Dr. Shyam P Lohani

In a society or a culture where a person is judged by accomplished results such as power, wealth, knowledge, and identity, megalomania is a frequent and quite regular phenomenon. It is the most common that every person starts to evaluate themselves and others early enough. However, some people often exaggerate their own worth more frequently. They boast of what they have done or are about to do or are excessively proud of some of their achievements, repeatedly demonstrating them. Boasters are usually very insensitive people and humiliate others more frequently.

Mental health has been recognised as an integral part of the overall health of an individual for a long time. There are many different conditions that are now recognised as mental illnesses. There are many forms of delusional mental disorders such as grandiose, erotomanic, jealous, persecutory, somatic, thought broadcasting, thought insertion, and mixed.

Delusional disorder
The delusional disorder has been considered an uncommon mental illness. With the data extracted from case series, case registry, and population-based samples, the prevalence of delusional disorder range from 0.05 to 0.1 per cent among the general population. About 0.02 per cent of the general population suffers from this condition in their lifetime.
Out of many mental illnesses, one condition which is often difficult to diagnose and treat is megalomania. This disease is a delusional type of self-awareness and personality behaviour characterised by an extreme degree of overestimation of the importance of self, fame, popularity, wealth, power, genius, political influence, and even omnipotence. Thus, megalomania is a kind of mental disorder when a person tends to overemphasise their self-abilities, possession, and possibilities.

The person might mistakenly believe s/he has a great talent or has made an important discovery. Those who believe superior owing to power, wealth, knowledge, origin, and/or religion often exhibit such behaviour repeatedly and sometimes unknowingly even in public. The term ‘megalomaniac’ is also more informally used for people who behave as if they are superior or great. Moreover, megalomania is a delusional disorder that causes patients to think that they have great or unlimited power or importance.

The megalomaniac patients often present more likely with complex delusions that typically impair judgment and self-esteem. These patients may be difficult to manage and/or treat because of their boundless energy and their grandiose misinterpretation of the surrounding situations. Many notorious past dictators and often great world leaders have shown megalomaniac traits. It is considered not an independent disease but a symptom of another pathological condition associated with a violation of the psyche. Megalomania most often occurs together with manic-depressive psychosis, an inferiority complex, and paranoid disorders.
Much rarer in its prevalence, the delusional disorder is much rarer than other conditions like schizophrenia, bipolar disorder, and other mood disorders due to also underreporting. They often do not seek mental health assistance unless persuaded by family or friends. The mean age of onset is about 40 years but ranges from 18 years to 90 years. Males suffer more from the persecutory, jealous, and grandiose type of delusion, while the erotomanic variety is more common in females.

Though rare, it does not show gender predominance. However, due to societal construct, in developing countries males dominantly exhibit megalomania and rarely seek professional support and treatment. People with delusional disorders are relatively stable. The exact cause of the delusional disorder is still unknown. Megalomania often manifests itself not just as non-acceptance of criticism and others’ viewpoints in general. Furthermore, people with megalomania sometimes tend to commit irrational and even dangerous deeds, completely not listening to the advice of other people.

Substance use, medical conditions, neurological conditions can lead to delusions. With cortical functioning remaining intact, the delusional disorder involves the limbic system and basal ganglia. The psychodynamic theories which have tried to explain delusional disorder include reaction formation, projection, and denial. People often develop delusion as a solution when factors like social isolation, envy, suspicion, distrust, low or high self-esteem are some of the factors which when becoming intolerable lead to a person seeking delusion as an explanation.

In the recent trend of international migration, immigrants having language barriers develop delusional disorders. People with visual and hearing problems and the elderly are special populations who are more vulnerable to some type of delusional disorder. Patients usually are well-nourished, appropriately groomed, and relatively stable. The mood is usually different with the type of delusion, for example, a grandiose patient may be euphoric, or a paranoid patient may be anxious. Mild depressive symptoms are present. Auditory hallucinations may be present in some. Memory and cognition are usually intact, and unless there is a specific delusion about person, place, or time, patients are well oriented.

Management
Megalomania most often occurs together with manic-depressive psychosis, an inferiority complex, and paranoid disorders. History of adherence to the medication helps healthcare providers select the appropriate treatment for the patient. The combination of psychopharmacology with psychotherapy usually forms a better treatment option. If left untreated, the delusional disorder might lead to depression, suicidal ideation, and suicide, often as a consequence of difficulties associated with the delusions. It can lead to dementia at a later stage. Delusions not only lead to violence or legal issues but also interfere with social cohesion.

Relapses are frequent despite the best treatment approach. The biggest obstacle to treatment is adherence to medication therapy. Mental health professionals such as clinical psychologists, psychiatrists, nurses, and clinical pharmacists should work in a team and follow up on these patients as they are more vulnerable to run into legal and work-related problems. A multidisciplinary team approach helps achieve the best patient outcomes.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)