Delusions, Hallucinations, and Illusions: NCLEX Review

Psychosocial Adaptation & Mental Health Nursing

  • Psychosocial adaptation is a key area tested on the NCLEX, potentially comprising up to 17% of the exam.
  • Focuses on communication, therapeutic communication, and the nurse-patient relationship.
  • Often referred to as mental health nursing or psychiatric nursing.

Psychosis: Delusions, Hallucinations, and Illusions

  • Delusions, hallucinations, and illusions are symptoms of psychosis.
  • First, determine if the patient is psychotic or non-psychotic.
  • The majority seeking mental health services have non-psychotic problems.

Psychotic vs. Non-Psychotic Patients

  • Non-Psychotic Patients: Patients with mental health disorders who possess insight and are reality-based.
    • Insight: They are aware of their illness, understand the problem, and recognize its impact on their lives.
    • Reality-Based: They perceive the same reality as others without the illness.
  • Psychotic Patients: Patients who lack insight and are not reality-based.
    • No Insight: They do not believe they are ill and deny any problems.
    • Not Reality-Based: They live in an alternative reality and may experience false thoughts, visions, or auditory hallucinations.

Examples Distinguishing Psychotic from Non-Psychotic

  • Non-Psychotic Example:
    • A patient with depression says, "I hate this depression. It's ruining my life. If this is the way my life is going to be, I want to kill myself."
    • Despite suicidal thoughts, the patient is non-psychotic because they show insight by acknowledging their depression and its impact.
  • Psychotic Example:
    • A patient with depression says, "I'm not sick. I don't know why I'm here. I'm the king of Jupiter, and I'm going to take over the world."
    • The patient lacks insight, denies illness, and displays a non-reality-based belief.

Psychotic Symptoms: Delusions, Hallucinations, and Illusions

  • Psychotic symptoms include delusions, hallucinations, and illusions.
  • Psychotic patients exhibit these symptoms due to their lack of insight and detachment from reality.
  • Non-psychotic patients do not experience these symptoms.

Delusions

  • A delusion is a false, fixed belief, idea, or thought without any sensory component.
  • Fixed means that the belief is unchanging over time.
  • Three types of delusions:
    • Persecutory/Paranoid Delusion: A false, fixed belief that individuals are being harmed or plotted against (e.g., thinking the mafia wants to kill them).
    • Grandiose Delusion: A false, fixed belief of being superior or better than others (e.g., believing to be the world's smartest or most powerful person). "I'm the king of Poland".
    • Somatic Delusion: A false, fixed belief about body parts (e.g., thinking ears have ultrasonic hearing or believing there are no organs inside the body). "Ants crawling inside eyeballs".

Hallucinations

  • A hallucination is a false, fixed sensory experience.
  • It is purely a sensation rather than a thought.
  • Five types of hallucinations based on the five senses:
    • Auditory: Hearing voices (most common). They always say the same thing. "You're evil, kill yourself".
    • Visual: Seeing things that are not real (e.g., angels or demons).
    • Tactile: Feeling sensations (e.g., worms crawling on the skin).
    • Olfactory: Smelling things that are not real (rare).
    • Gustatory: Tasting things that are not real (rare).
  • Seven Hallucinatory Words:
    • A tool to differentiate hallucinations from delusions.
    • If any of these words appear in a question, it indicates a hallucination:
      • Look
      • See
      • Listen
      • Hear
      • Taste
      • Smell
      • Feel
  • Example:
    • "There are worms crawling in my arm" - Delusion (no hallucinatory words).
    • "I can feel worms crawling in my arm" - Tactile Hallucination (contains the word "feel").
    • "Angels appear to me" - Grandiose delusion (there are no sensory words).
    • "Look. I see an angel." - Visual Hallucination (contains "look" and "see").

Illusions

  • An illusion is a misinterpretation of reality. It is a sensory experience.
  • Referent in Reality:
    • An illusion involves a real, existing object or event (referent) that is misinterpreted.
    • Referent referes to something that is real, that's actually there, to which they refer when they when they have their sensory experience that's false.
  • Differentiation from Hallucinations:
    • Illusions have a referent, while hallucinations do not.
  • Example:
    • "The patient looks at the clock on the wall and says, 'Look, I see a bomb'" - Illusion (the clock is the referent).
    • "During the interview, the client says, 'Look, I see a bomb'" - Hallucination (no referent mentioned).
  • An illusion is a hallucination with a referent.