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DELUSIONAL DISORDER
 


Prediction: Chronic

      Occupational-Economic:
  • Normal, except for delusion
      Social:
  • Normal
      Medical:
  • Normal


SYNOPSIS

Delusional Disorder F22.0 - ICD10 Description, World Health Organization
A disorder characterized by the development either of a single delusion or of a set of related delusions that are usually persistent and sometimes lifelong. The content of the delusion or delusions is very variable. Clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain disease are all incompatible with this diagnosis. However, the presence of occasional or transitory auditory hallucinations, particularly in elderly patients, does not rule out this diagnosis, provided that they are not typically schizophrenic and form only a small part of the overall clinical picture.
Delusional Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with delusional disorder needs to meet all of the following criteria:

  • The presence of one (or more) delusions with a duration of 1 month or longer.

  • Absence of the following active-phase symptoms of schizophrenia (which last for a significant portion of time during a 1-month period, or less if successfully treated):

    • Hallucinations. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).

    • Disorganized speech (e.g. frequent derailment or incoherence).

    • Grossly disorganized or catatonic behavior.

    • Negative symptoms (i.e., diminished emotional expression or avolition).

  • Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

  • If manic or depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.

  • The disturbance is not attributable to the physiological effects of a substance or a another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

  • Specify whether:

    • Erotomanic type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.

    • Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.

    • Jealous type: This subtype applies when the central theme of the individual's delusion is that his or her spouse or lover is unfaithful.

    • Persecutory type: This subtype applies when the central theme of the delusion involves the individual's belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligneed, harassed, or obstructed in the pursuit of long-term goals.

    • Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations.

    • Mixed type: This subtype applies when no one delusional theme predominates.

    • Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).

  • Specify if:

    • With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual's belief that a stranger has removed his or her internal organs and replaced them with someone else's organs without leaving any wounds or scars).
This uncommon disorder is diagnosed when prominent delusions are present for at least one month. Hallucinations, if present, are not prominent and are related to the delusional theme. This disorder is unlike schizophrenia in that it has: (1) no prominent hallucinations, (2) no disorganized speech, (3) no grossly disorganized or catatonic behavior, (4) no negative symptoms (i.e., diminished emotional expression or avolition), (5) psychosocial functioning is not markedly impaired, and (6) behavior is not obviously odd or bizarre. The delusions have lasted longer than any associated depression or mania. This disorder is not due to the effects of a drug, medication, or other medical condition. This disorder's delusions are not widely accepted beliefs in the individual's culture.

Effective Therapies

In terms of treatment, there are no randomized, placebo-controlled, double-blind clinical trials of the effectiveness of any treatment for this disorder. Treatment usually includes a combination of antipsychotic medication with cognitive therapy or supportive therapy. Antidepressants and anxiolytics are sometimes prescribed.

Ineffective Therapies

Vitamins, dietary supplements, cognitive training and cognitive rehabilitation have all proven to be ineffective in the treatment of psychotic disorders.

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