DELUSIONAL

and
SCHIZOAFFECTIVE DISORDERS

Oeh:
Dr. N.K. Sri Diniari, Sp.KJ
Delusional Disorder
Delusional Disorder
• The main symptoms (the most prominent )
are delusions.
• The nature of delusions: systematic.
• Delusion : A false belief based on incorrect
inference about external reality that is firmly
sustained despite what almost everyone else
believes and despite what constitutes
incontrovertible and obvious proof of
evidence to the contrary.
Delusional Disorder
Included in the group of :

SCHIZOPHRENIA SPECTRUM
and
Other PSYCHOTIC DISORDERS
Epidemiologi
• The prevalence: 0.025 - 0.03 %
• Annual incidence: 1 - 3 new cases / 100,000
persons.
• Female >male
• Male > paranoid delution; female > erotomania
• Onset : ± 40 years, (range: 18 -80 y.o)
Etiology
• Unknown
• Biological factors
– Limbic system and the basal ganglia
– Family history
• Psychodynamic Factors
– Defense mechanisms: reaction formation, projection,
and denial.
– Eric Ericson: trust vs mistrust
• Sensory impairment , Social isolation, Recent
immigration, etc
Diagnosis
• DSM-IV TR or DSM-5
• ICD-10
• PPDGJ-III
DSM-5 Diagnostic Criteria for Delusional Disorder:

A. The presence of one (or more) delusions with a

duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met.
C. Apart from the impact of the delusion(s) or its
ramifications, functioning is not markedly impaired
and behavior is not obviously odd or bizarre.
D. If manic or major depressive episodes have
occurred, these have been brief relative to the
duration of the delusional periods.
E. The disturbance is not attributed to the physiological
effects of a substance or another medical condition.
Specify type:
1. Erotomanic type: delusions that another person, usually of higher
status, is in love with the individual.
2. Grandiose type: delusions of inflated worth, power, knowledge,
identity, or special relationship to a deity or famous person
3. Jealous type: delusions that the individual's sexual partner is
unfaithful
4. Persecutory type: delusions that the person (or someone to whom
the person is close) is being malevolently treated in some way
5. Somatic type: delusions that the person has some physical defect
or general medical condition
6. Mixed type: delusions characteristic of more than one of the above
types but no one theme predominates
7. Unspecified type
PPDGJ-III:
GANGGUAN WAHAM (F22.0)
• Waham merupakan gejala paling mencolok
• ≥ 3 bulan
• Sifat: personal, bukan budaya setempat
• Mungkin ada depresif scr intermiten, tetapi
waham menetap
• Tidak ada penyakit otak
• Halusinasi kadang2 saja, sifat sementara.
• Tdk ada riwayat gejala skizofrenia.
Clinical Features
• Usually well groomed and well dressed,
without evidence of gross disintegration of
personality or of daily activities
• Seem eccentric, odd, suspicious, or hostile.
• Looks like a normal person, except for a
markedly abnormal delusional.
• The delusions are systematized
• Patients may attempt to engage clinicians as
allies in their delusions
 Differential Diagnosis

• Delirium, Dementia, Substance-Related

Disorders.
• Malingering , Factitious disorder
• Schizophrenia, Depression, Somatoform,
gangguan kepribadian paranoid.
Course and Prognosis
• A sudden onset ≥ an insidious onset.
• ± 50 % recovered at long-term follow-up
20 % decreased symptoms.
30 % exhibit no change.
• Persecutory, somatic, and erotic delusions
have a better prognosis than grandiose and
jealous delusions.
Treatment

• Psychotherapy
– Individual therapy, insight-oriented, supportive,
cognitive, and behavioral therapies
• Pharmacotherapy
– Patients are likely to refuse medication
– Severe agitated: antipsychotic intra muscular (i.m)
– Pimozide, haloperidol, risperidone
– if it fails with antipsychotics:antidepressan,
lithium, carbamazepine, divalvroic acid
• Hospitalization
SCHIZOAFFECTIVE DISORDER
SCHIZOAFFECTIVE DISORDER

schizophrenia
= +
Affective (mood)
disorders
Epidemiology

– Prevalence : ≤ 1% (0,5 – 0,8 %)

– The depressive type: older persons > younger
persons
– The bipolar type : young adults > older adults.
– Women > men
– Men with schizoaffective disorder are likely to
exhibit antisocial behavior and to have a markedly
flat or inappropriate affect.
Etiology
• Unknown
• May be a type of schizophrenia, a type of
mood disorder, or the simultaneous
expression of each.
• Genetic
• Biological factors
• Psychodynamic Factors
 Diagnosis and Clinical Features
• The DSM-IV-TR or DSM-5
• ICD-10
• PPDGJ-III
The DSM-5
A. An uninterrupted period of illness during which there is a
major mood episode ( major depressive or manic)
concurrent with criterion A schizophrenia
B. Delusions or hallucinations for 2 or more weeks in the
absence of a major mood episode (depressive or manic)
during the life time duration of the illness
C. Symptoms that meet criteria for a major mood episode are
present for majority of the total duration of the active and
residual portions of the illness.
D. The disturbance is not attributable to the effect of a
substance (e.g., a drug of abuse, a medication) or another
medical condition.
Specify type schizoaffective:
(DSM-5)
• Bipolar type: if the disturbance includes a
manic or a mixed episode (or a manic or a
mixed episode and major depressive episodes)
• Depressive type: if the disturbance only
includes major depressive episodes
PPDGJ-III
• Adanya gejala2 skizofrenia dan gangguan afektif
(mood) sama-sama menonjol pd saat yang
bersamaan (simultaneously), atau dalam bbrp hari
yg satu sesudah yg lain, dlm satu episode sakit yg
sama.
• Episode penyakit, tidak memenuhi kriteria
skizofrenia maupun episode manik atau depresif
• Tidak dpt digunakan untuk pasien yg menampilkan
gejala skizofrenia dan gangguan afektif tetapi dalam
episode penyakit yg berbeda.
Tipe Skizoafektif:
(PPDGJ-III)
• Gangguan skizoafektif tipe Manik
• Gangguan skizoafektif tipe Depresif
• Gangguan skizoafektif tipe Campuran
• Gangguan skizoafektif lainnya
Differential Diagnosis
• Psychiatric
– All mood disorders and schizophrenia
– Bipolar disorder
• Substance use
• Neurological abnormality
(e.g: temporal lobe epilepsy)
Course and Prognosis
• Difficult to determine the long-term course
and prognosis.
• Predominant symptoms were:
– affective : better prognosis
– schizophrenic : worse prognosis.
• One study: after 8 years found that the
outcomes of these patients more closely
resembled schizophrenia
Treatment
1. Psikofarmaka treatment
• Antipsychotic
• Mood stabilizers
– Carbamazepine
– Lithium carbonate
• Selective serotonin reuptake inhibitors (SSRI)
2. Psychosocial treatment
• Family therapy, social skills training, and
cognitive rehabilitation.
3. ECT (Electrocovulsive therapy)
TERIMA KASIH