Delusional disorder overview

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Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

## Overview

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Delusional disorder is a psychiatric condition in which the patients present with delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content. Non-bizarre delusions are fixed false beliefs that involve situations that could potentially occur in real life, such as being followed, having an infection, being loved, and being deceived by one's spouse. Bizarre delusions are clearly improbable. Delusions that express a loss of control over mind or body are generally considered to be bizarre and include belief that alien thoughts have been put into one's mind, that one’s thoughts have been removed by an outside force, or that one’s body or actions are being acted on or manipulated by an outside force. Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not generally seem odd or bizarre. However, the preoccupation with delusional ideas can be disruptive to their overall lives. For the diagnosis to be made, auditory and visual hallucinations cannot be prominent, though olfactory or tactile hallucinations related to the content of the delusion may be present.[1] Delusions are false beliefs based on incorrect assumption about external reality that persist despite the evidence to the contrary and these beliefs are not ordinarily accepted by other members of the person's culture. Delusional disorder may be classified according to Diagnostic and Statistical Manual based on content of the delusions into seven subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified.[1][2] The exact pathogenesis of delusional disorder is not fully understood. It is thought that delusional disorder may be produced by polymorphisms in genes coding for dopamine receptors (DRD3 and DRD4). The cause of delusional disorder has not been identified. Genetic, biochemical, psychological, and environmental factors may play a significant role in the development of delusional disorder. Delusional disorder must be differentiated from other diseases that cause delusions, such as substrate deficiency, neurodegenerative disorders, vascular disease, other CNS disorders, infectious diseases, vitamin deficiencies, metabolic disorders, endocrinopathies, medications, toxins, substances, and other mental disorders such as schizophrenia and mood disorders. The incidence of delusional disorders is approximately 0.7 to 3.0 cases per 100, 000 individuals annually. The prevalence of delusional disorders is approximately 24 to 30 cases per 100, 000 individuals annually. Females are more commonly affected with delusional disorder than males.[1] The diagnosis of delusional disorder is based on the DSM-5 diagnostic criteria, which include criterion A i.e the presence of one (or more) delusions with a duration of one month or longer, criterion B i.e criterion A for schizophrenia has never been met, criterion C i.e apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd, criterion D i.e if manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods, and criterion E i.e the disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.[2] The optimal therapy for delusional disorder includes pharmacotherapy, cognitive-behavioral therapy, supportive psychotherapy, involuntary treatment, and insight oriented therapy.

## Historical Perspective

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Delusional disorder was first introduced by Emil Kraepelin, a German Psychiatrist, in the year 1883. In the year 1977 Winokur redescribed paranoia under the name of delusional disorder. In the year 1987 delusional disorder was introduced in DSM-III-R and continued to be present in subsequent editions.[3][4][5]

## Classification

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Delusional disorder may be classified according to Diagnostic and Statistical Manual based on content of the delusions into seven subtypes: erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspecified.[1][6]

## Pathophysiology

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The exact pathogenesis of delusional disorder is not fully understood. It is thought that delusional disorder may be produced by polymorphisms in genes coding for dopamine receptors (DRD3 and DRD4).[7][8][9]

## Causes

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The cause of delusional disorder has not been identified. Genetic, biochemical, psychological, and environmental factors may play a significant role in the development of delusional disorder.[1][10][11][12][13][14][8]

## Differential Diagnosis

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Delusional disorder must be differentiated from other diseases that cause delusions, such as substrate deficiency, neurodegenerative disorders, vascular disease, other CNS disorders, infectious diseases, vitamin deficiencies, metabolic disorders, endocrinopathies, medications, toxins, substances, and other mental disorders such as schizophrenia and mood disorders.[15][16][17]

## Epidemiology and Demographics

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The incidence of delusional disorders is approximately 0.7 to 3.0 cases per 100, 000 individuals annually. The prevalence of delusional disorders is approximately 24 to 30 cases per 100, 000 individuals annually. Females are more commonly affected with delusional disorder than males.[1]

## Comorbid Conditions

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Common comorbid conditions associated with delusional disorder include depression and anxiety.[18][19][20][21]

