Delusional disorder is part of a cluster of diagnoses called the schizophrenia spectrum and other psychotic disorders. Schizophrenia spectrum and other psychotic disorders are a group of psychiatric conditions that include:
These disorders are characterized by symptoms that can be divided into two groups: positive and negative.
Positive symptoms are those which are in addition to normal experiences and which youth without schizophrenia will rarely experience. Positive symptoms include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or abnormal motor behavior (including catatonia). Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Hallucinations are perception-like experiences that occur without external stimulus. Disorganized thinking/speech is characterized by a derailment or loose associations in an individual's speech pattern. Grossly disorganized or abnormal motor behavior is a difficulty in sustaining goal-oriented behavior. This may manifest itself in a variety of ways, ranging from childlike "silliness" to unpredictable agitation.
Negative symptoms include diminished emotional expression, avolition, alogia and anhedonia. Negative symptoms are those that involve a loss of normal function or experience. Diminished emotional expression is the reductions in the expression of emotions in the face, eye contact, intonation of speech, and movement of hand, head, and face that normally give an emotional emphasis to speech. Avolition is a decrease in motivated self-initiated purposeful movement. Alogia is manifested by diminished speech output. Anhedoia is the decreased ability to experience pleasure from positive stimuli.
Delusional disorder is one of the less common psychotic disorders, in which patients have delusions but not the other classical symptoms of schizophrenia (thought disorder, hallucinations, mood disturbance or flat affect). Unlike most other psychotic disorders, the person with delusional disorder typically does not appear obviously odd, strange or peculiar during periods of active illness. Yet, the person might make unusual choices in day-to-day life because of the delusional beliefs. The delusion will not always include bizarre content.
There are several subtypes of Delusional Disorder:
Although the fixed belief may vary in nature, there are several characteristics of a delusion: (1) the individual expresses the belief(s) with unusual force and persistence; (2) the belief(s) exert an inordinate effect on the patient's life, often altering or dominating it; (3) despite profound conviction about the delusion, the individual is often secretive or suspicious in discussing it; (4) he/she tends to be sensitive and humorless regarding the delusion; (5) the belief is central to the person's existence, and questioning it elicits an inappropriately strong emotional reaction; (6) the belief is unlikely, and not in keeping with the person's social, cultural or religious background; (7) the person is highly invested emotionally in the belief, and other elements of their emotional health are negatively impacted; (8) If the belief is acted upon, abnormal behavior may result that is out of character for the individual; (9) the belief and behavior are felt to be uncharacteristic by those who know the individual.
Delusional disorder is infrequently seen in practice. This is possibly attributed to the often intact daily living skills and ability to function seen in people with the disorder, despite their delusions. Those who believe implicitly in their delusions may not feel the need for treatment and may resist the suggestions of others that they seek psychiatric attention.
Because of this profile, there is little to no information in the literature on the etiology, risk factors and prognosis of individuals with delusional disorder. The average age of onset for delusional disorder is between 34-45 years. Therefore, the disorder is not often seen in children and younger adolescents. It is hypothesized that delusions of persecution, such as being attacked or harassed, are more commonly seen in younger patients than in older patients.
There is currently insufficient research to make evidence-based recommendations for treatments for individuals with delusional disorder. Until further research is conducted in this area, the following treatments are recommended based on efficacy in other psychotic disorders in the pediatric population.
First Line Treatments
For more information about drug prescribing in delusional disorder, click here.
Second Line Treatments
In cases of nonresponse to first-line treatment, adjunctive treatments to be used in conjunction with antipsychotic medications with reasonable evidence of efficacy include:
Third Line Treatments
When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for better-validated treatments described above, might be considered.
First Line Treatments
For more information about drug prescribing in delusional disorder, click here.
Second Line Treatments
In cases of nonresponse to first-line treatment, adjunctive treatments to be used in conjunction with antipsychotic medications with reasonable evidence of efficacy include:
Third Line Treatments
When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for better-validated treatments described above, might be considered.