Delusional Disorder Somatic Type Research Articles

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

Influence of COVID-19 in the development of delusional ideas disorder. A case report

IntroductionHypochondria is characterized by the presence, for 6 months or more, of a generalized and non-delusional concern with fear of having (or the idea that one has) a serious illness, based on the wrong interpretation of the symptoms. In somatic-type delusional disorder, the delusional idea is fixed, indisputable, and occurs intensely because the patient is fully convinced of the physical nature of the disorder.Objectives To describe a clinical case and make a differential diagnosis of hypochondriac disorder vs somatic-type delusional disorder.MethodsCase report: 61-year-old woman, after suffering from COVID-19, develops a hypochondriacal disorder vs. somatic delusional disorder, presenting anxiety-depressive symptoms and digestive somatic complaints, with a loss of 15 kg of weight. She made frequent visits to doctors and multiple complementary tests discarding organicity. She required involuntary hospital admission for 48 days, and pharmacological treatment with Venlafaxine 150 mg, Olanzapine 5mg, Mirtazapine 30mg and Alprazolam 1mg. The patient presented slow evolution during admission, with ups and downs and stagnation, meriting enteral nutrition due to refusal to ingest, given abdominal kinesthetic hallucinations and digestive evaluation (EDS) with a result of antral gastritis and negative H. pylori. In subsequent follow-ups after partial remission of symptoms, obsessive personality traits are glimpsed, although with better personal functioning.ResultsThe diagnosis at discharge was inconclusive, however the data points to a somatic-type delusional disorder.ConclusionsThe influence of COVID-19 as a triggering factor, social isolation and premorbid personality traits, influence the development of a Somatic Delusional Disorder vs Hypochondriac Disorder, regarding this case.DisclosureNo significant relationships.

Oral cenesthopathy: A dilemma to dentists: A review

Cenesthopathy is characterized by abnormal sensations at various parts of the body. When it occurs in the oral cavity it is termed as oral cenesthopathy. These patients complain of unusual sensations without corresponding abnormal findings, such as excessive mucus secretion, a slimy sensation, or a feeling of coils or wires being present within the oral cavity. They usually visit multiple dentists rather than psychiatrists and repeatedly pursue unnecessary surgical procedures to remove their ‘foreign body’ which sometimes creates a dilemma for the dentists. This review focuses on the various aspects of oral cenesthopathy. Keywords: Oral cenesthopathy, Oral dysesthesia, Delusional disorder somatic type, Antidepressants, Antipsychotics.

Successful treatment of primary delusional parasitosis with paroxetine: A case report and narrative review

IntroductionAntipsychotics have been classically considered the treatment of choice for delusional disorder (DD) and antidepressant medications have been restricted to patients with comorbid depression.ObjectivesOur aim is to describe the case of a patient with DD with delusions of parasitosis, who responded to paroxetine as monotherapy. We also aimed to review the recent literature on the potential use of antidepressants as the main treatment for somatic type DD.MethodsAfter the case report, we present a narrative review on the use of antidepressants in DD, somatic type (DSM-criteria) by using PubMed database from inception until 2020.ResultsCase: 74 year-old woman without previous psychiatric diagnosis who suffered from long-term cutaneous and vulvar pruritus. She was referred to psychiatry from dermatology to assess thought content and sensoperceptive disturbances. In the past, she had received unsuccessful treatment with antihistamines. The patient brought a collection of “the identified parasite” (matchbox sign) to our first appointment. On assessment, she was diagnosed with DD with delusions of parasitosis. Risperidone 1mg/day was poorly tolerated (excessive sedation). She refused further antipsychotic treatment, so we started paroxetine up to 20mg/day. The patient went into total remission of her pruritus and delusions of parasitosis. Review. In line with our case, 6 studies reported on the successful use of antidepressants as monotherapy for DD, somatic type. Most of studies report the successful use of an antipsychotic/antidepressant combination (case-series, case reports).ConclusionsAlthough antipsychotics are the treatment of choice, antidepressant medications may be an effective alternative in somatic type DD when patients refuse antipsychotics.

