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Chapter 28Delusional and
Shared Psychotic Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Delusional disorder is a type of serious mental
illness in which a person holds unshakeable
beliefs in something untrue. It is relatively
uncommon in clinical settings, with most
studies suggesting that the disorder accounts
for 1% to 2% of admissions to inpatient mental
health facilities.
Cleveland Clinic, 2009
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
After studying this chapter, you should be able to
•
Discuss five risk factors related to the development of
delusional disorders
•
Identify the clinical symptoms of delusional disorders
•
Differentiate the predominant theme of the following
subtypes of delusional disorders: persecutory, conjugal
(jealous), erotomanic, grandiose, and somatic
•
Compare and contrast delusional disorder and shared
psychotic disorder
•
Recognize the importance of identifying the specific
cultural and religious background of a client diagnosed
with a delusional disorder
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (cont.)
• Articulate the rationale for the use of atypical
antipsychotics and anticonvulsants in the treatment of
delusional and shared psychotic disorders
• Explain why individual psychotherapy is considered to
be more effective than other interactive therapies in the
treatment of delusional and shared psychotic disorders
• Formulate a list of nursing interventions for the following
nursing diagnosis related to delusional disorder:
disturbed thought processes related to inaccurate
interpretation of environmental stimuli, resulting in
feelings of suspicion and fear
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology of Delusional Disorders
Predisposing factors include the following:
• Relocation due to immigration or emigration
• Social isolation
• Sensory impairments such as deafness or blindness
• Severe stress
• Low socioeconomic status in which the person may
experience feelings of discrimination or
powerlessness
• Personality features such as low self-esteem or
unusual interpersonal sensitivity
• Trust–fear conflicts
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics
• Persecutory subtype
• Conjugal (jealous) subtype
• Erotomanic subtype
• Grandiose subtype
• Somatic subtype
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Etiology of Shared Psychotic Disorder
• Shared psychotic disorder, or folie à deux,
involves two individuals who have a close
relationship and share the same delusion.
• This occurrence is attributed to the strong
influence of the more dominant (primary case or
inducer) person over the submissive (secondary
case) individual.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Shared Disorder
• In shared psychotic disorder, delusions may be bizarre
or nonbizarre. The dominant individual (primary case
or inducer) usually has a chronic psychotic disorder
with prominent delusions that the submissive
individual (secondary case) begins to believe.
• The submissive individual is usually healthy but
frequently less intelligent, more gullible, more passive,
or more lacking in self-esteem than the dominant
individual.
Sadock & Sadock, 2008
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment
• History and physical examination
• Transcultural considerations
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
• Disturbed thought processes
• Disturbed sensory perception
• Social isolation
• Risk for self-directed violence
• Defensive coping
• Fear
• Impaired social interaction
• Noncompliance
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcome Identification
Stated outcomes focus on the client’s ability to do the
following:
• Identify situations that contribute to delusional thoughts
• Identify problems in relating with others
• Minimize delusional material
• Differentiate between fantasy and reality
• Utilize interventions to stabilize mood and behavior
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Planning Interventions
Interventions are planned to
• Alleviate symptoms to the degree that is essential for
continued employment and community living
• Stabilize the client’s social and occupational relationships
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementation
• Assistance in meeting basic needs
• Medication management
• Interactive therapies
• Client education
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation
Clients who respond to treatment are able to
• Make satisfactory social adjustments
• Comply with the administration of low-dosage
antipsychotic or neuroleptic drugs
• Continue with supportive individual psychotherapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms
• Conjugal paranoia
• Ideas of reference
• Content-specific delusions
(CSDs)
• Nonbizarre delusions
• Delusion
• Paranoid
• Paradoxical conduct
• Erotomanic delusion
• Folie à deux
• Persecutory delusions
• Somatic delusions
• Grandiose delusion
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
According to the chapter-opening quote, delusional
disorder is considered to be relatively uncommon.
• Given the numerous precipitating factors that are
believed to cause delusional disorders, explain why you
believe the frequency of occurrence is only 1% to 2%.
• What questions could you ask a client during the
assessment process to determine if the client is at risk
for the development of a delusional disorder? Explain
the rationale for your questions.
?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins