Delusional disorder diagnostic criteria

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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

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.

Diagnostic Criteria

A detailed psychiatric history and exam can be used to distinguish delusional disorder from other mental disorders. A complete medical history, physical examination, and laboratory testing are used to rule out medical causes of psychosis. As delusional disorder is uncommon and it possesses some characteristics of the full range of paranoid illness, it is clearly a diagnosis of exclusion. A thorough history, mental status examination, and radiologic/laboratory evaluation should be performed to rule out other medical and psychiatric conditions that are commonly present with delusions. The clinical assessment of paranoid features requires the following three steps:

• Firstly the clinician must recognize, characterize, and judge as pathological the presenting paranoid features.
• Secondly, the clinician must determine whether the paranoid features form a part of a syndrome or are isolated.
• Thirdly and finally, the differential diagnosis should be developed. CNS illness is high on the differential diagnosis of any psychotic disorder, especially so in the onset of delusional disorder in patients older than the typical onset of schizophrenia. Delusional disorder should be seen as a diagnosis of exclusion. Differential diagnosis includes ruling out other causes such as dememtia, metabolic disorders, drug-induced conditions, infections, and endocrine disorders. Other psychiatric disorders must then be ruled out. In delusional disorder, mood symptoms tend to be brief or absent, and unlike schizophrenia, delusions are non-bizarre and hallucinations are minimal or absent. Differential diagnosis of delusional disorder can be found here

DSM-5 diagnostic criteria for delusional disorder are as follows:

DSM-V Diagnostic Criteria for Delusional Disorder

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A. The presence of one (or more) delusions with a duration of 1 month or longer. AND B. Criterion A for schizophrenia has never been met. 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). AND 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. AND D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. AND 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. Specify whether: Erotomanie type: This subtype applies when the central theme of the delusion is that another person is in love with the individual. OR 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. OR Jealous type: This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful. OR 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. OR Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations. OR Mixed type: This subtype applies when no one delusional theme predominates. OR 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). Specify if: The following course specifiers are only to be used after a 1-year duration of the disorder: 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. 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. 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. Multiple episodes, currently in acute episode OR Multiple episodes, currently in partial remission OR Multiple episodes, currently in full remission OR 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. OR Unspecified Specify current severity: 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). Note: Diagnosis of delusional disorder can be made without using this severity specifier.

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See also

• Delusion
• Monothematic delusions
• Paranoia
• Psychosis
• Schizophrenia