The Beginner's Guide to Sanity by Erica Crompton

Author:Erica Crompton
Language: eng
Format: epub
Publisher: Hammersmith Books Limited
Published: 2020-05-15T00:00:00+00:00

Managing delusional disorder

It should not be forgotten that most delusions present as part of a syndrome but that syndrome is usually schizophrenia, an affective psychosis, or an organic brain disease. Persecutory delusions as seen in delusional disorder have little diagnostic value in themselves, and the diagnosis of delusional disorder requires excluding organic, schizophrenic, and mood disorders. The importance of making these distinctions, and indeed in subtyping the delusional disorder is – as ever – how best to treat the condition.

Antipsychotic drugs are the mainstay of treatment, but there are no trial data to back up claims that any one drug is particularly effective. Antidepressants appear to be effective in treating depressive symptoms – and indeed the delusions, or at least dysmorphic delusions (Phillips, 2002).

Separation of the patient from the focus of the delusions, where possible, and supportive psychotherapy are the principles of psychosocial management. It is often quite difficult to establish a therapeutic relationship – people with delusional disorder do not usually view themselves as ill, often continue to function relatively well, and may wish to see a different type of doctor, if any.

In induced delusional disorder (‘folie à deux’), the delusion is usually paranoid or grandiose and arises within the confines of a close relationship in two (or more) people who are otherwise socially isolated. There is usually one dominant partner and the optimal treatment is of the underlying condition in the dominant person and separation or perhaps psychotherapy for the other.

Suicidal and homicidal thoughts in delusional disorder need to be taken seriously. Querulous litigants may target the lawyers; those with dysmorphic delusions, the plastic surgeons; and erotomanics, the objects of their affection – if their desires for litigation, cosmetic operations or love are frustrated. This is also true in delusional jealousy if for example the deluded partner feels impelled to force a confession.

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