Monosymptomatic hypochondriacal psychosis

Abstract

In brief, therefore, we are dealing with an illness characterised by a single delusional system - in this instance with hypochondriacal content - which can occur at any age from late adolescence onwards, appears to affect the sexes equally, and has a very poor prognosis without treatment. Its presentation appears to be relatively independent of cultural factors. A previous history, or a family history, of psychotic illness seems very uncommon. However, substance abuse and/or head injury seem to be background factors in a high proportion of younger patients and I would speculate about the role of the ageing brain in the more elderly patients. Within the delusional system, the patient shows marked illogicality insisting, against all evidence, on a physical aetiology, going to many physicians, and initiating strange 'cures' of his own. Although paranoid anger is not uncommonly a feature, secondary depression, shame and avoidant behaviour are more frequent. The illness causes great anguish, and sometimes suicide. Folie à deux is relatively common. At present, pimozide appears to be the most specific treatment and can be dramatically effective. There are scattered reports of improvement or even cure with other neuroleptics or tricyclic antidepressants but, in general, these seem less effective than pimozide (Cashman & Pollock, 1983; Brotman & Jenike, 1984; Pylko & Sicignan, 1985). However, a single case report recently from the USA is intriguing: an apparently excellent result with amoxapine, currently perhaps the most antidopaminergic of the antidepressant drugs (Tollefson, 1985). However, although the case description is suggestive of MHP, the author regards it as one of major depressive illness.(ABSTRACT TRUNCATED AT 250 WORDS)