Delusi

Delusi, or delusions, are fixed, false beliefs that are not in line with a person’s cultural background and remain resistant to contrary evidence. They are a core symptom of several psychiatric and neuropsychiatric conditions, most commonly schizophrenia spectrum disorders, delusional disorder, mood disorders with psychotic features, as well as certain neurological or medical illnesses and substance-associated states.

Delusions vary in content and can be persecutory (believing one is being harmed or watched), grandiose (belief in exceptional power or importance), referential (events are interpreted as having special meaning for the person), erotomanic, nihilistic, or somatic. They may be bizarre (clearly implausible) or non-bizarre (plausible within some contexts). Cultural and religious beliefs are important to consider, as culturally sanctioned beliefs should not be labeled as delusions without careful assessment.

Diagnosis relies on clinical evaluation, including a careful history, mental status examination, and assessment to exclude medical conditions or substances that could mimic psychosis. Diagnostic criteria are used to distinguish primary psychotic disorders from other causes; the persistence and impact of delusions, along with other symptoms, help determine the specific diagnosis and accompanying impairments.

Treatment typically involves antipsychotic medications and psychosocial interventions. Cognitive-behavioral therapy for psychosis, psychoeducation, and family support can reduce distress and improve functioning. Early treatment improves outcomes. Management also focuses on safety, addressing comorbid conditions, and considering cultural context to avoid misinterpretation and stigma.