Eliciting Delusions

Question 1

Front

Answer 1

Back

Question 2

What are the key areas to cover while eliciting delusions?

Answer 2

1. Address the patient’s main concerns and reasons for presentation.
2. Elicit the main abnormal belief.
3. Assess the nature, type, and content of the delusional idea.
4. Assess their onset (primary/secondary) and fixity (partial/complete).
5. Elaborate and seek explanation of delusional beliefs.
6. Assess the degree of conviction.
7. Evaluate effects and coping.
8. Screen for other delusional beliefs.
9. Conduct a risk assessment, especially for harm to self or others.

Question 3

What are some open questions to elicit delusions?

Answer 3

1. Have you experienced anything strange, bizarre, or unusual?
2. Do you have any particular worries preying on your mind at the moment?
3. Do you have any upsetting or distressing thoughts on your mind?

Question 4

What questions can help identify delusions of persecution?

Answer 4

1. How well have you been getting on with people?
2. Do you ever feel uncomfortable as if people are watching you or talking about you?
3. Do you feel people are trying to harm you in any way?
4. Is anyone trying to interfere with you or make your life miserable?
5. Is anyone deliberately trying to poison you or kill you?
6. Is there any organization like the Mafia behind it?

Question 5

How can you elicit delusions of reference?

Answer 5

1. Do people seem to drop hints about you or say things with a special meaning?
2. When you watch TV, listen to the radio, or read newspapers, do you feel the stories refer to you directly?
3. Do you see any messages or references to yourself on TV, radio, or in newspapers?
4. Do you feel the stories refer to things you have been doing?

Question 6

What are key questions to explore delusions of control or passivity?

Answer 6

1. Is there anyone trying to control you?
2. Do you feel you are under the control of a person or force other than yourself?
3. Do you feel as if you’re a robot or zombie with no will of your own?
4. Do they force you to think, say, or do things?
5. Do they change the way you feel in yourself?

Question 7

How can you identify delusions of guilt?

Answer 7

1. Do you feel you are to blame for anything or responsible for things going wrong?
2. Do you have any regrets?
3. Do you feel guilty as if you have committed a crime or sin?
4. Do you feel you deserve punishment?

Question 8

What questions are useful for assessing delusions of grandiosity?

Answer 8

1. How do you see yourself compared to others?
2. Is there something ‘out of the ordinary’ about you?
3. Do you have any special power or abilities?
4. Are you specially chosen in any way?
5. Is there a special mission to your life?
6. Are you a prominent person or related to someone prominent like royalty?
7. Are you very rich or famous?
8. What about special plans?

Question 9

What questions can help reveal nihilistic delusions?

Answer 9

1. How do you see the future?
2. Do you feel something terrible has happened or will happen to you?
3. Do you feel that you have died?
4. Has part of your body died or been removed?
5. Inquire about feelings of doom, being a pauper, intestines being blocked, etc.

Question 10

How can religious delusions be explored?

Answer 10

1. Are you especially close to God or Christ?
2. Can God communicate with you?

Question 11

What are key questions for hypochondriacal delusions?

Answer 11

1. How is your health?
2. Do you worry that there is anything wrong with your body?
3. Are you concerned that you might have a serious illness?

Question 12

What questions help in identifying delusions of jealousy?

Answer 12

1. Can you tell me about your relationship?
2. Do you feel that your partner reciprocates your loyalty?

Question 13

What should you always check when assessing delusions?

Answer 13

1. Whether the delusion is primary or secondary.
2. Degree of conviction.
3. Explanation, effects, and coping mechanisms.

Question 14

What are questions to determine the primary or secondary nature of a delusion?

Answer 14

1. How did it come into your mind that this was the explanation?
2. Did it happen suddenly or out of the blue?
3. How did it begin?

Question 15

How to assess the degree of conviction in delusions?

Answer 15

1. Even when you seemed most convinced, do you feel in the back of your mind that it might not be true?
2. Do you ever worry that all of this may be due to your mind playing tricks?

Question 16

What should you do if the patient responds positively to a delusional question?

Answer 16

1. Pick up clues from what the patient says.
2. Invite the patient to elaborate further.
3. Always probe for further elaboration of beliefs and seek examples.
4. Assess the degree of conviction, explanation, effects, and coping.
5. Assess the onset (primary/secondary) and fixity (partial/complete).

Question 17

What general questions help to understand the patient’s conviction and coping with delusions?

Answer 17

1. What do you think is causing these experiences?
2. Who do you think is causing them?
3. Why do they do so? And how do they do that?
4. How would you explain them?
5. How do you cope with these thoughts?
6. What have you done and what do you intend to do about them?