‫‪CONFERENCE ABOUT‬‬

‫‪Delusion‬‬

‫‪SUPERVISIED BY‬‬
‫‪Dr. Mona Fawzy‬‬

‫‪Dr. Hanan Faried‬‬

‫‪Fourth year - second semester‬‬

‫)‪Prepared by: (G.1‬‬

‫عبد الرحمن عصام حسن‬ ‫‪.1‬‬

‫عبد الرحمن علي بدوي اسماعيل‬ ‫‪.2‬‬
‫عبد الرحمن محمد احمد محمد‬ ‫‪.3‬‬
‫عبد الرحمن محمد عبد الرحمن احمد‬ ‫‪.4‬‬
‫عبد الرحمن محمد فتحى شحاته‬ ‫‪.5‬‬
‫عبد الرحمن مصطفى محمد على‬ ‫‪.6‬‬
‫عبد الرحمن نبيل فضل سليم‬ ‫‪.7‬‬
‫عبد الرحمن نصر محمد عبد النبى‬ ‫‪.8‬‬
‫عبد الرحيم محمد عبد الرحيم محمد‬ ‫‪.9‬‬
‫عبد الكريم خلف عبد النبى محمد حربى‬ ‫‪.10‬‬

‫‪2022-2023‬‬
Outlines
Introduction

Definition of delusion

Types of Delusions

Causes of delusion

Nursing diagnosis of Delusional

References and Sources

Introduction
A delusion is an unshakable belief in something that’s untrue. The belief isn’t a part of the
person’s culture or subculture, and almost everyone else knows this belief to be false.

Definition of Delusion
Delusions are fixed, false beliefs that conflict with reality. If a person is in a delusional state,
they can’t let go of their untrue convictions, despite contrary evidence.

Another definition :

- A delusion is an unshakable belief in something that’s untrue.

Types of Delusions
There are several different types of delusions that characterize the diagnosis of a delusion:

1. Erotomanic Delusions
▪ In this type of delusion, individuals believe that a person—usually with a higher social
standing—is in love with them.

An example of erotomanic delusional thinking would be someone who believes that an

actress loves them and that they are communicating with them via secret hand gestures
during their TV show.

2. Grandiose Delusions
▪ exaggerated conception of one’s importance power, or identity.

For example:
- a belief that one is famous or occupies a high position in society.
- a belief that one possesses magical skills such as the ability to read minds.
 3. Persecutory Delusions

▪ false belief that one is being harassed, cheated, or persecuted; often found in
litigious patients who have a pathological tendency to take legal action because of
imagined mistreatment.

For example:
- My neighbor is helping the CIA(central intelligence agency) spy on me so they
can kidnap and kill me.
- the helicopter above are from the government and they're following me.

4. Jealous Delusions
▪ A false belief derived from pathological jealousy that a Person's lover is unfaithful.

For example:
- Conviction that the spouse has some definite relation with some one else.

5. Somatic Delusions
▪ false belief involving functioning of one’s body.

For example :
▪ Belief that the brain is rotting or melting.

6. Religious delusions :
▪ the patient is preoccupied with false beliefs of a religious nature.

For example:

▪ Someone who believes god gave them the power to save the universe and everyday
they complete certain tasks that will help the planet continue on.
7. Ideas and delusion of reference:
▪ false belief that the behavior of others refers to himself or herself.

For example:
▪ a remark heard on television is believed to be directed specifically to the patient, or a
gesture by a stranger is believed to convey something about the patient.

8. Delusion of sin or guilt:

▪ False feeling of remorse and quilt.

For example:
▪ the person believes he or she committed a horrible crime or sin and should be
punished severely.

9. Delusion of passivity (being controlled):

▪ false feeling that a person’s will, thought, or feeling are being controlled by external
forces.

This type of delusion includes:

▪ Thought withdrawal:

Delusion that one’s thoughts are being removed from a person’s mind by other people or
forces.

For example:

person with paranoid personality might insist that the government is removing thoughts
from his or her mind.

▪ Thought insertion:

Delusion that’s one’s thoughts are being implanted in person’s mind by other people or
forces.
 ▪ Thought broadcasting/Audible thoughts:

Delusion that a person thoughts can be heard by others as Though they were being
broadcast into the air.

For example:

People may be at a coffee shop and might be thinking something about a man sitting right
beside them, but they will think that the man is hearing everything.

10.Delusion of mind reading:

-The patient believes that people can read his or her mind or know his or her thoughts.

-The Patient subjectively experiences and recognizes that others know his or her thoughts.

11. Delusion of poverty

▪ False belief about having lost one’s livelihood and that one is poor or that poverty is
inevitable

For example:

- The presence of delusion of poverty can be established by interviewing the patient.

12. delusion of nihilism

▪ the delusion of nonexistence: a fixed belief that the mind, body, or the world at large
or parts thereof no longer exists. Also called delusion of negation; nihilistic delusion.
▪ the belief that existence is without meaning or value.

