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UNIT 3 ■ Care of Patients With Psychiatric Disorders
Delusional Disorder Delusional disorder is characterized by the pres- ence of delusions that have been experienced by the individual for at least 1 month. Although the indi- vidual with schizophrenia may experience similar delusions, this disorder does not meet the diagnostic criteria for schizophrenia (APA, 2022). If present at all, hallucinations are not prominent, and behavior is not bizarre. The subtype of delusional disorder is based on the predominant delusional theme. The DSM-5 states that a specifier may be added to denote whether the delusions include bizarre content (i.e., whether the thought is “clearly implausible, not understandable, and not derived from ordinary life experiences”) (p. 105). Subtypes of delusional disor- ders include erotomanic, grandiose, jealous, persecu- tory, somatic, and mixed. These are discussed further in the section “Application of the Nursing Process.” Brief Psychotic Disorder This disorder is identified by the sudden onset of psy- chotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month, and there is an eventual full return to the premorbid level of func- tioning (APA, 2022). The individual experiences emotional turmoil or overwhelming perplexity or confusion. Evidence of impaired reality testing may include incoherent speech, delusions, hallucina- tions, bizarre behavior, and disorientation. Catatonic features also may be associated with this disorder. Substance- and Medication-Induced Psychotic Disorder The prominent hallucinations and delusions associ- ated with substance-induced or medication-induced disorder are found to be directly attributable to sub- stance intoxication or withdrawal or after exposure to a medication or toxin. This diagnosis is made when delusions and/or hallucinations predomi- nate during or soon after intoxication, withdrawal, or exposure to a substance or medication and they are severe enough to warrant clinical attention (APA, 2022). The medical history, physical examination, and laboratory findings provide evidence that the appearance of the symptoms occurred in association with a substance intoxication or withdrawal or expo- sure to a medication or toxin. Substances that are believed to induce psychotic disorders are presented in Box 15–4. Catatonic features may also be associ- ated with this disorder.
BOX 15–4 Substances That May Cause Psychotic Disorders DRUGS OF ABUSE Alcohol Amphetamines and related substances Cannabis Cocaine Hallucinogens Inhalants Opioids
Phencyclidine and related substances Sedatives, hypnotics, and anxiolytics MEDICATIONS Anesthetics and analgesics Anticholinergic agents Anticonvulsants Antidepressant medication Antihistamines
Antihypertensive agents Antimicrobial medications Antineoplastic medications Antiparkinsonian agents Cardiovascular medications Corticosteroids Disulfiram Gastrointestinal medications Muscle relaxants NSAIDs TOXINS Anticholinesterase Carbon dioxide Carbon monoxide Nerve gases Organophosphate insecticides Volatile substances (e.g., fuel, paint, gasoline, toluene)
Sources: Compiled from APA (2022); Freudenreich (2010).
Psychotic Disorder Due to Another Medical Condition
The essential features of this disorder are prominent hallucinations and delusions that can be directly attributed to another medical condition (APA, 2022). The diagnosis is not made if the symptoms occur during the course of a delirium. Refer to Box 15–3 for a number of medical conditions that can cause psychotic symptoms.
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