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Old 06-09-2009, 02:53 PM
Just Me 1973 Just Me 1973 is offline
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Default Any nurses here or other health care workers?

I am currently in psych rotation (nurse), and I am looking for professional opinions about a case:

The patient is 33 years old, addicted to drugs, but currently clean. He has been sober since February. He checked himself into the hospital because he got scared. He was paranoid to the extreme. So, his diagnose is dual - drug induced psychosis.

It has done him well to be in the hospital, but he is still paranoid. What he thinks is that the police is after him, and a couple of weeks ago when introduced to a new staff member, he figured the guy was an undercover agent. Yesterday he thought there was an undercover cop at the gym where he works out, and he wonders what they want? If they are following him around, he must have done something bad? But he can't remember doing anything bad, so what do they want? He can't stop thinking about it for a long period of time. It exhausts him. Heck, it would exhaust me too if I truly believed people were out to get me. He also suggests that they might want to get him for something he didn't do, and says it does happen that people go to prison for something they didn't do. His therapist asked him if he doesn't think they would just come and arrest him if they suspected him of anything, and he says "yeah.... maybe... but... what do they want? I haven't done anything." It is like running in circles. After the therapy session today I asked the therapist if it would help him if he could talk to a police officer and get some kind of confirmation that they aren't investigating him for anything, and hear there are no undercover cops around and about etc, but she said it wouldn't work, because he would find something else to ponder. She said we have to be really careful about reality checking paranoid patients. She never denies that someone is after him - she just asks questions to make him think things over, but thus far - nothing seems to help.

How would you treat this patient? Why is it so dangerous to talk to him about reality? There has to be some methods, theories or something that can help this patient come out of his paranoid world.
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Old 06-09-2009, 09:44 PM
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canthelpbutwait canthelpbutwait is offline
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my first question would be is he on meds.. i can ask a therapist i know about this though and get back to you later this week
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Old 06-10-2009, 01:37 AM
Just Me 1973 Just Me 1973 is offline
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Thus far, he's refuses to take medication.
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Old 06-10-2009, 04:53 AM
jesseswife jesseswife is offline
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I am not a doctor but I am a psych major and what we where taught that when it comes to paronoia it is hard to convice a pt that what they believe is not reality. Even if he was to speak to a police officer he might just believe that they are lying and make the situation worse. I also suffer from Paronoia yet not as exttreme as the pt. Example if I call someone on the phone even if it is my own mother and she does not pick up in my mind she is avoiding me even if she is truly not there. Then when I speak to her and she tries to reasure me I still do not believe her and we have a wonderful relationship. The Pt needs to acknowledge what his base fear is. I know that mine is from not trusting people and believing that everyone even people that I do not know r trying to hurt and betray me. So maybe concentrate on why he feels that way instead of concentrating on "fixing" him
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Old 06-10-2009, 06:57 AM
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It is my thought that bringing in a police officer, all though with good intentions, would then risk the trust factor he has with you and the therapist.This would then possibly send him over an edge, a place you don't want him, and even feel your involved as well as the therapist in a conspiracy. This patient has clear signs of paranoid schizophrenia. This is just my opinion. I dealt with a patient at one time, and he was showing the same signs and symptoms. He was later diagnosed with it. The fact that as a child he was treated with retlan. The doctors and parents thought he was hyperactive. He was on it for only a period of 6 months. That period was enough to alter his brain into a chemical imbalance. After living a normal life till he was 10, he then got involved with LSD, first time taking it, and that single dose sent his brain over to paranoid schizophrenia. He was paranoid of satan at that point. He went into a reatment facility for this and was given Haldol. Unfortuneatly, that is a med that you are not allowed to be in the heat with. The facility his mother moved him to, defiing all doctors orders, did not take note of this. He died at 21 due to heat stroke induced from the medication. This is just my opinion, I have no authority to diagnose this patient and am simply giving my medical opinion, for a look of possibly other signs and symptoms. This patient has been already claimed to have had a drug problem and a chemical imbalance can reveal itself at any day and any age, and can be simply even brought on by its own measure, or even due to alcohol consumtion. I speak of this daily in teens lifes as they face pear pressure to drink or to simply try a drug. without full knowledge the risk can actually be more then they imagined or send them down a path that they had no idea even existed.
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Old 06-11-2009, 11:00 AM
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I wads told to confront it head on is a bad idea that his psychosis would not be affected by that more than likely and that trying to dig into it as his counselor is probably wont get you far- that upon having a psychotic thought they need to be redirected to something positive that intrigues them in a way to try to bring the person back to reality
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