Dealing with patients that exhibit paranoid behavior can be difficult. Paranoia as well as suspicious thoughts can often happen in up to 10 to 15% of the general population (Trexler, 2012). Couple that with persecutory delusions, and this can lead to a diagnosis of psychosis. With the patient having a history of a psychotic break and displaying messages she believes as secret, she is displaying characteristics of paranoia. This has apparently affected her everyday life as she has altered sleeping and eating patterns and has missed work.
Because she does not want to go to an appointment and is attempting to rationalize her odd behavior, it is important to talk her into going to an appointment to try to get her to discuss her life situation and help her realize what is going on and approach the situations with cognitive-behavioral techniques to help reduce distress (Freeman & Garety, 2006). The patient will not go to the appointment if she feels she may be hospitalized or put on medication. “There are, of course, obstacles to forming a good collaborative relationship with an individual who has paranoid thoughts. Elements of the role of a psychiatrist bring problems. Two key issues are hospitalization and medication” (Freeman & Garety, 2006, p. 404). Therefore, it is important to assure her that if she comes in, it will only be to discuss things and that is it.
From there, treatment options will be considered after one is family with her current state and how it is affecting her daily life. It is very important to reduce the distress the patient is feeling first in order to help the patient deal with her mental issues. The first step should always be to cultivate the relationship of patient and medical professional and then provide treatment options.
References
Freeman, D., & Garety, P. (2006). Helping patients with paranoid and suspicious thoughts: a cognitive-behavioural approach. Advances in Psychiatric Treatment, 12(6), 404-415. doi:10.1192/apt.12.6.404
Trexler, L. E. (2012). Cognitive rehabilitation: Conceptualization and intervention. Place of publication not identified: Springer Science & Business Media.
