(PDF) Understanding delusions

1. Mental Status Examination
APPEARANCE- The early insight into Dimitrie’s appearance follows at the mental
health clinic, discovering he was sitting in a chair in an upright position, appearing to be
dazed and nervous. Dimitrie is a young man with black hair above the shoulders, with
Asian descent, wearing reading glasses, having a small build, moustache, and fair
complexion. Dimitrie wore a long sleeve flannel and pants; clothing appeared tidy,
which indicated a typical level of personal hygiene and self-care. Dimitrie did not have
any visible tattoos or piercings. Consequent to Dimitrie’s arrival at the clinic he emerges
as very tense at times and his facial expressions change rapidly from fixated to
disorientated which depicts his poor poise.
BEHAVIOUR- It was clear Dimitrie was distraught and anxious as he became agitated
with the voices that were in his head as they were ‘criticising’ him. Dimitrie presents
reduced eye contact to the mental health nurse, though he is able to build rapport and is
slow to engage with the clinician; he is co-operative and showing signs of compliance
as he mostly answers the nurse’s questions, appropriately. Signs of psychomotor
agitation can be shown as the patient shows episodes temporary inattentiveness, and
responds to the voices he is hearing; as he says ‘sorry what was the question again’ or in
response to his writing ‘I will finish it, so shut up’ which also demonstrates his negative
attitude and outlook. Dimitrie is unable to focus either looking into space or distracted
by saying ‘just leave me alone’ to the voices he hears.
AFFECT- Dimitrie produces some emotional responsiveness, suggested from his
anxious facial expressions; Dimitrie has also shown an impediment in terminating an
emotional response when triggered by voices, or discussing a sensitive topic; which

portrays a labile affect, when switching from listening to the nurse and the voices. When
asked questions from the nurse, the patient acts accordingly and appropriately; when not
restricted by the voices. This particular patient was showing signs of delusional thinking
as he was frightened by the experiences and mentioned ‘they do stuff to me which isn’t
pleasant’.
Inappropriate affect was shown when Dimitrie’s affect was incongruent with what he
was saying; for example when asked his job efforts he responded with ‘not really’ then
‘I’m a writer’ and ‘I will finish it, so shut up’, which lead to a flattened affect when
discussing impulses.
MOOD- The patient said he was ‘not entirely comfortable, because I am hearing voices’
and described the experience as ‘scary’. Dimitrie’s mood changes throughout the
meeting and seems to be fearful and worried, as a result of the voices. Overall emotional
tone was observed in the interview; there was spontaneous intense reactivity, by
Dimitrie from being distressed and when describing upsetting occurrences, he said ‘they
are very critical’ and ‘this is scary sometimes’ in reference to the voices.
SPEECH- Dimitrie speaks in a calm monotonous voice mostly to the nurse, unless he
starts hearing voices in his head; which shows him raising his voice ‘just leave me
alone’ to the voices. Dimitrie has a paucity of content in his speech, as his distracted by
the voices he is hearing, when talking to the nurse he has a clear normal prosody, and
lilt. The rate of speech was coerced with an inclination to emphasis on the deleterious
circumstances surrounding the voices.
THOUGHT FORM- Dimitrie is showing a poverty of ideas as is very vague when
asked about his writing; he also is exhibiting slow and hesitant thinking, and has goal

directed thinking which is tangential ‘I’m still getting back to writing’ representing
loose associations. Dimitrie also encounters disruptions of the train of thought before an
idea has been finished; he also indicates a failure to recollect what was being said or
anticipated to be said. ‘Sorry, what was the question? ’ demonstrates his inarticulate and
unfathomable connections of thoughts resulting in a word salad, at times.
THOUGHT CONTENT- The patient is experiencing persecutory delusions as he is
hearing the voices ‘I haven’t had my medication in a while, so I’m hearing voices’, and
is specifying signs he is being harassed and in fear. He believes he ‘was fine till until the
last month’ of his holiday, for which he ran out of medications on his trip to Japan.
Dimitrie also said ‘I have friends, I guess I don’t see them much’, ‘on Facebook and
stuff’ which demonstrates he has anti-social urges.
PERCEPTION- During the interview Dimitrie appears to be suffering from auditory
phenomena without an authentic stimulus. This can be demonstrated when he gets side-
tracked and declares ‘I’m not crazy’, in response to the nurse asking about being
monitored in hospital; which is exhibiting the misinterpretations as wells as the feelings
of depersonalisation and derealisation by Dimitrie.
COGNITION & INTELLECTUAL FUNCTIONING- Dimitrie is aware of where he is
and his friend Cheryl who brought him to the clinic, although he does not have an
immediate recall of the date; which takes him some time to work out as he starts out by
stating ‘Ahh, its December’ and eventually remembers the medication he should be
taking, so he is somewhat orientated. When questioned about a mathematical
calculation he initially took some time and after two attempts he stated the voices are
‘telling me my math sucks’. The patient does not establish a clear ability to plan or
implement as he does not socialise, telling the nurse he usually goes to the ‘movies by