The Dos and Don’ts of Caring for Patients with Hallucinations, Delusions, and Paranoia
Caregivers get to work with a lot of patients with varying needs, and the challenge is to meet their health needs by ensuring not just their physical well-being but their mental and emotional health as well.
In many cases, caregivers would encounter patients who experience hallucinations, delusions, and paranoia as part of their health condition, and it could be very troubling and scary to the caregiver.
What are hallucinations, delusions, and paranoia? How can caregivers best deal with these symptoms?
Hallucinations are experiences where patients see, hear, smell, taste or feel things that are not real. To these people, however, every detail of the experience is very real. So real that a patient can suddenly shout "Monster!” and take off running in fear because they don't want to be “eaten alive.”
Delusions, on the other hand, are false and fixed beliefs. The delusional patient cannot be convinced that what they are thinking is false, even if they are presented with proof. For example, a person firmly believes that a neighbor is madly in love with them, when in reality the neighbor just happens to jog past their house every morning.
Paranoia is a kind of delusion where the patient becomes overly suspicious of others. Paranoid patients believe that there are people who intend to harm them or take advantage of them. They can also falsely accuse another of being jealous or envious of them. These patients tend to be always on alert, cautious, distressed, and ready to fight back. They have difficulty trusting others, even their care providers.
As a caregiver, you might one day be assigned to care for patients with these symptoms.
If you happen to notice a patient having any of these experiences for the first time, report your observations to the supervisor immediately so that the physician can evaluate them. As you provide care, follow these very helpful tips:
1. DON’T argue and force them to accept reality. Remember that, to these patients, their experiences look and feel real, and proving them wrong doesn’t make any sense to them and can cause unnecessary stress.
DO let them express themselves as long as they do not put themselves or others in harm's way.
2. DON’T let them watch upsetting movies or TV shows, because these could trigger hallucinations and delusions.
DO change the channel or turn the TV off if a violent or crime movie comes on.
3. DON’T take it personally, even when they accuse you. The focus of suspicion is sometimes the caregiver, and patients may say hurtful words or get violent.
DO keep the patient and yourself safe. If the patient becomes violent, move away and ask for help. Distract the patient by offering to walk with them or lead them to another room for some activity. Try to understand what is troubling them and provide comfort if they are scared.
4. DON'T provoke them by fighting back, yelling at them, or even touching them, especially when they experience paranoia.
DO ask permission before doing any procedure on them. Talk to them in a gentle, non-threatening manner. Offer short and simple answers to their questions.
5. DON’T tell them to stop hallucinating, having delusions or being suspicious. Doing so could cause severe anxiety and anger.
DO make them comfortable and then distract them. Identify needs that could be the cause of their hallucinations and delusions.
6. DON’T talk about them behind their back or within hearing distance of them, because it worsens their paranoia.
DO engage them in meaningful conversation while directing them away from their delusions.
