Delusional disorder , previously called paranoid disorder,
is a type of serious mental illness called a psychotic
disorder. People who have it can’t tell what’s real from
what is imagined.
Delusions are the main symptom of delusional disorder.
They’re unshakable beliefs in something that isn’t true or
based on reality. But that doesn’t mean they’re
completely unrealistic. Delusional disorder involves
delusions that aren’t bizarre, having to do with situations
that could happen in real life, like being followed,
poisoned, deceived, conspired against, or loved from a
distance.
These delusions usually involve mistaken
perceptions or experiences. But in reality, the situations
are either not true at all or highly exaggerated.
A bizarre delusion, by contrast, is something that could
never happen in real life, such as being cloned by aliens
or having your thoughts broadcast on TV. A person who
has such thoughts might be considered delusional with
bizarre-type delusions.
People with delusional disorder often can continue to
socialize and function normally, apart from the subject
of their delusion, and generally do not behave in an
obviously odd or bizarre manner. This is unlike people
with other psychotic disorders , who also might have
delusions as a symptom of their disorder. But in some
cases, people with delusional disorder might become so
preoccupied with their delusions that their lives are
disrupted.
Although delusions might be a symptom of more
common disorders, such as schizophrenia, delusional
disorder itself is rather rare. Delusional disorder most
often happens in middle to late life and is slightly more
common in women than in men.
Types of Delusions in Delusional Disorders
The types are based on the main theme of the delusion:
Erotomanic: The person believes someone is in love
with them and might try to contact that person.
Often it’s someone important or famous. This can
lead to stalking behavior.
Grandiose: This person has an over-inflated sense of
worth, power, knowledge, or identity. They could
believe they have a great talent or made an important
discovery.
Jealous: A person with this type believes their
spouse or sexual partner is unfaithful.
Persecutory: Someone who has this believes they (or
someone close to them) are being mistreated, or that
someone is spying on them or planning to harm
them. They might make repeated complaints to legal
authorities.
Somatic: They believe they have a physical defect or
medical problem.
Mixed: These people have two or more of the types
of delusions listed above.
What Are the Symptoms of Delusional Disorder?
They usually include:
Non-bizarre delusions -- these are the most obvious
symptom
Irritable, angry, or low mood
Hallucinations (seeing, hearing, or feeling things that
aren’t really there) related to the delusion. For
example, someone who believes they have an odor
problem might smell a bad odor.
What are the Causes and Risk Factors for
Delusional Disorder?
As with many other psychotic disorders, the exact cause
of delusional disorder is not yet known. But researchers
are looking at the role of genetic, biological,
environmental, or psychological factors that make it
more likely.
Genetic: The fact that delusional disorder is more
common in people who have family members with
delusional disorder or schizophrenia suggests genes
may be involved. It is believed that, as with other
mental disorders, a tendency to have delusional
disorder might be passed on from parents to their
children.
Biological: Researchers are studying how delusional
disorders might happen when parts of the brain
aren’t normal. Abnormal brain regions that control
perception and thinking may be linked to the
delusional symptoms.
Environmental/psychological: Evidence suggests that
stress can trigger delusional disorder. Alcohol and
drug abuse also might contribute to it. People who
tend to be isolated, such as immigrants or those with
poor sight and hearing, appear to be more likely to
have delusional disorder.
How Is Delusional Disorder Diagnosed?
If you have symptoms of delusional disorder, your
doctor will likely give you a complete medical history and
physical exam . Although there are no lab tests to
specifically diagnose delusional disorder, the doctor
might use diagnostic tests, such as imaging studies or
blood tests, to rule out physical illness as the cause of
the symptoms. These include:
Alzheimer’s disease
Epilepsy
Obsessive-compulsive disorder
Delirium
Other schizophrenia spectrum disorders
If the doctor finds no physical reason for the symptoms,
they might refer the person to a psychiatrist or
psychologist, health care professionals trained to
diagnose and treat mental illnesses. They’ll use interview
and assessment tools to evaluate the person for a
psychotic disorder.
The doctor or therapist bases the diagnosis on the
person's symptoms and their own observation of the
person's attitude and behavior. They’ll decide if the
symptoms point to a disorder.
A diagnosis of delusional disorder is made if:
The person has one or more delusions that last a
month or longer.
