Hostname: page-component-7479d7b7d-k7p5g Total loading time: 0 Render date: 2024-07-11T21:11:45.891Z Has data issue: false hasContentIssue false
  • English
  • Français

Delusional disorder and schizophrenia: a comparison of the neurocognitive and clinical characteristics in first-episode patients

Published online by Cambridge University Press:  03 June 2015

C. L. M. Hui ,
E. H. M. Lee ,
W. C. Chang ,
S. K. W. Chan ,
J. Lin ,
J. Q. Xu  and
E. Y. H. Chen
C. L. M. Hui
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
E. H. M. Lee*
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
W. C. Chang
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
S. K. W. Chan
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
J. Lin
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
J. Q. Xu
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
E. Y. H. Chen
Affiliation:
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, SAR, China
*
*Address for correspondence: Dr E. M. H. Lee, Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China. (Email: edwinlhm@hku.hk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in ascertaining a representative sample size. Existing knowledge has been mostly generated from inpatient cohorts, which may be biased towards a more severe sample.

Method.

We compared the demographic, clinical and cognitive differences between 71 patients with first-episode DD and 71 age-matched patients with first-episode SZ. Participants were consecutively recruited from a population-based territory-wide study of early psychosis in Hong Kong targeting first-episode psychosis. Basic demographic information, premorbid functioning, duration of untreated psychosis, pathways to care, symptomatology, social, occupational, and cognitive functioning were comprehensively assessed using standardized measurements.

Results.

Patients with DD had less premorbid schizoid and schizotypal traits compared to patients with SZ. More patients with DD were married compared to patients with SZ. However, at first episode, there were no significant differences between the two groups in regards to the duration of untreated psychosis, pathways to care, symptom severity, neurocognitive performance, treatment, and functioning.

Conclusions.

Our findings challenge previous thinking that patients with DD had better functioning than patients with SZ. This study not only provides an updated perspective into conceptualizing the clinical differences between DD and SZ, but also expands the descriptive account of the two disorders to include the neurocognitive dimension.

