THE NUCLEUS Issue 2 Spring 2024

G R A N D I O S E D E L U S I O N S

treatment

Treatment for grandiose delusions can be especially challenging as it not only feels good to the person who experiences them (it is difficult to give up a sense of self importance), but also because they are often resistant to treatment due to their deeply rooted beliefs. Current forms of treatment mostly focus on managing and reducing symptoms instead of curing the underlying condition (e.g. schizophrenia). Anti-psychotic drugs and antidepressants (such as antipsychotic pimozide, risperidone and olanzapine at low doses) are the most common treatments for delusions. Other treatments may include cognitive behaviour, family and group therapy, which allow the person to develop healthier relationships and cope with their delusions. During therapy, token economies are also helpful by using a reward system to manage maladaptive behaviours through a secondary (such as giving tokens for good behaviour) and primary (such as giving a reward in exchange for the tokens) reinforcer system.

An interactionist approach towards treating people with a schizophrenic condition is important as it is considered a middle ground between the reductionist and deterministic impacts of nature and nurture on the individual. This considers both biological and psychological factors of these delusions, therefore combining the use of cognitive therapy and antipsychotic medication. By managing severe delusions (and other schizophrenic symptoms) with antipsychotics, psychological treatment will then be able to better access the individual’s cognitive skills. In the UK, this is increasingly standard practice as it allows the patient to process their own symptoms logically. However, the explanatory power of the interactionist treatment model may be limited by the causation-treatment fallacy, which argues that it is like suggesting pain can be taken away by antipsychotics, therefore pain is caused by a lack of antipsychotics (Okami & Jarvis 2019). Although taking a multidisciplinary approach doesn’t guarantee complete recovery, the interactionist approach is still considered to be necessary and effective.

Conclusions

Although you may not always come into contact with people with schizophrenia, it is important that we understand their condition and how these delusions affect their daily lives. By being more empathetic and considerate of how we act towards them, we can give them a chance to adjust to the real world, just as the Caterpillar becomes a butterfly in Alice in Wonderland.

However, there is still too little evidence for effectiveness of these treatments on schizophrenic delusions as current research is of too small scale and not high enough quality. Ongoing research to test for the effectiveness of clozapine, partial D2 agonists and long-acting injectable drugs compared to other drugs still lacks robust evidence, so there is not yet an optimal treatment for delusions.