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Jorge A. Cervilla - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of studies with clinician rated scales on the pharmacological treatment of Delusional Disorder
International Clinical Psychopharmacology, 2020Co-Authors: Jose E Munoznegro, Alexandre Gonzalezrodriguez, Victor Peralta, Francisco Jose Gomezsierra, Jorge A. CervillaAbstract:To collect the best available evidence and to compare the first-generation antipsychotics (FGAs) vs. the second-generation antipsychotics (SGAs) in the treatment of Delusional Disorder (DD). Systematic review including studies evaluating treatment response in DD using clinician-rated scales appearing in PubMed and Web of Science databases from inception till September 2019. Those studies meeting inclusion criteria were selected. Outcomes were summarized into two response categories: (1) response to treatment equal to or greater than 50% and (2) response less than 50%. Biases and quality of the studies were evaluated, and relevant data were extracted. Finally, both narrative review and quantitative synthesis were performed. The final sample included six studies (437 patients, 318 on treatment with SGAs). Antipsychotics achieved a good response in 32.3% of patients. Effectiveness differences between FGA and SGA were only marginal favouring the former. Among the most used antipsychotics, risperidone and olanzapine showed, respectively, 34.3 and 33.7% good response. Pimozide (n = 35) demonstrated a higher response rates compared with other antipsychotics. Inpatients showed the best treatment outcomes. Antipsychotics appeared to be an effective treatment in patients with DD. FGA were slightly superior to SGA. Pimozide does not seem to provide any advantage in most DD subtypes.
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cognition and functionality in Delusional Disorder
European Psychiatry, 2019Co-Authors: Covadonga M Diazcaneja, Jorge A. Cervilla, Josep Maria Haro, Celso Arango, Enrique De PortugalAbstract:Abstract Background Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in Delusional Disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD. Methods Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan’s Disability Inventory. Results In the final linear regression models, higher scores in the Paranoid (β = 0.471, p Conclusions Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD.
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a psychopathological comparison between Delusional Disorder and schizophrenia
The Canadian Journal of Psychiatry, 2018Co-Authors: Jose E Munoznegro, Enrique De Portugal, Inmaculada Ibanezcasas, Vanessa Lozanogutierrez, Rafael Martinezleal, Jorge A. CervillaAbstract: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 ...
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a systematic review on the pharmacological treatment of Delusional Disorder
Journal of Clinical Psychopharmacology, 2016Co-Authors: Jose Eduardo Munoznegro, Jorge A. CervillaAbstract:BackgroundPharmacological treatment is the criterion standard in Delusional Disorder (DD). No second-generation antipsychotic (SGA) is specifically authorized for the treatment of DD.AimsTo evaluate the evidence available on pharmacological treatments in adults with DD and to compare first-generatio
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a dimensional comparison between Delusional Disorder schizophrenia and schizoaffective Disorder
Schizophrenia Research, 2015Co-Authors: Jose E Munoznegro, Enrique De Portugal, Josep Maria Haro, Inmaculada Ibanezcasas, Susana Ochoa, Montserrat Dolz, Miguel Ruizveguilla, Juan De Dios Luna Del Castillo, Jorge A. CervillaAbstract:Abstract Introduction Since the early description of paranoia, the nosology of Delusional Disorder has always been controversial. The old idea of unitary psychosis has now gained some renewed value from the dimensional continuum model of psychotic symptoms. Aims 1. To study the psychopathological dimensions of the psychosis spectrum; 2. to explore the association between psychotic dimensions and categorical diagnoses; 3. to compare the different psychotic Disorders from a psychopathological and functional point of view. Material and methods This is an observational study utilizing a sample of some 550 patients with a psychotic Disorder. 373 participants had a diagnosis of schizophrenia, 137 had Delusional Disorder and 40 with a diagnosis of schizoaffective Disorder. The PANSS was used to elicit psychopathology and global functioning was ascertained using the GAF measure. Both exploratory and confirmatory factor analyses of the PANSS items were performed to extract psychopathological dimensions. Associations between diagnostic categories and dimensions were subsequently studied using ANOVA tests. Results 5 dimensions – manic, negative symptoms, depression, positive symptoms and cognitive – emerged. The model explained 57.27% of the total variance. The dimensional model was useful to explained differences and similarities between all three psychosis spectrum categories. The potential clinical usefulness of this dimensional model within and between clinical psychosis spectrum categories is discussed.
