Abstract

Introduction: Delusional disorder is characterised by the presence of non-bizarre, sometimes bizarre delusions of a single theme, in the absence of other mood or psychotic symptoms. We report a patient presenting with somatic symptoms with delusional explanations for the same.

Case History: A 38-yearold male with complaints of chest pain, anxiety and insomnia since 15 days with multiple consultations and investigations for the same was referred to us. History of death of his child 5 months back, following which he became increasingly anxious about his health. Meanwhile, he spotted 3 vermilion stained lemons inside his home following which he firmly believed that his cousins are doing Blackmagic to kill him and to make his reports normal. Though he visited sorcerers, his suspicion continued. Concurrently, when his wife was not well, he convinced by giving the same explanation for her ill-being.

MSE revealed a single, non-bizarre, systematized delusion with partial insight.

Diagnosis and Management: Delusional disorder was diagnosed and started on T. Risperidone 2mg HS and T. Trihexyphenidyl 2mg OD and was asked to follow up in 15 days.

Discussion: The diagnosis of grief, hypochondriasis and depression were considered. The interesting point here is the delusional explanation for his symptoms for which he has been consulting several doctors which suggests partial insight. Patients with delusional disorder absorb only selectively available information and make conclusions based on less information than healthy subjects and without considering alternative explanations. And therefore, it is difficult to develop therapeutic alliance and patients are likely to refuse medication because they can easily incorporate the administration of drugs into their delusional systems.

Conclusion: Isolated delusions with somatic pain symptoms are rare. However, as with any other delusional disorder, the treatment is challenging in this case because of his partial insight for somatic symptoms and involves both psychopharmacology and psychotherapy. Given the chronic nature of this condition, treatment strategies should be adjusted to the individual needs of the patients with a focus on relieving his anxiety regarding his health problems and improvising his quality of life.

Keywords: Delusional disorder; somatic symptoms.