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An Australian study of delusional disorder in late life

Published online by Cambridge University Press:  29 July 2019

Janani Nagendra  and
John Snowdon
Janani Nagendra*
Affiliation:
Concord Centre for Mental Health, Concord, NSW, Australia
John Snowdon
Affiliation:
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
*
Correspondence should be addressed to: Janani Nagendra, Concord Centre for Mental Health, Hospital Road, Concord, NSW 2139, Australia. Phone: + 61 2 9767 5000. Email: janani.nagendra@health.nsw.gov.au.
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Abstract

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.

Keywords

delusionsantipsychoticsdementiaaging
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 4: Issue Theme: Serious Mental Illnesses in Older Adults , April 2020 , pp. 453 - 462
Copyright
© International Psychogeriatric Association 2019

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References

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders: DSM-IIIR. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association.Google Scholar
Bleuler, E. (1912). Affectivity, Suggestibility, Paranoia. Translated by Ricksher, C.. New York: State Hospitals Press.Google Scholar
De Portugal, E., Gonzalez, N., Haro, J. M., Autonell, J. and Cervilla, J. A. (2008). A descriptive case-register study of delusional disorder. European Psychiatry, 23, 125–133.CrossRefGoogle ScholarPubMed
De Portugal, E., Martinez, C., Gonzalez, N., del Amo, V., Haro, J. M. and Cervilla, J. A. (2011). Clinical and cognitive correlates of psychiatric comorbidity in delusional disorder outpatients. Australian and New Zealand Journal of Psychiatry, 45, 416–425.CrossRefGoogle ScholarPubMed
De Portugal, E.et al. (2013). Empirical redefinition of delusional disorder and its phenomenology: the DELIREMP study. Comprehensive Psychiatry, 54, 243–255.CrossRefGoogle ScholarPubMed
Freeman, D. (2016). Persecutory delusions: a cognitive perspective on understanding and treatment. The Lancet Psychiatry, 3, 685–692.CrossRefGoogle ScholarPubMed
Freeman, D. and Garety, P. (2014). Advances in understanding and treating persecutory delusions: a review. Social Psychiatry and Psychiatric Epidemiology, 49, 1179–1189.CrossRefGoogle ScholarPubMed
Freeman, D. and Waite, F. (2017). Persistent persecutory delusions: the spirit, style and content of targeted treatment. World Psychiatry, 16, 208–209.CrossRefGoogle ScholarPubMed
González-Rodríguez, A., Catalán, R., Penadés, R., Ruiz, V., Torra, M. and Bernardo, M. (2016). Antipsychotic response in delusional disorder and schizophrenia: a prospective cohort study. Actas Españolas de Psiquiatria, 44, 125–135.Google ScholarPubMed
González-Rodríguez, A., Estrada, F., Monreal, J., Palao, D. and Labad, J. (2018). Operational definitions for antipsychotic response in delusional disorder: a systematic and critical review. Schizophrenia Bulletin, 44, 203–204.CrossRefGoogle Scholar
Grover, S., Biswas, P. and Avasthi, A. (2007). Delusional disorder: study from North India. Psychiatry and Clinical Neurosciences, 61, 462–470.CrossRefGoogle ScholarPubMed
Harris, B. S., Kotsopoulos, E. J. and Yamin, S. (2014). Phenotypic cognitive impairment in late-onset delusional disorder. International Psychogeriatrics, 26, 965–975.CrossRefGoogle ScholarPubMed
Herbel, B. L. and Stelmach, H. (2007). Involuntary medication treatment for competency restoration of 22 defendants with delusional disorder. Journal of the American Academy of Psychiatry Law, 35, 47–59.Google ScholarPubMed
Howard, R., Almeida, O. and Levy, R. (1994). Phenomenology, demography and diagnosis in late paraphrenia. Psychological Medicine, 24, 397–410.CrossRefGoogle ScholarPubMed
Howard, R., Rabins, P. V., Seeman, M. V. and Jeste, D. V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. American Journal of Psychiatry, 157, 172–178.CrossRefGoogle Scholar
Hsiao, M. C., Liu, C. Y., Yang, Y. Y. and Yeh, E. K. (1999). Delusional disorder: retrospective analysis of 86 Chinese outpatients. Psychiatry and Clinical Neurosciences, 53, 673–676.CrossRefGoogle ScholarPubMed
Ibanez-Casas, I. and Cervilla, J. A. (2012). Neuropsychological research in delusional disorder: a comprehensive review. Psychopathology, 45, 78–95.CrossRefGoogle ScholarPubMed
Ibanez-Casas, I.et al. (2013). Deficits in executive and memory processes in delusional disorder: a case-control study. PLOS ONE, 8, e67341. doi: 10.1371/journal.pone.0067341.CrossRefGoogle ScholarPubMed
