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Sebastian Wilson
Sebastian Wilson

Delusional



People with delusional disorder often experience non-bizarre delusions. Non-bizarre delusions involve situations that could possibly occur in real life, such as being followed, deceived or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, these situations are either untrue or are highly exaggerated.




delusional



Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Approximately 0.05% to 0.1% of the adult population has delusional disorder.


Other medications that healthcare providers might prescribe to treat delusional disorder include anxiolytics and antidepressants. Anxiolytics might help if the person has a very high level of anxiety and/or problems sleeping. Antidepressants can help treat depression, which often occurs in people with delusional disorder.


The prognosis of delusional disorder is better if the person sticks to their treatment plan. Almost 50% of people have a full recovery, more than 20% of people report a decrease in symptoms and less than 20% of people report minimal to no change in symptoms.


People with delusional disorder who feel pressured or repeatedly criticized by others will likely experience stress, which may worsen their symptoms. Because of this, a positive approach may be more helpful and effective.


This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. A set of minimal diagnostic criteria and a classification are provided. Patients with DI pose a truly interdisciplinary problem to the medical system. They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme "infestation" is stable and ubiquitous. Patients with self-diagnosed "Morgellons disease" can be seen as a variation of this delusional theme. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. The most intricate problem is to engage patients in psychiatric therapy. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. Pimozide is no longer the treatment of choice for reasons of drug safety. Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Innovative approaches will be needed, since otherwise patients are unlikely to adhere to any study protocol.


A bizarre delusion, by contrast, is something that could never happen in real life, such as being cloned by aliens or having your thoughts broadcast on TV. A person who has such thoughts might be considered delusional with bizarre-type delusions.


People with delusional disorder often can continue to socialize and function normally, apart from the subject of their delusion, and generally do not behave in an obviously odd or bizarre manner. This is unlike people with other psychotic disorders, who also might have delusions as a symptom of their disorder. But in some cases, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.


Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Delusional disorder most often happens in middle to late life and is slightly more common in women than in men.


As with many other psychotic disorders, the exact cause of delusional disorder is not yet known. But researchers are looking at the role of genetic, biological, environmental, or psychological factors that make it more likely.


If you have symptoms of delusional disorder, your doctor will likely give you a complete medical history and physical exam. Although there are no lab tests to specifically diagnose delusional disorder, the doctor might use diagnostic tests, such as imaging studies or blood tests, to rule out physical illness as the cause of the symptoms. These include:


Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and its impact on their lives. Psychotherapies that may be helpful in delusional disorder include:


Delusional disorder is typically a chronic (ongoing) condition, but when properly treated, many people can find relief from their symptoms. Some recover completely, while others have bouts of delusional beliefs with periods of remission (lack of symptoms).


Delusional disorder refers to a condition in which an individual displays one or more delusions for one month or longer. Delusional disorder is distinct from schizophrenia and cannot be diagnosed if a person meets the criteria for schizophrenia. If a person has delusional disorder, functioning is generally not impaired and behavior is not obviously odd, with the exception of the delusion. Delusions may seem believable at face value, and patients may appear normal as long as an outsider does not touch upon their delusional themes. Also, these delusions are not due to a medical condition or substance abuse.


The primary feature of delusional disorder is the presence of one or more delusions that persist for at least one month. These delusions can be considered bizarre if they are clearly not possible and peers within the same culture cannot understand them. Alternatively, non-bizarre delusions reflect situations that occur in real life but are not actually happening in the life of the person with the delusion.


Anger and violent behavior may be present if someone is experiencing persecutory, jealous, or erotomanic delusions. In general, people with delusional disorder are not able to accept that their delusions are irrational or inaccurate, even if they are able to recognize that other people would describe their delusions this way.


A delusional patient can love another person from afar, and the object of affection can be an actor, musician, or politician in the public eye. For example, a patient thinks that the lyrics of a popular song were written expressly for him. This type of delusion can be filled with intense emotion, with rejection as a sign of love. Stalkers are known to suffer from erotomania.


Delusional disorder is a rare condition and difficult to study; as a result, it is not widely discussed in clinical research. While the cause is unknown, some studies suggest that people develop delusions as a way to manage extreme stress or deal with a history of trauma. Genetics may also contribute to the development of a delusional disorder. Individuals are more likely to be diagnosed with delusional disorder if they have family members with schizophrenia or schizotypal personality disorder. An imbalance of chemicals or abnormalities in the brain can play a part in delusions.


Shared delusional disorder involves a more controlling person, often older, and a more passive person, often younger. When the controlling individual is removed from the situation, the more passive participant is often relieved of the delusions.


Careful assessment and diagnosis are critical to the treatment of delusional disorders. Because delusions are often ambiguous and are present in other conditions, it may be difficult to zero in on a diagnosis of delusional disorder. Additionally, coexisting psychiatric disorders should be identified and treated accordingly.


Treatment of delusional disorder often involves both psychopharmacology and psychotherapy. Given the chronic nature of this condition, treatment strategies should be tailored to the individual needs of the patient and focus on maintaining social function and improving quality of life. Establishing a therapeutic alliance as well as establishing treatment goals that are acceptable to the patient should be prioritized. Avoiding direct confrontation of the delusional symptoms enhances the possibility of treatment compliance and response. Hospitalization should be considered if the potential for self-harm or violence exists.


Antipsychotic medications may be used in the treatment of delusional disorder, although research on the efficacy of this form of treatment has been inconclusive. Studies have shown that somatic delusions appear potentially more responsive to antipsychotic therapy than other types of delusions. Antidepressants, such as SSRIs and clomipramine, have also been successfully used for the treatment of somatic type delusional disorder.


For most patients with delusional disorder, some form of supportive therapy is helpful. The goals of supportive therapy include facilitating treatment adherence and providing education about the illness and its treatment. Educational and social interventions can include social-skills training (such as not discussing delusional beliefs in social settings) and minimizing risk factors, including sensory impairment, isolation, stress, and precipitants of violence. Providing realistic guidance and assistance in dealing with problems stemming from the delusional disorder may be helpful.


Cognitive therapeutic approaches may be useful for some patients. In this form of therapy, the therapist uses interactive questioning and behavioral experiments to help the patient to identify problematic beliefs and then replace them with alternative, more adaptive thinking. Discussion of the unrealistic nature of delusional beliefs should be done gently and only after rapport with the patient has been established.


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