Udas

Nihilistic delusion

5 posts in this topic

Dear Afterlife 

I hope you are fine. I am wondering if you can help me please. How to assess this station - a unkempt lady of late 50s believes she died 3 days ago. She is preparing for her funeral by putting fire. 

Regards

Udas  

 

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Acknowledge and Empathize about her death.

"I am really sorry to hear that you were dead 3 days ago."

"How did you know that you became dead?" If it is due to auditory hallucinations, explore it.

" What/Who caused your death?"

Then challenge her belief that she is dead. Ask her to count the number of your fingers or ask her about her morning breakfast?

"A dead person would not be able to see/eat, you are able to see my fingers and count/you are able to eat; Could it be some illness making you to believe that you are dead?

Explore mood and anhedonia; "How was your mood before you became dead". 

Explore anergia and link the low mood, anergia with her unkempt/self neglect. 

Usually nihilism is also associated with delusions of guilt, delusion of wrong doing/sin, delusions of poverty. Explore them.

Rule out  schizophrenia by asking one question each about delusions of control and thought phenomenon.

End the station by telling "you need help and our services could help you to get better and I will arrange another early meeting with you to discuss about it.

 

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Dear Bretton  Gate 

Many thanks for your kindness and helpful gesture. I really appreciate this. 

Regards 

Udas 

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pass the casc video refer patient as a third person.

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On 1/23/2016 at 14:55, Udas said:

Dear Afterlife 

I hope you are fine. I am wondering if you can help me please. How to assess this station - a unkempt lady of late 50s believes she died 3 days ago. She is preparing for her funeral by putting fire. 

Regards

Udas  

 

Sorry for the delayed response. 

My take:

  • Sentences as above as laid down by Bretton Gate
  • ABC of history of presenting illness ie circumstances of perceived death and associated mental state
  • Elicit Psychotic symptoms first eg Nihilistic delusions, auditory,  visual and olfactory hallucinations (angel, rotting smell from the body etc.)
  • Ongoing suicidal thoughts ie thought of cremating the body
  • Core features of depressions just before percieved death
  • Other and somatic symptoms  just before perceived death
  • Past Psych history medications, compliance, alcohol, previous history of self harm and suicidal attempts etc. 
  • Social history and social supports
  • Any medical illnesses
  • That should be enough

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