Conditions & Diseases: Psychological & Mental Health

Delusional Disorder

See Also:
Delusional Disorder: Introduction & Overview
Delusional Disorder: Types
Delusional Disorder: Causes and Risk Factors
Delusional Disorder: Treatment

Delusional Disorder Treatment
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In some rare cases, these individuals might seek mental health care but usually to receive help regarding secondary symptoms of the disorder such as depression, fearfulness, rage, or constant worry.

Due to the chronic natural of the condition, the treatment combines psychopharmacology and psychotherapy based on the individual needs of each patient. The main goal of the treatment is to maintain an adequate social functioning and improve the overall quality of life. Usually, individuals with delusional disorder are being treated in outpatient settings and hospitalization is required only when there is a potential risk for harm or violence.

Psychopharmacology

One of the most prescribed medication in individuals with delusional disorder is the atypical antipsychotic medication such as Risperidone (Risperdal), Quetiapine (Seroquel), and Olanzapine (Zyprexa). Antipsychotics (such as Haloperidol and Lorazepam) are prescribed when the patient is in a stage of acute agitation or frantic activity accompanied by anger or exaggerated fear which can increase the risk of hurting themselves or other. These type of medication is usually administered orally on a daily basis.

Unfortunately, the available information related to the efficiency of the psychopharmacology treatment is limited mostly because the data collected up to this point is provided by case reports, small collection studies, or single case studies rather than systematically conducted studies. One of the oldest prescribed medications for individuals with delusional disorder is an antipsychotic called pimozide. Initially, this antipsychotic was prescribed in patients with delusional disorder, somatic type since the 1970s, but based on the psychiatric refferences it seemed to represent the preferential treatment for the delusional disorder. Based on the results of Munro and Mok's review of the treatment data published between 1985 and 1995 which included approximately 1000 cases, pimozide showed to have the strongest response in individuals with delusional disorder compared to efficiency of other antipsychotics with a recovery rate of 68.5 percent, a partial recovery rate of 22.4 percent. The recovery and partial recovery rate for patients treated with other antipsychotics was 22.6 percent and 45.3 percent. Based on the most recent review of the treatment data (conducted in 2006 by Manschreck and Khan that included additional data accumulated since 1995), most individuals with delusional disorder have been treated using a combination of antipsychotic and antidepressant medication and the disorder was reported "to be fairly responsive to treatment." According to this report, there were no significant differences between the efficiency of pimozide and other antipsychotics, however it was noticed that somatic delusions "appeared potentially more responsive to antipsychotic therapy than other types of delusions. However, this difference may result from the generally poor response rate observed for the few cases reports of treatment of delusional disorder with persecutory delusions." (2)

Based on the data provided by case reports, antidepressants (such as SSRI and clomiprmine) have been successfully used for the treatment of delusional disorder, the somatic type. Unfortunately, none of these reviews offer information regarding the dose of medication required in order to achieve the symptoms' remission.

Psychotherapy

Psychopharmacology is not the only effective approach in treating individuals with delusional disorder, and most patients benefit from a form of supportive therapy. The general goals of supportive therapy is to facilitate the treatment adherence and therapeutic alliance, to provide education about the disorder and treatment, to improve social skills, to minimize risk factors, and to manage behavioral and psychological problems associated with delusions. Through therapy, individuals suffering from delusional disorder learn to control and efficiently cope with their symptoms, identify early and in time the relapse signs, and develop and implement a relapse prevention plan. Some of the psychotherapeutic approaches used for patients with delusional disorder include:

Cognitive behavioral therapy (CBT) "CBT has shown promise as an emerging treatment for delusions." (4) Cognitive behavioral approach helps the patient to identify maladaptive thinking patterns by means of interactive questioning and behavioral experiments in order to generate alternative explanations and replace the old cognitions with more adaptive beliefs and attributions. The therapeutic process is conducted through hypothetical questions that forces the patient to figure out what is "...known and unknown before reaching a logical conclusions."(4) It is advised that the content of the delusional beliefs are discussed in a gentle manner and only after the therapeutic alliance was established, and to avoid directly confronting the person for their delusional beliefs.

Insight-orientated therapy is a form of psychotherapy that focuses on developing the therapeutic alliance, incorporating projected feelings of hatred, badness, and impotence, and "...developing a sense of creative doubt in the internal perception of the world through empathy with the patient's defensive position."(5) However, there is some controversy regarding the efficiency of this supportive form of therapy, because some researchers consider that this psychotherapeutic approach is rarely indicated, while others contra-indicated the use of insight-orientated therapy with individuals suffering from delusional disorder.

Family therapy. Although this form of therapy does not directly addresses the delusions displayed by the patient, it provides a great support for family members of individuals suffering from delusional disorder while encouraging the patient to regain their abilities. This form of therapy proved to be effective in providing information to family members about the disorder, its symptoms and course, and offering support in coping with such a complex disorder.

See Also:
Delusional Disorder: Introduction & Overview
Delusional Disorder: Types
Delusional Disorder: Causes and Risk Factors
Delusional Disorder: Treatment

Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com

Sources:

Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revised, Schizophrenia, May 2003 (1)
eMedicine, Delusional Disorder, June 15, 2006(2)
Medscape Today, Redefining Delusional Disorder, by Martin L. Korn, MD, 2004(3)
Encyclopedia of Mental Disorder, Delusional disorder, 2007 (4)
Psychology Today, Delusional Disorder, June 1, 2008 (5)
Alistair Munro, Delusional Disorder, Paranoia and related illnesses, 1999