Treatment Of Delusional Disorder Research Articles

Seventy Years of Treating Delusional Disorder with Antipsychotics: A Historical Perspective.

For many decades, delusional disorder (DD) has been considered a treatment-resistant disorder, with antipsychotics acknowledged as the best, though imperfect, treatment. It is possible that the discovery of the right drug could turn treatment resistance into treatment response. The goal of this narrative review is to provide a historical perspective of the treatment of DD since the introduction of antipsychotics 70 years ago. The following search terms were used to scan the literature: antipsychotics AND "delusional disorder". Findings were that therapy for DD symptoms has changed over time. Initial reports suggested that the drug of choice was the antipsychotic pimozide, and that this drug was especially effective for the somatic subtype of DD. Subsequent studies demonstrated that other antipsychotics, for instance, risperidone and olanzapine, were also highly effective. Treatment response may vary according to the presence or absence of specific symptoms, such as cognitive defect and depression. Clozapine, partial D2 agonists, and long-acting injectable drugs may be more effective than other drugs, but the evidence is not yet in. Because of the absence of robust evidence, treatment guidelines for the optimal management of DD are not yet available.

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.

A systematic review of the pharmacological treatment of delusional disorder

IntroductionPharmacological treatment is the gold standard in delusional disorder (DD), moreover the second generation antipsychotics (SGA) are widely used in the treatment of DD, in spite of this, none SGA is authorized for the treatment of DD.ObjectivesTo evaluate the evidence available for pharmacological treatment in adults with DD. Especially, that concerning SGA.MethodsA systematic review on pharmacological treatment of DD was conducted. We selected the best evidence available. Then, we analysed them critically, assessing its biases and quality, finally performed a narrative and quantitative synthesis.ResultsThe quality of the evidence was very low. There were not randomized clinical trials. n = 385, 177 SGA. Antipsychotics achieved a good response in a 33.6% of the patients. First generation antipsychotics (FGA) did show superiority compared to SGA (39% good response vs. 28%, respectively. P ≤ 0.02). We could not find data about superiority of any drug over other. Pimozide, traditionally considered the most effective drug, did not confirm to be a superior treatment compared to others. Reasons for superiority of FGA were analyzed. The role of another treatments were testimonial, but antidepressants can be a promising treatment.ConclusionsThere is no evidence to make strong recommendations, although antipsychotics in general appear to be an effective treatment for DD. Superiority of FGA against SGA was shown. We need to develop clinical trials in DD and SGA, since their better tolerance profile might be the best candidates to do.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The emergence of psychosis in a patient with severe hypothyroidism: A case report and literature review

Hypothyroidism is associated with changes in mental state that can range from mild cognitive impairment to depression to florid myxedema coma. A few cases have linked the occurence of psychotic symptoms in the context of severe hypothyroidism, an event referred in the literature as “myxedema madness”. We describe the case of a 48-year-old male with no past psychiatric history and a past medical history of hypertension and hypothyroidism who presented to the psychiatric unit for management of new-onset psychosis, particularly paranoid delusions. On basic medical screening, the patient was found to have severe hypothyroidism manifested by a TSH level of 51.85 and a free T4 level less than 0.4. The patient was treated with both an antipsychotic and thyroid hormone replacement, after which his hypothyroid symptoms and his psychosis improved. Liothyronine was also prescribed to speed up the recovery course, as his delusions were thought to be due to his hypothyroidism. The aim of this poster is to shed light on the possibility of development of psychosis concomitantly with severe hypothyroidism, given the rarity of such events, as well as to illustrate the importance of treating the underlying medical cause rather than only focusing on the treatment of the psychiatric symptoms. The use of Liothyronine proved to be beneficial in this case, as the patient's symptoms drastically improved after its administration. This could potentially illustrate the importance of using Liothyronine particularly in the treatment of delusional disorder in severe hypothyroidism.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case of delusional disorder

