DELUSIONS
A delusion is a persistent false belief. The feeling that one is being
followed or watched, that one has a bad odor even after frequent and careful
bathing, that one is superior to others—all are examples of delusions.
Although most patients presenting with a delusion have a functional
disorder, the astute clinician knows the organic disorders of the brain that
may be associated with a delusion. The mnemonic VINDICATE forms a
simple method for ready recall of these disorders.
V—Vascular disorders suggest cerebral arteriosclerosis with lacunar
infarcts or cerebral emboli.
I—Inflammatory disorders suggest cerebral abscess, tuberculomas,
viral encephalitis (e.g., herpes simplex), and general paresis.
N—Neoplasms, both primary and metastatic, should always be
considered, as these are potentially treatable.
D—Degenerative diseases include senile and presenile dementia,
Huntington chorea, diffuse sclerosis, and many other conditions.
I—Intoxication brings to mind alcoholism, bromism, chronic use of
both “uppers” and “downers,” lysergic acid diethylamide (LSD), and
cannabis. Uremia, CO2 narcosis, chronic anoxia, electrolyte disorders,
and early hepatic coma should also be considered.
C—Congenital diseases suggest Schilder disease, mongolism, Wilson
disease, and many other conditions associated with mental retardation.
A—Autoimmune diseases focus on lupus erythematosus, allergic
angiitis, and multiple sclerosis.
T—Trauma facilitates the recall of concussion and chronic subdural
hematomas.
E—Endocrine disorders include suprasellar tumors
that invade the hypothalamus, acromegaly, hypopi-
tuitarism, hyperthyroidism, Cushing
syndrome, and adrenal insufficiency. Parathyroid dysfunction can also cause
delusions.
Approach to the Diagnosis
The important thing to do before referring these patients to a
psychiatrist is to perform an evaluation of the mental status and a
neurologic examination. Memory of recent events, orientation in time and
place, ability to perform serial sevens, and interpretation of proverbial
phrases should all be tested for. Psychologic testing may be warranted in
borderline cases as well as an EEG, CT scan, skull roentgenogram, and spinal
tap. A drug screen may also be indicated. Additional tests are listed below.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Delusions
Read excerpts from these other book chapters related to Delusions:
Medical Books Excerpts
- DELUSIONS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- DELUSIONS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- DELUSIONS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Delusions
» Next page: Medications causing Delusions
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