## Risk Factors

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Common risk factors in the development of delusional disorder are family history of paranoid personality disorder, sensory impairment, middle age (18-40 years), social isolation, personality (sensitivity; narcissistic traits), immigration, and low socioeconomic status.[22][23][24][25][26][27][28]

## Screening

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According to the United States Preventive Services Task Force, screening for delusional disorder is not recommended.[29]

## Natural History, Complications and Prognosis

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If left untreated, delusional disorder may progress to develop life-long illness. Common complications of delusional disorder include depression, violence and legal problems, and isolation. The prognosis for people with delusional disorder varies depending on the type of delusional disorder, on the person, and the person's life circumstances, including the availability of support and a willingness to adhere with treatment.[30][31][32]

## Diagnostic Criteria

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The diagnosis of delusional disorder is based on the DSM-5 diagnostic criteria, which include 5 citeria:[2]

* Criterion A: Presence of one (or more) delusions with a duration of one month or longer
* Criterion B: Diagnostic criteria for schizophrenia have not been met
* Criterion C: Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd,
* Criterion D: If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods
* Criterion E: The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder

## History and Symptoms

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The hallmark of delusional disorder is non-bizarre delusions. A positive history of self-reference, aggressiveness, irritable, angry, or low mood and hallucinations that are related to the delusion is suggestive of delusional disorder.[1][33][26][34][35]

## Physical Examination

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Patients with delusional disorder usually appear well groomed and well-dressed without evidence of gross impairment. Mental status examination of patients with delusional disorder is usually remarkable for dysphoria, delusional beliefs, and suicidal or violent thinking.[1]

## Laboratory Findings

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There are no diagnostic lab findings associated with delusional disorder.

## Chest-X Ray

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There are no chest-x ray findings associated with delusional disorder.

## CT

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There are no CT findings associated with delusional disorder.

## MRI

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On MRI, delusional disorder is characterized by greater lateral ventricle volume and hyper intense MRI signals in deep white matter in temporal and frontal lobes.

## Other Imaging Findings

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There are no other imaging findings associated with delusional disorder.

## Other Diagnostic Studies

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There are no other diagnostic studies associated with delusional disorder.

## Medical Therapy

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The optimal therapy for delusional disorder includes pharmacotherapy, cognitive-behavioral therapy, supportive psychotherapy, involuntary treatment, and insight oriented therapy.[36][37][38][39][40][41][42][43][1]

## Primary Prevention

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There are no primary preventive measures available for delusional disorder.

## Secondary Prevention

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There are no secondary preventive measures available for delusional disorder.

