ADIGRAT UNIVERSITY

College of Medicine and

Health Since
Department of Psychiatry
delusional disorder
rd
3 year psychiatric student
GROUP 6
group assignment
1
 Outline
• Objectives
• Introduction
• Epidemiology
• Etiology
• Clinical feature
• Diagnostic criteria,DDX
• Course and prognosis,nursing Dx and intervention
• Treatment
• summary
• reference
2
 Objectives
After we completing the session we able to
Define delusion
Identify the clinical feature and diagnostic
criteria
Know the treatment of delusional disorder

3
 Introduction
Delusion
• false fixed belief
• Not keeping with the culture
• Most interesting psychiatric symptoms
• Because
Great Varity of false belief
Difficult to treat

4
Delusion is made when
 Person exhibit non- bizarre delusion at least 1
month duration
 Not explained by other mental disorder
Non bizarre means the delusion about a
situation present that occurs in a real life.

5
 Epidemiology
• Currently estimated 0.2 to 0.3% in us
• Much rare than schizophrenia which is 1%
• mean age of onset is 40 years
• Range of onset is 18-90 years
• Men likely develop paranoid delusion than
women and
• Women more likely develop erotomania than
men
6
 Common types of delusion
• Delusion of jealousy is believed that one's
sexual pattern is unfaithful
• Delusion of erotomania is a person is believe
in an individual is in love with themselves
especially women
• Delusion of grandiose is delusion of inflated
power,knowledge.eg I a special r /ships with
the famous person
• Delusion of reference is the patient knows
that people talking about him
7
• Nihilistic delusion is delusion in which a
patient denies the existence of the body or
the world
• Religious delusion is the patient is
preoccupied with false belief of religious
nature

8
 Etiology
Biopsychosocial
The genetic risk factors are
 Family history of schizophernia,delusional
disorder and paranoid personality disorder
Main neurotransmitter involved in the
implication are excessive Dopamine
The key neuro anatomical area involves are
the limbic system and basal ganglia
9
Cognitive deficit resulting in misinterpretation
of external reality
Other organic disorders such as
Alzheimer
Brain tumor
Brain metabolic disease
Endocrine abnormality

10
 Other psychosocial
• Isolation
• Migration in cultural barrier
• Socio-economic states
• conflict

11
 Clinical feature
• the presence of one or more delusions that
persist for at least one month.
• Non bizarre delusions reflect situations that occur
in real life
• are not actually happening in the life of the
person with the delusion.
• do not exhibit obviously odd or bizarre behavior.
• people with delusional disorder are not able to
accept that their delusions are irrational or
inaccurate 12
 Diagnostic criteria
DSM-5
 Delusions lasting for at least 1 month’s duration.
 Criterion A for schizophrenia has never been met
 Criterion A of schizophrenia requires two (or more) of
the following for 1-month period (or less if successfully
treated)
 delusions
 hallucinations
 disorganized speech (e.g., frequent derailment or
incoherence)
 grossly disorganized or catatonic behavior
 negative symptoms, i.e., affective flattening, alogia, or
avolition
13
 is not due to the direct physiological effects of
a substance /medication induced
 is not attributable in other medical condition.
 must not be explained by other mental
disorder
 functioning is not markedly impaired, and
behavior is not obviously bizarre or odd.

14
 ICD-10
 Delusions lasting ≥ 3 months
 Delusions are persistent and can be life-long
 Exclusion
1) Schizophrenia
2) No mood disorder
3) People present with first rank symptoms.
4) No long-term organic disorder.
5) No substance misuse.

15
 Differential Diagnosis
Obsessive-compulsive and related disorders
 involve an individual feeling that his or her
OCD beliefs are true
 delusional disorder diagnosis should not be
made,
 obsessive-compulsive disorder, with absent
insight/delusional beliefs specifier.

16
 Schizophrenia and schizophreniform disorder
 The absence of other characteristics of the active phase of
schizophrenia can differentiate delusional disorder from
schizophrenia and schizophreniform disorder.
 Delirium
 major neurocognitive disorder
 psychotic disorder due to another medical condition
 substance/medication-induced psychotic disorder
 Individuals with these disorders may show symptoms that
point to delusional disorder
 (e.g., simple persecutory delusions in major neurocognitive
disorder would be diagnosed as major neurocognitive
disorder with behavioral disturbance).

17
 Course and Prognosis:
• Complete recovery usually occurs within 2-3
months.
• Relapse is common.
• The more acute/abrupt the onset, the
better the long term outcome.
• Sudden onset onset is more common than
insidious onset
• 50% of patient have recovered after long term
follow up

18
Good prognosis is associated with
• Onset before age 30
• Sudden onset
• Short duration illness
• Female sex

19
 Common Nursing Diagnoses and
Interventions of delusional disorder
 RISK FOR SELF-DIRECTE OR OTHER-DIRECTED VIOLENCE
Related to
• Lack of trust (suspiciousness of others
• Catatonic excitement
• Delusional thinking
 As evidenced by
• Staying alone in room
• Uncommunicative, withdrawn
• Preoccupation with own thoughts; repetitive, meaningless
actions
Approaching staff for interaction, then refusing to respond to
staff’s acknowledgment

20
 Interventions with Selected
Rationales
1. Maintain low level of stimuli in client’s
environment
• low lighting,
• few people,
• simple decor,
• low noise level).
2. Observe client’s behavior frequently (every 15
minutes).
21
3. Remove all dangerous objects from client’s
environment
• in his or her agitated, confused state client
may not use
them to harm self or others.
4. Staff should maintain and convey a calm
attitude toward client.
5.Administer tranquilizing medications as
ordered by physician
22
6.Monitor medication for its effectiveness and
for any adverse side effects.

23
 Management
1) Hospitalization may be appropriate if the patient
has high risk of suicide or self-harm (e.g. high risk
for self operation
• in delusion of dysmorphophobia); high risk of
violence or aggression (e.g. a patient with morbid
• jealousy is using violence to interrogate the
spouse) and there is a need to apply Mental
Disorder and
• Treatment Act to treat the patient during
compulsory admission
24
2) Pharmacological treatment
similar to schizophrenia
antipsychotics and benzodiazepine
• Patient may require covert antipsychotics
e.g. administering liquid antipsychotics through
patient’s food in patient with
• very poor insight and refuses oral treatment

25
3) Psychosocial interventions includes
• cognitive therapy targeting at delusions
• family therapy and
• provide shelter or alternative accommodation
to the spouse of a patient with morbid
jealousy
• Emergency agitated 2mg Im at low dose
haloperidol or 2mg risperidone daily
26
 summary
 Delusions are fixed beliefs that do not change
 Delusional disorder refers to a condition in which
an individual displays one or more delusions for
one month
 Delusional disorder is distinct from schizophrenia
and cannot be diagnosed if a person meets the
criteria for schizophrenia.
 Treatment of delusional disorder often involves
both psychopharmacology and psychotherapy.
27
 References
• American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders, DSM-5.
American Psychiatric Publishing, Incorporated;
2013.
• Synopsis 11th edition
• A Short Textbook of Psychiatry Seventh Edition

28
29