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Questions and Answers
The prognosis for delusional disorder is considered to be good in most cases.
The prognosis for delusional disorder is considered to be good in most cases.
False (B)
Selective serotonin reuptake inhibitors (SSRIs) are suggested as the first-line treatment for body dysmorphic disorder with delusional features.
Selective serotonin reuptake inhibitors (SSRIs) are suggested as the first-line treatment for body dysmorphic disorder with delusional features.
True (A)
Delusions can reoccur rapidly when medication is discontinued.
Delusions can reoccur rapidly when medication is discontinued.
True (A)
Improvement in symptoms of delusional disorder can be noticed within several weeks of treatment.
Improvement in symptoms of delusional disorder can be noticed within several weeks of treatment.
Interpretative psychotherapy is a recommended treatment for patients with paranoid symptoms.
Interpretative psychotherapy is a recommended treatment for patients with paranoid symptoms.
Regular monitoring of suicide risk is deemed unnecessary during the treatment of delusional disorders.
Regular monitoring of suicide risk is deemed unnecessary during the treatment of delusional disorders.
Compliance with medication leads to recovery in approximately 50% of patients with delusional disorder.
Compliance with medication leads to recovery in approximately 50% of patients with delusional disorder.
Cognitive therapy may have a role in treating delusions in delusional disorder if a good therapeutic rapport exists.
Cognitive therapy may have a role in treating delusions in delusional disorder if a good therapeutic rapport exists.
Recognizing paranoid symptoms is always straightforward and requires little skill.
Recognizing paranoid symptoms is always straightforward and requires little skill.
Patients with delusional disorder typically see their beliefs as unjustified and therefore seek treatment.
Patients with delusional disorder typically see their beliefs as unjustified and therefore seek treatment.
The assessment of violent risk requires consideration of the patient's personality and history of violent behavior.
The assessment of violent risk requires consideration of the patient's personality and history of violent behavior.
The psychiatrist should actively collude in the patient's delusions to build trust.
The psychiatrist should actively collude in the patient's delusions to build trust.
Pimozide is considered the antipsychotic of choice for treating monosymptomatic hypochondriacal psychosis.
Pimozide is considered the antipsychotic of choice for treating monosymptomatic hypochondriacal psychosis.
When a delusion is disclosed, it is immediately clear whether it is a delusion or an overvalued idea.
When a delusion is disclosed, it is immediately clear whether it is a delusion or an overvalued idea.
Compulsory admission for treatment can be justified even if the patient refuses voluntary admission.
Compulsory admission for treatment can be justified even if the patient refuses voluntary admission.
The assessment of dangerousness is unrelated to the methods used in assessing suicide risk.
The assessment of dangerousness is unrelated to the methods used in assessing suicide risk.
Patients with paranoid symptoms frequently regard their treatment as a necessary intervention.
Patients with paranoid symptoms frequently regard their treatment as a necessary intervention.
Antipsychotic drugs are not typically used to treat paranoid symptoms in delusional disorder and other psychoses.
Antipsychotic drugs are not typically used to treat paranoid symptoms in delusional disorder and other psychoses.
Study Notes
Prognosis of Delusional Disorder
- Long-term outcomes of delusional disorder remain largely undetermined.
- Clinical impression indicates a generally poor prognosis; Munro (2009) reports 50% recovery in compliant patients and 30% with significant improvement.
- Compared to schizophrenia, long-term functioning tends to be better in delusional disorder.
- Medication may be reduced or stopped in some cases without negative effects, but most patients likely experience relapse upon discontinuation.
- Continuous treatment and regular monitoring are essential, along with patient discussions on risks and benefits of long-term treatment.
Psychological Treatment
- Patients with paranoid symptoms require comprehensive support, encouragement, and reassurance.
- Non-specific psychological treatment forms a vital part of management for gaining patient trust.
- Antipsychotic drugs are the primary treatment, while cognitive therapy can be beneficial if a good therapeutic rapport exists.
- Interpretative and group psychotherapy are inappropriate due to risk of misinterpretation by the patient.
Improvement
- Notable improvements can occur within days, including decreased preoccupation with delusions and reduced agitation.
- Establishing a strong therapeutic relationship is crucial for enhancing treatment collaboration.
- Selective serotonin reuptake inhibitors (SSRIs) may be more effective than antipsychotics for body dysmorphic disorder-associated delusions, with augmentation of antipsychotics for non-responders.
- Role of antidepressants in delusional disorders is unclear, though they are commonly used to address comorbid depressive symptoms.
- Regular monitoring of suicide risk is essential during treatment.
Assessment of Paranoid Symptoms
- Paranoid symptom assessment consists of recognizing signs and diagnosing underlying conditions.
- Interviews can be challenging due to suspicion, defensiveness, or avoidance of discussing delusions.
- Psychiatrists must maintain a detached, compassionate, and non-judgmental demeanor to encourage openness from the patient.
- Distinguishing between delusions and overvalued ideas is critical for accurate diagnosis.
- Assessing risk of harm towards others requires a thorough evaluation of the patient's history and signals of potential violence.
Treatment of Paranoid Symptoms and Delusional Disorder
General Principles
- Management is complicated; patients often defend their delusions and resist treatment.
- Tact and skill are needed to encourage symptom discussion and treatment acceptance.
- Addressing non-specific symptoms like anxiety or insomnia can aid in treatment acceptance.
- Inpatient care may be necessary if there is significant risk of violence or suicide; voluntary admission may be refused, requiring possible compulsory measures.
Drug Treatment
- Paranoid symptoms are treated with antipsychotic drugs, akin to treatment for other psychoses, though evidence from trials is limited.
- Pimozide is noted as the preferred antipsychotic for certain types of delusional disorder such as hypochondriacal psychosis and pathological jealousy.
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Description
This quiz evaluates your knowledge on the prognosis and psychological treatment of delusional disorder. It covers recovery rates, the effectiveness of antipsychotic medications, and the importance of psychological support for patients. Engage with key concepts to enhance your understanding of this complex mental health condition.
