An Australian study of delusional disorder in late life.

OBJECTIVES: There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic use and treatment outcomes in patients with DD aged 65 years and older. Secondarily, we sought to examine associated clinical features and socio-demographic variables. DESIGN AND SETTING: This descriptive study reviewed all consecutive cases of DD referred to an Australian old age psychiatry service over a 12-year period. Fifty-five patients were assessed in the inpatient and/or community setting, with data verified from a review of all individual medical records. MEASUREMENTS: Data were collected with respect to antipsychotic use, outcomes, and clinical features. Socio-demographic variables of DD cases were compared to a non-matched comparison group (n=278) and an age and gender matched comparison group with a 1:1 ratio (n=55). RESULTS: The predominant type of DD was persecutory (87%). Non-prominent hallucinations were experienced by 18%, and depressive symptoms occurred in 22%. There was a statistically significant association between having DD and social isolation (χ2= 11.04 (DF=1) p<0.001; McNemar's test p<0.001). Atypical antipsychotic medication was prescribed in 32 cases, with follow-up permitted in 51 of the 55 cases (mean duration 36.6 months). Sustained recovery occurred in 20%, and improvement in an additional 35% of the study sample. Four patients subsequently developed dementia, and two developed mild cognitive impairment. CONCLUSIONS: Clinical improvement, including sustained recovery, occurred in more than half of those with late life DD. The majority of those who improved (96%) received atypical antipsychotics.

[Paranoid personality disorder and criminal offense]. / Trouble de personnalité paranoïaque et infractions pénales.

BACKGROUND: Currently, all of the studies that focus on the relationship between paranoia and criminal offenses exclusively concern subjects suffering from a delusional paranoid disorder. However, subjects with single paranoid personality disorder, without any associated delusional disorder, are not uncommon in forensic practice. OBJECTIVES: This study aims to describe the offenses committed by subjects suffering from a single paranoid personality disorder and to compare them with the offenses committed by the subjects affected by a paranoid delusional disorder associated with paranoid personality disorder. Our initial hypothesis is that both populations have a comparable criminological profile. METHODS: Based on a 17 year-long experience carried out in the framework of a forensic assessment, we have selected all subjects presenting a paranoid personality disorder, whether single or associated with paranoid delusional disorder. The selected individuals were divided into two groups according to whether they presented paranoid delusional disorder or not. The offenses were grouped into criminal categories. The alpha risk was fixed at 1%. Data analysis is done by SAS software version 9.4. RESULTS: In a sample of 106 subjects presenting a paranoid personality disorder, including 4 women and 102 men, we found 79 subjects with a single paranoid personality and 27 with an associated paranoid delusional disorder. The average age at the time of the offense was 41 for those with single personality disorders and 49 for those with paranoid delusional disorders. Both groups had forensic antecedents (41%, 11/27 of paranoid delusional disorder and 51%, 40/79 of single paranoid personality disorder). Psychiatric history was more frequent in the paranoid delusional disorder group (59%, 16/27) than in the single paranoid personality disorder group (13%, 10/79). History of addiction was comparable in terms of alcohol abuse (26% in both groups) and other substances (7.5%, 2/27 of paranoid delusional disorder and 9%, 7/79 of single paranoid personality disorder). Comparison of the two groups highlighted significant differences in the type of criminal offenses committed (Fisher's exact test: P=0.0003, alpha risk <0.0001). The offenses committed by delusional authors essentially came down to verbal or physical violence, including homicide (44%, 12/27), and were usually focused on a designated persecutor. Sexual violence was rare. On the other hand, paranoid personality disorder was associated with a wider variety of offenses. Sexual offenses (including 28 rapes, 35%, 28/79) were thus almost as frequent as murder, and attempted murder (38%, 30/79). This diversity of committed offenses was found in their forensic antecedents. In these subjects, the logic of omnipotence may had over ruled the logic of revenge. CONCLUSION: We conducted a retrospective study on 106 subjects with paranoid personality disorder, including 27 subjects with associated paranoid delusional disorder. The comparison of the two groups demonstrated significant differences in offenses. Verbal and physical but non-sexual violence, committed in a delusional logic, was found among delusional subjects, while the forms of violence were more multiform in the single paranoid personality disorder group, frequently including sexual violence. This is, as far as we know, the first study describing the medico-legal acting-out of paranoid personalities. These results, which will need to be confirmed by future studies, point out the importance of the criminological risk that may be associated with paranoid personality disorder, without any associated delusional disorder.

