Delusional Disorder over the Reproductive Life Span: The Potential Influence of Menopause on the Clinical Course.

Background and Objectives. Recent evidence supports an association between estrogen levels and severity of psychopathology in schizophrenia women. Our main goal was to investigate whether delusional disorder (DD) women with premenopausal onset and those with postmenopausal onset differ in demographic and clinical features. Methods. Psychopathological symptoms were assessed in 80 DD women (DSM-IV-TR), at baseline and after six and 24 months. Scores in the PANSS, PSP for functionality, HRSD 17 items, C-SSRS for suicide, and the SUMD were considered outcome variables. For comparison purposes, t- and χ (2)-tests were performed and nonparametric tests when necessary. Analysis of Covariance (ANCOVA) was conducted for multivariate comparisons. Results. 57 out of 80 DD women completed the study. When unadjusted, DD with premenopausal onset had a longer DUP, higher educational level, and a tendency toward higher rates of gynaecological disorders. Erotomanic type was most frequent in DD women premenopausal onset, and somatic and jealous types were most frequent in those with postmenopausal onset. After 24 months, DD women with premenopausal onset showed higher depressive symptoms and a tendency toward higher rates of psychotic relapses. Conclusions. Our results support that some aspects of psychopathology and insight may differ according to the onset of DD and the reproductive status.

Variables reproductivas y uso de consulta ginecológica en pacientes con trastorno delirante / Reproductive variables and gynaecological service use in delusional disorder outpatients

Introducción: Se ha formulado la hipótesis de que los estrógenos confieren un efecto protector en los trastornos psicóticos. En las mujeres con esquizofrenia se evidencia una edad de la menarquia más tardía, menos embarazos y una edad más temprana de la menopausia. Sin embargo, hay poca información disponible centrada en mujeres con trastorno delirante (TD). El objetivo del presente estudio fue evaluar las variables ginecológicas y la psicopatología, al igual que el uso de servicios ginecológicos en casos ambulatorios de mujeres con TD. Métodos: Entre 2008 y 2013, en el Hospital Clínic de Barcelona fueron atendidos 46 pacientes con TD (DSM-IV-TR). Se registraron las variables demográficas y clínicas, al igual que las ginecológicas en 25 mujeres con TD. Se administraron las escalas clínicas siguientes: Hamilton de 17 ítems para depresión, escala de evaluación de síntomas negativos y positivos para psicopatología, escala de funcionamiento personal y social para funcionalidad y escala Columbia de evaluación de la severidad suicida. Resultados: La edad media (DE) de la menarquia fue de 12,83 (1,54) años, la edad media de la menopausia fue de 48,73 (2,69), y la edad media de inicio del trastorno fue de 48,70 (13,03) años. El 48% de los pacientes de la muestra no había recibido atención ginecológica en los 2-3 últimos años. No se encontraron correlaciones estadísticamente significativas entre la edad de la menopausia y la edad de inicio del trastorno. La edad de la menopausia mostró una tendencia a correlacionarse negativamente con las puntuaciones obtenidas en la escala de funcionamiento personal y social total (r = −0,431; p = 0,074), y se asoció positivamente con la intensidad de la ideación suicida (r = 0,541; p = 0,038). Sin embargo, tras un ajuste para las variables de apoyo social, esta relación dejó de ser significativa. Conclusiones: A pesar del reducido tamaño muestral, el presente estudio es la primera investigación que examina específicamente las variables ginecológicas en el TD. Se encontró una reducida tasa de asistencia en el uso de los servicios ginecológicos. No se encontraron correlaciones estadísticamente significativas entre la edad de la menopausia y otras variables clínicas (AU)

