Delusional Disorder
- Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration.
- Criterion A for Schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.
Criterion A of Schizophrenia requires two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
- delusions
- hallucinations
- disorganized speech (e.g., frequent derailment or incoherence)
- grossly disorganized or catatonic behavior
- negative symptoms, i.e., affective flattening, alogia, or avolition
Note: Criteria A of Schizophrenia requires only one symptom if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
- Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.
- If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
- The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Specify type:
- Erotomanic Type: delusions that another person, usually of higher status, is in love with the individual
- Grandiose Type: delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
- Jealous Type: delusions that the individual's sexual partner is unfaithful
- Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way
- Somatic Type: delusions that the person has some physical defect or general medical condition
- Mixed Type: delusions characteristic of more than one of the above types but no one theme predominates
- Unspecified Type
Antipsychotics: Doses and Side Effects for Chronic Use
| Antipsychotics (typical) |
Dose mg/day |
Anti- cholineric¹ |
EPS² |
Sedation |
Hypotension (orthostatic) |
| Chlorpromazine (Thorazine) |
100-2000 | ++++ | ++ | +++++ | +++++ |
| Thioridazine (Mellaril) |
100-600 | +++++ | + | ++++ | +++++ |
| Trifluoperazine (Stelazine) |
5-60 | ++ | ++++ | + | ++ |
| Thiothixene (Navane) |
5-60 | ++ | ++++ | ++ | ++ |
| Fluphenazine (Prolixin) |
5-30 | ++ | +++++ | ++ | ++ |
| Haloperidol (Haldol) |
2-200 | + | +++++ | ++ | + |
| Antipsychotics (atypical) |
Dose mg/day |
Anti- cholineric¹ |
EPS² |
Sedation |
Hypotension (orthostatic) |
| Risperidone (Risperdal) |
1-6 | + | + | + | ++ |
| Olanzapine (Zyprexa) |
5-20 | + | + | ++ | + |
| Clozapine³ (Clozaril) |
5-60 | +++++ | + | +++++ | +++++ |
¹ Dry mouth, constipation, blurred vision, urinary retention.
² Extrapyramidal side effects (dystonia, parkinsonism, akathisia, tardive dyskinesia).
³ Requires weekly White Blood Cell (WBC) count because of risk of agranulocytosis.
Adapted from Bernstein JG: Handbook of drug therapy in psychiatry, ed 3, St. Louis, 1995, Mosby.
Special Antipsychotic Adverse Reactions
- Neuroleptic Malignant Syndrome. May occur at any point during the course of treatment. Includes symptoms of autonomic instability, altered mental status, which may progress to hyperthermia, stupor, and muscle hypertonicity. Death may occur. Cause: Neuroleptics (phenothiazines, etc.)
Characteristics. Same symptoms as malignant hyperthermia (see below) but generally develops over days instead of minutes. Treatment: As per malignant hyperthermia.
- Malignant Hyperthermia.
Cause. 1:20,000 in response to a muscle-relaxing agent (such as succinylcholine) or an inhaled anesthetic (such as halothane). Is hereditary. May also be secondary to physical or emotional stress.
Characteristics. Hyperthermia, muscle rigidity, tachycardia, acidosis, shock, coma, rhabdomyolysis.
Treatment includes IV dantrolene 1 to 10 mg/kg IV titrated to effect, management of acidosis and shock, peripheral cooling (see management of heat stroke below).
- Malignant Hyperthermia.
- Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth, or jaw associated with long-term administration of antipsychotics. Elderly females at highest risk. May be irreversible.
- Psychosis
- Depressed Mood
- Somatic or Sexual Dysfunction
- Odd or Eccentric or Suspicious Personality
Some disorders have similar or even overlapping symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.
A delirium, a dementia. or Psychotic Disorder Due to a General Medical Condition; Substance-Induced Psychotic Disorder; Schizophrenia; Schizophreniform Disorder; Mood Disorders With Psychotic Features; Psychotic Disorder Not Otherwise Specified; Depressive Disorder Not Otherwise Specified; Bipolar Disorder Not Otherwise Specified; Shared Psychotic Disorder; Brief Psychotic Disorder; Psychotic Disorder Not Otherwise Specified; Hypochondriasis; Body Dysmorphic Disorder; Obsessive-Compulsive Disorder; Paranoid Personality Disorder.