Delusions

Delusions is an advanced CPD-accredited course by HealthCert Education that prepares general practitioners to understand and manage delusional disorders (DDs) across diverse patient populations. While rare, these chronic and resistant psychotic disorders often present subtly in primary care. This five-unit course—presented by Dr. Evangelia (Valia) Francis—offers a comprehensive foundation, from historical definitions to nuanced psychological and pharmacological strategies.

Unit 1: Introduction, History, and Definitions
This opening unit explores the historical evolution and core definitions of delusional disorders. Participants will learn the DSM-5 and ICD-11 criteria, focusing on chronic, monosymptomatic, and monothematic delusions. Unique features such as the absence of prominent hallucinations, preserved personality function, and the distinction from schizophrenia are explained. The discussion also delves into the exclusion criteria, including organic causes and comorbid psychotic or mood disorders.

Unit 2: Epidemiology, Pathogenesis, and Clinical Manifestations
This unit examines the elusive epidemiology of DDs, attributed to patients’ social integration and minimal overt psychotic symptoms. It highlights the disorder’s rare prevalence (under 0.5%), typical onset in mid to late adulthood, and equal gender distribution. Aetiological models explored include psychodynamic defenses, personality traits, neurobiological dysfunction, and dopamine-related mechanisms. Clinically, DDs present as persistent false beliefs—often resistant to challenge—with no cognitive impairment or broader psychiatric disturbance.

Unit 3: Erotomanic, Jealous, and Grandiose Delusions
Here, the course details three key subtypes:
- Erotomanic: Delusions of being loved by another, often leading to obsessive behaviors.
- Jealous (Othello syndrome): Delusions of infidelity, commonly triggering aggression or violence.
- Grandiose: Beliefs in exaggerated self-worth, power, or divine connection, often paired with persecutory ideation.
This unit emphasises the behavioural risks, such as stalking or violence, and the potential overlap between subtypes, particularly erotocentric presentations.

Unit 4: Persecutory, Somatic, and Mixed Delusions
Participants will explore:
- Persecutory delusions: Common, especially among males, and classified into flight, fight, and height types—each with distinct risks (e.g., social isolation, violence, legal action).
- Somatic delusions: Focusing on bodily dysfunction, such as delusional parasitosis or Cotard’s syndrome, often presenting in dermatological or general practice settings.
- Mixed delusions: Multiple delusional themes without one predominating, making diagnosis and treatment complex.
This unit aids clinicians in recognising nuanced symptom profiles that commonly result in specialist referrals.

Unit 5: Management (Including Pharmacotherapy and FPS for GPs)
The final unit equips GPs with practical strategies for treating DDs. While evidence is limited, an integrated approach is advised—combining antipsychotics (e.g., aripiprazole, clozapine) with cognitive behavioral therapy and supportive psychotherapy. Challenges such as poor insight, mistrust, and reluctance to engage in treatment are addressed. Clinicians are guided on documentation, referral coordination, and tailoring communication to minimise resistance and build therapeutic trust.