Introduction: Oestrogens have been hypothesized to have a protective effect in psychotic disorders. Women with schizophrenia have a later age of menarche, fewer pregnancies and earlier age of menopause. However, little information is available focusing on delusional disorder (DD). We aimed to evaluate gynaecological variables and psychopathology, and rates of gynaecological service use in female DD outpatients. Methods: Fourty-six outpatients with DD (DSM-IV-TR) were attended at the Hospital Clinic of Barcelona, from 2008 to 2013. Demographic and clinical variables, as well as gynaecological features were recorded in twenty-five women with DD. Hamilton Rating Scale for Depression-17 for depression, Positive and Negative Syndrome Scale for psychopathology, Personal and Social Performance for functionality, and Columbia Suicide Severity Rating Scale were assessed. Results: Mean age of menarche (SD) was 12.83(1.54) years, mean age of menopause 48.73(2.69), mean age at onset of DD was 48.70(13.03). 48% of the sample did not receive gynaecological attention in the last 2-3 years. No statistically significant correlations were found between age at menopause and age at onset of DD. Age at menopause showed a tendency to be negatively correlated with Personal and Social Performance total scores (r = −0.431; P = .074), and was positively associated with suicidal ideation intensity (r = 0.541; P = .038). However, after controlling for social support variables, this relationship was no longer significant. Conclusions: Although a small sample size, this is the first study to specifically examine gynaecological variables in DD. Low compliance rates in gynaecological service use were found. No correlations between age at menopause and clinical variables were statistically significant (AU)

[Reproductive variables and gynaecological service use in delusional disorder outpatients]. / Variables reproductivas y uso de consulta ginecológica en pacientes con trastorno delirante.

INTRODUCTION: Oestrogens have been hypothesized to have a protective effect in psychotic disorders. Women with schizophrenia have a later age of menarche, fewer pregnancies and earlier age of menopause. However, little information is available focusing on delusional disorder (DD). We aimed to evaluate gynaecological variables and psychopathology, and rates of gynaecological service use in female DD outpatients. METHODS: Fourty-six outpatients with DD (DSM-IV-TR) were attended at the Hospital Clinic of Barcelona, from 2008 to 2013. Demographic and clinical variables, as well as gynaecological features were recorded in twenty-five women with DD. Hamilton Rating Scale for Depression-17 for depression, Positive and Negative Syndrome Scale for psychopathology, Personal and Social Performance for functionality, and Columbia Suicide Severity Rating Scale were assessed. RESULTS: Mean age of menarche (SD) was 12.83(1.54) years, mean age of menopause 48.73(2.69), mean age at onset of DD was 48.70(13.03). 48% of the sample did not receive gynaecological attention in the last 2-3 years. No statistically significant correlations were found between age at menopause and age at onset of DD. Age at menopause showed a tendency to be negatively correlated with Personal and Social Performance total scores (r = -0.431; P = .074), and was positively associated with suicidal ideation intensity (r = 0.541; P = .038). However, after controlling for social support variables, this relationship was no longer significant. CONCLUSIONS: Although a small sample size, this is the first study to specifically examine gynaecological variables in DD. Low compliance rates in gynaecological service use were found. No correlations between age at menopause and clinical variables were statistically significant.

Estudio retrospectivo del tratamiento y uso de consultas en un grupo clínico de pacientes con trastorno delirante / A descriptive retrospective study of the treatment and outpatient service use in a clinical group of delusional disorder patients

