Delusional disorder

Delusional disorder is a chronic mental illness characterized by irrational and irreversible beliefs that could remain life-long if left untreated. Read and know more about the types, symptoms, causes and treatment of this rare ailment.

Delusional disorder Definition

It is a primary and stable form of mental condition in which affected individuals find it difficult to distinguish between a real and imaginary incident. It was previously called “Paranoid disorder”. Individuals suffering from this condition experience persistent, recurrent, and fixed delusions that involve situations which might actually occur in real life. These delusions are logically designed by the patients and are usually normal. The condition is not manifested by any type of hallucinations, blunted effect, mood or thought disorders.

It is also known as “Organic delusional disorder”. Sufferers generally socialize and act normally unlike those who have other forms of serious psychiatric disorders. Emil Kraepelin, a well-renowned German psychiatrist, has described patients with this condition as sensible, sound and controlled.

Delusional disorder Types

The Diagnostic and Statistical Manual of Mental Disorders (DSM) IV has categorized this condition into six subtypes, each of which displays a set of distinct characteristics. These are:

Erotomanic Type/Erotomania

In this form, affected individuals have a primary belief that another person is in love with them, which in most cases happens to be a public figure, or a complete stranger. Patients often stalk the targeted individual and may even make an attempt to communicate through several ways. In certain cases, such individuals may even turn violent against the desired person.

Grandiose Type

Individuals with this form of delusional disorder may consider him/her to be a famous and influential celebrity. They may also start accusing the actual person as a fraud. They may even believe to have good relations with famous personalities, or exceptional powers to dominate the whole world.

Jealous Type

This form of disorder is most commonly observed between romantic partners. Affected patients are under the assumption that their partner is cheating on them. They may even try to find minimal evidences to prove their statement, which is actually untrue. Sufferers may even show agitated behavior against their partners.

Persecutory/Paranoid Type

Patients may think that someone is trying to stalk or mistreat them. Such people very often believe that they are being tortured, spied on or mocked at. They may even give false police reports and take such delusional cases to the court.

Somatic Type

In this condition, affected ones become excessively concerned and worried about their health and presume to be suffering from a dreadful disorder, despite contradictory evidences. They become intolerant towards certain types of food and always fear of being infected or developing a physical deformity.

Mixed Type

In this type of delusion, nearly all the characteristics of the various subtypes are present in a single patient.

Delusional disorder Incidence

The average age of onset is approximately 40 years and ranges from 18-90 years. Males are more likely to develop paranoid delusions than females. However, maximum cases of Erotomania are reported in females. Causative factors may include being married, being employed, recent immigration, or low socio-economic status.

Delusional disorder Symptoms

There are several indicators of this particular mental disorder that may also provide specific diagnostic criteria. Some of these include:

• Firm delusional belief
• Humorless and oversensitive behavior
• Tendency to accept delusions unquestionably
• Irritability and hostility if proven incorrect
• Out-of-character behavior
• Complete emotional involvement, with delusional thought
• Absence of odd or bizarre behavior

Induced Delusional disorder

Identical delusional symptoms may often occur simultaneously in two individuals who are generally associated or related to each other.

Delusional disorder Causes

This rare condition of the mind does not arise due to drug abuse, a general medical condition or any mood disorders. According to medical experts, certain factors could be directly linked to this psychotic condition. These can be:

Genetic

Affected patients may have a family history of delusional and paranoid personality traits suggesting that such forms of mental disorders may have a genetic component. Individuals with delusional disorder may pass this condition to their offspring.

Biological

Neurological disorders are generally an outcome of abnormalities in certain regions of the brain that may often give rise to development of delusional thoughts. Imbalance of a few neurotransmitters in the brain may cause lack of transmission of brain signals, leading to this condition.

Delusional disorder Diagnosis

Health care professionals perform a complete assessment of the medical history of a patient to determine the underlying causes of the condition. A thorough physical examination is integral as many neurological disorders are associated with delusional symptoms. Measurement of body mass index, pulse, blood pressure, body temperature, and respiratory rate are generally done during diagnosis. Nutritional deficiencies, palpation of the abdomen or any other organ as well as abnormalities of the cardiovascular system are also evaluated.

Although there is no specific laboratory test to diagnose this disorder, physicians may opt for blood tests and neuroimaging studies such as

• Brain MRI
• CAT
• Magnetoencephalography

These techniques are generally performed to rule out other forms of physical ailments that are suspected as possible causes, owing to similar symptoms.

In some cases, physicians may directly ask the affected patients questions that may be of some assistance in identifying the exact condition. Mental status examination is often used to assess the concentration, logical thinking and memory of a patient which are generally found to be normal.