The person has never been diagnosed with
schizophrenia. Hallucinations , if they have them, are
related to the themes of their delusions.
Apart from the delusions and its effects, their life
isn’t really affected. Other behavior isn’t bizarre or
odd.
Manic or major depressive episodes, if they’ve
happened, have been brief, when compared with the
delusions.
There isn’t another mental disorder, medication , or
medical condition to blame.
How Is Delusional Disorder Treated?
Treatment most often includes medication and
psychotherapy (a type of counseling ). Delusional
disorder can be very difficult to treat, in part because
those who have it often have poor insight and do not
know there’s a psychiatric problem. Studies show that
close to half of patients treated with antipsychotic
medications show at least partial improvement.
The primary medications used to attempt to treat
delusional disorder are called antipsychotics. Drugs used
include:
Conventional antipsychotics: Also called neuroleptics,
these have been used to treat mental disorders since
the mid-1950s. They work by blocking dopamine
receptors in the brain. Dopamine is a neurotransmitter
believed to be involved in the development of
delusions. Conventional antipsychotics include
Chlorpromazine ( Thorazine )
Fluphenazine (Prolixin )
Haloperidol ( Haldol)
Loxapine (Oxilapine)
Perphenazine ( Trilafon ),
Thioridazine (Mellaril),
Thiothixene (Navane )
Trifluoperazine (Stelazine)
Atypical antipsychotics: These newer drugs appear
to be help treat the symptoms of delusional disorder
with fewer movement-related side effects than the
older typical antipsychotics. They work by blocking
dopamine and serotonin receptors in the brain.
Serotonin is another neurotransmitter believed to be
involved in delusional disorder. These drugs include:
Aripiprazole (Abilify)
Aripiprazole Lauroxil (Aristada)
Asenapine (Saphris)
Brexpiprazole (Rexulti)
Cariprazine (Vraylar)
Clozapine ( Clozaril)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Paliperidone (Invega Sustenna)
Paliperidone Palmitate (Invega Trinza)
Quetiapine (Seroquel ), Risperidone (Risperdal),
Olanzapine (Zyprexa )
Ziprasidone (Geodon )
Other medications: Sedatives and antidepressants
might also be used to treat anxiety or mood
symptoms if they happen with delusional disorder.
Tranquilizers might be used if the person has a very
high level of anxiety or problems sleeping.
Antidepressants might be used to treat
depression , which often happens in people with
delusional disorder
Psychotherapy can also be helpful, along with
medications, as a way to help people better manage and
cope with the stresses related to their delusional beliefs
and its impact on their lives. Psychotherapies that may
be helpful in delusional disorder include:
Individual psychotherapy can help the person
recognize and correct the thinking that has become
distorted.
Cognitive behavioral therapy (CBT) can help the
person learn to recognize and change thought
patterns and behaviors that lead to troublesome
feelings.
Family therapy can help families deal with a loved
one who has delusional disorder, enabling them help
the person.
People with severe symptoms or who are at risk of
hurting themselves or others might need to be
hospitalized until the condition is stabilized.
What Are the Complications of Delusional
Disorder?
People with delusional disorder might become
depressed, often as the result of difficulties
associated with the delusions.
Acting on the delusions also can lead to violence or
legal problems. For example, a person with an
erotomanic delusion who stalks or harasses the
object of the delusion could be arrested.
Also, people with this disorder can become alienated
from others, especially if their delusions interfere with
or damage their relationships.
What's the Outlook for People With Delusional
Disorder?
It varies, depending on the person, the type of
delusional disorder, and the person's life circumstances,
including the presence of support and a willingness to
stick with treatment.
Delusional disorder is typically a chronic (ongoing)
condition, but when properly treated, many people can
find relief from their symptoms. Some recover
completely, while others have bouts of delusional beliefs
with periods of remission (lack of symptoms).
Unfortunately, many people with this disorder don’t seek
help. It’s often hard for people with a mental disorder to
know they aren’t well. Or they may credit their
symptoms to other things, like the environment. They
also might be too embarrassed or afraid to seek
treatment. Without treatment, delusional disorder can be
a lifelong illness.
Can Delusional Disorder Be Prevented?
There’s no known way to prevent delusional disorder.
But early diagnosis and treatment can help lessen the
disruption to the person's life, family, and friendships.
Credit: https://www.webmd.com/schizophrenia/guide/delusional-disorder
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