Delusional Disorder
Delusional Disorder
A 24 year-old woman is brought to your office by her husband because her husband thinks she is delusional. Six weeks ago, one night they watched Tom Cruise’s movie Top Gun: Maverick. In one scene, Tom Cruise smiles at a coactor. The patient told her husband that Tom Cruise actually smiled at the patient. Since that night, the patient has been watching different movies featuring Tom Cruise. From Endless Love, made in 1981 to Mission:Impossible – Dead Reckoning, made in 2023, she watched every movie which featured Tom Cruise and she believes that ‘every time he smiled it was a ‘secret signal of love’ for me’. Her husband tried to convince her that many of those movies were made before 1999, the year she was born and none of his smiles are secret codes of love to the patient. However, the patient is not convinced. He reports ‘she is perfect’ in all other areas of life. She is not interested in contacting Tom Cruise in any way because the patient said, ‘I want to stay faithful to my husband’. She hears no voices other people don’t hear, she sees no objects other people don’t see, she is oriented to place, person and time, she denies any thought of hurting herself or others. She reports that she ‘sleeps like a baby’, no loss of appetite, no fatigue. She still enjoys things she always loved to do: her work as a school nurse, her hikes, and her swimming classes.
Which of the following is the most likely diagnosis in this patient?
A.Obsessive Compulsive Disorder
B.Schizoaffective Disorder
C.Delusional Disorder
D.Schizophrenia
E. Cocaine abuse
Correct Answer is C. This patient has delusional disorder, erotomanic type (de Clerambault syndrome) which is characterized by the delusion, which is, someone who is famous is in love with her. The diagnosis of delusional disorder depends on the presence of delusions for at least ≥1 month in the absence of meeting Criterion A for schizophrenia (at least two of the symptoms like delusions, hallucinations, disorganized speech, disorganized behavior and negative symptoms). Delusional disorder cannot be diagnosed in patients with a prior diagnosis of schizophrenia.Our patient has only delusions. Therefore, her correct diagnosis is Delusional Disorder. It typically develops in middle to late adult life. Six types of delusional disorder are described: 1.Erotomanic 2.Grandiose 3.Persecutory 4.Jealous 5.Somatic 6.Mixed
Incorrect Answers
A.Obsessive Compulsive Disorder: A delusional disorder may be easily confused with the obsessions of obsessive-compulsive disorder. However, in OCD the patient almost always has at least some insight into the exaggerated nature of the thoughts. Our patient has no reasonable analysis of her thinking. Her husband was unable to convince her about the true nature of her beliefs.
B.Schizoaffective Disorder: Schizoaffective disorder is a chronic psychotic disorder with prominent mood symptoms such as depression or mania or bipolar. Delusional thinking may happen in Schizoaffective disorder. Our patient has no other symptoms and signs of psychosis. She has no mood symptoms.
D.Schizophrenia is associated with more functional impairment, auditory hallucinations, and thought disorders. Except for Tom Cruise’s delusion, she is otherwise normal. Her husband’s testimony that ‘she is perfect’ in all other areas of life would not be possible if she were having schizophrenia or schizoaffective disorder.
E. Cocaine abuse can cause delusions. However, there is no history of suggestive of cocaine abuse in this patient.
Reference:
Current Diagnosis & Treatment: Psychiatry, 3e
Essentials of Modern Neuroscience
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To diagnose someone with Delusional Disorder, he or she should have one or more delusions for at least how long?
A.1 month
B.3 months
C.6 months
D.12 months
E.It does not matter
Correct Answer is A. To diagnose someone with Delusional Disorder, he or she should have one or more delusions for at least 1 month; they should never meet symptom criteria for schizophrenia and should not have functional impairment aside from the impact of the delusions.
