Persistent delusional disorder
The variations in human personality are astonishing. It is thanks to this branch that I am privy to a huge spectrum of behaviors and personalities of people.
Among the patients that I saw today was this individual whose wife suspects him to be having an extra-marital affair. Now what should have gone to a marriage counselor or a lawyer had come to me because the 'doubt' that the lady had was held with extraordinary conviction but apparently without any real evidence or trigger. In such cases the first question as a Psychiatrist is that am I dealing with a delusion or the lady has a genuine reason to suspect her husband of infidelity. Well, there are definite pointers that the lady has delusion of infidelity for example that the hapless husband hasn't displayed any such proclivities has been attested to by the relatives of the gentleman. Moreover the doubt pattern has a certain obsessive character as usually a female suspecting her husband of something such will not make her attempts at finding the ‘truth’ that obvious, while she would check his shirt for lipstick marks, pockets for any letter etc. The lady was not willing to talk to me. She was brought to the clinic on being forced by her husband to do so. At the clinic she kept her head down and stubbornly refused to talk.
Except for being certain of her husband's infidelity the lady doesn't have any other dysfunction in her life. She manages the household well, prepares the lunch etc for her kids adequately, maintains adequate health and hygiene and takes a good care of the house. She hasn't ever expressed a wish to leave her husband. Then you expect a trigger in such cases which again wasn't there. Anyway apart from the quandary that the husband finds himself in, the condition is quite distressing for this female too.
We don’t know what purpose such a delusion serves in nature. The disorder can be labelled as a Persistent Delusional Disorder. However labeling it such doesn't help the patient much as she and her family continue to suffer. We do not reliably understand the neurobiology delusion. The treatment is notoriously difficult. There are a few lucky ones who respond to anti psychotic medications but a majority do not show any response. There are other patients harboring single persistent delusions, though with a different content like this old man who believes that there is a machine inside his body that is preventing him from living a normal life, he attributes every symptom in his body like tremors etc to be caused by this machine. Then there's this girl who says that there is a heavy metal thing in her throat. She won’t live a normal life till that heavy thing is removed from inside her throat. In all these cases there has been a significant distress and dysfunction. Often the patient develops secondary depression. None of the anti-psychotics managed to elicit an iota of response. Any attempt at CBT failed to make a dent in the conviction in delusion. In case of the old man believing that there is a 'machine inside his body', I had to change tack and advise him that even if we accept his thoughts are real then we can still manage to live a normal life by not allowing the so called 'machine' to cause further distress. It is working somewhat but in every meeting the old man makes it a point to tell me all that the 'machine' is doing to him.
As a therapist feeling responsible towards his patients I find myself at loss on how to help these patients? will we have to wait till the neurobiology of such problems becomes clearer?
Among the patients that I saw today was this individual whose wife suspects him to be having an extra-marital affair. Now what should have gone to a marriage counselor or a lawyer had come to me because the 'doubt' that the lady had was held with extraordinary conviction but apparently without any real evidence or trigger. In such cases the first question as a Psychiatrist is that am I dealing with a delusion or the lady has a genuine reason to suspect her husband of infidelity. Well, there are definite pointers that the lady has delusion of infidelity for example that the hapless husband hasn't displayed any such proclivities has been attested to by the relatives of the gentleman. Moreover the doubt pattern has a certain obsessive character as usually a female suspecting her husband of something such will not make her attempts at finding the ‘truth’ that obvious, while she would check his shirt for lipstick marks, pockets for any letter etc. The lady was not willing to talk to me. She was brought to the clinic on being forced by her husband to do so. At the clinic she kept her head down and stubbornly refused to talk.
Except for being certain of her husband's infidelity the lady doesn't have any other dysfunction in her life. She manages the household well, prepares the lunch etc for her kids adequately, maintains adequate health and hygiene and takes a good care of the house. She hasn't ever expressed a wish to leave her husband. Then you expect a trigger in such cases which again wasn't there. Anyway apart from the quandary that the husband finds himself in, the condition is quite distressing for this female too.
We don’t know what purpose such a delusion serves in nature. The disorder can be labelled as a Persistent Delusional Disorder. However labeling it such doesn't help the patient much as she and her family continue to suffer. We do not reliably understand the neurobiology delusion. The treatment is notoriously difficult. There are a few lucky ones who respond to anti psychotic medications but a majority do not show any response. There are other patients harboring single persistent delusions, though with a different content like this old man who believes that there is a machine inside his body that is preventing him from living a normal life, he attributes every symptom in his body like tremors etc to be caused by this machine. Then there's this girl who says that there is a heavy metal thing in her throat. She won’t live a normal life till that heavy thing is removed from inside her throat. In all these cases there has been a significant distress and dysfunction. Often the patient develops secondary depression. None of the anti-psychotics managed to elicit an iota of response. Any attempt at CBT failed to make a dent in the conviction in delusion. In case of the old man believing that there is a 'machine inside his body', I had to change tack and advise him that even if we accept his thoughts are real then we can still manage to live a normal life by not allowing the so called 'machine' to cause further distress. It is working somewhat but in every meeting the old man makes it a point to tell me all that the 'machine' is doing to him.
As a therapist feeling responsible towards his patients I find myself at loss on how to help these patients? will we have to wait till the neurobiology of such problems becomes clearer?
Comments
Post a Comment