Abstract
Delusional disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this narrative review is to select from the clinical literature the psychosocial interventions that appear to work best for these conditions and to see whether similar strategies can be modeled or taught to family members so that tensions at home are reduced. Because the content of men’s and women’s delusions sometimes differ, it has been suggested that optimal interventions for the two sexes may also differ. This review explores three areas: (a) specific treatments for men and women; (b) recommended psychological approaches by health professionals, especially in early encounters with patients with DD; and (c) recommended psychoeducation for families. Findings are that there is no evidence for differentiated psychosocial treatment for men and women with delusional disorder. What is recommended in the literature is to empathically elicit the details of the content of delusions, to address the accompanying emotions rather than the logic of the presented argument, to teach self-soothing techniques, and to monitor behavior with respect to its safety. These recommendations have only been validated in individual patients and families. More rigorous clinical trials need to be conducted.
Highlights
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines delusional disorder (DD) as the presence of one or more delusions, lasting for at least one month or longer, in the absence of affective symptoms, prominent hallucinations or other symptoms of schizophrenia [1].The prevalence of DD is estimated to be approximately 0.2% [1]
Gender differences in DD have far been poorly studied, in marked contrast to illnesses such as schizophrenia, where symptoms in young adult women emerge later than they do in men, with a second peak of incidence at the end of the reproductive years
It has been shown that young women respond more completely to antipsychotic medication than do men, but that this wanes after menopause
Summary
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines delusional disorder (DD) as the presence of one or more delusions, lasting for at least one month or longer, in the absence of affective symptoms, prominent hallucinations or other symptoms of schizophrenia [1]. Gender differences in DD have far been poorly studied, in marked contrast to illnesses such as schizophrenia, where symptoms in young adult women emerge later than they do in men, with a second peak of incidence at the end of the reproductive years. The origins of delusional beliefs, whether in men or women, continue to baffle clinicians [11] so that psychological assistance cannot be directed at the putative source of whatever cognitive distortions exist. These same difficulties perplex the families of patients. Psychoeducational guidelines have been developed for families of patients with bipolar disorder [13] and schizophrenia [14], but not yet for families of sufferers from DD
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