Introducción: Las diferencias de género en la asistencia a consultas por trastorno delirante han sido escasamente estudiadas. Además, el trastorno delirante es tradicionalmente considerado como un trastorno resistente al tratamiento. Material y métodos: Se llevó a cabo un estudio retrospectivo longitudinal que incluyó 78 pacientes con trastorno delirante (DSM-IV-TR) que ingresaron consecutivamente en nuestro centro en un período de 10 años. Se realizó un seguimiento de los pacientes durante un a˜no con el objetivo de describir variables demográficas y clínicas y comparar la efectividad terapéutica. En este estudio, debido a su naturaleza no intervencionista, se realizó un análisis de las medidas de efectividad indirecta. La muestra se dividió en 3 grupos según el tratamiento antipsicótico recibido en el primer ingreso. Resultados: Veintitrés pacientes recibieron risperidona inyectable de acción prolongada (RILD), 30 risperidona oral y 25 otros antipsicóticos atípicos orales. Las mujeres con trastorno delirante presentaron un inicio más tardío del trastorno y requirieron un mayor tiempo de hospitalización. No se encontraron diferencias estadísticamente significativas entre los 3 grupos de tratamiento con respecto a los datos demográficos, al funcionamiento social y personal, así como a la psicopatología en el ingreso. En el seguimiento durante un año el grupo RILD mostró un mayor porcentaje de permanencia al final del período evaluado. Además, el grupo RILD requirió con menor frecuencia un tratamiento con antidepresivos y benzodiazepinas. Conclusiones: Concluimos que el tratamiento con RILD podría disminuir las pérdidas en el seguimiento del trastorno delirante en comparación con otros antipsicóticos atípicos (AU)

Introduction: Gender differences in attendance rates for appointments in delusional disorder have been poorly studied. Furthermore, delusional disorder is traditionally considered a treatment-resistant disorder. Material and methods: We conducted a longitudinal retrospective study with a one-year followup, including 78 delusional disorder patients (DSM-IV-TR), consecutively admitted over a period of 10 years. We performed a follow-up for one year in order to describe demographic and clinical variables, and to compare the therapeutic effectiveness. In this study, due to the non-interventional nature of this study, indirect measures were used to measure treatment effectiveness. The sample was divided into three groups according to the antipsychotic received at the first admission. Results: Twenty-three patients received Risperidone Long-Acting Injection (RILD), 30 oral risperidone, and 25 patients received other oral atypical antipsychotics. Delusional disorder women had a later age at onset and needed a longer duration of hospitalization. No statistically significant differences were found between the three treatment groups as regards demographic data, social and personal functioning, and psychopathology at admission. The RILD group showed higher maintenance rates at the end of the follow-up period. Furthermore, the RILD group required treatment with antidepressants and benzodiazepines less often. Conclusions: We concluded that treatment with RLAI may increase maintenance rates at followup in DD patients when compared with other oral atypical antipsychotics (AU)

Suicidal ideation and suicidal behaviour in delusional disorder: a clinical overview.

Background. Most of the existing studies suggest that suicide is one of the leading causes of premature death in patients with chronic psychotic disorders. However, very few studies have specifically investigated suicidal behaviour in patients with delusional disorder. Thus, our objective was to review the literature regarding the percentage of lifetime ideation and suicidal behaviour in delusional disorder in order to provide suggestions for clinical practice. Methods. MEDLINE and PsycINFO were searched from January 1980 to September 2012 using the following keywords: delusional disorder, paranoia, suicidal ideation, and suicidal behaviour. Results. A total of 10 studies were identified and included in the review. The percentage of suicidal behaviour in delusional disorder was established between 8 and 21%, which is similar to schizophrenia. Suicidal ideation and suicide attempts were more frequent in patients showing persecutory and somatic delusions in the reviewed studies. Conclusions. To the best of our knowledge this is the first attempt to specifically review the suicide phenomenon in patients with delusional disorder. Interestingly, our results support the notion that percentages of both suicidal ideation and behaviour in delusional disorder are similar to patients with schizophrenia.

Delusional disorder: no gender differences in age at onset, suicidal ideation, or suicidal behavior

Objective: To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD). Methods: We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates. Results: Seventy-six percent of the patients were women. The average age at onset was 48.76±12.67 years, mean age at first psychiatric consultation was 54.13±13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up. Conclusions: Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders. .

Effectiveness of long-acting injectable antipsychotics in delusional disorders with nonprominent hallucinations and without hallucinations.