A Psychopathological Comparison between Delusional Disorder and Schizophrenia.

OBJECTIVE: To contribute to a better differential clinical categorisation of delusional disorder (DD) versus schizophrenia (SZ) and to add and complete evidence from previous clinical studies of DD compared to schizophrenia. METHODS: A cross-sectional study using a clinical sample of 275 patients (132 patients with DD) was studied. Patients were consecutively attending public clinics located in urban and rural areas in both Andalusia and Catalonia (Spain). All participants met DSM-IV diagnostic criteria for either DD or SZ. Data were gathered on sociodemographics, illness duration, Barona-Index estimation of intelligence quotient (IQ), and global functioning, along with a thorough psychopathological assessment using the Positive and Negative Syndrome Scale (PANSS). Comparisons between both groups were calculated using χ2, Student t, and multivariate analysis of covariance tests. RESULTS: Patients with DD were older (mean [SD], 50.3 [14.6] years vs. 36.6 [11.1] years; t = 8.597; P ≤ 0.0001), were more frequently married (45.4% vs. 10.8%; χ2 = 38.569; P ≤ 0.0001), and had a higher mean estimated premorbid IQ (111.4 vs. 105.4; t = 2.609; P ≤ 0.01). On the other hand, SZ patients were predominantly male (71.4% vs. 48.9%; χ2 = 14.433; P ≤ 0.0001) and had greater work-related disability than DD patients (20.5% vs. 50.3%; χ2 = 19.564; P ≤ 0.001). Overall, the DD group showed a less severe PANSS psychopathology than SZ group. Thus, total mean (SD) PANSS scores for schizophrenia and delusional disorder, respectively, were 76.2 (22.4) versus 54.1 (18.4) ( t = -8.762; P ≤ 0.0001). Moreover, patients with DD showed a better global functioning than those with SZ (62.7 [13.2] vs. 51.9 [16.9]; F = 44.114; P ≤ 0.0001). CONCLUSIONS: DD is a milder and distinct disorder compared to SZ in terms of psychopathology and global functionality.

[Delusional misidentification syndromes: A factor associated with violence? Literature review of case reports]. / Les syndromes délirants d'identification : un facteur associé à la violence ? Revue de littérature à partir d'études de cas.

OBJECTIVES: Delusional misidentification syndromes (DMS) correspond to the delusional belief of misidentification of familiar persons, places or objects and to the conviction that they have been replaced or transformed. Several cases of patients who developed violent behavior while suffering from DMS have been published. This led some authors to consider patients with DMS at risk of violence. However, only a few studies have focused on the potential relationship between violence and DMS. The aim of our study was to explore this relationship with a literature review of published cases of patients having committed violent acts associated to DMS. METHODS: A systematic literature search was conducted on PubMed up to January 2017 using the following term combination "misidentification" and "violence" Fifteen cases of patients with DMS who had committed violent acts were identified. The data from these descriptions were analyzed and synthetized. RESULTS: Most of the patients were men with a diagnosis of schizophrenia and Capgras syndrome. Acts of violence were severe with a relatively high number of murders or attempted murders. For half of the patients these violent acts were perpetrated with weapons. Victims were regularly the patient's family members and the assaults were usually not planned. Delusional syndromes often progressed for several years. Importantly, substance abuse, which is known to increase the risk of violence in patients with schizophrenia, was only observed in two patients. CONCLUSION: DMS are associated with several risk factors of violence, such as a diagnosis of schizophrenia, specific delusions including megalomania, persecution, negative affects and identified targets. Despite this risk for severe violence, there are no existing guidelines on how to assess and treat DMS in schizophrenia. Accordingly, we propose (1) the establishment of formal diagnostic criteria, (2) the development of rigorous research on these syndromes and (3) the integration of DMS in assessment of violence risk in schizophrenic patients.