Delusional infestation: Clinical presentations, diagnosis, and management

Delusional infestation is a primary psychiatric disorder characterized by a somatic-type delusional disorder (primary delusional infestation) that may lead to self-induced cutaneous lesions which are often difficult to recognize and treat properly. It may be also secondary to other psychiatric disorders, medical diseases, or substance abuse. This review will describe prevalence, common clinical features, different clinical presentations, differential diagnoses, and treatment recommendation. Special focus has been put on psychological aspects. We conducted a literature search on PubMed from January 2001 to June 2020 with the search terms of delusional parasitosis, delusional infestation, psychological, Reference lists of identified articles were examined for further relevant studies. The search was limited to English language articles. No specified quality criteria were used for study inclusion. The clinical manifestations of delusional infestation are very important in the differential diagnosis and its psychological implications and management perspectives. This article presents an update regarding the clinical aspects and treatment options of delusional infestation in order to provide an up-to-date review for dermatologists and general practitioners.

Targeting all psychopathological dimensions in the treatment of anorexia nervosa

Efforts to improve the prognosis of subjects with anorexia nervosa [AN] through the development of specific therapeutic interventions have yielded unsatisfactory results. AN can be perceived as a mental disorder that is clinically composed of disturbed psychopathological dimensions found in major depressive disorder, obsessive compulsive disorder, body dysmorphic disorder, and delusional disorder somatic type. Future treatment strategies of patients with AN might target these multiple psychopathological dimensions. Considering that each of these dimensions is known to be best treated with psychopharmacologic drugs such as antidepressants, mood stabilizers and antipsychotic drugs, AN treatment guidelines may need to consider prescribing them to patients.

Abnormal cerebellar volume in somatic vs. non-somatic delusional disorders

BackgroundThere is abundant evidence for cerebellar involvement in schizophrenia, where the cerebellum has been suggested to contribute to cognitive, affective and motor dysfunction. More recently, specific cerebellar regions have also been associated with psychotic symptoms, particularly with auditory verbal hallucinations. In contrast, little is known about cerebellar contributions to delusions, and even less is known about whether cerebellar involvement differs by delusional content.MethodsUsing structural magnetic resonance imaging at 1.0 T together with cerebellum-optimized segmentation techniques, we investigated gray matter volume (GMV) in 14 patients with somatic-type delusional disorder (S-DD), 18 patients with non-somatic delusional disorder (NS-DD) and 18 patients with schizophrenia (SZ) with persistent non-somatic delusions. A total of 32 healthy controls (HC) were included. Between-group comparisons were adjusted for age, gender, chlorpromazine equivalents and illness duration.ResultsCompared to HC, S-DD patients showed decreased GMV in left lobule VIIIa. In addition, S-DD patients showed decreased GMV in lobule V and increased GMV in bilateral lobule VIIa/crus II compared to NS-DD. Patients with SZ showed increased GMV in right lobule VI and VIIa/crus I compared to HC. Significant differences between HC and NS-DD were not found.ConclusionsThe data support the notion of cerebellar dysfunction in psychotic disorders. Distinct cerebellar deficits, predominantly linked to sensorimotor processing, may be detected in delusional disorders presenting with predominantly somatic content.

Differential diagnosis: delusional disorder- somatic type vs anorexia nervosa

Delusional disorder is an illness characterized by at least 1 month of delusions but no other psychotic symptoms, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). (1) Somatic delusions are among the most frequent types of delusion encountered for inpatients, alongside persecutory, referential, grandiose and jealousy type. The differential diagnosis with psychosis is the first to be done and it's suggested by the fact that delusions are persistent and non-bizarre. (2,3) Then all somatic and psychiatric conditions associated with development of delusions must be eliminated. We present the case of a 38-year-old female with delusional disorder-somatic type who was admitted with conflicting symptoms suggesting rather anorexia nervosa associated with somatic symptom disorder. But after a thorough interview and a few days of admission, the delusional symptoms came out and the diagnosis became clear.

