Management of delusion Bsc h nursing psychiatric

1. S UBMITTED TO; S UBMITTED BY;
P RERNA M A”AM M ANSI
T UTOR 0 3 350306619
C ON, V M MC & SJH B SC(H) N URSING 3 R D Y R.
MANAGEMENT OF
DELUSION

2. DELUSION
Delusion is a strong
fixed unshakable
belief irrespective of
their sociocultural
background.

3. TYPESOF DELUSION
1. DELUSION OF PESECUTION:
Having a strong suspiciousness belief that
others are trying to harm her /him.
ex: Patient verbalizes that , my friend is
having a plan to kill me.
2.DELUSION OF GRANDEUR:
Strong unshakable belief that he/ she is an
important famous personally or superior
knowledge or ideation or power.
ex: patient verbalize that ‘ I am the god’.

4. 3.DELUSIONOFREFERENCE:
Strong unshakablebeliefthat other person is
referring oneself with a neutral event in the
environment.
Ex: patientsays that “ theyare talkingabout me’.
4.NIHLISTICDELUSION:
Strong unshakablebeliefthat the world is not
existingand patientdenies or does not accept the
existenceof his body , his lovedones.
Ex: patient verbalizes that “ world is not existing”
or “ he is dead” or “his leg is missing” or everyone
is dead”.

5. 5.DELUSIONOF JEALOUSY/DELUSIONOF
INFIDELITY/OTHELLO SYNDROME.
Strong unshakablebeliefthat his/ her spouse
has extramarital relationshipwithother person.
EX: patientverbalizesthat the my wife is having
a lovewith other guy.
6. EROTOMANICDELUSION/ DELUSIONOF LOVE
:
Strong unshakablebeliefthat some famous
personalityis havinglovedesire on oneself.
Ex: patientverbalizesthat “actor is havinglove
desire towardsme”.

6. 7. DELUSIONOF GUILT:
Strong unshakablebeliefthat the
individualfeel more guiltto an extent
which is unreal.
ex: Patient feel that “he is highly
responsiblefor the disasterhappened”.
8. DELUSIONOF POVERTY:
Strong unshakablebeliefthat he/she
will be deprivedof material possession.
ex: patientverbalizesthat my assets are
goingto be stolenby my friends.

7. 9. DELUSIONOF CONTROL:
Strongunshakablebeliefthat ones own
thoughtsor action has been controlledfrom
outside.
ex; patientverbalizesthat my actions are
controlledby ghost.
10. DELUSIONOF THOUGHT BROADCASTING;
Strongunshakable beliefthat ones own
thoughts has been projected/ displayed in
mass media such as television, newspapers,
internet,etc.
Ex;Patientsverbalizesthat ‘ my ideas are
shown in TV’.

8. MANAGEMENTOF DELUSION
1.PSYCHOLOGICAL THERAPY
(1) Cognitive therapy
Cognitive therapy is a form of psychotherapyin which the
distorted cognitions are modified into positive cognitions.
(2) FAMILY THERAPY
In this the issues and or problems or conflicts existing
among family members are addressed and the solution is
identified.
(3) INDIVIDUAL THERPAY
Interactional process between the patient and mental
health professional on one to one basis. The issues
addressed are life adjustment issues , relationship issues
and self esteem etc.

9. (4)GROUP PSYCHOTHERPAY
Mentally ill patients are placed into
groups , guided by the therapist for
the changing of maladaptive
behaviour .
(5) SUPPORTIVE PSYCHOTHERAPY
Defined as the kind of psychotherapy
which help to decrease the
psychological conflicts and strengthen
the patients defence with the help of
techniques such as suggestion ,
reassurance,counselling ,re-education
etc

10. PHARMACOLOGICAL TREATMENT
Primary medications used to help treat delusion disorder
are antipsychotics.
Medications include the following:
1. FIRST GENERATION ANTIPSYCHOTICS.
Chlorpromazine, Fluphenazine, haloperidol
,trifluoperazine.
2.SECOND GENERATION ANTIPSYCHOTICS
. Risperidone , clozapine, quetiapine , ziprasidone ,
olanzapine.