## References

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1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Delusional disorder. Wikipedia(2015) https://en.wikipedia.org/wiki/Delusional_disorder Accessed on November 30, 2015
2. ↑ 2.0 2.1 2.2 American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub, 2013.
3. ↑ Munro, Alistair. Delusional disorder paranoia and related illnesses. Cambridge New York: Cambridge University Press, 1999. Print.
4. ↑ Grover, Sandeep, Nitin Gupta, and Surendra Kumar Mattoo. "Delusional disorders: An overview." German J Psychiatry 9 (2006): 62-73.
5. ↑ Winokur, George, and Ming T. Tsuang. The natural history of mania, depression, and schizophrenia. Washington, DC: American Psychiatric Press, 1996. Print.
6. ↑ American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub, 2013.
7. ↑ Hales, Robert E., Stuart C. Yudofsky, and Laura W. Roberts. The American Psychiatric Publishing textbook of psychiatry. Washington, DC: American Psychiatric Publishing, 2014. Print.
8. ↑ 8.0 8.1 Morimoto K, Miyatake R, Nakamura M, Watanabe T, Hirao T, Suwaki H (2002). "Delusional disorder: molecular genetic evidence for dopamine psychosis". Neuropsychopharmacology. 26 (6): 794–801. doi:10.1016/S0893-133X(01)00421-3. PMID 12007750.CS1 maint: Multiple names: authors list (link)
9. ↑ Huber M, Kirchler E, Karner M, Pycha R (2007). "Delusional parasitosis and the dopamine transporter. A new insight of etiology?". Med Hypotheses. 68 (6): 1351–8. doi:10.1016/j.mehy.2006.07.061. PMID 17134847.CS1 maint: Multiple names: authors list (link)
10. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association, 2013. Print.
11. ↑ Conway CR, Bollini AM, Graham BG, Keefe RS, Schiffman SS, McEvoy JP (2002). "Sensory acuity and reasoning in delusional disorder". Compr Psychiatry. 43 (3): 175–8. PMID 11994833.CS1 maint: Multiple names: authors list (link)
12. ↑ Sadock, Benjamin J., Virginia A. Sadock, and Pedro Ruiz. Kaplan & Sadock's synopsis of psychiatry : behavioral sciences/clinical psychiatry. Philadelphia: Wolters Kluwer, 2015. Print.
13. ↑ Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's synopsis of psychiatry : behavioral sciences/clinical psychiatry. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.
14. ↑ Gorman DG, Cummings JL (1990). "Organic delusional syndrome". Semin Neurol. 10 (3): 229–38. doi:10.1055/s-2008-1041273. PMID [ 2259800 [ Check `|pmid=` value (help).
15. ↑ Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's synopsis of psychiatry : behavioral sciences/clinical psychiatry. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.
16. ↑ Manschreck TC, Petri M (1978). "The paranoid syndrome". Lancet. 2 (8083): 251–3. PMID 79043.
17. ↑ Manschreck, THEO C. "Delusional disorder and shared psychotic disorder." Comprehensive textbook of psychiatry 1 (2000): 1243-64.
18. ↑ de Portugal E, Martínez C, González N, del Amo V, Haro JM, Cervilla JA (2011). "Clinical and cognitive correlates of psychiatric comorbidity in delusional disorder outpatients". Aust N Z J Psychiatry. 45 (5): 416–25. doi:10.3109/00048674.2010.551279. PMID 21417554.CS1 maint: Multiple names: authors list (link)
19. ↑ Maina G, Albert U, Badà A, Bogetto F (2001). "Occurrence and clinical correlates of psychiatric co-morbidity in delusional disorder". Eur Psychiatry. 16 (4): 222–8. PMID 11418272.CS1 maint: Multiple names: authors list (link)
20. ↑ Marino C, Nobile M, Bellodi L, Smeraldi E (1993). "Delusional disorder and mood disorder: can they coexist?". Psychopathology. 26 (2): 53–61. PMID 8321893.CS1 maint: Multiple names: authors list (link)
21. ↑ Hsiao MC, Liu CY, Yang YY, Yeh EK (1999). "Delusional disorder: retrospective analysis of 86 Chinese outpatients". Psychiatry Clin Neurosci. 53 (6): 673–6. doi:10.1046/j.1440-1819.1999.00624.x. PMID 10687749.CS1 maint: Multiple names: authors list (link)
22. ↑ Thewissen V, Myin-Germeys I, Bentall R, de Graaf R, Vollebergh W, van Os J (2005). "Hearing impairment and psychosis revisited". Schizophr Res. 76 (1): 99–103. doi:10.1016/j.schres.2004.10.013. PMID 15927803.CS1 maint: Multiple names: authors list (link)
23. ↑ Munro A, Mok H (1995). "An overview of treatment in paranoia/delusional disorder". Can J Psychiatry. 40 (10): 616–22. PMID 8681259.
