Differential diagnosis

The illness must be distinguished from the following.

• Mania, in which grandiosity is associated with euphoria, overactivity, and, at times, irritability and suspiciousness. As the mood is highly volatile, the grandiose symptoms are unstable.

• Schizophrenia in which there is marked incongruity between ecstatic affect and relative thought poverty.

• Organic brain disorders, especially affecting the prefrontal cerebral lobes, which cause labile mood, disinhibited behaviour, and some degree of cognitive deficit. Cerebral syphilis (general paralysis of the insane) used to be the best-known exemplar.

• Antisocial personality disorder in which the individual feels above the law and may express grandiose ideas and behaviours. In these cases one finds evidence of marked impulsivity, lack of remorsefulness, and a long-standing history of delinquency.

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