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Wednesday, 21 September 2011

Troubled Mind

Mental Health and Delusional Disorder

Delusional disorder, previously called paranoid disorder, is a type of serious mental illness called a "psychosis" in which a person cannot tell what is real from what is imagined. The main feature of this disorder is the presence of delusions, which are unshakable beliefs in something untrue. People with delusional disorder experience non-bizarre delusions, which involve situations that could occur in real life, such as being followed, poisoned, deceived, conspired against, or loved from a distance. These delusions usually involve the misinterpretation of perceptions or experiences. In reality, however, the situations are either not true at all or highly exaggerated.
Patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening effect.People with delusional disorder often can continue to socialize and function normally, apart from the subject of their delusion, and generally do not behave in an obviously odd or bizarre manner. This is unlike people with other psychotic disorders, who also might have delusions as a symptom of their disorder. In some cases, however, people with delusional disorder might become so preoccupied with their delusions that their lives are disrupted.
Although delusions might be a symptom of more common disorders, such as schizophrenia, delusional disorder itself is rather rare. Delusional disorder most often occurs in middle to late life and is slightly more common in women than in men.





The types of delusional disorder include:
  • Erotomanic: Someone with this type of delusional disorder believes that another person, often someone important or famous, is in love with him or her. The person might attempt to contact the object of the delusion, and stalking behavior is not uncommon.
  • Grandiose: A person with this type of delusional disorder has an over-inflated sense of worth, power, knowledge, or identity. The person might believe he or she has a great talent or has made an important discovery.
  • Jealous: A person with this type of delusional disorder believes that his or her spouse or sexual partner is unfaithful.
  • Persecutory: People with this type of delusional disorder believe that they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them. It is not uncommon for people with this type of delusional disorder to make repeated complaints to legal authorities.
  • Somatic: A person with this type of delusional disorder believes that he or she has a physical defect or medical problem.
  • Mixed: People with this type of delusional disorder have two or more of the types of delusions listed above.


What Are the Symptoms of Delusional Disorder?

The presence of non-bizarre delusions is the most obvious symptom of this disorder. Other symptoms that mighty appear include:
  • An irritable, angry, or low mood
  • Hallucinations (seeing, hearing, or feeling things that are not really there) that are related to the delusion (For example, a person who believes he or she has an odor problem may smell a bad odor.)
Clarifying: A person may be irrational in episodes without being insane, if it is "not" continuous or too persistent. One may even seem disconnected from reality for a period of time (and recover after months) without permanent psychosis or incompetence.




Indicators of a delusion

The following can indicate a delusion:
  1. The patient expresses an idea or belief with unusual persistence or force.
  2. That idea appears to exert an undue influence on the patient's life, and the way of life is often altered to an inexplicable extent.
  3. Despite his/her profound conviction, there is often a quality of secretiveness or suspicion when the patient is questioned about it.
  4. The individual tends to be humorless and oversensitive, especially about the belief.
  5. There is a quality of centrality: no matter how unlikely it is that these strange things are happening to him, the patient accepts them relatively unquestioningly.
  6. An attempt to contradict the belief is likely to arouse an inappropriately strong emotional reaction, often with irritability and hostility.
  7. The belief is, at the least, unlikely, and out of keeping with the patient's social, cultural and religious background.
  8. The patient is emotionally over-invested in the idea and it overwhelms other elements of their psyche.
  9. The delusion, if acted out, often leads to behaviors which are abnormal and/or out of character, although perhaps understandable in the light of the delusional beliefs.
  10. Individuals who know the patient observe that the belief and behavior are uncharacteristic and alien.

 Features

The following features are found:
  1. It is a primary disorder.
  2. It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity.
  3. The illness is chronic and frequently lifelong.
  4. The delusions are logically constructed and internally consistent.
  5. The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs.
  6. The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.

Causes

When delusional disorders occur late in life they suggest a hereditary predisposition. Researchers also suggest that these disorders are the result of early childhood experiences with an authoritarian family structure. According to other researchers, any person with a sensitive personality is particularly vulnerable to developing a delusional disorder.
Although its exact cause is unknown, it is believed that genetic, biochemical and environmental factors play a significant role in the development of delusional disorder.