24. ↑ Munro, Alistair. Delusional disorder paranoia and related illnesses. Cambridge New York: Cambridge University Press, 1999. Print.
25. ↑ Kendler KS, Walsh D (1995). "Schizophreniform disorder, delusional disorder and psychotic disorder not otherwise specified: clinical features, outcome and familial psychopathology". Acta Psychiatr Scand. 91 (6): 370–8. PMID 7676834.
26. ↑ 26.0 26.1 de Portugal E, González N, Haro JM, Autonell J, Cervilla JA (2008). "A descriptive case-register study of delusional disorder". Eur Psychiatry. 23 (2): 125–33. doi:10.1016/j.eurpsy.2007.10.001. PMID 18082379.CS1 maint: Multiple names: authors list (link)
27. ↑ Kendler KS, Masterson CC, Davis KL (1985). "Psychiatric illness in first-degree relatives of patients with paranoid psychosis, schizophrenia and medical illness". Br J Psychiatry. 147: 524–31. PMID 4075047.CS1 maint: Multiple names: authors list (link)
28. ↑ Fujii, Daryl, and Iqbal Ahmed. The Spectrum of Psychotic Disorders Neurobiology, Etiology & Pathogenesis. City: Cambridge Univ Pr, 2012. Print.
29. ↑ http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=delusional+disorder Accessed on December 10, 2015.
30. ↑ Grover, Sandeep, Nitin Gupta, and Surendra Kumar Mattoo. "Delusional disorders: An overview." German J Psychiatry 9 (2006): 62-73.
31. ↑ Fujii, Daryl, and Iqbal Ahmed, eds. The spectrum of psychotic disorders: Neurobiology, Etiology & Pathogenesis. Cambridge University Press, 2007.
32. ↑ Sadock, Benjamin J., and Virginia A. Sadock. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins, 2011.
33. ↑ Manschreck TC (1996). "Delusional disorder: the recognition and management of paranoia". J Clin Psychiatry. 57 Suppl 3: 32–8, discussion 49. PMID 8626368.
34. ↑ Ramos N, Wystrach C, Bolton M, Shaywitz J, IsHak WW (2013). "Delusional disorder, somatic type: olfactory reference syndrome in a patient with delusional trimethylaminuria". J Nerv Ment Dis. 201 (6): 537–8. doi:10.1097/NMD.0b013e31829482fd. PMID 23719328.CS1 maint: Multiple names: authors list (link)
35. ↑ Reid WH (2005). "Delusional disorder and the law". J Psychiatr Pract. 11 (2): 126–30. PMID 15803048.
36. ↑ Freudenmann RW, Lepping P (2008). "Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy". J Clin Psychopharmacol. 28 (5): 500–8. doi:10.1097/JCP.0b013e318185e774. PMID 18794644.
37. ↑ Freudenmann RW, Schönfeldt-Lecuona C, Lepping P (2007). "Primary delusional parasitosis treated with olanzapine". Int Psychogeriatr. 19 (6): 1161–8. doi:10.1017/S1041610207004814. PMID 17397562.CS1 maint: Multiple names: authors list (link)
38. ↑ Manschreck TC, Khan NL (2006). "Recent advances in the treatment of delusional disorder". Can J Psychiatry. 51 (2): 114–9. PMID 16989110.
39. ↑ Hayashi H, Oshino S, Ishikawa J, Kawakatsu S, Otani K (2004). "Paroxetine treatment of delusional disorder, somatic type". Hum Psychopharmacol. 19 (5): 351–2, 1p following 352. doi:10.1002/hup.590. PMID 15252828.CS1 maint: Multiple names: authors list (link)
40. ↑ Sondheimer A (1988). "Clomipramine treatment of delusional disorder-somatic type". J Am Acad Child Adolesc Psychiatry. 27 (2): 188–92. PMID 3360722.
41. ↑ Wada T, Kawakatsu S, Nadaoka T, Okuyama N, Otani K (1999). "Clomipramine treatment of delusional disorder, somatic type". Int Clin Psychopharmacol. 14 (3): 181–3. PMID 10435772.CS1 maint: Multiple names: authors list (link)
42. ↑ Nagata T, van Vliet I, Yamada H, Kataoka K, Iketani T, Kiriike N (2006). "An open trial of paroxetine for the "offensive subtype" of taijin kyofusho and social anxiety disorder". Depress Anxiety. 23 (3): 168–74. doi:10.1002/da.20153. PMID 16456863.CS1 maint: Multiple names: authors list (link)
43. ↑ Ota M, Mizukami K, Katano T, Sato S, Takeda T, Asada T (2003). "A case of delusional disorder, somatic type with remarkable improvement of clinical symptoms and single photon emission computed tomograpy findings following modified electroconvulsive therapy". Prog Neuropsychopharmacol Biol Psychiatry. 27 (5): 881–4. doi:10.1016/S0278-5846(03)00118-0. PMID 12921924.CS1 maint: Multiple names: authors list (link)

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