Delusional versus nondelusional body dysmorphic disorder

This study assessed demographic and clinical features in 65 subjects with body dysmorphic disorder (BDD) and compared the 39 (60%) with the delusional form (receiving an additional diagnosis of delusional disorder, somatic type) with those who did not meet delusionality criteria. Delusional and nondelusional patients did not statistically differ on most demographic and clinical variables. Delusional patients, however, had significantly more severe BDD symptoms at both baseline and follow-up assessments than those of nondelusional patients. Furthermore, poorer insight was significantly associated with more severe BDD symptoms at both baseline and follow-up. Overall improvement in BDD symptom severity was similar for the 2 groups. Our results support other studies in the view that BDD and its delusional variant have more similarities than differences and that the delusional variant may be simply a more severe form of BDD. Implications for the diagnostic classification of BDD and future research directions are discussed.     

Delusional Parasitosis

Abstract: In order to examine the clinical characteristics of delusional parasitosis in a large sample, we previously analyzed 102 cases reported in Japan. In this article, these results are shown briefly, and psychopathological symptoms and nosological classifications are discussed.
In our study, 53 cases were classified in to pure type excluding endogenous psychoses, induced psychosis and somatically based psychoses. Two thirds of the pure type cases had visual experiences. These cases involved both hallucinatory and delusional factors, and symptoms considered delusional perception or bodily hallucinations "being made" by parasites were included in these experiences. Although these symptoms are thought to be specific to schizophrenia, some biological findings were often present. Furthermore, the facts concerning sex difference, age at onset, and no personality changes resembled late-onset paraphrenia, that is, a type of atypical psychoses. Therefore, both psychopathological and biological studies should be carried out continuously from now on.     

Delusional versus nondelusional body dysmorphic disorder: clinical features and course of illness

DSM-IV's classification of body dysmorphic disorder (BDD) is controversial. Whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder. However, the relationship between these BDD variants has received little investigation. In this study, we compared BDD's delusional and nondelusional variants in 191 subjects using reliable and valid measures that assessed a variety of domains. Subjects with delusional BDD were similar to those with nondelusional BDD in terms of most variables, including most demographic features, BDD characteristics, most measures of functional impairment and quality of life, comorbidity, and family history. Delusional and nondelusional subjects also had a similar probability of remitting from BDD over 1 year of prospective follow-up. However, delusional subjects had significantly lower educational attainment, were more likely to have attempted suicide, had poorer social functioning on several measures, were more likely to have drug abuse or dependence, were less likely to currently be receiving mental health treatment, and had more severe BDD symptoms. However, when controlling for BDD symptom severity, the two groups differed only in terms of educational attainment. These findings indicate that BDD's delusional and nondelusional forms have many more similarities than differences, although on several measures delusional subjects evidenced greater morbidity, which appeared accounted for by their more severe BDD symptoms. Thus, these findings offer some support for the hypothesis that these two BDD variants may constitute the same disorder. Additional studies are needed to examine this issue, which may have relevance for other disorders with both delusional and nondelusional variants in DSM.     

Delusional misidentification

The purpose of the present study was to investigate differences in brain activation with functional magnetic resonance imaging (fMRI) during imagery of painful and non-painful ‘finger movements’ and ‘hand positioning’ in a subject with an amputated arm. The subject was a right-handed man in his mid-thirties who lost his right arm just above the elbow in a car-train accident. MRI was performed with a 1.5 T Siemens Vision Plus scanner. The basic design involved four conditions: imagining ‘painful finger movements’, ‘non-painful finger movements’, ‘painful hand positioning’, ‘non-painful hand positioning’. Imagery of finger movements uniquely activated the contralateral primary motor cortex which contains the classic ‘hand area’. The lateral part of the anterior cerebellar lobe was also activated during imagery of finger movements. Imagery of pain uniquely activated the somatosensory area, and areas in the left insula and bilaterally in the ventral posterior lateral nucleus of the thalamus. It is suggested that the insula and thalamus may involve neuronal pathways that are critical for mental processing of pain-related experiences, which may relate to a better understanding of the neurobiology of phantom limb pain.     

Delusional loving

Erotomania is reexamined by an in-depth study of eight patients. There appear to be two main varieties: the phantom lover syndrome, or fixed delusion elaborated around a person who does not exist, and erotomania proper, a recurrent tendency to believe that one is loved by a powerful, prominent man.     

Temporal discrimination threshold on various parts of the body

The temporal discrimination threshold (TDT) of various parts of the body was investigated in 35 healthy volunteers, and the effect of aging on the TDT was studied in 80 subjects (aged 18-82 years). Ascending (ATDT) and descending (DTDT) TDT values were measured in 13 areas using a pair of electrical stimuli. Both ATDT and DTDT differed significantly among the body parts (P < 0.01, one-way repeated ANOVA), and the TDT was shortest on the index finger and longest on the lower leg, where it was approximately 156% of that on the finger. There was no difference of the TDT value with gender or between sides. There was no effect of aging on the TDT in subjects aged 18-64 years, but the value was prolonged in subjects over 65 years. We suggest that the TDT difference among body parts is mainly due to the difference in sensory processes in the central nervous system, and that it may provide information about changes in the system related to aging.     

