Nurse:“How have you been sleeping lately?”
Client:“Oh, I go to bed early, so I can get plenty
of rest. I like to listen to music or read before bed.
Right now I’m reading a good mystery. Maybe I’ll
write a mystery someday. But it isn’t helping, reading
I mean. I have been getting only 2 or 3 hours of sleep
at night.”
Poverty of content (alogia) describes the lack of
any real meaning or substance in what the client
says:
Nurse: “How have you been sleeping lately?”
Client:“Well, I guess, I don’t know, hard to tell.”
DELUSIONS
Clients with schizophrenia usually experience delu-
sions(fixed, false beliefs with no basis in reality) in
the psychotic phase of the illness. A common charac-
teristic of schizophrenic delusions is the direct, im-
mediate, and total certainty with which the client
holds these beliefs. Because the client believes the
delusion, he or she will therefore act accordingly. For
example, the client with delusions of persecution will
probably be suspicious, mistrustful, and guarded
about disclosing personal information; he or she may
examine the room periodically or speak in hushed,
secretive tones.
The theme or content of the delusions may vary.
Box 14-3 describes and provides examples of the var-
ious types of delusions. External, contradictory in-
formation or facts cannot alter these delusional be-
liefs. If asked why he or she believes such an unlikely
idea, the client often replies, “I just know it.”14 SCHIZOPHRENIA 309
Thought broadcastingBox 14-3
➤ TYPES OFDELUSIONS
Persecutory/paranoid delusionsinvolve the
client’s belief that “others” are planning to harm
the client or are spying, following, ridiculing, or
belittling the client in some way. Sometimes the
client cannot define who these “others” are.
Examples: The client may think that food has
been poisoned or that rooms are bugged with
listening devices. Sometimes the “persecutor”
is the government, FBI, or other powerful
organization. Occasionally, specific individuals,
even family members, may be named as the
“persecutor.”
Grandiose delusionsare characterized by the
client’s claim to association with famous people
or celebrities, or the client’s belief that he or she
is famous or capable of great feats.
Examples: The client may claim to be engaged
to a famous movie star or related to some public
figure such as claiming to be the daughter of the
President of the United States; may claim he or
she has found a cure for cancer.
Religious delusionsoften center around the second
coming of Christ or another significant religious
figure or prophet. These religious delusions
appear suddenly as part of the client’s psychosis
and are not part of his or her religious faith or
that of others.
Examples: Client claims to be the Messiah or
some prophet sent from God; believes that God
communicates directly to him or her, or that he
or she has a “special” religious mission in life or
special religious powers.
Somatic delusionsare generally vague and unreal-
istic beliefs about the client’s health or bodily
functions. Factual information or diagnostic test-
ing does not change these beliefs.
Example: A male client may say that he is preg-
nant, or a client may report decaying intestines
or worms in the brain.
Referential delusionsor ideas of referenceinvolve
the client’s belief that television broadcasts,
music, or newspaper articles have special mean-
ing for him or her.
Examples: The client may report that the presi-
dent was speaking directly to him on a news
broadcast or that special messages are sent
through newspaper articles.