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Positive Symptoms: Delusions (Nursing)

by Brenda Marshall, EdD, MSN, RN

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      Slides Schizophrenia Nursing.pdf
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      Review Sheet Psychiatric Symptoms Hallucinations vs Delusions Nursing.pdf
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    00:00 Let's think about delusions, because delusion is another positive symptom is one of those things that is very difficult to deal with when the patient is having a delusion. The patient has this belief and it is not true, it is a false fixed belief, and no matter what we tell them, they will not see that it is not true. So, sometimes we have ideas of reference. So, that's when we misconstrue an event and we give them a personal meaning. For example, you're watching the television and they're telling you it's going to be raining this afternoon and the weather person says "Do not forget to take your umbrella" and the person with schizophrenia is sure that that person there is talking just to that person with schizophrenia.

    01:00 It is a specific message and it has personal meaning "because that person loves me and therefore that person really wants to take care of me. That is an idea of reference because the weather person doesn't know me at all." Grandeur. Ideas of grandeur. "I am the most powerful and most important person in the world." One time I was talking to one of my patients and he had the diagnosis of schizophrenia and he was telling me how important he was and he said "I just want you to know that I've got the president on speed dial because the president knows how important I am. And if you want anything, I can get it for you.

    01:45 Just let me know, I've got him on speed dial." Of course, there was no president on speed dial, but this was his delusion of grandeur that he was so important that the President of the United States had him on speed dial and allowed him to have them. Jealousy. This kind of delusions that someone is cheating on you, that someone is after the person that you love, this can become a harmful situation because this kind of delusion can become overpowering and even when the person is being faithful there is no way to discourage these delusions of jealousy. You have to be able to understand that the evidence is not going to change the person's mind. There is something that we call thought insertion, and these are false beliefs that somebody is putting an idea into your mind. At one point, I did have a patient who had schizophrenia, but I also thought that that person was having some seizure activity and it's not unusual for a comorbid seizure disorder and schizophrenia and I spoke to the physician-in-charge and the physician said "Well, the one problem is that we cannot have this person have an EEG, we can't do what we normally do to identify a seizure disorder." Because he might have a delusion of thought insertion that by putting the electrodes on his head that we were actually inserting thoughts into his brain. Sometimes, you'll also hear someone say "There's a radio tower near my house and I have to move because there are thoughts that are being inserted into my brain from that radio tower." Again, a delusion is a fixed false belief and when you hear it it's important to write it down, but you can't convince that person that that is not what is going to happen. They may have a persecutory delusion that people are really out to get them, to be hurt, that they are the worst person for this person who is their boss and their boss is out to get them, and everything that happens is only happening to them and nobody else. And things are misconstrued. So, if somebody is busy and on their phone and walks by, this person with schizophrenia might misinterpret that behavior as that person was deliberately trying to ignore me. Remembering delusions as being fixed false beliefs is really important. You also might have a somatic delusion, and that's a false belief that there is some body change that's going on in an odd way. There was a movie called Black Swan at one point, and if you've ever seen it you know that in this movie the protagonist who is a ballerina started to believe that she had become the black swan in Swan Lake and that feathers were protruding from her skin, and that her body was changing into one of an actual swan.

    05:22 Sometimes they think that part of their body is rotting. This is a delusion. Again, we cannot convince them otherwise. There is also a delusion of thought broadcasting, thinking that their thoughts can be heard by others and when we watch them and they look around and there is a little bit of paranoia that we see, it's because they think we can hear what they are thinking. Sometimes they think they can hear what you are thinking. They also have thought withdrawal. These are false belief thoughts that had been withdrawn from one minds. Okay, so that you had a thought and someone stole it from you. This is a delusion.

    06:11 Now, a person with schizophrenia, it's really important to know they don't have all of these.

    06:16 They may have one of these, they may have none of these, they may have two of these.

    06:21 You're going to stay with that individual. As they talk to you, you will find out if they have a delusion or not. And sometimes these delusions are actually combined with hallucinations and so the increased stress that that brings actually increases these negative symptoms and positive symptoms of fear, anxiety, delusions, and hallucinations. The other one is outside control when they believe that there is some force or an agency like the FBI or the CIA that has taken control of their mind, and so their own thoughts are not their thoughts.

    07:00 They're thoughts are being put in there and now this outside force has control over their mind. Now if this sounds like almost every single one of the movies that you've seen in the past 10, 15 years, you're right. These are really confusing but exciting things to think about unless they happen to be happening to you. And when it is something that you cannot control when these thoughts and these beliefs happen to you, it's really important that there's someone that they can go to who is going to be able to keep them safe, who's going to keep a safe environment, who is going to assess what's going on, who's going to focus on them and helping them to recover and who is going to evaluate what each of the things that we're doing has, as an impact, to help that person on their road to recovery.


    About the Lecture

    The lecture Positive Symptoms: Delusions (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Schizophrenia (Nursing).


    Included Quiz Questions

    1. The client that is convinced the Illuminati is trying to recruit them to lead the organization.
    2. The client that requests to change rooms three times today because they report smelling a gas leak in their room.
    3. The client that reports hearing loud sirens and an overhead announcement telling everyone to evacuate the building.
    4. The client that runs from their room suddenly, exclaiming that their bed is full of snakes.
    1. Ideas of reference
    2. Grandeur
    3. Jealousy
    4. Persecution
    5. Thought insertion
    1. Thought withdrawal
    2. Thought insertion
    3. Thought broadcasting
    4. Outside control
    1. “Not all clients with schizophrenia experience delusions.”
    2. “The best way to help a client with delusions is to show the client evidence that contradicts what they believe.”
    3. “Clients do not experience hallucinations and delusions concurrently.”
    4. “Delusions are sensory in nature and can affect all five senses.”
    1. Outside control
    2. Thought broadcasting
    3. Somatic delusions
    4. Persecution

    Author of lecture Positive Symptoms: Delusions (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN


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