02.10 Paranoid Disorders

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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!
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