Descriptive Psychopathology: The Signs and Symptoms of ...

282 Section 3: Examination domainsmood disorders (22.5%) and other psychiatric disorders (10%). 46 While rightsidedtemporal or parietal lobe lesions are the most common sites reported, lefttemporal lobe lesions are also associated with erotomania. 47Delusions of jealousy are associated with cognitive executive function difficulties.48 The frequency of these delusions in patients with schizophrenia and mooddisorder is less than 3% and 0.1%, respectively.Delusional disorder with grandiose delusionsThis combination of features was defined as monomania with exaltation. Generalparesis was the common cause in the nineteenth century, the delusion of beingNapoleon the stereotype. It remains an indicator of frontal lobe circuitry disease.Other features of frontal lobe dysfunction will be present if identifiable pathophysiologyis present (see Patient 11.2). Unlike the typical manic episode thatblossoms within a few days or weeks, delusional disorder with grandiose delusionsdevelops gradually with circumscribed ideas of self-importance, superioraccomplishments, bodily perfections, and the attention of others becoming morepronounced and then coalescing into a single delusional conclusion. Despite thegrandiose delusion, the sufferer initially continues his usual activities and maygo unnoticed by the casual observer. Theatrical speech or manner may occur.Hallucinations and illusions are experienced, but do not dominate the picture. 49Initial good humor, jocularity, and exaltation are characteristic, but as the illnessprogresses the sufferer becomes more intense in his actions, persistent in hisdemands and irritable if frustrated. These behaviors alert the authorities and mayforce hospitalization.Patient 11.2A man in his twenties became convinced that he was someone special. Heconcluded that his parents must have adopted him and that he was related to afamous family whose name sounded similar to his. He claimed that he ownedtheir large corporation. At first elated, he became irritable when the corporatemanagers refused to acknowledge him. He stalked the family and was arrested,and then hospitalized.Other than his delusional conviction and Witzelsucht he showed no psychopathology.Cognitive assessment suggested an executive function decline.Brain imaging identified normal pressure hydrocephalus, which was relievedby surgical shunting. The delusional syndrome resolved. The patient, however,was a periodic marijuana user and periods of heavy use were followed by areturn of his symptoms.