DOCSLIB.ORG

Identify Criteria for Major Depression and Bipolar II Disorder Identify

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Identify Criteria for Major Depression and Bipolar II Disorder Identify 10/15/2013 Identify criteria for major depression and bipolar II disorder Identify screening tools and interventions that can assist in identifying symptoms of hypomania Identify medications that are FDA-approved to manage bipolar II disorder Kelly M. Rock, DNP, CRNP Identify the FNP role in managing patients with depression vs bipolar II Think “BIG PICTURE” Think episodic Think in context of history Patients with Inaccurate bipolar II wait 8- diagnosis often Inadequate 10 years for leads to treatment can correct inadequate be deadly diagnosis treatment When a patient presents with a depressive episode, you MUST consider both major depressive disorder (MDD) and bipolar disorder (especially bipolar II disorder) as a potential diagnosis WHY?? Because a depressive episode looks exactly the same in MDD as it does is bipolar II disorder If you do not screen for hypomania, you will miss it! 1 10/15/2013 Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the A distinct period of abnormally and persistently elevated, expansive, or symptoms is either (1) depressed mood or (2) loss of interest or pleasure. NOTE: irritable mood and abnormally and persistently increased activity or Do not include symptoms that are clearly attributable to another medical energy, lasting at least 4 consecutive days and present most of the day, condition nearly every day. Depressed mood most of the day, nearly every day, as indicated by either subjective report During the period of mood disturbance and increased energy and activity, (e.g. feels sad, empty, hopeless) or observation made by others (e.g. appears tearful). (NOTE: 3 (or more) of the following symptoms (4 if the mood is only irritable) In children and adolescents, can be irritable mood). have persisted, represent a noticeable change from usual behavior, and . Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day (as indicated by either subjective account or observation) have been present to a significant degree: . Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body . Inflated self-esteem or grandiosity. weight in a month), or decrease or increase in appetite nearly every day. (NOTE: In children, . consider failure to make expected weight gain) Decreased need for sleep (e.g. feels rested after only 3 hours of sleep). Insomnia or hypersomnia nearly every day . More talkative than usual or a pressure to keep talking. Psychomotor agitation or retardation nearly every day (observable by others, not merely . Flight of ideas or subjective experience that thoughts are racing. subjective feelings of restless or being slowed down) . Distractibility (i.e. attention too easily drawn to unimportant or irrelevant . Fatigue or loss of energy nearly every day external stimuli), as reported or observed . Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) . Increase in goal-directed activity (either socially, at work or school, or sexually) . Diminished ability to think or concentration, or indecisiveness, nearly every day (either by or psychomotor agitation. subjective account or as observed by others). Excessive involvement in activities that have a high potential for painful . Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a consequences (e.g. engaging in unrestrained buying sprees, sexual specific plan, or a suicide attempt or a specific plan for committing suicide. indiscretions, or foolish business investments) The episode is associated with an unequivocal change You can then put all of the information in functioning that is characteristic of the individual when not symptomatic together to formulate a diagnosis The disturbance in mood and the change in . DSM 5 is your guide functioning are observable by others. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. The episode is not attributable to the physiological effects of a substance (e.g. medication, ECT) Meets criteria for one or more lifetime episode(s) of a Major depressive disorder (MDD) major depressive episode (as previously defined) Cyclothymic disorder (cyclothymia) The symptoms cause clinically significant distress or impairment in social, occupational, or other important Bipolar II disorder area of functioning. The episode is not attributable to the physiological effects of a substance or to another medical condition The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. There has never been a manic episode or a hypomanic episode 2 10/15/2013 For at least 2 years (at least 1 year in children/adolescents) there have Criteria have been met for at least one hypomanic been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive episode and at least one major depressive episode. symptoms that do not meet criteria for a major depressive episode. There has never been a manic episode. During the above 2-year period (1 year in children/adolescents), the The occurrence of the hypomanic episode(s) and major hypomanic and depressive periods have been present for at least half the depressive episode(s) is not better explained by time and the individual has not been without the symptoms for more than 2 months at a time. schizoaffective disorder, schizophrenia, schizophreniform Criteria for a major depressive, manic, or hypomanic episode have never disorder, delusional disorder, or other specified or been met unspecified schizophrenia spectrum and other psychotic The symptoms are not better explained by schizoaffective disorder, disorder. schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic The symptoms of depression or the unpredictability disorder caused by frequent alternation between periods of The symptoms are not attributable to the physiological effects of a depression and hypomania causes clinically significant substance (e.g. a drug of abuse, a medication) or another medical distress or impairment in social, occupation, or other condition (e.g. hypothyroidism) important areas of functioning. