Delusional disorders

Mood-incongruent psychosis (e.g., schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified). 

Copeland JR, Dewey ME, Scott A et al. (1998) Schizophrenia and delusional disorder in older age community prevalence, incidence, comorbidity, and outcome. Schizophr Bull 24 (1) ... 

Deiusionai Disorder. It can be particularly difficult to distinguish patients with delusional disorder from those with a PPD. Again, the key difference is one of degree. The patient with a paranoid personality has vague suspicious thoughts, but these do not reach delusional intensity. In addition, the delusions of someone with a delusional disorder are often very focused and circumscribed, whereas the paranoia of the patient with PPD is more generalized. 

Delusional Disorder and Schizotypal Personality Disorder. In onr experience, patients with BPD at times resemble those with Clnster A personality disorders or those with an Axis 1 psychotic disorder. Psychotic symptoms in the BPD patient, although intense, tend to arise in the context of some stressor and to be relatively short-lived. This usually takes the form of a brief psychotic disorder. Placing the BPD patient in a structured and supportive environment usually hastens the resolution of these psychotic symptoms. By contrast, the psychotic symptoms of a patient with a delusional disorder or a Cluster A personality disorder are long-term and potentially intractable even with antipsychotic treatment. 

Schizophrenia, Schizotypal, and Delusional Disorders (ICD-10) Schizophrenia and Other Psychotic Disorders (DSM-IV)... 

Induced delusional disorder Shated psychotic disotdet (folie a deux)... 

Schizophreniform disorder in DSM-FV is somewhat different from schizotypal disorder in ICD-10. The diagnosis of schizophreniform disorder requires the identical criteria of schizophrenia (criterion A), except for two differences the total duration of the illness is at least 1 month, but less than 6 months (criterion B), and impaired social or occupational functioning during some part of the illness is not required. The delusional disorder in DSM-IV corresponds more or less to the category persistent delusional disorder of ICD-10, and brief psychotic disorder (DSM-IV) is similar to the ICD-10 category acute and transient psychotic disorder, whereas the shared psychotic disorder of DSM-IV corresponds to induced delusional disorder of ICD-10. 

Delusions are false beliefs that the patient maintains in the face of incontrovertible, contradictory evidence. The schizophrenic patient usually has no insight that these beliefs are not real, but rather maintains a firm conviction in them. Schizophrenia is characterized by a variety of delusions, of which the persecutory type predominates. Other delusions often involve bizarre bodily changes. In contrast to delusional disorder, these delusions are not as well formed and occur in the context of other psychotic symptoms (e.g., hallucinations, negative symptoms). 

Delusional disorder is relatively uncommon, with an incidence 25 times less than that of schizophrenia, although the true incidence may be greater, given the fact that such patients do not readily acknowledge their delusions. Both sexes are equally affected. The term late paraphrenia refers to the development of delusions (often with hallucinations) in elderly patients (i.e., patients over age 55 without preexisting major psychiatric illness). Interestingly, deafness is present in a substantial... 

The central core of this delusional variant is that one is loved in a highly idealized, romantic, or spiritual manner. Sometimes the delusion is kept secret, but frequently, efforts (e.g., telephone calls, letters, gifts, visits) are made to contact the person who is the object of the delusion, often a famous person or a superior at work. Although female patients are usually seen clinically, many men with this erotomanic-type delusional disorder become involved with the legal system when they stalk or try to inappropriately contact the individual who is the focus of their delusion. 

Psychiatric disorders caused by a medical condition (e.g., acquired immune deficiency syndrome [AIDS] organic delusional disorders)... 

Those disorders that require the presence of psychosis (Table 10—1) as a defining feature of the diagnosis include schizophrenia, substance-induced (i.e., drug-induced) psychotic disorder, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, and psychotic disorder due to a general medical condition. Disorders that may or may not have psychotic symptoms (Table 10—2) as an associated feature include mania and depression as well as several cognitive disorders such as Alzheimer s dementia. 

DSM-IV has abandoned the terms paranoia and paraphrenia and replaced them with the term delusional disorder to describe non-affective and non-bizarre delusional states. 

An 85-year-old woman with a 3-year history of delusional disorder developed florid manic symptoms, which resolved 2 weeks after withdrawal (145). 

Four patients developed adverse effects attributable to combinations of benzodiazepines with tricyclic antidepressants, including exacerbations of delusional disorder (174). 

CASE DELUSIONAL DISORDER, SOMATIO TYPE Case Description... 

Brief reactive psychosis Delusional disorder Schizophrenia Schizophreniform disorder Schizoaffective disorder Induced psychotic disorder... 

Delusional disorder refers to a disorder with persistent nonbizarre delusions without bizarre behavior or prominent hallucinations. Thus, if someone has the delusion they are under surveillance by the FBI, they may meet the criteria. But if delusions are bizarre—for example, if a patient thinks she is under surveillance by Martians— she does not meet the criteria. The disorder is classified by type of delusion eroto-manic, grandiose, jealous, persecutory, or somatic. 

The antipsychotic medications tend to be effective in the treatment of psychotic symptoms, regardless of the disorder. They can be effective in substance-induced delusional disorders, delirium, schizophrenia, mania, delusional disorder, and so on. Standard antipsychotics tend to be much more effective for positive symptoms but do little to improve negative symptoms. The newer, atypical antipsychotics are more effective for negative symptoms although clearly not a panacea since they are successful in only about 30 percent of cases. 

Schizophrenia involves the exhibiting of psychotic symptoms. For many social workers trying to help, these clients can be difflcult because the mental health conditions in this category usually include symptoms of delusions, hallucinations, uncooperativeness, and thought disorders (Kaplan Sadock, 1990). The specific conditions that are treated with antipsychotic medications usually include schizophrenia, delusional disorders, depressive psychoses, mania, and drug-induced psychoses (Kaplan Sadock, 1990). See Table 7.1 for a list and brief description of the schizophrenic or primary psychotic disorders. 

Delusional disorder, paranoid type has fixed, focal delusions paranoid personality disorder does not... 

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