Delusional Disorder
- Nonbizarre delusions (i.e., involving situations that occur in real life such as being poisoned, loved at a distance, deceived by a spouse) of at least one month’s duration.
- Criterion A for Schizophrenia never met.
- Apart from the impact of delusions, functioning not markedly impaired.
- Not due to mood disorder or substance.
- Lifetime prevalence = 0.03%.
Mean Age of Onset
- Mean age of onset is ~40 years.
- Slightly higher in females compared to males.
Delusional Disorder Subtypes
- Erotomanic
- Grandiose
- Persecutory
- Jealous
- Somatic
- Mixed
See erotomanic delusions more often in women.
See persecutory delusions more often in men.
Brief Psychotic Disorder
-
Presence of one or more of the following:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
-
Duration of episode is <1 month with eventual return to premorbid level of functioning.
Psychosis NOS
- If patient has psychotic symptoms but does not meet criteria for any diagnosis, they get the Psychosis NOS diagnosis.
Case Study
- 29-year-old woman was brought to the emergency room by the police after she started screaming at Starbucks then threw coffee at the barista. In the emergency room, she stated “I need to be taken to jail. I think I contaminated someone with a virus and I need to go to jail. Don’t get near me… I will make you sick too.”
- PE, VS, lab work all unremarkable.
Differential Diagnoses for Psychotic Disorders
- Mood Disorders with Psychotic Features
- Schizophrenia and Schizophreniform Disorder
- Substance-Induced Psychotic Disorder
- Delusional Disorder
- Psychotic Disorder due to General Medical Condition
- Shared Psychotic Disorder (Folie à Deux)
- Psychotic Disorder NOS
- Look-alikes: BPD, OCD, PPD, schizotypal PD
MDD with Psychotic Features
- Leading diagnosis given depressive themes to psychosis, depressed mood, negative Utox, no abnormalities in labs, normal PE, and lack of negative symptoms.
To Rule in the Diagnosis
- Patient needs to currently meet criteria for a major depressive episode and not have other reasons for psychosis.
Information Needed to Rule Out Other Diagnoses
- No history of manic episodes - r/o BAD.
- No drug/ETOH use in recent past - r/o SIPD.
- No medical issues such as hypothyroidism - r/o psychotic disorder due to a GMC.
- Does not meet criteria for schizophrenia.