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. MDD Cyclothymia Bipolar II Prevalence 12 month prevalence in US is Lifetime prevalence 0.4-1% 12 month prevalence in US is 7% 0.8% Gender Female:Male ratio No consistent gender No consistent gender MDD Cyclothymia Bipolar II 1.5-3:1 differences in literature differences in literature No lifetime episodes Onset Likely onset puberty. Peak Usually begins in Average onset is mid 20s, At least 1 lifetime At least 1 lifetime of major depression, in 20s. Late onset common. adolescence or early though can occur earlier or episode of major episode of major adulthood later but some depressive depression depression symptoms Course Course is extremely variable Course is variable. 15-50% Course is variable develop bipolar I or II disorder No lifetime episodes At least 1 lifetime No lifetime episode of hypomania, but episode of of hypomania some hypomanic hypomania Suicide risk Suicide is risk at all times in Suicide data not available Suicide risk HIGH. 1/3 report symptoms MDD. attempting suicide Depressive episodes look exactly the same in WRONG! It’s actually very difficult! MDD and bipolar II disorder (not as severe in . WHY IS IT SO HARD? cyclothymic disorder). The only thing that ▪ Who is ever going to come into your office saying that they feel wonderful, have plenty of energy, are differentiates MDD from bipolar II disorder is incredibly productive, don’t need much sleep, and are the presence or absence of a lifetime not having any problems functioning? ▪ Depression will almost always be CC hypomanic episode! ▪ On top of that, who is going to think that this is ‘abnormal’ or ‘out of the ordinary’ or ‘a problem’? ▪ And if it’s only happened a time or two, who is actually going to remember it?? 3 10/15/2013 Tools to help identify past/present hypomania Chief complaint History of present illness Remember: think “episode” Past psychiatric history . Inpatient psych admissions, specialized outpatient treatment, past diagnoses, past med trials, suicide attempts, history of self-injury Family psychiatric history Personal history (developmental, academic, social) *A psychiatric interview in specialty care would have other components Clinical interview D = distractibility/easily frustrated . Use DSM 5 criteria I = Irresponsible/erratic behavior Collateral information sources G = Grandiosity . Parents, partner, children F = Flight of ideas . Request old records A = Activity is increased Mood disorder questionnaire S = Sleep is decreased . Quick, easy, free T = Talkativeness . *This is a mnemonic for mania. May not capture hypomania! 4 10/15/2013 Not “diagnostic” for bipolar disorder. Simply Can’t I treat every depressive episode the raises level
Load more

Recommended publications
  • Paranoid – Suspicious; Argumentative; Paranoid; Continually on The
    Disorder Gathering 34, 36, 49 Answer Keys A N S W E R K E Y, Disorder Gathering 34 1. Avital Agoraphobia – 2. Ewelina Alcoholism – 3. Martyna Anorexia – 4. Clarissa Bipolar Personality Disorder –. 5. Lysette Bulimia – 6. Kev, Annabelle Co-Dependant Relationship – 7. Archer Cognitive Distortions / all-of-nothing thinking (Splitting) – 8. Josephine Cognitive Distortions / Mental Filter – 9. Mendel Cognitive Distortions / Disqualifying the Positive – 10. Melvira Cognitive Disorder / Labeling and Mislabeling – 11. Liat Cognitive Disorder / Personalization – 12. Noa Cognitive Disorder / Narcissistic Rage – 13. Regev Delusional Disorder – 14. Connor Dependant Relationship – 15. Moira Dissociative Amnesia / Psychogenic Amnesia – (*Jason Bourne character) 16. Eylam Dissociative Fugue / Psychogenic Fugue – 17. Amit Dissociative Identity Disorder / Multiple Personality Disorder – 18. Liam Echolalia – 19. Dax Factitous Disorder – 20. Lorna Neurotic Fear of the Future – 21. Ciaran Ganser Syndrome – 22. Jean-Pierre Korsakoff’s Syndrome – 23. Ivor Neurotic Paranoia – 24. Tucker Persecutory Delusions / Querulant Delusions – 25. Lewis Post-Traumatic Stress Disorder – 26. Abdul Proprioception – 27. Alisa Repressed Memories – 28. Kirk Schizophrenia – 29. Trevor Self-Victimization – 30. Jerome Shame-based Personality – 31. Aimee Stockholm Syndrome – 32. Delphine Taijin kyofusho (Japanese culture-specific syndrome) – 33. Lyndon Tourette’s Syndrome – 34. Adar Social phobias – A N S W E R K E Y, Disorder Gathering 36 Adjustment Disorder – BERKELEY Apotemnophilia
    [Show full text]
  • First Episode Psychosis an Information Guide Revised Edition
