AIIMS Delhi NO- 2019
Psychiatric Nursing
Medium
A patient states, “My organs have stopped working; I am already dead.” This delusion is called:?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- Nihilistic delusion.
- This is defined by a false belief that oneself, a part of one's body, or the world is non-existent or has been destroyed.
- The patient's statement 'I am already dead' is a direct expression of a nihilistic belief, which negates their own existence.
- This specific type of delusion is also known as Cotard's syndrome, which can involve beliefs about having lost internal organs or being deceased.
Why Other Options Were Wrong
- Option A: While the statement includes a somatic component ('My organs have stopped working'), the core belief is the negation of life ('I am already dead'), which goes beyond a typical somatic delusion.
- Option C: A grandiose delusion involves an inflated sense of self-worth, power, or identity (e.g., believing one is a god or a famous person). The patient's statement reflects the opposite—a sense of nothingness.
- Option D: A referential delusion involves the belief that neutral, external events have a special, personal meaning. The patient's statement is an internal belief about their own state of being, not an interpretation of outside events.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Identification of Delusion Types in Psychiatric Nursing to guide bedside assessment, documentation, and the next nursing action.
- Recognizing the specific type of delusion is crucial for a nurse to assess the patient's risk, particularly for suicide, as nihilistic delusions are strongly associated with severe depression and hopelessness.
- Nursing interventions must be tailored to the delusion. For nihilistic delusions, the priority is safety and managing severe depressive symptoms, whereas for persecutory delusions, building trust and ensuring the patient feels safe from perceived threats is key.
- What if the patient only said, 'My organs are rotting'? If the statement was limited to a belief about bodily decay without the declaration of being dead, the primary consideration would shift to a Somatic delusion. The nursing approach would then focus more on addressing the health anxiety and physical complaints, while still assessing for underlying depression.
How to Approach the Question
- First, analyze the patient's statement provided in the question stem: 'My organs have stopped working; I am already dead.'
- Break down the statement into its components. 'My organs have stopped working' points towards a physical or somatic theme. 'I am already dead' points towards a theme of non-existence.
- Evaluate which component is the core or ultimate conclusion of the delusion. The declaration of being dead is a more profound and defining belief than the organ complaint.
- Review the definitions of the delusion types provided in the options.
- Match the core theme of the patient's delusion to the correct definition. The belief in being dead directly aligns with the definition of a nihilistic delusion.
- Differentiate it from the closest distractor (Somatic delusion) by noting that the nihilistic aspect (being dead) overrides the somatic component.
Concept Tested & Keywords
- Concept Tested: Identification of Delusion Types in Psychiatric Nursing
- Stem keywords: delusion, organs have stopped working, already dead
- Lead-in keywords: is called
- Clinical cues: Patient statement: 'My organs have stopped working; I am already dead.' - This combination of a somatic complaint with a declaration of non-existence is key to the diagnosis.
Question ID
QIOwpIliQot8VtFVO7cPQj
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 3249-3251, 5268-5270
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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