Treatment of delusional disorder

The treatment approaches to the delusional misidentification syndromes, paraphrenia, and folie a deux have been dealt with in their respective sections, but for several reasons the treatment of delusional disorder has been touched on only briefly until now. Firstly, it is necessary for the reader to have a grasp of the disorder's features and to know something of its status within a group of illnesses with delusions. Secondly, there are special aspects to the treatment of delusional disorder which need emphasis, especially since many clinicians are unfamiliar with them.

During the many years when paranoia was all but forgotten many psychiatric illnesses previously regarded as hopeless became readily treatable. When paranoia was again recognized—as delusional disorder—by DSM-IIIR in 198Z it seemed that the therapeutic hopelessness of an earlier era was also revived. Even now most texts state that treatment response is poor and are vague about the specifics of medication approaches. In fact, by far the greatest problem is not treatment responsiveness, but persuading the patient to accept that he needs psychiatric help because his delusions militate against this.

It must be stated categorically that, given careful diagnosis and an approach that encourages the patient to co-operate, delusional disorder is a highly treatable illness.

Unfortunately most of the literature supporting that statement is anecdotal but it shows good consensus on the remediability of the disorder. Virtually all the reports of success refer to psychopharmacological, specifically neuroleptic, treatment.

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