In 1975, Riding and Munro reported on the successful treatment of five cases of monodelusional hypochondriacal psychosis (MHP) (now more often referred to as delusional disorder, somatic subtype), and in 1982 the present author followed this up with a report of a further 45 cases. Since then there has been an increasing number of communications regarding the successful treatment of the different subtypes of delusional disorder, unfortunately most of them on an anecdotal basis, but overall adding up to a refutation of the belief that delusional disorder is irremediable. Virtually all of these reports refer to psychopharmacological treatment.

Treatment of delusions in general

To be accurate, we rarely attempt to treat a delusion by itself but rather the illness of which it is a part, although there is a respectable psychological literature showing that delusions per se, as well as hallucinations, can be considerably modified by, for example, cognitive–behavioural therapy (Chadwick and Birchwood, 1994; Garety and Hemsley, 1994; Kingdon, Turkington and John, 1994). Psychotic disorders characterized by delusions are usually treated by neuroleptic medications or, in some cases, with electroconvulsive therapy and careful diagnosis is required to determine which treatments are most appropriate. We usually expect the delusions to improve as the underlying illness resolves although, as noted in Chapter 7 on paraphrenia, they can often be much more persistent than we realise.

In Chapter 2 we discussed illnesses associated with delusions.