Thomas Tsirakis, BA
Attempting a home visit on a paranoid patient often presents the clinician with a number of difficult challenges. These include: gaining and maintaining the patient's trust, addressing the patient's concerns without reinforcing their suspicions or delusions, attempting to physically examine the patient, the avoidance of becoming incorporated into a patient's delusion(s) and avoiding personal injury when confronted with a potentially violent patient.
The term paranoid describes those individuals who display "fixed suspicions, delusions of reference, jealousy, or persecution, dominant ideas or grandiose trends, which are logically elaborated with due regard for reality once a false premise has been accepted." It is important to remember that paranoia is only a symptom of an underlying pathology and is not a diagnosis. Thus, if the patient is unknown to the clinician, it is important to determine (via family or the patient's physician) whether the paranoia is of acute onset or chronic in nature and whether it has already been medically addressed.
There are a number of factors (some reversible) which may generate paranoid reactions in the elderly, and should be completely ruled out (see Table 1).