Delusional Disorder: Paranoia and Related Illnesses

Cover......Page 1
Half-title......Page 3
Series-title......Page 4
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Case descriptions......Page 13
Preface......Page 15
Part I Delusional disorders and delusions: introductory aspects......Page 17
An introduction to the delusional disorders......Page 19
A note on terminology......Page 20
The recognition of cases of delusional disorder......Page 21
The derivation of current concepts regarding delusional disorders......Page 24
Problems concerning nomenclature......Page 25
Paranoia until the late nineteenth century......Page 26
The influence of Kraepelin......Page 27
Kraepelin’s views on paraphrenia......Page 29
Other contributions to the conceptualization of the delusional disorders......Page 30
Paranoia......Page 32
The clinical subtypes of paranoia......Page 33
Paraphrenia......Page 35
Late paraphrenia......Page 36
Late onset schizophrenia......Page 37
Delusional misidentification syndromes – background aspects......Page 38
Reactive psychoses......Page 39
Paranoid personality disorder......Page 40
Conclusions regarding the delusional disorders......Page 41
Introduction......Page 42
Phenomenology and psychopathology of delusions......Page 43
Delusions and nosology......Page 47
Recent experimental work on delusions......Page 48
Delusions in clinical practice: a practical approach......Page 50
References......Page 52
Part II Descriptive and clinical aspects of paranoia/delusional disorder......Page 59
What is meant by paranoia?......Page 61
Case No. 1 Delusional disorder, persecutory subtype......Page 62
Overall features of delusional disorder (Munro, 1995)......Page 64
Delusional contents......Page 67
Illnesses associated with delusions: the differential diagnosis of delusional disorder......Page 68
Dementia......Page 69
Substance-induced psychotic disorder......Page 70
Non-delusional illnesses which may mimic delusional disorder: further differential diagnostic considerations......Page 71
Considerations of aetiological factors in delusional disorder......Page 72
Genetic factors in delusional disorders......Page 73
Organic factors in the aetiology of delusional disorder......Page 75
Delusional disorders – interplay with mood factors......Page 77
Delusional disorder: a brief commentary on psychodynamic contributions......Page 80
Conclusion......Page 82
References......Page 83
Somatization and hypochondriasis (Munro, 1988; Kellner, 1992; Warwick and colleagues, 1996)......Page 87
Characteristics of the somatizing patient (Katon and colleagues, 1991)......Page 88
The general recognition of somatizing patients......Page 89
Body image and its disorders......Page 90
Delusional disorder, somatic subtype: general concerns......Page 91
Difficulties in nomenclature......Page 92
Overall clinical features of patients with delusional disorder, somatic subtype......Page 95
Case No. 2 Delusional disorder, somatic subtype, with dysmorphic delusion......Page 97
Behavioural factors......Page 98
Illness factors......Page 99
Specific delusional contents of the somatic subtype......Page 100
Dermatological presentations......Page 101
How the patient presents in delusional infestation......Page 102
Other dermatological presentations related to delusional disorder......Page 104
Case No 3 Delusional disorder, somatic subtype, with delusions of infestation......Page 105
Delusional disorder, somatic subtype, with a dysmorphic delusion......Page 106
Delusional disorder, somatic subtype, with a delusion of smell......Page 107
Case No. 4 Delusional disorder, somatic subtype, with a delusion of smell......Page 109
Delusional disorder, somatic subtype, with facial and dental symptoms......Page 110
Case No. 5 Delusional disorder, somatic subtype, with complaint of dental malocclusion......Page 111
Delusional disorder, somatic subtype, with a delusion of sexually transmitted disease......Page 113
Case No. 6 Delusional disorder, somatic subtype, with a delusion of sexually transmitted disease (AIDS)......Page 114
Conclusion......Page 115
References......Page 116
4 Delusional disorder, jealousy subtype......Page 120
When is jealousy pathological?......Page 121
Case No 7 Delusional disorder, jealousy subtype......Page 123
General aspects of delusional jealousy......Page 125
The psychopathology of morbid jealousy......Page 127
The differential diagnosis of delusional jealousy......Page 128
