of the treatment status.

Clinical profile, treatment received, follow up and current status of individuals treated for delusional disorder at a tertiary care centre

Background Delusional disorder presents with a stable and well-defined delusional system. Many are unwilling to accept that they have a mental disorder or that they require psychiatric treatment. The condition responds to treatment in most cases. This study aims to assess the clinical profile, treatment pattern and response to it, frequency of follow-up and current status of patients previously diagnosed as delusional disorder. Method The case records of all patients who had come to Psychiatry OPD for 3 years with diagnosis of Delusional Disorder according to ICD 10 criteria were taken and data collected. Forty eight patients were enrolled for the study. The current status was assessed from relatives through telephone calls. Results The sample consisted more of males, majority were married. The most common delusion was infidelity followed by persecution. Co-morbidity was present in 43.8% of subjects. Best response was with risperidone. At follow up, all were reported to be doing a job or engaging in household work and majority maintained improvement. Eight had delusions and six were troublesome. Less than half of responders were continuing their treatment. Conclusion Male preponderance and married status were noticeable. Delusion of infidelity was the most common. Delusional disorder has much co-morbidity. Non-compliance with treatment is common. But the level of functioning is found to be reasonably fair irrespective of the treatment status.

Cognition and functionality in delusional disorder

BackgroundEven if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD. MethodsSeventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan’s Disability Inventory. ResultsIn the final linear regression models, higher scores in the Paranoid (β = 0.471, p < .001, r2 = 0.273) and Cognitive (β = 0.325, p < .001, r2 = 0.180) symptomatic dimensions and lower scores in verbal memory (β = −0.273, p < .05, r2 = 0.075) were significantly associated with poorer psychosocial functioning in patients with DD. Lower scores in verbal memory (β = −0.337, p < .01, r2 = 0.158) and executive functions (β = −0.323, p < .01, r2 = 0.094) were significantly associated with higher self-perceived disability. ConclusionsImpaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD.

A case of pharmacologic extrapyramidal syndrome

IntroductionMore than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.MethodsIt is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).ConclusionsThe mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Alcohol consumption in 2049 patients with paranoia

IntroductionEpidemiological studies have reported associations between alcohol consumption or abuse and occurrence of delusional disorder (F.22) rather than in general population. Alcohol has not been described as the main cause of the delusional idea, but is an enhancer factor which would inhibit behavioral brake and executive function in prefrontal cortex facilitating the development of the existing delusional idea.HypothesisWe want to confirm this association in our influence area so this study aims to report compared frequency of alcoholism in DD versus a control group published in andalusian population.AimsTo review the literature on the potential links between alcohol abuse and delusional disorder and this relationship in general population.ResultsThis poster presents a brief but updated systematic literature review on the associations between DD and alcohol abuse. We will also present data from a relatively large case-mix of 2049 patients with the diagnosis of delusional disorder resulting from a thorough retrospective, medical-record based, assessment of patients attended in our clinical catchment area.In our sample, alcohol abuse and other drugs consumption was significantly less common in Delusional Disorder than in other psychoses.This result suggests that alcohol and other drugs consumption can be a greater importance parameter in other psychoses correlates than in delusional disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Unexpected subthreshold autism spectrum in a 25-year-old male stalker hospitalized for delusional disorder: a case report

This paper highlights the clinical challenges faced when assessing patients with stalking behaviors with psychotic disorders, suggesting the need for an accurate assessment of adult autism spectrum symptoms. A 25-year-old man with a diagnosis of delusional disorder, erotomanic type, was hospitalized for acute psychotic symptoms occurred in the framework of a repeated stalking behavior towards his ex girlfriend. When assessed for adult autism spectrum symptoms upon an accurate clinical evaluation, he reported elevated scores in the mentalizing deficit and social anxiety domains by means of the 14 item Ritvo Autism and Asperger Diagnostic Scale (RAADS-14). Authors discuss a possible role of adult (subthreshold) autism spectrum symptoms, generally disregarded in adult psychiatry, on the type of psychotic features and stalking behavior developed that may help for appropriate diagnosis and treatment.

From Paranoia to Delusional Disorder – Review Based in a Clinical Case

Introduction Until the second half of the nineteenth century the word paranoia was used to mean 'out of mind”. Kraeplin has been determinant to change the conceptual history of paranoia, leading, with the contribution of other authors, to the emergence of delusional disorder in current classifications. Objectives We intend to characterize delusional disorder and its clinical utility. Methods We describe and analyse a case of a man with the diagnosis of delusional disorder – persecutory subtype and make a bibliographic review about this disorder. Results The delusional disorder has a prevalence of 0,03%. The key feature is the existence of an encapsulated delusional system without impairment of other mental functions. As expected our patient has personality traits characterized by suspiciousness, rigidity, an inappropriate sense of personal rights and a tendency to misconstrue the actions of others as hostile. His defense mechanisms are mainly denial, projection and reaction formation. The beginning of the disease was between 35-45 years. First time he was observed by Psychiatry he was taken by family and recently it was by court order. The differential diagnoses were excluded (paranoid personality, schizophrenia, dementia, other medical conditions, disorders induced by substances). Conclusions The cause of delusional disorder is unknown. The importance of personality traits, life events and genetic factors seems to be uncertain and probably variable. The typical lack of insight conditions the therapeutic adhesion and establishing the necessary adequate therapeutic relationship remain a big challenge.

Le traitement du trouble délirant et ses aspects cognitifs

This article reviews the cognitive phenomenology of delusional disorders (DD) and examines the current cognitive models. Some case studies have shown considerable promise concerning the utilisation of cognitive behavioral therapy (CBT) for the treatment of DD, even if this approach is in its infancy. Although the stages of CBT to treat DD are very similar to that of other psychotic disorders, there are also considerable differences. However, it is essential to combine several strategies in order to modify inferences specific to DD. The clinical evaluation of delusions as well as the application of CBT as a treatment is illustrated in two cases with a diagnosis of DD with persecutory subtype. The cases required different time periods for different stages of CBT and highlight the importance of tailoring CBT according to need.

The consistency of DSM-III-R delusional disorder in a first-admission sample.

The temporal consistency of the research diagnosis of DSM-III-R delusional disorder was assessed. Subsequent to their first psychiatric hospitalization, psychotic patients were diagnosed twice using a best-estimate procedure after 6- and 24-month follow-up. Only 57.1% of the 7 subjects diagnosed at the 6-month follow-up conference retained the diagnosis at the 24-month review. Conversely, 50.0% of the 8 subjects given this diagnosis at 24 months had different 6-month diagnoses. By contrast, 100% of a matched control group maintained the same diagnosis at both time points. Course and outcome in this sample varied considerably, with 2 of the subjects making severe suicide attempts. Longitudinal assessment in psychotic patients in their first episode is mandatory, and an initial diagnosis of delusional disorder has to be interpreted as provisional.