Delusions and hallucinations MCQ

A delusional perception is one where a normal perception (being handed a receipt) is connected with a delusional conclusion that has no discernible connection with the original perception (not only are all birds unlikely to die tomorrow, but there is no way being passed a receipt would have any relationship with such an event). Delusional perceptions are one of Schneider's First Rank symptoms of schizophrenia. Watch this video for another example of a delusional perception: https://youtu.be/CfXjTPInwpI

An illusion is when a patient misinterprets a real stimulus, whereas an hallucination is when a patient has a sensory experience that wasn't real. In this case, the cat cast a real shadow on the floor, so the sensory stimulus was real.

This is a hallucination because the patient is imagining these voices. It is a second person hallucination because the voices are speaking to the patient whereas the voices would be talking about the patient in a third person hallucination. In first person hallucinations, the patient would hear themselves speaking allowed, also known as thought echo. A running commentary is a type of third person hallucination. Although the voices may be threatening the patient, there is nothing in the description to say he thinks he is in danger.

This is a type of somatic hallucination known as 'formication', where a patient may feel insects on or under their skin. It is common in alcohol withdrawal and with cocaine use. In this case, the patient would probably be given lorazepam to manage the delirium tremens and these hallucinations.

This is a delusion because the patient believes they have been given this mission.

This is a sign of a nihilistic delusion. Patients with major depression may experience nihilistic delusions or negative hallucinations such as hearing screaming voices or seeing demons.

When a patient believes that other people can hear their thoughts, that is thought broadcasting. Note, he is not hearing these thoughts himself which would thought echo/1st person auditory hallucination.

This is an elemental hallucination - the patient can hear a sound rather than voices. Other examples of elemental hallucinations might include seeing flashing lights or zigzig lines. Elemental hallucinations are normally a symptom of an organic pathology rather than psychosis. In this woman's case, she could just be experiencing tinnitus, but you would want to explore if they had any problems with hearing loss, balance, vertigo, facial weakness, sight and aural fullness to help determine your differentials and investigations.

As the patient hears voices talking about him rather than to him, this is a third person auditory hallucination. Note that the mental health worker seeks further clarification to help confirm whether this is a hallucination; maybe he could have overheard his neighbours talking about him on the street. In some cases the voices the patient hears are describing what the patient is doing. This is a form of third person auditory hallucination called running commentary.

A delusion of reference is simply any delusional idea in which ordinary, everyday occurrences in the outside world are believed by the patient to relate to them in some special, personal way. Other examples include a newscaster on the TV speaking to the patient directly, or car licence plates containing coded text only the patient understands.

You might have thought this was a delusional perception (correct perception with delusional conclusion) but because the information on the receipt is communicating something personal to the patient, delusion of reference is the correct definition.