A clinical report of thymoleptic-responsive atypical paranoid psychoses.

The paranoid disorders of five patients remitted after treatment with thymoleptic agents despite the absence of a full affective syndrome. Their clinical symptoms at admission included suspiciousness, hypervigilance, ideas of reference, hostility, belligerence, and delusions of persecution or of infidelity. Some had phasic disturbances with somatic complaints or prominent phobic anxiety symptoms, a family history of affective disorder, or prior responses to thymoleptic drugs. These observations suggest that some patients with paranoid psychosis who do not have a full DSM-III affective syndrome may respond to antidepressant pharmacotherapy alone, i.e., without neuroleptics. Systematic, prospective studies of this phenomenon would help to ascertain diagnostic criteria for such patients and the range of therapeutic responses.