[Schizophrenia spectrum disorders in elderly patients : Analysis of reasons for admission to a department of geriatric psychiatry]. / Erkrankungen des schizophrenen Formenkreises bei älteren Patienten : Analyse der Aufnahmegründe in einer Abteilung für Alterspsychiatrie.

OBJECTIVE: The aim of this study was to analyze the possible reasons for acute admission to a department for geriatric psychiatry. The reasons for hospitalization, the psychiatric and somatic comorbidities of the patients over 65 years old with schizophrenia, schizoaffective disorder and delusional disorder were examined to identify patterns and risk profiles. MATERIAL AND METHODS: A retrospective analysis was carried out using paper and electronic patient records of a department of acute care for geriatric psychiatry and psychotherapy. During the assessment period 206 successive patients over 65 years old were included in the study. The patient cohort included 64 patients with schizophrenia according to the international classification of diseases 10 (ICD-10, category F20), 78 patients with persistent delusional disorder (ICD-10, F22) and 64 patients with schizoaffective disorder (ICD-10, F25). RESULTS: The reason for admission for one third of the patients in all three groups was aggressive behavior, whereas delusions and hallucinations were more frequent in the groups of F20 and F22 patients than in patients with schizoaffective disorders (F25). Somatic comorbidities were seen significantly more often in the group of F22 patients than in the other two groups. CONCLUSION: Acute admission was essentially due to acute psychiatric symptoms. Additional somatic comorbidities and psychosocial influencing factors played only a minor role in this study. The patients examined in this study constituted a special group within the acute treatment of inpatient psychiatry because they showed distinctive psychopathological productive symptoms but were relatively healthy from a somatic point of view. Patients with the diagnosis of schizophrenia (F20) or schizoaffective disorder (F25) were significantly different from patients classified into the group of delusional disorders (F22).

[Late life psychotic disorders : clinical aspects]. / Troubles psychotiques de l'âge avancé : aspects cliniques.

Old age is a vulnerable period of life for either the apparition or the exacerbation of psychiatric disorders. Among others, psychoses are relatively frequent in the elderly. Alas diagnoses of non-organic psychoses are still matters of debate, namely because of the important variability of symptoms and the lack of data in the elderly population. DSM-5 adds only little precision to this nosographic issue. These questions are however important in practice, since they influence prognostic aspects and treatment choices. Thus diagnostic criteria and care remain complex. The present article summarizes these clinical aspects for the most frequent forms of late life psychoses, namely early- and late-onset schizophrenia and delusional disorder.

La vieillesse est une phase de la vie vulnérable à l'apparition ou à l'exacerbation de troubles psychiatriques, dont les psychoses, relativement fréquentes chez l'âgé. Le diagnostic des psychoses non organiques continue hélas à faire l'objet de controverses en raison notamment de l'importante variabilité des symptômes et d'un manque de données chez l'âgé. Le DSM-5 n'a apporté que peu de réponses par rapport à ces difficultés nosographiques. Cette détermination reste néanmoins importante en pratique, influençant le pronostic et les choix thérapeutiques. Les critères diagnostiques et la prise en charge restent donc complexes. Le présent article résume les aspects cliniques des psychoses de l'âge avancé les plus courantes : les schizophrénies à débuts précoce et tardif, ainsi que le trouble délirant.

Social disorganization of neighborhoods and incidence of psychotic disorders: a 7-year first-contact incidence study.

