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With regard to delusional disorder-somatic subtype there may be a relationship with body dysmorphic disorder. There are reports that some delusional disorders can evolve to become schizophrenia. Similarly, the treatment of such disorders with antipsychotics has been documented. This report describes a case of delusional disorder - somatic type - preceding a psychotic episode and its successful treatment with an antipsychotic drug, thus contributing to what has been documented on the subject.The classification of body dysmorphic disorder (BDD) is controversial; whereas BDD is classified as a somatoform disorder, its delusional variant is classified as a psychotic disorder.This psychotic variant is also referred to as delusional disorder somatic type. It is sometimes very difficult to distinguish cases of delusional disorder of somatic subtypefrom severe somatization disorder, and claims have been made that there is a continuum between these illnesses. The condition differs from other conditions with h hypochondriacal symptoms in degree of reality impairment. The reported prevalence of BDD differs between studies; ranging from 2% of patients who requested plastic surgery to 12% of patients with obsessive-compulsive disorder.
Fifty percent of BDD patients are reportedly delusional. The disorder may be under diagnosed because many of the patients with somatic delusions present to other specialists such as dermatologists or plastic surgeons, more often than to psychiatrists in the unremitting search for curative cosmetic procedures which they are usually denied. But if the surgeon does not perceive the illogicality of the complaint an operation may take place. While some successes have been reported, the general consensus is that most cases need psychiatric rather than surgical intervention and that surgery may seriously worsen the mental disorder in the longer term.
Conclusion
It is therefore proposed that the reported case describes one of schizophrenia preceded by a somatic delusional disorder
https://www.omicsonline.org/open-access/JOP/JOP-13-283.pdf?aid=18562
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