General aspects of the treatment of delusions

We usually aim to treat the illness of which the delusion is a part, but there is good evidence that delusions themselves, as well as hallucinations, can be considerably modified by a psychological approach. In severe psychotic illnesses the institution of psychological treatment usually has to await the initial controlling of symptoms with medications or, on occasion, electroconvulsive therapy. Thereafter, a cognitive-behavioural approach or, to a much lesser extent, conventional psychotherapy can help the individual to reduce preoccupation with false beliefs, become less isolated from society, and reorientate towards reality. (1. 103) However, there is no good evidence that psychological methods by themselves can completely eliminate delusions.

Since many illnesses are associated with delusions we have to tailor the psychopharmacological approach to suit each particular condition. In delusional disorder, the schizophrenias, and schizoaffective disorder, neuroleptics are the mainstay, with antidepressants, mood stabilizers, and electroconvulsive therapy sometimes playing subsidiary roles.

The rate of symptom response to treatment in a psychotic disorder is not uniform.(102) For example, hallucinations often resolve quite quickly, but delusions tend to be much more persistent. Despite vigorous treatment they can last for many months and, in some patients, never fully remit. If the patient continues to be deluded, non-compliance with treatment is likely to be present, especially in delusional disorder where the individual is often expert at concealing his or her lack of co-operation.

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