The nurse is collecting history from the husband of Mrs. X brought to psychiatry OPD. Which of the following symptom reported by her husband leads the nurse towards the diagnosis of schizophrenia?

1. A

   Hallucinations

2. B

   Excessive worry

3. C

   Delirium

4. D

   Grandiosity

Appeared in: GMCH Nursing Officer-2025

Explanation

• Hallucinations are a primary positive symptom and a core diagnostic feature of schizophrenia, as per DSM-5 and ICD-10 criteria.
• They are defined as sensory perceptions in the absence of any real external stimuli.
• Auditory hallucinations, such as hearing voices that comment on the person's actions or converse with them, are the most common type experienced in schizophrenia.
• A report from a family member about the patient talking to themselves or reacting to unseen things is a strong indicator of hallucinations.

Why Other Options Were Wrong

• Option B: Excessive worry is the cardinal symptom of Generalized Anxiety Disorder (GAD), not schizophrenia. It involves persistent, uncontrollable worry about numerous events or activities.
• Option C: Delirium is an acute disorder of attention and consciousness, characterized by a fluctuating course. It is typically caused by an underlying medical condition, substance use, or withdrawal, and is not a primary symptom of schizophrenia.
• Option D: Grandiosity, or delusions of grandeur, is an inflated sense of self-importance, power, or identity. While it can occur in schizophrenia, it is more classically a hallmark symptom of a manic episode in Bipolar I Disorder.

Related Visual

• Visual 1: Infographic: A chart comparing the positive symptoms (hallucinations, delusions, disorganized thought) and negative symptoms (affective flattening, alogia, avolition) of schizophrenia.
• Visual 2: Table: A comparison table differentiating the key features of Schizophrenia, Bipolar I Disorder (Mania), and Delirium to aid in differential diagnosis.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Core symptoms of schizophrenia for differential diagnosis to guide bedside assessment, documentation, and the next nursing action.
• Accurate history-taking from family members is vital in psychiatric nursing, as patients with psychotic disorders often have poor insight (anosognosia) and may not recognize their symptoms as abnormal.
• Identifying core psychotic symptoms like hallucinations is the first step toward ensuring patient safety (e.g., assessing for command hallucinations) and initiating appropriate antipsychotic treatment.
• What if? If the husband had reported that his wife had an inflated sense of self-importance, was sleeping only 2 hours a night, and was involved in reckless spending sprees, the nurse's suspicion should shift towards a manic episode of Bipolar I Disorder, not schizophrenia.

How to Approach the Question

• First, identify the core task of the question: to select the symptom most characteristic of schizophrenia from the given options.
• Recall the fundamental symptoms of schizophrenia, particularly the 'positive' symptoms which include hallucinations and delusions.
• Evaluate each option against the diagnostic criteria for schizophrenia. Hallucinations are a classic positive symptom.
• Systematically rule out the other options by associating them with their more typical diagnoses: 'Excessive worry' with Anxiety Disorders, 'Delirium' with acute medical/toxic states, and 'Grandiosity' with Bipolar Mania.
• Conclude that hallucinations are the most direct and common indicator of schizophrenia among the choices provided.

Concept Tested & Keywords

• Concept Tested: Core symptoms of schizophrenia for differential diagnosis.
• Stem keywords: schizophrenia, symptom, history, psychiatry OPD, husband
• Lead-in keywords: leads the nurse towards the diagnosis
• Clinical cues: History is being collected from a family member, which is common when a patient may lack insight into their illness.
• Negative lead-in flag: false

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Qx6bjIZkCGfmMokOL2bsNH

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