IntroductionFunctioning of patients with delusional disorder may be impaired, particularly if the delusional thinking is chronic rather than episodic. They refuse to characterize their beliefs as false and view opposing views with surprise, if not hostility and disdain, dismissing or ignoring them, and continuing their struggle to find resolution or restitution for the wrongs they have endured or the illnesses from which they suffer. They typically reject and often resent the suggestion that they are mentally compromised. They are a difficult group to engage clinically, often refusing to meet with a clinician about their delusions and/or to take medication. The first-line treatment of delusional disorder is antipsychotic medication rather than other clinical interventions. Patients with the disorder often reject psychiatric treatment, it is particularly important that medication be prescribed in the context of a therapeutic relationship that includes support, education, encouragement of healthier pursuits, and discouragement of damaging, delusion-inspired actions.MethodsWe describe a case of a 55-year-old woman with a delusional disorder that was diagnosed 4 years before. The supervision of the right take of the treatment was not possible and the intensity of behavioral disturbances increased. Then we started the treatment with long-acting injectable aripiprazole.ResultsWithin the 4 months following the start of treatment, her mental state improved by attenuation of psychotic symptoms.ConclusionsLong-acting aripiprazole could be an effective tool for treatment of psychotic symptoms in patients with no insight and difficulties to check the proper treatment take.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Descriptive study of the treatment of delusional disorder. Survey study DELIRANDA

IntroductionWe currently lack clinical guidelines for the treatment of Delusional Disorder (DD) F-22, the low prevalence of the disease coupled with no awareness of illness and poor adherence to prescribed treatment make it difficult to study. The limited evidence available for the treatment is based mainly on clinical series.ObjectivesThis study evaluates the knowledge and preferences in the treatment of the DD, in order to improve clinical practice and gain information of the DD to conduct clinical studies of effectiveness of the different treatments.Material and methodsA self-administered survey was conducted on a sample of 80 psychiatrists proceeding on a wide array of mental health care services. Participants provided socio-demographic data and information about clinical details, together with their opinions regarding the, epidemiological aspects, clinical management, diagnosis and therapy. Descriptive statistics were subsequently calculated with SPSS.ResultsMost of our sample's of Psychiatrists estimated that the DD prevalence was higher than the one previously established. Ninety-three percent of the sample considered the SGAs as the first treatment option in DD, being Aripiprazol 20.7%, Risperidone 17.4% and Paliperidone 15% the first line treatment chosen by our Psychiatrists.Conclusions and proposalsThere is an increasing gap between the old standard DD treatment and the clinical practice of Andalusian Psychiatrists, for this reason we emphasize the need of implementing clinical trials and effectiveness clinical studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatments for Delusional Disorder.

Background Delusional disorder is commonly considered to be difficult to treat. Antipsychotic medications are frequently used and there is growing interest in a potential role for psychological therapies such as cognitive behavioural therapy (CBT) in the treatment of delusional disorder. Objectives To evaluate the effectiveness of medication (antipsychotic medication, antidepressants, mood stabilisers) and psychotherapy, in comparison with placebo in delusional disorder. Search methods We searched the Cochrane Schizophrenia Group's Trials Register (28 February 2012). Selection criteria Relevant randomised controlled trials (RCTs) investigating treatments in delusional disorder. Data collection and analysis All review authors extracted data independently for the one eligible trial. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis with a fixed-effect model. Where possible, we calculated illustrative comparative risks for primary outcomes. For continuous data, we calculated mean differences (MD), again with a fixed-effect model. We assessed the risk of bias of the included study and used the GRADE approach to rate the quality of the evidence. Main results Only one randomised trial met our inclusion criteria, despite our initial search yielding 141 citations. This was a small study, with 17 people completing a trial comparing CBT to an attention placebo (supportive psychotherapy) for people with delusional disorder. Most participants were already taking medication and this was continued during the trial. We were not able to include any randomised trials on medications of any type due to poor data reporting, which left us with no usable data for these trials. For the included study, usable data were limited, risk of bias varied and the numbers involved were small, making interpretation of data difficult. In particular there were no data on outcomes such as global state and behaviour, nor any information on possible adverse effects. A positive effect for CBT was found for social self esteem using the Social Self-Esteem Inventory (1 RCT, n = 17, MD 30.5, CI 7.51 to 53.49, very low quality evidence), however this is only a measure of self worth in social situations and may thus not be well correlated to social function. More people left the study early if they were in the supportive psychotherapy group with 6/12 leaving early compared to 1/6 from the CBT group, but the difference was not significant (1 RCT, n = 17, RR 0.17, CI 0.02 to 1.18, moderate quality evidence). For mental state outcomes the results were skewed making interpretation difficult, especially given the small sample. Authors' conclusions Despite international recognition of this disorder in psychiatric classification systems such as ICD-10 and DSM-5, there is a paucity of high quality randomised trials on delusional disorder. There is currently insufficient evidence to make evidence-based recommendations for treatments of any type for people with delusional disorder. The limited evidence that we found is not generalisable to the population of people with delusional disorder. Until further evidence is found, it seems reasonable to offer treatments which have efficacy in other psychotic disorders. Further research is needed in this area and could be enhanced in two ways: firstly, by conducting randomised trials specifically for people with delusional disorder and, secondly, by high quality reporting of results for people with delusional disorder who are often recruited into larger studies for people with a variety of psychoses.

