Behavioral Science
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92 Deja Review: <strong>Behavioral</strong> <strong>Science</strong><br />
What is a delusional disorder?<br />
What are some types of delusions<br />
that may occur in this disorder?<br />
What is a shared psychotic disorder?<br />
Patients with delusional disorder tend<br />
to have an isolated, fixed, nonbizarre<br />
delusion (eg, the Internal Revenue<br />
Service [IRS] is after them, or their partner<br />
is cheating). Even if the delusion is<br />
unfounded, it is plausible. They are not<br />
disorganized in thoughts or affect, and<br />
patients do not meet criteria for<br />
schizophrenia.<br />
1. Erotomanic: Someone is in love with<br />
patient.<br />
2. Somatic.<br />
3. Grandiose.<br />
4. Jealous: Wife/husband is cheating.<br />
5. Persecutory: Patient is being<br />
mistreated.<br />
A rare disorder where the patient<br />
believes the delusions of another person<br />
with a primary psychotic disorder.<br />
CLINICAL VIGNETTES<br />
A 27-year-old male presents to your clinic with a 4-year history of hallucinations<br />
and delusions for which he has been intermittently managed with antipsychotics.<br />
He is currently untreated. He also complains of 4 months of depressed mood,<br />
weight loss, insomnia, fatigue, and loss of interest in activities. He denies using<br />
any illicit substances or having any other medical conditions. What is the most<br />
likely diagnosis?<br />
Schizoaffective Disorder. Note that there have been psychotic symptoms without<br />
affective symptoms present, but now also meets criteria for a depressive episode.<br />
A 76-year-old man presents with 1 year of worsening depressive symptoms. He has<br />
trouble falling asleep, feels worthless, cannot concentrate, and has thoughts of<br />
death. Over 3 years ago his wife passed away from cancer. For 6 months now he<br />
has adamantly stated that the cancer was his fault and that he was the one that<br />
killed his wife, despite all evidence to the contrary. He also often hears her voice<br />
scolding him when no one is around. What is the most likely diagnosis?<br />
Depression with Psychotic Features. Note the mood-congruent delusion in the<br />
setting of depression and psychotic symptoms that only appear during affective<br />
episode. Also remember schizophrenia rarely presents in this advanced age.
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