Interviewing A Patient With Delusional Disorder

Key Communication Skills to Engage with Delusional Patients

1. Describe the key communication skills you will use in order to engage with her in the interview.

2. There are a number of clinical signs and symptoms in the scenario so far. Identify three significant signs or symptoms and support your clinical opinion with evidence from the scenario.

3. Discuss the education you will need to provide to Sarah about her medication.

4. Her response may suggest that she did not fully grasp the information you were providing. Discuss your clinical plan to address compliance issues that might arise for Sarah. 

1. The young woman gives her name as Sarah. In response to asking why she has attended, she gives a clearly articulated story about a school teacher using radiation to control her thoughts. She describes difficulty getting onto the train to attend school as she feels other passengers can find out what she is thinking. When you ask her how she feels about her situation she says it is very confusing and frightening. In response to the doctor asking if he can help, she says she wants him to “make it all stop”. Then she was asked what is bothering her. In the reply, she told that one of the teachers is applying radiation on her to control her thoughts. She was asked about her difficulties. She told that she found difficulties in her daily life, like, socialisation, recreation, personal hygiene, family responsibilities, work etc (Kilicaslan et al. 2016). During interview, the author as a nurse has to be very patient. She has to emphasize on the feelings of Sarah’s speech, rather than the words. When she will feel that she is listened completely, then she will feel comfortable and open herself. This will help in further assessment. She will be asked when she first experienced this incident. How often she experiences this incident. She was asked what she would do after this incident. Then she will be asked about her family history, her hobbies, her job, her past medical history and her school atmosphere. She will be asked about the teacher, who is doing this type of magic. She will be asked that did she believe in supernatural power or not. The author can also ask about her childhood memories or certain incidents where she felt happy. She will be asked about her daily routine. She will be asked about the teaching profesion.The author can also ask about her idea regarding delusions.

Identifying Clinical Signs and Symptoms

2. Following a basic physical and presenting history the doctor acknowledged the confusion and distress, explaining she is experiencing psychotic symptoms. He seeks Sarah’s permission to ring her mother. He also makes an appointment for the next day to see her again. Before leaving, she is provided with a script for 5mgolanzapine nocte. Sarah is feeling very scared when she travelled the train. She feels very isolated when she get scared. These are the symptoms of Delusions. She is not able to function properly in her daily life. She feels hallucinated. She is scared in each situation. It gives the identification that she is undergoing some mental problems (Hu et al. 2015). She found difficulties in her daily life, like, socialisation, recreation, personal hygiene, family responsibilities, work etc. It states het mental status. She is in depression and anxiety because of delusion. During travelling, she is thinking that people are getting to know her thinking. She is losing trust on the people. This is also a symptom of hallucination. Overall, her health is not proper. She is not getting proper sleep. So she feels drowsy. Her life is being hampered. She is losing confidence. Due to this instability, she is not able to concentrate to her school (Kumar et al. 2013). That is the reason; her job life is also being hampered. It will affect her career. 

3. Sarah briefly acknowledges the education you provided to her. However, you notice that her responses are monosyllabic with a flat tone, and she did not ask any questions. She will be provided with the knowledge that includes the importance of the prescribed therapies. The therapy plan will be clearly discussed to her. Therefore, that she will be not having any confusions. She will be also told about the impacts of the prescribed medicines. Not only, Sarah, but also her family members will be provided with the knowledge. For better understanding, small videos can be shown to her based on those treatments. She will also be provided with the benefits of these treatments (Peters et al. 2014). Many meetings and discussions will be planned for discussing this treatment. She will be provided with the comfort zone so that she can undergo the treatment easily. Communication section may be arranged for her with other patients. She can feel comfort and can share her problems. She will also get the knowledge from these types of sessions. She will be given special importance to her diet and medication. She will also be told about the drugs doses and their benefits. Her medical reports will be updated on a regular basis. So that she can keep a track of her health. Once the treatment will start, and when she will see the improvements in her, she will be very much motivated. Dietician will provide her special diet chart. The diets will be taken care of by her family members (Freeman et al. 2016). Above all, she should get motivated that there are no problems in her health. She should get the confidence that she can overcome this easily. 