For example:

- I died twenty-five years ago, and now only my spirit remains

Causes of Delusions
Researchers aren’t exactly sure what causes delusional behavior and states. It
appears that a variety of genetic, biological, psychological, and environmental factors
may be at play.
 • Genetic causes: Psychotic disorders seem to run in families, so researchers suspect
that there is a genetic component to delusions. 5 Children born to a parent
with schizophrenia, for example, may be at a higher risk of developing delusions.

• Biological causes: Abnormalities in the brain may contribute to delusional thoughts

and behaviors.6 An imbalance of neurotransmitters (chemical messengers in the
brain) might increase the likelihood that an individual will develop delusions.

• Environmental factors:-

▪ Physical illness.
▪ Stress predisposes to suspicions
thinking.
▪ Loss whether financial, social,
emotional or physical.
▪ Rejection, disappointment and loneliness.

• Psychodynamic explanation

▪ Freud's theory believed that the major assumption concerning delusional systems was
that the unconscious homosexuality.

The person (object) of the homosexual wishes and the conflicts are repressed through the
mechanism of denial.

Failure of the denial mechanism to repress the conflict results in a return of the
homosexual impulses. These impulses are dealt with by projective delusional defenses.

▪ Sullivan postulated that, the paranoid person suffer from deep sense of inferiority,
insecurity, and feeling of rejection. This brings feeling of loneliness and unworthiness
that are intolerable and lead to delusional thinking.

▪ Erickson believed that, delusion caused due to unachieved basic trust in the first stage
of development.

Nursing diagnosis of Delusion

 ❖ Nursing Diagnosis:
Altered thought processes

related to:

- Inability to trust.
- Biochemical/neurological imbalance.
- Panic levels of anxiety.
- Overwhelming stressful life events.
- Chemical alterations.

Evidenced by:

- Delusions.
- Impaired volition.
- Inability to concentrate.
- Inability to solve problems.

Goals:

- Patient will eliminate pattern of delusional thinking trust in others.

Nursing interventions:

A- Convey acceptance of patient's need for the false belief but share the belief.

B- Do not urge or deny the belief, use reasonable doubts as a therapeutic technique.

C- Communicate the patient by simple, concrete or concise sentences.

D-Reinforce &focus on reality.

E- If patient highly suspicious:

• To prompt trust use the same staff as much as possible, be honest &keep all
promises.
• Avoid physical contact; avoid laughing or talking quietly where the patient can see &
Cannot hear.
• Avoid competitive activities
• Use assertive matter of fact

❖ Nursing Diagnosis:
Risk for self-directed or other-directed violence
related to:

- Lack of trust.
- Panic level of anxiety.
- Catatonic excitement.
- Negative role modeling.
- Command hallucinations.
- Delusion thinking.

Evidenced by:

- Body language.
- Rigid posture.
- Clenching of fists and jaw.
- Hyperactivity.
- Pacing.
- Breathlessness and threatening stances.

Goals:

- Client will recognize signs of increasing anxiety and agitation and to staff for
assistance with intervention.
- Client will not harm self or others.

Nursing interventions:

1) Maintain low level of stimuli in client's environment.

2) Observe client's behavior frequently every 15 minutes.

3) Remove all dangerous objects from client's environment.

5) Staff should maintain and convey a calm attitude toward client.

6) Administer tranquilizing medications as ordered by physician. 7) If client is not calmed by

talking down or by medication, use of mechanical restraints may be necessary.

8) Observe the client in restraints every 15 minutes (or according to institutional policy).

9) As agitation decreases, assess client's readiness for restraint removal or reduction.

❖ Nursing Diagnosis:
Imbalanced nutrition Less than body requirement.

Related to:
 - Delusional belief.

Evidenced by:

- Refuse to eat, believe that food is poison...

NURSING GOALS

- The patient balance of diet. Will establish a balance of diet.

INTERVENTION

- Determine daily caloric requirements that are realistic and adequate

- Explain the importance of adequate nutrition.
- Arrange dietary consultation with input by the patient.
- Monitor the patient's food and fluid intake.
- Give the patient some control by allowing patient to select food (Serve food in
original container)
- Provide the patient with preferred followed frequently.
- Ensure that patient is taking medications as prescribed.
- Suggest parent, or partner to bring meals that patient likes when they visit.
- Encourage family to visit the patient at meal times occasionally.
- Allow patient to eat alone initially: gradually allow him to eat with increasing
numbers of patients and Mealtimes.

❖ Nursing Diagnosis:
Social isolation

related to:

- Inability to trust.
- Negative self-image.
- Low self-esteem.

Evidenced by:

- Impaired social interactions.

- Mistrust of others.
- Disabled family Coping.

Goal:

- Patient showed the Promoting Socialization.

Nursing interventions:

1) Encourage patient to talk about feelings in the context of a trusting,supportive

relationship.

2) Allow patient time to reveal delusions to you without engaging power struggle over the
content or the reality of the delusions.

3) Use a supportive, empathic approach to focus on patient's feelings about troubling

events or conflicts.

4) Provide opportunities for socialization and encourage participation in group activities.

5) Be aware of patient's personal space and use touch judiciously.

6) Help patient to identify behaviors that alienate significant others and family members.

Other nursing diagnosis:

A- Impaired verbal communication.

B-Sleep pattern disturbance.

