Delusional disorder history and symptoms

med

Delusional disorder Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Delusions from other Diseases
Epidemiology and Demographics
Comorbid Conditions
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Delusional disorder history and symptoms On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Delusional disorder history and symptoms All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Delusional disorder history and symptoms
CDC on Delusional disorder history and symptoms
Delusional disorder history and symptoms in the news
Blogs on Delusional disorder history and symptoms
Directions to Hospitals Treating Tongue cancer
Risk calculators and risk factors for Delusional disorder history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The hallmark of delusional disorder is non-bizarre delusions. A positive history of self-reference, aggressiveness, irritable, angry, or low mood and hallucinations that are related to the delusion is suggestive of delusional disorder.

History

• Interviews are important tools to obtain information about the patient's life situation and past history to help make a diagnosis. Clinicians generally review earlier medical records to gather a full history. Clinicians also try to interview the patient's immediate family, as this can be helpful in determining the presence of delusions. Patients usually have impaired judgement and little insight regarding their illness.

• Patients with delusional disorder do not have good insight into their pathological experiences. However, despite significant delusions, many other psychosocial abilities remain intact, as if the delusions are circumscribed. This is one of the key differences between delusional disorder and other primary psychotic disorders. Family members, coworkers, police, and physicians other than psychiatrists are usually the first to suspect the problem and seek psychiatric consultation. When permitted by the patient, seeking corroborative information, is often crucial. It is permissible to seek collateral history but that it should not be withheld from the patient.
• It is extremely important to assess homicidal or suicidal ideation in evaluating patients with delusional disorder. The presence of suicidal or homicidal thoughts related to delusions should be screened for and the risk of carrying out violent plans should be carefully assessed. History of previous violent acts and history of how aggressive feelings were managed in the past may help to assess the risk. Access to weapons should be explored.
• 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
• The following features can indicate a delusion:
  • The patient expresses an idea or belief with unusual persistence or force.
  • That idea appears to have an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent.
  • Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
  • The individual tends to be humorless and oversensitive, especially about the belief.
  • There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
  • An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
  • The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background.
  • The patient is emotionally over-invested in the idea and it overwhelms other elements of their psyche.
  • The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
  • Individuals who know the patient observe that the belief and behavior are uncharacteristic and alien.

Symptoms

• The presence of non-bizarre delusions is the most obvious symptom of this disorder.
• Other symptoms include the following:
  • Self-reference
  • An irritable, angry, or low mood. Mild dysphoria may be present without regard of type of delusions. Mood and affect are consistent with delusional content: for example, patients with persecutory delusions may be suspicious and anxious.
  • Agressiveness
  • Tactile and olfactory hallucinations may be present. Hallucinations are related to the delusion.

References

Template:WikiDoc Sources