12. STRATEGIES FOR WORKINGWITH
PATIENTSWHO HAVEDELUSIONS.
1.Identify the triggeringfactors
2.Asses the intensity, frequency and duration of delusion.
3.Identify emotional componentof the delusion.
4. observespeechfor symptoms of a thoughtdisorder.
5.Distinguishbetweenthe descriptionof the experienceand the facts of
the situation.
6.Carefullyquestionthe facts ass they are presentedand their meaning .
7.Discuss the consequencesofthe delusionswhen the patient is ready.
8. promotedistractionsas a way stopfocusing on the delusion.

13. BARRIERS TO SUCCESFULINTERVENTIONS
FOR DELUSIONS
1. Becoming anxious and avoiding the person
2. Reinforcingthe delusion.
3.Attemptingto prove the person is wrong .
4. Failingto clarify confusion surrounding the delusion.
5.Being inconsistentin the interventions.
6.seeing the delusion first and the person second.

14. NURSING MANAGEMENT
1.NURSING DIAGNOSIS
Disturbedthought processrelatedto neurochemicalfactorsas evidenced by delusion of persecution.
INTERVENTION
➢ Assessthe intensity , content, frequencyand durationof delusion.
➢Assessthe environmentaltriggering factors.
➢Communicatewith client calmly and gentaly.
➢Avoidingarguing about delusion.
➢Encourageto ventilate distressingthoughts .
➢Assign the same staffto taking care of the patient.
➢Don’t touch the client unnecessarily and avoidlaughing , murmuring or whispering in front of the
patient.

15. 2.NURSINGDIAGNOSIS
SELFCAREDEFICITRELATEDTOCOGNITIVEIMPAIREMENTORLACKOF
TRUSTEVIDENCEDBYINABILITYTODOTHETAKSSUCHASBATHING,
TOILETING, SLEEPING.
INTERVENTION
➢ Assess the patients ability to perform the self care activities .
➢Assist the client to perform self care activities .
➢Encourage the client to do task independentaly .
➢Demonstrate the activities need to be performed in simple steps .
➢Allow enough time to perform the self care activities .
➢Withdraw the assistance gradually and supervise the patients self
care activities.

16. 3.NURSING DIAGNOSIS
Ineffective health maintenance related to poor dietary intake or
suspiciousness that food is poisioned evidenced by significant
loss of weight.
INTERVENTION
➢Assess the nutritional statusof the patients.
➢Monitor the food intakeregularly .
➢If the client is suspicious about the food is poisonous , ask the
client himself/ herself to get the food from shop.
➢Provide the menu plan to the patient .
➢Provide food that the client likes.

17. 4.NURSINGDIAGNOSIS.
IMPAIREDVERBALCOMMUNICATIONRELATEDTO UNREALIOSTIC
THOUGHTS AS EVIDENCEDBY FLIGHT OF IDEAS.
INTERVENTIONS
➢Use therapeutictechniquesof communicatione.g clarification–can
you clarify it still more better
➢Assign the staff nurse consistentlywith the patientwho feel reluctant
to talk with other staff nurse.
➢Talk in a simple language.
➢Motivatethe clientto talk to other patients .

18. 5.NURSINGDIAGNOSIS
Ineffective family coping related to conflicts among family members , impaired
communication among family members and more concern on illness .
INTERVENTION
➢Assess the communication pattern , conflicts and importance of patients
among family members.
➢Give psychoeducation to the family members regarding the treatment
process and prognosis.
➢Educate the family members that the conflicts occurring in your family will
affects prognosis of the patients .
➢Facilitates the proper communication among family members.

20. SUMMARY
➢Definition of delusion
➢Types of delusion
➢Management of Delusion
➢ Psychotherapies
➢Strategies for working with patients who have delusion.
➢Barriers to successful interventions of delusion
➢Nursing management

21. BIBLIOGRAPHY
➢P Prakash mental health and psychiatric nursing book
➢R Sreevani psychiatric nursing book
➢Stuart principles and practices of psychiatric nursing , page no.
366-365 & 566.