Delusional misidentification involving the self

The delusion of replacement of one's self by a double or imposter is a feature of two delusional misidentification syndromes. In the syndrome of subjective doubles, the self-delusional misidentification syndromes. In the syndrome of subjective doubles, the self-delusion is the sole delusion of doubles. In the Capgras syndrome, the delusion of a self-double is infrequently reported; however, when it is reported, self-replacement is always accompanied by delusions of duplication of other people and sometimes of places. We review all such cases reported since 1900 and highlight the variety of presentations.     

Delusional misidentification.

The Capgras syndrome and other forms of delusional misidentification may be encountered frequently in neuropsychiatric settings. DMS can occur in the presence of idiopathic psychiatric illness, in diffuse brain illness such as dementia, and in focal neurologic disease. In patients who have focal lesions, there is evidence that right hemisphere damage is necessary for the production of DMS. Although DMS is associated with a pattern of neuropsychologic impairments in the domains of memory, perception, and executive function, these impairments alone do not account for the selectivity and delusional nature of DMS. Therefore, other factors such as premorbid psychopathology, motivation, and loss of ego functions may be important in determining which vulnerable patients develop DMS and which do not.     

Delusional disorders in the elderly

Delusions and paranoid ideation are common in the elderly, and they pose a diagnostic and clinical challenge. This article reviews recent findings in the classification of these symptoms, biologic underpinnings, treatment, and prognosis. Based on a review of the relevant literature, delusional disorder in the elderly should be regarded as part of a continuum of late-life psychoses. Although lateonset psychosis may have a neurodevelopmental origin, there is an increasing body of evidence that delusional disorders could be a heralding sign for a neurodegenerative process leading to cognitive decline and dementia. Atypical antipsychotic agents continue to be the first-line treatment for late-onset psychosis despite the lack of robust randomized clinical trials in this population. Increased risk of mortality and cerebrovascular accidents associated with these agents stresses the importance of the need for appropriate patient selection and carefully weighing the benefits and risks when initiating these agents.     

Delusional disorder in a chronic renal dialysis patient--deprivation and reclaiming of body and narrative]

We report a female case treated with hemodialysis over 20 years who demonstrated good social functioning, until she suffered from delusional disorder with persecutory delusions involving medical staff performing the dialysis and also auditory hallucinations involving them. We examined the bio-psycho-social invasiveness of the renal dialysis treatment, especially concerning the effects on the patient's self-image of her body resulting in the loss of a feeling of unity between her mind and body, or the sense of her body belonging to her, referring to J. Lacan's concept of "corps imaginaire= imaginary body". We supposed the situation of "body deprivation" on the ground of the patient's behavior when she developed persecutory delusions that the medical staff were trying to deprive her of her ideal body. In this case, her persecutory delusions should be regarded as a reclaim for her right not to be deprived of her self-body. We pointed out the general situation which the hegemony of modern medicine over patients brings about, where patients are deprived of chances to express their personal feelings about their illness and be listened to attentively by medical staffs. We recognized such a situation in the present patient and described the situation as "narrative deprivation". Her delusions seemed to have the aspect of the claim for her rebelling against the narrative deprivation. We emphasized the role of psychiatric staff to confirm the existence of the body-narrative deprivation situation on the side of the patient and listen attentively to the patient's personal narrative of illness in the practice of consultation-liaison psychiatry, especially when performing therapy in patients with persecutory delusions involving medical staff.     

Localization of body parts in brain injured subjects

The issues which were dealt with in this study were whether the determinants of failure in body part identification differed as a function of modality of stimulus presentation or as a function of response conditions, and whether such differences could be attributed to neurologically determined variables, or to a generalized disorder of awareness of body topology. No evidence was found to support any of these latter factors as an explanation for impaired body part identification. Rather it can be concluded that a common factor underlies success in identifying body parts under all conditions and that this factor is the strength and precision of the conceptual representation of individual body parts.     

Delusional Depression and Suicide

Abstract: During the 12-year period of retrospective observation, 38 cases of 93 major depressive inpatients were delusional and the remainders were nondelusional. We evaluated the differences on several variables, especially about suicide, between the two groups. The mean age at the onset of illness of delusional depressive patients was higher than that of nondelusional ones. The incidence of psychomotor retardation was lower in the former group than in the latter. The frequency of suicidal ideation and suicidal attempts were higher in the former group than the latter. The suicidal methods in the delusional depressives tended to be more active and violent than those in nondelusional depressives and were supposed to have a twofold mortality than those in the nondelusional ones. We discussed this high rate of suicides of delusional depression from the viewpoint of disinhibition of psychomotor retardation, chronicity, partial affinity of delusional depressives to schizophrenics and neuroendocrinological perspective.     

Delusional depression and suicide

After a short survey of the relevant literature, the authors discuss the significance of delusional depression symptoms for suicidality, whereby they do not regard such symptoms alone as a sufficient condition for classifying a delusional patient as suicidal. In a comparison of delusional depressed patients with a non-delusional control group (matched pairs), the former were adjudged to be significantly less suicidal than the control group and did not differ from the control group in regard to suicide frequency.