Treatments for delusional disorder.

Delusional disorder is commonly considered to be difficult to treat. Antipsychotic medications are frequently used and there is growing interest in a potential role for psychological therapies such as cognitive behavioural therapy (CBT) in the treatment of delusional disorder. To evaluate the effectiveness of medication (antipsychotic medication, antidepressants, mood stabilisers) and psychotherapy, in comparison with placebo in delusional disorder. We searched the Cochrane Schizophrenia Group's Trials Register (28 February 2012). Relevant randomised controlled trials (RCTs) investigating treatments in delusional disorder. All review authors extracted data independently for the one eligible trial. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis with a fixed-effect model. Where possible, we calculated illustrative comparative risks for primary outcomes. For continuous data, we calculated mean differences (MD), again with a fixed-effect model. We assessed the risk of bias of the included study and used the GRADE approach to rate the quality of the evidence. Only one randomised trial met our inclusion criteria, despite our initial search yielding 141 citations. This was a small study, with 17 people completing a trial comparing CBT to an attention placebo (supportive psychotherapy) for people with delusional disorder. Most participants were already taking medication and this was continued during the trial. We were not able to include any randomised trials on medications of any type due to poor data reporting, which left us with no usable data for these trials. For the included study, usable data were limited, risk of bias varied and the numbers involved were small, making interpretation of data difficult. In particular there were no data on outcomes such as global state and behaviour, nor any information on possible adverse effects.A positive effect for CBT was found for social self esteem using the Social Self-Esteem Inventory (1 RCT, n = 17, MD 30.5, CI 7.51 to 53.49, very low quality evidence), however this is only a measure of self worth in social situations and may thus not be well correlated to social function. More people left the study early if they were in the supportive psychotherapy group with 6/12 leaving early compared to 1/6 from the CBT group, but the difference was not significant (1 RCT, n = 17, RR 0.17, CI 0.02 to 1.18, moderate quality evidence). For mental state outcomes the results were skewed making interpretation difficult, especially given the small sample. Despite international recognition of this disorder in psychiatric classification systems such as ICD-10 and DSM-5, there is a paucity of high quality randomised trials on delusional disorder. There is currently insufficient evidence to make evidence-based recommendations for treatments of any type for people with delusional disorder. The limited evidence that we found is not generalisable to the population of people with delusional disorder. Until further evidence is found, it seems reasonable to offer treatments which have efficacy in other psychotic disorders. Further research is needed in this area and could be enhanced in two ways: firstly, by conducting randomised trials specifically for people with delusional disorder and, secondly, by high quality reporting of results for people with delusional disorder who are often recruited into larger studies for people with a variety of psychoses.