Koichi Otani - One of the best experts on this subject based on the ideXlab platform.
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delusion of reduplication of tongue accompanied by dangerous self treatments in a patient with alzheimer s disease
Australian and New Zealand Journal of Psychiatry, 2011Co-Authors: Hiroshi Hayashi, Akihito Suzuki, Yoshihiko Matsumoto, Koichi OtaniAbstract: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 ...
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Successful treatment by paroxetine of Delusional Disorder, somatic type, accompanied by severe secondary depression.
Clinical Neuropharmacology, 2010Co-Authors: Hiroshi Hayashi, Shinobu Kawakatsu, Takaki Akahane, Haruyoshi Suzuki, Tetsuya Sasaki, Koichi OtaniAbstract:The case of a 42-year-old woman with Delusional Disorder, somatic type (DDST), with infestation delusion and delusions of body odor and halitosis accompanied by severe secondary depression is presented. These somatic delusions and depressive symptoms responded favorably to treatment with paroxetine 10 to 30 mg/d. Hypoperfusion in the left temporal and parietal lobes observed when she had marked clinical symptoms was improved at near recovery. The present report suggests that paroxetine is effective and a reasonable drug for DDSTwith secondary depression. It also supports previous observations that DDST is associated with hypoperfusion in the temporal and parietal lobes.
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Extremely grotesque somatic delusions in a patient of Delusional Disorder and its response to risperidone treatment
General Hospital Psychiatry, 2008Co-Authors: Takaki Akahane, Shinobu Kawakatsu, Hiroshi Hayashi, Haruyoshi Suzuki, Koichi OtaniAbstract:Abstract A 54-year-old man with Delusional Disorder, somatic type (DDST) showed extremely grotesque somatic delusions, i.e., the presence of another lower jaw with teeth and tongue accompanied by annoying sensations. These somatic delusions responded favorably to treatment with risperidone 2–3 mg/day. The single photon emission computed tomography taken when he had marked somatic delusions showed hypoperfusion in the temporal and parietal lobes. The present report suggests that delusion of reduplication of body parts, which has been generally associated with organic brain diseases, is also observed in DDST. This report also supports prior observations on the efficacy of risperidone for DDST and the association between this Disorder and hypoperfusion in the temporal and parietal lobes.
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paroxetine treatment of Delusional Disorder somatic type
Human Psychopharmacology-clinical and Experimental, 2004Co-Authors: Hiroshi Hayashi, Shinobu Kawakatsu, Shingo Oshino, Junichi Ishikawa, Koichi OtaniAbstract:A 77-year-old female showed delusion of infestation in the oral cavity. She was treated by paroxetine 20 mg/day, and the hypochondriacal delusion disappeared after 8 weeks. Hypoperfusion in the left temporal and parietal lobes which was observed when she had the delusion was normalized after resolution of the delusion. This report suggests that paroxetine may be effective for Delusional Disorder, somatic type. It also supports the previous views that this Disorder is associated with serotonergic dysfunction and hypoperfusion in the temporal and parietal lobes.
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clomipramine treatment of Delusional Disorder somatic type
International Clinical Psychopharmacology, 1999Co-Authors: Tadashi Wada, Shinobu Kawakatsu, T Nadaoka, Naoyuki Okuyama, Koichi OtaniAbstract:Four patients of Delusional Disorder, somatic type, were treated with clomipramine 60-120 mg/day. All patients showed marked clinical improvement after 27-57 days of clomipramine treatment. In one case, previous treatments by various antipsychotic drugs including pimozide had been unsuccessful. This report suggests that clomipramine is effective at least for some patients with Delusional Disorder, somatic type, including pimozide-resistant cases. It is also suggested that there is some association between Delusional Disorder, somatic type, and serotonergic dysfunction.
