A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing:
A. A delusion
B. Flight of ideas
C. Ideas of reference
D. Hallucination
Correct Answer: D. Hallucination
A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. The word “hallucination” comes from Latin and means “to wander mentally.” Hallucinations are defined as the “perception of a nonexistent object or event” and “sensory experiences that are not caused by stimulation of the relevant sensory organs.” Hallucinations occur frequently in people with psychiatric conditions, including schizophrenia and bipolar disorder, however, you don’t necessarily need to have a mental illness to experience hallucinations.
Option A: A delusion is a false belief. Delusions are defined as fixed, false beliefs that conflict with reality. Despite contrary evidence, a person in a delusional state can’t let go of their convictions. Delusions are often reinforced by the misinterpretation of events. Many delusions also involve some level of paranoia. For example, someone might contend that the government is controlling our every move via radio waves despite evidence to the contrary. Delusions are often part of psychotic disorders. They may occur along with hallucinations, which involve perceiving something that isn’t really there, like hearing voices or feeling bugs crawling on your skin.
Option B: Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent. It is part of the DSM -5 criteria for Manic episodes.
Option C: Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client’s ideas or behavior. In people with bipolar disorder, mania and hypomania can comprise various symptoms, from reckless spending to sexual promiscuity. In addition, some more subtle symptoms may also occur, such as the belief held by some patients that everything occurring around them is related somehow to them when in fact it isn’t. This symptom is known as ideas of reference. An extension of those irrational beliefs, delusions of reference, can cause patients to change their behavior significantly because of this mistaken belief.