EPA-0235 – Effectiveness of long-acting injectable antipsychotics (pplai and rlai) in the treatment of delusional disorder with non-prominent hallucinations

Recent meta-analysis in schizophrenia report that patients treated with long-acting injectable antipsychotics (LAI) show a significant improvement in hallucinations. However, little evidence supports their efficacy in non-prominent hallucinations in delusional disorder (DD) patients. To examine treatment effectiveness of LAI antipsychotics (PPLAI and RLAI) with other oral antipsychotics in DD with non-prominent hallucinations. A prospective and observational study was carried out by including 60 consecutive cases of DD outpatients, as part of the DEVCODEL Study. All patients were followed up for at least 6 months. Outcome variables: Scores in PANSS, HRSD-17 items, PSP for functionality, and C-SSRS for suicide. To investigate whether differences between treatment groups were biased by confounding variables, scores in assessment scales at 6 months served as dependent variables, and hallucinatory and treatment groups were included as between-subject factors when analysis of covariance (ANCOVA) was applied. 24(40%) patients had non-prominent hallucinations. Although not statistically significant, when uncorrected for influencing factors, DD patients receiving PPLAI or RLAI (n=27;45.5%) were less frequently treated with antidepressants (32%vs.68%) and showed lower suicidality (44.4%vs.55.6%). Patients treated with PPLAI or RLAI had lower scores in psychotic symptoms and suicidal ideation intensity, and higher functionality. After adjustment, patients with non-prominent hallucinations receiving PPLAI or RLAI showed a tendency of improvement in functionality, lower scores in PANSS positive (p=0.003) and negative (p=0.047) subscales, and suicidal ideation severity (p<0.001) compared to those treated with oral antipsychotics. Non-prominent hallucinatory patients treated with PPLAI or RLAI showed a significant improvement in psychopathology and suicidal ideation.

Delusional Disorder and Oncology: Review of the Literature and Case Report

Delusional disorder is an infrequent diagnosis in outpatient clinical practice. While delusional thought processes are a fairly common part of symptom clusters in chronic psychiatric disorders such as schizophrenia and bipolar disorders, true delusional disorders are believed to be fairly rare. In this article, we review scientific data on incidence, diagnosis, and treatment of delusional disorders. This was done by PubMed search utilizing the search terms "delusional disorder," "oncology," "diagnosis," and "treatment." Relevant articles were excluded if they dealt predominantly with schizophrenia instead of primary delusional disorder. We present a case of a patient diagnosed with follicular lymphoma and an apparent longstanding history of persecutory delusions. The patient's symptoms eventually led to intervention in the oncology practice involving the medical center faculty and staff, as well as local police and the court system. Delusional disorder is an under-researched condition, and limited information is known regarding the treatment of this condition when it impacts upon medical care. Future research directions are proposed.

P.3.c.011 Risperidone and olanzapine in treatment of delusional disorders

P.3.c.011 Risperidone and olanzapine in treatment of delusional disorders

P03-132 - Risperidone and olanzapine in treatment of delusional disorders

Delusional disorders are severe psychotic disorders with characteristic non-bizarre delusions often organized in permanent delusional system.AimTo estimate efficacy of risperidone and olanzapine in treatment of DD.Methods135 patients with DD were divided into Haloperidol-control (41), Risperidone (49) and Olanzapine group (45 patients). Patients were observed for 6 months according to protocol, which included PANSS Scale and CGI1-4 Scale. Control group was treated with haloperidol 5–30 mg/24 h. Experimental groups were treated with risperidone 2–6 mg/24 h and olanzapine 10–20 mg/24 h.ResultsPretrial PANSS score was 57.28 in risperidone(R), 60.47 in olanzapine(O) and 58.45 in control(H) group. PANSS score after 180 days was 34.32 in R, 35.58 in O and 37.97 in H group. There was no statistical difference in pretrial scores for PANSS (p = 0.691), CGI1 (p = 0.733), CGI2 (p = 1.000), and CGI3 (p = 1.000) scores. There was statistical significance in PANSS and CGI1-4 score reduction after 180 days in all groups (p = 0.000). There was no statistical difference in PANSS score reduction between R and H (p = 0.114) and O and H group (p = 0.136). CGI1-4 scores reduction: CGI1, Rvs.H, p = 0.019 and Ovs.H, p = 0.032 with high statistical significance; CGI2, Rvs.H, p = 0.153 and Ovs.H, p = 0.179 with no statistical significance; CGI3, Rvs.H, p = 0.183 and Ovs.H, p = 0.161 with no statistical significance; CGI4, Rvs.H, p = 0.000 and Ovs.H, p = 0.000 with high statistical significance. Adverse effects were significantly lower in Risperidone (21.42%) and Olanzapine (21.81%) than in Haloperidol (57.5%) group.ConclusionRisperidone and Olanzapine have slightly better efficacy in treatment of DD comparing to haloperidol, with statisticaly significant lower adverse effects rate.

