Delusional disorders and acute & transient psychosis are types of non-organic psychosis. Delusional disorders involve long-standing non-bizarre delusions for at least 3 months in disorders like somatic, persecutory, grandiose, jealous, and erotomanic types. Acute & transient psychotic disorders have an abrupt onset of symptoms within 2 weeks, and include disorders with polymorphic symptoms, schizophrenia-like symptoms, or predominantly delusional features. Both conditions are treated primarily with antipsychotics and psychotherapy, with good prognosis in many cases of acute & transient psychosis but a chronic course in some delusional disorders.

1. 1
DELUSIONAL DISORDERS
&
ACUTE & TRANSIENT
PSYCHOSIS

2. INDEX
• Definition of psychosis
• Types
• Delusional disorders
• Epidemiology
• Aetiology
• Associated medical conditions
• Clinical types
• Clinical Features
• Differential diagnosis
• Course and prognosis
• Management
• Acute & Transient psychotic disorders
• Types
• Differential diagnosis
• Prognosis
• Treatment
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3. DEFINITION
Psychosis –
• Gross impairment in reality testing(‘not in contact’
with reality)
• Marked disturbance in personality, with impairment
in social, interpersonal, occupational functioning.
• Marked impairment in judgement & absent
understanding of current symptoms & behaviour(loss
of insight)
• Presence of characteristic symptoms like delusions &
hallucinations.
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4. TYPES OF NON-ORGANIC PSYCHOSIS
• Delusional disorders
• Acute & Transient psychotic disorders
• Schizoaffective disorders
• Postpartum psychosis
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5. 5
DELUSIONAL DISORDERS

6. DELUSIONAL DISORDERS
• A group of disorders where long standing,
non-bizarre delusions are the primary or only
manifestation of the illness.
• Included in ICD-10
• Must be persistent for atleast 3 months.
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7. EPIDEMIOLOGY
• Prevalence rate- 0.24%-0.3%
• Late middle age (42-15 years)
• Female:Male – 3:1
• More common among relatives of
Schizophrenia
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8. AETIOLOGY/RISK FACTORS
• Social isolation
• Migration
• Sensory impairment(deafness>blindness)
• Celibacy
• Widowhood
Very common among substance
abusers(cocaine).
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9. ASSOCIATED MEDICAL CONDITIONS
• Multiple sclerosis
• Vitamin deficiency(B12 & nicotinic acid)
• Hepatitis
• Hypothyroidism
• Diabetes mellitus
• Dementia
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10. CLINICAL TYPES
• Somatic type
• Persecutory type
• Grandiose type
• Jealous type
• Erotomanic type
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11. SOMATIC TYPE
• Also called Monosymptomatic hypochondriacal
psychosis.
• Delusions related to body.
Eg. – patient might feel that foul smell emanates
from them.
That some of their body parts are mishapen(eg.
nose) or non-functioning(eg. intestine).
That lice or other parasites have infested their body.
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13. PERSECUTORY TYPE
• Most common type
• Patient believes that he is
conspired against & harassed
or bodily injured, spied or followed
or poisoned by others.
• Resentful, may resort to legal
methods in order to be redressed.
OR
• May resort to violence against
his alleged persecutors.
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14. GRANDIOSE TYPE
• Exalted ideas about oneself, of birth,
possessions & achievements.
• In a religious context may believe that they
are the chosen prophets of GOD & have
mysterious powers to head the masses.
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15. JEALOUS TYPE
• More common in males.
• Also called-Sexual jealousy, erotic jealousy, morbid
jealousy, psychiatric jealousy, Othello syndrome.
• Allegations of infidelity are made against the spouse
supported by evidence collected in the form of changes
& manner of dress, behaviour or remarks made by the
partner.
• The inferences drawn are wrong & not factual.
• Held firmly on inadeguate grounds & are unchanged
even in the face of evidence that they are false.
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16. Cont..
• Other secondary delusions may be present like he
is drugged or poisoned to be put to sleep or to
lose virility.
• Mood- sadness, misery, apprehension, rage.
• Patient resorts to spying or coercing confession
from the partner often through violence that they
are true.
• Elaborate steps are taken to catch the paramour
‘red handed’ & private detectives may be
engaged to watch the movements of his spouse.
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17. Cont..
• He promises ‘to forget the whole thing & forgive
them’&’not to persue the matter anymore’ once
she confesses.
• The unsuspecting wife is a bid to put an end to
further turmoil ‘confesses’ which aggravates her
partner’s suspicion who attempts to coerce her
more with greater fervor.
• Very resistent to treatment
• Continues till divorce or separation or death of
spouse.
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18. Cont..
• Assaults often continued even after
separation as he pleads his wife to come back
and live together again.
• Potentially dangerous & may lead to suicide or
homicide.
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Delusion of infidelity

