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Case Reports
Extremely grotesque somatic delusions in a patient of delusional disorder and its response to risperidone treatment
Takaki Akahane, M.D., Hiroshi Hayashi, M.D., Ph.D.
⁎
, Haruyoshi Suzuki, M.D.,Shinobu Kawakatsu, M.D., Ph.D., Koichi Otani, M.D., Ph.D.
Department of Psychiatry, Yamagata University School of Medicine, Yamagata 990-9585, Japan
Received 3 June 2008; accepted 11 July 2008
Abstract
A 54-year-old man with delusional disorder, somatic type (DDST) showed extremely grotesque somatic delusions, i.e., the presence of another lower jaw with teeth and tongue accompanied by annoying sensations. These somatic delusions responded favorably to treatment with risperidone 2
–
3 mg/day. The single photon emission computed tomography taken when he had marked somatic delusions showedhypoperfusion in the temporal and parietal lobes. The present report suggests that delusion of reduplication of body parts, which has beengenerally associated with organic brain diseases, is also observed in DDST. This report also supports prior observations on the efficacy of risperidone for DDST and the association between this disorder and hypoperfusion in the temporal and parietal lobes.© 2009 Elsevier Inc. All rights reserved.
Keywords:
Delusional disorder; Risperidone; Somatic delusion; SPECT
1. Introduction
Delusional disorder, somatic type (DDST), also known asmonosymptomatic hypochondriacal psychosis (MHP), ischaracterized by somatic or hypochondriacal delusions[1].The most common delusions in DDST are that he or sheemits a foul odor from the skin, mouth, rectum or vagina;that there is an infestation of insects on or in the skin; that there is an internal parasite; that certain parts of the body aredefinitely misshapen or ugly or that parts of the body are not functioning[2].KnowledgeofaetiologyinDDSTisscanty,becausesolittlemodern research has been conducted[1]. Some researchersincluding us have suggested that DDST has some associationwith hypoperfusion in the temporal and parietal lobes[3
5].Astotreatment,Munrohasrecommendedpimozideasthefirst choicedrugforDDST[1].However,recentreportssuggesttheefficacy of risperidone[4,6]that has a more benign side effect profile than pimozide[7].We describe the case of a patient with DDST, who showedextremely grotesque somatic delusions accompanied byhypoperfusion in the temporal and parietal lobes, andresponded favourably to risperidone treatment.
2. Case report
The case was a 54-year-old man. He had no past history or family history of psychiatric disorders. His social andoccupational histories were quite normal. In August of 2005,he felt that
“
something has stuck between under front teeth.
”
From September, he felt that
“
there is another lower jaw withteethbetweentherealupperjawandreallowerjaw,andthereisanother tongue between the false lower jaw and the real lower jaw
”
;
“
theteethonthefalselowerjawaregrowingsteadily
”
;
“
Itrytocutthefalseteethoffwiththerealteeth,butthefalseteethdo not stop growing
”
;
“
the false teeth melt into holes in thefalse lower jaw, but later grow again from those holes
”
;
“
something like spaghetti is coming into and going out fromthe holes
”
and
“
the false lower jaw rolls up and is coming intothe throat.
”
Becauseof these annoyingsensations, he had milddepressive symptoms such as depressed mood, decrease inappetite, restlessness and fatigue. Despite these symptoms, hewas able to continue working.In October, he visited our out patient clinic. He had thegrotesque somatic delusions and mild depressive symptoms
Available online at www.sciencedirect.com
General Hospital Psychiatry 31 (2009) 185
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186
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Corresponding author. Tel.: +81 23 628 5322; fax: +81 23 628 5325.
E-mail address:
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