BACKGROUND: Environmental factors such as urban birth and ethnic minority position have been related to risk for psychotic disorders. There is some evidence that not only individual, but also neighborhood characteristics influence this risk. The aim of this study was to investigate social disorganization of neighborhoods and incidence of psychotic disorders. METHOD: The research was a 7-year first-contact incidence study of psychotic disorders in The Hague. Neighborhood characteristics included continuous, dichotomous and cumulative measures of socio-economic level, residential mobility, ethnic diversity, proportion of single person households, voter turnout, population density and crime level. Using multilevel Poisson regression analysis, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of psychotic disorders were calculated for the indicators of neighborhood social disorganization. RESULTS: A total of 618 incident cases were identified. Neighborhood socio-economic level and residential mobility had the strongest association with incidence of psychotic disorders [individual-level adjusted Wald χ2 1 = 13.03 (p = 0.0003) and 5.51 (p = 0.02), respectively]. All but one (proportion of single person households) of the dichotomous neighborhood indicators were significantly associated with a higher IRR. The cumulative degree of neighborhood social disorganization was strongly and linearly associated with the incidence of psychotic disorders (trend test, Wald χ2 5 = 25.76, p = 0.0001). The IRR in neighborhoods with the highest degree of social disorganization was 1.95 (95% CI 1.38-2.75) compared with the lowest disorganization category. CONCLUSIONS: The findings suggest that the risk for developing a psychotic disorder is higher for people living in socially disorganized environments. Longitudinal studies are needed to investigate causality.

Delusional infestation: an Australian multicentre study of 23 consecutive cases.

Delusional infestation remains a debilitating condition that is therapeutically challenging for clinicians. This case series identifies 23 patients with delusional infestation in an Australian setting. The majority of patients are women and unlikely to have a psychiatric comorbid background. The use of unnecessary anti-parasitic medication is prevalent.

Association of interleukin 2 (IL-2), interleukin 6 (IL-6), and TNF-alpha (TNFα) gene polymorphisms with paranoid schizophrenia in a Polish population.

Numerous reports have brought attention to the potential role of cytokines in schizophrenia. The aim of the study was to determine whether polymorphisms of IL-2, IL-6, and TNFα genes are risk factors for development of paranoid schizophrenia in a Polish population. Promoter polymorphisms of IL-6 (rs1800795), TNFα (rs1800629), and IL-2 (rs2069762) genes in patients (N=115) and controls (N=135) were genotyped by PCR-RFLP and AS-PCR methods, respectively. Genotype TT and allele T for IL-2 polymorphism, and genotype AA and allele A for TNFα polymorphism were found to be significantly associated with paranoid schizophrenia. Similarly, haplotypes CTA and GTA increased the risk (4.4 times and 5.9 times, respectively) of schizophrenia. To reveal associations between Positive and Negative Symptom Scale subscales and age at onset of schizophrenia, the authors used a novel method called Grade Correspondence Analysis. This analysis revealed that patients with early age at onset have higher scores on the Negative and General subscales of PANSS, and, in that group of patients, haplotype CTA was the most represented. As far as is known, this analysis was used for the first time with reference to genetic data.

Variations in incidence and age of onset of acute and transient psychotic disorders.

