There are no systematic studies on treatment approaches and results in Delusional Disorder. The patient's distrust and suspiciousness usually prevents any contact with a therapist.
Hospitalization is indicated if a potential for danger is present; otherwise outpatient management is advisable. Unfortunately, involuntary hospitalization may increase distrust and resentment and increase the patient's persecutory delusions.
Antipsychotic medication may be useful, particularly for accompanying anxiety, agitation, and psychosis. Because patients may be suspicious of medication, depot forms may be helpful. Although antipsychotic drugs are often only marginally effective, specific forms of Delusional Disorder (e.g., monohypochondriacal paranoia) may have a good response to antipsychotic medication.
Other treatments have been tried (electroconvulsive therapy, insulin shock therapy, and psychosurgery), but these approaches are not recommended.
The patient can be gently persuaded to accept treatment by suggesting that he or she should have treatment for associated depressive symptoms or anxiety and not for his or her delusions. Once rapport has been established, the therapist may gently challenge the patient's beliefs by showing how they interfere with the patient's life. The therapist must neither condemn nor collude in the beliefs. Also, the patient's confidentiality should be respected and the therapist should not discuss matters with the patient's family without the patient's awareness.
Insight-oriented psychotherapy is not recommended because the patient's suspiciousness and hypersensitivity may lead to misinterpretation. Usually a supportive, problem-oriented psychotherapy is more effective.
Group therapy is not recommended.
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