Two Case Studies of Delusions Leading to Suicide, a Selective Review
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Two Case Studies of Delusions Leading to Suicide, a Selective Review Alexandre González-Rodríguez 1
& Mary V. Seeman
2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Many questions pertaining to delusional disorder (DD) remain unanswered. It is unclear what syndromes to include under this category of psychotic illness and when to treat with antidepressants, cognitive therapy, or antipsychotic medication. DD is associated with psychiatric comorbidity, especially depression, and rates of suicidal behavior are high when the two conditions co-exist. In this selective review, we present two instances of suicide in the context of DD, one illustrating risks for the somatic subtype and the second, risks for the persecutory subtype. The frequency of suicidal behaviour in these two subtypes of DD is estimated at 8–21%. The literature suggests a prominent role for social emotions (shame, humiliation) in the pathway leading to suicide. In addition, risk factors found in our two patients point to factors such as poverty, living alone, vulnerable risk periods, stigma, and lack of trust in mental health services. Building trust may be the most effective preventive measure. Keywords Body dysmorphic disorder . Delusional disorder . Prevention . Shame . Suicide
Introduction Delusional disorder (DD) has been widely regarded as a difficult-to-treat disorder, generally resistant to treatment. Available scientific evidence for the effectiveness of pharmacological treatments is considered meagre [1]. The vast majority of published studies are case-series, retrospective studies or case-reports, and most conclude that DD symptoms, on the whole, fail to respond to psychotropic medications [2]. Affective disorders are a frequent comorbidity [3], their precise prevalence in DD varying from study to study. A general estimate is that this
* Mary V. Seeman [email protected]
1
Department of Mental Health, Parc Tauli University Hospital. I3PT. Autonomous University of Barcelona (UAB), Sabadell, Barcelona, Spain
2
Department of Psychiatry, University of Toronto, 260 Heath Street West, Suite #605, Toronto, ON M5P 3L6, Canada
Psychiatric Quarterly
association occurs in 21–58% of cases [4]. Although this estimate translates into a high rate of co-morbid depression in DD, antidepressant use appears to be relatively rare, an observation difficult to justify since antidepressants have been shown to be effective for the depressive symptoms of DD, especially so for patients the somatic subtype of DD [5]. DD with comorbid depression may represent a discrete syndrome [4], marked by an earlier age of onset than is the case for DD alone. Recognizing the comorbidity is important because suicidal ideation can be pronounced, and rates of suicidal behavior have been reported as high [6]. However, perhaps because rates of completed suicide are lower in this population than they are in the context of schizophrenia or schizoaffective disorder [7], comparatively little psychiatric attention has been paid to suicidal r
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