PURPOSE: To determine incidence and age of onset of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs) characterised by subtypes with polymorphic, schizophrenic and predominantly delusional symptoms, pointing out differences from schizophrenia (SZ) and bipolar affective disorder (BD). METHODS: We identified all subjects aged 15-64 years who were listed for the first time in the Danish Psychiatric Register with a diagnosis of ATPDs (n = 3,350), SZ (n = 4,576) and BD (n = 3,200) in 1995-2008. Incidence rates and rate ratios (IRR; 95 % confidence interval) by gender and age were calculated. RESULTS: The incidence of ATPDs was 6.7 per 100,000 person-years, similarly high for both genders (IRR 1.0; 0.9-1.1). Among the ATPD subtypes, polymorphic psychotic disorder was more common in females (IRR 1.4; 1.2-1.6) as opposed to those featuring schizophrenic symptoms, which tended to occur in younger males (IRR 1.4; 1.2-1.7). No significant gender difference was found for acute predominantly delusional disorder (IRR 1.0; 0.9-1.2), which had a later onset than any ATPD subtypes. SZ had an incidence twice as high in males (IRR 2.0; 1.9-2.2), and an earlier age of onset than ATPDs. A different pattern was observed for BD in terms of a slightly greater incidence in females (IRR 1.1; 1.0-1.1), and a later age of onset than both ATPDs and SZ. CONCLUSION: These findings are likely to reflect the heterogeneity of the clinical features encompassed by ATPDs, and contribute to building a case for their revision in ICD-11.

[Tardive dyskinesia induced by classical antipsychotic drugs: a Tunisian sample of schizophrenics]. / Dyskinésies tardives sous neuroleptiques classiques: à propos d'une population tunisienne de schizophrènes.

INTRODUCTION: The term tardive dyskinesia (TD) is used to describe abnormal movement, primarily associated with typical antipsychotic drugs, which are used to treat psychotic states such as schizophrenia. TD is characterised by repetitive involuntary purposeless muscle contractions that force parts of the body into abnormal, and sometimes painful, movements or postures. These movements are involuntary and are difficult or impossible to control. TD usually begins with the face, mouth, lips and tongue, and includes grimacing, lip-smacking, tongue movements and rapid blinking. It may also involve the rest of the body and produce involuntary gestures, tics and writhing movements. TD is severe physically and socially disabling. Schizophrenia is thought to be the psychiatric diagnosis the most frequently associated with TD. MATERIALS AND METHODS: The purpose of this article is to study the characteristics of TD in a Tunisian sample of 157 schizophrenics. A variety of demographic and clinical information was obtained by a questionnaire. Diagnoses of schizophrenia and TD were determined by using DSM-VI-R criteria. TD was assessed using the Abnormal Involuntary Movements Scale (AIMS). RESULTS: The average age in this sample was 37 ± 6 years. The intermediate duration of evolution of the disease was 8 ± 3 years with a medium full number of hospitalizations of 4 ± 3. We found 58% of the paranoid sub-type. The intermediate duration of exposure to classical neuroleptics was 7 ± 3 years. The average of daily neuroleptic amount was 572.9 ± 145.3 equivalent milligrams of chlorpromazine. Extended release antipsychotics were used in 64.3% of cases, with fluphenazine deaconate in 90% and haloperidol deaconate in 10%. Anticholinergics were used by 74.5% of patients, with use of biperidene in 96% of cases. Therapeutic observance was good in 89.2% of patients. The prevalence of TD was an estimated 35%. The average of AIMS score was 17 ± 9, with a minimal score of 3 and a maximal one of 34. The distribution of patients according to severity found a prevalence of 52.7% of subjects with moderate TD, 38.2% with light TD and 9.1% with severe TD. The distribution of patients according to type, according to DSM-IV criteria, found 78.4% of cases with choreiform TD, 17.5% of cases with athetosic TD and 4.1% of cases with rhythmic TD. The intermediate duration of evolution of TD was estimated at 18 ± 6 months with a minimal duration of 3 months and a maximum of 72 months. The distribution of subjects according to duration of evolution of TD found that approximately three quarter of patients presented with TD that had evolved since one duration, lower or equal to one year. The average age of patients at the moment of installation of TD was estimated at 36 ± 6 years with 22 years as a minimal and 46 years as a maximal age. Among them, 81.8% of patients were aged over 30 at the time of the installation of TD. CONCLUSION: The majority of patients with schizophrenia in Tunisia are still treated with typical antipsychotic drugs, and that's why the prevalence of TD remains relatively high.

