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Delusional Disorders

Delusional disorder is a psychiatric diagnosis denoting a mental illness that involves holding one or more non-bizarre delusions 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 hallucinations , although tactile (touch) or olfactory (smell) hallucinations may be present if they are related to the theme of the delusion.

Delusional disorders commonly begin in middle or late adulthood, usually between ages 40 and 55, but they can occur at a younger age. These uncommon illnesses affect less than 1% of the population; the incidence is about equal in men and women.

Typically chronic, these disorders often interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly.

Causes

Delusional disorders of later life strongly suggest a hereditary predisposition. At least one study has linked the development of delusional disorders to inferiority feelings in the family.

Certain medical conditions - head injury, chronic alcoholism, and deafness-and aging are known to increase the risk for delusional disorders. Predisposing factors linked to aging include isolation, lack of stimulating interpersonal relationships, physical illness, and impaired hearing and vision.

Severe stress (such as a move to a foreign country) may also precipitate a delusional disorder.

Signs and symptoms

The presence of non-bizarre delusions is the most obvious symptom of this disorder. Other symptoms that might appear include:

• An irritable, angry, or low mood
• Hallucinations (seeing, hearing, or feeling things that are not really there) that are related to the delusion (For example, a person who believes he or she has an odor problem may smell a bad odor.)

Types of Delusional Disorder

There are different types of delusional disorder based on the main theme of the delusions experienced. The types of delusional disorder include:

• Erotomanic: Someone with this type of delusional disorder believes that another person, often someone important or famous, is in love with him or her. The person might attempt to contact the object of the delusion, and stalking behavior is not uncommon.
• Grandiose: A person with this type of delusional disorder has an over-inflated sense of worth, power, knowledge, or identity. The person might believe he or she has a great talent or has made an important discovery.
• Jealous: A person with this type of delusional disorder believes that his or her spouse or sexual partner is unfaithful.
• Persecutory: People with this type of delusional disorder believe that they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them. It is not uncommon for people with this type of delusional disorder to make repeated complaints to legal authorities.
• Somatic: A person with this type of delusional disorder believes that he or she has a physical defect or medical problem.
• Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.

Diagnosis

The DSM-IV describes a characteristic set of behaviors that mark the patient with delusional disorder.

In addition, blood and urine tests, psychological tests, and neurologic evaluation can rule out organic causes of the delusions, such as amphetamine-induced psychoses and Alzheimer's disease. Endocrine function tests rule out hyperadrenalism, pernicious anemia, and thyroid disorders such as "myxedema madness."

Treatment

Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient's mistaken belief system. Treatment also may include mobilizing a support system for the isolated elderly patient.

Antipsychotic drug therapy

Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.

Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents.

Haloperidol decanoate, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M. They release the drug gradually over a 30-day period, improving compliance.

Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.

However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia.

Routine blood monitoring is essential to detect the estimated 1 % to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.

Prevention

There is no known way to prevent delusional disorder. However, early diagnosis and treatment can help decrease the disruption to the person's life, family, and friendships.