Symptom Finder - Delusions
DELUSIONS
A delusion is a persistent false belief. The feeling that one is being followed or watched, that one has a bad odor even after frequent and
careful bathing, that one is superior to others—all are examples of delusions. Although most patients presenting with a delusion have a functional disorder, the astute clinician knows the organic disorders of the brain that may be associated with a delusion. The mnemonic
VINDICATE forms a simple method for ready recall of these disorders.
V—Vascular disorders suggest cerebral arteriosclerosis with lacunar infarcts or cerebral emboli.
I—Inflammatory disorders suggest cerebral abscess, tuberculomas, viral encephalitis (e.g., herpes simplex), and general paresis.
N—Neoplasms, both primary and metastatic, should always be considered, as these are potentially treatable.
D—Degenerative diseases include senile and presenile dementia, Huntington chorea, diffuse sclerosis, and many other conditions.
I—Intoxication brings to mind alcoholism, bromism, chronic use of both “uppers” and “downers,” lysergic acid diethylamide (LSD), and
cannabis. Uremia, CO2 narcosis, chronic anoxia, electrolyte disorders, and early hepatic coma should also be considered.
C—Congenital diseases suggest Schilder disease, mongolism, Wilson disease, and many other conditions associated with mental retardation.
A—Autoimmune diseases focus on lupus erythematosus, allergic angiitis,
and MS.
T—Trauma facilitates the recall of concussion and chronic subdural hematomas.
E—Endocrine disorders include suprasellar tumors that invade the hypothalamus, acromegaly, hypopituitarism, hyperthyroidism, Cushing
syndrome, and adrenal insufficiency. Parathyroid dysfunction can also cause delusions.
Approach to the Diagnosis
The important thing to do before referring these patients to a psychiatrist is to perform an evaluation of the mental status and a neurologic
examination. Memory of recent events, orientation in time and place, ability to perform serial sevens, and interpretation of proverbial phrases should all be tested for. Psychologic testing may be warranted in borderline cases as well as an EEG, CT scan, skull roentgenogram, and
spinal tap. A drug screen may also be indicated. Additional tests are listed below.
A delusion is a persistent false belief. The feeling that one is being followed or watched, that one has a bad odor even after frequent and
careful bathing, that one is superior to others—all are examples of delusions. Although most patients presenting with a delusion have a functional disorder, the astute clinician knows the organic disorders of the brain that may be associated with a delusion. The mnemonic
VINDICATE forms a simple method for ready recall of these disorders.
V—Vascular disorders suggest cerebral arteriosclerosis with lacunar infarcts or cerebral emboli.
I—Inflammatory disorders suggest cerebral abscess, tuberculomas, viral encephalitis (e.g., herpes simplex), and general paresis.
N—Neoplasms, both primary and metastatic, should always be considered, as these are potentially treatable.
D—Degenerative diseases include senile and presenile dementia, Huntington chorea, diffuse sclerosis, and many other conditions.
I—Intoxication brings to mind alcoholism, bromism, chronic use of both “uppers” and “downers,” lysergic acid diethylamide (LSD), and
cannabis. Uremia, CO2 narcosis, chronic anoxia, electrolyte disorders, and early hepatic coma should also be considered.
C—Congenital diseases suggest Schilder disease, mongolism, Wilson disease, and many other conditions associated with mental retardation.
A—Autoimmune diseases focus on lupus erythematosus, allergic angiitis,
and MS.
T—Trauma facilitates the recall of concussion and chronic subdural hematomas.
E—Endocrine disorders include suprasellar tumors that invade the hypothalamus, acromegaly, hypopituitarism, hyperthyroidism, Cushing
syndrome, and adrenal insufficiency. Parathyroid dysfunction can also cause delusions.
Approach to the Diagnosis
The important thing to do before referring these patients to a psychiatrist is to perform an evaluation of the mental status and a neurologic
examination. Memory of recent events, orientation in time and place, ability to perform serial sevens, and interpretation of proverbial phrases should all be tested for. Psychologic testing may be warranted in borderline cases as well as an EEG, CT scan, skull roentgenogram, and
spinal tap. A drug screen may also be indicated. Additional tests are listed below.
