Your question shed a light over an important field in helping psychotic patient in my view. First, if a patient ask me if a perception of hers is an allucination during an interview, I would answer yes, I think it is ( well, if I dont have a similar perception, the simplest case). On the other hand it would make no sense simply arguing the allucinatory origin of a perception without real origin of a patient. But as you seem to imply, in your question, allucinations are important for the patients, even if this importance can vary a lot. Then I think that the correct attitude is to be near the patient in discussing with interest, concern and in a no judgemental way their psychotic sympoms, when this is possible, of course.

Hallucinations and delusions are disorders present mostly in two psychiatric pathologies: Psychosis and Bipolar Syndrome. Well, when the psychotic patient is in an acute phase the problem does not arise. In fact he is not able to understand any explanations of those phenomena, in particular about the delusions which are by definition incorrigible. Trying to explain these phenomena to bipolar patient in the manic phase would be absolutely useless as well the auditory hallucinations in the depressive patient. These explanations are more useful and understandable to patients in psychopathological compensation and I think it is useful to provide them whenever their clinic condition allows it.

Assumption:

We wish to feel n control of our lives

.

-Motivating patients to achieve some control is essential. (Thought disturbances create out-of-control feelings.)

-Denial is a major coping mechanism: who would wish to have a psychiatric illness?

-Possible medical causes of psychotic symptoms need to be ruled out.

-Many patients can be taught ways to verify their perceptions/reality.

-Hallucinations and delusions are most likely unpleasant and frightening - recognizing them, using techniques such as distraction, may help.

Acutely psychotic patients are unlikely to respond to psychological interventions until medicated.

Good one dear Jutta Eachle,

1) Please illustrate what would you say to motivate patients experiencing delusions ?

2) Would you be kind to reveal your strategy against or for denial.

Denial is a first step of the 5 steps of defence against acute stressful event or distress. Patients who stick to denial eventually may become noncompliant.

Please throw light .

Thanks to all of you for advancing and making this discussion interesting one.

Invite more researchers to jump in.

Yes, or You shuld see this psychopathological phenomena through behaviour, motoric, speech and emotional reaction of patient

The reaction a patient sees in the interviewer is used like a mirror. Too often, chronic mental illness means a patient loses personhood in their own and in the eyes of society. Difficult to avoid moral judgements as "bad" or "deficient" if you have a psychiatric label.

--Avoid assumptions of supportive family.

Trust is earned, a person under stress more defensive and vulnerable both.

--You need to be perceived as an empathetic, respectful listener who can help identify the patient's desires and show what the patient can do to achieve those. The patient has to maintain/achieve control (and hopefully independence.).

--Realizing desirable consequences of actions is much more effective than following someone elses directives.

--Treatment and medication compliance may be rewarded by the control achieved

--Everyone has some things they would want, concrete or abstract, in the near or farther future. Those are the motivators to acknowledge impediments (here, thought disturbances but also applicable to personality disturbances ) and implement coping strategies

-Encourage patient to speak of frequency, intensity, content, triggers. Get collateral information if patient permits.

--Tell the patient what you see and hear in turn

--Identify thought disturbances, patient reactions, and their consequences on daily life, goal, emotional status. Determine severity of impairments. Denial, anger, resentment, fear, self-isolation are likely reactions.

--Assess for suicidality, substance abuse (which may be cause of the problem, coping, or addiction), co-morbidities.

--Identify adaptive strategies like talking back, distraction, relaxation techniques.

--Consider cognitive remediation ( see "Cognitive Remediation Therapy for Schizophrenia" authors: Wykes and Reeder) , neurocognitive testing and therapy.

--Acknowledge cultural considerations: for example, seeing or hearing spirits of a deceased person is acceptable ( not a mental health issue) in some cultures but not others. Religious considerations may also apply.

--Supportive families may be harmful: They may severely beat the patient to "exorcise the demon", for example.

(Questions like: what would you like to do with your time, your life. What values are important to you? What kind of person do you respect/admire? How do you want others to think of you? What would you like to do to get...? Wat might help you become...?)

Great, detailing Jutta. I agree with you.

Denial is a coping mechanism, many would agree.

Denial gives rise to non compliance, many would observe.

Would you break denial? If yes, how?

Realisation of possible consequences of psychotic actions could be impossible if denial is not resolved.

I practise breaking denial while offering psychoeducation. While doing so, I negotiate with patient to accept their brain's genetically disposed disorder. By doing so I offer explanation that patient is not responsible for those ill experiences, e.g. they hear or believe that somebody is abusing them or talking bad words for them. This experience is NOT true, and is because of genetically disposed illness, where patient simply suffer. So patient should stand up to summon courage to fight with illness. Ways to fight with disease are suggested , if suits them, they could implement.

So, what is your take when I declare on them point blank that they are suffering from mental illness which is genetically inherited and can be treated wholely or partially ?

I ask this because I think and see many practicing psychiatrist hesitate to do so ?

Their hesitation indirectly facilitate non compliance, I assume.

What's your take ?

Thanks for active participation.

Concerning your last statement I have to add that in the case of negative or threatening allucinations I does not change my attitude of exploring them with concern with the patient. Indeed, if it can be useful, I show the patient that I dont believe the bad allucinations standing with the patient. This is the point. Not challenging the patient but standing with the patient, if this is possible. For the same reason you can argue the bological nature of the illness in order to improve his compliance.

Great Sir,

That's my point.

Telling the patient that I as a doctor, I don't believe that contents of hallucination are true! Meaning delusions and hallucination are NOT real, though patient experiences so. Patient's own brain is deceiving patient !

Be aware my dear , I am revealing this to you only because it's my duty as a treating doctor.

You may not believe in me now or at once. I don't mind even if you disbelieve in my suggestions. Eventually you will sure realise that your doctor had told you the truth !

Such or alike dialogues with patient facilitate rapport and helps build trust in between.

-What is the patient's goal?

Usually, it is to deal with symptoms which may have become intolerable. So the diagnosis is not be primary item to deal with. It is fear which leads to denial. The opposite would be control over the fear inducing circumstances and reassurance.

-Offering the patient the hope or the actual means of control (most often medication to begin with) over the symptoms first is likely to result in a better reception of the education you will offer. Emphasis on "chemical imbalance in the body", "comparable to chronic physical illness requiring medication to control symptoms- like diabetes" allow the patient to consider the likelihood that what they are experiencing is not their "fault" and it does not make them a "bad" person.

-Peer recovery specialists can be invaluable.

I wish to remind everyone that delirium is incorrigible by definition. So any attempt to do it is useless. Hallucinations instead can and must be explained when the patient's clinical condition are adequate. That gives a better outcome according to my personal experience

Dear Jutta Eschle,

Good, "what they are experiencing is not their fault", must be told to psychotic patients.

This is what I recommend.

One can tell such patients in a graded method, I.e. tell them step by step so that they can accept, comprehend, and gradually feel to take control of psychotic symptoms. Control over symptoms means (1) Not getting agitated or uncomfortable with symptoms. (2) Return to past behaviour or let behaviour not getting affected because of persistent symptoms. (3) Remain hopeful, motivated in daily rituals.

psychotic diseases are positive and negative symptoms that different for per person not only delusions ,..but also might be diturb in social and life performance .so should diagnosed based on dsm 4,5 but many not be empasis on the diagnose and other terms pay attention .