Psychopharmacological treatment and course in paranoid personality disorder: a case series.

Little is known about the role of psychopharmacological treatment and course of illness in patients diagnosed with a paranoid personality disorder. This short communication provides a naturalistic study of a psychiatric hospital case series. Fifteen consecutive patients were retrospectively studied. The Clinical Global Impression was rated at first admission, at last psychiatric contact, and after a 6-week observation period with or without antipsychotic treatment. During psychiatric admissions, three patients improved markedly, eight showed only minor changes, and four worsened. In total, seven patients had been administered any antipsychotic medication. The median duration of treatment was 15 weeks (range 4 days-328 weeks). No major adverse effects were noted. Among patients with sixth-week observations available, four had received antipsychotics; they appeared to improve considerably compared with six patients who had not received antipsychotics. Although the findings should be interpreted with caution, they support the notion of the disorder being a relatively chronic condition, although antipsychotics appeared to be safe and possibly had an effect in the short term.

Delusional disorder: the predictive validity of the concept.

A sample of 72 first-admitted patients with delusional disorder was personally re-examined after a mean of 10 years, and 42 of them after an average of 27 years. The mean observation period for all patients from admission to last follow-up was 20 years (3-39). There was a trend that patients with delusions of jealousy did better on course variables, but similar outcomes were revealed in groups with delusions of jealousy, persecution and a mixed group with different main delusions. Duration of symptoms prior to admission was a significant predictor of outcome, indicating dividing lines of 1 and 6 months at 10-year follow-up and 3 and 6 months at long-term follow-up. Based on the data, a minimal duration of 6 months is proposed for persistent delusional disorder.

The relationship between the court and the doctor on the issue of an inpatient's refusal of psychotropic medication.

New procedures, tailored after such court decisions as Rogers v. Commissioner of the Department of Mental Health, have restricted the doctor's ability to treat psychiatric inpatients with psychotropic medication and have increased the protection of a competent patient's right to refuse. This study investigates how the relationship between the doctor and the court has adapted to these new procedures. All 40 court cases of a maximum security forensic hospital over a two-year period were reviewed. Results suggest that the new procedures have had no dramatic effect upon either the treatment patients receive or the doctor-court relationship. While abstract arguments both in favor of and against these new procedures can be drawn from the same data, the concrete relationship still remains poorly understood.

Psychiatric syndromes in Huntington's disease.

Thirty patients with Huntington's disease, a genetically transmitted neuropsychiatric disorder that can be diagnosed reliably, were evaluated systematically for psychopathology, followed for extended periods, and treated with psychopharmacological medications when necessary. DSM-III criteria were used for establishing syndromic diagnoses. Twenty-four individuals demonstrated substantial behavioral abnormalities, including affective and schizophrenic syndromes, changes of personality, and disorders that could not be classified adequately. Pharmacotherapy was modestly beneficial in some cases. Consideration of the array of behavioral disturbances encountered in this pathogenetically unified disorder suggests that a dimensional approach to symptom classification might prove more useful heuristically than present typological methods.