Keywords

Delusional disorderfirst episodeneurocognitionschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 3085 - 3095
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. revised. American Psychiatric Association: Washington, DC.Google Scholar
Andreasen, NC (1983). The Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.Google Scholar
Andreasen, NC (1984). The Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City.Google Scholar
Brugha, T, Bebbington, P, Tennant, C, Hurry, J (1985). The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189–194.Google Scholar
Cannon-Spoor, HE, Potkin, SG, Wyatt, RJ (1982). Measurement of premorbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470–484.Google Scholar
Crumlish, N, Whitty, P, Clarke, M, Browne, S, Kamali, M, Gervin, M, McTique, O, Kinsella, A, Waddington, JL, Larkin, C, O'Callaghan, E (2009). Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. British Journal of Psychiatry 194, 18–24.Google Scholar
Evans, JD, Paulsen, JS, Harris, MJ, Heaton, RK, Jeste, DV (1996). A clinical and neuropsychological comparison of delusional disorder and schizophrenia. Journal of Neuropsychiatry and Clinical Neurosciences 8, 281–286.Google Scholar
Fabrega, H, Ahn, C, Mezzich, JE (1992). On the descriptive validity of DSM III schizophrenia. Psychopathology 25, 70–89.Google Scholar
Foerster, A, Lewis, S, Owen, M, Murray, R (1991). Pre-morbid adjustment and personality in psychosis: effects of sex and diagnosis. British Journal of Psychiatry 158, 171–176.Google Scholar
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 1148–1156.Google Scholar
Goodman, SH, Sewell, DR, Cooley, EL, Leavitt, N (1993). Assessing levels of adaptive functioning: the role functioning scale. Community Mental Health J 29, 119–131.Google Scholar
Grover, S, Biswas, P, Avasthi, A (2007). Delusional disorder: study from North India. Psychiatry and Clinical Neurosciences 61, 462–470.Google Scholar
Häfner, H, Riecher-Rössler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fatkenheuer, B, Loffler, W, an der Heiden, W (1992). IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209–223.CrossRefGoogle ScholarPubMed
Hong Kong Psychological Society (1989). The Wechsler Adult Intelligence Scale-Revised (Cantonese Version). Hong Kong Psychological Society: Hong Kong.Google Scholar
Hui, CLM, Chang, WC, Chan, SKW, Lee, EHM, Tam, WWY, Lai, DC, Wong, GHY, Tang, JYM, Li, FWS, Leung, KF, McGhee, SM, Sham, PC, Chen, EYH (2014). Early intervention and evaluation for adult-onset psychosis: the JCEP study rationale and design. Early Intervention in Psychiatry 8, 261–268.Google Scholar
Hui, CLM, Tang, JYM, Wong, GHY, Chang, WC, Chan, SKW, Lee, EHM, Chen, EYH (2013). Predictors of help-seeking duration in adult onset psychosis in Hong Kong. Social Psychiatry and Psychiatric Epidemiology 48, 1819–1828.CrossRefGoogle ScholarPubMed
Ibanez-Casas, I, Cervilla, JA (2012). Neuropsychological research in delusional disorder: a comprehensive review. Psychopathology 45, 78–95.CrossRefGoogle ScholarPubMed
Insel, T, Cuthbert, B, Garvey, M, Heinssen, R, Pine, DS, Quinn, K, Sanislow, C, Wang, P (2010). Research domain criteria (RDoC): toward a new classification frame work for research on mental disorders. American Journal of Psychiatry 167, 748–751.CrossRefGoogle Scholar
Jager, M, Bottlender, R, Strauss, A, Moller, HJ (2003). On the descriptive validity of ICD-10 schizophrenia. Empirical analyses in the spectrum of non-affective functional psychoses. Psychopathology 36, 152–159.Google Scholar
Jeste, DV, Harris, MJ, Krull, A, Kuck, J, McAdams, LA, Heaton, R (1995). Clinical and neuropsychological characteristics of patients with late-onset schizophrenia. American Journal of Psychiatry 152, 722–730.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). Positive and Negative Symptom Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 21–76.Google Scholar
Kendler, KS (1982). Demography of paranoid psychosis (delusional disorder): a review and comparison with schizophrenia and affective illness. Archives of General Psychiatry 39, 890–902.Google Scholar
Kraepelin, E (1915). Psychiatrie. Ein lehrbuch fur Studierende und Arzte, 8th edn. Johann Ambrosius Barth: Leipzig, Germany.Google Scholar
Lapcin, S, Guler, J, Ceylan, E, Maner, F, Ger, C, Satmis, N (2008 a). Attention impairment in patients with paranoid schizophrenia and delusional disorder: a controlled study. International Journal of Neuropsychopharmacology 11, 251.Google Scholar
Lapcin, S, Guler, J, Maner, F, Ceylan, E, Keskinkilic, C, Satmis, N, Ergen, N (2008 b). Verbal learning and verbal memory deficits in patients with paranoid schizophrenia and delusional disorder: a controlled study. International Journal of Neuropsychopharmacology 11, 251.Google Scholar
Leckman, JF, Sholomskas, D, Thompson, WD, Belanger, A, Weissman, MM (1982). Best estimate of lifetime psychiatric diagnosis: a methodological study. Archives of General Psychiatry 39, 879–883.Google Scholar
Malla, A, Norman, R, Schmitz, N, Manchanda, R, Béchard-Evans, L, Takhar, J, Haricharan, R (2006). Predictors of rate and time to remission in first-episode psychosis: a two-year outcome study. Psychological Medicine 36, 649–658.Google Scholar
Marneros, A, Pillmann, F, Wustmann, T (2012). Delusional disorders – are they simply paranoid schizophrenia? Schizophrenia Bulletin 38, 561–568.Google Scholar
Munro, A, Mok, H (1995). An overview of treatment on paranoid/delusional disorder. Canadian Journal of Psychiatry 10, 610–622.Google Scholar
Opjordsmoen, S (2014). Delusional disorder as a partial psychosis. Schizophrenia Bulletin 40, 244–247.Google Scholar
So, E, Kam, I, Leung, CM, Chung, D, Liu, Z, Fong, S (2003). The Chinese-bilingual SCID-I/P project: stage 1 – reliability for mood disorders and schizophrenia. Hong Kong Journal of Psychiatry 13, 7–18.Google Scholar
Wechsler, D (1981). Wechsler Adult Intelligence Scale – Revised. Psychological Corporation: New York.Google Scholar
Wechsler, D (1987). Wechsler Memory Scale Revised Manual. The Psychological Corporation: San Antonio, TX.Google Scholar
Winokur, G (1977). Delusional disorder (paranoia). Comprehensive Psychiatry 18, 511–521.Google Scholar
Yamada, N, Nakajima, S, Noguchi, T (1998). Age of onset of delusional disorder is dependent on the delusional theme. Acta Psychiatrica Scandinavica 97, 122–124.Google Scholar