Delusional disorder natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
If left untreated, delusional disorder may progress to develop life-long illness. Common complications of delusional disorder include depression, violence and legal problems, and isolation. The prognosis for people with delusional disorder varies depending on the type of delusional disorder, on the person, and the person's life circumstances, including the availability of support and a willingness to adhere with treatment.[1][2][3]
Natural History
- The onset of delusional disorder can be acute, sudden, or less commonly the disorder develops gradually. If the onset is acute, it is usually associated with the presence of a precipitating event. Some clinicians and some research data indicate that an identifiable psychosocial stressor often accompanies the onset of delusional disorder. However, the nature of the stressor, warrant some suspicion or concern. Examples of such stressors are recent immigration, social conflict with family members or friends, and social isolation.
- A sudden onset is more common than insidious onset. Clinicians believe that a person with delusional disorder is likely to have a below-average intelligence and the premorbid personality of such a person is likely to be extroverted, dominant and hypersensitive. Delusions are often the initial manifestation of the delusional disorder, but some premorbid traits which include odd behavior and personality changes, have been reported in some cases.
- Chronic forms of the illness, that is, patients who present with features of the illness that have been present for more than six months, tend to have onset, early in the fifth decade.
- Onset is generally acute in two-thirds of cases, and more gradual in the remainder. Chronicity develops in nearly 10%, and a relapsing course is seen in 37%. An acute and earlier onset of illness predicts a more favorable outcome For acute forms of the illness the age of onset is in the fourth decade and recovery occurs in over half of the cases.
- Delusional disorder is commonly a chronic condition, but if properly treated, the majority of people with this disorder can find relief from their symptoms. Some people recover completely from delusional disorders and others experience episodes of delusional beliefs with periods of remission. Delusional disorder is generally a disabling illness.
- The available studies on outcome in delusional disorder have shown the re-diagnoses of 3-8% as affective illness and 3-28% as schizophrenia: in others-the diagnosis was stable. The condition often disrupts progress to occupational and personal goals; patients with the delusional disorder typically achieve less in their lives than their innate abilities would propound. However, the clinical course can be influenced by the availability of personal support, personal circumstances such as education, socioeconomic status, and physical health, and willingness to maintain treatment. The other psychosocial abilities usually remain intact in patients with delusional disorders.
- The majority of the individuals with delusional disorders may rarely seek psychiatric help, remain isolated, and often present to surgeons, internists, policemen, and lawyers rather than psychiatrists. The majority of people with the delusional disorders do not seek help. Without treatment, delusional disorder can be a life-long illness.[4][5][6]
Complications
Complications of delusional disorder include the following:
- Depression
- Acting on the delusions may lead to violence or legal problems
- People with the delusional disorder can eventually become isolated from others, especially if their delusions interfere with their relationships
- Based on several small studies, rates of suicidal ideation and behavior in patients with delusional disorder, may be greater than in patients without psychiatric disorders and comparable to rates seen in patients with schizophrenia. Individuals afflicted with somatic and persecutory delusions are more likely than other subtypes to report suicidality.[7]
Prognosis
- The prognosis for people with delusional disorder varies depending on the type of delusional disorder, on the person, and the person's life circumstances, including the availability of support and a willingness to adhere with treatment. The majority of people with the delusional disorder do not seek help. Without treatment, delusional disorder can be a life-long illness.
- In approximately two-thirds of cases, the course of the delusional disorder is life-long, with delusions present continuously in some cases and periodically in others cases. In approximately one-third of cases spontaneous remission of delusional disorder is reported. The diagnostic stability of delusional disorder is usually less than that of some psychotic disorders. The most frequent change is re diagnosis of delusional disorder to schizophrenia. Data has suggested that patients with delusional disorders have a better global outcome than patients with schizophrenia.
- Patients with persecutory, somatic, and erotic delusions have a better prognosis than patients with grandiose and jealous delusions.[8][9][10]
- Approximately 10% of delusional disorder cases will show some improvement of delusional symptoms though irrational beliefs may remain. Approximately 33–50% of delusional disorder cases may show complete remission. In 30–40% of cases there will be persistent non-improving symptoms. The prognosis for patients with delusional disorder is largely related to the openness the person has for allowing information that contradicts the delusion and to the level of conviction regarding the delusions.[11][12][13]
Poor prognostic features of delusional disorder include the following:
- Reclusive personality
- Poor premorbid history
- Onset 6 months or more before admission
- Gradual onset
- Lack of insight
- Single marital status
- Lack of precipitating factors for delusional disorder.
Good prognostic features of delusional disorder include the following:
- High level of occupational, emotional and functional adjustments
- Female sex
- Onset before the age of 30
- Sudden onset
- Short duration of the illness
- The presence of precipitating factors
References
- ↑ Grover, Sandeep, Nitin Gupta, and Surendra Kumar Mattoo. "Delusional disorders: An overview." German J Psychiatry 9 (2006): 62-73.
- ↑ Fujii, Daryl, and Iqbal Ahmed, eds. The spectrum of psychotic disorders: Neurobiology, Etiology & Pathogenesis. Cambridge University Press, 2007.
- ↑ Sadock, Benjamin J., and Virginia A. Sadock. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins, 2011.
- ↑ Opjordsmoen S (1988). "Long-term course and outcome in delusional disorder". Acta Psychiatr Scand. 78 (5): 576–86. PMID 3232535.
- ↑ Craddock, N. (2008). "The Spectrum of Psychotic Disorders: Neurobiology, Etiology and Pathogenesis". The British Journal of Psychiatry. 192 (6): 478–478. doi:10.1192/bjp.bp.107.039578. ISSN 0007-1250.
- ↑ Grover, Sandeep, Nitin Gupta, and Surendra Kumar Mattoo. "Delusional disorders: An overview." German J Psychiatry 9 (2006): 62-73.
- ↑ González-Rodríguez A, Molina-Andreu O, Navarro Odriozola V, Gastó Ferrer C, Penadés R, Catalán R (2014). "Suicidal ideation and suicidal behaviour in delusional disorder: a clinical overview". Psychiatry J. 2014: 834901. doi:10.1155/2014/834901. PMC 3994904. PMID 24829903.
- ↑ Grover, Sandeep, Nitin Gupta, and Surendra Kumar Mattoo. "Delusional disorders: An overview." German J Psychiatry 9 (2006): 62-73.
- ↑ Opjordsmoen S (2014). "Delusional disorder as a partial psychosis". Schizophr Bull. 40 (2): 244–7. doi:10.1093/schbul/sbt203. PMC 3932094. PMID 24421383.
- ↑ Kendler KS, Walsh D (1995). "Schizophreniform disorder, delusional disorder and psychotic disorder not otherwise specified: clinical features, outcome and familial psychopathology". Acta Psychiatr Scand. 91 (6): 370–8. PMID 7676834.
- ↑ Grover, Sandeep, Nitin Gupta, and Surendra Kumar Mattoo. "Delusional disorders: An overview." German J Psychiatry 9 (2006): 62-73.
- ↑ Fujii, Daryl, and Iqbal Ahmed, eds. The spectrum of psychotic disorders: Neurobiology, Etiology & Pathogenesis. Cambridge University Press, 2007.
- ↑ Sadock, Benjamin J., and Virginia A. Sadock. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry. Lippincott Williams & Wilkins, 2011.