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| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Delusional disorder |
| | {{Delusional disorder}} |
| ICD10 = F22 |
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| ICD9 = {{ICD9|297.1}} |
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| {{SI}}
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| {{CMG}}; {{AE}} {{JH}}
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| {{SK}} Apparition; false impression; fantasy; head trip; phantasm; phantom | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| ==Overview==
| | {{CMG}}{{AE}}{{Simrat}} |
| '''Delusional disorder''' is a psychiatric diagnosis denoting a [[psychosis|psychotic]] [[mental illness]] that involves holding one or more non-bizarre [[delusion]]s in the absence of any other significant psychopathology (signs or symptoms of mental illness). In particular, a person with delusional disorder has never met any other criteria for [[schizophrenia]] and does not have any marked [[hallucination]]s, although tactile (touch) or olfactory (smell) hallucinations may be present if they are related to the theme of the delusion. Symptoms last at least one month (pg 329: DSM IV-TR, APA 2000) and should pass with group therapy and guidance from a family member or a friend. Someone who suffers momentarily does not hear or see things that are not there but believes in his or her mind that they are invincible or have a defeatus attitude syndrome.
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| A person with delusional disorder can be quite functional and does not tend to show any odd or bizarre behavior except as a direct result of the delusional belief. "Despite the encapsulation of the delusional system and the realtive sparing of the personality, the patient's way of life is likely to become more and more overwhelmed by the dominating effect of the abnormal beliefs". (Munro, 1999)
| | {{SK}} Delusional disorders; DD |
| | ==[[Delusional disorder overview|Overview]]== |
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| It is worth noting that the term [[paranoia]] was previously used in [[psychiatry]] to denote what is now called 'delusional disorder'. The modern psychiatric use of the word paranoia is subtly different but now rarely refers to this specific diagnosis.
| | ==[[Delusional disorder historical perspective|Historical Perspective]]== |
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| ==Indicators of a delusion== | | ==[[Delusional disorder classification|Classification]]== |
| (Munro, 1999)
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| # The patient expresses an idea or belief with unusual persistence or force.
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| # That idea appears to exert an undue influence on his or her life, and the way of life is often altered to an inexplicable extent.
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| # Despite his profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
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| # The individual tends to be humorless and oversensitive, especially about the belief.
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| # There is a quality of ''centrality'': no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
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| # An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
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| # The belief is, at the least, unlikely.
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| # The patient is emotionally over-invested in the idea and it overwhelms other elements of his [[psyche (psychology)]].
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| # The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
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| # Individuals who know the patient will observe that his belief and behavior are uncharacteristic and alien.
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| ==Features== | | ==[[Delusional disorder pathophysiology|Pathophysiology]]== |
| (Munro, 1999)
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| # It is a primary disorder.
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| # It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
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| # The illness is chronic and frequently lifelong.
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| # The delusions are logically constructed and internally consistent.
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| # The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
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| # The individual experiences a heightened sense of self-reference. Events which, to others, are insignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.
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| ==Types== | | ==[[Delusional disorder causes|Causes]]== |
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| * Erotomanic Type (see [[erotomania]]): delusion that another person, usually of higher status, is in love with the individual.
| | ==[[Delusional disorder differential diagnosis|Differentiating Delusional Disorder from Other Diseases]]== |
| * [[Grandiose Delusion|Grandiose Type]]: delusion of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person (e.g. see [[Jerusalem syndrome]])
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| * Jealous Type: delusion that the individual's sexual partner is unfaithful (see [[delusional jealousy]]).
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| * Persecutory Type: delusion that the person (or someone to whom the person is close) is being malevolently treated in some way.
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| * Somatic Type: delusions that the person has some physical defect or general medical condition (for example, see [[delusional parasitosis]]).
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| A diagnosis of 'mixed type' or 'unspecified type' may also be given if the delusions fall into several or none of these categories.
| | ==[[Delusional disorder epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Differential Diagnosis== | | ==[[Delusional disorder comorbid conditions|Comorbid Conditions]]== |
| *[[Obsessive compulsive disorder]]
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| *[[Delirium]]
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| *[[Major neurocognitive disorder]]
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| *[[Psychotic disorder]]
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| *[[Schizophrenia]]
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| *[[Schizophreniform disorder]]
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| *[[Depressive disorder]]
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| *{{Bipolar disorder]]
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| *{{Schizoaffective disorder]]<ref name=DSMV>{{cite book | +title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
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| ==Epidemiology and Demographics== | | ==[[Delusional disorder risk factors|Risk Factors]]== |
| ===Prevalence=== | | ==[[Delusional disorder screening|Screening]]== |
| The prevalence of delusional disorder is 200 per 100,000 (0.2%) of the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
| | ==[[Delusional disorder natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Risk Factors==
| | ==Diagnosis== |
| | | [[Delusional disorder diagnostic criteria| Diagnostic Criteria]] | [[Delusional disorder history and symptoms| History and Symptoms]] | [[Delusional disorder physical examination | Physical Examination]] | [[Delusional disorder laboratory findings|Laboratory Findings]] | [[Delusional disorder chest x ray|Chest X Ray]] | [[Delusional disorder CT|CT]] | [[Delusional disorder MRI|MRI]] | [[Delusional disorder other imaging findings|Other Imaging Findings]] | [[Delusional disorder other diagnostic studies|Other Diagnostic Studies]] |
| ==Natural History, Complications and Prognosis==
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| ==Diagnosis Criteria== | |
| ====DSM-V Diagnostic Criteria for Dilusional Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>====
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| {{cquote|
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| * A. The presence of one (or more) delusions with a duration of 1 month or longer.
