Paranoid Schizophrenia

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Specializes in Medical-Surgical, Emergency.

Good day!

I'm a student nurse.. Currently, I am in a Psychiatric nursing rotation.. We just had our Christmas break, then we will resume again in January..

The essence of this message is that I would like to seek advice for my mentally-challenged client.. She's an old-adult with Paranoid Schizophrenia.. Will it be right for me to present her with reality or would it be a non-therapeutic approach because I would "challenge" her? I just thought that exploration or agreeing would just make her get indulged more with her delusions.. Another concern is that she told me that she did not like the previous student-nurses, she had nurse-patient interaction with, whom she said, "did not believe her (referring to her delusions).."

I'm just concerned with losing the established rapport with her.. We will still be meeting for 5 days for this coming January.. May I know what could be my possible approach or when will be the best time to start presenting her with reality?

The movie a Beautiful Mind inspired me that there's hope if the mentally-challenged client will be able to accept and realize the delusions on her own..

If it will be alright, encourage me to post her delusions if it will help with suggesting interventions.. If it would compromise privacy, I'll settle with "delusions.."

Thank you! :)

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I would certainly not try to get her to see reality. If she could she wouldn't be mentally ill.

Therapeutic responses to her delusions should acknowledge her feelings while keeping her on trck with what needs to be accomplished. "Well, I don't believe your room mate is in the CIA. But let's .... now." "That's must be upsetting to you but I do not think that the aide wants to hurt you. Now, let's...." Kindly, of course, and gently, but firmly and accepting the delusions without reinforcing their validity. It's a very fine, difficult line to walk.

Good luck.

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Specializes in Family Nurse Practitioner.

I agree with Suesquatch and usually say things like "I know you hear the voices but I do not. That must be scary/distracting etc., what are they saying?" That affirms that you believe her and hopefully can get some insight into her frame of mind eg. suicidal or homocidal. I wouldn't let her complaint about the previous nursing student make you nervous. Its anyone's guess as to what their interactions truly were and remember that our psych patients are often very intelligent and expert splitters. Good luck. :)

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Specializes in Medical-Surgical, Emergency.

Ow, I forgot to include that my client is a nurse.. So that's another problem I have..:D She knows about the meds, approaches, and denies that she is mentally-challenged..

..thank you for the Comments..^^ a Merry Christmas to you..! :)

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Specializes in Family Nurse Practitioner.

Ewwww, I'm not sure I'd want to tackle that one, lol. Acutally I bet you will learn a ton from her this will be an excellent clinical experience for you. Do let us know how you make out. :up:

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Specializes in Medical-Surgical, Emergency.

Yes, I believe this case is challenging, to note that it's my first time.. I'll take not of your suggestions and carry them out..:D Again, thank you for your help..^^

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Specializes in psych, addictions, hospice, education.

Also, remember that one of the classic symptoms of schizophrenia is disbelief that one has the disease....

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Specializes in Medical-Surgical, Emergency.

Will it be a good thing to just let her delusions be? Or should I try presenting her with reality?

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Will it be a good thing to just let her delusions be? Or should I try presenting her with reality?

Denying her delusions or challenging them will most likely not end well. Sue had it right with acknowledging but not validating.

When you are in the midst of a delusion it is as real as your normal reality. Someone denying it can lead to all kinds of issues, anger and mistrust being big ones.

(Not speaking from nursing experience, speaking from the experience of having been delusional :) )

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Specializes in Medical-Surgical, Emergency.

It's really nice to hear from people who actually experience.. I appreciate your courage..:)

..in her situation, she does not see nor feel but only believes in her delusions.. will it be right too state? uhm, it's like this, she thinks that she has a husband and children but in reality, she's single and never been pregnant..

..in our first NPI, I tried asking for the ages of her children and was able to conclude that her eldest would not be of that age she stated when it will be in reality.. The age stated would have been for 4 years from this year to be possible.. Though I didn't tell her about that and replied with an "ok, i see.." only.. You think I gave a wrong reply? :(

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..in our first NPI, I tried asking for the ages of her children and was able to conclude that her eldest would not be of that age she stated when it will be in reality.. The age stated would have been for 4 years from this year to be possible.. Though I didn't tell her about that and replied with an "ok, i see.." only.. You think I gave a wrong reply? :(

My sister has been sick since she was 16, 35 years now. She still thinks that she is 120 pounds and breaking back into modeling.

No, it doesn't work. Wrong? Not so much wrong as useless.

Her favorite joke is the guy who breaks down outside of the mental hospital. He hears a voice from the bushes say, "Let the car sit for 10 minutes. You flooded the engine."

The guy waits and the car starts. He calls out, "How'd you know that?"

The voice from the bushes answers, "I'm here because I'm nuts, not stupid."

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Specializes in Med-Surg, Psych.
The movie a Beautiful Mind inspired me that there's hope if the mentally-challenged client will be able to accept and realize the delusions on her own..

Just a warning that Hollywood does not depict psychiatric disorders accurately.

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