Some paranoid disorders such as paranoid personality disorder and paranoid schizophrenia may have more bizarre behavior and have intense feelings of distrust or fear. These clients will not confide in others and may be difficult to talk to as they often misinterpret harmless conversation or behavior.
Criteria and symptoms must persist for one month or more, and cannot be attributed to substance use or another medical or mental condition.
- Extreme distrust and suspiciousness of others, misinterpreting motives as malevolent, begins early in adulthood
- Presents by at least four of the following:
- Suspects, without reason, that others are exploiting, harming or deceiving him or her
- Is preoccupied with unjustified doubts about the trustworthiness of friends or associates
- Is reluctant to confide in others because of fear that information will be used against him or her
- Misinterprets threatening meanings into harmless remarks or events
- Bears grudges or is unforgiving of insults, injuries
- Perceives attacks on his or her character or reputation
- Recurrent, unjustified suspicions about partner’s fidelity
- Does not occur only during, but may be diagnosed before, schizophrenia
The client will be able to identify appropriate coping techniques. The client remains safe and free from harm.
Paranoid Disorders Nursing Care Plan
- Fear of being deceived
- Feelings of being persecuted
- Poor self-image
- Social isolation
- Easily offended
- Self-righteous attitude
- Rigid behaviors and beliefs
Nursing Interventions and Rationales
- Assess the client’s neurological status
To determine if other issues may be causing symptoms or if the disorder has progressed to another serious condition such as schizophrenia
- Monitor behaviors and interactions with staff and other clients
Determine how the client interacts with others. Paranoid clients may exhibit aggressive behaviors for no apparent reason.
- Talk openly with the client about their beliefs and thoughts, showing empathy and support
Help build trust and rapport with clients. Paranoid clients may be more reluctant to trust anyone, but open communication generally offers more cooperation
- Explain all procedures clearly and carefully, and their purpose, before starting them
Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps develop trust.
- Remain aware of the client’s personal space. Avoid startling the client, sudden movements or touching the client unnecessarily
Even the best of intentions, such as a handshake, tidying the room, or body language may be misinterpreted as threatening and may lead to aggressive behavior. Showing respect for the client’s space and possessions helps build trust.
- Discuss feelings and help the client identify behaviors that cause conflict or alienate others
Helping clients see the reality of their behaviors can help treatment progress and lead to more appropriate behaviors and interactions.
- Discuss and have client demonstrate (through role-play if appropriate) more acceptable responses and reactions to behaviors and stressors
Helps the client develop more positive coping skills for dealing with delusions, suspicions, and fears
- Minimize environmental stimuli
Overstimulation from loud noises, excessive talking, television, or radio may increase paranoia and prompt erratic or aggressive behaviors.
- Encourage socialization with others, but do not force participation in activities
Help clients develop relationships and more positive interactions with others. Helps reorient the client to reality. Forcing them to participate may trigger paranoia that you are trying to trick or trap them.
- Set behavior boundaries and enforce per facility protocols with medications or restraints as necessary
Promote the safety of clients during agitated moments and the safety of others from aggressive behaviors. Follow your facility’s specific protocol regarding supervision, restraint, and documentation.
- Administer medications appropriately and monitor for reactions to medications
Antipsychotic medications may be given to manage delusions and behaviors. Monitor for adverse reactions.
- Offer praise and encouragement for accomplishments of tasks
Promote a sense of self-worth and improves self-esteem
- Consider any cultural concerns or impacts of treatment
Depending on their culture, some behaviors and beliefs may be considered acceptable to the client. Take these into consideration when implementing interventions.
- Provide reorientation as appropriate, but avoid confrontation of the delusions
The client may need to be refocused to reality at times, but avoid confrontation that may be interpreted as argumentative to avoid non-compliance and uncooperative behaviors.
- Provide education, resources, and support for client’s family and loved ones
Help family members understand the nature of the client’s illness and avoid conflict that could exacerbate the client’s symptoms. Encourages the coping skills of family members through each other and support groups.
- As client agrees, and per facility protocol, incorporate client’s family or loved ones in the ongoing treatment plan
Help develop trust between client and loved ones and promote positive management of illness going forward. Help clients and family members stay on track with treatment.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell