Delusional Disorder

Question 1

What is the ICD 10 classification of delusional disorder?

Answer 1

Delusional disorder = persistent/life-long delusions with few/no hallucinations

<3 months means temporary and >3 months is persistent

Cannot include:

1. Clear auditory hallucinations
2. Schizophrenic symptoms (delusions of control, blunting of affect)
3. Evidence of organic/brain disease

Question 2

What are the RFs of delusional disorder?

Answer 2

Old age 
Social isolation 
Group delusions
Low socioeconomic status 
Premorbid personality disorder 
Sensory impairment
Immigration 
FHx 
Head injury
Substance abuse

Question 3

What is the aetiology of delusional disorders?

Answer 3

Biological (Excess DA and ACh activity)
Neurological lesions to temporal lobe, limbic system, BG
Cortical damage (persecutory delusions)

Psychosocial
Freud (delusions serve defensive functions)
Distrust, suspicion, jealousy, low self-esteem
Social isolation, seeing own defects in others
Rumination over meaning and motivation

Question 4

What are the signs and symptoms of delusional disorder?

Answer 4

A- Nil
S- Nil
E- Nil
P- Non bizarre, rarely hallucinations
T- 
Process unimpaired, content preoccupied, single theme of thoughts 

Erotomaniac (excessive sexual desire, often believe a VIP in love with them) “De Clerembault’s syndrome”

Othello syndrome (believe partner unfaithful)

Fregoli syndrome (≥2 people are same person changing disguises to deceive)

Folie á deux (shared delusions/hallucinations between people)

Factitious disorder (consciously pretending you have a medical illness)

I- Impaired
C- Intact1

Question 5

What investigations might you do for Delusional Disorder?

Answer 5

Full history and collateral history + MSE

Exclude organic causes

Question 6

What are the differentials for delusional disorder?

Answer 6

Substance-induced 
Mood disorder with delusions 
Schizophrenia
Dementia + delirium 
Body dysmorphia 
OCD
Hypochondriasis 
Paranoid (personality disorder)

Question 7

What is the management of delusional disorder?

Answer 7

o Consider admission (if high risk to self, to others or from others)

o Biological (limited evidence)
Antipsychotics (poor evidence)
SSRI (cover other potential missed differentials)
BDZ (for anxiety)

o Psychological: Social:
Individual CBT Social skills training Family therapy
Psychoeducation Psychoeducation