4. 3 ORGANIC DELUSIONAL (SCHIZOPHRENIA-LIKE) DISORDER
A wide range of neurological, toxic
and metabolic disorders can lead to secondary psychosis. Clinical features
that should trigger consideration of a neurodiagnostic assessment of
psychotic patients include atypical age of onset, specially after age 45;
absence of a family history of psychiatric illness; absence of any past
psychiatric disturbances or premorbid behaviors characteristic of
functional psychiatric disorders; presence of family history of neurologic
disorders such as Huntington’s disease; presence of focal neurological
signs; presence of mental status deficits suggestive of focal or
degenerative brain disorders; presence of unusual psychiatric syndromes or
atypical mixed states (such as prominent mood changes with
mood-incongruent delusions); history of a medical disorder or neurologic
condition, even if remote; presence of unusual temporal features such as
abrupt onset, quick resolution, or rapid fluctuation; and treatment
resistance or unusual treatment response (Cummings and Mega, 2003).
Most of the secondary psychoses are
manifested by paranoid delusions and ideas of reference and/or
persecution. Schneiderian first rank symptoms have been reported in a
number of neurological illnesses including epilepsy, Huntington’s disease
and idiopathic basal ganglia calcification (Chow and Cummings, 2000). In
some cases, delusions have a specific theme or are confined to a single
topic. The principal content specific delusions are listed below.
Delusion
|
Content
|
Seen in
|
Capgras syndrome
|
Someone, usually a family member,
has been replaced by an identical-appearing imposter. |
Intracerebral hemorrhage, HIV
encephalopathy, temporal lobe epilepsy, hypothyroidism, vitamin B12
deficiency |
Fregoli Syndrome
|
A persecutor takes on the form of
others in the environment. |
Epileptic psychoses |
Syndrome of intermetamorphosis
|
The familiar person and the
misidentified stranger share physical as well as psychological
similarities. |
Epileptic psychoses |
Syndrome of subjective doubles
|
Another person has been
physically transformed into his own self. |
|
Heutoscopy (the syndrome of
doubles, the doppelganger)
|
One has an exact double |
Migraine, intracranial
hemorrhage, encephalitis. |
Othello syndrome
|
One’s mate is unfaithful |
Huntington’s disease,
encephalitis, general paresis |
De Clerambault syndrome
(erotomania)
|
One is secretly loved by another,
usually someone of higher social or economic status. |
Alzheimer’s disease, CNS tumors,
toxic psychoses |
Delusional Incubus / succubus
|
Demon or phantom sits on top of
or has sex with the individual during sleep |
|
Ekbom syndrome (acrophobia,
parasitophobia, delusion of infestation)
|
One is infected by insects or
vermin |
Vitamin B12 deficiency, Iron
deficiency, toxic psychoses. |
Lycanthropy (werewolfism)
|
One is periodically transformed
into a wolf or other animal. |
LSD use |
Delusional phantom boarder
|
Unwelcome guests are living in
the home |
Alzheimer’s disease |
Picture sign
|
Individuals seen on television or
in magazines are present in the home. |
Alzheimer’s disease |
Dorian Gray Syndrome
|
One is not aging |
Alzheimer’s disease |
Koro
|
One’s penis is shrinking and
retracting into the abdomen |
Corpus callosum tumors, Right
brain strokes. |
Reduplicative paramnesia
|
One has been relocated, usually
to a position closer to one’s home. |
Recovery from acute confusional
states |
Treatment of organic psychoses must
address both the underlying disease and the psychosis. The effects of
drugs used in the treatment of neuromedical illnesses must be reviewed for
their potential role in the genesis of delusions (Cummings and Mega,
2003). |
