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Of all psychological disorders, schizophrenia is, perhaps, the best known; it has been discussed widely in a variety of media types and interpreted in a range of fiction stories. While the attitude, which the subject matter has been receiving over the past few decades, has triggered a mass increase in awareness on the disorder, it has also led to the creation of numerous myths.
Some of the latter may pose a tangible threat to the wellbeing of not only patients, but also the people that they communicate with, as prejudices and misconceptions may prevent from diagnosing the disorder or mistake an entirely different mental problem for schizophrenia. Traditionally, the latter is confused with the delusional disorder, as the line between schizophrenia induced hallucinations and delusions is very thin.
Can the delusional disorder be considered as a phenomenon linked directly to schizophrenia and the prerequisite thereof?
Seeing that the research is aimed at determining primarily qualitative relationships between the key variables (i.e., schizophrenia and the delusional disorder), including the identification of the possible hierarchical relationships between the two, a qualitative research design is suggested as the basis for identifying the above-mentioned connection.
The relationship between the variables in question will be identified with the help of a general study. An experimental design of the research was declined as time-consuming because of the need to carry out lengthy observations of the possible participants. Instead, an overview of relevant peer-reviewed sources, which have been published within the past five years, was conducted.
Therefore, a structured text was the primary type of data collected in the course of the study, whereas a literature analysis served as the essential method of data interpretation. Snowball sampling was used to retrieve the information reviewed with the help of a discourse analysis based on an inductive approach.
As it has been stressed above, the subject matter has been discussed in a variety of scholarly researches. For example, a range of scholars have attempted to identify schizophrenia and the delusional disorder as phenomena.
According to The American Psychiatric Association and the key tenets of the theory provided in the Diagnosis and Statistical Manual of Mental Disorders (DSM-V), schizophrenia is currently defined as a “heterogeneous clinical syndrome” (American Psychiatric Association, 2013, p. 100), whereas the delusional disorder is identified in the following manner: “The essential feature of delusional disorder is the presence of one or more delusions that persist for at least 1 month” (American Psychiatric Association, 2013, p. 92). Therefore, despite the seemingly close connection to the two, schizophrenia and the delusional disorder, in fact, have very few things in common.
The DSM-V shows quite clearly that hallucinations are among prime signals for the patient to be suffering from schizophrenia or schizophrenia related disorders: according to the research, schizophrenia an schizophrenia spectrum disorders are characterized by “abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms” (American Psychiatric Association, 2013, p. 87).
Therefore, the instances of delirium must be viewed as possible indicators of schizophrenia. However, in the cases when the patient only shows deep convictions for an obviously erroneous concept without displaying any signs of visual or aural illusions, schizophrenia may not be the only possible diagnosis.
According to the existing studies on the issue, the cases, in which the patient remains under specific delusions, which are not accompanied by any kind of hallucinations, should be identified as delusional disorders (Korenis & Kucheria, 2015). For instance, the issue on schizophrenia that has been studied recently displays in a very graphic manner that the issue of hallucinations is linked directly to schizophrenia and at the same time may have a lot to do with delusions:
Without special weighting, the schizophrenia patient would be diagnosed with delusional disorder. The five schizoaffective disorder patients, who in addition to BD reported mood episodes for a substantial portion of the illness duration, would be diagnosed with psychotic disorder NOS. (Shinn, Heckers, & Öngür, 2013, p. 20)
Delusions, however, do not necessarily mean that the patient suffers from schizophrenia and may not be followed by hallucinations, either visual or aural, as the study mentioned above shows. Therefore, some hallucinations may include delusions, yet being under a delusion does not mean that the patient suffers from hallucinations.
Though supporting the fact that the patient suffers from a psychosis and a rather graphic evidence for the importance of further interventions (Opjordsmoen, 2014), the symptoms in question cannot be viewed as the indisputable proof for the fact that the two notions are interrelated.
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It is worth bearing in mind, though, that some of the symptoms displayed by the victims of schizophrenia are strikingly similar to those shown by patients with the delusional disorder; particularly, the inclination towards suicidal behaviors needs to be brought up.
A recent research shows that the people, who suffer from schizophrenia, are apt to be suicidal (González-Rodríguez et al., 2014); however, the specified type of behavior is also common for the patients suffering from the delusional disorder: “Of the 64 DD patients included in the study, 10 (15.6%) had attempted suicide at lifetime. No statistically significant differences were found with regard to sociodemographic variables between DD patients who attempted suicide and those who did not attempt” (Molina-Andreu et al., 2014, p. 157).
The specified phenomenon can be attributed to the fact that both schizophrenia and the delusional disorder trigger a significant increase in the patient’s depression rates, thus, suppressing positive emotions and causing one to experience extraordinary pain, which leads to the development of suicidal moods.