Forensic complications......Page 129
Treatment and prognosis of delusional disorder, jealousy subtype......Page 130
Conclusion......Page 131
References......Page 132
5 Delusional disorder, erotomanic subtype......Page 135
The differential diagnosis of erotomania......Page 137
Sex distribution of erotomania......Page 138
Case No. 8 Delusional disorder, erotomanic subtype......Page 139
Forensic aspects......Page 141
Course and prognosis......Page 142
References......Page 143
Persecutory and litigious presentations......Page 146
‘Querulous paranoia’: a variation on delusional disorder, persecutory subtype......Page 147
Case No. 9 Delusional disorder, persecutory subtype: with litigious features......Page 151
The dangerous paranoid patient......Page 153
Delusional disorder – grandiose subtype......Page 156
Case No. 10 Delusional disorder, grandiose subtype......Page 158
References......Page 159
Part III ‘Paranoid spectrum’ illnesses which should be included in the category of delusional disorder......Page 161
Diagnostic diffculties in psychiatry: in general and in particular......Page 163
Paraphrenia: the background......Page 165
Descriptions of paraphrenia in the literature......Page 166
Case No. 11 Paraphrenia in a middle-aged man......Page 167
Case No. 12 Paraphrenia in an older female......Page 168
The paranoid spectrum: a venerable concept (Munro, 1982)......Page 171
Proposed diagnostic criteria for paraphrenia (Munro, 1991)......Page 173
Course and prognosis......Page 174
Risk factors......Page 175
Treatment outcome......Page 176
Conclusion......Page 177
Paranoid schizophrenia......Page 178
Case No. 13 Paranoid schizophrenia......Page 179
References......Page 181
Introduction......Page 184
Case No. 14 Paraphrenia originating in older age......Page 185
‘Late’ paraphrenia......Page 186
Conclusion......Page 189
Schizophrenia of late onset......Page 190
Conclusion......Page 191
References......Page 192
9 Delusional misidentification syndrome (DMS)......Page 194
Hypothesized psychodynamic factors in DMS......Page 195
Features of DMS......Page 196
Case No. 15 Delusional misidentification syndrome: Capgras subtype......Page 198
Conclusion......Page 199
References......Page 200
10 Folie à deux: an accompaniment of illnesses with delusions......Page 202
Nomenclature......Page 204
A caution to the physician......Page 205
Conclusion......Page 206
References......Page 207
Part IV Illnesses which are liable to be misdiagnosed as delusional disorders......Page 209
Introduction......Page 211
Reactive psychoses......Page 213
Case No. 17 Brief psychotic disorder......Page 216
Cycloid psychosis (also known as periodic psychosis)......Page 217
Clinical features......Page 218
Course and prognosis......Page 219
Case No. 18 Cycloid psychosis......Page 220
Conclusion......Page 222
References......Page 223
The ‘group A’ (paranoid, schizoid and schizotypal) personality disorders......Page 225
Case No. 19 Paranoid personality disorder......Page 226
Case No. 20 Schizoid personality disorder......Page 227
Case No. 21 Schizotypal personality disorder......Page 228
Case No. 22 Obsessive–compulsive disorder (with bizarre features)......Page 229
Somatoform disorders, with especial emphasis on body dysmorphic disorder......Page 230
Case No. 23 Body dysmorphic disorder......Page 231
Case No. 24 Dissociative disorder......Page 232
Case No. 25 Factitious disorder......Page 233
Case No. 26 Asperger’s disorder......Page 234
Eating disorders......Page 235
Case No. 27 Delusional disorder presenting as anorexia nervosa......Page 236
Case No. 28 Pathological bereavement......Page 237
References......Page 238
Part V Treatment of delusional disorder and overall conclusions......Page 241
Treatment of delusions in general......Page 243
Treatment of paranoia/delusional disorder......Page 245
Treatment outcome in 209 delusional disorder cases (Munro and Mok, 1995)......Page 247
Practical aspects of treatment......Page 248
Maintenance of treatment......Page 249
Non-drug treatment of delusional disorder......Page 250
Choice of medication in the treatment of delusional disorder......Page 251
Pimozide – mechanisms, side effects and uses......Page 254
Conclusion......Page 255
References......Page 256
Introduction......Page 259
Delusional disorder – making order out of chaos......Page 261
The paranoid spectrum......Page 262
‘The delusional disorders’......Page 264
Reference......Page 265
Recommended reading......Page 266
Index......Page 267