Delusional disorder, previously called paranoid disorder, is a type of serious mental illness called a psychotic disorder. People who have it can’t tell what’s real from what is imagined. Delusions are the main symptom of delusional disorder. They’re unshakable beliefs in something that isn’t true or based on reality. But that doesn’t mean they’re completely unrealistic. Delusional disorder involves delusions that aren’t bizarre, having to do with situations that could happen in real life, like being followed, poisoned, deceived, conspired against, or loved from a distance. These delusions usually involve mistaken perceptions or experiences. But in reality, the situations are either not true at all or highly exaggerated. A bizarre delusion, by contrast, is something that could never happen in real life, such as being cloned by aliens or having your thoughts broadcast on TV. A person who has such thoughts might be considered delusional with bizarre-type delusions. People with delusional disorder often can continue to socialize and function normally, apart from the subject of their delusion, and generally do not behave in an obviously odd or bizarre manner. This is unlike people with other psychotic disorders, who also might have delusions as a symptom of their disorder. But in some cases, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted. Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Delusional disorder most often happens in middle to late life and is slightly more common in women than in men. The types are based on the main theme of the delusion:
They usually include:
As with many other psychotic disorders, the exact cause of delusional disorder is not yet known. But researchers are looking at the role of genetic, biological, environmental, or psychological factors that make it more likely.
If you have symptoms of delusional disorder, your doctor will likely give you a complete medical history and physical exam. Although there are no lab tests to specifically diagnose delusional disorder, the doctor might use diagnostic tests, such as imaging studies or blood tests, to rule out physical illness as the cause of the symptoms. These include:
If the doctor finds no physical reason for the symptoms, they might refer the person to a psychiatrist or psychologist, health care professionals trained to diagnose and treat mental illnesses. They’ll use interview and assessment tools to evaluate the person for a psychotic disorder. The doctor or therapist bases the diagnosis on the person's symptoms and their own observation of the person's attitude and behavior. They’ll decide if the symptoms point to a disorder. A diagnosis of delusional disorder is made if:
Treatment most often includes medication and psychotherapy (a type of counseling). Delusional disorder can be very difficult to treat, in part because those who have it often have poor insight and do not know there’s a psychiatric problem. Studies show that close to half of patients treated with antipsychotic medications show at least partial improvement. The primary medications used to attempt to treat delusional disorder are called antipsychotics. Drugs used include: Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and its impact on their lives. Psychotherapies that may be helpful in delusional disorder include:
People with severe symptoms or who are at risk of hurting themselves or others might need to be hospitalized until the condition is stabilized.
It varies, depending on the person, the type of delusional disorder, and the person's life circumstances, including the presence of support and a willingness to stick with treatment. Delusional disorder is typically a chronic (ongoing) condition, but when properly treated, many people can find relief from their symptoms. Some recover completely, while others have bouts of delusional beliefs with periods of remission (lack of symptoms). Unfortunately, many people with this disorder don’t seek help. It’s often hard for people with a mental disorder to know they aren’t well. Or they may credit their symptoms to other things, like the environment. They also might be too embarrassed or afraid to seek treatment. Without treatment, delusional disorder can be a lifelong illness. There’s no known way to prevent delusional disorder. But early diagnosis and treatment can help lessen the disruption to the person's life, family, and friendships. If you have schizophrenia, there is much reason for hope. New antipsychotic drugs are being studied, and brain research is revealing more about the roots of this mental illness. While there is no known cure, it is possible to live a meaningful and happy life with schizophrenia. There are many effective treatments, best provided by a team. These include medication, psychotherapy, behavioral therapy, and social services, as well as tools to help you stay in school or keep working. Psychiatrists, primary care doctors, psychologists, social workers, and other mental health professionals will help you and your family find the treatments best for you. The earlier you get help, the better your outcome. With treatment, many recover to the point of living functional, rewarding lives in their communities. The first signs of schizophrenia usually appear between your late teens and mid-30s. According to one large analysis, the median age of the start of schizophrenia around the world was 25, meaning that half of the cases appeared before that age and half appeared later. It may take a year or two before the vaguely strange early symptoms of schizophrenia – during what’s called a “prodromal phase” – turn serious enough to prompt a visit to a psychiatrist. In some people, the illness never goes beyond this point, but in most cases, it does. The active phase of your schizophrenia may last several years or up to a decade. This can be an alarming period for you and your loved ones. But it’s often followed by a less stormy phase where your more intense symptoms, like hallucinations, stabilize. But such symptoms as loss of interest, trouble thinking, and relationship problems are more likely to linger. Some people do recover “fully” from schizophrenia. Ten years after diagnosis:
Antipsychotic medications work well. One study found that symptoms go away in about 70% of the people who get treatment. Their social occupational functions often improve within 6 months, although that score may not rise much after that. Your quality of life can get better most of the time. Long-term numbers for 30 years after diagnosis are similar to those at the decade mark, except that more people get better and can live on their own. The lifetime risk of suicide for people with schizophrenia is about 5%, but getting treatment and taking medication seem to lower that risk. Women seem to be better than men at staying in recovery long-term. Medications, cognitive therapy, and a strong support network can help you find ways to lead a successful life with your mental illness. If you or a loved one has schizophrenia, here are a couple of things that may affect success long-term:
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