Delusions
Definition
A delusion is an unshakable belief in something untrue. These irrational beliefs defy normal reasoning, and remain firm even when overwhelming proof is presented to dispute them. Delusions are often accompanied by hallucinations and/or feelings of paranoia, which act to strengthen confidence in the delusion. Delusions are distinct from culturally or religiously based beliefs that may be seen as untrue by outsiders.
Description
Delusions are a common symptom of several mood and personality-related mental illnesses, including schizoaffective disorder, schizophrenia, shared psychotic disorder, major depressive disorder, and bipolar disorder. They are also the major feature of delusional disorder. Individuals with delusional disorder suffer from long-term, complex delusions that fall into one of six categories: persecutory, grandiose, jealousy, erotomanic, somatic, or mixed. There are also delusional disorders such as dementia that clearly have organic or physical causes.
Persecutory
Individuals with persecutory delusional disorder are plagued by feelings of paranoia and an irrational yet unshakable belief that someone is plotting against them, or out to harm them.
Grandiose
Individuals with grandiose delusional disorder have an over-inflated sense of self-worth. Their delusions center on their own importance, such as believing that they have done or created something of extreme value or have a "special mission."
Causes & symptoms
Some studies have indicated that delusions may be generated by abnormalities in the limbic system, the portion of the brain on the inner edge of the cerebral cortex that is believed to regulate emotions. The exact source of delusions has not been conclusively found, but potential causes include genetics, neurological abnormalities, and changes in brain chemistry. Delusions are also a known possible side effect of drug use and abuse (e.g., amphetamines, cocaine, PCP).
Diagnosis
Patients with delusional symptoms should undergo a thorough physical examination and patient history to rule out possible organic causes (such as dementia). If a psychological cause is suspected, a mental health professional will typically conduct an interview with the patient and administer one of several clinical inventories, or tests, to evaluate mental status.
Treatment
Delusions that are symptomatic of delusional disorder should be treated by a psychologist and/or psychiatrist. Though antipsychotic drugs are often not effective, antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be prescribed, and cognitive therapy or psychotherapy may be attempted.
If an underlying condition such as schizophrenia, depression, or drug abuse is found to be triggering the delusions, an appropriate course of medication and/or psychosocial therapy is employed to treat the primary disorder. The medication, typically, will include an antipsychotic agent.
Prognosis
Delusional disorder is typically a chronic condition, but with appropriate treatment, a remission of delusional symptoms occurs in up to 50% of patients. However, because of their strong belief in the reality of their delusions and a lack of insight into their condition, individuals with this disorder may never seek treatment, or may be resistant to exploring their condition in psychotherapy.
Terms:
Hallucinations
False or distorted sensory experiences that appear to be real perceptions.
Paranoia
An unfounded or exaggerated distrust of others.
Shared psychotic disorder
Also known as folie à deux; shared psychotic disorder is an uncommon disorder in which the same delusion is shared by two or more individuals.
Resources:
BOOKS
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Maxmen, Jerrold S., and Nicholas G. Ward. "Schizophrenia and Related Disorders." In Essential Psychopathology and Its Treatment, 2nd ed. New York: W.W. Norton, 1995.
Siegel, Ronald K. Whispers: The Voices of Paranoia. New York: Crown, 1994.
PERIODICALS
Manschreck, Theo C. "Delusional Disorder: The Recognition and Management of Paranoia." Journal of Clinical Psychiatry 57, supplement 3 (1996): 32-38.
ORGANIZATIONS
American Psychiatric Association (APA). Office of Public Affairs. 1400 K Street NW, Washington, DC 20005. (202) 682-6119.
http://www.psych.org/. American Psychological Association (APA). Office of Public Affairs. 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700.
http://www.apa.org/. National Alliance for the Mentally Ill (NAMI). 200 North Glebe Road, Suite 1015, Arlington, VA 22203-3754. (800) 950-6264.
http://www.nami.org. National Institutes of Mental Health (NIMH). 5600 Fishers Lane, Rm. 7C-02, Bethesda, MD 20857. (301) 443-4513.
http://www.nimh.nih.gov/.