Specific Nursing Management for Psychotic disorders

(Conditions where reality testing is lost — hallucinations, delusions, disorganized thinking)

1. Schizophrenia Spectrum Disorders: Schizophrenia, Schizoaffective disorder, Schizophreniform disorder, Brief psychotic disorder, Delusional disorder

2. Mood Disorders With Psychotic Features: Major depressive disorder with psychosis, Bipolar disorder with psychotic features (mania or depression)

3. Substance- & Medication-Induced Psychosis: Alcohol-induced psychosis, Cannabis-induced psychosis, Cocaine/amphetamine-induced psychosis, Steroid-induced psychosis

4. Organic / Medical Psychoses: Dementia with psychosis, Delirium with psychotic symptoms, Brain tumors and epilepsy-related psychosis, HIV/AIDS-related psychosis, Syphilis-related psychosis

5. Other Psychotic Disorders: Postpartum psychosis, Psychosis due to sleep deprivation, Shared psychotic disorder (Folie à deux)

(Conditions where reality testing is intact — patient knows they are unwell)

1. Anxiety Disorders: Generalized anxiety disorder (GAD), Panic disorder, Phobic disorders (agoraphobia, social phobia, specific phobias), Separation anxiety disorder

2. Obsessive–Compulsive and Related Disorders: Obsessive–compulsive disorder (OCD), Body dysmorphic disorder, Trichotillomania (hair pulling), Excoriation disorder (skin picking)

3. Somatic Symptom & Related Disorders: Somatic symptom disorder, Illness anxiety disorder (hypochondriasis), Conversion (functional neurological) disorder, Factitious disorder (neurotic category traditionally)

4. Dissociative Disorders: Dissociative amnesia, Dissociative identity disorder, Depersonalization/derealization disorder

5. Stress-Related Disorders: Adjustment disorder, Acute stress disorder, Post-traumatic stress disorder (PTSD)(Some classify PTSD separately, but traditionally under neuroses.)

6. Mild to Moderate Mood Disorders; Dysthymia (Persistent depressive disorder), Mild to moderate depression (without psychosis)

1. Building Therapeutic Rapport

• I will approach the patient calmly and respectfully to reduce fear or suspicion.

• I will introduce myself at every encounter to build trust and orientation.

• I will maintain a consistent nurse–patient relationship to minimize confusion and anxiety.

• I will listen attentively and avoid arguing about delusions, instead focusing on the patient’s feelings.

• I will acknowledge the patient’s experiences without validating false beliefs (e.g., “I understand this is real to you, but I do not see or hear it”).

2. Maintaining Safety (for the patient and others)

• I will assess the patient frequently for suicidal or homicidal thoughts.

• I will minimize environmental stimuli (loud noise, crowds) that may worsen hallucinations.

• I will remove dangerous objects to prevent self-harm or aggression.

• I will observe the patient closely, especially when they appear frightened or responding to voices.

• I will intervene early when escalating behavior is noticed (pacing, clenched fists, shouting).

• I will implement de-escalation techniques before using restraints or sedation.

3. Managing Hallucinations

• I will assess the content of hallucinations to identify risks (e.g., command hallucinations).

• I will help the patient recognize hallucinations as part of the illness, gently and over time.

• I will encourage distraction techniques such as listening to music or engaging in a simple activity.

• I will speak clearly and calmly, using short, simple sentences.

• I will avoid touching the patient without warning, as it may increase fear.

4. Managing Delusions

• I will avoid arguing or challenging delusional beliefs.

• I will gently redirect conversations toward reality-based topics.

• I will encourage the patient to express feelings behind the delusion (e.g., fear, suspicion).

• I will focus on building trust to reduce defensiveness and paranoia.

• I will encourage participation in social and therapeutic activities to reduce isolation.

5. Promoting Reality Orientation

• I will reorient the patient regularly to person, place, and time using clocks, calendars, and routines.

• I will encourage involvement in structured daily activities to improve focus.

• I will avoid overwhelming the patient with too much information at once.

6. Supporting Activities of Daily Living (ADLs)

• I will assist the patient with hygiene, grooming, and nutrition when needed.

• I will encourage independence by allowing the patient to perform tasks they are capable of.

• I will provide step-by-step instructions for tasks when attention or concentration is poor.

7. Administering and Monitoring Medications

• I will administer prescribed antipsychotics (e.g., haloperidol, risperidone, olanzapine).

• I will monitor for side effects such as EPS, NMS, metabolic changes, and sedation.

• I will educate the patient about the importance of medication adherence.

• I will report immediate side effects, especially signs of NMS (fever, rigidity).

• I will encourage the family to support long-term treatment compliance.

8. Enhancing Communication

• I will use simple, concrete language and avoid metaphors that may be misinterpreted.

• I will give one instruction at a time to reduce confusion.

• I will allow extra time for the patient to respond if thought processing is slowed.

• I will validate feelings even when thoughts are disorganized.

9. Promoting Social Skills and Rehabilitation

• I will encourage participation in group therapy once the patient is stable.

• I will help the patient practice communication and coping skills.

• I will involve occupation and recreational therapy to build confidence.

• I will prepare the patient for community reintegration through psychoeducation.

10. Family and Community Education

• I will educate the family about the illness, including symptoms, triggers, and prognosis.

• I will teach early-warning signs of relapse (e.g., insomnia, withdrawal, suspiciousness).

• I will involve the family in developing a relapse-prevention plan.

• I will provide information about community resources, support groups, and follow-up care.