Low-Dose Quetiapine for the Treatment of Delusional Disorder in a Patient With Von Hippel-Lindau Disease

Prakash, Om; Garg, Amit; Sinha, Pallavi

doi:10.1176/appi.neuropsych.12080192

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…The mean age of onset in recent reports (Table 1) was older than 45 years. Further, in our summary of 25 individuals [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], women became ill significantly later than men which is consistent with other recent studies [2••, 7••, 12••] and some previous ones [10]. Since DD appears to be a disorder mostly seen in later stages of life, physicians and caregivers should be cautious about medication side effects and drug-drug interactions when it comes to pharmacological treatment.…”

Section: Psychopharmacological Treatment Methodssupporting

confidence: 90%

Current Treatments for Delusional Disorder

Roudsari¹,

Chun

Manschreck

2015

Curr Treat Options Psych

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Delusional disorders form part of the spectrum of psychotic disorders in psychiatry. They are poorly understood in practically every aspect of their nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis. The key symptom in delusional disorders is one or more delusions. A cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship. Diagnosis and differential diagnosis are critical tasks. Delusional conditions may arise from many sources and, only when the case conforms to the criteria and is clearly idiopathic-is a primary delusional disorder-can we feel confident that the patient suffers from delusional disorder rather than a secondary delusional condition. Adequate treatment follows principles for the treatment of delusions. First line pharmacological treatment for delusional disorder is antipsychotic medication, both first and second-generation agents, and some evidence suggests that clozapine may be effective in certain cases. The assumption in such a formulation is that the delusion(s) encountered in delusional disorders respond as a class of symptoms found in different disorders. Hence, the approach for failed interventions with these agents may be similar to that proposed for the treatment of schizophrenia or other psychotic disorders. Namely, searching for evidence of failure to take medication, inadequate dosing, a missed diagnosis of a substance disorder, medical condition, or even another psychiatric disorder should be considered. For individuals with delusional disorders who are also experiencing comorbid depression or anxiety, the addition of appropriate agents for those symptoms may provide a synergistic strategy for overall effectiveness. Psychotherapy is another important clinical tool. Cognitive behavioral therapy focusing on different aspects of delusions (i.e., anxiety, reasoning biases, faulty logic, etc.) has demonstrated some value for at least short-term improvement. Various techniques may be useful in allying with the patient and supplying means to assist in managing their thinking and approach to circumstances and factors that promote delusion formation and encourage actions taken to respond. A significant problem in applying what we know about delusional disorders to treatment is the limited available evidence. Lack of randomized controlled trials, which form the standard in most clinical disorders, is a major shortcoming. Recent observations of compromised cognitive functioning in working memory, attention, and executive function should be replicated with similar standards. Systematic case studies and large series are useful, and a growing effort to be more rigorous methodologically in all contributions including case registries and longer followup studies is promising. Nevertheless, our knowledge remains less than optimal. These comments apply not only to pharmacological observations but also to those of neuropsyc...

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Section: Psychopharmacological Treatment Methodssupporting

confidence: 90%

Current Treatments for Delusional Disorder

Roudsari¹,

Chun

Manschreck

2015

Curr Treat Options Psych

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“…Pimozide is equally effective in other psychotic syndromes, but is currently rarely used because of cardiac toxicity. Similarly, all antipsychotic medications are effective in DD treatment, though tolerability and, thus, adherence differ [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. The mechanism of action is generally attributable to action on dopamine and serotonin pathways, though other neurotransmitters may also be involved.…”

Section: Discussionmentioning

confidence: 99%

“…Quetiapine, another popular second-generation drug, has affinity for D2 receptors, serotonergic receptors, and alpha 1 and histaminergic receptors, but, as with most other antipsychotics, mainly works via dopamine and serotonin pathways. Prakash et al [ 46 ] reported on a 29-year-old man suffering from DD and von Hippel–Lindau disease, a hereditary condition associated with tumors in multiple organs. The patient was treated with quetiapine 50 mg daily, which was progressively increased to 200 mg/day.…”

Section: Use Of Second-generation Antipsychotics In the Treatment Of ...mentioning

confidence: 99%

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

et al. 2022

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For many decades, delusional disorder (DD) has been considered a treatment-resistant disorder, with antipsychotics acknowledged as the best, though imperfect, treatment. It is possible that the discovery of the right drug could turn treatment resistance into treatment response. The goal of this narrative review is to provide a historical perspective of the treatment of DD since the introduction of antipsychotics 70 years ago. The following search terms were used to scan the literature: antipsychotics AND “delusional disorder”. Findings were that therapy for DD symptoms has changed over time. Initial reports suggested that the drug of choice was the antipsychotic pimozide, and that this drug was especially effective for the somatic subtype of DD. Subsequent studies demonstrated that other antipsychotics, for instance, risperidone and olanzapine, were also highly effective. Treatment response may vary according to the presence or absence of specific symptoms, such as cognitive defect and depression. Clozapine, partial D2 agonists, and long-acting injectable drugs may be more effective than other drugs, but the evidence is not yet in. Because of the absence of robust evidence, treatment guidelines for the optimal management of DD are not yet available.

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Low-Dose Quetiapine for the Treatment of Delusional Disorder in a Patient With Von Hippel-Lindau Disease

Cited by 2 publications

References 4 publications

Current Treatments for Delusional Disorder

Current Treatments for Delusional Disorder

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

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