Fixed abnormal beliefs Flashcards
Define delusion
fixed, false beliefs, held despite rational argument or evidence to the contrary. Out of keeping with the person’s cultural or social background. To the patient, the belief is completely true and important
What is the criteria for delusions
Certainty (held with absolute conviction)
Incorrigibility (not changeable by proof to contrary)
Falsity (implausible, bizarre or patently untrue)
What is the difference between primary and secondary delusions
Primary = occurs out of the blue
Secondary = developed after another symptoms e.g. hearing a voice, smelling a gas
What is the definition of delusional disorder (ICD-10)
Persistent/life-long delusions with few/no hallucinations
<3 months = temporary; ≥3 months = persistent
Cannot include:
- Clear auditory hallucinations
- Schizophrenic symptoms (delusions of control, blunting of affect)
- Evidence of organic/brain disease
NOTE: the presence of an occasional or transitory auditory hallucination does NOT rule out the diagnosis
What is the aetiology of delusional disorder
Biological: excess DA and ACh activity, neuro lesions to the temporal lobe/limbic system/BG, cortical damage
Psychosocial: distrust, suspicion, jealousy, low self-esteem, social isolation, rumination
What are the risk factors for delusional disorder
Old age
Social isolations
Group delusions
Low socioeconomic status
Immigration
Substance abuse
Premorbid personality disorder
Family history
Sensory impairment
Head injury
What investigations should be done for delusional disorder
Full history
Collateral history
MSE
Exclude organic cause
What is the management for delusional disorder
Biological
- Antipsychotics
- SSRI
- Benzodiazepines for anxiety
Psychological
- Individual CBT
- Psychoeducation
Social
- Psychoeducation
- Social skills training
- Family therapy
What are persecutory delusions and what are they associated with
Someone is watching them, they are constantly on TV
Schizophrenia
What are delusions of passivity and what are they associated with
Someone is controlling their actions i.e. like with a remote
Schizophrenia
What are grandiose delusions and what are they associated with
They are the best person in the world
BPAD
What are nihilistic delusions and what are they associated with
belief about body rotting
Depression
What are Cotard delusions and what are they associated with
They are, or part of them is, dying or non-existent / insides are ‘rotting’
Depression
What are erotomania/De Clerambault’s delusions
Someone (often a famous person) is in love with them
More common in women
What are delusions of reference
delusion that something is specifically targeting the patient
neutral stimulus has a special message
