1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 28Delusional and Shared Psychotic Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Delusional disorder is a type of serious mental illness in which a person holds unshakeable beliefs in something untrue. It is relatively uncommon in clinical settings, with most studies suggesting that the disorder accounts for 1% to 2% of admissions to inpatient mental health facilities.  Cleveland Clinic, 2009

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Discuss five risk factors related to the development of delusional disorders Identify the clinical symptoms of delusional disorders Differentiate the predominant theme of the following subtypes of delusional disorders: persecutory, conjugal (jealous), erotomanic, grandiose, and somatic Compare and contrast delusional disorder and shared psychotic disorder Recognize the importance of identifying the specific cultural and religious background of a client diagnosed with a delusional disorder

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Articulate the rationale for the use of atypical antipsychotics and anticonvulsants in the treatment of delusional and shared psychotic disorders Explain why individual psychotherapy is considered to be more effective than other interactive therapies in the treatment of delusional and shared psychotic disorders Formulate a list of nursing interventions for the following nursing diagnosis related to delusional disorder: disturbed thought processes related to inaccurate interpretation of environmental stimuli, resulting in feelings of suspicion and fear

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Delusional Disorders Predisposing factors include the following: Relocation due to immigration or emigration Social isolation Sensory impairments such as deafness or blindness Severe stress Low socioeconomic status in which the person may experience feelings of discrimination or powerlessness Personality features such as low self-esteem or unusual interpersonal sensitivity Trust–fear conflicts

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics Persecutory subtype Conjugal (jealous) subtype Erotomanic subtype Grandiose subtype Somatic subtype

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology of Shared Psychotic Disorder Shared psychotic disorder, or folie à deux, involves two individuals who have a close relationship and share the same delusion. This occurrence is attributed to the strong influence of the more dominant (primary case or inducer) person over the submissive (secondary case) individual.

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Shared Disorder In shared psychotic disorder, delusions may be bizarre or nonbizarre. The dominant individual (primary case or inducer) usually has a chronic psychotic disorder with prominent delusions that the submissive individual (secondary case) begins to believe. The submissive individual is usually healthy but frequently less intelligent, more gullible, more passive, or more lacking in self-esteem than the dominant individual.  Sadock & Sadock, 2008 ‏

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment History and physical examination Transcultural considerations

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Disturbed thought processes Disturbed sensory perception Social isolation Risk for self-directed violence Defensive coping Fear Impaired social interaction Noncompliance

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Stated outcomes focus on the client’s ability to do the following: Identify situations that contribute to delusional thoughts Identify problems in relating with others Minimize delusional material Differentiate between fantasy and reality Utilize interventions to stabilize mood and behavior

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Interventions are planned to Alleviate symptoms to the degree that is essential for continued employment and community living Stabilize the client’s social and occupational relationships

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance in meeting basic needs Medication management Interactive therapies Client education

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Clients who respond to treatment are able to Make satisfactory social adjustments Comply with the administration of low-dosage antipsychotic or neuroleptic drugs Continue with supportive individual psychotherapy

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Conjugal paranoia Content-specific delusions (CSDs) ‏ Delusion Erotomanic delusion Folie à deux Grandiose delusion Ideas of reference Nonbizarre delusions Paranoid Paradoxical conduct Persecutory delusions Somatic delusions

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection According to the chapter-opening quote, delusional disorder is considered to be relatively uncommon. Given the numerous precipitating factors that are believed to cause delusional disorders, explain why you believe the frequency of occurrence is only 1% to 2%. What questions could you ask a client during the assessment process to determine if the client is at risk for the development of a delusional disorder? Explain the rationale for your questions. ?