A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them

Question

The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, "They're all plotting to destroy me. Isn't that true?" Which would be the most appropriate response? a. "No, that is not true. People here are trying to help you if you will let them.".
b. "Let's think about it: what reason would people have to want to destroy you?"
c. "Thinking that people want to destroy you must be very frightening.".
d. "That doesn't make sense; staff are health care workers, not murderers.".

Answer 1

C
The patient is expressing paranoid delusions. By definition, a delusion is a persistent irrational belief held despite evidence to the contrary. Therefore, stating that his belief is untrue will not make sense to him and may reinforce his belief that people are set against him. Similarly, because the delusion is believed firmly regardless of the evidence, providing more evidence that the belief is wrong or guiding the patient to look at the evidence are unlikely to be helpful and may reinforce his delusion. The most therapeutic response is the one which focuses on the feeling associated with the belief rather than the belief itself. It conveys empathy and interest in the patient's concerns, helping to build trust in the staff and giving him an opportunity to work through the fear he is experiencing.