Delusional Disorder


Definition
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Highlights: Delusional Disorder

Delusional disorder refers to a condition associated with one or more nonbizarre delusions of thinking—such as expressing beliefs that occur in real life such as being followed, being poisoned, being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are exhibited.

Delusions may seem believable at face value, and patients may appear normal as long as an outsider does not touch upon their delusional themes.

Themes of delusions may fall into the following types: erotomanic type (patient believes that a person, usually of higher social standing, is in love with the individual); grandiose type (patient believes that he has some great but unrecognized talent or insight, a special identity, knowledge, power, self-worth, or special relationship with someone famous or with God); jealous type (patient believes his partner has been unfaithful); persecutory type (patient believes he is being cheated, spied on, drugged, followed, slandered or somehow mistreated); somatic type (patient believes he is experiencing physical sensations or bodily dysfunctions—such as foul odors or insects crawling on or under the skin—or is suffering from a general medical condition or defect); mixed type (characteristics of more than one of the above types, but no one theme dominates); or unspecified type (patient's delusions do not fall in described categories).

Symptoms
  • Nonbizarre delusions—delusional thoughts reflecting situations that occur in real life—with duration of one month or longer
  • Other symptoms of schizophrenia have never been met, except tactile and olfactory delusions may be present if consistent with delusional themes.
  • Functioning and behavior are not markedly impaired nor odd or bizarre aside from delusions.
  • Duration of any mood symptoms accompanying delusional symptoms has been brief in comparison to duration of delusions.
  • Disorder is not caused directly by use of substances or medical condition.
  • Onset tends to be later in life. (This disorder is quite uncommon.)

Causes

There are a variety of associated features to the Delusional Disorder including the development of an irritable or gloomy mood as a reaction to their delusional beliefs. Especially with persecutory and jealous types, marked anger and violent behavior can occur. Hearing deficiency or severe psychosocial stressors—such as low socioeconomic status—may predispose a person to some types of delusional disorder such as the paranoid type. Legal difficulties or engaging in litigious behavior can occur in the jealous type or erotomanic types. Subjecting oneself to unnecessary medical tests and procedures may be associated with the somatic type.

Treatment

Treatment approaches may be found similar to those used to treat symptoms of schizophrenia. Antipsychotic drugs are often very effective in treating delusions. A number of new antipsychotic drugs (the so-called "atypical antipsychotics") have been introduced since 1990. The first of these, clozapine (Clozaril), has been shown to be more effective than other antipsychotics, although the possibility of severe side effects—in particular, a condition called agranulocytosis (loss of the white blood cells that fight infection)—requires that patients be monitored with blood tests every one or two weeks. Even newer antipsychotic drugs, such as risperidone (Risperdal) and olanzapine (Zyprexa), are safer than the older drugs or clozapine, and they also may be better tolerated. They may or may not treat the illness as well as clozapine, however. Several additional antipsychotics are currently under development.

Antipsychotic drugs, like virtually all medications, have unwanted effects along with their beneficial effects. During the early phases of drug treatment, patients may be troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry mouth or blurring of vision. Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs. A patient may do better with one drug than another.

The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most often affecting the mouth, lips and tongue—and sometimes the trunk or other parts of the body, such as arms and legs. It occurs in about 15 to 20 percent of patients who have been receiving the older, typical antipsychotic drugs for many years, but TD can also develop in patients who have been treated with these drugs for shorter periods of time. In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements.

Antipsychotic medications developed in recent years all appear to have a much lower risk of producing TD than the older, traditional antipsychotics. The risk is not zero, however, and they can produce side effects of their own such as weight gain. In addition, if given at too high a dose, the newer medications may lead to problems such as social withdrawal and symptoms resembling Parkinson's disease, a disorder that affects movement. Nevertheless, the newer antipsychotics are a significant advance in treatment, and their optimal use in people with schizophrenia is a subject of much current research.

These medications have proven to be crucial in relieving psychotic symptoms such as hallucinations, delusions and incoherence, but they are not consistent in relieving the behavioral symptoms of the disorder. Even when relatively free of psychotic symptoms, many patients have extraordinary difficulty with communication, motivation, self-care and establishing and maintaining relationships with others. Also, patients can become ill during the critical career-forming years of life (ages 18 to 35), they are less likely to complete the training required for skilled work. Therefore, many suffer from a lack social and work skills, along with experiencing cognitive and emotional difficulties.

Psychosocial treatments may help most with psychological, social and occupational problems. While psychosocial approaches have limited value for acutely psychotic patients (those who are out of touch with reality or have prominent hallucinations or delusions), they may be useful for patients with less severe symptoms or for patients whose psychotic symptoms are under control. Numerous forms of psychosocial therapy are available, and most focus on improving the patient's social functioning whether in the hospital or community, at home or on the job. Unfortunately, the availability of different forms of treatment varies greatly from place to place.

Those close to people who suffer are often unsure of how to respond when patients make statements that seem strange or are clearly false. For the individual, the bizarre beliefs or hallucinations seem quite real—they are not just imaginary fantasies. Instead of going along with a person's delusions, family members or friends can tell the person that they do not see things the same way or do not agree with his or her conclusions, while acknowledging that things may appear otherwise to the patient. It may also be useful for those who know the individual well to keep a record of what types of symptoms have appeared, what medications (including dosages) have been taken and what effects various treatments have had. By knowing what symptoms have been present before, family members may know what to look for in the future. Families may even be able to identify some early warning signs of potential relapses, such as increased withdrawal or changes in sleep patterns, even better and earlier than the patients themselves. Thus, return of psychosis may be detected early and treatment may prevent a full-blown relapse. Also, by knowing which medications have helped and which have caused troublesome side effects in the past, the family can help those treating the patient to find the best treatment more quickly.

In addition to involvement with seeking help, family, friends and peer groups can provide support and encourage the patient to regain his or her abilities. It is important that goals be attainable, since a patient who feels pressured or repeatedly criticized by others will probably experience stress that may lead to a worsening of symptoms. A positive approach may be helpful—and perhaps more effective in the long run than criticism. This advice applies to everyone who interacts with the person.

Sources:

  • National Institutes of Health
  • American Psychiatric Association

Last Reviewed: 28 Oct 2005
Last Reviewed By: Laura Stephens