Delusional idea (delirium)


Information about delirium

What is delirium?

Delirium is one of the main symptoms of acute psychotic disorder. It can be described more accurately as a rambling chatter. Firstly, it seems like psychosis and it is mainly linked to indistinct speech. According to Modern Greek psychiatry, the term “delirium” is used to denote the absurdity, the illusion and the imagination of a person who is unable to understand the reality.

It is a false belief that a person has despite clear and obvious evidence that it isn’t true. Such beliefs are usually referred to the idea of being threatened or unjustly condemned, which are signs of persecutory delusion. Or the idea that an external force like television or newspaper are trying to influence their emotions and thoughts, which is an example of delusions of control.

Other people think they possess superior qualities, or believe they are famous historical figures, which are symptoms of delusions of grandeur. There are also people with somatic delusions who falsely believe their body is somehow abnormal or diseased. All these obsessions may be organized or not, complex, realistic or completely improbable and unrealistic.

Deliriums derive from an insecurity of the ego and make the affected person feel threatened. Unlike obsessive compulsive disorders, a person with a delusion perceives the environment in a way quite active, usually threatening, critical or derogatory. In milder cases or before the symptoms develop into persecution delusion, the affected person may believe that he or she is the center of attention of some people who criticize and mock them, despite the fact they are planning something evil against them.

Causes of delirium

Delirium is a psychosocial disorder and often appears due to a history of emotional or physical abuse, an extremely strict or perfectionist upbringing and a lack of basic trust. Consequently, the delusional person believes that the environment is constantly hostile and potentially dangerous.

Symptoms of delirium

Disorders of thought content reflect the patient’s beliefs, ideas and interpretations of stimuli. Here belong the delusional ideas, the delusions of passivity or influence as well as the delusions of reference. The content of delusional ideas is variable and may involve delusion of reference, delusion of persecution, delusion of grandeur, religious delusion, hypochondriacal delusion, erotomania, delusional jealousy etc. However, persecution and reference delusions are the most common delusional themes.

Delusions are unstructured, paranoid and unrealistic and they are characterized by illogical thinking. Moreover, they are emotionally charged. The term “loss of ego boundaries” describes the absence of the body, the mind and the influence of these people, compared to other living organisms and inanimate objects of the environment. For example, many patients have ideas of reference when they watch TV and believe that someone in the TV station is talking to them.

Diagnosis of delirium

This disorder is characterized by delusions of various types – persecution, jealousy, erotomania, somatic, greatness etc. Consequently, the term “delusional disorder” is preferred to the term “paranoia”, as it was previously called and used to refer only to persecutory and grandiose paranoid delusions. According to DSM-IV (Manos 1997), the diagnostic criteria for delusional disorder are:

  •    Non-bizarre delusions (refer to real-life situations and include feelings of being followed, poisoned, infected, deceived or conspired against, or loved at a distance), of at least 1 month’s duration.
  •    If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
  •    The disturbance is not attributable to the physiological effects of a substance or another medical condition. (e.g. a drug of abuse, a medication)

The delusion may manifest itself as any of the following types:

Erotomanic Type, Grandiose Type, Jealous Type, Persecutory Type, Somatic Type, Mixed Type, Unspecified Type.

Delusional disorder most often occurs in middle to late adult life. The development of delusional disorders varies. It may be a chronic fluctuating disorder, an isolated episode without relapse or an acute episode.

How is delirium treated?

Antipsychotic medications are used to treat delirium when combined with supportive therapy. Moreover, the patient’s hospitalisation is necessary in order to prevent acts of violence. Psychotherapy is based on the trustful relationship between the therapist and the patient. The therapist must tell the truth to the patient and be on time for their medical appointment.

First of all, it is important not to directly challenge the delusions and instead to try -through the psychotherapeutic relationship- to explain to the patient that these ideas prevent him/her from living productively, to inform him/her about the risk factors that increase chances of paranoia as well as about the meaning of delusions. Psychotherapy and antidepressant or antipsychotic medication may treat anxiety, ease discomfort and depression and reduce the intensity of delusions.

What specialty

The doctors to treat delirium are the Psychologist and the Psychiatrist

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