Delusions, Illusions and Hallucinations

Question 1

What is the first question you ask with when dealing with a psychiatric pt?

Answer 1

Is my pt. psychotic or non-psychotic?

Question 2

Describe Non-Psychotic Patient

Answer 2

Non-Psychotic Patient has insight ( knows whats wrong with them). They are reality based, they hear, taste, smell, feel everything you do. They are emotionally distressed, but they are not psychotic. i.e. depressed pt.

Question 3

What TX. techniques answers do you pick for Non-Psychotic Patient?

Answer 3

Good therapeutic communication. Talk about how the pt. feels. Tell me more about what you are experiencing? TX. like any other pt. that has insight

Question 4

Describe Psychotic Patient

Answer 4

Psychotic Patient :
- No insight 
- Not reality based
- Everyone else's fault
- Don't think they are sick
- Therapeutic communication does not work 
- Psychotic symptoms include: delusions, hallucinations 
  and illusions

Question 5

Describe Delusions, including the 2 different types.

Answer 5

Delusions:

• False, Fixed, idea or belief.
• No sensory component - just thinking.

Grandiose Delusions: false, fixed delusion that your superior.

Somatic Delusion: false fixed belief re: body part i.e pt. believes they have x-ray vision, they can melt stone with their eyes etc. Pregnant at 83 yrs & male.

Question 6

Describe Hullucinations

Answer 6

False, Fixed, Sensory one for each sense:
1. Auditory Hallucination (most common) i.e. voices telling
you to harm yourself.
2. Visual Hallucinations seeing things that are not there.
3. Tactile Hallucinations feeling things that are not there.
4. Gustatory Hallucinations tasting things arent there.
5. Olfactory Hallucinations smelling things that are not there.
NOTE: There are 5 hallucinations for 5 senses!

Question 7

Describe Illusions

Answer 7

A misinterpretation of reality, your misinterpreting whats really going on its a sensory experience.

Question 8

How do hallucinations and illusions differ?

Answer 8

Illusions are a referent within reality, a referent is something, which a pt. refers when they say something - theres actually something there pt. just misinterprets what it is. Hallucinations - nothing is there!

i.e Hallucination pt says “ listen i hear demon voices” and theres no voices to be heard.

Illusion pt says “ listen i hear demon voices” and theres nurses talking to eachother at the nurses station. Pt. just misinterprets them.

i.e pt. mistakes fire extinguisher on the wall for a bomb

Question 9

How do we deal with these psychotic symptoms in psychotic patients?

Answer 9

First Ask:
1. Are they Psychotic or Non Psychotic?
2. If Psychotic then what type of psychosis do they have
A. Functional B.Dementia C.Delirium?
3. If Non Psychotic - Use good therapeutic communication

Question 10

Describe a Functional Psychotic and how we teach reality to them.

Answer 10

Functional Psychosis = pt that can function in everyday life. They have no brain damage, just chemicals out of whack, so need meds and a set structure to balance them. They are your Schizo, Schizo, Major, Manics.
They have the potential to learn reality. We teach them reality by using the 4 step process:
1. Acknowledge feelings
2. Present Reality
3. Set Limits
4. Enforce Limits

Question 11

Describe a Dementia and how we teach reality to them.

Answer 11

1. Dementia = False fixed belief, pt. cannot learn reality, they have no insight, because there is damage to their brain i.e stroke, brain injury, Alzheimer’s, senile etc..
2. We teach them reality by using the 2 step process:
   
   1. Acknowledge feelings
   2. Redirect

Do not present reality b/c they cannot learn it, but don’t confuse this reality orientation person, place & time.

Question 12

Describe a Delerium and how we teach reality to them.

Answer 12

• Temporary
• Sudden
• Dramatic
• Secondary
• Due to chemical inbalance
• Loss of reality
• Crazy ppl. for short term b/c somethings causing it i.e drug reaction, Downer W/D or Upper O/D
• Post-op
• ICU Psychosis
• UTI, Elderly occult infection
• Thyroid storm
• Adrenal Crisis
• Roid Rage
• Good News: all temporary, so keep safe and remove underlying cause.

We teach them reality by using the 2 step process:

1. Acknowledge feelings
2. Reassure their safety i.e. what you are feel is temporary, it will go away, you are safe.

Question 13

Question: Pt. with Schizo Affective Disorder looks at a table across the room and says those ppl. are trying to kill me! How do you respond?

Answer 13

Ask: Psychotic or Non-Psychotic
Psychotic: Ask: functional, dementia or delirium?
Functional: Use 4 step Process
1. Acknowledge feeling - that must be very scary for you
2. Present reality - but nobody is trying to kill you here, you are safe.
3. Set Limits- we are not going to discuss this anymore.
4. Enforce Limits: I see you are still to ill to have a reality based conversation i will be back in half and hour to see how you are doing.

Question 14

Question: Pt. with Alzheimers looks at a table across the room and says those ppl. are trying to kill me! How do you respond?

Answer 14

Use 2 step process:

1. Acknowledge feeling
2. Redirect

Question 15

Question: Pt. with Delirium Tremens looks at a table across the room and says those ppl. are trying to kill me! How do you respond?

Answer 15

Use 2 step process:

1. Acknowledge feeling
2. Reassure safety and that the feeling is temporary

Question 16

With personality disorders use ________ unless they are abnormal (ABN) personality disorders then TX. as a _______ and use ________

Answer 16

Good Therapeutic Communication
Functional Psychotic
4 step process - Ack. Feelings, reality, set limits, enforce.

ABN: Antisocial, Borderline Personality, Narcissistic

Question 17

Describe loosening of association and the 4 different types.

Answer 17

Thoughts are all over the map.

1. Flight of ideas -go from thought to thought. Speaks in phases that make sense individually, but not paired with another.
2. Word Salad - Babble random words
3. Neogistically - Make up new words
4. Narrowed Self Concept - functional psychotic that will to leave room and refusing to change clothes. They define who they are unless they are wearing the same clothes and in the same room. - do not make them change or leave room if they don’t want to.

However, a similar scenario with a depressed pt. requires a different response- they are non-psychotic = good therapeutic communication i.e. i see that you are depressed and feeling down, but its time for your shower- you tell the pt. be very direct, if they won’t makes choices then you make them for them - only pt. you can make decisions for.