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Communicating with someone who has delusions

A delusion is a fixed false belief that can't be swayed by reasoning. Paranoid, grandiose, and religious delusions are most common.
A paranoid delusion is very frightening: The person thinks someone is out to harm him. Acknowledge what he says but don't agree. For example, if your patient tells you that the FBI is after him, hone in on his feelings: "Sensing that you're being watched all the time must be very frightening."

Keep your patient's environment as safe as you can. Try to have the same staff assigned to his care each day and prepare him for any changes without providing too many details; for example, "Mr. Jones, we're getting some new patients today so we have to move you to a different room." If he responds negatively, reassure him that he'll be safe and you'll protect him.

Grandiose and religious delusions are typically less frightening. A person having a grandiose delusion, for example, thinks he's someone very powerful or important. Someone with a religious delusion may claim to be a religious figure.

Follow these guidelines to maintain a therapeutic relationship with your patient:
* Accept him as he is. His mental illness is causing his abnormal perceptions.
* Monitor for hallucinations and delusions to assess his response to psychotropic medications.
* Assess his safety and monitor for warning signs such as withdrawal and depression.
* Give him appropriate feedback on how you interpret his communications and try to help him focus on the realities around him.
* Encourage him to learn about his medical illness and help with his care; involve him with diversions such as reading, writing, or solving puzzles. These activities can diminish irrational thinking and help him feel comfortable and safe.

Responding to disorganized speech

Classic verbal disturbances that might occur with schizophrenia include associative looseness, neologisms, clang association, word salad, and echolalia.

Associative looseness means one thought isn't connected to the next. When you tell your patient you've brought his medication, he might reply, "Blue lights and gold. I go round and round. The grass is green." These phrases seem disconnected but could shed light on his thoughts. If you suspect that the colors are significant, ask, "Are you asking what different medications you're getting here?" If you can't make a connection, tell him you don't understand but you'll keep trying.

A neologism is a word or phrase the patient constructs that's meaningless to everyone else, such as "I bessaton the coaglese and vergified the rest."
Clang association is meaningless use of rhyming words: "I read the bed and said the head then led Ted to the dead."
Word salad is a mix of words or phrases that has no meaning to the listener, such as "animals, fast food, family, working, birds, loving, the net."

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• Psychotherapy