B. Diagnosis of Delusional Disorder is not given if person ...images2.wikia.nocookie.net/adultpsychopathology/images/2/2e/... · •B. Diagnosis of Delusional Disorder is not given

•A. Presence of one or more non-bizarre delusions that persist for at least one month•B. Diagnosis of Delusional Disorder is not given if person has had symptom presentation that met criterion A for Schizophrenia•C. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired and behavior is neither obviously functioning is not markedly impaired and behavior is neither obviously odd nor bizarre•D. If mood episodes occur concurrently with delusions, the total duration of these mood episodes is relatively brief compared to the total duration of the delusional periods•E. Delusions are not due to the direct physiological effects of substance or general medical condition

Non-bizarre-instances that could occur in everyday life (being followed, poisoned, infected, loved at a distance, or deceived by a lover) B. Auditory or visual hallucinations may be present, but not necessarily prominent. Tactile or olfactory hallucinations may be present if they are related to the theme of the delusion

• Erotomanic type- central theme of the delusion is that another person is in love with the individual. • Grandiose type- central theme of the delusion is the conviction of having some great (unrecognized) talent or insight or having made an important discovery• Jealous type- central theme of the delusion is that his or her spouse • Jealous type- central theme of the delusion is that his or her spouse or lover is unfaithful.• Persecutory type- central them of the delusion involves person’s belief that he or she is being conspired against, cheated, spied on, followed, etc. • Somatic type- central theme of delusion involves bodily functions or sensations. • Mixed type-when no one delusional theme predominates• Unspecified type-when the dominant delusional belief cannot be clearly determined or is not described in the specific types

Erotomanic-usually person involved is of higher status; celebrity stalkers Grandiose-may have religious content-person may believe that deity speaks to them. Jealous-based on incorrect inferences supported by minimal “evidence” (disarrayed clothing) Somatic-most common delusion is person is emitting foul smell from skin, mouth, anus; may have insects on the skin; internal parasite

•Medication

•Cognitive Behavioral Therapy

•Antipsychotic meds are frequently used•Two types of antipsychotics:

• Second generation (Atypical)• First Generation

(Conventional/typical)

•Drugs approved by the FDA:• Clozapine• Zyprexa• Risperdal• SeroquelSeroquel• Abilify

•Atypicals effective at managing hallucinations, delusions, loss of motivation and lack of emotion•Lack extra-pyramidal symptoms that create involuntary body movements•Side effects of these drugs include:

• Weight gain, high cholesterol and diabetes

Clozapine can cause agranulocytosis which is a loss of the white blood cells that help a person fight infection.

•In 2008, researchers in Japan wanted to determine if Abilify was successful in treating delusional disorder. •After two months, participant experienced reductions in delusionsreductions in delusions

• Developed Parkinsonism•Decreased to 6mg

• Developed slight akathisia•Decreased to 3mg

• Gained insight into her delusions • No other side effects witnessed

Patient was a 60-year-old woman who believed people around her (neighbors, husband) were spying on and persecuting her. Began on 3mg of Abilify and increased to 9mg Akathisia-inner restlessness Parkinsonism-tremors, rigidity No follow up with participant has been documented Small sample size

•Study conducted in 2002 by Fear and Libretto•Original study had four participants, but three dropped out•Given 1mg of Risperdal•Given 1mg of Risperdal

• Continued for two weeks •Increased to 2 mg•Incidents of persecution were completely gone after 24 weeks of treatment

Participant was 50 year old woman who had persecutory type Believed colleagues and employer were prosecuting her by breaking into her home Noticed “suspicious” behaviors from her postman Reluctant to leave the house unattended Five months after study, participant continues to do well on Risperdal

•Haldol•Thorazine•Trilafon•Equally effective in controlling delusions and hallucinations•Equally effective in controlling delusions and hallucinations•Side effects are more serious:

• Involuntary movements of the face, tongue, limbs and hands (tardive dyskinesia)

•Cheaper than atypical meds

Side effects also include persistent muscle spasms, tremors, restlessness

•In 2006, Manschreck & Khan attempted to analyze research articles regarding delusional disorder and treatment.•Majority of the participants had persecutory type•Results determined:

• Second generation meds (atypicals) have greatly changed the way delusional disorder is treatedchanged the way delusional disorder is treated

• Many particpants are also currently treated with anti-depressants and anti-psychotic meds

• Patients constantly receive more than one antipsychotic med over the course of their illness

• Treatment usually is a combination of CBT and concomitant anti-psychotic meds

•93% of all patients on anti-psychotics showed improvement or full recovery

Articles were from 1994 to 2004; 209 cases were reviewed Women outnumbered men 4 to 3 Age range for women- 29 to 78 Age range for men- 17 to 72 Concomitant- two or more drugs used or given at almost at the same time (one after the other, on the same day, etc.).

