Establishing a trusting relationship with the patient, though not always easy, is of prime importance in the treatment of paranoid states.

Objective information about the social setting and cultural background must be sought. Some 'paranoid delusions' are based on genuine persecution, and some 'religious delusions' could be viewed as spiritual experiences rather than as a manifestation of mental illness.

A psychotherapeutic approach is often suitable for milder cases, but if delusions are present, an antipsychotic drug is indicated. Small doses of the strongest antipsychotic drugs such as haloperidol are probably the treatment of choice. Some patients are reluctant to take medication because they suspect it is poisoned, or insist they are not ill. Compulsory detention and treatment under the Mental Health Act 1983 may be necessary if there is disturbed or violent behaviour, or a risk thereof.

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