What is nonsense and what topics are encountered?
Delusion is a false conclusion that arises not from a lack of information, but from a painful change in thinking. This is why logical arguments do not work: any argument is built into a belief system as another confirmation. In delusional disorder, delusions usually have features of plausibility: surveillance, conspiracy of neighbors, betrayal of a spouse, damage to property. A person can spend years collecting “evidence,” contacting authorities, and changing the locks. Other signs of psychosis—voices, gross disorganization of speech and behavior—are mild or absent in this disorder.
- Delusions of persecution - surveillance, conspiracy, harm from others
- Delusions of jealousy - confidence in a partner’s betrayal
- Hypochondriacal delusion - belief in a serious illness
- Delusions of Grandeur - special mission or abilities
- Erotomanic delusion - confidence in someone else's love
- Delusional relationship - everything around “hints” at a person
Causes and risk factors
There is no single reason. Hereditary predisposition, peculiarities of information processing by the brain and personality traits play a role - suspicion, vulnerability, a tendency to see hidden meaning in neutral events. The risk is higher with social isolation, migration, language barriers, as well as with decreased hearing and vision, when it is more difficult for a person to check his guesses. A separate group of causes are substances and diseases: alcohol, stimulants, some medications, tumors, stroke, dementia, infections. In these cases, they speak not of an independent disorder, but of a symptom of the underlying disease.
- Hereditary burden
- Personality characteristics: suspiciousness, isolation
- Social isolation and loneliness
- Decreased hearing and vision
- Alcohol and psychoactive substances
- Brain diseases, dementia, stroke
How it manifests itself and how it differs from schizophrenia
The main difference is the relative preservation of personality. A person with delusional disorder continues to work, maintain everyday life, and looks adequate as long as the conversation does not touch on the topic of delusion. In schizophrenia, thinking, emotions and will are more affected, voices and severe disorganization are often present. It is also important to distinguish nonsense from overvalued ideas and from well-founded suspicions: sometimes there is a real conflict behind the complaint about “surveillance”. Only a doctor can assess this during a conversation and taking into account the story of loved ones.
- Work, self-care, speech preserved
- The delusion is believable and systematic
- Voices are absent or minimal
- Emotions and will are not flattened
- There is no criticism of one’s condition
Survey
The diagnosis is made clinically: a psychiatrist talks with the person and, with his consent, with relatives, assesses the duration and structure of beliefs, the presence of hallucinations, mood, and substance use. A mandatory step is to rule out physical and neurological causes, especially if the delusion first appeared in old age, developed quickly, or is accompanied by confusion. To do this, blood tests, assessment of thyroid function and neuroimaging are prescribed. Hearing and vision are also checked, because their deterioration can support suspicion.
- Clinical interview and observation
- Information from loved ones with the patient’s consent
- General and biochemical blood test
- TSH
- MRI or CT scan of the brain for the first episode in the elderly
- Hearing and vision testing
Treatment and how to behave to loved ones
The basis of treatment is antipsychotic drugs, which are selected by a psychiatrist, starting with small doses and assessing tolerability. The course is long, self-cancellation leads to a return of symptoms. Psychotherapy can help reduce stress, improve sleep, and reduce the impact of delusions on daily life, even if the belief does not go away completely. It is important for relatives not to argue or assent: arguing increases mistrust, and agreement perpetuates delusion. It is better to maintain contact, talk about the person’s feelings and gently lead to a visit to the doctor.
- Long-term antipsychotics as prescribed by a doctor
- Psychotherapy and coping skills training
- Working with family, reducing conflict
- Hearing and vision correction
- Avoiding alcohol and stimulants
- Immediate response to threats and aggression