Delusion and desire: erotomania revisited

Case Report: De Clerambault's Syndrome in Dementia With Lewy Bodies

Background: Erotomania, also known as de Clerambault's syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to dementia with Lewy bodies (DLB). Case Presentation: The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. She was treated with a small dose of antipsychotic agents. Conclusions: This case report suggests the possibility of de Clerambault's syndrome during the early stages of DLB. Further investigations are required to clarify the mechanism and treatment of de Clerambault's syndrome in patients with DLB.

De Clérambault's syndrome revisited: a case report of Erotomania in a male

BACKGROUND

Erotomania, also known as "de Clérambault's Syndrome", is a psychiatric syndrome characterized by the delusional belief that one is loved by another person of, generally of a higher social status. Erotomania has always been a target of attempts of conceptualization, and the utility of regarding Erotomania as an independent syndrome has been questioned to this day. Erotomania has a much higher prevalence in the female sex, and male Erotomania is a rare and probably underdiagnosed condition. Male Erotomania is only more prevalent in forensic samples, since male sex is one of the risk factors for violent behavior in this disorder. In this article, we aim to describe an uncommon case of Erotomania occurring in a male, hoping to add to literature and to reflect on the implications of the occurrence of Erotomania in men. By discussing the case in light of the different described clinical pictures, proposed diagnostic criteria and classifications, we also aim to contribute to the ongoing attempt to conceptualize this syndrome and to understand the pertinence of considering it an independent nosological entity.

CASE PRESENTATION

We describe a case of Erotomania in a middle-aged Caucasian Portuguese male, with consecutive erotic delusions, followed by a classic turn to a persecutory delusion. The patient was admitted as an inpatient in a psychiatry unit and he was medicated with risperidone 3 mg and diazepam 3 mg daily. His persecutory delusion remitted a 4 days later, he gained insight and was discharged to follow-up as an outpatient. He retains his erotic delusional beliefs, but these are less intense, and has not presented further aggressive behavior.

CONCLUSIONS

We can conclude that it seems reasonable to retain the operative concept of Erotomania as a subtype of Persistent Delusional Disorder/Delusional Disorder, since cases fitting the classical descriptions of the syndrome have been reported, including the presented case. The diagnosis of Erotomania has implications in case management, treatment and prognosis, and missing it, especially in men, may culminate in violent situations that can have legal implications. The developed diagnostic criteria and classifications seem to retain use and should be kept in mind, in the sense that they facilitate making an important diagnosis.

The de Clérambault syndrome: more than just a delusional disorder?

The de Clérambault syndrome, commonly known as erotomania, is a delusional disorder in which the patient is convinced that another person has fallen in love with him or her. The syndrome is more frequent in female patients, who usually believe that their lover is a man belonging to a higher social and economic class, or is married, unknown, or even imaginary or deceased person. The course of the syndrome is usually chronic, with serious problematic behavioural consequences, including stalking behaviours, such as repetitive calling, unexpected visits or continuous attempts to send gifts or letters. According to the DSM-5, this syndrome is included in the erotomanic type of the delusional disorder, however, it is usually neglected in psychiatric practice and almost forgotten by modern psychiatrists.

Uncommon and/or bizarre features of dementia. Part II

In the past decades, clinicians have recognized that dementia may appear as atypical or variant syndromes, as well as the typical form. This study aimed at describing uncommon or bizarre symptoms/syndromes observed in patients suffering from dementia. Medline and Google scholar searches were conducted for relevant articles, chapters, and books published before 2017. Search terms used included delusional jealousy, delusion of pregnancy, dementia, erotomania, folie à deux, and lycanthropy. Publications found through this indexed search were reviewed for further relevant references. The uncommon symptoms/syndromes were described as case reports and there were no systematic investigations.

An Unusual Case of Erotomania and Delusional Misidentification Syndrome

Delusional misidentification syndromes and erotomania are rare entities, each with several distinct manifestations and no clearly defined treatment regimen. Here we expand upon an earlier literature review and describe the case of a 40-year-old woman with a history of bipolar I disorder who presented after an extended period of medication nonadherence with symptoms consistent with both of these conditions; she believed that the staff on the unit were in fact disguised celebrities and fictional characters, and she claimed to be married to a famous singer. The exact relationship of these symptoms (and indeed, even their basic etiologies) remains unclear; however, both delusional syndromes resolved with a combination of risperidone and lithium therapy. Although earlier literature has suggested pimozide as the most effective agent for treating delusional syndromes, given the more favorable side-effect profile of atypical versus typical antipsychotics, this case suggests a role for risperidone as a first-line treatment in such situations.

