A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:
A. Delusion
B. Looseness of association
C. Illusion
D. Hallucination
Correct Answer: D. Hallucination
Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Auditory hallucinations are the sensory perceptions of hearing voices without an external stimulus. This symptom is particularly associated with schizophrenia and related psychotic disorders but is not specific to it. Auditory hallucinations are one of the major symptoms of psychosis.
Option A: Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Jaspers (1883-1969) was amongst the first to describe and classify delusions. In his book General Psychopathology (1913), he suggests that a delusion is a “perverted view of reality, incorrigibly held.” These perversions are enigmatically derived, held with extraordinary certainty, and absolutely unamenable. He further emphasized that these false beliefs exist along a continuum of thought disturbance, increasing in severity of distortion from normal thinking patterns to ‘true’ delusions. One hundred years later, Jaspers’ postulation remains a leading candidate in the investigation of delusion morphology.
Option B: Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren’t clearly linked to one another. A thought disturbance demonstrated by speech that is disconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea. It is essentially equivalent to derailment.
Option C: Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia. Illusion, a misrepresentation of a “real” sensory stimulus—that is, an interpretation that contradicts objective “reality” as defined by general agreement. For example, a child who perceives tree branches at night as if they are goblins may be said to be having an illusion.