Liu Chen-Chung, Wang Yen-Chin, Hwang Tzung-Jeng
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
Int Clin Psychopharmacol. 2018 Mar;33(2):92-97. doi: 10.1097/YIC.0000000000000207.
To determine whether primary delusional jealousy can be treated effectively with antipsychotics or antidepressants, and whether any clinical variables are associated with response to pharmacotherapy, we carried out a retrospective case series observational study by reviewing clinical records of patients with an International Classification of Disease, 9th ed., diagnostic code of 297 (delusional disorders) who were treated at the Department of Psychiatry of a university affiliated hospital from January 2010 to December 2015. Only those records showing obvious delusional jealousy not secondary to other medical conditions, dementia, or schizophrenia were scrutinized thoroughly with respect to types of pharmacotherapy, treatment response, and other demographic and clinical variables likely to be associated with clinical outcomes. All except one of 32 patients, 16 men and 16 women, between 37 and 79 (60.9±10.6) years of age, were treated with low-dose antipsychotics. The general response was favorable as 19 (59.4%) were rated as good and 13 as inadequate responders (seven partial and six limited). Compared with antipsychotic monotherapy, concomitant therapy with antidepressants had a higher rate of good response, although statistically insignificant (75 vs. 53%, P=0.21). Younger age (P=0.01) and presentation at the index visit with their suspected unfaithful spouse were associated with a good response (P=0.036); comorbidity with delusions other than the jealous type was associated with a poor response (P=0.006). The overall outcome for delusional jealousy looks promising if the patients can accept pharmacotherapy in an outpatient setting.
为了确定原发性妄想性嫉妒能否通过抗精神病药物或抗抑郁药物得到有效治疗，以及是否有任何临床变量与药物治疗反应相关，我们进行了一项回顾性病例系列观察研究，回顾了2010年1月至2015年12月在一家大学附属医院精神科接受治疗、国际疾病分类第9版诊断代码为297（妄想性障碍）的患者的临床记录。仅对那些显示出明显的、并非继发于其他医学状况、痴呆或精神分裂症的妄想性嫉妒的记录，就药物治疗类型、治疗反应以及其他可能与临床结果相关的人口统计学和临床变量进行了全面审查。32例患者（16例男性和16例女性，年龄在37至79岁之间，平均年龄为60.9±10.6岁）中，除1例患者外，其余均接受了低剂量抗精神病药物治疗。总体反应良好，19例（59.4%）被评为反应良好，13例为反应不佳者（7例部分反应和6例有限反应）。与抗精神病药物单一疗法相比，联合使用抗抑郁药物的良好反应率更高，尽管在统计学上无显著差异（75%对53%，P = 0.21）。年龄较小（P = 0.0）以及在首次就诊时与疑似不忠配偶一同前来与良好反应相关（P = 0.036）；除嫉妒型妄想外还合并其他妄想与反应不佳相关（P = 0.006）。如果患者能够在门诊环境中接受药物治疗，妄想性嫉妒的总体治疗结果看起来很有希望。
