NCP Delusional Disorder

DSM-IV

297.1 Delusional disorder

Specific type:

Erotomanic (delusions that another person of higher status is in love with the individual)

Grandiose (delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person)

Jealous (delusions that one’s sexual partner is unfaithful)

Persecutory (delusions that one, or someone to whom one is close, is being malevolently treated in some way)

Somatic (delusions that one has some physical defect or general medical condition)

Mixed (delusions characteristic of more than one of the above types, but no one theme predominates)

ETIOLOGICAL THEORIES

Psychodynamics

Emotional development is delayed because of a lack of maternal stimulation/attention. The infant is deprived of a sense of security and fails to establish basic trust. A fragile ego results in severely impaired self-esteem, a sense of loss of control, fear, and severe anxiety. A suspicious attitude toward others is manifested and may continue throughout life. Projection is the most common mechanism used as a defense against feelings.

Biological

A relatively strong familial pattern of involvement appears to be associated with these disorders. Individuals whose family members manifest symptoms of these disorders are at greater risk for development than the general population. Twin studies have also suggested genetic involvement.

Family Dynamics

Some theorists believe that paranoid persons had parents who were distant, rigid, demanding, and perfectionistic, engendering rage, a sense of exaggerated self-importance, and mistrust in the individual. The clients become vulnerable as adults because of this early experience.

CLIENT ASSESSMENT DATA BASE

Refer to CP: Schizophrenia for physical symptoms.

Ego Integrity

May present with severe anxiety; inability to relax, exaggeration of difficulties, being easily agitated

Expresses feelings of inadequacy, worthlessness, lack of acceptance, and trust of others

Demonstrates difficulty in coping with stress, uses maladjusted coping mechanisms (e.g., excessive use of projection and aggressive behavior, takes unnecessary precautions, avoids accepting blame)

Neurosensory

Nonbizarre delusional system of at least 1 month’s duration

Experiencing emotions and behavior congruent with the content of belief system/fears that either self or significant others are in danger, are being followed/conspired against, poisoned, infected; have a disease; are being deceived by one’s spouse, cheated by others; are loving/being loved from a distance.

Exhibits controlled, cold, unemotional affect; guarded/evasive/distrustful behavior

Vigilant, looks for hidden motives; every person/event is under suspicion

Displays keen perception; will demonstrate impaired judgment about the perception

Delusions of reference or control that may incorporate the FBI, CIA, radio/TV

(Prominent auditory or visual hallucinations not usually present)

Safety

May display assaultive/violent behavior

Social Interactions

Significant impairment in social/marital functioning possibly noted; behavior in all other areas of life usually normal

Litigiousness common

Teaching/Learning

Onset most often in middle or late adult life

May have history of substance abuse/physical illness

DIAGNOSTIC STUDIES

Refer to CP: Schizophrenia.

NURSING PRIORITIES

1. Promote safe environment, safety of client/others.

2. Provide open, honest atmosphere in which client can begin to trust self/others.

3. Encourage client/family to focus on defining methods for coping with anxieties and life stressors.

4. Promote a sense of self-worth and increased self-esteem.

discharge goals

1. Copes with anxiety without the use of threats or assaultive behavior.

2. Recognizes reality; agrees to give up or live with the delusional system.

3. Client/family/SOs participate in therapy (e.g., behavioral, group).

4. Family/SO(s) provide emotional support for the client.

5. Plan in place to meet needs after discharge.