•In 2004 researchers in Japan used Paxil to treat delusional disorder, somatic type. •Given 10mg a day for the first 7 daysIncreased to 20mg a day on day 8•Increased to 20mg a day on day 8

•On day 22, delusions began to decrease•Day 53-delusions were completely gone

Participant was 77 year old housewife who complained of having a membrane stuck to the roof of her mouth; called it slimy, burning, painful. Orap usually prescribed for this type of dd Cardiovascular side effects

• Enables the recipient to establish links between thoughts, feelings and actions• Helps monitor behavior and develop alternative ways of copingalternative ways of coping• The goal is a correction of misperceptions, irrational beliefs and reasoning biases•Provides client with safe place to express his or her delusions.

CBT developed by Aaron Beck Main stages Build rapport and engage Work on the delusion itself using peripheral questioning Reality test Peripheral questioning-This is a technique for sensitively helping the patient to draw his own conclusions about some of the inconsistencies surrounding the delusion

•1996 study by Turkington and John•N= 4 participants with drug resistant delusional disorder•Each participant evaluated pre-therapy, after their 8 sessions and at their 1 year follow up using Global Scale of Delusional SeverityDelusional Severity•Results

• Decrease for all participants in delusional severity and belief conviction

• Symptoms continued to reduce at one year check up• Decrease in delusional severity remained stable

Received 8 sessions and booster sessions were given for one month Follow up occurred at one year

•In 2007, study was completed to determine if CBT was more effective than an attention placebo group• Random assignment was used to place participants into CBT or AP group•Both groups received personalized weekly meetings with psychologists specializing in CBT. •Results•Results

• Both groups had increased ability to control actions and communications related to the belief.

• CBT showed improvements with depression and self-esteem.

• CBT also showed showed a greater change in the cognitive components that are active in maintenance of DD • ability to challenge belief• modify strength of belief,• and act against the belief

17 participants were used, 11 in CBT and 6 in AP No other psychotic or other major problems on Axes I and II. Medication was kept constant over the studies course CBT group-followed the main stages of preparation, cognitive challenge, and reality testing. AP group-the therapist and patient discussed any immediate problems and recurrent themes in a nondirective and supportive manner, encapsulating the proper supportive psychotherapeutic approach to the paranoia patient of interested, attentive, relaxed, and unaffected attitude with an unfeigned air of detachment and suspended judgment, which has been shown to lead to some remission of symptoms.''

•2008 study in Denmark •1437 participants aged 60 and older•77% of participants were female. • Risk of getting dementia diagnosis is at its • Risk of getting dementia diagnosis is at its highest in the first 6 months after a diagnosis of delusional disorder.• Patients with very late first-contact delusional disorder were 8.14 times more likely to develop dementia compared to the general population.

Aim was to determine whether very late first-contact delusional disorder carries a risk for later development of dementia. Reasons-in some cases the presence of delusional symptoms has obscured an underlying dementia disorder. Sxs of dementia may have become apparent at the time of dd 2. Some of the patients primarily diagnosed as suffering from delusional disorder may indeed already have been suffering from a dementia disorder complicated by delusional symptoms.

James is a 19-year-old man with a 5 year history of delusional disorder. At 14 years, when he was experiencing the onset of puberty, he developed the delusion that he smelled of urine, and just prior to therapy, this developed into the belief that he smelled of urine, feces and sweat. James that he smelled of urine, feces and sweat. James described a happy childhood until the time his delusion began, relating that while at school he had been told that he had body odor, and that some of the other children occasionally shied away from him as though he might have smelled, however this had not occurred for some time. Since the development of his delusion, James had no social life outside school apart from occasional visits to the gymnasium with one friend.

