Successful treatment of delusional disorder, somatic type by escitalopram: A case report and literature review.

Abstract

Background: Delusional disorder, somatic type (DDST) is characterized by the presence of persistent delusions related to having a physical illness or bodily dysfunction, despite contradictory medical evidence. Antipsychotics like pimozide have shown efficacy in the treatment of DDST, and several case reports suggest that antidepressants may also be effective for this disorder. We are the first to report the effectiveness of escitalopram, which is a most selective and potent serotonin reuptake inhibitor, in a patient with DDST.

Case presentation: The case was a 62-year-old woman with DDST, presenting with oral somatic delusions. Escitalopram treatment (10 mg/day, increased to 20 mg/day) led to significant symptom improvement, and the symptoms of DDST had nearly resolved ∼5 weeks after the initiation of escitalopram. Single-photon emission computed tomography imaging during DDST symptoms showed reduced regional cerebral blood flow (rCBF) in the cerebral cortex, particularly in the temporal and parietal lobes, with follow-up imaging after 9 weeks of escitalopram treatment demonstrating rCBF improvement correlating with clinical recovery.

Conclusion: This case suggests that escitalopram was effective in treating DDST, providing further support for the involvement of serotonergic dysfunction in the pathophysiology of DDST. The improvement in rCBF following treatment suggests that DDST may be associated with reduced rCBF in the temporal and parietal lobes.