DELUSIONAL DISORDER

Dr. Subhash Meena

NORMAL THINKING�

“NORMAL’’ thinking is characterized by

• goal directed

​

• succession of ideas ,associations and

symbols

​

• leading to rational conclusion

​

Grave errors in any of the above mentioned steps qualifies for a thought disorder

DELUSIONAL DISORDER

​

• The former term paranoia was derived from Greek words meaning “beside” and “mind”.
• In modern usage, paranoia is taken to mean extreme suspiciousness, usually not based on realistic assessment of the situation.

​

EPIDEMIOLOGY

• relatively rare (the prevalence = 0.03%).

​

• annual incidence: 1-3 new cases per 100,000 people, about 4% of all first admissions to psychiatric hospitals.

​

• mean age of onset: 40 years
• range for the age of onset runs from 18 to the 90s.

​

• slight preponderance of female patients.

ETIOLOGY

As with all major psychiatric disorders, the cause of delusional disorder is unknown.

• Family studies
• increased prevalence of delusional disorder and related personality traits (e.g. suspiciousness, jealousy, and secretiveness) in the relatives of delusional disorder probands.

ETIOLOGY

• Biological factors
• Neurological conditions most commonly associated with delusions are conditions that affect the limbic system and the basal ganglia.

​

• Patients with neurological disorder with intellectual impairments often have simple delusions.

SCALES TO ASSESS DELUSIONS

• (1) BROWN ASSESSMENT OF BELIEFS SCALE (BABS).

​

• (2) THE 21-ITEM Peters et al. Delusional Inventory (PDI) scale.

TYPES�DSM-IV specifies seven types of delusional disorder,

• Erotomanic type: delusions that another person, usually of higher status, is in love with the individual.

​

• Grandiose type: delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

​

• Jealous type: delusions that individual’s sexual partner is unfaithful.

​

• Persecutory type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.

• Somatic type: delusions that the person has some physical defect or general medical condition.

​

• Mixed type: delusions characteristic of more then one of the above types but no one theme predominates.

​

• Unspecified type

Persecutory and jealous types are most common, and erotomanic and somatic types are the most unusual.

​

Content of Delusions

• Delusion of persecution
• Delusion of guilt
• Morbid jealousy and delusion of infedility
• Delusion of love
• Grandiose delusion
• Delusion of nihilistic delusion
• Hypochondriacal delusion
• Somatic delusions
• Delusion of infestation
• Delusions of control

​

​

Forms of Delusions of Persecution

• Delusion of reference : the patient knows that people are talking about him, slandering him or spying on him.
• Delusion of guilt :seen in patients with severe depression who feel they are extremely wicked thus, it is justified to spy on him.
• Delusion of being poisoned

​

Delusion of guilt

The patients believe that they are bad or evil. And have ruined their family.

Seen in cases of severe depression.

Delusion of infidelity

• Also known incorrectly

as delusion of jealousy

​

• Patients of delusions of infidelity have morbid jealousy instead of delusion of jealousy

​

• Can occur in both organic and functional disorders. Also very common in alcohol dependence

​

Delusion of love

Oh ! Salman khan is in love with me

• Also known as fantasy lover syndrome

And erotomania.

​

• The patient is convinced that

someone is in Love with them although the alleged lover may have never spoken to them.

​

• These may be a part of

schizophrenia or they may

also be isolated

symptoms in certain

personality.

Delusion of grandiosity

Primary are seen in

schizophrenia

Secondary in mania.

PATIENT believes that

He is special or has

Special powers.

Nihilistic delusion

The patient denies the existence of their body, their mind, their loved ones and the world around them.

​

Seen in severe agitated depression, schizophrenia and states of delirium.

Hypochondriacal delusion/delusions of ill health/somatic delusions

• Patients believe that they have some serious illness
• Seen in depression, schizophrenia etc.
• Patient may also feel his body is diseased or changed

Delusion of infestation

In ekboms syndrome, the patient believes that he is infested with small but macroscopic organisms.

​

Seen in hypochondriasis, persistent delusional disorder, organic brain syndromes.

Delusion of control

The core belief of the patient is that he is no longer in sole control of his own body, thoughts, feelings, impulses or behavior.

Reality of delusions

Not all delusions lead to action. Depressive delusions of Guilt and hypochondriasis may lead to action if the patient does not exhibit psychomotor retardation.

​

Hypochondriacal delusions may lead to suicide or

if involve the family may lead to homicide.

CLINICAL FEATURES

MENTAL STATUS

​

• General description. Mental status examination is usually remarkably normal except for the presence of markedly abnormal delusional system.

​

• Mood, feelings and affect. Patients' moods are consistent with the content of their delusions (e.g. patient with grandiose delusion is euphoric; one with persecutory delusions is suspicious).

​

• Perceptual disturbances.Patients with delusional disorder do not have prominent or sustained hallucinations. Tactile or olfactory hallucinations may be present if they are consistent with the delusion (e.g. somatic delusion of body odor).

CLINICAL FEATURES

MENTAL STATUS

• Thought . Disorder of thought content in the form of delusions is the key symptom of the disorder. The delusions are usually systematized and are characterized as being possible (e.g. delusions of being persecuted , of having an unfaithful spouse , of being infected with a virus, etc.). This examples of delusional content contrast with the bizarre and impossible delusional content in some patients with schizophrenia. The delusional system itself may be complex or simple.

CLINICAL FEATURES

• Sensorium and cognition. Patients usually have no abnormality in orientation unless they have a specific delusion about a person, place , or time. Memory and other cognitive processes are not damged in these patients.

​

• Impulse control. Clinicians must evaluate patients with delusional disorder for ideation or plans to act on their delusional material by suicide, homicide or other violence. If patients are unable to control their impulses hospitalization is probably necessary.

​

• Judgment and insight. These patients have virtually no insight in to their condition and are almost always brought to the hospital by the police, family members or employers.

​

TREATMENT

Hospitalization

• Often needed because patients may need a complete medical and neurological evaluation to determine whether a nonpsychiatric medical condition is causing the delusional symptoms.

​

• Patients may need an assessment of their ability to control violent impulses, such as to commit suicide and homicide.

​

• Patient's behavior about the delusions may have significantly affected their ability to function within their family or occupational settings so they may require professional intervention to stabilize social or occupational relationships.

TREATMENT

Pharmacotherapy

• In an emergency, severely agitated patients should be given an antipsychotic drug intramuscularly.

​

• Most clinicians think that antipsychotic drugs are the treatment of choice for delusional disorder.

​

• If the patient receives no benefit from antipsychotic medication the drug should be discontinued. In patients who do respond to antipsychotic drugs data indicate that maintenance doses can be low.

​

TREATMENT

Psychotherapy

• The essential element is to establish a relationship in which patients begin to trust a therapist.

​

• Individual therapy seems to be more effective than group therapy.

​

• Insight-oriented supportive,cognitive and behavioral therapies are often effective.

​

• The family may benefite from the thrapist's support and may thus be supportive of the patient.

​

​

TREATMENT

• A good therapeutic outcome depends on a psychiatrist's ability to respond to the patient's mistrust of others and the resulting interpersonal conflicts , fustrations and failures.
• The mark of succesful treatment may be a satifactory social adjustment rather than an abatement of the patient's delusions.

​

THANK YOU!