neurological delusion

[toby jones]

Some delusions arise in response to acquired cerebral injury (e.g., the Capgras delusion). These delusions seem to be different from delusions that arise in the context of a psychotic episode as they seem to be monothematic (focused on a single theme) and comparatively unelaborated.

I know that these conditions are fairly rare, but what I'm wondering is whether neurological delusions are treated with anti-psychotics (similarly to delusions that occur within the context of a psychotic episode) and if so do they tend to respond similarly to treatment?

Thanks.

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[tofurious]

While the specific types of delusions may be rare (Capgras syndrome, Cotard syndrome, Anton syndrome), delusions as a whole are not rare (delusion of theft in Alzheimer disease, more complex delusion in FTD). Antipsychotics such as quetiapine can be helpful in suppressing the delusions (or at least the presentation of these delusions).

 

[Wheezy]

True delusions are not rare in practice. Personally I wouldn't choose quetiapine for patients with alzheimer disease, because it accelerates their cognitive decline.[1] other atypical antipsychotics are also poorly tolerated.[2] So where does this leave us drugwise? Old antipsychotics? or a nonquetiapine antipsychotic & hope they tolerate the side effects.

I don't know the right answer. For delusions in Alzheimers I think I might use haloperidol (typical) or resperidone (atypical).

References:
1. Ballard, C., et al., Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. Bmj, 2005. 330(7496): p. 874.
2. Schneider, L.S., et al., Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med, 2006. 355(15): p. 1525-38.

 

[toby jones]

Thanks for the responses. Garety and Hemsley state that 'delusions are to be found across 75 different neurological, endocrine, and psychiatric conditions' so yeah, I guess delusions aren't particularly rare. That being said, I think that from memory the most common forms of delusion are paranoid delusions (in the context of a psychotic episode or drug induced) and delusions of reference (in the context of a psychotic episode).

There has been some work done on explaining the typically monothematic and relatively circumscribed delusions that arise from acquired cerebral trauma (e.g., Capgras delusion). It is an open question whehter these delusions are importantly different with respect to the mechanism of production to a delusion with comperable content that arises in the context of a psychotic episode. So I guess I was wondering... Whether anybody knew whether delusions arising from acquired cerebral trauma (and the Capgras delusion in particular) was treatable with anti-psychotics comperably to delusions arising within a psychotic episode.