Hypothetical Q's about psychotic beliefs and antipsychotics

[Rev. Rye]

From what I've learnt, psychosis is a false perception of reality, which is categorized into 2 kinds: hallucinations and delusions.

1) I believe that antipsychotics are usually prescribed when a person has a paranoid belief. However, I think that psychiatrists rarely bother to check whether the paranoid belief is true or not. They just assume that the paranoid belief is false because they deem it implausible. Consider person A who thinks his wife is spying on him. If he is right about his wife spying on him, then his belief that his wife is spying on him is not psychotic. In fact, if his wife was really spying on him and he believed that she wasn't, then that would be a psychotic belief, for it would be false. So why don't psychiatrists spend more time verifying the falsity of a particular paranoid belief before labeling it a "delusion".

2) Suppose person B believes that his wife isn't spying on him when in fact she is. B is psychotic because he has a false belief about his wife. Would he respond to antipsychotics? This is an example of a psychotic (false) belief that isn't paranoid.

3) For another psychotic belief that isn't paranoid, consider a physics student who believes that the sun actually rises in the west and that it is an optical illusion that it rises in the east. Would he respond to antipsychotics? Or more importantly, should society prescribe him antipsychotics or try to engage him in an intellectual debate? For all we know, he may be the next Einstein!

4) Finally, and relevant to this forum, should religious people be prescribed antipsychotics? Have any religious people become atheists as a result of antipsychotic treatment? I ask because we know that religious belief is one delusion that does not respond well to reason or argument by itself.

From what I understand, paranoid delusions are not in and of itself sufficient for the sort of diagnosis that would merit antipsychotics.  The DSM says of the following symptoms, two would be necessary:

(1) delusions
(2) hallucinations
(3) disorganized speech (e.g., frequent derailment or incoherence) 
(4) grossly disorganized or catatonic behavior
(5) negative symptoms, i.e., affective flattening, alogia, or avolition

However, one would be sufficient under specific situations, like a voice doing running commentary over a person's actions or thoughts or multiple voices conversing, or, in a more germane example: delusions that are bizarre. I had a coworker who claimed he knew another person who complained that his dog was selling condos on his property. That's the sort of paranoid delusion that would be an instant diagnosis. That said, I don't think psychologists are likely to do such an investigation over paranoid delusions that are actually plausible, and may be likely to err on the side of delusion.