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The diagnosis of delusional disorder can be made when a person exhibits nonbizarre delusions of at least 1 month duration that cannot be attributed to other psychiatric disorders. Nonbizarre delusions must be about phenomena that, although not real, are within the realm of being possible. In general, the patient’s delusions are well systematized and have been logically developed. The person’s behavioral and emotional responses to the delusions appear to be appropriate. Usually the person’s functioning and personality are well preserved and show minimal deterioration if at all.

Characteristics of delusional disorder

  • Nonbizarre delusions of at least 1 month’s duration
  • No positive or negative symptoms of schizophrenia present
  • Tactile or olfactory hallucinations may be present and related to the delusional theme
  • Functioning not markedly impaired and behavior not obviously bizarre or odd
  • Only brief mood episodes, if any
  • Not due to direct physiologic effects of a chemical or a general medical condition

Etiology of delusional disorder

Etiology of the delusional disorder is unknown. Risk factors associated with the disorder include advanced age, sensory impairment/isolation, family history, social isolation, personality features (e.g. unusual interpersonal sensitivity), and recent immigration. Some have reported higher association of delusional disorder with widowhood, celibacy, and history of substance abuse. Age of onset is later than schizophrenia and earlier in men compared to women.

Subtypes of delusional disorder

Persecutory Type

Here the person affected believes that he or she is being followed, spied on, poisoned or drugged, harassed, or conspired against. The person affected may get preoccupied by small slights that can become incorporated into the delusional system. These individuals may resort to legal actions to remedy perceived injustice. Individuals suffering from these delusions often become resentful and angry with a potential to get violent against those believed to be against them.

Jealous Type

Individuals with this subtype have the delusional belief that their spouses/lovers are unfaithful. Jealousy is a powerful emotion and when it occurs in delusional disorder or as part of another condition, it can be potentially dangerous and has been associated with violence including suicidal and homicidal behavior.

Delusions of infi delity have also been called conjugal paranoia . The term Othello syndrome has been used to describe morbid jealousy.

Erotomanic Type

Persons with delusional disorder of the erotomanic type have delusions of being loved by another. The patient believes that a perceived suitor, usually more socially prominent than herself, is in love with her. Erotomania shares many features with, is derived from, and is often referred to as de Clerambault’s syndrome .

Somatic Type

Delusional disorder with somatic delusions has been called monosymptomatic hypochondriacal psychosis . This disorder differs from other conditions with hypochondriacal symptoms in degree of reality impairment. Munro ( 1991 ) has described the largest series of cases and has used content of delusions to defi ne three main types:

Delusions of Infestations (Including Parasitosis).

Delusional parasitosis has been described in association with many physical illnesses such as vitamin B 12 defi ciency, pellagra, neurosyphilis, multiple sclerosis, thalamic dysfunction, hypophyseal tumors, diabetes mellitus, severe renal disease, hepatitis, hypothyroidism, mediastinal lymphoma, and leprosy. Use of cocaine and presence of dementia has also been reported. Psychogenic parasitosis was also known as Ekbom’s syndrome before being referred to as delusional parasitosis .

Delusions of Dysmorphophobia

This condition includes delusions such as of misshapenness, personal ugliness, or exaggerated size of body parts.

Delusions of Foul Body Odors or Halitosis.

This is also called olfactory reference syndrome.

Grandiose Type

This is also referred to as megalomania . In this subtype, the central theme of the delusion is the grandiosity of having made some important discovery or having great talent. Sometimes there may be a religious theme to the delusional thinking such that the person believes that he or she has a special message from god.

Mixed Type

This subtype is reserved for those with two or more delusional themes. However, it should be used only where it is difficult to clearly discern one theme of delusion. This subtype is used for cases in which the predominant delusion cannot be subtyped within the above mentioned categories. A possible example is certain delusions of misidentification, for example, Capgras’s syndrome , named after the French psychiatrist who described the ‘illusions of doubles.’

The delusion here is the belief that a familiar person has been replaced by an imposter. A variant of this is Fregoli’s syndrome where the delusion is that the persecutors or familiar persons can assume the guise of strangers and the very rare delusion that familiar persons could change themselves into other persons at will (intermetamorphosis).

COMPLICATIONS of delusional disorder

  • If left undiagnosed, untreated, or ineffectively treated, schizophrenia can lead to profound inability to function and contribute to the problem of homelessness in our society.
  • Neglect of other medical conditions; therefore, complications due to untreated medical illness are common.
  • Depression and suicide.
  • Substance use, abuse, or dependency.


Nursing Diagnosis Delusional Disorder

Nursing Diagnosis for Delusional Disorder determine from what we found in Nursing Assessment Nursing Care Plans for Delusional Disorder.

Nursing assessment nursing care Plans for Delusional Disorders

Assess for positive symptoms of schizophrenia. These symptoms reflect aberrant mental activity and are usually present early in the first phase of the schizophrenic illness.

Alterations in Thinking

  • Delusion: false, fixed belief that is not amenable to change by reasoning. The most frequent elicited delusions include:
    • Ideas of reference.
    • Delusions of grandeur.
    • Delusions of jealousy.
    • Delusions of persecution.
    • Somatic delusions.
  • Loose associations: the thought process becomes illogical and confused.
  • Neologisms: made-up words that have a special meaning to the delusional person.
  • Concrete thinking: an overemphasis on small or specific details and an impaired ability to abstract.
  • Echolalia: pathologic repeating of another’s words.
  • Clang associations: the meaningless rhyming of a word in a forceful way.
  • Word salad: a mixture of words that is meaningless to the listener.