Providing Education about Medication

4. The treatment plan for delusional disorders consist of different therapies, like, psychotherapy, speech therapy, behavioral therapy, and drug therapy. It will help to correct mood disturbances and behavior. She also needs the treatment, which is associated with support system. The drugs are same like schizophrenic disorders (Emsley et al. 2016). The drugs for this disorder contain antipsychotic agents. Antipsychotics appear to function by blocking postsynaptic dopamine receptors. Certain psychotic symptoms, like, these drugs to relieve agitation and anxiety reduce delusions and hallucinations. Other psychiatric drugs, like, anxiolytics and antidepressants help to control these symptoms. Some examples of antipsychotics with high-potency are, trifluoperazine, thiothixene, haloperidol, fluphenazine etc. perphenazine, molindone and Loxapine are intermediate in potency and thioridazine and chlorpromazine are low potent agents. She cannot be hospitalized at any cost, as she is already very scared. If needed, then she will be treated in her own home. In behavioral therapy, the treatments will be planned through many sittings. The therapy will be conducted with doctors, nurses, and also in the presence of family members (Kohut, 2013). In psychotherapy, psychiatrist will take the session and different psychology assessments will be conducted. It is very important to build the trust between patient nd the experts. This therapy will be continued until she will lead her normal life. This therapy may be challenging. It takes much time. Clinicians have to be very direct and honest to her. The clinician has to be very careful that the confidentiality and privacy of her will not be disturbed.  It will help to build up her confidence. Caregivers will also provide therapies to make her comfort. There are certain self-support groups. These groups will support Sarah to do her work. Her family members will also be told about these therapies (Hou & Lai, 2014). This treatment plan will be given to her. The medications can be changed according to her progress. Her progress will also help to guide the therapies. If it is necessary then certain other therapies also will be included after consulting the doctors.  

References: 

Freeman, D., Bradley, J., Waite, F., Sheaves, B., DeWeever, N., Bourke, E., ... & Garety, P. (2016). Targeting recovery in persistent persecutory delusions: a proof of principle study of a new translational psychological treatment. Behavioural and cognitive psychotherapy, 1.

Freeman, D., Waite, F., Emsley, R., Kingdon, D., Davies, L., Fitzpatrick, R., & Dunn, G. (2016). The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomised controlled trial (The Feeling Safe Study). Trials, 17(1), 1.

Hou, Y. C., & Lai, C. H. (2014). To the Editor: The standard treatment of obsessive compulsive disorder (OCD) usually means antidepres-sants. A low dose of antipsychotic can be an option of augmentation.

Hu, L. Y., Lee, Y. T., Lu, T., Hung, M. B., & Hung, Y. Y. (2015). Using aripiprazole to treat new-onset hyperprolactinemia-related delusion of pregnancy. Australian and New Zealand Journal of Psychiatry, 0004867415589796.

Kilicaslan, E. E., Acar, G., Eksioglu, S., Kesebir, S., & Tezcan, E. (2016). The Effect of Delusion and Hallucination Types on Treatment Response in Schizophrenia and Schizoaffective Disorder. Dusunen Adam, 29(1), 29.

Kohut, H. (2013). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. University of Chicago Press.

Kumar, D., Rao, M. G., Raveendranathan, D., Venkatasubramanian, G., Varambally, S., & Gangadhar, B. N. (2013). Metacognitive Training for Delusion in Treatment-Resistant Schizophrenia: A Case Report. Clinical schizophrenia & related psychoses, 9(1), 40-43.

So, S. H. W., Peters, E. R., Swendsen, J., Garety, P. A., & Kapur, S. (2014). Changes in delusions in the early phase of antipsychotic treatment–An experience sampling study. Psychiatry research, 215(3), 568-573.