A patient seems distracted and describes things feeling 'off' lately. You want to check specifically for derealisation. Before revealing the answer, decide what you would actually ask.

Ask in plain language: "Has the world around you ever felt strange, distant, or somehow not quite real, even though you knew nothing had actually changed?" Check retained insight directly by asking whether they believe the world has genuinely changed or stopped existing, or whether it simply feels that way. Then ask whether the sense of unreality is confined to the surroundings, or whether they also feel detached from themselves, to help distinguish it from depersonalisation.