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Inicio Revista de Psiquiatría y Salud Mental (English Edition) An empirical study of psychosocial and clinical correlates of delusional disorde...
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Vol. 2. Núm. 2.
Páginas 72-82 (enero 2009)
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Vol. 2. Núm. 2.
Páginas 72-82 (enero 2009)
Acceso a texto completo
An empirical study of psychosocial and clinical correlates of delusional disorder: the DELIREMP study
Un estudio empírico de los correlatos psicosociales y clínicos del trastorno delirante: el estudio DELIREMP
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Enrique de Portugala, Nieves Gonzálezb, Míriam Vilaplanab, Josep M. Haroc, Judit Usallc, Jorge A. Cervillad,
Autor para correspondencia
jacb@ugr.es

Corresponding author.
a Department of Psychiatry, Hospital Gregorio Marañón, Madrid, Spain
b Research and Development Unit, Sant-Joan de Déu-SSM, Barcelona, Spain
c Research and Development Unit, Sant-Joan de Déu-SSM, CIBER en Salud Mental (CIBERSAM) nodo de Sant Joan de Déu, Barcelona, Spain
d Department of Psychiatry & Institute of Neurosciences, University of Granada, CIBER en Salud Mental (CIBERSAM) nodo de la Universidad de Granada, Granada, Spain
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Abstract
Objective

We aim to describe psychosocial and clinical correlates of DD and its types. This approach is important because most knowledge on DD does not come from empirical data collected using a validated systematic research method.

Methods

A cross-sectional study was conducted in a sample of 86 patients fulfilling DSM-IV criteria for DD as established using the SCID-I. Variables were evaluated using a systematic methodology and standardized instruments, and included possible psychosocial risk factors (low socioeconomic status or social isolation, immigration, sensory deficits, older age at onset), family history of psychiatric disorders and premorbid personality (SAP), psychotic psychopathology (PANSS), depressive syndrome (MADRS), global cognitive functioning (MMSE), axis I comorbidity (MINI) and other clinical aspects such as global functionality (GAF), and disability (SDI). A sociodemographic and clinical questionnaire was also completed.

Results

The mean age at onset was 39.6 years and 61.6% of the cases were female. The most frequent DD types were persecutory (59.3%) and jealous (22.1%). Nearly 21% had a family history of schizophrenia and 17.4% had DD (significantly higher among those with the jealous subtype). Sixty-four percent had a premorbid personality disorder (38.4% paranoid, 12.8% schizoid). The grandiose type was significantly associated with higher scores on the PANSS positive subscale and the mixed type with lower scores on the PANSS negative subscale. Depression affected 45.3% of subjects (mainly mild depression) and 45.3% had hallucinations (20.9% tactile, 16.3% olfactory), which were more common among somatic cases. The mean MMSE was 27.6 (SD=2.5) suggesting a preserved cognitive function. Mean GAF was 63.9 (SD=11.3) indicating a moderate degree of disability, which was significantly worse amongst grandiose cases.

Conclusion

This study provides unique empirical and reliable evidence on the real psychosocial, clinical, and psychopathological correlates of DD and its types.

Keywords:
Delusional disorder
Paranoia
Psychopathology
Psychosis
Symptoms
Resumen
Objetivo

La finalidad de este estudio es describir los correlatos psicosociales y clínicos del trastorno delirante (TD) y sus tipos. Este enfoque es importante porque la mayor parte del conocimiento existente sobre el TD no procede de datos empíricos obtenidos con el empleo de un método de investigación sistemático validado.

Métodos

Se llevó a cabo un estudio transversal en una muestra de 86 pacientes que cumplían los criterios del DSM-IV para el TD según lo determinado con la aplicación del SCID-I. Las variables estudiadas se evaluaron con una metodología sistemática y con instrumentos estandarizados, e incluyeron los posibles factores de riesgo psicosocial (bajo nivel socioeconómico o aislamiento social, inmigración, deficiencias sensoriales, edad avanzada al inicio), los antecedentes psiquiátricos familiares y personalidad premórbida (SAP), la psicopatología psicótica (PANSS), el síndrome depresivo (MADRS), la función cognitiva general (MMSE), la comorbilidad de eje I (MINI) y otros aspectos clínicos, como el funcionamiento general (GAF) y la discapacidad (SDI). Se completó también un cuestionario sociodemográfico y clínico.

Resultados

La media de edad al inicio del TD era 39,6 años y un 61,6% de los pacientes eran mujeres. Los tipos más frecuentes de TD fueron el persecutorio (59,3%) y el celotípico (22,1%). Casi un 21% de los pacientes tenían antecedentes familiares de esquizofrenia y el 17,4%, de TD (en un porcentaje significativamente mayor en el tipo celotípico). El 64% de los pacientes tenían trastorno de la personalidad premórbido (el 38,4%, paranoide, y el 12,8%, esquizoide). El tipo de TD de grandiosidad se relacionaba de manera significativa con unas puntuaciones más altas de la subescala positiva de la PANSS, y el tipo mixto, con puntuaciones más bajas de la subescala negativa de la PANSS. La depresión afectaba al 45,3% de los pacientes (principalmente, depresión leve) y un 45,3% tenía alucinaciones (el 20,9%, táctiles, y el 16,3%, olfatorias), que eran más frecuentes en los casos de tipo somático. La media ± desviación estándar de la MMSE era 27,6±2,5, lo cual indicaba una función cognitiva preservada. La media de GAF era 63,9±11,3, que corresponde a un grado moderado de discapacidad; este aspecto era significativamente peor en los casos del tipo de grandiosidad.

Conclusiones

Este estudio aporta una evidencia única, de carácter empírico y fiable, sobre los correlatos psicosociales, clínicos y psicopatológicos reales del TD y sus tipos.

Palabras clave:
Trastorno delirante
Paranoia
Psicopatología
Psicosis
Síntomas
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