Delusions

False unshakable belief which is out of keeping with the patients social and cultural background.

Primary delusions.

Secondary delusions.

Primary delusions
A new meaning arises not in connection with other psychopathological event and is not understandable.

Delusional mood: has knowledge of something going on around him but do not know what it is.

Delusional perception: attribution of new meaning to a normally perceived object.

Delusional idea: delusion appears fully formed in the mind.

Secondary delusions
A delusion which is understandable in terms of persons cultural background or emotional state.

Content of delusions
Delusions of persecution

Persons or groups.

About to be killed or being tortured.

Being robbed of property or knowledge.

Of being poisoned or infected.

Delusions of reference.

Delusions of influence.

Delusions of jealousy.

Infidelity- seen in brain disease, alcohol addiction, affective psychoses and can be dangerous, may
attempt murder.
Delusions of love.

Erotomania: may try to follow, contact or persuade.

Grandiose delusions.

Schizophrenia, drug dependence ,organic brain syndromes, mania (jocular and haughty).

Regarding worth, talent, knowledge or power.

Delusions of ill health

Depressive illness, schizophrenia.

Could be extended to cover persecutory delusions.

Hypochondriacal delusions.

Some physical defect, disorder or incurable diseases.

Infestations, ugly or dysfunctional body parts

May include spouse or children.

Result of somatic hallucinations in schizophrenia.

Delusions of guilt

Unpardonable sin.

Can give rise to persecutory delusions.

Lead to suicide.

Nihilistic delusions .

Denies the existence of body, mind, loved ones or the whole world.

Very agitated depression, delirium, schizophrenia.

Delusions of poverty- Destitution is facing him and family.

Delusional misidentification.

Capgras syndrome.

Religious delusions- Can be grandiose in nature.

Delusions of control.
Treatment
Antipsychotics

Typical

Atypical

Sedatives / hypnotics

Understanding levels of intensity

Stage 1

Moderate anxiety.

Usually pleasant.

Inappropriate grinning, moving lips, silent and preoccupied.

Stage 2
Repulsive content.

Autonomic signs.

Poor attention span.

Lose ability to differentiate from reality.

Stage 3
Severe anxiety.

Directions will be followed.

Physical symptoms of severe anxiety.

Stage 4
Panic stage.

Terror stricken behaviors.

Potential for homicide or suicide.

Physical activity reflects content of hallucination

Management

Goal of Management
Help to increase awareness of the symptoms to distinguish the reality.

Steps
Facilitative communication.

Observation and listening.

Can talk about hallucination to know about the level of symptoms.

Talking about hallucination is reassuring and self validating for the patient.

If left alone, it will overwhelm coping resources.

Interactive discussions are very helpful.

Communicate right at the time of hallucination.

Modulation of sensory stimulation.

Principles
Eye contact.

Speak simply but slightly louder.

Call by name.

Use touch.

Strategies
Establish trusting IPR.

Calm, patient, acceptance, active listening.

Asses for symptoms duration, intensity and frequency.

Observe for behavioral clues.

Help to record number of hallucinations.

Focus on symptoms and help to describe the happening.

Empower by helping to understand.

Help to control over hallucinations.

Identify whether drugs or alcohol have been used.

If asked, point out that you are not experiencing same stimuli.

Do not argue.

Suggest and reinforce use of interpersonal relationships as a symptom management technique.

Encourage to talk.

Help to mobilize social support.

Help to describe and compare current and past hallucinations.

Determine the pattern if any.

Encourage to remember when it began first.

Pay attention to the content may helpful in predicting the behavior.

Alert for commanding hallucinations.

Determine the impact of the patients symptoms on ADL.

Provide feedback on coping responses.

Help to recognize symptom triggers and management strategies.

Place delusion in a time frame and identify triggers.

Identify all the components , triggers related to stress or anxiety.

If related with anxiety, teach anxiety management skills.

Develop symptom management program.

Assess intensity frequency and duration

Fleeting delusions can be worked out in a short time frame.

Listen quietly until need to discuss.

Identify emotional components.

Respond to the underlying feeling.

Encourage discussions with out assuming right or wrong.

Observe for evidence of concrete thinking.

Is patient and nurse using language in the same way.

Is patient takes you literally.

Observe speech for symptoms of a thought disorder.

May not be a time for discrepancy.

Observe ability to use cause and effect relationship.

Is patient making logical predictions based on past experiences.

Is patient conceptualizes time.

Is patient using recent or remote memory meaning fully.

Distinguish between description and facts of the situation.

Identify false situations.

Promote the ability to test reality.

Determine hallucinations.

Carefully question the facts as they are presented and their meaning.

To be done after previous steps.

Discuss consequences when the person is ready.

Allow to take responsibility of own action.

Encourage personal responsibility in wellness and recovery.

Promote distraction as a way to stop focusing on delusions.

Promote physical activities.

Recognize and reinforce healthy and positive aspects of personality.

Nurses responsibility
Don’t argue or reject.

Try to keep them engaged.

Encourage to practice some relaxation techniques.

Use distractions, exercising, hobbies, saying stop.

Calming by a glass of water or counting.

Be tactful in approach.

Do not express approval.

Acknowledge feelings or fear.

Reassure and encourage.

Explain clearly what you are doing and why.

Maintain consistency.

Keep communication open and non judgmental.

Listen understand and respect their feelings.

References
Stuart GW, Lararia MT. Principles and practices of psychiatric nursing (8th edn) Mosby publications;
Missouri, 2005.

Hamilton M. Fish's clinical psychopathology (2nd edn) Varghese Publications; Bombay ,1994.