Paranoia is also called a delusional disorder because of the considerable confusion of terminology in English-speaking psychiatry. Paranoia is often confused with the term ‘paranoid’, which essentially means a bunch of psychotic disorders, most often a layman’s description of sudden rage, suspicious attitude and irritable impulses. In another way, paranoia is a very exclusive psychological ailment characterized by a stable and persistent system where the personality of the diseased person is intact but the person clings to the delusional fantasies, in rare cases frantic impulses and hallucinations.
The illness is chronic, and often lifelong, but it doesn’t have the principal characteristics of schizophrenia. Let’s do some case studies of paranoia/delusional disorder, which typify features that a layperson associates with paranoia.
Case Study 1
A middle-aged man was arrested by the police for hijacking a radio station for several hours. He had threatened staff with a loaded pistol and forced them to transmit his message to the public. In the legal proceeding, he was found unfit to plead because of his mental disorder. So, he was put into a forensic psychiatric facility for long.
After four years, he moved to another city and befriended with a prostitute. He spent days with this woman, but suddenly he developed a conviction that that woman transmitted a deadly disease to him. So, he went for many medical check-ups and he was thoroughly tested. He was utterly dismayed when there was not a single disease found in his body. Nonetheless, he didn’t relieve his belief and by the time he understood what was going on, his delusional system elaborated beyond believe. He had started to believe that he was chosen as a global plot which involved Jewish people. He thought the plot is to infect the whole humankind and eventually total annihilation.
He stayed in a forensic unit and maintained his delusional belief and consistently refused treatment. There was a one-month period when he was legally required to take neuroleptic medication and temporarily, he appeared less concerned about his delusions and even admitted he felt better.
Overall Features of Delusional Disorder
In general terms, delusional disorder has certain characteristics such as:
- It is an exclusive or say primary disorder, if not any secondary disorder of a psychiatric condition.
- The disorder is fairly stable. It means the patient clings to his or her delusion with extraordinary tenacity.
- The illness is often chronic and long-lasting.
- The delusional theories are logically constructed and internally consistent.
- The delusion is often monomania, meaning a persistent theme.
- The delusion doesn’t interfere with general logical and reasoning ability.
Illness Associated with Delusions
Although paranoia can also be called a delusional disorder, the vast majority of illnesses associated with delusion is not essentially paranoia. That’s the point where the controversy emerges. Many modern authorities already labelled all forms of psychiatric illnesses with delusions, subcategorizing them in different other forms such as schizophrenia, mood disorders, bipolar syndrome and organic mental disorder.
While talking about delusional disorder or paranoia, there are certain principal illnesses with delusions that can be excluded are:
- Paranoid schizophrenia Other schizophrenias
- Organic mental disorder, including mental disorders due to a medical condition
- Psychoactive substance-induced organic mental disorders and withdrawal disorders
- Psychotic disorders not elsewhere classified
- Mood disorders with delusions
- Delusional misidentification syndromes
Delusional Disorder Subtypes
There are different subtypes, which are quite important to know when you are studying or dealing with delusional disorder.
- Somatic Type: In this case delusion happens when the person is convinced that one part or a bodily function is impaired.
- Erotomanic Type: This is quite a common one when the individual believes with a staunch tenacity that someone loves them, and this may result in stalking or other forms of unwanted activities.
- Jealous Type: There is a strong conviction with perfect logical assertion when the sufferer finds his or her lover or partner is unfaithful and often results in physical violence.
- Grandiose Type: This type involves delusions of unimaginable self-importance.
- Persecutory Type: The individual thinks that delusion happens the loved one is being is unfairly treated, spied on etc. and often results in embarrassingly legal actions.
- Mixed Type: This is the combination of more than one subtype without being prevalent than the other.
Exploring Treatment Options for Delusional Disorder or Paranoia
First thing is to understand whether the person really suffers from a delusion or it is just a passing mental agony. Paranoia is a serious disorder and often long-lasting, and thus it should be treated with seriousness. The primary method is behavioural therapy, often administered by professional psychiatrists.
Lack of insight into the condition and continuous denial, probably out of love for the patient might be catastrophic. A strong alliance between a good psychiatrist and the patient is a significant aspect of recovery.
Pharmaceutical intervention is another way to treat the patient. Nonetheless, it is not a long-term solution and often results in drug dependency.
The second generation of antipsychotics, popularly known in medical parlance as atypical antipsychotics, block D2 receptors as well as a specific subtype of serotonin receptor, the 5HT2A receptor. Our whole emotions and physical activities are controlled by CNS and motor neurons. The neurotransmitters that act as a part of nerve cells called receptors. When the antipsychotic drugs act on these receptors and block it, particularly in case of delusional disorder, subtype of serotonin receptor the 5HT2A and dopamine D2 receptor, it is believed that these drugs block both positive and negative symptoms.
The primary side-effect of the drugs is the dependency associated with drugs. Other side-effects include weight gain, diabetes, and lipid disorders. The problem with drugs is they do not cure the disease, just like diabetes but to control it. In the case of diabetes, it is primarily a physiological disease, but delusion is primarily a psychological disease that needs attention far beyond the physiological aspect of the human body.
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