Delusions

Delusions are firmly held, stable, but false beliefs that are not consistent with educational or cultural background and are not given up even in the face of contrary evidence. They are an essential feature of psychosis. Delusions take many forms, such as persecutory or grandiose ideas, thoughts of being controlled or of a partner's infidelity, ideas of reference (believing neutral external events have specific personal meaning), or religious.

Differential Diagnosis

• Schizophrenia
  –Delusions are the key symptom
  –Complex, disorganized, persecutory thoughts; ideas of reference; thoughts of being controlled
  –Hallucinations (usually auditory)
  –Thought disorders
  –Catatonic or disorganized behavior
  –Disorganized speech
  –Minimum 6 month duration
  –Social/occupational dysfunction

• Mania or hypomania
  –Delusions are usually grandiose
  –Associated with frantic, ill-considered activity (e.g., hypersexuality, gambling, overspending), irritability, reduced sleep, and reduced appetite
  –Bipolar with depression

• Psychotic depression
  –Delusions of guilt, worthlessness in context of depressed mood, loss of interest/pleasure (anhedonia), suicidal ideas/plans, and sleep/appetite disturbance

• Delirium
  –Disorganized thought, fluctuating
  awareness, misperceptions, paranoid fears
  –Temporary
  –“Delusions” not fixed

• Dementia
  –Delusions often seen in context of global cognitive decline
• Chronic psychostimulant and alcohol abuse
  –Psychosis with delusions can develop
• Schizoaffective disorder
• Delusional disorder
  –Rare condition
  –Well-formed, specific, fixed delusions (e.g.,
  of being loved, persecuted, having specific somatic abnormality)
  –Persistent, but does not interfere with other areas of functioning
  –No other psychiatric symptoms
• Illicit drugs (e.g., LSD, mescaline, phencyclidine, mushrooms, amphetamines)
• Alzheimer's disease (usually paranoid type)
• Hyperparathyroidism

Workup and Diagnosis

• Careful history is necessary to distinguish between psychiatric syndromes
  –Mental status examination is required, including suicidal ideation/plan
  –Past, family, and social history may shed light on diagnosis
  –Consider interviewing family and/or friends
  –Drug and alcohol history and appropriate workup if present
  –Dementia assessment, including mini-mental status examination and appropriate workup if present
• Consider CBC, electrolytes, calcium, glucose, BUN/creatinine, pulse oximetry, and TSH

Treatment

• Antipsychotic medications are effective more for behavioral control, associated symptoms (e.g., hallucinations), and distress than for complete elimination of delusions
  –Newer antipsychotics (e.g., risperidone, olanzapine, quetiapine) cause fewer dystonic side effects; however, may cause weight gain and diabetes
  –Administer IM haloperidol if patient is unable or unwilling to take oral medications in the acute setting
  –In acute disorders in young patients, higher end of dose range used; in older patients, low doses are preferred
• Mood stabilizers (e.g., lithium, valproic acid) for manic patients and antidepressants (e.g., SSRIs) for depression
• Psychotherapy may provide structure and support but usually does not eliminate delusions
• Environmental support and safety management is necessary in impaired patients, severe chronic schizophrenia, and dementia

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Delusions

Read excerpts from these other book chapters related to Delusions:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Delusions

• Back to symptom: Delusions: Introduction (review 147 causes)
• Next Book Extract About Delusions: Hallucinations (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Delusions

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Hallucinations (In A Page: Pediatric Signs and Symptoms)

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• HALLUCINATIONS (Differential Diagnosis in Primary Care)
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• Delusional disorders (Professional Guide to Diseases (Eighth Edition))

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