Alexandre Gonzalezrodriguez - One of the best experts on this subject based on the ideXlab platform.
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addressing delusions in women and men with Delusional Disorder key points for clinical management
International Journal of Environmental Research and Public Health, 2020Co-Authors: Alexandre Gonzalezrodriguez, Mary V SeemanAbstract:Delusional Disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this narrative review is to select from the clinical literature the psychosocial interventions that appear to work best for these conditions and to see whether similar strategies can be modeled or taught to family members so that tensions at home are reduced. Because the content of men's and women's delusions sometimes differ, it has been suggested that optimal interventions for the two sexes may also differ. This review explores three areas: (a) specific treatments for men and women; (b) recommended psychological approaches by health professionals, especially in early encounters with patients with DD; and (c) recommended psychoeducation for families. Findings are that there is no evidence for differentiated psychosocial treatment for men and women with Delusional Disorder. What is recommended in the literature is to empathically elicit the details of the content of delusions, to address the accompanying emotions rather than the logic of the presented argument, to teach self-soothing techniques, and to monitor behavior with respect to its safety. These recommendations have only been validated in individual patients and families. More rigorous clinical trials need to be conducted.
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a systematic review of studies with clinician rated scales on the pharmacological treatment of Delusional Disorder
International Clinical Psychopharmacology, 2020Co-Authors: Jose E Munoznegro, Alexandre Gonzalezrodriguez, Victor Peralta, Francisco Jose Gomezsierra, Jorge A. CervillaAbstract:To collect the best available evidence and to compare the first-generation antipsychotics (FGAs) vs. the second-generation antipsychotics (SGAs) in the treatment of Delusional Disorder (DD). Systematic review including studies evaluating treatment response in DD using clinician-rated scales appearing in PubMed and Web of Science databases from inception till September 2019. Those studies meeting inclusion criteria were selected. Outcomes were summarized into two response categories: (1) response to treatment equal to or greater than 50% and (2) response less than 50%. Biases and quality of the studies were evaluated, and relevant data were extracted. Finally, both narrative review and quantitative synthesis were performed. The final sample included six studies (437 patients, 318 on treatment with SGAs). Antipsychotics achieved a good response in 32.3% of patients. Effectiveness differences between FGA and SGA were only marginal favouring the former. Among the most used antipsychotics, risperidone and olanzapine showed, respectively, 34.3 and 33.7% good response. Pimozide (n = 35) demonstrated a higher response rates compared with other antipsychotics. Inpatients showed the best treatment outcomes. Antipsychotics appeared to be an effective treatment in patients with DD. FGA were slightly superior to SGA. Pimozide does not seem to provide any advantage in most DD subtypes.
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moderators and mediators of antipsychotic response in Delusional Disorder further steps are needed
World journal of psychiatry, 2020Co-Authors: Alexandre Gonzalezrodriguez, Armand Guardia, Diego Palao, Javier Labad, Mary V SeemanAbstract:Delusional Disorder (DD) has been traditionally considered a relatively rare and treatment-resistant psychotic Disorder. In the last decade, increasing attention has focused on therapeutic outcomes of individuals affected by this Disorder. The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research: (1) For which patients with DD do antipsychotic medications work best (the moderators of response); and (2) What variables best explain the relationship between such treatments and their effectiveness (the mediators of response). We searched PubMed and Google Scholar databases for English, German, French and Spanish language papers published since 2000. We also included a few classic earlier papers addressing this topic. Variables potentially moderating antipsychotic response in DD are gender, reproductive status, age, duration of illness, the presence of comorbidity (especially psychiatric comorbidity) and its treatment, brain structure, and genetics of neurochemical receptors and drug metabolizing enzymes. Antipsychotic and hormonal blood levels during treatment, as well as functional brain changes, are potential mediating variables. Some, but not all, patients with DD benefit from antipsychotic treatment. Understanding the circumstances under which treatment works best can serve to guide optimal management.
