What questions might you ask Nate to see whether he is experiencing command hallucinations? You are welcome to use an outside credible source on mental status exams to inform your response.

Nate Monahan is a thirty-seven-year-old man who has been afflicted with HIV/AIDS for the past eleven years, seven asymptomatic and the last four increasingly debilitated by the onset of the disease. Nate's emotional state started to deteriorate rapidly about three years ago after the first symptoms of AIDS had appeared. A tentative reconciliation with his family, from whom he had been estranged from the time he revealed his diagnosis, has faltered as he has became more withdrawn and paranoid. In particular, he feared continued recrimination from his father and refused the overtures of his mother to bring the two men together.

While his lover was dying, both men were being cared for in their apartment by the services of a home health agency. However, since his lover's death, Nate has not permitted the agency staff in his apartment. He has been living alone, has often failed to keep clinic appointments, and, on the rare occasions that he is seen by neighbors, appears both malnourished and unclean. Telephone messages to him routinely go unanswered, and he frequently does not respond to his doorbell except to yell at whomever is there to leave. During this period, he also lost several other friends to the disease, and Nate endures far more bad days than good ones.

At the funeral of his lover, which was attended by only a brother from Nate's family, a friend, also symptomatic, encouraged Nate to attend a support group. Reluctantly, Nate attended one meeting and never returned. However, at that one meeting, he listened intently as other people with AIDS discussed their right to die. In fact, a few of them indicated that they were stockpiling prescription medication to have on hand in the event they ever decided to exercise this right. Nate said nothing at the meeting but quietly indicated to the friend who brought him to the support group that he might follow the same course. Without disclosing his plans to anyone else, Nate suddenly began keeping clinic appointments, always complained of pain, and had all the prescriptions for narcotics, which he was given, filled and refilled.