It is often embarrassing for patients to admit to such things, and we don’t want them to shut down. Next, I like to follow up: “What can you tell me about the experience?” and let the patient fill you in rather than making them feel interrogated about it. If hallucinations (and/or delusions) are reported as occurring regularly regardless of mood, then it could be more indicative of a Schizophrenia-spectrum condition. Can you tell me whenthe last time the voices (or seeing things, etc) happened?” Be sure to ask if they may occur any time, or, if the person is prone to depression, only during the times they’re depressed. I know it might not be easy to talk about. If the patient says they have experienced hallucinations, a clinician can respectfully dig deeper by replying : “Thanks for willing to share that with me. More than once, it was clarified “hearing voices” meant their own train of thought. I preface with “when you’re awake” because some interviewees, when I’d ask when the voices occur, replied, “well, in my dreams.” I also find it important to ask if it sounds like their own voice, such as hearing themselves think, or if it sounds like someone is speaking to them but nobody is there. To assess for hallucinations, a clinician might pose the question like this: “When you’re awake, has anything ever happened where you thought you were experiencing, or maybe you were even sure you were experiencing, hearing or seeing things that other people couldn’t?” Diagnostic protocol dictates that we not only note if Psychotic Features are present, but also if they are mood congruent or incongruent. While it’s merely a hypothesis, perhaps mood incongruent hallucinations are the subconscious’ way of trying to correct the depressed mood. Mood incongruent psychotic features are associated with poorer prognosis. An example of mood incongruent hallucinations during MDD would be voices telling the person positive things about themselves, or that they have superpowers. Some people experience mood incongruent hallucinations. The examples above are known as mood congruent hallucinations- they are related to the theme of depression.
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