Drug to use

Atypical antipsychotic


Skeletal formula of clozapine, the first atypical antipsychotic
The atypical antipsychotics (AAP) (also known as second generation antipsychotics) are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia. Some carry FDA approved indications for acute mania, bipolar depression, psychotic agitation, bipolar maintenance, and other indications. Both generations of medication tend to block receptors in the brain's dopamine pathways, but atypicals differ from typical antipsychotics in that they are less likely to cause extrapyramidal motor control disabilities in patients, which include unsteady Parkinson's disease-type movements, body rigidity and involuntary tremors.These abnormal body movements can become permanent even after medication is stopped.
During the course of treatment atypical antipsychotics are associated with the following benefits; higher rate of responders, efficiency in patients with refractory disease, lower risk of suicides, better functional capacity and an improved quality of life. However, there has been considerable debate about whether second-generation antipsychotic drugs are better than first-generation antipsychotic drugs. Although atypical antipsychotics are thought to be safer than typical antipsychotics, they still have severe side effects, including tardive dyskinesia, a serious movement disorder, neuroleptic malignant syndrome, and increased risk of stroke, sudden cardiac death, blood clots, and diabetes. Significant weight gain may also occur.



List of atypical antipsychotics

The following are approved and marketed in various parts of the world:




    Amisulpride (Solian)
    Aripiprazole (Abilify)
    Asenapine (Saphris)
    Blonanserin (Lonasen)
    Clotiapine (Entumine)
    Clozapine (Clozaril)
    Iloperidone (Fanapt)
    Lurasidone (Latuda)
    Mosapramine (Cremin)
    Olanzapine (Zyprexa)
    Paliperidone (Invega)
    Perospirone (Lullan)
    Quetiapine (Seroquel)
    Remoxipride (Roxiam)
    Risperidone (Risperdal)
    Sertindole (Serdolect)
    Sulpiride (Sulpirid, Eglonyl)
    Ziprasidone (Geodon, Zeldox)
    Zotepine (Nipolept)


Delusional Disorder

Delusional, Personal Stories
In March 2009 I was diagnosed with Delusional Disorder- a relatively new classification subsumed under the general classification of Paranoid Schizophrenia until the advent of DSMIII-r in 1987.
I am afflicted by delusions and hallucinations. I believe that some kind of a device or power opens up my thoughts to the public so that everyone can know what I’m thinking or feeling. This is particularly problematic in crowds, when everyone is staring at me and whispering about me. Frustratingly, while the crowd all know what I’m thinking, I have no idea what they are thinking or saying.
I hear strange voices, especially in crowds, directing derogatory expletives at me.
I am also bothered by the appearance of shadowy bugs crawling all over my walls. But when I jump after them to squash them they are always gone, or they were never there to begin with.
Bizarre and obnoxious odors plague me often. One smell I can best describe as the stench of an old man’s dirty dentures. Another is like burning rat excrement. Another is a sweet chemical smell.
Some times there is a very frightening sound in my house. When my family is not home I hear what sounds like soldiers marching in the upper story. When I go up to investigate I can never find them.
All of this came upon me gradually from early adulthood. It all escaped diagnosis until I was 52 years old. I had always just thought I was different and strange. I have never liked crowds. I have never had close friends. I crave silence and isolation. I pretty much stay in my home and listen to music, which masks and covers the voices and sounds. I am on Risperidone. citalopram, and bupropion. These medications have helped significantly, but not cured the problem.


Most common Risperdal Side Effects:
      • Abdominal pain
      • Vomiting
      • Constipation
      • Diarrhea
      • Dry mouth
      • Sore throat
      • Abnormal walk
      • Agitation
      • Aggression
      • Anxiety
      • Chest pain
      • Coughing
      • Involuntary movements
      • Nasal inflammation
      • Decreased activity
      • Decreased sexual desires
      • Lack of coordination
      • Impotence
      • Dizziness
      • Dry skin
      • Difficulty urinating
      • Heavy menstruation
      • Tremor
      • Weight gain
      • Lethargic feelings
      • Join pain
      • Difficulty ejaculating
      • Tremor
      • Respiratory infection 
Choose to be pain in your body or pain in your head. Sacrifices....The choice is your. Blue Pill or Red Pill?      








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