Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment

Smith, D.; Buckley, Peter F.

doi:10.1002/bsl.683

Cited by 15 publications

(6 citation statements)

References 91 publications

(60 reference statements)

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“…In the landmark case on involuntary pharmacotherapy for restoration of competence to stand trial ( Sell v. U.S., 2003 ), the American Psychiatric Association supported the use of antipsychotic medication ( American Psychiatric Association, 2003 ), whereas the American Psychological Association rejected this approach ( American Psychological Association, 2002 ) in their respective briefs to the Supreme Court. In contrast to the pharmacotherapy of impulsive aggression, we are aware of no cross-over double-blind studies having been conducted to determine the efficacy of any agent for the treatment of this disorder ( Felthous et al, 2001 ; Smith and Buckley, 2006 ; Skelton et al, 2015 ). For whatever reason, some disorders are simply not sufficiently investigated neurobiologically and pharmacologically.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

et al. 2021

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Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.

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Section: Discussionmentioning

confidence: 99%

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

et al. 2021

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“…Delusional disorder has an estimated prevalence of only 0,03% in the general population [Smith and Buckley, 2006] and the age of onset is generally in the mid-to late 30s. It mostly has an insidious onset and functioning tends to be preserved [Sadock and Sadock, 2005].…”

Section: Discussionmentioning

confidence: 99%

Delusional and psychotic disorders in juvenile myotonic dystrophy type‐1

Jacobs

Willekens

Die‐Smulders

et al. 2017

American J of Med Genetics Pt B

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We investigated the clinically derived hypothesis of a relatively high incidence of delusional and psychotic disorders in adolescents with juvenile Myotonic Dystrophy type-1 (DM1). Twenty-seven subjects of age 16-25 with juvenile DM1 and their parents were invited to have a clinical psychiatric interview, and to complete an ASEBA behavior checklist (YSR, ASR, CBCL, and ABCL). We diagnosed a Delusional Disorder in 19% of our patients and a Psychotic Disorder not otherwise specified in another 19%. These two groups of patients had a significantly worse level of clinically defined general functioning. It is clinically relevant to investigate in patients with juvenile DM the symptom of delusions and the presence of a delusional and psychotic disorder, and to consider the presence of juvenile DM in youngsters presenting with such a thought disorder. These disorders compromise the general functioning of the subjects and are often to some extent treatable. © 2017 Wiley Periodicals, Inc.

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“…There are no definitive treatment guidelines for DD, and it has been suggested that clinicians rely on what is known of schizophrenia management when caring for these patients. 3 Portugal et al 2 found that 81.4% of DD patients were managed with antipsychotic medication, 60% of which were on an atypical antipsychotic medication. For the somatic subtype specifically, pimozide has been classically used for treatment with one study finding 47 out of 64 patients with the somatic-type DD being treated with pimozide over a 10-year period to 2004.…”

Section: Introductionmentioning

confidence: 99%

Delusions of Glass Under Skin: An Unusual Case of Somatic-Type Delusional Disorder Treated with Olanzapine

Comardelle

Edinoff

Fort

2022

Health Psychology Research

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Introduction The management of delusional disorder (DD) remains difficult due to poor patient insight and a lack of definitive treatment guidelines. For the somatic subtype specifically, prior studies have shown successful treatment with the first-generation antipsychotics (FGA) pimozide, but these studies did not specify the nature of the delusions. It has been theorized that pimozide effectiveness is due to its unique ability to relieve itching sensations, which are commonly associated with somatic delusions (e.g., delusions of parasitosis). The use of FGAs is not without risk, however, and should be avoided when possible due to the significant side-effect profile. Thus, there is a need for safer alternatives for the treatment of somatic-type DD. This manuscript discusses a case of DD characterized by painful sensations of glass under the skin managed with the second-generation antipsychotic olanzapine. Case A 67-year-old female with a past medical history including depression presented to the ED with complaints of glass in her hands and fingernails bilaterally. The patient has been evaluated by several physicians in the past without any evidence of glass being found. She was able factually able to describe that others viewed her complaints as irrational, but she refused to accept this as truth. Cognitive screening testing was normal, and a physical exam showed several areas of excoriation on the hands and arms bilaterally, a removed left thumbnail, and a thin frame (BMI: 18.02). The patient was admitted to the psychiatry service, where organic causes were ruled out (infection, metabolic abnormalities, drug use). The patient received olanzapine 5mg PO nightly treatment with adjunctive psychotherapy and experienced acute psychotic relief after a two-day admission period. She did not endorse any side effects from the medication. Discussion To our knowledge, there haven’t been prior studies exploring treatment efficacy in somatic-type DD subdivided by the nature of false bodily sensation. Despite this limitation, it was found that most cases of somatic-type DD characterized by foreign bodies under the skin were treated with pimozide. Although this drug appears to be a reasonable option for the more common presentation involving false pruritis, it might not be recommended for rare presentations that don’t involve itchiness due to the high risk of adverse symptoms. Accordingly, clinicians should consider the nature of the delusions along with the unique side effect profile of the pharmacological therapy as any harm might outweigh the potential benefit. This was highlighted in the current presentation as clinicians determined olanzapine to be the most appropriate treatment despite no similar cases of DD described in the literature. Furthermore, this case exemplified the utility of second-generation antipsychotics in the treatment of somatic-type DD.

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Pharmacotherapy of delusional disorders in the context of offending and the potential for compulsory treatment

Cited by 15 publications

References 91 publications

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

Pharmacotherapy of Primary Impulsive Aggression in Violent Criminal Offenders

Delusional and psychotic disorders in juvenile myotonic dystrophy type‐1

Delusions of Glass Under Skin: An Unusual Case of Somatic-Type Delusional Disorder Treated with Olanzapine

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