Delusion of Pregnancy as a Somatic-Type Delusional Disorder in a Young Male From the South of Iran

Introduction: Delusion of pregnancy is a bizarre delusion in which one feels s/he is carrying a fetus. The etiology is unknown, but aloneness, masturbation, and stress may precipitate this disorder. Case Presentation: We introduce a young, single man who has delusions of pregnancy. This type of delusion is not a well-known disorder; based on investigated articles, this type of somatic delusion is rare. Conclusion: This was a chronic case, the exact cause and development of which was unknown. We suggest this phenomenon as a novel symptom. No similar case was found in the literature.

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.

Somatic-type delusional disorder and comorbidity mood disorder

Chronic delusional disorder encompasses what classical termed as paranoia and paraphrenia. This disorder is characterized by the presence of one or more non-bizarre, permanent and systematized delusions. Cognitive functions of the patient not affected, judgment and reason are not affected if the subject is not addressed delirious. Delusional theme includes life-like experiences, including: persecution – persecutory type –, suffering from a disease – somatic type –, to be loved by someone famous – erotomaniac type –, the partner is unfaithful – jealous type – or having a special quality or gift – megalomaniac type –. Usually, patients lack awareness of mental illness and often prior to contact with mental health, made a pilgrimage by different specialists looking for an organic explanation.The description of a case report of a 47-year-old male who has a delusional belief body deformity secondary to manipulation by a physiotherapist suffering a muscular pain in the lumbar region is performed. Prior to psychiatric diagnosis, begins a long journey by different specialists.As a consequence, somatic-type delusional disorder is a challenge in the diagnosis and treatment in the medical field because it is required a multidisciplinary approach for these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Olfactory Reference Syndrome Developed After Stressful Life Events and Response to Pharmacological Treatment: Report of Four Cases

Olfactory reference syndrome (ORS) is a disorder of thought content characterized by strong beliefs in transmitting an unpleasant body odor and disturbing other people. ORS had not been recognized in the DSM-IV as a separate diagnosis; rather, it used to be categorized under delusional disorder, somatic type (DDST). Considering recent changes in the DSM-5, the syndrome is currently listed under the section of other specified obsessive-compulsive and related disorder with the name Jikoshu-kyofu, thus still not described as a major distinct entity. We claim that a universally accepted set of diagnostic criteria is lacking, and there is a set of overlapping symptoms with various other disorders. In this paper, we discuss four patients presenting with ORS after a triggering stressful life event from the nosological and treatment perspective, focusing primarily on antipsychotic augmentation.

Unremitting body odour: A case of Olfactory Reference Syndrome.

Olfactory reference syndrome (ORS) is a person's fear of exuding an offensive body odour which is not perceived by others. The objective of this case report is to highlight the challenges in diagnosing olfactory reference syndrome due to the lack of diagnostic criteria as well as its similarities to other psychiatric illnesses. We report a case of a young Chinese gentleman who was preoccupied with the belief that he had an offensive body odour which was not noticeable by others since the age of 10. As a result of this, he developed compulsive behaviour, social anxiety and avoidance, as well as depression. The patient had an array of psychiatric symptoms. He had symptoms which fulfilled criteria for obsessive compulsive disorder (OCD), delusional disorder somatic type, and social anxiety disorder. ORS remains a diagnostic challenge. Further studies are needed in this area for a better understanding of the disorder.

“Worm crawling inside my brain”: a rare case of delusional parasitosis

Delusional parasitosis is a disorder in which persons suffering have a firm and unshakeable belief of harbouring some parasite or worm in his/her body. In today's nosology, it has been placed under delusional disorder-somatic type in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (297.1) and under persistent delusional disorders in the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (F22). Existing literature has extensively described this condition to affect mainly the skin with some instances of affecting the oral mucosa and the intestine. We are reporting a rare case of delusional disorder of parasite infestation in the brain.

