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.
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.
Type: Predominately erotomanic delusions.
Type: Predominately grandiose delusions.
Type: Predominately delusions of jealousy.
Type: Predominately persecutory delusions.
Type: Predominately somatic delusions.
Type: Doesn't fit any of the previous categories.
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.
or Sexual Dysfunction
or Eccentric or Suspicious Personality
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.
Body Dysmorphic Disorder
Limbic System Pathology
Serious Liver and Kidney disease.
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,
disorder appears to run distinct from schizophrenia
and mood disorders, and does
not appear to be a prodrome to either of these conditions.
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
Theories: use of the defense mechanisms of reaction
formation, denial, projection: e.g. paranoia
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.
and Psychotherapy [ See
Therapy Section ]:
[ See Psychopharmacology
Section ] :
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
Doses and Side Effects for Chronic Use
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
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.