Clinical Course and Personality in Reactive, Compared with Nonreactive, Delusional Disorder

Objective: Reactive delusional disorder (DD) (with a precipitating factor) has been postulated to differ clinically from nonreactive DD and to show a better prognosis. Our study tests this hypothesis in a sample of patients with persistent DD (International Classification of Diseases, 10th Revision) or DD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) followed during a period of more than 10 years. Method: As part of a long-term study on DD, 19 patients with DD and a stressful life event preceding the onset of the disorder were compared with 24 DD patients without such a life event. Diagnoses, social and biographical data, life events, and outcome were assessed by a semistructured interview and validated rating scales. Personality features were assessed by the NEO Five-Factor Inventory and by the Inventory of Clinical Personality Accentuations. Results: Patients with reactive DD tended to be somewhat younger but showed otherwise little differences to patients with nonreactive DD. In particular, there were no differences in the course of the disorder. However, patients with reactive DD were significantly more often in a stable relationship and showed higher values on neuroticism and more pronounced dependent and borderline personality accentuations in dimensional personality measures. Conclusions: Reactive DD was not found to have a better prognosis than nonreactive DD. However, the results suggest an increased vulnerability for interpersonal conflicts in these patients. Objectif : Le trouble delirant (TD) reactionnel (avec un facteur declenchant) est postule differer cliniquement du TD non reactionnel et presenter un meilleur pronostic. Notre etude verifie cette hypothese chez un echantillon de patients souffrant de TD persistant (Classification internationale des maladies, 10e revision) ou de TD (Manuel diagnostique et statistique des troubles mentaux, 4e edition) suivis durant une periode de plus de 10 ans. Methode : Dans le cadre d'une etude a long terme sur le TD, 19 patients souffrant de TD et ayant vecu un evenement stressant de la vie avant l'apparition du trouble ont ete compares avec 24 patients du TD sans un tel evenement stressant. Les diagnostics, donnees sociales et biographiques, evenements de la vie, et resultats ont ete evalues par une entrevue semi-structuree et des echelles de cotation validees. Les traits de personnalite ont ete evalues par l'inventaire NEO des 5 facteurs et par l'inventaire des accentuations de la personnalite clinique. Resultats : Les patients souffrant de TD reactionnel tendaient a etre un peu plus jeunes mais ne presentaient autrement que de petites differences avec les patients souffrant de TD non reactionnel. En particulier, il n'y avait pas de differences dans l'evolution du trouble. Cependant, les patients souffrant de TD reactionnel etaient significativement plus souvent dans une relation stable et presentaient des valeurs plus elevees de nevrosisme et des accentuations plus prononcees de personnalite dependante et limite dans les mesures dimensionnelles de la personnalite. Conclusions : Nous n'avons pas observe que le TD reactionnel avait un meilleur pronostic que le TD non reactionnel. Toutefois, les resultats suggerent une vulnerabilite accrue aux conflits interpersonnels chez ces patients. Key Words: delusional disorder, life events, reactive psychosis, personality, NEO Five-Factor Inventory Received August 2011 , revised, and received September 2011. Abbreviations DO delusional disorder DSM Diagnostic and Statistical Manual of Mental Disorders GAF Global Assessment of Functioning HADES Halle Delusional Syndromes Study ICD International Classification of Diseases ICP Inventory of Clinical Personality Accentuations NEO-FFI NEO Five-Factor Inventory PANSS Positive and Negative Syndrome Scale Delusional disorders are characterized by the development and often chronic persistence of delusional ideas without other prominent psychotic symptoms and in the absence of major affective or cognitive abnormalities. …