Iglewicz, A., Meeks, T. W. and Jeste, D. V. (2011). New wine in old bottle: late life psychosis. Psychiatric Clinics of North America, 34, 295–318.CrossRefGoogle ScholarPubMed
Kendler, K. S. (1982). Demography of paranoid psychosis (delusional disorder): a review and comparison with schizophrenia and affective illness. Archives of General Psychiatry, 39, 890–902.CrossRefGoogle ScholarPubMed
Kendler, K. S. (2017). The clinical features of paranoia in the 20th century and their representation in diagnostic criteria from DSM-III through DSM-5. Schizophrenia Bulletin, 43, 332–343.Google ScholarPubMed
Kørner, A., Lopez, A. G., Lauritzen, L., Andersen, P. K. and Kessing, L. V. (2008). Delusional disorder in old age and the risk of developing dementia: a nationwide register-based study. Aging and Mental Health, 12, 625–629.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1899). Psychiatry, A Textbook for Students and Physicians (6th ed., Vol. 1). Translated by H. Metoui. (1990). Massachusetts: Science History Publications.Google Scholar
Kulkarni, K. R.et al. (2016). Clinical presentation and course of persistent delusional disorder: data from a tertiary care center in India. Primary Care Companion for CNS Disorders, 18. doi:10.4088/PCC.15m01883.CrossRefGoogle Scholar
Lo, Y., Tsai, S. J., Chang, C. H., Hwang, J. P. and Sim, C. B. (1997). Organic delusional disorder in psychiatric in-patients: comparison with delusional disorder. Acta Psychiatrica Scandinavica, 95, 161–163.CrossRefGoogle ScholarPubMed
Maina, G., Albert, U., Badà, A. and Bogetto, F. (2001). Occurrence and clinical correlates of psychiatric comorbidity in delusional disorder. European Psychiatry, 16, 222–228.CrossRefGoogle ScholarPubMed
Manschreck, T. C. and Khan, N. L. (2006). Recent advances in the treatment of delusional disorder. Canadian Journal of Psychiatry, 51, 114–119.CrossRefGoogle ScholarPubMed
Marino, C., Nobile, M., Bellodi, L. and Smeraldi, E. (1993). Delusional disorder and mood disorder: can they coexist? Psychopathology, 95, 161–163.Google Scholar
Marneros, A., Pillmann, F. and Wustmann, T. (2010). Delusional disorders: are they simply paranoid schizophrenia? Schizophrenia Bulletin, 38, 561–568.CrossRefGoogle ScholarPubMed
Muñoz-Negro, J. E. and Cervilla, J. A. (2016). A systematic review on the pharmacological treatment of delusional disorder. Journal of Clinical Psychopharmacology, 36, 684–690.CrossRefGoogle ScholarPubMed
Muñoz-Negro, J. E.et al. (2015). A dimensional comparison between delusional disorder, schizophrenia and schizoaffective disorder. Schizophrenia Research, 169, 248–254.CrossRefGoogle ScholarPubMed
Munro, A. (2008). Aspects of persecutory delusions in the setting of delusional disorder. In: Freeman, D., Bentall, R. and Garety, P. (Eds.), Persecutory Delusions: Assessment, Theory, and Treatment (pp. 105–120). Oxford: Oxford University Press.CrossRefGoogle Scholar
Munro, A. and Mok, H. (1995). An overview of treatment in paranoia/delusional disorder. Canadian Journal of Psychiatry, 40, 616–622.CrossRefGoogle ScholarPubMed
Opjordsmoen, S. (2014). Delusional disorder as a partial psychosis. Schizophrenia Bulletin, 40, 244–247.CrossRefGoogle ScholarPubMed
Peralta, V. and Cuesta, M. J. (2016). Delusional disorder and schizophrenia: a comparative study across multiple domains. Psychological Medicine, 46, 2829–2839.CrossRefGoogle ScholarPubMed
Roth, M. and Morrissey, J. D. (1952). Problems in the diagnosis and classification of mental disorders in old age. The Journal of Mental Science, 98, 66–80.CrossRefGoogle Scholar
Serretti, A., Lattuada, E., Cusin, C. and Smeraldi, E. (1999). Factor analysis of delusional disorder symptomatology. Comprehensive Psychiatry, 40, 143–147.CrossRefGoogle ScholarPubMed
Skelton, M., Khokhar, W. A. and Thacker, S. P. (2015). Treatments for delusional disorder. Cochrane Database of Systematic Reviews, Issue 5, CD009785.CrossRefGoogle Scholar
Smith, D. A. and Buckley, P. F. (2006). Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment. Behavioural Sciences and the Law, 24, 351–367.CrossRefGoogle ScholarPubMed
Snowdon, J. (1987). Psychiatric services for the elderly. Australian and New Zealand Journal of Psychiatry, 21, 131–136.CrossRefGoogle ScholarPubMed
Vicens, V.et al. (2016). Structural and functional brain changes in delusional disorder. British Journal of Psychiatry, 208, 153–159.CrossRefGoogle ScholarPubMed
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. Geneva: World Health Organization.Google Scholar
Yamada, N., Nakajima, S. and Noguchi, T. (1998). Age at onset of delusional disorder is dependent on the delusional theme. Acta Psychiatrica Scandinavica, 97, 122–124.CrossRefGoogle ScholarPubMed