Alternative Therapy : Identify one other type of psychotherapy that will effectively manage paranoid personality disorder.
Mindfulness Meditation: helps reduce stress, depression, anxiety, and feelings of paranoia.
Art therapy: helps to serve as a source of distraction from disturbing or paranoid thoughts.
Health Promotion: I reviewed medical /psychiatric histories with the patient and educated the patient on the need for medication compliance to prevent decompensation, possible seizure activity, and life-threatening symptoms which may lead to inpatient hospitalization. The patient was also encouraged to set phone reminders to promote medication compliance. I enlightened the patient to give about 4 – 6 weeks to experience the maximum effect of the medications.
· Encouraged the patient to engage in physical activities/exercise to improve mood, sense of control, coping ability, and overall self-esteem.
· Encouraged the patient to eat a balanced diet and sleep hygiene such as consistent sleep time and avoiding noise at bedtime.
· Abstinence from marijuana or any illicit drug use and social events that will encourage use.
· The patient was encouraged to contract to safety to call 911, or the Baltimore Crisis Line at 410 433 5175 with active self-harm, suicidal and/or homicidal thoughts.
Phone calls: Called mother and sister to encourage patient’s medication compliance.
Time spent: about 15 minutes was set aside for the patient for questions and answers.
Labs reviewed include: CMP, CBC, UDS, Pregnancy, Liver function test, thyroid function test, alcohol level, and ammonia.
Order placed: Gene testing to identify which medication will be most effective for the patient.
Return to clinic: in 1 week.
To evaluate the patient’s response to new medication, Haldol 5mg p.o daily, medication compliance, and attitude towards the treatment plan/recommendations.
Suppose the patient continues to comply with Haldol 5mg p.o daily and can tolerate the drug over time. The plan will be to switch Haldol p.o to Haloperidol decanoate IM ( 10 – 20 times the p.o dosage), following all relevant safety protocols to manage this patient and further ensure medication compliance.
Discussion Questions / Prompts:
1. Identify other ways to encourage medication compliance in a patient with a paranoid personality disorder.
2. Identify other alternative therapies that will be beneficial in managing an individual with a paranoid personality disorder.
3. Identify one other type of psychotherapy that will effectively manage paranoid personality disorder.
References
American Psychiatric Association. (2013). Personality disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, V: Author.
American Psychiatric Association. (2013). Delusional Disorder. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, V: Author.
Doustkam,M., Pourheidari, S., Mansouri, A. (2017). Interpretation bias towards vague faces in individuals with paranoid personality disorder traits. Journal of Fundamentals of Mental Health, 19(6), 441–450. https://doi.org/10.22038/jfmh.2017.9550
Mendez-Miller, M., Naccarato, J., Radico, J. (2022). Borderline Personality Disorder. American Family Physician, 105(2), 156–161.
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 1–4. https://doi.org/10.1186/s13030-021-00219-w
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Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic Reviews, 9(1), 1–18. https://doi.org/10.1186/s13643-020-1274-3
Tonna, M., Paglia, F., Ottoni, R., Ossola, P., De Panfilis, C., Marchesi, C. (2018). Delusional disorder: The role of personality and emotions on delusional ideation. Comprehensive Psychiatry, 85, 78–83. https://doi.org/10.1016/j.comppsych.2018.07.002