    First episode psychosis An information guide revised edition Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) i First episode psychosis An information guide Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) A Pan American Health Organization / World Health Organization Collaborating Centre ii Library and Archives Canada Cataloguing in Publication Bromley, Sarah, 1969-, author First episode psychosis : an information guide : a guide for people with psychosis and their families / Sarah Bromley, OT Reg (Ont), Monica Choi, MD, Sabiha Faruqui, MSc (OT). -- Revised edition. Revised edition of: First episode psychosis / Donna Czuchta, Kathryn Ryan. 1999. Includes bibliographical references. Issued in print and electronic formats. ISBN 978-1-77052-595-5 (PRINT).--ISBN 978-1-77052-596-2 (PDF).-- ISBN 978-1-77052-597-9 (HTML).--ISBN 978-1-77052-598-6 (ePUB).-- ISBN 978-1-77114-224-3 (Kindle) 1. Psychoses--Popular works. I. Choi, Monica Arrina, 1978-, author II. Faruqui, Sabiha, 1983-, author III. Centre for Addiction and Mental Health, issuing body IV. Title. RC512.B76 2015 616.89 C2015-901241-4 C2015-901242-2 Printed in Canada Copyright © 1999, 2007, 2015 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work. This publication may be available in other formats. For information about alterna- tive formats or other CAMH publications, or to place an order, please contact Sales and Distribution: Toll-free: 1 800 661-1111 Toronto: 416 595-6059 E-mail: [email protected] Online store: http://store.camh.ca Website: www.camh.ca Disponible en français sous le titre : Le premier épisode psychotique : Guide pour les personnes atteintes de psychose et leur famille This guide was produced by CAMH Publications.
    [Show full text]
  • The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
    The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in
    [Show full text]
  • Quick Lesson About
    QUICK Delusional Disorder: Grandiose Type LESSON ABOUT Description/Etiology Delusional disorder is characterized by the presence for at least one month of delusions and the absence of other symptoms associated with psychotic, mood, or personality disorders that usually include delusions. Delusions are fixed beliefs that persist despite objective evidence that they are not true. Whether a particular belief is considered delusional varies from culture to culture; to be considered a delusion the belief cannot be accepted by members of the believer’s own culture or subculture. Delusions are categorized as either nonbizarre or bizarre. Nonbizarre delusions are beliefs that could conceivably be true (e.g., a life partner having an affair, being the object of unspoken love, being spied on by a government agency), whereas bizarre delusions have no possible basis in reality (e.g., having all of one’s organs replaced without surgery, being controlled by messages received from the CIA through a hat made of aluminum foil). The primary change in criteria for diagnosis of delusional disorder in the Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5) from the fourth edition of the manual is the removal of the requirement that delusions are nonbizarre. The criteria for delusional disorder are delusions of at least one month’s duration; criterion A for schizophrenia has never been met (nonprominent hallucinations that are related to the theme of the delusion may be present); functioning is not noticeably impaired and behavior is not odd (except possibly for the direct impact and ramifications of the delusion); symptoms of mood disorders, if any, are brief relative to the duration of the delusion; and the delusion is not directly due to a general medical condition or the physiological effect of a substance.
    [Show full text]
  • Care for Women with Delusional Disorder: Towards a Specialized Approach
    Review Care for Women with Delusional Disorder: Towards a Specialized Approach Alexandre González-Rodríguez 1,* , Mary V. Seeman 2 , Aida Álvarez 3, Armand Guàrdia 3, Nadia Sanz 3, Genís F. Fucho 3, Diego J. Palao 1 and Javier Labad 4 1 Department of Mental Health, Parc Tauli University Hospital, Autonomous University of Barcelona (UAB), I3PT, CIBERSAM, Sabadell, 08280 Barcelona, Spain; [email protected] 2 Department of Psychiatry, University of Toronto, 605 260 Heath Street West, Toronto, ON M5T 1R8, Canada; [email protected] 3 Department of Mental Health, Parc Tauli University Hospital, Sabadell, 08280 Barcelona, Spain; [email protected] (A.Á.); [email protected] (A.G.); [email protected] (N.S.); gff[email protected] (G.F.F.) 4 Department of Mental Health, Consorci Sanitari del Maresme, CIBERSAM, 08304 Mataró, Spain; [email protected] * Correspondence: [email protected] Received: 11 December 2020; Accepted: 11 January 2021; Published: 15 January 2021 Abstract: Delusional disorder is a difficult-to-treat clinical condition with health needs that are often undertreated. Although individuals with delusional disorder may be high functioning in daily life, they suffer from serious health complaints that may be sex-specific. The main aim of this narrative review is to address these sex-specific health needs and to find ways of integrating their management into service programs. Age is an important issue. Delusional disorder most often first occurs in middle to late adult life, a time that corresponds to menopause in women, and menopausal age correlates with increased development of both somatic and psychological health problems in women. It is associated with a rise in the prevalence of depression and a worsening of prior psychotic symptoms.