The presence of nonprominent hallucinations in delusional disorder (DD) has been accepted by the current Diagnostic and Statistical Manual of Mental Disorders, 5th ed. A recent meta-analysis revealed that patients with schizophrenia treated with long-acting atypical antipsychotics showed a significant improvement in psychotic symptoms. However, little research has been conducted on DD. Our goal was to investigate demographic and clinical differences between two subgroups of DD patients, those with nonprominent hallucinations and those without hallucinations, and to determine treatment effectiveness of long-acting antipsychotics in these patients. We conducted a longitudinal observational study with a 6-month follow-up period in a clinical group of 45 DD outpatients. Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale, and Hamilton Rating Scale for Depression-17 (HRSD-17) were used for assessment. Age at onset of DD, scores in baseline assessment scales, and drug compliance were included in the analysis as potential confounders. When uncorrected for influencing factors, patients treated with long-acting antipsychotics showed lower scores in PANSS positive and negative subscales. There were no statistically significant clinical subgroup×treatment group interactions for any of the scores in assessment scales at 6 months. After adjustment, patients treated with long-acting antipsychotics showed lower scores in the PANSS negative subscale and a tendency toward improvement in scores in the PANSS positive subscale. Our study suggests that risperidone long-acting injection and paliperidone palmitate long-acting injection may be useful in the treatment of DD patients, specifically those with nonprominent hallucinations.

Impacto de la conducta suicida en el trastorno delirante: descripción de una serie de 44 casos / Clinical significance of suicidal behaviour in delusional disorder: A 44 case-series descriptive study

Fundamento y objetivo: La conducta suicida en el trastorno delirante (TD) ha sido escasamente estudiada. El objetivo del estudio fue describir la prevalencia de depresión clínicamente significativa, ideación y conducta suicida en TD, y relacionar el suicidio con síntomas psicóticos y/o depresivos. Pacientes y método: Se realizó un estudio transversal que incluyó 44 pacientes ambulatorios con TD (DSM- IV -TR). Se registraron datos sociodemográficos, clínicos y puntuaciones en las escalas clínicas: Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale, Hamilton Depression Rating Scale (17-item version) y Columbia Suicide Severity Rating Scale. Se dividió la muestra según la presencia o ausencia de comorbilidad depresiva (CD). Resultados: Quince pacientes (34,1%) presentaron CD, 14 (31,8%) ideación suicida y 7 (15,9%) conducta suicida en los 2 años previos. Los pacientes con CD presentaron una edad de inicio más precoz, se vincularon antes a la red de salud mental y presentaron puntuaciones más altas en la subescala general de la PANSS (p = 0,043) y en intensidad de la ideación suicida (p = 0,001). Conclusiones: En nuestra muestra, los pacientes con TD y CD presentan con más frecuencia ideación y conducta suicida, respecto a los que no presentan CD (AU)

Background and objective: Suicidal behaviour in delusional disorder (DD) has been poorly studied. This study aimed to describe the prevalence of clinically significant depression, suicidal ideation and behaviour in these patients, and to relate them with psychotic or depressive symptoms. Patients and method: A cross-sectional study including 44 outpatients with DD (DSM-IV-TR) was conducted. Demographic and clinical data, as well as scores in clinical assessment scales: Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale, Hamilton Depression Rating Scale (17-item version) and Columbia Suicide Severity Rating Scale, were recorded. The sample was divided into 2 groups according to presence or absence of comorbid depression (CD). Results: Fifteen patients (34.1%) had CD, 14 (31.8%) suicidal ideation and 7 (15.9%) suicidal behaviour in the previous 2 years. Patients with CD had an earlier age at onset and for a first psychiatric appointment, and had higher scores on the PANSS general subscale (p = 0,043) and in intensity of suicidal ideation (p = 0,001). Conclusions: In our sample, patients with DD and CD have more frequently suicidal ideation and behaviour than those without CD (AU)

Delusional disorder: no gender differences in age at onset, suicidal ideation, or suicidal behavior.

