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

Abstract

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.

Collaboration between Psychiatrists and Other Allied Medical Specialists for the Treatment of Delusional Disorders

“…The use of long-acting antipsychotic medications is not common in DD but has been described [ 109 ] in a longitudinal observational study with a 6-month follow-up that included 45 DD outpatients. The sample was divided into two groups according to the presence or absence of non-prominent hallucinations (relatively rare in DD).…”

Seventy Years of Treating Delusional Disorder with Antipsychotics: A Historical Perspective

“…González-Rodríguez et al [ 68 ] investigated the effectiveness of long-acting injectable antipsychotics in the treatment of DD patients, some of whom also reported hallucinations [ 68 ]. A total of 45 outpatients were followed for 6 months; psychopathological symptoms were evaluated by means of the PANSS, and depressive symptoms by the 17-item Hamilton rating scale for depression (HRSD-17).…”

Psychosis in Later Life

“…96 The only study to evaluate any of the newer antipsychotics in delusional disorder is a longitudinal observational study that found that compared to those treated with various oral antipsychotics, patients treated with a longacting, injectable antipsychotic (either paliperidone palmitate or risperidone long-acting injectable) exhibited a significant improvement in negative symptoms and a trend toward improvement in positive symptoms. 97 On average, patients in this study had an age of onset in their mid 40s and were evaluated in their early 50s.…”