The delusional disorder is characterized by delirium, it ie a persistent belief that does not correspond to reality. It is a belief that people generally do not have in a society.
In this disorder there are no other characteristics of schizophrenia such as flat affection, negative symptoms or anhedonia . While in schizophrenia very strange beliefs are given, those of this disorder might occur in real life, even if they do not correspond to it.
Examples of people with this disorder would be:
- A man who thinks the police are after him.
- A woman who thinks she wants to poison him.
Persistent delirium is not the result of organic, cerebral, or other types of psychosis and can occur for several years.
Another characteristic is that people can be socially isolated because they tend to distrust others.
Because these characteristics are often more common in people who have relatives with the same disorder, there seems to be a hereditary component to their appearance.
In addition, some scientists have suggested that social isolation or stressful experiences can influence many of the cases.
On the other hand, it is important to take into account that delusions are not attributable only to this disorder, but to other conditions:
- Alcohol abuse.
- Drugs abuse.
- Brain tumors .
Types of delusional disorder
There are the following types:
- Greatness: the person believes too much in his own worth.
- Erotomania: The person believes that another person loves him, usually of high economic class.
- Somatic: The person believes that he has a medical or physical problem.
- Persecution : the person believes that others treat him / her badly.
- Mixed: delusional ideas are more of a kind than the previous ones.
Symptoms of delirium
The following symptoms may indicate the existence of a delusion:
- The person expresses an idea or belief with unusual strength or persistence.
- The idea seems to have an undue influence on the life of the person and the way of life is altered to an unexplained degree.
- Despite his deep conviction, there may be some suspicion when the patient is questioned about it.
- The person usually has little sense of humor and feel very sensitive about the belief.
- The person accepts the belief without question although what happens to him is improbable or are strange things.
- An attempt to contradict belief may trigger an inappropriate emotional reaction to irritability and hostility.
- The belief is unlikely according to the social, religious and cultural past of the person.
- Belief can lead to abnormal behaviors, although understandable in the light of belief.
- People who know the patient observe that beliefs and behaviors are strange.
Causes of delusional disorder
The cause of the delusional disorder is unknown, although genetic, biomedical and environmental factors may play an important role.
Some people with this disorder may have an imbalance of neurotransmitters, chemicals that send and receive messages in the brain.
There seems to be a family component, social isolation, immigration (persecutory reasons), drug abuse , being married, being unemployed, excessive stress, low socioeconomic status, celibacy in men and widowhood in women.
In psychiatric practice, this disorder is uncommon. The prevalence of this condition is 24-30 cases per 100,000 people while there are 0.7-3 new cases each year.
It tends to appear from mid-adulthood to the onset of old age, and most admissions to hospitals occur between ages 33 and 55.
It is more common in women than men, and immigrants appear to be at greater risk.
Diagnostic criteria for delusional disorder (DSM IV)
- A) Non-strange delusions involving situations that occur in real life such as: being followed, poisoned, infected, loved at a distance or deceived, having a disease … At least 1 month.
- B) Criterion A for schizophrenia (1 month of delusions, hallucinations, disorganized languages, catatonic behavior and negative symptoms) has not been met.
- C) Except for the impact of delusional ideas or their ramifications, the person’s psychosocial activity is not significantly impaired and behavior is not uncommon or strange.
- D) If there have been affective episodes simultaneous to delusional ideas, their total duration has been short in relation to the duration of delusional periods.
- E) The alteration is not due to the physiological effects of substances (drugs or drugs) or medical illnesses.
Treatment of delusional disorder often includes medication and psychotherapy.
It can be very difficult to treat because people who suffer from it have difficulty recognizing that there is a psychotic problem.
Studies show that half of the patients treated with antipsychotic medication show at least a 50% improvement.
The main treatments are:
- Family therapy: it can help families deal more effectively with people with the disorder.
- Cognitive-behavioral therapy (CBT): it can help a person to recognize and change behavior patterns that lead to problematic feelings.
- Antipsychotics: Also called neuroleptics , they have been used since the mid-1950s to treat mental disorders and work by blocking dopamine receptors in the brain . The Dopamine is a neurotransmitter that is believed to be involved in the development of delusions. Conventional antipsychotics are Thorazine, Loxapine, Prolixin, Haldol, Navane, Stelazine, Trilafon and Mellaril.
- Atypical antipsychotics: these new drugs appear to be effective in treating delusional disorder symptoms, in addition with fewer side effects than conventional antipsychotics. They work by blocking the serotonin and dopamine receptors in the brain. These drugs include: Risperdal, Clozaril, Seroquel, Geodon and Zyprexa.
- Other medication: Antidepressants and anxiolytics can be used to relieve anxiety , if combined with symptoms of this disorder.
One challenge in treating patients with this disorder is that most do not recognize that there is a problem.
Most are treated as outpatients, although hospitalization may be required if there is a risk of harm to others.
Complications and Co morbidity
- People with this disorder may develop depression, often as a result of difficulties associated with delusions.
- Delusions can lead to legal problems.
Social isolation and interfere with personal relationships