Recent developments in the management of delusional disorders

Abstract

SummaryDelusional disorder, rare in clinical practice, remains one of the most enigmatic conditions in psychiatry. Linked to schizophrenia spectrum disorders since the mid-20th century, recent work has confirmed 19th-century notions of an aetiology based on attentional biases and personality dimensions. Unfortunately, the literature exists largely as case reports and series, often published as ‘curiosities’, and therefore lacks the rigour of formal diagnosis. This article reviews current thinking on aetiology and epidemiology, considers diagnosis, and reviews recent work on physical and psychological therapies. It concludes that delusional disorder is likely to respond well to treatment with standard antipsychotics, often at low doses, but that adherence and concordance remain particular problems. Cognitive therapy has been shown to be beneficial but is time-consuming and resource-intensive. Selective serotonin reuptake inhibitors may profit further investigation. There remains considerable scope for investigation of this fascinating condition.

Meningioma and psychosis – cause or coincidence?

“…18 More recently, there has been limited evidence that atypical antipsychotics such as risperidone may be helpful in the treatment of delusional disorders more widely, including erotomania. 19 There have also been positive reports of effective treatment with clozapine. 16 However, due to potential significant side-effects and monitoring required with clozapine (especially in older adults with comorbidity), this option would need to be carefully considered as a last resort, for example, following a lack of success with other antipsychotic options and with sufficient risk evident to justify the treatment.…”

“…However, evidence for pimozide is limited and the side-effect profile is less favourable. 19 Hospitalisation may, of course, be required if an individual becomes challenging to treat in the community and a danger to themselves, to the object of their affection or to anyone else. In treatment-resistant cases, ECT may provide remission from delusional beliefs.…”

Towards a Multi-Level Phenomenology of Delusional Disorder: The Dissociative Thought-Script

“…The attention biases and personality dimensions that formed the 19th century aetiology of DD were left out of ongoing attempts to classify the disorder [3], as diagnostic manuals gradually overlooked previous perspectives on the psychological aspects of DD [2]. …”

“…Individuals with this disorder continue to be classified by delusional content and placed within schizophrenia spectrum disorders [3]; their treatment still relies on medication, mostly antipsychotics. Many psychiatric interventions now rely on single level etiological explanations (e.g., neurotransmitter abnormalities), which assume that DD and other psychotic disorders are underpinned by the same underlying mechanisms.…”