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a systematic review of the operational definitions for antipsychotic response in Delusional Disorder
International Clinical Psychopharmacology, 2018Co-Authors: Alexandre Gonzalezrodriguez, José Antonio Monreal, Diego Palao, Francesc Estrada, Javier LabadAbstract:This review aimed to examine and analyse the definitions used for antipsychotic response in Delusional Disorder (DD) and to provide a discussion of the methodology used. A systematic review was performed using the PubMed, Scopus and PsycINFO databases (1990-October 2017) according to the PRISMA statement. In addition, reference searches were performed manually through identified studies to obtain other relevant articles. The search terms included 'antipsychotic response', 'antipsychotics', 'treatment response' and 'Delusional Disorder'. After the screening and selection processes, 11 studies fulfilled our inclusion criteria using different methods to define antipsychotic response in DD. Studies included chart reviews (n=5) and observer-rated scales (n=6), in which two studies used the Clinical Global Impression-Improvement scale, two studies evaluated antipsychotic response by mean changes from the baseline to endpoint scores [Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale], one study combined the Clinical Global Impression-Improvement scale and mean changes from baseline scores (PANSS) and one study reported responder rates on the basis of a scale-derived cut-off (PANSS). A lack of consensus in the definitions of antipsychotic response in DD and a high degree of heterogeneity of the methods used are reflected. Recent proposals on the use of scale-derived cut-offs to evaluate antipsychotic response in schizophrenia would be highly recommended for DD research.
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t225 operational definitions for antipsychotic response in Delusional Disorder a systematic and critical review
Schizophrenia Bulletin, 2018Co-Authors: Alexandre Gonzalezrodriguez, José Antonio Monreal, Diego Palao, Francesc Estrada, Javier LabadAbstract:AbstractBackgroundRecent research in schizophrenia has revealed that there is no consensus to which is the most appropriate definition for antipsychotic response. Response rates allow the clinician to know how many subjects have responded to a specific treatment. However, once again, levels of response or the cutoff chosen have been subject of controversy, as a high variety of values have been applied in schizophrenia research. This systematic review aimed to examine all the definitions used for antipsychotic response in Delusional Disorder (DD), to analyze them and provide a discussion of the methodology used.MethodsA systematic computerized literature search was performed by using Pubmed, Scopus and PsycINFO databases (1990-September 2017) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In addition, reference searches were manually conducted through identified studies in order to obtain other relevant articles not previously found on the initial search strategy. The following search terms were used: [(Antipsychotic response) OR (antipsychotics) OR (treatment response)] AND [(Delusional Disorder)]. Studies were only included if the met our inclusion criteria: (a) be published in a peer-reviewed journal, (b) prospective or retrospective studies focusing on antipsychotic response, (c) studies assessing response in DD based on clinical judgment or clinical records, (d) studies including a definition of antipsychotic response based on assessment scales and (e) diagnostic criteria based on ICD or DSM. The literature search strategy was conducted independently by two of the authors (A.G. and F.E.). The last search was conducted on 30th October, 2017.ResultsSeventy-four studies were initially identified. 39 studies were excluded after titles and abstracts were read, as they did not meet our initial inclusion criteria or met any of the exclusion criteria. 22 studies were excluded after reading the full text-document as they failed to meet our inclusion criteria or met any exclusion criteria, and 2 articles were excluded as studies for the assessment were duplicated. After the screening and selection processes, a total of 11 studies met our inclusion criteria, using different methods to define antipsychotic response in DD. Chart review (n=5) and observer-rated scales (n=6), from which 2 of them used the CGI improvement scale for assessing response, 2 studies evaluated it by mean changes from baseline to endpoint scores (PANSS, BPRS), one study combined the CGI improvement scale and mean changes from baseline scores (PANSS), and one study reported responder rates based on a scale-derived cutoff (PANSS).DiscussionA lack of consensus in the definitions of antipsychotic response in Delusional Disorder and a high degree of heterogeneity of the methods used are reflected on this systematic review. Although no consensus for the response definition appears to exist in Delusional Disorder, there is a need to better quantify the treatment response in terms of percentages of response, and linking these findings with those derived from the CGI. Recommendations from Leucht (2014) in schizophrenia would be a first step in defining response among Delusional Disorder patients.
