González-Rodríguez Alexandre, Guàrdia Armand, Palao Diego José, Labad Javier, Seeman Mary V
Department of Mental Health, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell 08280, Spain.
Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada.
World J Psychiatry. 2020 Apr 19;10(4):34-45. doi: 10.5498/wjp.v10.i4.34.
Delusional disorder (DD) has been traditionally considered a relatively rare and treatment-resistant psychotic disorder. In the last decade, increasing attention has focused on therapeutic outcomes of individuals affected by this disorder. The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research: (1) For which patients with DD do antipsychotic medications work best (the moderators of response); and (2) What variables best explain the relationship between such treatments and their effectiveness (the mediators of response). We searched PubMed and Google Scholar databases for English, German, French and Spanish language papers published since 2000. We also included a few classic earlier papers addressing this topic. Variables potentially moderating antipsychotic response in DD are gender, reproductive status, age, duration of illness, the presence of comorbidity (especially psychiatric comorbidity) and its treatment, brain structure, and genetics of neurochemical receptors and drug metabolizing enzymes. Antipsychotic and hormonal blood levels during treatment, as well as functional brain changes, are potential mediating variables. Some, but not all, patients with DD benefit from antipsychotic treatment. Understanding the circumstances under which treatment works best can serve to guide optimal management.
妄想障碍（DD）传统上被认为是一种相对罕见且难治的精神障碍。在过去十年中，越来越多的关注集中在受该障碍影响个体的治疗结果上。本文的目的是综合文献，探讨DD研究中出现的两个非常重要的问题：（1）抗精神病药物对哪些DD患者效果最佳（反应的调节因素）；（2）哪些变量能最好地解释此类治疗与其有效性之间的关系（反应的中介因素）。我们在PubMed和谷歌学术数据库中搜索了自2000年以来发表的英文、德文、法文和西班牙文论文。我们还纳入了一些早期探讨该主题的经典论文。DD中可能调节抗精神病反应的变量包括性别、生殖状态、年龄、病程、共病情况（尤其是精神科共病）及其治疗、脑结构以及神经化学受体和药物代谢酶的遗传学。治疗期间的抗精神病药物和激素血药水平以及脑功能变化是潜在的中介变量。部分但并非所有DD患者都能从抗精神病治疗中获益。了解治疗效果最佳的情况有助于指导优化管理。