    [Show full text]
  • Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies
    Review Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies Alexandre González-Rodríguez 1 , Javier Labad 2 and Mary V. Seeman 3,* 1 Department of Mental Health, Parc Tauli University Hospital, Autonomous University of Barcelona (UAB), I3PT, Sabadell, 08280 Barcelona, Spain; [email protected] 2 Department of Psychiatry, Hospital of Mataró, Consorci Sanitari del Maresme, Institut d’Investigació i Innovació Parc Tauli (I3PT), CIBERSAM, Mataró, 08304 Barcelona, Spain; [email protected] 3 Department of Psychiatry, University of Toronto, #605 260 Heath St. West, Toronto, ON M5T 1R8, Canada * Correspondence: [email protected] Received: 1 September 2020; Accepted: 12 October 2020; Published: 16 October 2020 Abstract: Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review’s findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen.
    [Show full text]
  • Schizophrenia Spectrum and Other Psychotic Disorders
    1 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS 2 OBJECTIVES Know and understand: • How to evaluate a person with psychotic symptoms • The epidemiology and clinical characteristics of late- onset schizophrenia • Evaluation of psychotic symptoms associated with disorders other than schizophrenia • Management of older adult patients with psychotic symptoms 3 TOPICS COVERED • Schizophrenia and Schizophrenia Spectrum Syndromes • Psychotic Symptoms in Delirium and Delusional Disorder • Psychotic Symptoms in Mood Disorder • Psychotic Symptoms in Dementia • Isolated Suspiciousness • Syndromes of Isolated Hallucinations: Charles Bonnet Syndrome • Other Psychotic Disorders Ø Psychotic Disorder Due to Another Medical Condition Ø Substance/Medication-Induced Psychotic Disorder 4 PSYCHOTIC SYMPTOMS • Hallucinations are perceptions without stimuli that can affect any of the 5 sensory modalities (auditory, visual, tactile, olfactory, gustatory) • Delusions are fixed, false, idiosyncratic beliefs that can be: Ø Suspicious (paranoid) Ø Grandiose Ø Somatic Ø Self-blaming Ø Hopeless 5 EVALUATION OF A PERSON WITH PSYCHOTIC SYMPTOMS • First evaluate for underlying causes such as delirium, dementia, stroke, or Parkinson disease Ø Acute onset of altered level of consciousness or inability to sustain attention suggests delirium Ø Delirium, most often superimposed on an underlying dementia, is the most common cause of new-onset psychosis in late life • Next, consider a primary mood disorder • Only after other causes are excluded should the diagnosis of
    [Show full text]
  • Depression Treatment Guide DSM V Criteria for Major Depressive Disorders
    MindsMatter Ohio Psychotropic Medication Quality Improvement Collaborative Depression Treatment Guide DSM V Criteria for Major Depressive Disorders A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1) Depressed mood most of the day, nearly every day, as 5) Psychomotor agitation or retardation nearly every day indicated by either subjec tive report (e.g., feels sad, empty, (observable by others, not merely subjective feelings of hopeless) or observation made by others (e.g., appears restlessness or being slowed down). tearful). (Note: In children and adolescents, can be irritable 6) Fatigue or loss of energy nearly every day. mood.) 7) Feelings of worthlessness or excessive or inappropriate 2) Markedly diminished interest or pleasure in all, or almost all, guilt (which may be delu sional) nearly every day (not activities most of the day, nearly every day (as indicated by merely self-reproach or guilt about being sick). either subjective account or observation). 8) Diminished ability to think or concentrate, or 3) Significant weight loss when not dieting or weight gain indecisiveness, nearly every day (ei ther by subjective (e.g., a change of more than 5% of body weight in a account or as observed by others). month}, or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected 9) Recurrent thoughts of death (not just fear of dying), weight gain.) recurrent suicidal ideation with out a specific plan, or a suicide attempt or a specific plan for committing suicide.