Enrique De Portugal - One of the best experts on this subject based on the ideXlab platform.
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cognition and functionality in Delusional Disorder
European Psychiatry, 2019Co-Authors: Covadonga M Diazcaneja, Jorge A. Cervilla, Josep Maria Haro, Celso Arango, Enrique De PortugalAbstract:Abstract Background Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in Delusional Disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD. Methods Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan’s Disability Inventory. Results In the final linear regression models, higher scores in the Paranoid (β = 0.471, p Conclusions Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD.
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a psychopathological comparison between Delusional Disorder and schizophrenia
The Canadian Journal of Psychiatry, 2018Co-Authors: Jose E Munoznegro, Enrique De Portugal, Inmaculada Ibanezcasas, Vanessa Lozanogutierrez, Rafael Martinezleal, Jorge A. CervillaAbstract: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 ...
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a dimensional comparison between Delusional Disorder schizophrenia and schizoaffective Disorder
Schizophrenia Research, 2015Co-Authors: Jose E Munoznegro, Enrique De Portugal, Josep Maria Haro, Inmaculada Ibanezcasas, Susana Ochoa, Montserrat Dolz, Miguel Ruizveguilla, Juan De Dios Luna Del Castillo, Jorge A. CervillaAbstract:Abstract Introduction Since the early description of paranoia, the nosology of Delusional Disorder has always been controversial. The old idea of unitary psychosis has now gained some renewed value from the dimensional continuum model of psychotic symptoms. Aims 1. To study the psychopathological dimensions of the psychosis spectrum; 2. to explore the association between psychotic dimensions and categorical diagnoses; 3. to compare the different psychotic Disorders from a psychopathological and functional point of view. Material and methods This is an observational study utilizing a sample of some 550 patients with a psychotic Disorder. 373 participants had a diagnosis of schizophrenia, 137 had Delusional Disorder and 40 with a diagnosis of schizoaffective Disorder. The PANSS was used to elicit psychopathology and global functioning was ascertained using the GAF measure. Both exploratory and confirmatory factor analyses of the PANSS items were performed to extract psychopathological dimensions. Associations between diagnostic categories and dimensions were subsequently studied using ANOVA tests. Results 5 dimensions – manic, negative symptoms, depression, positive symptoms and cognitive – emerged. The model explained 57.27% of the total variance. The dimensional model was useful to explained differences and similarities between all three psychosis spectrum categories. The potential clinical usefulness of this dimensional model within and between clinical psychosis spectrum categories is discussed.
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deficits in executive and memory processes in Delusional Disorder a case control study
PLOS ONE, 2013Co-Authors: Inmaculada Ibanezcasas, Enrique De Portugal, Nieves González, Josep Maria Haro, Kathryn Mckenney, Judith Usall, Miguel Perezgarcia, Jorge A. CervillaAbstract:Objective: Delusional Disorder has been traditionally considered a psychotic syndrome that does not evolve to cognitive deterioration. However, to date, very little empirical research has been done to explore cognitive executive components and memory processes in Delusional Disorder patients. This study will investigate whether patients with Delusional Disorder are intact in both executive function components (such as flexibility, impulsivity and updating components) and memory processes (such as immediate, short term and long term recall, learning and recognition). Methods: A large sample of patients with Delusional Disorder (n=86) and a group of healthy controls (n=343) were compared with regard to their performance in a broad battery of neuropsychological tests including Trail Making Test, Wisconsin Card Sorting Test, Colour-Word Stroop Test, and Complutense Verbal Learning Test (TAVEC). Results: When compared to controls, cases of Delusional Disorder showed a significantly poorer performance in most cognitive tests. Thus, we demonstrate deficits in flexibility, impulsivity and updating components of executive functions as well as in memory processes. These findings held significant after taking into account sex, age, educational level and premorbid IQ.