[Personality and personality disorders in the elderly: diagnostic, course and management]. / Personnalité normale et pathologique au cours du vieillissement : diagnostic, évolution, et prise en charge.

OBJECTIVE: Little is known about personality and personality disorders in the elderly. This paper summarizes the literature in these fields. METHODS: Articles were selected using a Medline and Google Scholar search. The keywords were personality, personality disorder, aging and elderly. RESULTS: Personality is not fixed and can change across the life-time including in the elderly. Personality disorders are frequent with a prevalence estimated between 10 and 20%. These rates are essentially equivalent to that of younger groups. Clinical presentation of these disorders may change over time. Longitudinal observations generally support that the "immature" personality disorders (cluster B), show improvement over time, while the more "mature" (clusters A and C) are characterized by a more chronic course. Many patients with late onset schizophrenia or delusional disorder have a premorbid cluster A personality. Patients with cluster C personality are also stable, and exposed, like all other personality disorders, to depression. Studies suggest that personality disorders may attenuate, re-emerge or appear de novo according to the cluster and the social context. Diagnosing personality disorders in the elderly is a complex undertaking, largely because of the difficulty encountered in distinguishing functional impairments related to personality from those related to physiological and environmental aspects of aging. Tools for assessing personality disorders exist, but there is no ideal assessment instrument for geriatric personality disorders. Psychiatric history and biographical elements have to be collected accurately. Personality disorders may seriously complicate mental and physical health and quality of life. Indeed, a greater risk of depression, suicide, dementia and social isolation is shown in this population. Different types of caring and treatment exist including psychotherapy and pharmacotherapy. Pharmacological strategies should consider augmentation with psychotherapeutic strategies. Interventions should target the predominant presenting problems. Indeed, personality disordered elderly people are a heterogeneous group with frequent axis I comorbidities. Care should be taken on how to administer pharmacological treatment (risk of noncompliance or abuse), pharmacokinetics, pharmacodynamics and finally interaction with age-specific comorbidities. Psychotherapy has shown its effectiveness notably in the management of depression. In institutions, clinical identification of a personality disorder would inform and advise staff regarding the approach to be adopted, and also avoid negative countertransference, emphasizing the pathological aspect of the subject's personality and his/her suffering. CONCLUSION: Future research should develop adapted and specific diagnosis tools (dimensional and categorical mixed approach), prevention and caring in the elder population. Those studies would be able to determine the link between normal and pathological personality, mortality, depression and dementia.

[Clinical zoanthropy]. / Klinische zoantropie.

BACKGROUND: Clinical zoanthropy is a rare delusion in which a person believes himself or herself to be an animal. AIM: To assess the clinical and scientific relevance of this classical diagnostic category. METHOD: A search was conducted in the classical and scientific literature and in PubMed, Embase, and Ovid. RESULTS: Only 56 cases of clinical zoanthropy could be found in the international scientific literature. Since specific studies have yielded a relatively large numbers of cases in the past, it can be concluded that the disorder is probably more prevalent than is suggested in the literature. These cases may well be not only primary types, based on mental or unclear causes, but also secondary types, mediated by aberrant somatosensory sensations. Treatment of the underlying condition (in most cases a psychotic or mood disorder) has proved to be increasingly successful over time. CONCLUSION: Because of the possible co-occurrence of zoanthropy and alterations in coenesthesis, i.e. the sensation of physical existence, mental health workers should be on the lookout for cases of clinical zoanthropy in clinical practice and avoid treating them in the same way as they would treat other delusions. All cases that occur should be subjected to extra somatic investigations ­ including an EEG and neuroimaging ­ and treatment should be adjusted in accordance with the findings.

Gender differences in the young-onset persistent delusional disorder.