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| : '''''AND'''''
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| * B. Criterion A for [[schizophrenia]] has never been met.
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| : <SMALL>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).</SMALL>
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| : '''''AND'''''
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| * C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and [[behavior]] is not obviously bizarre or odd.
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| : '''''AND'''''
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| * D. If manic or [[major depressive episodes]] have occurred, these have been brief relative to the duration of the delusional periods.
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| : '''''AND'''''
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| * E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as [[body dysmorphic disorder]] or [[obsessive-compulsive disorder]].
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| Specify whether:
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| : '''Erotomanie type:''' This subtype applies when the central theme of the delusion is that another person is in love with the individual.
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| : '''''OR'''''
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| : '''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.
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| : '''''OR'''''
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| : '''Jealous type:''' This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful.
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| : '''''OR'''''
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| : '''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 maligned, harassed, or obstructed in the pursuit of long-term goals.
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| : '''''OR'''''
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| : '''Somatic type:''' This subtype applies when the central theme of the delusion involves bodily functions or sensations.
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| : '''''OR'''''
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| : '''Mixed type:''' This subtype applies when no one delusional theme predominates.
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| : '''''OR'''''
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| : '''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).
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| Specify if:
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| : '''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).
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| Specify if:
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| The following course specifiers are only to be used after a 1-year duration of the disorder:
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| : '''First episode, currently in acute episode:''' First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.
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| : '''First episode, currently in partial remission:''' Partial remission is a time period during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled.
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| First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.
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| : '''Multiple episodes, currently in acute episode'''
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| : '''''OR'''''
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| : '''Multiple episodes, currently in partial remission'''
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| : '''''OR'''''
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| : '''Multiple episodes, currently in full remission'''
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| : '''''OR'''''
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| : '''Continuous:''' Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.
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| : '''''OR'''''
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| : '''Unspecified'''
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| Specify current severity:
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| : Severity is rated by a quantitative assessment of the primary symptoms of [[psychosis]], including delusions, [[hallucinations]], disorganized speech, [[abnormal psychomotor behavior]], and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).
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| : <SMALL>Note: Diagnosis of delusional disorder can be made without using this severity specifier.</SMALL>
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| }}
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| ==Treatment== | | ==Treatment== |
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| | [[Delusional disorder medical therapy|Medical Therapy]] | [[Delusional disorder primary prevention|Primary Prevention]] | [[Delusional disorder secondary prevention|Secondary Prevention]] | [[Delusional disorder cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Delusional disorder future or investigational therapies|Future or Investigational Therapies]] |
| Getting a patient to seek a mental health professional and getting them to accept treatment is an extremely diificult process. There is no effective insight and because the delusion is held with extrordinary conviction, any attempt at contradiction is met with anger and disdain.
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| [[Antipsychotic medication]], if the patient will use it, is often ineffective in controling the delusional system. | |
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| | ==Case Studies== |
| | [[Delusional disorder case study one|Case#1]] |
| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |
| | {{WikiDoc Help Menu}} |
| | {{WikiDoc Sources}} |
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| ==See also==
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| * [[Delusion]]
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| * [[Monothematic delusions]]
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| * [[Paranoia]]
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| * [[Psychosis]]
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| * [[Schizophrenia]]
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| ==Further reading==
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| * Munro, A. (1999) ''Delusional disorder''. Cambridge: Cambridge University Press. ISBN 0-521-58180-X
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| * Sims, A. (1995) ''Symptoms in the mind: An introduction to descriptive psychopathology''. Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1
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| * APA.(2000) "Diagnostic and Statistical Manual, Fourth Edition, Text Revision". Washington DC: American Psychiatric Association. ISBN 978-0890420249
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| [[Category:Psychiatry]] | | [[Category:Psychiatry]] |
| [[Category:Mature chapter]] | | [[Category:Mature chapter]] |
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| [[nl:Waanstoornis]]
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| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |