Delusional disorders - detailed description

They include a wide range of manifestations and symptoms that cannot be strictly classified as mental disorders of an organic or functional nature, since most of them manifest themselves in the same way. It is also difficult to distinguish them from schizophrenia.
The diagnostic criteria for delusional disorders are:
1. The presence of bizarre delusions: the patient is attached to reality and creates preconceived ideas, exaggerating or inventing a fantastic story with a starting point in the real fact: he gets the impression that he is being watched, investigated or bullied, he thinks that his spouse is cheating on him or that he is very ill, complains of symptoms, which cannot be objectified by clinical examination (hypochondria).
2. A person does not behave strangely, he just lives by his delusional ideas. His behavior does not become strange or inappropriate. This does not meet the diagnostic criteria for schizophrenia, since schizophrenia involves living in a parallel reality of one's own fantasies and abandoning everyday life. The patient may have auditory, visual, or olfactory hallucinations, but they correspond to delusional ideas about reality, while the patient does not get lost in his own hallucinations, like a schizophrenic, but remains attached to reality.
3. Affective episodes that overlap with episodes of delirium are short-lived, the episode of delirium lasts longer and monopolizes the patient's life.
4. The patient does not suffer from any organic disease that could be the source of these manifestations, and has not been exposed to hallucinogenic substances such as drugs, anesthetics or other drugs with such effects.
Delirium, which characterizes delusional disorders, should last at least three months so that the patient can be suspected of such a mental illness. Four chronic non-schizophrenic delusional disorders are described: paranoia, paraphrenia, paranoid psychosis, and sensory deficits.
Paranoia is a chronic endogenous psychosis in which the patient builds his own system of illusions, while maintaining clarity in his thoughts and actions. Delusions seem insidious, being systematic and not hallucinatory, the patient has low self-esteem, and there is a discrepancy between his own aspirations and the opportunities he has to realize these aspirations. As a rule, it develops against the background of a paranoid personality disorder, which is not a pathological formation, but an increase in the features that define this personality disorder can gradually lead to paranoia.
Paranoid psychosis is characterized by extreme delusional behavior, when the paranoid patient is at the mercy of his own illusions.
Paraphrenia is a chronic endogenous psychosis characterized by the presence of hallucinations that have nothing to do with reality, but despite them, the patient firmly adheres to reality. The illusions have a fantastic theme, the patient's imaginary world overlaps with the real one, but the patient adapts well to reality, leading a normal life, his behavior and personality are not affected.
Depending on the prevailing theme of delusions, several subtypes of delusional disorder have been identified, namely:
The type of greatness - the general theme of delusions is the belief that a person has a certain talent, giftedness or intelligence above average and that he is or will be a significant person. Some misconceptions are religious in nature, when a person claims to receive messages from the deity.
The type of jealousy is a delusional topic - it is the belief that a partner is cheating. There is no concrete evidence on this score, but the patient begins to obsessively collect it, and even any normal behavior of the accused can cause real outbursts of anger.
Type of persecution - The central theme of delirium is the patient's belief that he is being persecuted or that someone wants to kill/poison/harm him. It all starts with injustice towards the patient at work or in his social circle, and this patient will direct all his efforts to prove that the person who committed this injustice wants to harm him.
Somatic type - delirium focuses on various bodily sensations or symptoms. The patient is obsessed with being sick (hypochondria) or that some parts of his body look scary (somatoform disorders).
Mixed type - there is no central idea of delusion, illusions of various subjects.
Unidentified type - The basic idea of delirium does not apply to any of the above types.
The most common subtype of psychotic disorder is the type of harassment. The onset is usually fixed between the ages of 35 and 45, unlike schizophrenia, where the average age of onset is 25 years. There is no clear link between delusional disorder and schizophrenia, and it has not been shown that people with schizophrenia in their family are more likely to have delusional psychotic disorders.

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