We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N = 236) with onset of illness before the age of 30 years. Gender differences in marital and employment status were significant (p-0.001). Delusion of infidelity and erotomania were more common in females, while males had more body dysmorphic and persecutory delusions (X2-20.45, p-0.009). Males had more substance dependence (X2-21.31, p < 0.001), as well as a family history of substance abuse and PDD (X2-18.5, p < 0.01). To conclude, gender differences in PDD comprised some psychopathology, co-morbidity, and family history among those with young onset PDD.

Schizophrenia spectrum disorders in later life: prevalence and distribution of age at onset and sex in a dutch catchment area.

OBJECTIVES: The prevalence of schizophrenia in later life is affected by both outflow of early onset patients, due to recovery and excess mortality, and inflow of patients with a later age at onset, making it likely that characteristics of older patients differ markedly from younger patients. We assessed the prevalence of schizophrenia and spectrum disorders and their distribution according to age at onset and sex in an elderly population. DESIGN: Case register study. SETTING AND PARTICIPANTS: All patients age 60 years and older, in contact with the Mental Health Organization in a psychiatric catchment area in Amsterdam (the Netherlands), diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. MEASUREMENTS: One-year prevalence estimates, including rates according to age group, age at onset, and sex. In addition, we determined the effect of using different criteria for age at onset. RESULTS: The one-year prevalence of all disorders was 0.71%, subdivided in 0.55% for schizophrenia, 0.14% for schizoaffective disorder, and 0.03% for delusional disorder. The one-year prevalence of early-onset schizophrenia was 0.35%, of late-onset schizophrenia 0.14%, and of very-late-onset schizophrenia-like psychosis 0.05%. Variation of onset criterion affected the proportion of early-onset versus late-onset schizophrenia patients stronger in women than in men. Women outnumbered men markedly in the prevalence estimates for most diagnostic subgroups, including early-onset schizophrenia. CONCLUSIONS: We found the prevalence of schizophrenia among older persons to be well within the range reported for younger populations. The considerable proportion with a later age at onset and the strong female preponderance are distinguishing characteristics of older patients with clinical implications.

Delusional infestation: clinical presentation in 147 patients seen at Mayo Clinic.

BACKGROUND: Delusional infestation is the conviction that one's skin is infested with foreign organisms or materials despite contradictory objective evidence. OBJECTIVE: To delineate clinical characteristics of patients presenting with delusional infestation. METHODS: We performed a retrospective study of patients meeting delusional infestation criteria who were seen for diagnosis and treatment in our tertiary care academic medical center (2001-2007). Medical records were reviewed to abstract demographic, historical, and physical findings and treatment. RESULTS: Over 7 years, 147 patients presented with delusional infestation; 87% (123/142) for another opinion. Mean age was 57 years; female-to-male ratio was 2.89 to 1; 82 (56%) were married. Mean duration of symptoms was 31 months. Employment data were available for 145 patients: 48 (33%) were self-described as disabled, 16 of whom cited delusions as their disability; 41 (28%) were retired; and 38 (26%) were employed. Reported infestations included multiple materials (45% [64/143]), not limited to insects (79% [113/143]), worms (27% [39/143]), and fibers (20% [29/143]). Most patients presented initially to dermatology or other specialties; only 3 presented to psychiatry. A high proportion (81%) had prior psychiatric conditions. Thirty-eight (26%) of the 147 patients had a shared psychotic disorder. LIMITATIONS: The retrospective nature of the study and the incompleteness of some data because not all the characteristics that were analyzed were documented for every patient. CONCLUSION: Patients were predominantly female, had a long history of symptoms, and had been seen previously at many medical centers. A large proportion were disabled or retired. Patients reported skin infestation with both animate and inanimate objects.

Imprisonment, alcohol dependence and risk of delusional disorder: a cross-sectional study.

