Delusional disorder Health Article

Symptoms

The criteria that define delusional disorder are furnished in the Diagnostic and Statistical Manual of Mental DisordersFourth Edition Text Revision, or DSM-IV-TR, published by the American Psychiatric Association. The criteria for delusional disorder are as follows:

• non-bizarre delusions which have been present for at least one month
• absence of obviously odd or bizarre behavior
• absence of hallucinations, or hallucinations that only occur infrequently in comparison to other psychotic disorders
• no memory loss, medical illness or drug or alcohol-related effects are associated with the development of delusions

Demographics

The base rate of delusional disorder in adults is unclear. The prevalence is estimated at 0.025-0.03%, lower than the rates for schizophrenia (1%). Delusional disorder may account for 1–2% of admissions to inpatient psychiatric hospitals. Age at onset ranges from 18–90 years, with a mean age of 40 years. More females than males (overall) suffer from delusional disorder, especially the late onset form that is observed in the elderly.

Diagnosis

Client interviews focused on obtaining information about the sufferer's life situation and past history aid in identification of delusional disorder. With the client's permission, the clinician obtains details from earlier medical records, and engages in thorough discussion with the client's immediate family—helpful measures in determining whether delusions are present. The clinician may use a semi-structured interview called a mental status examination to assess the patient's concentration, memory, understanding the individual's situation and logical thinking. The mental status examination is intended to reveal peculiar thought processes in the patient. The Peters Delusion Inventory (PDI) is a psychological test that focuses on identifying and understanding delusional thinking; but its use is more common in research than in clinical practice.

Even using the DSM-IV-TRcriteria listed above, classification of delusional disorder is relatively subjective. The criteria "non-bizarre" and "resistant to change" and "not culturally accepted" are all subject to very individual interpretations. They create variability in how professionals diagnose the illness. The utility of diagnosing the syndrome rather than focusing on successful treatment of delusion in any form of illness is debated in the medical community. Some researchers further contend that delusional disorder, currently classified as a psychotic disorder, is actually a variation of depression and might respond better to antidepressants or therapy more similar to that utilized for depression. Also, the meaning and implications of "culturally accepted" can create problems. The cultural relativity of "delusions,"—most evident where the beliefs shown are typical of the person's subculture or religion yet would be viewed as strange or delusional by the dominant culture—can force complex choices to be made in diagnosis and treatment. An example could be that of a Haitian immigrant to the United States who believed in voodoo. If that person became aggressive toward neighbors issuing curses or hexes, believing that death is imminent at the hands of those neighbors, a question arises. The belief is typical of the individual's subculture, so the issue is whether it should be diagnosed or treated. If it were to be treated, whether the remedy should come through Western medicine, or be conducted through voodoo shamanistic treatment is the problem to be solved.

Treatments

Delusional disorder treatment often involves atypical(also callednovelornewer-generation) antipsychotic medications, which can be effective in some patients. Risperidone(Risperdal), quetiapine(Seroquel), and olanzapine(Zyprexa) are all examples of atypical or novel antipsychotic medications. If agitationoccurs, a number of different antipsychotics can be used to conclude the outbreak of acute agitation. Agitation, a state of frantic activity experienced concurrently with anger or exaggerated fearfulness, increases the risk that the client will endanger self or others. To decrease anxiety and slow behavior in emergency situations where agitation is a factor, an injection of haloperidol(Haldol) is often given usually in combination with other medications (often lorazepam, also known as Ativan). Agitation in delusional disorder is a typical response to severe or harsh confrontation when dealing with the existence of the delusions. It can also be a result of blocking the individual from performing inappropriate actions the client views as urgent in light of the delusional reality. A novel antipsychotic is generally given orally on a daily basis for ongoing treatment meant for long-term effect on the symptoms. Response to antipsychotics in delusional disorder seems to follow the "rule of thirds," in which about one-third of patients respond somewhat positively, one-third show little change, and one-third worsen or are unable to comply.

Cognitive therapy has shown promise as an emerging treatment for delusions. The cognitive therapist tries to capitalize on any doubt the individual has about the delusions; then attempts to develop a joint effort with the sufferer to generate alternative explanations, assisting the client in checking the evidence. This examination proceeds in favor of the various explanations. Much of the work is done by use of empathy, asking hypothetical questions in a form of therapeutic Socratic dialogue—a process that follows a basic question and answer format, figuring out what is known and unknown before reaching a logical conclusion. Combining pharmacotherapy with cognitive therapy integrates both treating the possible underlying biological problems and decreasing the symptoms with psychotherapy.