Non-bizarre delusions
including feelings of being followed, poisoned, infected, deceived
or conspired against, or loved at a distance. Non-bizarre referred
to real life situations which could be true, but are not or are greatly
exaggerated. Bizarre delusions, which would rule out this disorder,
are those such as believing that your stomach is missing or that aliens
are seeking you out to be their leader. Delusional disorder can be
subtyped into the following categories: erotomanic, grandiose, jealous,
persecutory, somatic, and mixed. Symptoms include:
Nonbizarre delusions for at least one month.
Absence of obviously odd or bizarre behavior.
Schizoaffective Disorder
and Mood Disorder with Psychotic
Features have been ruled out.
Absence of evidence that an organic factor initiated and maintained
this psychotic disturbance.
Absence of prominent hallucinations of a voice for at least one week.
Absence of visual hallucinations for at least one week.
Has never met the criteria for the active phase of Schizophrenia.
Subtypes
Erotomanic Type:
Predominately erotomanic delusions.
Grandiose Type:
Predominately grandiose delusions.
Jealous Type:
Predominately delusions of jealousy.
Persecutory
Type: Predominately persecutory delusions.
Somatic Type:
Predominately somatic delusions.
Unspecified
Type: Doesn't fit any of the previous categories.
These patients,
who tend to be in their 40's, may be may not realise that they have
a delusional disorder until it is pointed out by family or friends.
Even the diagnosis may be difficult because many do not voluntarily
seek treatment. They are frequently hypersensitive and argumentative.
Although they may perform well occupationally and in areas distant
from their delusions, they tend to be social isolates either by preference
or as a result of their interpersonal inhospitality (i.e., spouses
frequently abandon them). Social and occupational dysfunction, when
it occurs, usually is in direct response to their delusions.
Associated
Features:
Psychosis
Depressed
Mood
Somatic
or Sexual Dysfunction
Odd
or Eccentric or Suspicious Personality
Differential
Diagnosis :
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Schizophrenia
Mood
Disorders
Psychosis NOS
Paranoid
Personality Disorder
Body Dysmorphic Disorder
Parkinson's
Disease
Huntington's
Vitamin Deficiency
Delirium
Dementia
Drug-Induced
Endocrinopathies
Limbic System Pathology
Serious Liver and Kidney disease.
Cause:
The cause of delusional
disorder is not known. Some studies suggest a biological component
due to increased prevalence in first degree relatives of individuals
with the disorder. There is a tendency for their family relationships
to be characterized by turbulence, callousness, and coldness yet the
significance of the patter is unclear typical defense mechanisms seen
in these patients include denial, projection, and regression.
A delusional disorder
appears to run distinct from schizophrenia
and mood disorders, and does not
appear to be a prodrome to either of these conditions.
Biologic
Theories: the relatively common occurrence of delusions
in neurological illness has led investigators to speculate on the
role of the limbic system, basal ganglia, and neocortical association
areas. No good current unifying theory
Psychodynamic
Theories: use of the defense mechanisms of reaction formation,
denial, projection: e.g. paranoia
Treatment:
Hospitalize if patient is a
danger to self or others, need a rapid diagnostic work-up. Antipsychotic
drugs are the drugs of choice, efficacy is not clear.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Medications
can be helpful but are often refused due to the nature of the disorder.
Some individuals function quite normally, while others may react
to their delusion in ways that can greatly disrupt their life.
Antipsychotics:
Doses and Side Effects for Chronic Use
Antipsychotics.
Chlorpromazine.
Thioridazine.
Trifluoperazine.
Thiothixene.
Fluphenazine.
Haloperidol.
Special Antipsychotic Adverse Reactions
Neuroleptic Malignant Syndrome. May occur at any point during the
course of treatment. Includes symptoms of autonomic instability, altered
mental status, which may progress to hyperthermia, stupor, and muscle
hypertonicity. Death may occur. Cause: Neuroleptics (phenothiazines,
etc.) Characteristics. Same symptoms as malignant hyperthermia (see
below) but generally develops over days instead of minutes. Treatment:
As per malignant hyperthermia.
Malignant Hyperthermia. Cause. 1:20,000 in response to a muscle-relaxing
agent (such as succinylcholine) or an inhaled anesthetic (such as
halothane). Is hereditary. May also be secondary to physical or emotional
stress. Characteristics. Hyperthermia, muscle rigidity, tachycardia,
acidosis, shock, coma, rhabdomyolysis. Treatment includes IV dantrolene
1 to 10 mg/kg IV titrated to effect, management of acidosis and shock,
peripheral cooling (see management of heat stroke below).
Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth,
or jaw associated with long-term administration of antipsychotics.
Elderly females at highest risk. May be irreversible.
