748751
research-article2018
ANP0010.1177/0004867417748751ANZJP CorrespondenceANZJP Correspondence
Letter
Letter
Paroxetine therapy
for somatic delusion –
Implications for underlying
serotonergic dysfunction
Vijay Niranjan, Koustubh
R Bagul and Pali Rastogi
Department of Psychiatry, Mahatma Gandhi
Memorial Medical College, Indore, India
Corresponding author:
Vijay Niranjan, Department of Psychiatry,
Mahatma Gandhi Memorial Medical College,
A.B. Road, Indore 452 001, India.
Email: dr.vijayniranjan@gmail.com
DOI: 10.1177/0004867417748751
To the Editor
Delusional disorder, somatic type
(DDST) is characterized by hypochon-
driacal delusions. Pimozide is recom-
mended as the first-choice drug for this
disorder (Munro, 1988). However,
there have been reports that tricyclic
antidepressants are effective (Hayashi
et al., 2004), suggesting serotonergic
dysfunction. There is, therefore, a case
for selective serotonin reuptake inhibi-
tors (SSRIs) to be considered as treat-
ment options for this disorder. We
present a case of successful manage-
ment of such a patient with
paroxetine.
A 32-year-old male presented with
an 8-year history of a belief that his
head has become numb from the
inside and his brain’s vessels have
become blocked. He stopped pouring
water over his head while bathing and
started wearing a scarf over his head
always as he believed that water/cold
air could make his head more blocked.
He had previously been treated with
first-generation antipsychotics. His
mental status examination revealed
somatic delusion, while other domains
of mental state showed no abnormal-
ity. Physical examination, relevant
hematological tests, magnetic reso-
nance imaging (MRI) of the brain and
electroencephalogram (EEG) did not
reveal any abnormality.
The patient was initially treated
with olanzapine 20 mg/day for 4 weeks,
but he continued to maintain his belief
with the same intensity. The olanzap-
ine was stopped and the patient was
subsequently treated with paroxetine
25 mg/day, and the dose was gradually
increased to 37.5 mg/day on the sec-
ond week. About 10 days later, it was
observed that he stopped wearing
scarf overhead and started to pour
water over his head while bathing.
Three weeks later, he reported that
the ‘block’ was much minimized and
he maintained the improvement till
1 year of follow-up.
Pimozide is reported as a first-
choice drug for DDST, but it has
serious cardiovascular side effects
like QTc prolongation. Earlier
research has suggested that DDST is
related to serotonergic dysfunction
as there is reported efficacy of tricy-
clic antidepressants for the treat-
ment (Hayashi et al., 2004). However,
paroxetine holds a safer side effect
Australian & New Zealand Journal of Psychiatry, 00(0)
Australian & New Zealand Journal of Psychiatry
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https://doi.org/10.1177/0004867417748751
© The Royal Australian and
New Zealand College of Psychiatrists 2018
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profile, for example, fewer anticho-
linergic effects and a lower incidence
of cessation due to adverse events
compared to tricyclics (Wagstaff
et al., 2002). Hayashi et al. (2004)
also reported successful use of par-
oxetine in a case with DDST and sug-
gested that paroxetine normalizes
hypoperfusion in the left temporal
and parietal lobes.
In conclusion, this report suggests
that paroxetine may be an effective
treatment option for ‘DDST’ and
supports the previous views that
DDST is associated with serotonergic
dysfunction.
Declaration of Conflicting
Interests
The author(s) declared no potential con-
flicts of interest with respect to the
research, authorship and/or publication of
this article.
Funding
The author(s) received no financial sup-
port for the research, authorship and/or
publication of this article.
References
Hayashi H, Oshino S, Ishikawa J, et al. (2004)
Paroxetine treatment of delusional disorder,
somatic type. Human Psychopharmacology:
Clinical and Experimental 19: 351–352.
Munro A (1988) Monosymptomatic hypochon-
driacal psychosis. British Journal of Psychiatry
153(Suppl. 2): 37–40.
Wagstaff AJ, Cheer SM, Matheson AJ, et al. (2002)
Paroxetine: An update of its use in psychiatric
disorders in adults. Drugs 62: 655–703.