Therefore, a careful assessment of the key symptoms and characteristics of the patient needs to be conducted prior to diagnosing the problem. Because of the confusion that the similarities between the two notions create, it is crucial to identify the threats that the possible misdiagnosis may lead to.
Results and Discussion
As the overview of the recently published studies has shown, the difference between the concept of schizophrenia and the notion of a delusional disorder is rather basic. Not only do the two have entirely different definitions but also do not have to emerge simultaneously or follow one another; quite on the contrary, an instance of schizophrenia may have no traces of the delusional disorder. More to the point, the delusional disorder may occur in the patient, who does not suffer from schizophrenia.
The above-mentioned conclusions allow to assume that the two concepts are mixed because of the seeming similarity between schizophrenia induced hallucinations and delusions, which a person may suffer without having a schizophrenic disorder.
The key problem, therefore, lies in the broad definition of the phenomenon of delusions and the misconception about hallucinations being a synonym for the above-mentioned delusions. In other words, the psychological problems triggering delusions are consumed with somatic and psychosomatic changes that occur to the brain of the person with schizophrenia and causing hallucinations.
In other words, most studies seem to indicate that the concept of the delusional disorder is not to be confused with that one of hallucinations caused by schizophrenia. Judging by the instances of mistreatment provided above, the misrepresentation of a disorder and the following misdiagnosing thereof is likely to affect the patient in a very severe way.
Seeing that the delusional disorder requires a set of treatment measures that are quite different from the ones used for addressing schizophrenia, misdiagnosing the health issues under analysis may cause a significant aggravation of the situation, leading to complications rapidly setting in.
Thus, in order to diagnose the problem correctly, one must pay close attention of the symptoms displayed by the patient and be capable of discriminating between the ones of schizophrenia and of the delusional disorder. Particularly, the specific features of the patient’s misinterpretation of the world need to be identified and analyzed.
For instance, in the cases, when actual hallucinations, either visual or aural, occur, schizophrenia needs to be considered prior to assuming any other possibilities. In cases when the patient does not suffer from either visions or aural phenomena induced by the malfunctioning of their neural system and only tends to have an idea fix, the delusional disorder should be open to question before considering other possible diagnoses.
The above-mentioned measures are admittedly vague, as they do not allow for identifying the cause of the patient’s mental problems; however, it still works as a protection against the possibility of a misdiagnosis.
As the latter is traditionally viewed as one of the situation that is likely to cause the greatest aggravation of the problem and the worst complication of the disorder, being mistreated and advanced to a drastic rate, it is essential that the above-mentioned measures should be taken in order to avoid misdiagnosing the problem and drawing a very thick line between schizophrenia and the delusional disorder.
Addressing the issue of schizophrenia is one of the most challenging tasks in psychiatry, mostly because of the lack of clarity concerning the symptoms and their interpretation; as a result, schizophrenia is often confused with the delusional disorder, especially by the family members and at early stages of the disorder development.
However, the issue is also viewed as a major problem among professional psychiatrist. By identifying the type of a misrepresentation of reality, which the patient has, one may distinguish between the two and make sure that the patient under analysis has been diagnosed with the correct problem.
Particularly, the specific characteristics of the misrepresentations in question need to be looked into; as long as the delusions mentioned above are either aural, or visual, the patient should be diagnosed with possible schizophrenia; however, in the instances, when no actual hallucinations occur, and when the patient only seems to be consistently under a false impression, the delusional disorder must be considered a possible problem. As long as the symptoms are identified carefully and analyzed in a proper manner, the patient is most likely to receive proper treatment.
American Psychiatric Association. (2013). Diagnosis and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
González-Rodríguez, A., Molina-Andreu, O., Odriozola, V. N., Ferrer, C. G., Penadés, R. & Catalán, R. (2014). Suicidal ideation and suicidal behaviour in delusional disorder: A clinical overview. Psychiatry Journal, 1(1), 1–8.
Korenis, P. & Kucheria, P. (2015). Caudate and putamen lesions with rare somatosensory hallucinations in a woman with schizophrenia: A case report. Journal of Psychiatry Journal of Psychiatry, 18(4), 1–2.
Molina-Andreu, O., González-Rodríguez, A., Villanueva, A. P., Penadés, R., Catalán, R. & Bernardo, M. (2014). Awareness of illness and suicidal behavior in delusional disorder patients. European Archives of Psychiatry and Clinical Neuroscience, 41(6), 156–158.
Opjordsmoen, S. (2014). Delusional disorder as a partial psychosis. Schizophrenia Bulletin, 1(1), 1–4.
Shinn, A. K., Heckers, S. & Öngür, D. (2013). The special treatment of first rank auditory hallucinations and bizarre delusions in the diagnosis of schizophrenia. Schizophrenia Research, 146(1), 1–12.