FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Psychoticlow yield

Delusional disorder

Overview

≥1 month of one or more fixed delusions WITHOUT prominent hallucinations, disorganisation or negative symptoms; functioning is otherwise relatively preserved.

Recognise

  • Single encapsulated delusional system (persecutory, jealous, erotomanic, somatic, grandiose)
  • Behaviour/affect normal outside the delusion
  • No prominent hallucinations or thought disorder

Red flags

  • Delusions driving harmful behaviour (e.g. morbid jealousy, persecution)

Differentials & how to tell them apart

Schizophreniaprominent hallucinations, negative symptoms, disorganisation, broader decline
Psychotic depressionmood-congruent delusions within a depressive episode
OCD with poor insightego-dystonic, resisted

Investigations

Clinical; exclude organic and mood/schizophrenia. Assess risk especially in jealous/persecutory types.

Management

  1. 1Specialist referral; build therapeutic alliance. Antipsychotic ± CBT.
  2. 2Risk management (e.g. morbid jealousy can be dangerous).
Antipsychotic — often less responsive than schizophrenia; engagement is difficult

Key points

Erotomania (de Clérambault), morbid jealousy (Othello), Cotard, Capgras are named variants.

Monitor & prognosis

Risk to others; treatment adherence.

Often chronic; partial response.

Source: ICD-11; StatPearls