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PSYCHIATRIC NURSING
PARANOID DISORDERS
Objectives:
At the end of the discussion, students will be able to:
Differentiate paranoid disorder from the other mental disorders.
Enumerate nursing interventions applicable for paranoid clients
Utilize knowledge and apply appropriate interventions in dealing
with mentally ill
clients.
A. Descriptiona. The client demonstrates suspiciousness and
mistrust of others.b. The client is often viewed by others as
hostile, stubborn, and defensive.c. Concrete, pervasive delusional
system characterized by persecutory and grandiose
beliefs.
B. Behaviora. Suspicious and mistrustfulb. Emotionally distantc.
Distorts realityd. Poor insighte. Hypervigilancef. Low
self-esteemg. Highly sensitive, difficulty in admitting own error,
and takes pride in being correcth. Hypercritical and intolerant of
othersi. Hostile, aggressive, and quarrelsomej. Evasive
C. Delusionsa. Serves a purpose in establishing identity and
self-esteemb. Grandiose and personality delusionsc. Process of
delusions includes denial, projection, and rationalizationd. As
trust for others increases, the need for delusions decreases
D. Types of Paranoid Disordera. Paranoid Personality
i. Suspiciousnessii. Non-psychoticiii. No hallucinations or
delusionsiv. No symptoms of schizophrenia
b. Paranoid Statei. Onset is abrupt in response to stress and
subsides when stress decreasesii. No hallucinations but experiences
paranoid delusions
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iii. Maybe sensitive and suspicious before the development of
delusionsiv. Psychotic statev. No symptoms of schizophrenia
c. Paranoiai. Client appears normal except for delusional
systemii.
Single, highly organized delusional systemiii. No
hallucinations
iv. Reserved and sensitive before onsetv. Psychotic statevi. No
symptoms of schizophrenia
d. Paranoid Schizophreniai. Prior to the onset client becomes
cold, withdrawn, distrustful, resentful,
argumentative, sarcastic, and defiant.
ii. Delusions become less logical as the client becomes more
disorganizediii. Persecutory hallucinationsiv.
Psychotic statev. All symptoms of schizophrenia are present
E. Nursing Interventionsa. Assess for suicide risksb. Diminish
suspicious behaviorc. Establish a trusting relationshipd. Promote
increased self-esteeme. Remain calm, non-threatening, and
non-judgmentalf. Provide continuity of careg. Respond honestly to
clienth. Follow through on commitments made to the clienti.
Acknowledge the clients feelings, but tell the client that you do
not share same
interpretations of events.
j. Provide a daily schedule of activities.k. Assist the client
to identify diversionary activities.l. Gradually introduce client
to groups.m. Refocus conversations to reality based topics.n. Use
role playing to help client identify thoughts and feelings.o.
Provide positive reinforcements for successes.p. Do not argue with
delusions.q. Use concrete, specific words.r. Do not be secretive
with the client.s. Do not whisper in the clients presence.t. Assure
client that he/she will be safe.u. Involve client in
nor-competitive tasks.v. Provide client opportunity to complete
small tasks.w. Monitor eating, drinking, sleeping, and elimination
patterns.x. Limit physical contact.