Delusional Disorder, Somatic Type

Delusions of foul body odors (often referred to as olfactory reference syndrome [ORS]) currently fall under the category of delusional disorder, somatic type (DDST), in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). We present the case of a 51-year-old man with no previous psychiatric history who presented with perceived foul odors that he delusionally attributed to trimethylaminuria (TMAU). TMAU is a rare metabolic disorder associated with foul body odors. The patient also experienced severe concurrent mood symptoms because of social isolation resulting from his delusion about his body odors. After considerable discussion of differential diagnoses, a diagnosis of DDST was ultimately made, given the patient's unrelenting nonbizarre delusions and lack of insight pertaining to his body odors. However, this case proved to be very useful in exploring the diagnostic challenges in this type of disorder and recent discussions of ORS and its proposed inclusion in the DSM-5.

“Holes in My Head”

To the Editor: Delusional parasitosis is a somatic type delusional disorder in which sufferers maintain a fixed false belief that they are infested with parasites. Secondary forms of delusional parasitosis are addressed by treating the primary associated psychological or physical condition. We present a case of primary delusional parasitosis in a patient with end-stage renal disease. Case report. Mr A, a 63-year-old African American man, was admitted in 2010 to the medical floor from the dialysis unit after making some bizarre statements during a dialysis session. Psychiatry consult was requested by the medical team after the patient continued to endorse a fixed delusion that he had had 2 holes in his forehead for 2 months, which appeared intermittently and were reported by the patient to have closed before he was interviewed by the psychiatric consult team. Mr A also stated that he was not sure if any worms were crawling around in his head (pointing to his head) and was in the hospital to get the condition investigated. Upon further interview, the patient reported feeling that bugs were crawling on his skin, and he explained that insects were the reason for his severe pruritus and chronic skin condition. The patient also had a past history of increased confusion and making bizarre statements during dialysis sessions. His medical history was significant for diabetes mellitus with retinopathy, end-stage renal disease, anemia, glaucoma with partial blindness, and cutaneous lymphocytosis as well as chronic pruritus treated by glucocorticoid. Findings of head computed tomography without contrast were within normal limits, except for mild age-related generalized atrophy. Significant laboratory values included serum PO4 level of 6.2 mg/dL, serum magnesium level of 1.6 mg/dL, serum chloride level of 95 mg/dL, random blood glucose level of 375 mg/dL, blood urea nitrate level of 32 mg/dL, serum creatinine level of 5.5 mg/dL, and estimated glomerular filtration rate 13 mL/h. Differential diagnosis included chronic delirium due to dialysis and polypharmacy, delusional parasitosis, and cognitive disorder not other specified. Psychiatric consultants recommended optimization of medications and reduction of polypharmacy: Mr A was using clobetasol topical cream twice a day, fluocinonide topical twice a day, and terbinafine topical cream twice a day and taking triamcinolone 80 mg 4 times a day, finasteride 5 mg at night, clonidine 0.3 mg 3 times a day, furosemide 80 mg twice a day, hydralazine 20 mg 4 times a day, heparin 5,000 mg subcutaneously 3 times a day, labetalol 400 mg 3 times a day, isosorbide mononitrate 60 mg daily, ropinirole 1 mg at night, sliding scale insulin, pravastatin 20 mg at night, sodium bicarbonate 650 mg 3 times a day, diazepam 5 mg every 8 hours as needed, and zolpidem 12.5 mg at night. The patient was prescribed a number of sedating medications, including diazepam, zolpidem, clonidine, and hydroxyzine. Both ropinirole and hydralazine have been shown to cause psychotic symptoms.1,2 The patient’s diazepam was discontinued. His medical team was also advised to start a low dose of haloperidol, 1 mg twice a day, for delusions. The medical team was advised to premedicate with an antipsychotic, adjust the patient’s dialysis schedule, and consider changing dialysate to help reduce delirium; although dialysate was not changed, the other 2 changes were implemented as recommended. Confusion and delusions subsided after 4 days, at which time he was discharged from the hospital. Delusional parasitosis is usually diagnosed as a subtype of delusional disorder. The mean age at onset is 56.9 years, and the male-to-female ratio is 1:1.5.1 Patients describe a parasitic invasion on or inside the skin; they may bring in objects such as hair, lint, or skin—the “matchbox sign”—as proof of the infestation despite normal findings on examination.2 Patients rarely seek the help of a psychiatrist; rather, because of their belief in a somatic complaint, patients often see primary care physicians or dermatologists for treatment.1,2 Management initially involves ruling out a general medical condition and excluding the use of drugs, illicit or prescribed. Traditionally, treatment is pimozide, a dopamine antagonist, although some patients may respond to neuroleptics such as haloperidol or risperidone. Duration of treatment varies from 2 weeks to 3 months before use is tapered, but compliance can be challenging.1,3,4 Careful strategy is required to convince patients with delusional parasitosis of the importance of a psychiatric referral.

