Involuntary treatment of delusional disorder, persecutory type

Patients with delusional disorder, persecutory type have strongly held self-referent delusions. Because they are also usually profoundly insightless, these patients are difficult to engage in treatment. As well as high levels of suicidal ideation, they also frequently have the belief that others intend to cause them harm and they may act on their delusions and become violent. A selective narrative review of the research into the treatment of delusional disorder, persecutory type published since September 2019 found no randomised clinical trials of pharmacological treatments. A critical appraisal of those few identified studies highlighted the limitations and the low quality of evidence including a lack of consistent, validated measures of antipsychotic response or symptom outcome.The implication of these findings is that for many patients with delusional disorder, persecutory type, the risk–benefit ratio may weigh heavily towards assertive treatment by a specialist mental health service using long-acting injectable antipsychotics and that management may require to be facilitated by the involuntary treatment provisions of the relevant mental health legislation.