Psychiatry - Delusional Disorder Flashcards
1
Q
Delusional Disorder?
A
- Uncommon, non-bizarre delusions (DSM-5 now allows ‘with bizarre content’), absence of prominent hallucinations and thought disorder, mood disorder or flattening of affect
- DSM-5: Symptoms for at least 1 month. ICD-10: At least 3 months (but if less = persistent delusional disorder)
DSM-5 subtypes:
- Erotomanic (De Clérambault syndrome)
- Grandiose
- Jealous (Othello syndrome)
- Persecutory This is the most common presentation of delusional disorder.
- Somatic
- Mixed Presence of one or more of the above themes; no single theme predominating
- Unspecified The theme cannot be determined or does not fit the listed categories
2
Q
Delusional Disorder?
Risk factors?
A
- Advanced age
- Social isolation
- Group delusions
- Low socio-economic status
- Premorbid personality disorder
- Sensory impairment (particularly deafness)
- Recent immigration
- Family history
- History of head injury or substance abuse disorders
3
Q
Delusional Disorder?
Management?
A
Obstacles to Tx:
- Pt’s denial of the illness
- Pt’s experiences of significant social and interpersonal problems (which may confirm their firmly held beliefs)
- •Antipsychotic medication is often of limited efficacy
Admission if required, otherwise outpatient management
Separation - from source or focus of delusional ideas (if possible)
Pharmacological:
- Antipsychotics
- Evidence also favours the use of SSRIs given the overlap with OCD, body dysmorphic disorder, and mood disorder
- Benzodiazepines - anxiety symptoms
Psychological/psychotherapeutic:
- Individual therapy, supportive therapy, cognitive
- Educational and social interventions
4
Q
Delusional Disorder?
Course and Prognosis?
A
- Onset may be acute or insidious
- Course is very variable—with treatment: remission (33–50%), improvement (10%), persisting symptoms (33–50%)
- Better prognosis in acute subtypes, where stress is a factor, and for jealous or persecutory subtypes
- If symptoms have persisted for >6mths outcome is worse
