A patient claims that they are being watched by the government and that their life is at risk. This is an example of which type of delusion?

1. A

   Delusion of reference

2. B

   Delusion of grandeur

3. C

   Delusion of persecution

4. D

   Delusion of control

Appeared in: NORCET 7 Prelims -2024

Explanation

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• Delusions of persecution are fixed, false beliefs that one is being harmed, threatened, spied on, or conspired against.
• The patient's belief that the government is watching them and that their life is in danger is a classic presentation of a persecutory delusion, as the core theme is the belief of being targeted for harm.
• According to psychiatric texts, persecutory delusions are the most common type of delusion in schizophrenia and other psychotic disorders.

Why Other Options Were Wrong

• Option A: This involves misinterpreting random events as having personal significance, not a direct threat from an entity like the government.
• Option B: This is a belief of inflated self-worth, power, or identity, which is the opposite of feeling victimized or threatened.
• Option D: This is the belief that one's actions or thoughts are being controlled by others, not that one is being threatened or harmed.

Related Visual

• Visual 1: Infographic: A chart comparing different types of delusions (Persecution, Grandeur, Reference, Control, Somatic) with clear definitions and examples for each.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Types of Delusions in Psychiatric Nursing to guide bedside assessment, documentation, and the next nursing action.
• A nurse's primary role is to ensure safety, as patients with persecutory delusions may act on their beliefs to 'protect' themselves, potentially harming themselves or others.
• It is crucial to build trust without validating the delusion. Acknowledge the patient's fear ('That must feel very frightening') without agreeing with the content of the delusion ('I don't see any government agents, but I want to help you feel safe here').
• What if? If the patient also had auditory hallucinations (e.g., hearing voices from the government), the immediate priority would shift to assessing for command hallucinations, which could instruct the patient to harm themselves or others, requiring more urgent safety interventions.

How to Approach the Question

• First, identify the core belief expressed by the patient in the clinical scenario.
• The patient believes they are being watched and are in danger. This points to a theme of threat and harm.
• Next, review the definitions of the delusion types provided in the options.
• Match the patient's core belief to the correct definition. 'Persecution' is the belief of being targeted for harm.
• Eliminate other options. 'Reference' is about personal significance of random events, 'grandeur' is about inflated self-worth, and 'control' is about external influence on one's actions/thoughts. None of these fit the theme of being threatened.

Concept Tested & Keywords

• Concept Tested: Types of Delusions in Psychiatric Nursing
• Stem keywords: delusion, watched by the government, life is at risk
• Lead-in keywords: example of which type
• Clinical cues: Patient's statement: 'watched by the government' suggests paranoia and threat.
• Clinical cues: Patient's statement: 'life is at risk' indicates a belief of impending harm.

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