DELUSIONAL DISORDER; how it manifests, and treatment outcomes

 DELUSIONAL DISORDER; how it manifests, and treatment options

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DELUSIONAL DISORDER: A delusion is a fixed belief based on

inaccurate interpretation of an external reality despite evidence

to the contrary. This diagnosis is made when a person has one

or more delusional thoughts. Delusional thoughts that have

persisted for a minimum of one month. An individual's cultural

beliefs merit consideration before making a diagnosis. Cultural

beliefs can have an impact the content of delusions.

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OBJECTIVES

   1. describe different types of delusions

   2. summarize epidemiology of delusional disorder 

   3. describe/evaluate delusional disorder

   4. implement an professional team for improving outcomes

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SOME OF THE MOST COMMON DELUSIONS

1. DELUSIONAL JEALOUSY: that one's partner is being unfaithful

2. BIZZARE: a delusion involving a phenomenon that is impossible,

not understandable, unrelated to daily life.

3. EGOMANIC: a delusion that a person of a higher status in life

is in love with you.

4. GRANDIOSE: convictions of talent, discovery, inflated self-worth

and feelings of great power and knowledge

5. PERSECUTORY: the central theme is being conspired against,

attacked, harassed; behavior that effects everyday life and long

term goals.

6. SOMATIC: these involve body and body sensations

7. MiXED: no single delusion is all-consuming

8. THOUGHT BROADCASTING: delusions that one's own thoughts

are being discovered by others

9. THOUGHT INSERTION: a delusion that one's thoughts

are being influenced by an outside entity

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ETIOLOGY

  Delusional disorder is relatively far, and has a later onset;

and does not show a GENDER preference. Many biological 

conditions, like substance abuse, medical conditions, and

neurological conditions can cause delusions. The delusions

involves the limbic system.

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EPIDEMEOLOGY 

    The lifetime morbidity rate of delusional disorder in the

general population has been estimated to be anywhere from

0.005-1% of the population. Delusional disorder is more rare

than Bipolar Disorder. Average age of onset is 40 years. The

jealous type is more common in males. The erotomanic is more

common in females.

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PATHOPHYSIOLOGY 

   Generally (GAL), or global functioning can be significantly

impacted by one's occupation. There may be social isolation.

1. PERSECUTORY TYPE: this is one of the most common delusions.

Patients can be anxious, irritable, assertive, even aggressive

2. JEALOUS TYPE: also known as "Othello Syndrome", this type

is most common in males. It can sometimes correlate with either

suicidal ideation and or homicidal ideation.

3. EROTOMANIC: this type of delusion involves a belief that a

person of a higher status is in love with the patient. These

patients are socially/occupationally impaired.

4. SOMATIC TYPE: impairment is severe. The patient is

inarguably convinced of severity of symptoms. Most common is

an infestation of bugs, and signs and symptoms of Body

Dysmorphic Disorder.

5. GRANDIOSE TYPE: notable because of their own inflated

self-importance

6. MIXED TYPE: patients may have two or more distinct delusional

beliefs.

7. UNSPECIFIED: sometimes a predominant delusion cannot be

identified.

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HISTORY AND PHYSICAL

  General description : patients are usually well-nourished

and appropriately groomed.

MOOD: mood is usually congruent with delusion

COGNITION: memory and cognition are usually intact, and

patients are usually oriented X3.

IMPULSE CONTROL: important to evaluate suicidal and homicidal

ideations. If there is a history of aggression, they should be 

hospitalized.

INSIGHT AND JUDGMENT: most have no insight regarding 

delusions

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EVALUATION

  Imagery and lab tests should be considered to rule out any

organic issues. Substance-induced conditions should be ruled out

by drug screens. Clinicians, additionally, ask follow-up questions.

A complete mental health examination should be performed.

Interviewing family members should be considered because

they can provide further detail about delusions, as well as

a time frame in which delusions could have developed.

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TREATMENT/MANAGEMENT

   Treatment is difficult due to lack of insight on the patient's

part.

   A patient's history of medication compliance is the best guide

to selecting anti-psychotic medication. Treatment response

is best when pairing psychology and pharmacology.

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PROGNOSIS

    The prognosis is better with treatment and medication

compliance. Almost 50% of patients have a good response

to medication; another 20% report no noticeable changes in

thoughts or behavior. Delusional disorder is usually a chronic

condition. However, when treated patients tend to have

overall improved social functioning.

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COMPLICATIONS

   If left untreated, might lead to depression. Delusions can also

lead to violence and other legal issues.

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