In the article by Riddle et al,1 the authors state that in the example of Cluster A type personality disorder, the elderly male patient’s paranoid disorder should be ignored, rather than confronting the paranoia. We do not need to confront the paranoia, but we need to treat the paranoid disorder. The symptom of paranoia extends beyond the single diagnostic category of delusional disorder and has been noted in many elderly patients with other underlying disorders.2 This patient needs early psychiatric consultation and therapy.
They also give recommendations regarding Ms. B for her ever-increasing need of opiates. I find it too naïve for me to offer this patient “…choices, such as walking with her around the unit or listen to the music.” This patient needs pain physician consultations and aggressive interventional pain control.3