Delusional disorder is quite common - it can be part of another disease or an independent disorder. Delusions or delusions can accompany a patient with alcoholism or other chemical dependence, or with paranoid schizophrenia. With delusional disorder as a separate disease, a person leads a normal lifestyle, but at the same time he has pathological thoughts, for example, it seems to him that his wife or husband is cheating on him or that he is sick with an incurable disease. Aggression and increased irritability are common in delusional disorders. Treatment for these disorders includes medication and cognitive behavioral therapy.
Delusional disorder was previously referred to as paranoia. The main manifestation of this disorder is delusional thoughts, most often persecution, jealousy, relationships. It is important to note that, unlike delusional thoughts in schizophrenia, they are often logical in nature. In other words, the situation described by the patient may occur in real life.
As a rule, delusional thoughts are limited in content to a certain plot; in all other areas of mental and work activity, the patient may look normal.
Since these patients, as a rule, function normally in most life situations, the disease is most often detected due to severe manifestations of anxiety, during a routine examination by a doctor or when the patient attempts to resolve the situation by contacting official authorities or resolving the issue on their own, but sometimes by illegal means.
Unlike schizophrenia and schizoaffective disorder, this disease usually begins in middle or late age. That is why a patient with such manifestations needs an in-depth general medical examination, since psychosis can be a manifestation of physical pathology.
The incidence of delusional disorder is lower than schizophrenia; it is diagnosed in 0.05% of the population. The frequency is the same in both men and women.
Interestingly, the essence of delusional thoughts often depends on cultural factors. For example, in the USSR, the most common type of delusional disorder was persecution by the KGB, while in Israel people most often consult a doctor with suspicions of betrayal and persecution.
Based on specific delusional manifestations, the following subtypes of delusional disorders can be divided:
• Erotomanic type
Erotomania can be sexual or platonic. With sexual erotomania, the patient suffers from an obsession with sexual intimacy with the chosen object. Often this can be a public figure - an artist, politician, public figure. Other names: hyperaphrodesia, hypersexuality, sexomania, nymphomania.
Platonic erotomania manifests itself in an obsessive desire to captivate a person with oneself. Special plans are developed, letters are sent, and the pursuit of the object begins. An erotomaniac is confident in mutual feelings, even if there are no real grounds for this. Tough measures are often taken: kidnapping, violence.
Diagnosis of the erotomanic type of delusional disorder consists of a clinical interview with the patient and a conversation with his relatives.
• Grandiose type
With this type of disorder, a person begins to feel special. Such a patient may feel that he is a descendant of an ancient royal family or that he has suddenly discovered superpowers, for example, the ability to see the future and past. The basis for the grandiose type of disorder is narcissism.
Diagnosis of the grandiose type of delusional disorder consists of a clinical interview with the patient and conversation with his relatives, and specialized psychological tests.
• Idea of jealousy
The patient suffers from an obsession with infidelity; he is sure that his partner is cheating on him. Any delay of 3 minutes, an unanswered phone call, or a greeting with another person becomes the basis for serious suspicions of cheating. The patient begins to literally pursue the partner, each time adjusting any facts to fit his theory of infidelity.
The danger is that the patient may turn to revenge for an imaginary betrayal - use physical violence or even kill.
Diagnosis of this type of delusional disorder involves a clinical interview with the patient and a conversation with his relatives.
• The idea of persecution
The patient feels as if he is being pursued all the time. These could be fictional FSB officers, alien intelligence, neighbors or maniacs. A person begins to write complaints to higher authorities, contact the police and other departments, because he is firmly convinced that he is being persecuted.
Diagnosis consists of passing a series of tests and taking an anamnesis.
• Somatic type (characterized by delusional thoughts about the presence of physical diseases or life-threatening conditions)
Patients suffer from obsessive thoughts about the presence of serious and incurable diseases. They begin to go for medical examinations, undergo diagnostics from specialized specialists, and they are confident that they have a dangerous disease, even if the examination does not confirm this. Such patients speak about the incompetence of doctors who cannot detect the disease, change specialists and undergo examinations again. It seems to them that they are about to die, and every time they find confirmation of their conditions.
Diagnosis consists of a clinical interview with the patient, collecting anamnesis, and passing psychological tests. Differential diagnosis with Munchausen syndrome is necessary.
Often delusional thoughts are combined with the following symptoms:
• Irritability
• Aggressiveness
• Social and family problems (as a result of delusional thoughts)
Treatment for delusional disorder is quite similar to treatment for other chronic psychoses. As a rule, antipsychotic drugs are prescribed.
The causes of delusional or delusional disorders include the following:
• Hormonal disbalance. If hormonal regulation is disrupted in the body or there is a lack of a certain group of hormones for the normal functioning of the body, then patients may experience delusional states;
• Stress. Severe stress can also cause delusional disorder and delusions;
• Change in life situation. For example, if the patient retires or his daily social circle is sharply reduced;
• Hereditary factor. Parents suffering from delusional disorders are a serious risk factor for the child to develop the same disease;
• Somatic disease. Sometimes delusional disorder occurs as a result of the patient's current illness.
Only a medical specialist can diagnose delusional disorder, but there are signs that may help you understand that your loved one may be exhibiting symptoms of this disorder:
• aggression;
• suspicion;
• illogical reasoning;
• delusional ideas;
• anxiety;
• confidence in one's own importance;
• lack of a sense of humor;
• the desire for perfectionism, for order in everything.
As a rule, such patients themselves do not recognize the presence of the disorder, so usually relatives turn to a psychiatrist to conduct a comprehensive diagnosis of delusional disorder.
Treatment of delusional disorders is carried out only by psychiatrists. Delusional disorders such as delusions of jealousy and delusions of falling in love are characterized by a tendency towards stalking, that is, the patient literally pursues the object of his disorder. Therefore, when selecting methods for treating delusional disorders, specialists consider the patient’s condition, the type of delusional disorder, and the presence or absence of aggression.
Typically, treatment for delusional disorder consists of a combination of drug therapy in the first stage (to relieve the acute condition) and cognitive behavioral therapy. The specialists of the IsraClinic clinic are well able to work with various patients and apply the most modern treatment methods in practice:
• cognitive behavioral therapy;
• maintenance therapy;
• auxiliary therapeutic techniques (sports therapy, art therapy, hydrotherapy, hippotherapy and others);
• psychological correction;
• drug treatment.
Among the medications, modern antipsychotics (usually atypical) are prescribed; drugs such as SSRIs (selective serotonin reuptake inhibitors), anxiolytics, etc. may be recommended.
After treatment, specialists will give several recommendations to the patient on how to avoid new attacks of the disease. Among the general recommendations it should be noted:
• Supportive psychotherapy
• Drug treatment
• Avoidance of stressful conditions
• Mental hygiene
• Contacting a psychologist or psychotherapist for complex psychological conditions