1. Describe two treatment options used to treat Delusional Disorder

2. Discuss reasons why many studies have low sample sizes in the U.S.

Meds & CBT Many participants drop out, participants don’t feel comfortable speaking about delusions, participants are not aware they are having delusions.

•http://psychcentral.com/disorders/sx11t.htmWebsite discusses treatment options for Delusional Disorder

•http://www.omnimedicalsearch.com/conditions-diseases/delusional-disorder-treatment.htmlWebsite discusses different types of meds used to treat Delusional Disorder.

• American Psychiatric Association. (2000). Diagnostic and statistical manual or mental disorders (4th ed., text rev.). Washington, D.C.Manual helps to identify and diagnosis specific mental disorders.

• Fear, C. & Libretto, S. (2002). Risperidone for the treatment of delusional disorder. International Journal of Psychiatry in Clinical Practice, 6, 113-116. DOI: 10.1080/136515002753724126Article discusses the use of Risperidone in the the treatment of delusional disorder. Risperidone appears to be effective in decreasing delusions, but the study uses a small sample size. sample size.

• Hayashi, H.; Oshino, S.; Ishikawa, J.; Kawakatsu, S. & Otani, K. (2004). Paroxetine treatment of delusional disorder, somatic type. Human Psychopharmacology: Clinical & Experimental, 19, 351-352. Article discusses the use of Paxil in treating delusional disorder, somatic type. Paxil appears to work well in treating this subtype of delusional disorder.

• How is schizophrenia treated? (2009, September). National Institute for Mental Health. Retrieved from http://www.nimh.nih.gov/health/publications/schizophrenia/what-is-schizophrenia.shtml. Website provides valuable information on atypical and typical meds.

• Kørner, A.; Lopez, A.G; Lauritzen, L.; Andersen, K & Kessing, L.V. (2008). Delusional disorder in old age and the risk of developing dementia-a nationwide register-based study. Aging & Mental Health, 12, 625-629. DOI:10.1080/13607860802343118.Article examines link between being diagnosed with delusional disorder later in life and developing dementia.

• Manschreck, T. & Khan, N. (2006). Recent advances in the treatment of delusional disorder. Canadian Journal of Psychiatry, 51-114-119.Meta-analyses on how effective atypical drugs are in treating Delusional Disorders. According to the article, atypical drugs are especially effective in treating Delusional Disorders without hazardous side effects. Disorders without hazardous side effects.

• Miyamoto, S.; Miyake, N.; Ogino, S.; Endo, T. & Yamaguchi, N. (2008). Successful treatment of delusional disorder with low-dose aripiprazole. Psychiatry & Clinical Neurosciences, 62, 369.DOI: 10.1111/j.1440-1819.2008.01812.xArticle discusses the use of Risperidone in the the treatment of delusional disorder. Risperidone appears to be effective in decreasing delusions, but the study uses a small sample size.

• O'Connor, K.; Stip, E.; Pélissier, M.C.; Aardema, F.; Guay, S.; Gaudette, G.; Van Haaster, I.; Robillard, S.; Grenier, S.; Careau, Y.; Doucet, P. &Leblanc, V. (2007). Treating delusional disorder: A comparison of cognitive-behavioural therapy and attention placebo control. Canadian Journal of Psychiatry, 52, 182-190.Article examines the benefit of using CBT along with medication to treat Delusional Disorder

•Taylor, P. (2006). Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom? Behavioral Sciences & the Law, 24, 313-331. DOI:10.1002/bsl.686Article discusses using CBT to help violent people with delusional disorder calm down and become more socially appropriate.

• Turkington, D.; John, C.; Siddle, R.; Ward, D. & Birmingham, L. (1996). Cognitive therapy in the treatment of drug- resistant delusional disorder. Clinical Psychology & Psychotherapy, 3, 118-128. Article discusses the treatment of CBT on four individuals who have been resistant to medication to treat Delusional Disorder. All particpants showed tremendous improvement with the use of CBT.

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B. Diagnosis of Delusional Disorder is not given if person ...images2.wikia.nocookie.net/adultpsychopathology/images/2/2e/... · •B. Diagnosis of Delusional Disorder is not given