Delusional infestation: treatment outcome with antipsychotics in 17 consecutive patients (using standardized reporting criteria)

Objective The multietiological nature of delusional infestation (DI) implies that therapy needs to be customized according to the various forms of DI (primary/secondary). Usually, treatment of DI is difficult to achieve in psychiatric settings because of the patients' nonpsychiatric concept of the illness. Methods We analyzed the data of all consecutive DI patients seen in the Psychiatric Outpatient Department of the General Hospital Bruneck/Italy from 1998 to 2010, including structural brain imaging findings. Standardized reporting criteria are applied for the presentation of the cases in a naturalistic setting. Results Our sample consisted of 17 patients. Notably, 15 out of these 17 patients (88%) could be engaged in an antipsychotic treatment trial. With different, mainly second-generation antipsychotics, all but one patient profited from antipsychotics, at least after substances were changed: 12 (71%) of the cases reached full remission, and another 2 (12%) had partial remission. The average duration of treatment was remarkably long: 3.8 years. Eight cases were classified as secondary to a brain disorder or medical condition, four cases were classified as secondary to psychiatric disorders and five cases fulfilled the criteria for primary DI (i.e., delusional disorder somatic type). All cases secondary to a brain disorder/medical condition showed macroscopic brain lesions mainly in the basal ganglia. Conclusions Our study confirmed previous experience that an excellent clinical outcome can be achieved in unselected patients with different DI forms provided that patients can be engaged in antipsychotic treatment. Although studies in DI are difficult to conduct, randomized controlled trials would be desirable to evaluate specific antipsychotic medication in DI in general and in the different forms of DI. More sophisticated investigations (single photon emission computed tomography and positron emission tomography) than structural brain imaging (magnetic resonance imaging and computed tomography) are needed to better elucidate underlying brain dysfunction in DI.

Delusion of Reduplication of Tongue Accompanied by Dangerous Self-Treatments in a Patient with Alzheimer's Disease

Delusion of reduplication of body parts is a rare somatic delusion, and has been reported in association with delusional disorder, somatic type (DDST) [1], brain tumours, and head injuries [2]. We ...

Somatic-type Delusional Disorder: A Case Report and Comments

Somatic-type Delusional Disorder: A Case Report and Comments

Hyperperfusion in primary somatosensory region related to somatic hallucination in the elderly

The purpose of the present study was to investigate the regional cerebral blood flow (rCBF) of patients with delusional disorder, somatic type (DDST) exhibiting somatic hallucination. Five patients diagnosed with DDST, as well as 20 control subjects, were examined. All subjects underwent technetium-99m ethyl cysteinate dimer brain perfusion single-photon emission computed tomography. Statistical analysis was performed with SPM5, using a two-sample t-test model to test the regional population effect on rCBF. Patients with DDST had a significant increase in perfusion in the left post-central gyrus and the right paracentral lobule, both of which are involved in somatic sensory processing. Somatic hallucination might be associated with increased perfusion in the primary somatosensory regions.