## Evaluation Evaluating delusional states can prove difficult, even for the seasoned clinician. Before a psychiatric evaluation, the clinician should rule out delusional manifestations in the setting of a medical disease. No specific diagnostic test exists to identify delusions; however, the following factors should be considered essential in any clinical evaluation. - **Genetics and family history as a risk factor:** A positive family history of mental disorders should be considered a risk factor in symptom expression. [\[34\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) - **Environment as moderator:** Smeets et al (2014) noted evidence suggesting environmental implications on the manifestation and theme of delusions. [\[35\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) - **Early exposure to trauma as a specific risk factor:** There is a significant body of research on the link between early/childhood exposure to trauma and the subsequent development and severity of delusions. [\[36\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) Some researchers have proposed that the type of trauma may impact the level of risk and the expression of the delusional material. [\[36\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) [\[37\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) - **Tenacity of beliefs:** Despite their encapsulation, these beliefs are impervious to reasoning, evidence, and argument; attempts to confront the delusions may precipitate resistance, early treatment termination, and alienation from the patient. [\[38\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) - **Content and culture:** Delusions appear in many cultures. Persecutory delusions appear most frequently, followed by religious and grandiose delusions. However, recent research indicates that the delusional content and expression partly reflect the person's culture and the socio-economic and political events experienced by that person. [\[39\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) [\[40\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) [\[41\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) Go to: ## Treatment / Management Individuals experiencing delusions do not often seek medical attention voluntarily, as their delusions are ego-syntonic, leading to the externalization of psychic distress onto others. Often, patients are prompted to seek help by concerned family members after noticing social and occupational dysfunction. [\[42\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) If an individual seeks treatment, creating therapeutic rapport is the quintessential aim for the clinician. [\[43\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) Direct attempts to confront delusions are unlikely to be successful and may lead to significant patient distress. A more fruitful focus for clinicians may be to suspend judgment and examine these beliefs' impact and potential function in the patient's daily life. Focusing on context, exploration, and further understanding of the patient's culture and history will likely prove more productive. Bebbington and Freeman (2017) proposed an integrated neuropsychiatric framework for understanding and treating delusions. The authors indicate that treatment requires amelioration of biological and psychological aspects and that both processes must occur to lead to remission. The remission of the biological aspect consists of the dampening of mesolimbic dopamine release with antipsychotic medication. This reduced dopaminergic activity decreases the uneven salience and attribution of personalized meaning to surrounding stimuli. With the decrease in salience intensity, the person can reassess the stimuli and more accurately distribute attention, reducing the level of over-personalized meaning and leading to a more realistic appraisal of the situation. The therapist can attempt to "shake" the once "unshakable" delusion as insight improves. [\[44\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#) Psychological remission consists of the reappraisal of primary psychotic experiences. Both remission forms are partially independent, and shifts in both areas are required to remission symptoms. [\[45\]](https://www.ncbi.nlm.nih.gov/books/NBK563175/?utm_source=chatgpt.com#)