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Empirical redefinition of Delusional Disorder and its phenomenology: the DELIREMP study
Comprehensive Psychiatry, 2012Co-Authors: Enrique De Portugal, Nieves González, Josep Maria Haro, Covadonga M. Díaz-caneja, Juan De Dios Luna Del Castillo, Jorge A. CervillaAbstract:Abstract Aims Since Kraepelin, the controversy has persisted surrounding the nature of Delusional Disorder (DD) as a separate nosological entity or its clinical subtypes. Nevertheless, there has been no systematic study of its psychopathological structure based on patient interviews. Our goal was to empirically explore syndromic subentities in DD. Methods A cross-sectional study was conducted in 86 outpatients with DSM-IV-confirmed DD using SCID-I. Psychopathological factors were identified by factor analysis of PANSS scores. The association between these factors and clinical variables (as per standardized instruments) was analyzed using uni- and multivariate techniques. Results PANSS symptoms were consistent with four factors ( Paranoid, Cognitive, Schizoid , and Affective dimensions), accounting for 59.4% of the total variance. The Paranoid Dimension was associated with premorbid paranoid personality Disorder, more adverse childhood experiences, chronic course, legal problems, worse global functioning, and poorer treatment adherence and response. The Cognitive Dimension was associated with poorer cognitive functioning, premorbid substance abuse, comorbid somatic diseases, mainly non-prominent visual hallucinations, fewer comorbid depressive Disorders, and poorer global functioning. The Schizoid Dimension was associated with being single, a family history of schizophrenia, premorbid personality Disorders (largely schizoid and schizotypal), non-prominent auditory hallucinations, and dysthymia. Finally, the Affective Dimension was associated with a family history of depression, premorbid obsessive personality, somatic delusions, absence of reference delusions, tactile and olfactory hallucinations, depressive and anxiety Disorders, risk of suicide, and higher perceived stress. Conclusion The identification and clinical validation of four separate psychopathological dimensions in DD provide evidence toward a more accurate conceptualization of DD and its types.
Karishma Kulkarni - One of the best experts on this subject based on the ideXlab platform.
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the impact of depressive symptoms on the clinical presentation of persistent Delusional Disorder
Asian Journal of Psychiatry, 2018Co-Authors: Karishma Kulkarni, Rashmi Arasappa, Krishna M Prasad, Amit Zutshi, Prabhat Chand, Kesavan Muralidharan, Pratima MurthyAbstract:Abstract Background Our aim was to investigate the influence of depressive symptoms on the clinical presentation of Persistent Delusional Disorder (PDD). Methods We have previously conducted a retrospective review of patients diagnosed with PDD (n = 455). We divided this sample into two groups according to the presence or absence of co-morbid depressive symptoms – a subsample of PDD with depressive co-morbidity (PDD + D; n = 187) and a subsample of PDD without depressive co-morbidity (PDD only; n = 268). Results PDD + D group had a significantly younger age at onset of PDD. The PDD + D group received significantly more antidepressants but had similar response and adherence rates. Conclusions The presence of depressive symptoms in 41% of the study population did not appear to influence the clinical presentation or response to treatment.
