Paranoid Disorders
Included In This Lesson
Study Tools For Paranoid Disorders
Outline
Overview
- This includes paranoid personality disorders (Cluster A), paranoia, paranoia-induced state, and paranoid schizophrenia
Nursing Points
General
- Characterized by delusions, irrationality and closely related to anxiety and fear.
- Patients typically mistrust others and are highly suspicious, while to others they seem hostile, disturbed, and defensive.
- Things that most would view as a coincidence, those suffering from paranoia would view it as intentional
- Attribution bias
Assessment
- Some defining behaviors:
- Low self-esteem
- High value on being right/correct and find it difficult to admit they’re wrong or incorrect
- Very sensitive
- Distorts reality
- Attribution bias
- Another’s accidental behavior is viewed as very purposeful/intentional to hurt them/cause them harm
- Very critical of others
- Poor judgment
- Hypervigilant
- Very suspicious of others
- Social anxiety
- Typically single or does not have many interpersonal relationships, as maintaining friendships is difficult
Therapeutic Management
- Understand delusions
- False belief firmly held to be true, despite the rational argument
- For the patient suffering from paranoia, the delusions are actually part of who they are and their self-esteem – VERY important
- As they begin to trust and engage with others, the need for their delusion decreases
- It is very real to them
- Understand paranoia (as a stand-alone condition)
- No symptoms of schizophrenia or hallucinations (important distinction!)
- Delusions are organize
- Prior to onset, they may be more sensitive or quiet
- What to do
- SAFETY is always the priority / reassure patient that they are safe
- Start with a self-harm/suicide assessment
- Be conscious of all of your actions
- Small and seemingly meaningless things may be perceived by a patient suffering from paranoia as threatening or increase their paranoia and/or delusions.
- Start small and progress
- 1:1 interaction, gradually progress to group interaction
- Start with small, simple tasks/activities and progress to larger and more complex
- Always remain cool, calm, and collected in your actions
- Establish rapport/trust
- Consider decreasing or removing stimuli
- For example, moving from a day room to a quieter/more private area
- Be honest and genuine
- When the patient speaks in reality, use positive reinforcement
- What NOT to do
- Do NOT promote/play competitive activities
- Do not play into the delusions; stay in reality and refocus when need
- Do not speak in an accusatory manner
- Do not hold direct eye contact
- Do not whisper near them or touch them.
Nursing Concepts
- Mood Affect
- Safety
[lesson-linker lesson=”221535″]
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Paranoid Disorders
Transcript
Okay guys, in this lesson we’re going to talk about paranoid disorders.
So clients with paranoia and paranoid disorders have delusions and irrationality related to anxiety and fear, characterized by suspicion and mistrust and inability to rationalize with reality. So essentially they find it very difficult to trust others, they are highly suspicious of those around them. But, to others they appear to just be hostile or disturbed and defensive, because their paranoia doesn’t seem to be based in reality or any kind of rational thought. This includes Paranoid Schizophrenia, Paranoid Personality Disorder, and Paranoia on its own.
Some defining characteristics of paranoid disorders are when clients highly value being right, they refuse to admit when they’re wrong (or possibly can’t even see that they’re wrong), and are very critical of others. Clients will be very sensitive and hyper-vigilant and may actually resort to violence when their anxiety level is too high or fear, or if someone challenges them. Again, they are very anxious and suspicious of others and they tend to distort reality. Now there’s a difference here between distorting reality which might kind of look funny if this is reality and breaking from reality. They don’t necessarily break from reality, but they do distort it. So some things might be based in some aspects of reality, but for the most part, they have this hyper suspicion of things going on around them. Many clients with paranoid disorders experience something called attribution bias which is when something happens that most people would see as a coincidence or an accident but these clients are absolutely convinced that it was intentional. So let’s say you told them you would bring them a glass of water, but you literally just forgot because you got busy. They will be convinced that you did it intentionally, that you are trying to deprive them of water and trying to harm them. As you can imagine being critical and hyper-vigilant and super suspicious and having this attribution bias where you’re convinced that everything everyone does is intentionally trying to harm you, it can make it very difficult to develop strong personal relationships, which can be very frustrating for these clients and their family members.
Just a couple of important points, I want to remind you that delusions are false beliefs that are held firmly to be true despite rational argument. They are very real to the patient even though they are not real. Think of them like a security blanket, these delusions are what help this client cope with their paranoia so it is a very real feeling or belief to them. The more they trust you and their Healthcare team the less they need the delusions to feel safe. Now when we talk about paranoia on its own separate from paranoid schizophrenia or paranoid personality disorder, it’s a little bit different. With isolated paranoia the delusions are very organized and almost always based in some sort of reality. And what will notice is that prior to onset of the paranoia this client might be very quiet or very sensitive and then suddenly they develop this paranoid delusion. Sometimes the attribution bias is what initiates that paranoia.
As far as interventions remember that safety is our number one priority. We have said this before that some of these lists are long of interventions because of safety being a concern. Remember that those with paranoid disorders have a tendency towards violence when challenged or when they feel like they are cornered. So be very very conscious of your actions around them and never ever whisper near or around a client with paranoia of any kind. Even if all your Whispering about is what to get for lunch, they will not see it that way. Also avoid any physical Touch without permission. As with other mental health disorders, we want to decrease stimuli and start small and progress in terms of one to one interaction and then group or small tasks to more complex tasks. We also want to establish Rapport and trust and be honest and genuine in all of our interactions with these clients. One big thing is that we never do competitive activities with a client that has paranoid disorders because if they were to lose the game fair and square there’s a tendency with the attribution bias to feel like everyone is out to get them or that it was intentionally meant to make them fail. No matter what we don’t argue and we only ever reinforce things that are based in reality. That may mean that you need to set boundaries and remove yourself from a situation if needed.
So, priority nursing concepts for a patient with paranoid disorders are safety, coping, and mood affect. Always maintain a safe environment even if that means removing yourself from it.
Quick recap. Paranoid disorders are characterized by delusions and a rationality that are usually based in fear and anxiety. These clients are suspicious of everyone and this paranoia becomes a bit of a coping mechanism. Make sure we always stay in reality don’t argue with them and only reinforced things that are based in reality. Be very mindful of how you’re communicating with them including your tone as well as the things that you say. And remember no Whispering or touching without permission. This is all about safety first for you as well as the client. So make sure that you do a self harm assessment and always avoid any kind of perception of Confrontation. Remember that perception is everything in these cases.
So that’s it for paranoid disorders. Make sure you check out all of the resources attached to this lesson to learn more. Now go out and be your best self today. And, as always, happy nursing!
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
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- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
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- Nervous System
- Central Nervous System Disorders – Brain
- Renal
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- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
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- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
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- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
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- Urinary Disorders
- Postpartum Care
- Basic
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- Bipolar Disorders
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- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System