Delusional disorder overview: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The exact pathogenesis of delusional disorder is not fully understood. It is thought that delusional disorder may be produced by polymorphisms in genes coding for dopamine receptors (DRD3 and DRD4). | The exact pathogenesis of delusional disorder is not fully understood. It is thought that delusional disorder may be produced by polymorphisms in genes coding for dopamine receptors (DRD3 and DRD4). | ||
==Causes== | |||
The cause of delusional disorder has not been identified. Genetic, biochemical, psychological, and environmental factors may play a significant role in the development of delusional disorder. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Delusional disorder must be differentiated from other diseases that cause delusions, such as substrate deficiency, neurodegenerative disorders, vascular disease, other CNS disorders, infectious diseases, vitamin deficiencies, metabolic disorders, endocrinopathies, medications, toxins, substances and other mental disorders such as schizophrenia and mood disorders. | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The incidence of delusional disorders is approximately 0.7 to 3.0 cases per 100, 000 individuals annually. The prevalence of delusional disorders is approximately 24 to 30 cases per 100, 000 individuals annually. Females are more commonly affected with delusional disorder than males<ref name="wiki"> Delusional disorder. Wikipedia(2015) https://en.wikipedia.org/wiki/Delusional_disorder Accessed on November 30, 2015</ref > | |||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of delusional disorder are family history of paranoid personality disorder, sensory impairment, age, subtle brain abnormality, social isolation, personality (sensitivity; narcissistic traits), sensory impairment, immigration, lower socioeconomic status. | |||
==Screening== | ==Screening== | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
If left untreated, delusional disorder may progress to develop life-long illness. Common complications of delusional disorder include depression, violence and legal problems, and isolation. The prognosis for people with delusional disorder varies depending on the type of delusional disorder, on the person, and the person's life circumstances, including the availability of support and a willingness to adhere with treatment. | |||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
The diagnosis of delusional disorder is based on the DSM-5 diagnostic criteria, which include criterion A i.e the presence of one (or more) delusions with a duration of one month or longer, criterion B i.e criterion A for schizophrenia has never been met, criterion C i.e apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd, criterion D i.e if manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods, and criterion E i.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.<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> | |||
==History and Symptoms== | ==History and Symptoms== | ||
The hallmark of delusional disorder is non-bizarre delusions. A positive history of self-reference, agressiveness, irritable, angry, or low mood and hallucinations that are related to the delusion is suggestive of delusional disorder. | |||
==Physical Examination== | ==Physical Examination== | ||
Patients with delusional disorder usually appear well groomed and well-dressed without evidence of gross impairment. Mental status examination of patients with delusional disorder is usually remarkable for dysphoria, delusional beliefs, and suicidal or violent thinking.<ref name="wiki"> Delusional disorder. Wikipedia(2015) https://en.wikipedia.org/wiki/Delusional_disorder#Causes Accessed on December2, 2015</ref > | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
==Chest-X Ray== | ==Chest-X Ray== | ||
Revision as of 00:23, 8 December 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Delusional disorder is a psychiatric condition in which the patients present with delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content. Non-bizarre delusions are fixed false beliefs that involve situations that could potentially occur in real life; examples include being followed or poisoned. Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not generally seem odd or bizarre. However, the preoccupation with delusional ideas can be disruptive to their overall lives. For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present. Delusions are false beliefs based on incorrect inference about external reality that persist despite the evidence to the contrary and these beliefs are not ordinarily accepted by other members of the person's culture or subculture. Nonbizarre delusions are about situations that could occur in real life, such as being followed, being loved, having an infection, and being deceived by one's spouse. Bizarre delusions are clearly implausible. Delusions that express a loss of control over mind or body are generally considered to be bizarre and include belief that one’s thoughts have been removed by an outside force, that alien thoughts have been put into one’s mind, or that one’s body or actions are being acted on or manipulated by an outside force.
Historical Perspective
Classification
According to the Diagnostic and Statistical Manual of Mental Disorders, delusional disorder may be classified into seven types based on content of delusions.[1]
Pathophysiology
The exact pathogenesis of delusional disorder is not fully understood. It is thought that delusional disorder may be produced by polymorphisms in genes coding for dopamine receptors (DRD3 and DRD4).
Causes
The cause of delusional disorder has not been identified. Genetic, biochemical, psychological, and environmental factors may play a significant role in the development of delusional disorder.
Differential Diagnosis
Delusional disorder must be differentiated from other diseases that cause delusions, such as substrate deficiency, neurodegenerative disorders, vascular disease, other CNS disorders, infectious diseases, vitamin deficiencies, metabolic disorders, endocrinopathies, medications, toxins, substances and other mental disorders such as schizophrenia and mood disorders.
Epidemiology and Demographics
The incidence of delusional disorders is approximately 0.7 to 3.0 cases per 100, 000 individuals annually. The prevalence of delusional disorders is approximately 24 to 30 cases per 100, 000 individuals annually. Females are more commonly affected with delusional disorder than males[1]
Risk Factors
Common risk factors in the development of delusional disorder are family history of paranoid personality disorder, sensory impairment, age, subtle brain abnormality, social isolation, personality (sensitivity; narcissistic traits), sensory impairment, immigration, lower socioeconomic status.
Screening
Natural History, Complications and Prognosis
If left untreated, delusional disorder may progress to develop life-long illness. Common complications of delusional disorder include depression, violence and legal problems, and isolation. The prognosis for people with delusional disorder varies depending on the type of delusional disorder, on the person, and the person's life circumstances, including the availability of support and a willingness to adhere with treatment.
Diagnostic Criteria
The diagnosis of delusional disorder is based on the DSM-5 diagnostic criteria, which include criterion A i.e the presence of one (or more) delusions with a duration of one month or longer, criterion B i.e criterion A for schizophrenia has never been met, criterion C i.e apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd, criterion D i.e if manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods, and criterion E i.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.[2]
History and Symptoms
The hallmark of delusional disorder is non-bizarre delusions. A positive history of self-reference, agressiveness, irritable, angry, or low mood and hallucinations that are related to the delusion is suggestive of delusional disorder.
Physical Examination
Patients with delusional disorder usually appear well groomed and well-dressed without evidence of gross impairment. Mental status examination of patients with delusional disorder is usually remarkable for dysphoria, delusional beliefs, and suicidal or violent thinking.[1]
Laboratory Findings
Chest-X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 Delusional disorder. Wikipedia(2015) https://en.wikipedia.org/wiki/Delusional_disorder Accessed on November 30, 2015
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.