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A Journal on Psychiatry, Psychology and Psychopharmacology
Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index
Minerva Psichiatrica 2004 September;45(3):149-54
A Kretschemer's delusion of reference in Parkinson's disease
Galeazzi G. M.
Psychotic symptoms and delusions frequently accompany Parkinson's disease. Circadian dysrhythmia with insomnia and side effects due to anti-Parkinson drugs are considered important causal or contributing factors. Interven-tions include reduction or adjustment of dopaminomimetic drug regimens, measures to restore normal sleep-wake rhythms, and atypical antipsychotic medication. The author describes the development of a persecutory delusion in a patient with Parkinson's disease treated with pergolide 2 mg/die. The patient presented initially with simple auditory and visual hallucinations, but gradually developed the delusional idea that neighbors had discovered by accident that he masturbated at home and were commenting and spying on him and intentionally disturbing him. His psychosis resolved with quetiapine 200 mg/die, but over the next 10 months he had a relapse and a postpsychotic depressive episode requiring higher doses of quetiapine and short-term use of antidepressant drugs. His third relapse, 18 months after his initial presentation, resolved only partially with quetiapine 400 mg/die which was therefore replaced by clozapine, to which he responded at a daily dose of 75 mg/die. Psycho-therapy was provided in order to address the patient's sense of shame for his disability and his internalized stigma for his neurological disorder. This case presents features similar to the construct of Kretschmer's delusion of reference, a precursor of modern vulnerability/stress/coping conceptions of psychosis, which highlights the interaction among personality traits, key life events, and social environment. This construct was a useful explanatory model to guide diagnostic, therapeutic, and prognostic evaluations and interventions.