Erotomania : epidemiology and management

Erotomania is generally classified as a delusional disorder in contemporary classification systems (DSM-IV and ICD-10). The incidence of erotomania is not known, but that of delusional disorder in general has been reported as approximately 15 cases per 100,000 of the population per year, with a female : male ratio of 3 : 1. Both primary and secondary types of erotomania have been identified, the latter being associated with evidence of an aetiologically significant organic or psychiatric condition. The aetiology of primary erotomania is not yet fully understood, but neuroimaging, genetic studies and findings from evolutionary psychopathology hold considerable promise for a deeper and broader understanding of this condition. The initial management of secondary erotomania focuses on treating the underlying organic or psychiatric illness. The management of primary and secondary erotomania involves a combination of pharmacological treatments, psychosocial interventions and risk management strategies. In the past, the antipsychotic medication pimozide was commonly used, at least in certain countries (such as the US and Canada), despite a paucity of systematic studies of its use in this disorder. In recent years, there have been reports of positive therapeutic outcomes with atypical antipsychotics (risperidone, clozapine), which, as a result of their improved tolerability over older agents such as pimozide, will hopefully enhance patient acceptability and, thereby, improve clinical outcome. Despite this advance, there is still a strong need for controlled clinical trials of therapeutic strategies for primary erotomania and related syndromes.

[The De Clèrambault's syndrome: a bibliographic revision]

De Clèrambault's syndrome (or erotomania) consists in a delusional conviction, by the patient, in which someone of higher social status has fallen in love with him or her. Sexual privation can be an important psychodynamic factor on the development of this condition, but organic factors related to its genesis continue on investigation. This study revises the most important aspects that the literature brings us about this disease and its causes. The databases MEDLINE and LILACS have been consulted, and the most appropriate articles were examined. It is established that erotomania is not much found in the scientific literature, and, probably, it isn't as rare as it has been proposed. The major part of its etiologic explanation is based on psychodynamic factors, without, however, confirmed relation of cause with its clinic presentation. The progress in the neurobiologic researches will improve, perhaps, the accuracy of diagnose and treatment of these patients.

Síndrome de De Clèrambault: segundo relato de caso em português

A síndrome de De Clèrambault, ou erotomania, é a convicção delirante que um paciente pode desenvolver de estar sendo amado por alguém de posição social muito proeminente. A síndrome está alocada entre os transtornos delirantes. Relata-se o caso de uma paciente de 46 anos de idade cujos delírios persistem há 32 anos, mantendo um médico como núcleo de seu sistema delirante.

Mastery in patients with schizophrenia living in the community: relationship to sociodemographic and clinical characteristics, needs for care and support, and social network

In line with user involvement and empowerment in individuals who suffer from a severe mental illness, the sense of mastery is important. Few studies have investigated factors that contribute to mastery in individuals with schizophrenia. The aims of the present 18-month follow-up study were to investigate associations between mastery and clinical and sociodemographic factors, needs for care and support and social network, and to investigate whether changes in mastery were related to changes with regard to these aspects in a group of patients (n = 120) with schizophrenia living in the community. Structural interviews were performed at baseline and after 18 months. Pearlin's mastery scale, the Camberwell Assessment of Needs (CAN), the Interview Schedule for Social Interaction (ISSI), and the Brief Psychiatric Rating Scale (BPRS) were used on both interview occasions. A stepwise regression analysis showed a negative relationship between psychopathology, especially affective and negative symptoms, and mastery. Stronger mastery was associated with younger age and less severe basic needs. In total psychopathology, age and basic needs explained 50.7% of the variance in mastery. Changes in mastery were positively correlated to changes in access to social contact but negatively correlated to changes in affective symptoms. In order to target mastery in individuals with schizophrenia, the community-based nursing services need to develop, implement, and evaluate interventions that are effective for psychiatric symptoms, social skills performance, and needs for care and support in areas of living, nutrition, and daytime activities.

Erotomania induced by venlafaxine: a case study

OBJECTIVE

To describe a never previously reported case of erotomania induced by venlafaxine and highlight the effect of antidepressants on the dopaminergic system.

METHOD

A case of erotomania is described.

RESULT

Erotomania occurring in two separate occasions developed after treatment with high doses of venlafaxine. The episode remitted only after lowering the dose of the venlafaxine.

CONCLUSION

Erotomania may occur with agents such as antidepressants. The dopamine neurotransmission of mood can provide further evidence for the development of newer classes of antidepressants.