Eliciting Hallucinations

Question 1

Front

Answer 1

Back

Question 2

What areas should be covered when eliciting hallucinations?

Answer 2

1. Explore the hallucinatory experience and its modality (e.g., auditory hallucinations)
2. Clarify whether these are elementary or complex hallucinations
3. Identify if they are true or pseudo hallucinations (source)
4. Content of hallucinations
5. Timing of hallucinations
6. Reality with which they are experienced
7. Explore hallucinations in other modalities
8. Duration, effects, and coping
9. Clarify if auditory hallucinations are second or third person, command, or running commentary in nature

Question 3

How to introduce the topic of auditory hallucinations to a patient?

Answer 3

1. I understand that recently you have been hearing voices when there is no one around you and nothing else to explain it. Can you tell me more about it?
   (OR)
2. I should like to ask you a routine question, which we ask of everybody.
   Do you ever seem to hear voices or noises when there is no one about and nothing else to explain it?

Question 4

What questions help identify second person auditory hallucinations?

Answer 4

1. Do you hear voices?
2. Can you please give me some examples of the sort of things the voice said?
3. Who is it you are talking to? Can you recognize those voices?
4. If you recognize them, then whose voices are they?
5. How many voices do you hear?
6. Do the voices belong to men, women, or children?
7. Do they speak directly to you?
8. Do you hear your name being called?
9. Do they tell you what to do? Can you please give me an example?
10. Do they give orders? Do you obey?
11. Can you carry on a two-way conversation with the voices?

Question 5

What questions help identify third person auditory hallucinations?

Answer 5

1. Do you hear several voices talking about you?
2. Do they refer to you as ‘he’ or ‘she’ like a 3rd person?
3. What do they say?
4. Do you hear voices like a running commentary instructing you to do things?
5. Do they seem to comment on what you are thinking, reading, or doing?

Question 6

How to confirm whether auditory hallucinations are true hallucinations?

Answer 6

1. Where do these voices appear to come from?
2. Do you hear them in your mind or in your ears?
3. Do the voices come from inside or outside your head?
4. Do you hear them as clearly as you hear me?
5. Can you start or stop them?
6. Do you feel that they are real or do you feel that they are just voices?

Question 7

What to ask about hypnagogic/hypnopompic hallucinations?

Answer 7

1. When did this occur? Were you fully awake when you heard these voices?
2. Do these voices disturb your sleep?
3. Do you hear them more at any particular time like when you go to bed or when you wake up?

Question 8

How to explore visual hallucinations?

Answer 8

1. Have you seen things that other people can’t see?
2. What did you see? Can you please give me an example?
3. When do you see them and how often?
4. Was the vision seen with your eyes or in your mind?
5. How do you explain it?
6. Were you half asleep at that time?
7. Has it occurred when you are fully awake?
8. Did you realize that you are fully awake?

Question 9

How to explore olfactory hallucinations?

Answer 9

1. Is there anything unusual about the way things feel or taste or smell?
2. Do you ever notice strange smells that other people aren’t bothered by?
3. What did you smell? Can you please give me an example?
4. How do you explain it?

Question 10

How to explore gustatory hallucinations?

Answer 10

1. Have you noticed that food or drink seems to have an unusual taste recently?
2. What did you taste? Can you please give me an example?
3. How do you explain it?

Question 11

How to explore tactile hallucinations?

Answer 11

1. Have you had any strange or unusual feelings in your body?
2. Do you ever feel that someone is touching you, but when you look there is nobody there?
3. Some people have funny sensations on the body, for example, insects crawling or electricity passing or muscles being stretched or squeezed. Have you had any such experiences?
4. How do you explain it?

Question 12

What to ask about the duration

Answer 12

course

Question 13

What comorbidities should be ruled out during hallucination assessment?

Answer 13

1. Contributing factors to illness and stressors
2. Anxiety
3. Depression
4. Mania/Hypomania
5. Coping strategies like alcohol and illicit drug use

Question 14

How to assess the risk of harm to self and others secondary to hallucinations?

Answer 14

1. Direct questioning about thoughts of harm to self or others
2. Observing for signs of distress or agitation related to hallucinations
3. Assessing the content of hallucinations for harmful commands