Paranoid Disorders

I. e. Nursing interventions
A. Description
1. Disorders in which the client exhibits a mistrust 2. Paranoid delusional disorder
and a suspiciousness of others a. Description: disorder in which there is paranoia
2. The client is often misunderstood and judged to or persecutory delusions (fixed false beliefs)
be obstinate, defensive, and hostile.
b. Assessment
B. Assessment 1) Belief or paranoia that the person or loved ones
1. Feelings of grandiosity are singled out for being victimized, such as being
2. Persecutory behavior watched by the Federal Bureau of Investigation
3. Distorted reality (FBI), being followed, or being plotted against
2) Feelings of being conspired against, spied or
C. Nursing Diagnoses cheated on, poisoned or drugged, and harassed
1. Anxiety 3) Often ends up in court to rectify issues that are
2. Ineffective denial caused by the person’s belief that others are
3. Defensive coping intentionally harassing him
4. Risk for violence other directed 4) No hallucinations
5. Ineffective coping 5) Uses denial as a defense mechanism
6. Social isolation 6) Ideas of reference (things in the environment are
7. Impaired adjustment taken personally)
7) Lack of trust
D. Types of Paranoid Disorders 8) Irritable
9) Angry or violent
1. Paranoid schizophrenia
a. Description c. Nursing interventions
1) Devastating disorder affecting an individual’s 1) Instruct the client on relaxation techniques, such
thinking, language, emotions, ability to perceive as visual imagery, deep breathing, and progressive
reality, and social behavior muscle relaxation.
2) Predominant features are delusions and
hallucinations. 2) Instruct the client on calming techniques, such as
3) The average age of onset is in late adolescence or soothing music, warm milk, prayer, meditation, or
early adulthood. going for a walk.
b. Theories 3) Encourage recreational games or cooperative
c. Assessment sports.
1) Persecutory delusions: preoccupation with one or 4) Encourage individual counseling.
more untrue beliefs 5) Identify stressors and responses to those
2) Auditory hallucinations stressors.
3) Disturbed ability to achieve education, work, and 6) Use distractions.
maintain relationships 7) Assist the client to develop a selfawareness of
4) Social isolation delusional thoughts.
5) Unable to establish trust 8) Encourage identification of feelings.
6) Argumentative 9) Assist the client to develop new ways to change
7) Anger and potential violence problematic behavior.
8) Threatened safety of self and others 10) Encourage the client to journal feelings.
9) Anxiety 11) Promote resiliency such as connectedness to a
d. Assessment trusted adult or a spiritual belief system.
12) Provide emotional support.
13) Actively listen to the client’s concerns.
 Paranoid Disorders
14) Enhance coping by facilitation of meditation 16) Sense of self-importance
and relaxation. 17) Nervousness
15) Assist the client to develop a support system. 18) Lack of social support systems
16) Ensure safety for the client and others. 19) Delusional thinking
17) Provide opportunity for the development of 20) Uses projection as a defense mechanism
problem-solving skills. 21) Very private
18) Promote a sense of trust by maintaining eye
contact with the client. d. Nursing interventions
1) Remove dangerous objects from the client’s
3. Paranoid personality disorder environment.
2) Identify stressors and the responses to those
a. Description stressors.
1) A sense of distrust and suspiciousness in others; 3) Provide counseling.
perceive their motives as malevolent 4) Foster trust with the client.
2) More common in men 5) Actively listen to the client’s concerns.
3) Develops early in adolescence and early 6) Provide assistance in utilizing anger control
adulthood techniques.
7) Encourage anxiety reduction and relaxation
b. Theories exercises.
1) Biological 8) Identify impulsive thoughts and behaviors.
a) Genetic predisposition: more common in families 9) Encourage new coping strategies.
with persecutory delusional disorders and chronic
schizophrenia; excess of limbic and sympathetic 4. Paranoia from substance withdrawal
system reactivity with an acceleration of synaptic
activity; not a result of a medical condition a. Assessment
1) Amphetamines
2) Environmental a) Paranoia
a) One’s experiences contribute to its development. b) Restlessness and agitation
c) Decreased or increased sleep
c. Assessment d) Exhaustion
1) Is highly suspicious of others and finds hidden e) Disorientation
meanings f) Depression and suicidal thoughts
2) Mistrusts others, including friends and relatives
3) Believes others are exploiting him 2) Cocaine and crack cocaine
4) Extreme jealousy over his partner a) See assessment section for amphetamines.
5) Doubts the fidelity of his partner b) Increased appetite
6) Questions the loyalty of others c) Drug cravings
7) Suspects others’ motives
8) Hypersensitive and hypervigilant 3) Alcohol
9) Misperceives criticism from a) Tremors or seizures, or both
others b) Tachycardia and hypertension
10) Blames others for his difficulties c) Decreased appetite
11) Unable to confide in others d) Disorientation
12) Becomes easily angered or has a lack of humor e) Decreased sleep
13) Holds grudges persistently f) Delusions
14) Avoids relationships, especially those in which g) Visual hallucinations
he feels lack of control
15) Rigid, with a need to be in control
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b. Nursing interventions for substance withdrawal
1) Monitor vital signs.
2) Monitor for suicidal thoughts.
3) Ensure a nonstimulating environment.
4) Encourage rest and sleep, if possible.
5) Remain with the client if disoriented.
6) Promote reality orientation.