delusional disorder

Epidemiology

• uncommon, 0.01% of the population
• occurs predominantly in men > 50 years of age
• men are more likely to be single
• women are more likely to be widowed

Clinical manifestations

• persecutory delusions in the absence of memory impairment or confusion
  • continuing function without impairment
• discrete, plausible delusional ideas
  • generally not perceived as odd or bizarre
  • somatic delusions of physical defect or abnormality
• absence of hallucinations*
• delusions have lasted at least one month
• no disorganization or negative symptoms characteristic of schizophrenia
• no prominent mood component
• grandiosity

* hearing voices in the walls = auditory hallucinations

* smelling gas (unverified) = olfactory hallucination

Differential diagnosis

• paranoia
• late-onset schizophrenia
  • auditory hallucinations* suggests schizophrenia
    • hearing voices in the walls = auditory hallucinations
  • visual hallucinations
  • olfactory hallucinations
  • no impaired sensorium
  • sustained course
  • persecutory delusions common in very-late onset schizophrenia
  • bizzare or complex delusions
  • disorganized speech or behavior
• Alzheimer's disease
  • delusions typically involve beliefs of theft, infidelity, abandonment, not living in their home, & persecutions
  • cognitive inpairment
• somatoform disorder
  • symptoms cause emotional distress & psychosocial impairment
  • present for >= 6 months
• minimal cognitive impairment
  • complaint of memory impairment
  • executive dysfunction
  • delusions or psychosis not a feature

Management

• tends to be refractory to treatment
• antipsychotics may be of benefit
  • atypical antipsychotics agents of choice
    • risperidone
    • quetiapine
    • olanzapine
  • haloperidol
• patients are generally in denial
  • medication compliance is low
• cognitive behavioral therapy may be helpful
• electroconvulsive therapy may be useful for refractory cases

More general terms

• psychiatric disease; behavioral disorder
• chronic mental disorder

More specific terms

• anosognosia
• Capgras syndrome
• Kapgras syndrome
• reduplicative paramnesia

Additional terms

• delusion