Alistair Munro

Monosymptomatic Hypochondriacal Psychosis: A Diagnostic Checklist Based on 50 Cases of the Disorder

The authors present a checklist of symptoms and characteristics of monosymptomatic hypochondriacal psychosis, based on a unique series of 50 cases of the disorder. The condition appears to be a subtype of paranoia. Pimozide is reported to be an effective treatment in a majority of cases.

Two cases of "pure" or "primary" erotomania successfully treated with pimozide.

Erotomania is a mono-delusional disorder which, in its “pure” or “primary” form, should probably belong to the diagnostic category of Paranoia. Traditionally, the prognosis and response to treatment are very poor, but one of the present authors has previously proposed that the condition should respond to pimozide. Case histories of two patients successfully treated with this drug are presented.

Delusional (Paranoid) disorders: etiologic and taxonomic considerations. I: The possible significance of organic brain factors in etiology of delusional disorders

The term “Paranoid Disorders” is used vaguely and indiscriminately by many authors. This article provides brief working descriptions of a small number of paranoid/delusional conditions and, making reference to the authors series of monodelusional disorders, describes certain organic brain factors which appear to be surprisingly common in the background of these cases. It is hypothesized that the group of paranoid/delusional disorders may be linked to schizophrenia, especially of the paranoid type: however, in the paranoid/delusional disorders, hereditary schizophrenic factors may be weak and adverse organic brain factors relatively much stronger.

Delusional (Paranoid) Disorders

The group of paranoid or delusional disorders, although not nearly as common as the mood and schizophrenic disorders, may be much more frequent than has usually been thought. DSM-III R has made a decisive step in recognizably defining at least one group of them. Interestingly, this change partly came about because the advent of an effective treatment helped to define that group more clearly. Nevertheless, DSM-III Rs classification is too restrictive, and it was wrong to exclude the diagnosis of paraphrenia. Cases fitting this description will have to be consigned to the category of Psychotic Disorder NOS, which will inevitably be a grab-bag of mixed diagnoses. Also, DSM-III R does not emphasize the link between the delusional disorders and paranoid schizophrenia, and the somewhat less well defined overlap with affective disorders, both of which give rise to much diagnostic confusion and inappropriate treatment. Precise history taking and mental status examination and, above all, an up-to-date knowledge of their existence are essential to the recognition and appropriate treatment of the delusional disorders.

Folie à deux revisited

Folie à deux (shared paranoid disorder) is misleadingly defined in DSM-III. It is not an illness in itself, but a phenomenon associated with delusional psychiatric illnesses. There are two main types of folie à deux. An updated nomenclature is proposed.

BODY DYSMORPHIC DISORDER AND THE DSM-IV : THE DEMISE OF DYSMORPHOPHOBIA

To some extent, the failure of some authors, reporting on dysmorphophic patients, to specify clearly the level at which the belief is held, has confounded clarification of the phenomenon. Birtchnell (1) Dysmorphophobia is a controversial term. It is not a phobia, reliable data on it are few, and many authors write about it without attempting to define it. DSM-III-R introduced the term “body dysmorphic disorder” to describe a non-psychotic condition in which there is pathological preoccupation with physical appearance and with the intention of replacing the term “dysmorphophobia”. However, psychiatrists continue to use the word dysmorphophobia, often unaware that it may have several distinct meanings. This article, 1. demonstrates the current confusion in terminology, 2. elaborates on DSM-III-Rs concept of body dysmorphic disorder, and 3. suggests refinements for the DSM-IV description.

Delusional (Paranoid) disorders: etiologic and taxonomic considerations. II: A possible relationship between delusional and affective disorders

Paranoid (delusional) disorders are usually thought to overlap with schizophrenic disorders, and there may be a continuum, especially with paranoid schizophrenia. There is also some recent evidence of an overlap with affective disorders. This article refers to the authors series of monodelusional disorders, emphasizing certain mood concomitants, and discussing the implications of these for delusional disorders in general.

Neither lions nor tigers: disorders which lie between schizophrenia and affective disorder

Are schizophrenia and major affective disorders truly distinct conditions? The answer remains debatable, but it is suggested that lack of recognition of intermediate disorders is a factor in preventing an authoritative answer to the question.

A plea for paraphrenia

Clinicians who deal with psychotic patients see individuals whose illness is similar to schizophrenia, but whose symptoms are less florid, and deterioration less severe, than in schizophrenia. The diagnosis of atypical psychosis or psychotic disorder NOS is not satisfactory since it lumps disparate conditions together, whereas the term “paraphrenia” can include such illnesses. Paraphrenia is a well-established concept that was ignored in the DSM-III and the DSM-III-R and may be excluded from the ICD-10. There is a need to re-establish the diagnosis, for accurate diagnostic purposes and for future research of the paranoid/delusional disorders.

A possible case of Asperger's syndrome.

Aspergers syndrome is an autistic-like disorder, probably neuropsychiatric in character, which fits with DSM-III criteria for Atypical Pervasive Development Disorder. Because the abnormality is less pervasive than Autistic Disorder, it may be misdiagnosed as Personality Disorder in the adolescent, and the author presents an illustrative case in this respect. The condition is sometimes associated with Tourettes Syndrome, though not in this particular patient. Treatment remains speculative.