BACKGROUND: Compared to the general population, an excess of psychotic illnesses, major depression and dependence disorders among prisoners has been reported. However, the impact of prison on detainees' psychopathology has rarely been studied. OBJECTIVE: To determine the mental disorders liable to develop or regress on entry into prison and over time. METHOD: Two samples of French prisoners detained in local prisons were interviewed using the same methodology. The first sample consisted of 267 new arrivals. The second was a random sample of 450 prisoners. Diagnoses were assessed using a thorough methodology: each prisoner was interviewed for approximately 2 hours by two clinicians. One of the clinicians used a structured clinical interview, which generates DSM IV diagnoses (MINI plus v 5.0); the second completed the procedure with an open clinical interview. The final DSM IV diagnoses were obtained as a consensus between the two approaches. Multilevel logistic regressions were used to take into account potential confounders. RESULTS: Prevalence rates of mental disorders were substantially higher in prison even for the sample of newcomers (major depression disorder: 24.7%, substance dependence: 17.6% and schizophrenia: 4.1%). Alcohol dependence disorder was significantly more frequent in the sample of newcomers (OR 1.84 [1.01-3.51]). No significant difference was evidenced between samples for substance dependence disorder. Psychotic disorders were significantly less frequent at entry into prison, particularly delusional disorder (OR 0.29 [0.08-0.98]). CONCLUSION: This study shows the contrasted potential effects of prison on psychopathology: alcohol dependence disorders were significantly more frequent for the newcomers, while the frequency of delusional disorders was lower. This evidence is arguing in favour of the validity of the old concept: prison psychosis. Moreover, prisoners should receive relevant help from clinicians to cope with these disorders.

Religious content of hallucinations in paranoid schizophrenia.

BACKGROUND: Different environmental factors are thought to be responsible for 15-20% of schizophrenia pathogenesis. Religion has long been considered a major force in human life, regardless of economic, social or political affiliation. How the perception of religion has changed over time, especially in the context of mental illness, was the focal point of this long-term comparative study. SUBJECTS AND METHODS: A random selection of 100 case histories from the years 1932, 1952, 1972 and 1992 was selected. By reviewing the subject history and medical notes, information on the presence of religious hallucinations and/or delusions were collected and grouped. RESULTS: Religious topics were demonstrated in 46.8% of the test population. Whereas there was a clear diversity of religious-themed delusions, "God", "Christ", "Mary", "Satan/devil" and "hell" all figured prominently across all reviewed years. There is a progressive decrease in the number of religious topics in paranoid schizophrenia. The transfer of holiness from historical saints onto a subject was observed. Evil dominates over good in productive symptoms in paranoid schizophrenia. The phenomenon of apocalyptic subjects in paranoid hallucinations and delusions increased after the Second World War. CONCLUSION: Religious topics of hallucinations and delusions change over time and relate to objective historical events and reflect changes in religiosity in society.

[Retrospective analysis of psychopathological presentation of psychotic episodes in adolescent inpatients]. / Retrospektywna analiza obrazu psychopatologicznego epizodów psychotycznych u hospitalizowanej mlodziezy.

AIM: Analysis of a clinical presentation and course of psychotic episodes in adolescent inpatients. METHOD: A retrospective analysis of charts of all (n=104) inpatients diagnosed with one of the schizophrenia-spectrum disorders (schizophrenia, schizotypal disorder and acute and transient psychotic disorders: F20, F21 and F23 according to ICD-10) and assessed with the Positive and Negative Syndrome Scale (PANSS) over a 10-year period (1998-2008) in the Child and Adolescent Psychiatry Department. A psychopathological profile of different disorders and correlation between symptoms and demographic and clinical data were analysed. RESULTS: Severity of symptoms correlated with length of hospitalisation. In schizophrenia higher PANSS total score and more severe some general symptoms then in schizotypal disorders were observed. Also in schizophrenia more negative symptoms then in acute and transient psychotic disorders were detected. In all three disorders, the psychopathological profile included negative symptoms. CONCLUSION: In schizophrenia psychopathological symptoms were more severe than in other disorders. Presence of negative symptoms may indicate that all schizophrenia spectrum disorders may have a neurodevelopmental component.