A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which of the following interventions would be most appropriate under these circumstances?
a. Feed the patient via tube, involuntarily via court order if needed.
b. Offer to taste each food item on the tray yourself while he watches.
c. Allow the patient to contact a local restaurant to deliver his meals.
d. Allow him supervised access to use food vending machines in the hospital lobby.
D
The patient may perceive foods in sealed containers, packages, or natural shells that he has selected himself as being less likely to have been adulterated. Attempts to tube feed are seen as threatening and tend to increase mistrust and worsen paranoia. His mistrust would cause him to assume that any food "taster" was simply making it seem as if the food was safe (e.g., the patient could believe that the staff member tasting the food has taken an antidote to the poison before tasting.) The patient who is delusional about his food being poisoned is likely to believe restaurant food might also be poisoned during preparation or delivery.
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