19. EROTOMANIC TYPE
• More prevalent in females.
• Also known as- Clerambault’s Syndrome
• Patient believes that another person, usually of a
higher status or endowed with greater qualities, is
loving her.
• Persue their objects of delusion physically or through
letters & presents.
• Very often the affected woman is not attractive, hails
from a poor socio-economic strata & works at a lower
level job.
• If males affected- may be violent or aggressive with the
objects of love.
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20. CLINICAL FEATURES
Presence of delusion- single or a set of related
delusions for atleast 3 months-
• Well systematised
• Non-bizarre
• Involve situations which can occur in normal
life
• ‘Encapsulated’ – they do not affect the other
life spheres of the patient.
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21. Cont..
• Hallucinations are absent.If present, are
transient & rudimentary & are auditory, tactile
or olfactory.
• Only when the area of delusion is probed or
confronted , the dysfunction becomes evident.
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22. DIFFERENTIAL DIAGNOSIS
• Paranoid schizophrenia
• Paranoid personality disorder
• Substance induced delusion
• Mood disorders
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23. Features Paranoid
schizophrenia
Delusional
disorder
Paranoid
personality
disorder
General
behaviour
Eccentricities,
mannerisms,
stereotypies,
decreased self care,
social withdrawal,
guarded & evasive.
Eccentricities,
decreased social
interaction.
Restrained social
interaction.
Personality Disorganised Disturbed in
delusional areas,
normal in other
areas.
No deterioration.
Thought disorder Delusions, loosening
of association, formal
thought disorder,
delusions may be
bizarre.
Non- bizarre
delusions, are well
systematized. No
other thought
disorder.
No thought
disorder.
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24. Hallucinations Auditory common Uncommon. If
present, not
persistent.
absent
Contact with reality Markedly disturbed Disturbed in areas
of delusional
beliefs.
Intact
Insight absent absent present
Affect/ mood in
relation to thought
Often
inappropriate
Usually
inappropriate
Usually
inappropriate
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25. COURSE & PROGNOSIS
• About half the cases have a chronic &
unremitting course
• In some, the symptoms occur periodically &
intervals between the episodes are totally
asymptomatic.
• Suicide is often associated.
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26. MANAGEMENT
• Hospitalisation if severe impairment or
suicidal/homicidal threats/ patient non-
cooperative for treatment.
• Antipsychotic + Antidepressant.
• Antipsychotics control agitation & treat the
psychotic features.
• Drug of choice- Pimozide
• 68% full remission, 22% partial remission.
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27. Cont..
• Antidepressants of SSRI group such as
fluoxetine preferred.
• Many may be refractory to treatment.
• Electro convulsive treatment may be needed
for secondary repression.
• Psychotherapy
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28. ACUTE & TRANSIENT PSYCHOTIC
DISORDERS
• These are psychotic disorders characterized by
an abrupt (<48 hours) or an acute(</= 2weeks)
onset of symptoms.
• Precipitated by visible stress like bereavement
but can occur even if no evident stress.
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29. TYPES
• Acute polymorphic psychotic disorder without
symptoms of schizophrenia.
• Acute polymorphic psychotic disorder with
symptoms of schizophrenia.
• Acute schizophrenia- like psychotic disorder.
• Other acute predominantly delusional
psychotic disorders.
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30. ACUTE POLYMORPHIC PSYCHOTIC
DISORDER WITHOUT SYMPTOMS OF
SCHIZOPHRENIA
• Acute onset within 2 weeks(from non-psychotic to
psychotic state).
• Polymorphic picture(unstable and markedly variable
clinical picture that changes from day to day or hour to
hour).
• Several types of hallucinations and/or delusions,
changing in both type or intensity from day to day or
within the same day.
• Marked emotional turmoil(intense feelings of
happiness & ecstasy to anxiety & irritability).
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31. ACUTE POLYMORPHIC PSYCHOTIC
DISORDER WITH SYMPTOMS OF
SCHIZOPHRENIA
• Meets the descriptive criteria for acute
polymorphic psychotic disorder but in which
typically schizophrenic symptoms are also
consistently present.
• If schizophrenic symptoms persist for > 1
month, diagnosis changed to schizophrenia.
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32. ACUTE SCHIZOPHRENIA-LIKE
PSYCHOTIC DISORDER
• Characterised by acute onset of a psychotic
disorder in which psychotic symptoms are
comparatively stable(& not polymorphic) &
fulfill the criteria for schizophrenia but have
lasted for < 1month.

33. OTHER ACUTE PREDOMINANTLY
DELUSIONAL PSYCHOTIC DISORDERS
• Acute onset of a psychotic disorder in which
comparatively stable delusions or
hallucinations are the main clinical features
but do not fulfil the criteria for schizophrenia.
• Delusions of persecution or reference are
common & hallucinations are usually auditory.
• Criteria for acute polymorphic psychotic
disorder or schizophrenia should not be
fulfilled.
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34. DIFFERENTIAL DIAGNOSIS
• Organic mental disorders
• Psychoactive substance use disorders
• Schizophrenia
• Mood disorders
• Delusional disorders
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35. PROGNOSIS
Good prognostic factors
• Well adjusted premorbid personality
• Absence of family history of schizophrenia
• Presence of severe precipitating stressor before
th onset
• Sudden onset of symptoms
• Presence of affective symptoms, confusion,
perplexity &/or disorientation in clinical pictuer.
• Short duration of symptoms
• First episode
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36. TREATMENT
• Antipsychotics- mainstay of treatment. Used
to control agitation & psychotic features.
• Oral or parenteral.
• Antidepressants as adjuvants.
• ECT- in case of marked agitation & emotional
turmoil as well as in cases where there is a
danger to self or others.
• Psychotherapy.
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37. REFERENCE
• A short textbook of psychiatry-Niraj Ahuja(7th
edition)
• Concise textbook of psychiatry-Namboodiri(3rd
edition)
• Essentials of psychiatry-N.Kumar
• Kaplan & Sadock’s concise text book of clinical
psychiatry
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