OBJECTIVE: To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD). METHODS: We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates. RESULTS: Seventy-six percent of the patients were women. The average age at onset was 48.76 ± 12.67 years, mean age at first psychiatric consultation was 54.13 ± 13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up. CONCLUSIONS: Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders.

A descriptive retrospective study of the treatment and outpatient service use in a clinical group of delusional disorder patients.

INTRODUCTION: Gender differences in attendance rates for appointments in delusional disorder have been poorly studied. Furthermore, delusional disorder is traditionally considered a treatment-resistant disorder. MATERIAL AND METHODS: We conducted a longitudinal retrospective study with a one-year follow-up, including 78 delusional disorder patients (DSM-IV-TR), consecutively admitted over a period of 10 years. We performed a follow-up for one year in order to describe demographic and clinical variables, and to compare the therapeutic effectiveness. In this study, due to the non-interventional nature of this study, indirect measures were used to measure treatment effectiveness. The sample was divided into three groups according to the antipsychotic received at the first admission. RESULTS: Twenty-three patients received Risperidone Long-Acting Injection (RILD), 30 oral risperidone, and 25 patients received other oral atypical antipsychotics. Delusional disorder women had a later age at onset and needed a longer duration of hospitalization. No statistically significant differences were found between the three treatment groups as regards demographic data, social and personal functioning, and psychopathology at admission. The RILD group showed higher maintenance rates at the end of the follow-up period. Furthermore, the RILD group required treatment with antidepressants and benzodiazepines less often. CONCLUSIONS: We concluded that treatment with RLAI may increase maintenance rates at follow-up in DD patients when compared with other oral atypical antipsychotics.

[Clinical significance of suicidal behaviour in delusional disorder: a 44 case-series descriptive study]. / Impacto de la conducta suicida en el trastorno delirante: descripción de una serie de 44 casos.

BACKGROUND AND OBJECTIVE: Suicidal behaviour in delusional disorder (DD) has been poorly studied. This study aimed to describe the prevalence of clinically significant depression, suicidal ideation and behaviour in these patients, and to relate them with psychotic or depressive symptoms. PATIENTS AND METHOD: A cross-sectional study including 44 outpatients with DD (DSM-IV-TR) was conducted. Demographic and clinical data, as well as scores in clinical assessment scales: Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale, Hamilton Depression Rating Scale (17-item version) and Columbia Suicide Severity Rating Scale, were recorded. The sample was divided into 2 groups according to presence or absence of comorbid depression (CD). RESULTS: Fifteen patients (34.1%) had CD, 14 (31.8%) suicidal ideation and 7 (15.9%) suicidal behaviour in the previous 2 years. Patients with CD had an earlier age at onset and for a first psychiatric appointment, and had higher scores on the PANSS general subscale (p=0,043) and in intensity of suicidal ideation (p=0,001). CONCLUSIONS: In our sample, patients with DD and CD have more frequently suicidal ideation and behaviour than those without CD.

Delusional disorder: An overview of affectivesymptoms and antidepressant use

Background and Objectives: In clinical practice, the coexistence of delusionsand affective symptoms is often observed. The current Diagnostic and StatisticalManual of Mental Disorders, fourth edition- Text Revision (DSM-IV-TR) accepts the existenceof mood disturbances in delusional disorder. Little research has been done regardingthis field and prevalence rates are unclear. Our purpose was to review the frequency ofaffective symptoms in delusional disorder patients and to identify the proportion of thesepatients that are reported to be treated with antidepressants.Methods: Three electronic databases were searched from 1980 to July 2012: MEDLINE,PsycINFO and PubMed, using the following keywords: delusional disorder, depression,affective illness, antidepressants and paranoia.Results: A high frequency of affective disturbances was found in this population (21-55.8%). In contrast, a low antidepressants prescription rate was shown. When focusing ondelusional disorder somatic subtype, a particularly high mood disorder comorbidity ratewas described and a good efficacy of antidepressant drugs was reported, in monotherapyor in combination with antipsychotics (AU)