Delusional Disorder - Treatment

Treatment

Treatment of delusional disorders includes a combination of drug therapy and psychotherapy although it is a challenging disorder to treat for many reasons such as the patient's denial that they have a problem of a psychological nature.

Atypical antipsychotic medications (also known as novel or newer-generation) are used in the treatment of delusional disorder as well as in schizophrenic disorders. Some examples of such medications are risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa). These medications work by blocking postsynaptic dopamine receptors and reduce the incidence of psychotic symptoms including hallucinations and delusions. They also relieve anxiety and agitation. When these drugs are tried but the symptoms do not improve, other types of antipsychotics may be prescribed. Some examples are: fluphenazine decanoate and fluphenazine enanthate. One very effective drug in delusional disorders is also pimozide.

In some cases agitation may occur as a response to severe or harsh confrontation when dealing with the existence of the delusions. If agitation occurs, different antipsychotics can be administered to conclude its outbreak. For instance, an injection of haloperidol (Haldol) can decrease anxiety and slow behavior, it is often combined with medications including lorazepam (Ativan).

Among new drugs, asenapine (Saphris) is very effective against delusions, since loxapine (Adasuve) is widely used in France for the treatment of psychosis-associated behavior disturbances, such as agitation and aggression. French psychiatrists classify loxapine as a sedative antipsychotic.

In cases when severely ill patients do not respond to standard treatment, Clozapine may be prescribed although it may cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, seizures and agranulocytosis.

To treat long term symptoms, an oral novel antipsychotic is often prescribed on a daily basis. Antidepressants and anxiolytics are also prescribed to control associated symptoms.

Psychotherapy for patients with delusional disorder include cognitive therapy which is conducted with the use of empathy. During the process, the therapist asks hypothetical questions in a form of therapeutic Socratic dialogue. This therapy has been mostly studied in patients with the persecutory type. The combination of pharmacotherapy with cognitive therapy integrates treating the possible underlying biological problems and decreasing the symptoms with psychotherapy as well. Psychotherapy has been said to be the most useful form of treatment because of the trust formed in a patient and therapist relationship. The therapist is there for support and must not show any signs that implicate that the patient is mentally ill.

Supportive therapy has also shown to be helpful. Its goal is to facilitate treatment adherence and provide education about the illness and its treatment.

Furthermore, providing social skills training has been applicable to a high number of persons. It should focus on promoting interpersonal competence as well as confidence and comfort when interacting with those individuals perceived as a threat.

Reports have shown successful use of insight-oriented therapy although it may also be contraindicated for delusional disorder. Its goals are to develop therapeutic alliance, containment of projected feelings of hatred, impotence, and badness; measured interpretation as well as the development of a sense of creative doubt in the internal perception of the world. The latter requires the empathy with the patient's defensive position.