Addressing Delusions in Women and Men with Delusional Disorder: Key Points for Clinical Management

Abstract

Delusional disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this narrative review is to select from the clinical literature the psychosocial interventions that appear to work best for these conditions and to see whether similar strategies can be modeled or taught to family members so that tensions at home are reduced. Because the content of men’s and women’s delusions sometimes differ, it has been suggested that optimal interventions for the two sexes may also differ. This review explores three areas: (a) specific treatments for men and women; (b) recommended psychological approaches by health professionals, especially in early encounters with patients with DD; and (c) recommended psychoeducation for families. Findings are that there is no evidence for differentiated psychosocial treatment for men and women with delusional disorder. What is recommended in the literature is to empathically elicit the details of the content of delusions, to address the accompanying emotions rather than the logic of the presented argument, to teach self-soothing techniques, and to monitor behavior with respect to its safety. These recommendations have only been validated in individual patients and families. More rigorous clinical trials need to be conducted.

Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies

“…There are many pitfalls to sleep treatment in this population because a delusional person can misinterpret a clinician’s intent and refuse to co-operate with therapy. The first step to successful treatment is to establish a therapeutic relationship of trust [ 101 ]. The content of the delusional belief needs to be considered.…”

Care for Women with Delusional Disorder: Towards a Specialized Approach

“…Perhaps because gender differences in DD have been under-investigated, debate has arisen with respect to demographics [9]. While DSM-5 [10] reports no major gender differences in the prevalence or incidence of DD, study results depend on the study design and methodology used.…”

“…While DSM-5 [10] reports no major gender differences in the prevalence or incidence of DD, study results depend on the study design and methodology used. In other words, the estimate of the prevalence or incidence of DD is influenced by the setting from which the sample is recruited (prison, community, inpatient units) and which diagnostic criteria were applied (e.g., prospective, retrospective) [9].…”

“…With respect to treatment selection, both cognitive ability and psychiatric comorbidity seem to determine the choice of treatment for patients with DD [9,20]. Again, no trials on this issue have considered gender differences.…”

“…In the related illness of schizophrenia, reduced estrogen levels at the time of menopause means the loss of the neuroprotection conferred by estrogens [37]. The postmenopausal stage of schizophrenia requires special therapeutic attention as these women show a worsening of psychotic symptoms, require higher antipsychotic doses [9,38] and present with greater severity of depressive symptoms at this time [39]. DD starts at this age [9], when psychotic symptoms, antipsychotic adverse effects, and comorbid conditions all increase.…”