Hallucinations and Paranoia

When someone hallucinates, he sees or hears things no one else does (e.g. kittens walking on the floor).  As a rule, if the hallucination is not upsetting, don’t intervene. Delusions are beliefs contrary to fact. Delusions remain persistent despite all evidence to the contrary (e.g. a paranoid delusion is that a nurse in the home took all of your money).

Possible causes:

• Sensory changes (hearing and vision diminishes)
• Medications or physical illness
• Unrecognized environment or caregivers, inadequate lighting
• Disruption of routines
• Removal of items from the person (i.e. money or jewellery)

Strategies:

• Meet with her physician to review medications and schedule hearing and vision tests.
• Seek medical evaluation for illness, infection, bowel impaction, UTI etc.
• When she experiences suspiciousness:  look for lost articles and remind her where the valuables are stored. Don’t scold for losing or hiding things and keep a spare set of frequently lost items (if possible). Investigate suspicions that might be true.
• Increase lighting in the room.
• Do not directly disagree with a false idea.
• Use physical touch as reassurance.

Example: Kate is fearful at night because she sees spiders crawling on her bedroom walls.

Don’t:

• Tell her nothing is on her walls. “You see Kate; nothing is there. Go back to bed.”

Do:

• Validate the fear, “That must be very frightening for you.” 
• Do not get angry and argue. This is real to her.
• Check for shadows that could be misinterpreted as spiders and try to remove them (i.e. increase lighting).
• Distract with music, exercise, playing cards or photos.
• It may be useful to see if she has any hearing or vision problems at this time.

Don’t:

• Gently explain no one stole her purse and, just like last time, she lost her bag.

Do:

• Validate her feelings.
• Try to alleviate the distress (e.g. look for the “stolen” purse and then distract her).
• Investigate suspicions that could be true. She could be a victim. But if this paranoia continues, have similar purses ready as replacements.