Aripiprazole in Delusional Disorder

Though it has been known for a long time, due to the fact that the controlled studies are limited and the disorder is uncommon, case reports have been important supporting the data of the treatments. In general, depending on whether the patient used drug before and considering the effects and side effects of the drugs the first choice in the treatment is antipsychotic drugs. New atypical antipsychotic agents are preferred for their relatively less side effects and higher drug adaptation. We aimed to report a case of delusional disorder (jealous type) which did not respond to different atypical antipsychotic agents previously but shows a prognostic improvement by aripiprazole of 30mg/day. Aripiprazole may be an effective option for the treatment of delusional disorder, with few side effects, high drug compliance and efficacy.

P.3.c.028 Olanzapine in treatment of delusional disorders

P.3.c.028 Olanzapine in treatment of delusional disorders

P.3.c.003 Risperidone in treatment of delusional disorders

P.3.c.003 Risperidone in treatment of delusional disorders

Treatment of Delusional Disorder

Treatment of Delusional Disorder

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.

Recent Advances in the Treatment of Delusional Disorder

Often considered difficult to treat in the past, even treatment-resistant, delusional disorder is now regarded as a treatable condition that responds to medication in many instances. Munro and Mok previously reviewed the published record of its treatment to 1994. This review aims to update and extend their observations and to examine the impact of new second-generation antipsychotic agents on the treatment of this condition. We attempted to gather all published reports of delusional disorder from 1994 to 2004, using various database strategies. We then assessed the reports for clarity and completeness, treatment, and outcome descriptions, thereby selecting a patient sample for analysis. Of 224 cases identified as delusional disorder, only 134 case descriptions provided sufficient treatment and outcome data to inform this review. The demographics of this sample were similar to those of the earlier review. Depression as a comorbid condition was more frequent than before. Adherence to medication regimens was seldom explicitly addressed. Most cases showed improvement regardless of which antipsychotic medication the patients received. Pimozide and other conventional antipsychotics, as well as second-generation antipsychotics, and even clozapine, were used in many of the case reports. Family history of delusional disorder was seldom recorded. A positive response to medication treatment occurred in nearly 50% of the cases in our review, which is consistent with the earlier review.

Risperidone for the treatment of delusional disorder

INTRODUCTION : The overlap between diagnostic criteria for schizophrenia and delusional disorder (DD) may cause diagnostic confusion. This is important if response to treatment differs. Risperidone, an atypical antipsychotic, is established in the treatment of schizophrenia, although less so in other psychotic conditions. METHOD : We report the case of a woman who developed DD, persecutory type, at the age of 50 years. Treatment with sulpiride 200-800 mg daily caused side-effects of drowsiness and 'hangover' and, consequently, non-compliance. Written informed consent was gained for a 24-week, randomized, double-blind, placebo-controlled, crossover trial of risperidone, initiated at 1 mg daily and increasing to 2 mg daily. RESULTS : Significant improvement was found, as assessed by the Brief Psychiatric Rating Scale, Positive and Negative Symptom Schedule and Maudsley Assessment of Delusions Schedule. CONCLUSION : We believe that this is the first case study reporting the resolution of persecutory DD with risperidone. A controlled clinical trial of risperidone in the treatment of patients with DD is warranted. (Int J Psych Clin Pract 2002; 6: 113-116)

Delusional Disorder: Paranoia and Related Illnesses

Delusional Disorder: Paranoia and Related Illnesses