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risperidone versus olanzapine in the acute treatment of persistent Delusional Disorder a retrospective analysis
Psychiatry Research-neuroimaging, 2017Co-Authors: Karishma Kulkarni, Rashmi Arasappa, Amit Zutshi, Prabhat Chand, Pratima Murthy, Krishna Prasad M, Mariamma Philip, Kesavan MuralidharanAbstract:There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our study indicates that acute PDD responds well to treatment with both risperidone and olanzapine, provided adherence can be ensured. In the absence of specific treatment guidelines and randomized controlled trials for PDD, our analysis reaffirms the efficacy of SGAs.
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comorbid depressive symptoms in persistent Delusional Disorder a retrospective study from india
European Psychiatry, 2017Co-Authors: Karishma Kulkarni, Rashmi Arasappa, Krishna M Prasad, Amit Zutshi, Prabhat Chand, Pratima Murthy, Muralidharan KesavanAbstract:Background Previous studies have reported depressive symptoms in patients with persistent Delusional Disorder (PDD). Patients with PDD and depression may need antidepressants for treatment. Aim The aim of the study was to compare the sociodemographic profile, clinical presentation and treatment response in patients with PDD with and without comorbid depressive symptoms. Methods We conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455). We divided the patients into PDD + depression (n = 187) and PDD only (n = 268) for analysis. Results Of the 187 patients with PDD + D, only eighteen (3.9%) were diagnosed with syndromal depression. There were no significant differences in sociodemographic profile including sex, marital and socioeconomic status (all P > 0.05). PDD + D group had a significantly younger age at onset ([PDD + D: 30.6 9.2 years vs. PDD: 33.5 11.1 years]; t = 2.9, P 0.3). However, comorbid substance dependence was significantly higher in patients with PDD only. (χ2 = 5.3, P = 0.02). In terms of treatment, response to antipsychotics was also comparable ([> 75% response: PDD + D = 77/142 vs. PDD = 106/179); χ2 = 1.9, P = 0.3). There was a significant difference between the two groups in terms of antidepressant treatment ([PDD + D = 32/187; 17% vs PDD: 17/268; 6%), χ2 = 12.9, P = 0.001). Discussion Patients with PDD + D had significantly earlier onset of illness. These patients may require antidepressants for treatment.
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clinical presentation and course of persistent Delusional Disorder data from a tertiary care center in india
The Primary Care Companion To The Journal of Clinical Psychiatry, 2016Co-Authors: Karishma Kulkarni, Rashmi Arasappa, Krishna M Prasad, Amit Zutshi, Prabhat Chand, Kesavan Muralidharan, Pratima MurthyAbstract:OBJECTIVE: Despite its long history as a psychiatric diagnosis, little is known about the sociodemographic and clinical profile of persistent Delusional Disorder (PDD) or its subtypes, treatment response, and outcomes, particularly in India. We examined the clinical characteristics and course of PDD in patients presenting to a tertiary neuropsychiatry center in India. METHOD: A retrospective chart review of patients diagnosed with PDD (ICD-10) between January 2000 and May 2014 was conducted. Sociodemographic and clinical data including age at onset, total duration of the illness, clinical symptoms and treatment, hospitalizations, occupational functioning, and follow-up were extracted from the files. The study was approved by the institute ethics committee. RESULTS: The sample (N = 455) consisted of 236 men and 219 women. The mean age at onset was 32.36 ± 10.47 years. The most common delusion was infidelity (n = 203, 44.6%) followed by persecution (n = 149, 32.7%). Hallucinations were present in 78 (17.1%), depressive symptoms in 187 (41.1%), and comorbid substance dependence in 61 (13.4%) subjects; 141 subjects (31.0%) had a family history of mental illness. Follow-up data were available for 308 subjects, of whom 285 (92.5%) reported good compliance with medication. Of the subjects, 163 (52.9%) showed a good response to treatment. The diagnosis of PDD remained unchanged in 274 of 308 subjects (88.9%). CONCLUSION: In our center, PDD appears to be uncommon and has a near-equal gender representation. Infidelity was the most common delusion, which is in contrast to the reported literature. The diagnosis of PDD appears to be stable with good response to atypical antipsychotics if compliance can be ensured.