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In this MCQ, we have ten questions for you to practice distinguishing between some of the basic classifications of hallucination and delusion.

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Delusions and hallucinations

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Question 1
For the following questions, identify the type of delusion or hallucination being described.

When a patient went to the supermarket he was handed a receipt and knew that was the sign that the plans were in place.
A
Delusion of control
B
Delusion of reference
C
Grandiose delusion
D
Nihilistic delusion
E
Perceptional delusion
Question 1 Explanation: 
A perceptional delusion is one where a normal perception (being handed a receipt) is interpreted in a delusional way (is a sign that the plans are ready). Watch this video for another example of a delusional perception: https://youtu.be/Gc2Nox6PMnc
Question 2
A patient was frightened when they mistook their cat's shadow for an intruder.
A
Delusion of perception
B
Delusion of reference
C
Illusion
D
Persecutory delusion
E
Visual hallucination
Question 2 Explanation: 
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.
Question 3
A patient is speaking to his psychiatrist. He describes hearing two male voices with local accents who are telling him what to do and threatening him. The patient can hear them now. They are telling the patient that he (the patient) will be in trouble when he leaves this meeting.
A
Elemental auditory hallucination
B
2nd person auditory hallucination
C
3rd person auditory hallucination
D
Running commentary
E
Persecutory delusion
Question 3 Explanation: 
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.
Question 4
An alcoholic is on AMU experiencing delirium tremens as he goes through acute alcohol withdrawal. He is scared and scratching himself because he can feel insects crawling under his skin.
A
Elemental hallucination
B
Delusion of perception
C
Illusion
D
Pseudohallucination
E
Somatic hallucination
Question 4 Explanation: 
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.
Question 5
A patient confides in you that they are on a secret mission for British Intelligence. They have been entrusted to break up a Russian spy ring and capture a code book being used by their agents.
A
Command hallucination
B
Delusion of grandeur
C
Delusion of perception
D
Persecutory delusion
E
Thought insertion
Question 5 Explanation: 
This is a delusion because the patient believes they have been given this mission.
Question 6
A patient says they don’t want to eat. There’s no point in eating as they are dying and their insides are rotting.
A
Delusion of control
B
Delusion of reference
C
Gustatory hallucination
D
Nihilistic delusion
E
Somatic hallucination
Question 6 Explanation: 
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.
Question 7
A patient doesn’t trust his family and tries to avoid them because they can hear what he is thinking.
A
1st person auditory hallucination
B
Control delusion
C
Running commentary
D
Thought broadcast
E
Thought withdrawal
Question 7 Explanation: 
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.
Question 8
A patient visits her GP complaining of hearing a low-pitched buzzing.
A
Delusion of perception
B
Delusion of reference
C
Elemental hallucination
D
Illusion
E
Pseudohallucination
Question 8 Explanation: 
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.
Question 9
A young man suffering form schizophrenia tells his mental health worker that he has been hearing his neighbours talking about him. When the mental health worker explores further, he explains that he hears them not only at home, but when he is on the bus or in the shops.
A
1st person auditory hallucination
B
2nd person auditory hallucination
C
3rd person auditory hallucination
D
Persecutory delusion
E
Delusion of perception
Question 9 Explanation: 
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. People with schizophrenia suffer a lot of social stigma and the MDT approach to treating it includes helping patients deal with felt and enacted stigma.
Question 10
A patient says he avoids the post box at the end of his street. It’s a powerful antenna and used by the government to control and communicate with spies in the area.
A
Delusion of control
B
Delusion of reference
C
Elemental hallucination
D
Thought insertion
E
Persecutory delusion
Question 10 Explanation: 
This is a delusion of reference as the patient is giving the post box a special meaning. As the patient describes the post box being used to control and communicate with people, you may have thought this was a delusion of control or thought insertion; however, the patient never says he is being controlled or spoken to through it. For another example of delusion of reference, see https://youtu.be/SNs6yaa9MGk
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