Peters Delusion Inventory (PDI) is another psychological test conducted on the affected individuals that helps in understanding and identifying delusional thinking. However, it is more often used in research than in diagnosis.

Delusional disorder Differential Diagnosis

Delusional symptoms are quite identical to a number of other mental conditions that need to be segregated in order to detect the disorder. The following conditions that are considered during the diagnosis include:

• Schizophrenia
• Dementia
• Hypochondriasis
• Body dysmorphic disorder
• Obsessive-compulsive disorder
• Paranoid personality disorder
• Shared psychotic disorder
• Alzheimer disease
• Pick disease
• Huntington disease
• Parkinson Disease
• Basal ganglia calcification
• Multiple sclerosis
• Metachromatic leukodystrophy
• Epilepsy
• Subdural hematoma
• Bipolar disorder
• Anoxic brain injury
• Fat embolism

Delusional disorder Treatment

A combination of psychopharmacology and psychotherapy is largely used to treat the chronic nature of this condition. Several treatment techniques are available that are normally used according to the symptoms present in the patients. Some of the commonly applied therapeutic procedures involve:

Drug therapy

Atypical antipsychotics, a group of tranquilizing drugs are frequently utilized to treat psychiatric conditions, including schizophrenic and delusional symptoms. The most commonly used medications are:

• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Olanzapine (Zyprexa)

These drugs tend to block the postsynaptic dopamine receptors and alleviate symptoms such as hallucinations, delusions, agitation and anxiety. In case patients do not respond to these medications, other forms of antipsychotics like Fluphenazine decanoate and Fluphenazine enanthate are administered. Pimozide is believed to be the most effective drug for this condition that may reduce most of its symptoms.

In several cases, patients have been found to be extremely violent and enraged when contradicted with their delusional beliefs. An injection of haloperidol may help in reducing agitation and abnormal behavior. Lorazepam is often combined with haloperidol and administered for faster recovery.

New-found drugs such as asenapine (Saphris) are more powerful and used along with Loxapine (Adasuve), a sedative antipsychotic. Clozapine is usually prescribed to patients who are severely affected with this condition. However, it may give rise to a host of side-effects such as drowsiness, sedation, excessive salivation, tachycardia, dizziness, seizures and agranulocytosis. Oral novel antipsychotics are preferred for treatment of long-term symptoms.

Psychotherapeutic therapy

It is the most useful form of treatment as many mental therapists make an attempt to build trust with the affected patients. Some of the regularly methods used include:

Cognitive therapy

In this type of psychotherapy, patients are asked to recognize and reassess their delusional thoughts and replace them with positive thoughts, having real existence. A set of hypothetical questions are asked where the affected individuals are asked to draw conclusions and give opinions. It is highly used in the case of persecutory type of delusion.

Supportive therapy

This particular therapeutic method helps in creating an effective mode of communication with mentally disturbed patients. Supportive measures include proper guidance, suggestion, reassurance, and persuasion.

Social skills training

It is a sort of behavior modification where the patients are encouraged to improve their interpersonal skills. Various social situations are simulated for those individuals who are often unaware of the consequences of an aggressive behavior.

Insight-oriented therapy

It is an intensive form of talk therapy that may aid in discovering and processing the various types of unconscious and delusional thoughts as well as desires. Patterns of situations are often presented to the psychologically disturbed patients in order to measure the levels of stress and anxiety.

Delusional disorder Case Study

The condition was once reported in a 40 year old woman who had a drastic weight loss over the course of 2 years. Initially, she weighed 60 kg that eventually dropped down to 29 kg. She was later diagnosed with Anorexia nervosa as a consequence of undernourishment. After further examination, however, she was found to be suffering from Somatic Delusional Disorder. She presumed that eating food would actually prove fatal to her health that ultimately led to reduced nutrient uptake. However, physicians were successful in getting her back to a healthy weight using appropriate treatment procedures.

Delusional disorder Forum

Psychforums.com/delusional-disorder and ehealthforum.com are some of the online forums where affected individuals and their family members can discuss their problems with various health experts.

Although a very challenging condition, Delusional disorder is still manageable and can be treated effectively by utilizing numerous psychotherapeutic strategies. Patients with this disease can regain their confidence and normal behavior under the guidance of a good psychotherapist. Immediate medical aid should be availed in case a patient displays violent behavior.

References:

http://en.wikipedia.org/wiki/Delusional_disorder

http://www.webmd.com/schizophrenia/delusional-disorder

http://emedicine.medscape.com/article/292991-overview#aw2aab6b5

http://www.minddisorders.com/Br-Del/Delusional-disorder.html#b