Delusional disorder medical therapy
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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
Medical Therapy
Treatment Principles of Delusional Disorder include the following: | |||||||||||||||||||
| Establish a therapeutic alliance and negotiate acceptable symptomatic treatment goals. Start where "the patient is at," and offer empathy, concern, and interest in the experiences of the individual | |||||||||||||||||||
| Avoid direct confrontation of the delusional symptoms to enhance the possibility of treatment compliance and response | |||||||||||||||||||
| Consider the impact of culture for treatment planning | |||||||||||||||||||
| Use medication judiciously to target core symptoms and associated problems (eg, anger) | |||||||||||||||||||
| Use outpatient treatment unless there is potential for harm or violence | |||||||||||||||||||
| Tailor treatment strategies to the individual needs of the patient and focus on maintaining social function and improving quality of life | |||||||||||||||||||
| Recognize and treat coexisting psychiatric disorders | |||||||||||||||||||
| Inpatient hospitalization should be considered if a patient’s delusions cause him or her to be a threat to self, others, or if he or she is deemed to be gravely disabled | |||||||||||||||||||
Pharmacotherapy
- Treatment of patients with delusional disorder with antipsychotic medication requires careful effort because of the patient’s denial of illness. It is particularly important to discuss and provide the patient with information about how the antipsychotic medication would be useful, for what target symptoms, what are possible side effects of antipsychotics, and the likely length of treatment of the delusional disorder.
- An antipsychotic agent with as few side effects as possible such as ariprazole or ziprasidone should be used.
- Start the medication at a low dose and increase the dose gradually over a several days or weeks to assure tolerability.
- Once a therapeutic dose is achieved, examine for evidence of response at two weeks before changing the medication or increasing the dose further.
Psychosocial interventions
Any psychiatric treatment of delusional disorder should incorporate the following psychotherapeutic principles:
- Alliance building
- Education
- Support
- Recognition of the challenges inherent in treating these patients.
For patients who deny that their concerns are delusional, a supportive approach to psychotherapy, with a verbally and listening supportive strategy intended to ease distress, is helpful. There have been no clinical trials of specific psychosocial interventions for delusional disorder. Cognitive-behavioral therapy (CBT), core family therapy, and supportive therapy have been suggested for the disorder [3].
Cognitive-behavioral therapy
CBT has been adapted to treat psychotic disorders, principally schizophrenia. The approach aims to identify and address patient features believed to be associated with delusions, such as data gathering biases, interpersonal sensitivity, reasoning style, worry, and insomnia, factors thought to influence how a delusional patient interprets evidence pertinent to delusions or how he or she considers alternative (nonpsychotic) explanations for the phenomena. Discussion and critique of the patient’s explanations for delusional ideas are practical techniques aimed at breaking down the certitude and emotional underpinnings that maintain the idea. CBT has not been formally tested in patients with delusional disorders. Case reports and preliminary trials that included patients with delusional disorders have not been sufficient to evaluate CBT’s efficacy [42-45].
Supportive psychotherapy=
In supportive psychotherapy, the clinician attempts to gain insight into the often painful quality of these patients’ experiences with delusional disorder and connect with the patient in such areas with understanding and suggestions aimed at reducing discomfort.
Involuntary treatment
Involuntary treatment with antipsychotic medication may have a role in the treatment of a patient with delusional disorder at serious risk of harming oneself or others. Clinical decisions about involuntary treatment are subject to legal regulations that vary by country and locality.