Delusional disorder Flashcards
What is a delusion? Is the patient aware that they are dilusional?
A false belief out of keeping with the patient’s sociocultural background. This is held with unshakeable conviction even in the face of contradictory evidence
To the patient this is completely true and usually very important.
What are the two categories of delusions?
Primary delusions - occur out of the blue
Secondary delusions - develop after another symptom e.g. hearing a voice, smelling something
Give 5 examples of types of delusions.
Types of delusions:
- Persecutory (most common) i.e. the belief that people are conspiring against you
- Grandiose
- Nihilistic
- Hypochondriacal
- Of guilt
- Of reference i.e. that people on TV/radio are talking to/about you
- Erotomania
- Of thought inference e,g, that someone is speaking to them from radio/TV
Define delusional disorder.
This is a rare mental illness in which a patient experiences delusion, but with no accompanying hallucinations, thought disorder, mood disorder or flattening of affect.
What is the criteria for diagnosing delusional disorder?
Patient must show delusions in absence of any other psychotic symptoms or reversible cause (drugs)
What are the main characteristics of delusional disorders?
Their main characteristics are:
(1) Chronicity—they may last several months, years, or decades, and in some patients even lifelong
(2) Stability—they usually are stable, that is, they only rarely shift into another psychotic disorder
(3) Monosymptomatic—delusions are the only symptom; rarely accompanied by other symptoms, like hallucinations, but if they occur, they are not prominent and usually derivable from the delusions
(4) Monothematic—the delusions have a single theme and only rarely a combination
(5) Difficult to treat
(6) Autochthonous i.e. independent, and autonomous, having their own clinical features and rules
What is the management of delusional disorder?
Psychotherapy (CBT) is main line + antipsychotics
What is the prognosis with delusional disorder?
They are difficult to treat.
Apart from their delusions, people may continue to socialize and function in a normal manner and their behaviour does not generally seem odd or bizarre.
Sometimes, the preoccupation with delusional ideas can be disruptive to their overall lives.
How would you explore this delusion?
- “My neighbour is poisoning me”
- “She always smiles at me. I know what she’s up to.”
- “She’s putting something in my food, she’s making me sick/she’s gassing me”
Ask questions such as these to test the strength of the belief:
- How do you know?
- What’s that?
- Can you tell me how she is doing that?
- How does she get to your food?
- Does it taste/smell different?
- Can you smell something unusual?
- Why does she want to poison you? Who else has noticed this?
What questions should you ask to test the strength of delusions?
Needs to be done sensitively, asking as if you are curious, otherwise they will stop cooperating with you.
- Why do you think this is happening to you?
- How do you explain what has been going on?
- What do your friends/family think about this?
- Sometimes our brains can play tricks on us and make us believe things that are not true. Could this be happening to you?
Sometimes the patient may be aware that things don’t quite make sense. Sometimes they are absolutely sure and will attempt to explain it to you but their logic is flawed
What is a shared delusional disorder also called?
Folie à deux - sometimes called shared psychosis; symptoms of a delusional belief, and sometimes hallucinations, are transmitted from one individual to another.
Define Cotard syndrome.
This a delusion which is characterised by a false belief of death
The patient believes that they are dead, or a part of their body is non-existent
It is associated with psychotic depression and can lead to extreme neglect as patients believe they no longer need to eat or drink
Define De Clerambault’s syndrome.
Called erotomania - a delusion about love
e.g. seen in young women, who will falsely believe that a famous person has fallen in love with them
Define Othello delusion.
The patient believes that their spouse is being unfaithful without any real proof
Define delusional parasitosis.
A fixed, false belief (delusion) that they are infested by ‘bugs’ e.g. worms, parasites, mites, bacteria, fungus.
This may occur in conjunction with other psychiatric conditions or may present by itself, with patients often otherwise quite functional despite the delusion.