    [Show full text]
  • Empirical Redefinition of Delusional Disorder and Its Phenomenology: the DELIREMP Study ⁎ Enrique De Portugala, , Nieves Gonzálezb, Victoria Del Amoc, Josep M
    Available online at www.sciencedirect.com Comprehensive Psychiatry 54 (2013) 243–255 www.elsevier.com/locate/comppsych Empirical redefinition of delusional disorder and its phenomenology: the DELIREMP study ⁎ Enrique de Portugala, , Nieves Gonzálezb, Victoria del Amoc, Josep M. Harod, Covadonga M. Díaz-Caneja e, Juan de Dios Luna del Castillof, Jorge A. Cervillag aDepartment of Psychiatry, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital General Universitario Gregorio Marañón, Madrid, Spain bResearch and Development Unit, Sant-Joan de Déu-SSM, Barcelona, Spain cDepartment of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain dParc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Sant Boi de Llobregat, Barcelona, Spain eChild and Adolescent Psychiatry Department. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain fDepartment of Psychiatry & Institute of Neurosciences, University of Granada, Spain gCentro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitario San Cecilio, Granada, Spain Abstract Aims: Since Kraepelin, the controversy has persisted surrounding the nature of delusional disorder (DD) as a separate nosological entity or its clinical subtypes. Nevertheless, there has been no systematic study of its psychopathological structure based on patient interviews. Our goal was to empirically explore syndromic subentities in DD. Methods: A cross-sectional study was conducted in 86 outpatients with DSM-IV-confirmed DD using SCID-I. Psychopathological factors were identified by factor analysis of PANSS scores. The association between these factors and clinical variables (as per standardized instruments) was analyzed using uni- and multivariate techniques.
    [Show full text]
  • Is Faith Delusion?
    Is Faith Delusion? Professor Andrew Sims It has been claimed that God is a delusion. I plan to examine that proposition from the standpoint of psychopathology. Delusion has now become a psychiatric word. Although in the past, the word delusion could refer to being fooled or cheated 1, in modern speech it always implies a suspicion of psychiatric illness. It has been appropriated by psychiatry and invariably implies a psychiatric diagnosis. If I am deluded, then I am necessarily mentally ill. In English law, delusion has been the cardinal feature of insanity for the last 200 years 2. It is a mitigating circumstance and can convey diminished responsibility. It is, therefore, within our professional competence as psychiatrists to say what is, and is not, delusion. I have had the temerity to entitle this, ‘Is faith delusion?’ as if I could answer that question for all faiths and, therefore, know about all religions and philosophies. Of course, this is not so, but there is a dilemma here; the person who can state, objectively, ‘religion is, or says…’ , in doing so, puts himself outside religion, and all religion, each faith, can only be truly known from inside. I therefore hope that the disadvantage of not being able to speak for all religions is outweighed by knowing well the subjective experience of one type of believer. Are all people with religious belief, a priori, suffering from mental illness? Sigmund Freud in 'Moses and Monotheism’ stated that belief in a single God is delusional 3. His contemporary, William James, was somewhat more circumspect and considered that spiritual and psychotic experiences were broadly distinguishable 4.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
    The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other
    [Show full text]
  • DELUSIONAL DISORDER Paranoia and Related Illnesses
    job:LAY00 12-10-1998 page:1 colour:1 black±text DELUSIONAL DISORDER Paranoia and Related Illnesses Delusional disorder, once termed paranoia, was an important diagnosis in the late nineteenth and early twentieth centuries. Subsequently it was subsumed with schizophrenia, and only in 1987 was it reintroduced into modern psychiatric diagnosis. This book aims to reconcile recent knowledge with older ideas about the condition, and thereby to provide a contemporary perspective to the concept of delusional disorder and to integrate the scattered literature on the topic. The illness has a characteristic form, but the content of the delusional system can vary widely. SuVerers may deny mental illness and refuse psychiatric help, so that mental health professionals, who should be at the forefront in dealing with delusional disorder, are often the last to see it. Psychiatrists and other clinicians will therefore appreciate this review of a disorder once considered untreatable but in fact, as the author shows, responsive to appropriate management. The text deals with the emergence of the concept of delusional disorder, and goes on to detail its manifold presentations, diVerential diagnosis and treatment. Many instructive case histories are provided, illustrating manifestations of delusional disorder including the persecutory and somatic subtypes, and variants including dysmorphic and infestation delusion, erotomania, and related conditions in the paranoid spectrum such as paraphrenia, folie a` deux and paranoid personality disorder. This is the most wide ranging and authoritative text on the subject to have appeared for many years, and the Wrst to suggest, based on the author’s extensive experience, that the category of delusional disorder should contain not one but several conditions.
    [Show full text]