Objective: To investigate gender differences in age at onset, psychopathology, and suicidal behavior rates in delusional disorder (DD). Methods: We conducted a prospective longitudinal study of 97 patients with DD. Demographic and clinical data at baseline were recorded. Gender differences were investigated by applying analysis of covariance, using age at onset and age at first psychiatric consultation as dependent variables, comorbid depression and gender as between-subject factors, and employment status, social support, and DD types as covariates. Results: Seventy-six percent of the patients were women. The average age at onset was 48.76±12.67 years, mean age at first psychiatric consultation was 54.13±13.67 years, and men were more likely to be employed than women (p = 0.041). Despite the earlier age at onset and at first psychiatric consultation in men, these differences tended to disappear when adjusted for potential confounders. There were no significant gender differences in depressive comorbidity, presence of suicidal ideation and behavior, or compliance rates at follow-up. Conclusions: Our findings could not confirm that male and female DD patients differ in age at onset, age at first psychiatric consultation, or suicidal ideation and behavior, even after controlling for potential confounders.

Background The relationship between insight and suicidal behavior among psychotic patients is poorly studied and possibly mediated by clinical variables. Objectives Our goal was to investigate clinical differences in suicidal and non-suicidal delusional disorder (DD) patients, and to evaluate the relationship between insight, psychotic and depressive symptoms. Methods Cross-sectional study in 64 consecutive DD patients. For assessment, we used the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HRSD-17), the Columbia Suicide Severity Rating Scale (C-SSRS), the Personal and Social Performance Scale (PSP), and the first three items of the SUMD scale for insight. The sample was divided according to the presence of suicide attempts. To investigate psychopathological associations, bivariate correlation coefficients were used. Age at onset served as covariate in subsequent analyses. Results Suicidal DD patients had higher depressive symptoms and were more frequently admitted than non-suicidal patients. A logistic regression model confirmed that insight, depressive symptoms and age at onset were predictors of suicidal behavior. Unawareness of the effects of medication was negatively related to depressive symptoms. After adjustment, depressive symptoms were weakly correlated to better insight into the effects of medication. No other statistically significant correlations were found. Discussion Depressive symptoms, insight and age at onset of disease may be potential predictors of suicidal behavior in DD patients.

Background and Objectives: In clinical practice, the coexistence of delusions and affective symptoms is often observed. The current Diagnostic and Statistical Manual of Mental Disorders, fourth edition- Text Revision (DSM-IV-TR) accepts the existence of mood disturbances in delusional disorder. Little research has been done regarding this field and prevalence rates are unclear. Our purpose was to review the frequency of affective symptoms in delusional disorder patients and to identify the proportion of these patients that are reported to be treated with antidepressants. Methods: Three electronic databases were searched from 1980 to July 2012: MEDLINE, PsycINFO and PubMed, using the following keywords: delusional disorder, depression, affective illness, antidepressants and paranoia. Results: A high frequency of affective disturbances was found in this population (21-55.8%). In contrast, a low antidepressants prescription rate was shown. When focusing on delusional disorder somatic subtype, a particularly high mood disorder comorbidity rate was described and a good efficacy of antidepressant drugs was reported, in monotherapy or in combination with antipsychotics. Conclusions: A high frequency of comorbid depression in delusional disorder and a low antidepressants prescription rate could be concluded. Further studies are needed to better clarify the role of mood symptoms in clinical practice among delusional disorder patients.