Delusional disorder

Question 1

ICD 10 definition of delusional disorder

Answer 1

defined as - peristent/life long delusions with no/few hallucinations
<3m temporary, >3m persistent
cannot have:
-clear (constant) auditory hallucinations
-Schizophrenic sx (delusion of control, blunting of affect
- evidence of organic brain disease

(occasional auditory hallucinations doesnt rule it out)

Question 2

Aetiology and RF of delusional diosrder

Answer 2

Aetiology -
bio -exessive DA and ACh
Neuro lesions to temporal/limbic/BG
Cortical damage

psychosocial-
Freud says delusions are defensive
distrust, suspricious, jealousy, low self esteem, social isolation, seeing own defects in other, rumination over meaning and motivation

RF -
Old, poor, isolated, immigrant
Substance abuse, head injury, 
Sensory impairments, group delusion, premorbid personality disorder
FHX

Question 3

Sx and MSE of delusional disorder

Answer 3

ASE–nil
P- non bizzare delusions (could occur), rarely hallucinations
T -process unimpaired. SINGLE theme of thought-often around
Erotomaniac/De clerembault (believes vip in love with them)
Othello syndrome (partner unfaithful
Fregoli (2 people switching disguised to decieve
Folie a deux (shared delusion
Facitious (consciouly pretending to have illness

I -impaired/they dont have any
C- intact

alaways asses risk to themselves, other and from others

Question 4

Ix of delusional disorder

Answer 4

Full hx, collateral hx, MSE
exclude organic causes

differential -
Schizo, Mood disorder with delusion, OCD
Hyperchondriac
Body dysmorphia, paranoid
substance induced (urine), demetion/delirium

Question 5

mx of delusional disorder

Answer 5

Consider admssions -if high risk to self, other and from other

Biological - limited evidence for all
Antipsychotics (limited evidence)
SSRI -cover for missed differentials
BDZ -for anxiety

Psycho -
individual CBT, Psychoeducation
Social -social skill training, fam therapy, psychoed