C- Disturbed personal identity.

D-Ineffective individual coping

❖ Nursing Diagnosis: Disturbed Sensory Perception (Auditory/Visual)

Related to:
• Severe stress
• Sleep deprivation
• Excessive stimulation
• Altered sensory perception
• Misuse of medications, alcohol, or illegal substances
As evidenced by:
• Anxiety
• Panic
• Talking or laughing to self
• Rapid mood swings
• Seeing or hearing things that aren’t there (hallucinations)
• Inappropriate responses
• Disorientation
 • Tilting head as if to listen to something

❖ Disturbed thought process related to inability to trust evidenced by Suspicious of

other.
Nursing goal:
Patient will eliminate pattern of delusional thinking trust in others.
Intervention:
• Provide patient with honest and Consistent feedback in a nonthreatening manner.
• Don't make promises that you can't keep.
• Use simple and clear language when speaking to patient.
• Don't urge or deny the belief, use reasonable doubts as a therapeutic technique.
• If patient highly suspicious:-
- To prompt trust use the same stuff as much as possible.
- Avoid physical contact avoid laughing or talking quietly where the patient. can
see, Can't hear.
- Avoid Competitive activities.
Evaluation:
Exhibits improved reality orientation concentration, and attention span as demonstrated
through speech and behavior.

❖ Risk For Self directed or other-directed violence related to Delusional thinking

evidenced by Body language rigid posture Clenching of fists and jaw, hyperactivity,
Pacing breathlessness and threatening stances.

Nursing goal:
Patient will not harm self or others.
Intervention:
-Staff should maintain and Convey a calm attitude toward patient.
-Try to redirect the violent behavior with physical outlets for patient's anxiety. physical
exercise is a safe and effective way of relieving pent-up tension.
-observe patient's behavior Frequently (every 15 minutes)
-Have sufficient staff available to indicate a show of strength to client if it becomes
necessary. This shows the client evidence of control over the situation and provides
some physical security for staff.
-Administer tranquilizing medications as ordered by physician. Monitor medication for
its effectiveness and for any adverse side effects. The avenue of the least restrictive
alternative‖ must be selected when planning interventions for a psychiatric client.
-If client is not calmed by talking down‖ or by medication, use of mechanical restraints
 may be necessary. Be sure to havesufficient staff available to assist. Follow protocol
established by the institution. The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) requires that the physician reissue a new order for restraints
every 4 hours for adults and every1-2 hours for children and adolescents.
-Observe the client in restraints every 15 minutes (or according to institutional policy).
Ensure that circulation to extremities is not compromised (check temperature, color,
pulses). Assist client with needs related to nutrition, hydration, and elimination.
Position client so that comfort is facilitated and aspiration can be prevented. Client
safety is a nursing priority.
-As agitation decreases, assess client‘s readiness for restraint removal or reduction.
Remove one restraint at a time while assessing client‘s response. This minimizes risk of
injury to client and staff.
Evaluation:
Patient remains free from harm or violent acts.

❖ Imbalanced nutrition less than body requirement related to delusional belief

evidenced by refuse to eat, believe that food is poisoned.

Nursing goal:
The patient will establish a balance of diet.
Intervention:
-Determine daily caloric requirements that are realistic and adequate

-Explain the importance of adequate nutrition.

-arrange dietary Consultation with input by the patient.

-Monitor the patient’s food and fluid intake.
-Give the patient some control by allowing patient to select food (Serve food in original
container.
-Provide the patient with preferred followed frequently.
-Ensure that patient is taking medications as prescribed.
-Suggest parent, or partner to bring meals that patient likes when they visit.
-Encourage family to visit the patient at meal times occasionally.
-Allow patient to eat alone initially; gradually allow him to eat with increasing numbers of
patients and mealtimes.
Evaluation:

The patient ingest adequate amounts of food and fluids.

References and Sources
1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide
Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
2. Kopelowicz, A., Liberman, R. P., & Zarate, R. (2006). Recent advances in social skills
training for schizophrenia. Schizophrenia bulletin, 32 Suppl 1(Suppl 1), S12–S23.
3. Langdon, R., Connors, M. H., & Connaughton, E. (2014, December 4). Social cognition
and social judgment in schizophrenia. Science Direct.
4. Townsend, M. C. (2011). Nursing Diagnoses in Psychiatric Nursing Care Plans and
Psychotropic Medications.
5. Arnold K, Vakhrusheva J (2015). "Resist the negation reflex: Minimizing reactance in
psychotherapy of delusions". Psychosis.
6. Bell V, Halligan PW, Ellis H (2003). "Beliefs about delusions" (PDF). The Psychologist.
Archived from the original (PDF) on 28 July 2011.
7. Blackwood NJ, Howard RJ, Bentall RP, Murray RM (April 2001). "Cognitive
neuropsychiatric models of persecutory delusions". The American Journal of
Psychiatry.
8. Coltheart M.; Davies M., eds. (2000). Pathologies of belief. Oxford: Blackwell.
9. Persaud, R. (2003). From the Edge of the Couch: Bizarre Psychiatric Cases and What
They Teach Us About Ourselves. Bantam.