Delusional Disorders
Â
Â
Â
Â
Â
Â
Â
Â
Â
Outline
- Definition of psychosis
- Types
- Delusional disorders
- Epidemiology
- Aetiology
- Associated medical conditions
- Clinical types
- Clinical Features
- Differential diagnosis
- Course and prognosis
- Management
Psychosis –
- Gross impairment in reality testing(‘not in contact’ with reality)
- Marked disturbance in personality, with impairment in social, interpersonal, occupational functioning.
- Marked impairment in judgement & absent understanding of current symptoms & behaviour(loss of insight)
- Presence of characteristic symptoms like delusions & hallucinations.
Types of non-organic psychosis
- Delusional disorders
- Acute & Transient psychotic disorders
- Schizoaffective disorders
- Postpartum psychosis
Delusional Disorders
- A group of disorders where long standing, non-bizarre delusions are the primary or only manifestation of the illness
- Included in ICD-10
- Must be persistent for atleast 3 months.
Epidemiology
- Prevalence rate- 0.24%-0.3%
- Late middle age
- Female:Male – 3:1
- More common among relatives of Schizophrenia
Aetiology/Risk factors
- Social isolation
- Migration
- Sensory impairment(deafness>blindness)
- Celibacy
- Widowhood
Very common among substance abusers (cocaine).
Associated Medical Conditions
- Multiple sclerosis
- Vitamin deficiency(B12 & nicotinic acid)
- Hepatitis
- Hypothyroidism
- Diabetes mellitus
- Dementia
Clinical Types
- Somatic type
- Persecutory type
- Grandiose type
- Jealous type
- Erotomanic type
Somatic Type
- Also called Monosymptomatic hypochondriacal psychosis.
- Delusions related to body.
Eg. – patient might feel that foul smell emanates from them.
That some of their body parts are mishapen(eg. nose) or non-functioning(eg. intestine).
That lice or other parasites have infested their body.
Persecutory Type
- Most common type
- Patient believes that he is conspired against & harassed
or bodily injured, spied or followed or poisoned by others.
- Resentful, may resort to legal methods in order to be redressed.
OR
- May resort to violence against his alleged persecutors.
Grandiose Type
- Exalted ideas about oneself, of birth, possessions & achievements.
- In a religious context may believe that they are the chosen prophets of GOD & have mysterious powers to head the masses
Jealous Type
- More common in males.
- Also called-Sexual jealousy, erotic jealousy, morbid jealousy, psychiatric jealousy, Othello syndrome.
- Allegations of infidelity are made against the spouse supported by evidence collected in the form of changes & manner of dress, behaviour or remarks made by the partner.
- The inferences drawn are wrong & not factual.
- Held firmly on inadeguate grounds & are unchanged even in the face of evidence that they are false
- Other secondary delusions may be present like he is drugged or poisoned to be put to sleep or to lose virility.
- Mood- sadness, misery, apprehension, rage.
- Patient resorts to spying or coercing confession from the partner often through violence that they are true.
- Elaborate steps are taken to catch the paramour ‘red handed’ & private detectives may be engaged to watch the movements of his spouse.
- He promises ‘to forget the whole thing & forgive them’&’not to persue the matter anymore’ once she confesses.
- The unsuspecting wife is a bid to put an end to further turmoil ‘confesses’ which aggravates her partner’s suspicion who attempts to coerce her more with greater fervor.
- Very resistent to treatment
- Continues till divorce or separation or death of spouse.
- Assaults often continued even after separation as he pleads his wife to come back and live together again.
- Potentially dangerous & may lead to suicide or homicide.
Erotomanic Type
- More prevalent in females.
- Also known as- Clerambault’s Syndrome
- Patient believes that another person, usually of a higher status or endowed with greater qualities, is loving her.
- Persue their objects of delusion physically or through letters & presents.
- Very often the affected woman is not attractive, hails from a poor socio-economic strata & works at a lower level job.
- If males affected- may be violent or aggressive with the objects of love.
Clinical Features
Presence of delusion - single or a set of related delusions for atleast 3 months
- Well systematised
- Non-bizarre
- Involve situations which can occur in normal life
- ‘Encapsulated’ – they do not affect the other life spheres of the patient.
- Hallucinations are absent.If present, are transient & rudimentary & are auditory, tactile or olfactory.
- Only when the area of delusion is probed or confronted , the dysfunction becomes evident.
Differential diagnosis
- Paranoid schizophrenia
- Paranoid personality disorder
- Substance induced delusion
- Mood disorders
Course & Prognosis
- About half the cases have a chronic & unremitting course
- In some, the symptoms occur periodically & intervals between the episodes are totally asymptomatic.
- Suicide is often associated.
Management
- Hospitalisation if severe impairment or suicidal/homicidal threats/ patient non- cooperative for treatment.
- Antipsychotic + Antidepressant.
- Antipsychotics control agitation & treat the psychotic features.
- Drug of choice-Â Pimozide
- 68% full remission, 22% partial remission.
- Antidepressants of SSRI group such as
fluoxetine preferred.
- Many may be refractory to treatment.
- Electro convulsive treatment may be needed for secondary repression.
- Psychotherapy
Other resources