Alterations in Behavioral Responses

  • Bizarre behavioral patterns
    • Motor agitation and restlessness
    • Automatic obedience or robotlike movement
    • Autonomic obedience or robotlike movement
    • Negativism
    • Stereotyped behaviors
    • Stupor
    • Waxy flexibility (allowing another person to reposition extremities)
  • Agitated or impulsive behavior
  • Assess for negative symptoms of schizophrenia that reflect a deficiency of mental functioning
    • Alogia (lack of speech)
    • Anergia ( inability to react)
    • Anhedonia ( inability to experience pleasure)
    • Avolition (lack of motivation or initiation)
    • Poor social functioning
    • Poverty of speech
    • Social withdrawal
    • Thought blocking
  • Assess for associated symptoms of schizophrenia
    • Substance use, abuse, or dependence
    • Depression
    • Fantasy
    • Violent or aggressive behavior
    • Water intoxication
    • Withdrawal

Common nursing diagnosis found in Nursing Care Plans for Delusional Disorder

  • Disturbed Thought Processes related to perceptual and cognitive distortions, as demonstrated by suspiciousness, defensive behavior, and disruptions in thought
  • Social Isolation related to an inability to trust
  • Activity Intolerance related to adverse reactions to psychopharmacologic drugs
  • Ineffective Coping related to misinterpretation of environment and impaired communication ability
  • Risk for Self-directed or Other-directed Violence related to delusional thinking and hallucinatory experiences

Nursing Care Plans for Delusional Disorder

Nursing Care Plans For Delusional Disorder, delusional disorder diagnosis can be made when a person exhibits nonbizarre delusions of at least 1 month duration that cannot be attributed to other psychiatric disorders. Nonbizarre delusions must be about phenomena that, although not real, are within the realm of being possible. In general, the patient’s delusions are well systematized and have been logically developed. The person’s behavioral and emotional responses to the delusions appear to be appropriate. Usually the person’s functioning and personality are well preserved and show minimal deterioration if at all.

Nursing Assessment Nursing Care Plans for Delusional Disorder

Nursing Diagnosis for Delusional Disorder

Nursing Care Plans Delusional Disorder with nursing diagnosis; Disturbed Thought Processes, Social Isolation, Activity Intolerance, Ineffective Coping, Risk for Self-directed or Other-directed Violence.

NURSING DIAGNOSE

NURSING OUTCOME

INTERVENTION

EVALUATION

Disturbed Thought Processes related to perceptual and cognitive distortions, as demonstrated by suspiciousness, defensive behavior, and disruptions in thought Patient showed the Differentiation Between Delusions and Reality
  • Provide patient with honest and consistent feedback in a nonthreatening manner.
  • Avoid challenging the content of patient’s behaviors.
  • Focus interactions on patient’s behaviors.
  • Administer drugs as prescribed while monitoring and documenting patient’s response to the drug regimen.
  • Use simple and clear language when speaking with patient.
  • Explain all procedures, tests, and activities to patient before starting them, and provide written or video material for learning purposes.
Exhibits improved reality orientation, concentration, and attention span as demonstrated through speech and behavior
Social Isolation related to an inability to trust Patient showed the Promoting Socialization
  • Encourage patient to talk about feelings in the context of a trusting, supportive relationship.
  • Allow patient time to reveal delusions to you without engaging in a power struggle over the content or the reality of the delusions.
  • Use a supportive, empathic approach to focus on patient’s feelings about troubling events or conflicts.
  • Provide opportunities for socialization and encourage participation in group activities.
  • Be aware of patient’s personal space and use touch judiciously.
  • Help patient to identify behaviors that alienate significant others and family members.
Communicates with family and staff in a clear manner without evidence of loose, dissociated thinking
Activity Intolerance related to adverse reactions to psychopharmacologic drugs Patient showed the Improving Activity Tolerance
  • Assess patient’s response to prescribed antipsychotic drug.
  • Collaborate with patient and occupational and physical therapy specialists to assess patient’s ability to perform ADLs.
  • Collaborate with patient to establish a daily, achievable routine within physical limitations.
  • Teach strategies to manage adverse effects of antipsychotic drug that affect patient’s functional status, including:
    • Change positions slowly
    • Gradually increase physical activities
    • Limit overdoing it in hot, sunny weather
    • Use sun precautions
    • Use caution in activities if extrapyramidal symptoms develop.
Independently maintains personal hygiene without fatigue
Ineffective Coping related to misinterpretation of environment and impaired communication ability Patient showed the Improving Coping with Thoughts and Feelings
  • Encourage patient to express feelings.
  • Focus on patient’s feelings and behavior.
  • Provide honest perceptions of reality and feedback about symptoms and behaviors.
  • Encourage patient to explore adaptive behaviors that increase abilities and success in socializing and accomplishing ADLs.
  • Decrease environmental stimuli.
Attends group activities
Risk for Self-directed or Other-directed Violence related to delusional thinking and hallucinatory experiences Safety appears
  • Monitor patient for behaviors that indicate increased anxiety and agitation.
  • Collaborate with patient to identify anxious behaviors as well as the causes.
  • Tell patient that you will help with maintaining behavioral control.
  • Establish consistent limits on patient’s behaviors and clearly communicate these limits to patient, family members, and health care providers.
  • Secure all potential weapons and articles from patient’s room and the unit environment that could be used to inflict an injury.
  • To prepare for possible continued escalation, form a psychiatric emergency assist team and designate a leader to facilitate an effective and safe aggression-management process.
  • Determine the need for external control, including seclusion or restraints. Communicate the decision to patient and put plan into action.
  • Frequently monitor patient within the guidelines of facility’s policy on restrictive devices and assess the patient’s level of agitation.
  • When patient’s level of agitation begins to decrease and self-control is regained, establish a behavioral agreement that identifies specific behaviors that indicate self-control against a reescalation of agitation.
Remains free from harm or violent acts

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