EpistemisDelusional ideas of persecution
Specialty: Psychiatry.
Why it occurs
- Paranoid schizophrenia
- Chronic delusional disorder (paranoia)
- Manic episode with psychotic symptoms
- Psychotic depression
- Acute delirium (organic, infectious or metabolic)
- Substance-induced psychosis (amphetamines, cocaine, alcohol)
Initial workup
Positive and Negative Symptoms Scale (PANSS); complete analysis that includes kidney and liver function, ions, calcium, ammonium, TSH; urine toxic screening; Brain CT or MRI in case of first psychotic episode or suspicion of underlying organic pathology.
red flags
Violent defensive behavior, stockpiling of weapons for "self-protection", absolute refusal to eat food or liquids for fear of poisoning, or disorganized flight behaviors that are life-threatening.
Standard management
- Risperidone — atypical antipsychotic with powerful D2 and 5-HT2A blockade, first line in schizophrenia
- Haloperidol — high potency antipsychotic, useful in acute delirium or paranoid agitation
- Paliperidone — active metabolite of risperidone, with the option of a long-acting injectable formulation to ensure adherence
- Olanzapine — useful if there is a marked component of anxiety or insomnia associated with delirium
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 6
- Treatment options
- 4