Verbal Hallucinations: Understanding Symptoms And Care Options

Appearance and Behavior

Discuss About The Verbal Hallucinations Cambridge University.

APPEARANCE: Young Asian black haired man. He is wearing glasses. His clothing is appropriate for his age. Has a slim figure. He was dressed in cargo pants with red and black flannel shirt along with glasses. Appeared disengage as his head was hung down, arms crossed and restrictive posture. His Grooming is adequate and he was cooperative about the examination.

BEHAVIOUR:  The patient is avoiding eye contact, probably due to the sense of insecurity or fear. He was Looking different direction, fidgeting with his fingers and appeared uncomfortable while answering the questions, but became comfortable after sometimes. He had a poor concentration. His eyes sometimes become fixated in the opposite wall.

AFFECT: His affect was labile, response was stable and within the context.

MOOD: He reports that it is scary to hear the voices sometimes and he feels extremely uncomfortable. He sometimes became distracted by financial voices, while conversing with the nurse. The curtains distracted him.

SPEECH: clients pitch was very low and not within a normal pace throughout the conversation. Client sometimes becomes distracted with the voices and doesn’t answer the nurse.

THOUGHT FORM: He was talking abstract in the beginning, but as the conversation went on, his response seems logical.

THOUGHT CONTENT: He has friends but goes out on movies by himself, he has expressed interest on calling her mom.

PERCEPTION: The boy was having auditory hallucinations and can hear voices. He reported that the voices in the background often make fun of him for being weak in math and criticize him.  He sometimes gets distracted by the voices. He has reported he was also suffering from sleeping disorders due to the voices as they often wake him up from sleep.

COGNITION & INTELLECTUAL FUNCTIONING: He is alert and orientated. He knows he is in a clinical mental health unit and knows the date, year and knows why he is in that particular unit. Client appeared unfocused as he said that he is getting distracted by the voices. The client confesses that he might have poor cognitive skills as he feels that he cannot do math.

INSIGHT & JUDGEMENT (Insight- He was aware he has a problem and needs medication as he knows that his symptoms remain in control as long as he is under medications, But becomes anxious with the thought of going to the hospital, insight to a degree – denial; judgment = on the self-defense question he wouldn’t harm anyone understanding of consequences of their behaviors, hence he says that the voice does not tell him to cause harm to others). He likes writing. He is worried about his mother.  He remembers that he in under medications.

Affect, Mood, and Speech

• The risk factors are the cognitive, affective and the psychomotor factors.
• The voices wake him up sometimes from his sleeps that can also lead to sleeping disorders.
• Another risk factor is that the hearing voices may arise suicidal tendencies on him as he had already told that he cannot concentrate on his studies as the voices constantly distracts him (Hepworth et al., 2012).
• Another risk factor is that the patient is weak in math and hence has developed a sense of frustration. He has also stated that the voices do not let him to do math. Hence the boy may also get into depression for not being able to do his studies and he feared that he might be humiliated by his classmates. Furthermore he is also concerned that his mother will become anxious if he comes to know regarding his problems

1. CLINICAL ISSUE: Hearing voices.

RATIONALE FOR CHOSEN ISSUE: Hearing voices is a clinical issue as it is a common type of auditory hallucination faced by the people of with psychotic disorders. The sounds can be unusual sounds, familiar sounds and even human voices. A proper plan of care is needed as the sounds can be extremely disturbing, pleasant or threatening.

GOAL/S: The goal is to provide a healthy life style to the patient; patient would stop hearing voices and would be able to concentrate on his life

INTERVENTIONS –  1.    To monitor the behavioral pattern of the patient. 2.    To check whether there the voices are accompanied by the blue coloration of the skin or cold and clammy skin. 3.    To check whether the patient have shown any suicidal tendencies.

RATIONALES  1. This would help the health care professionals to evaluate the predisposing factors behind the behavior (Thomas et al., 2014). 2. This is because such symptoms are often caused by the seizures and serious brain injury (Shinn et al., 2012). 3. Auditory hallucinations can be deadly as patients at some pint might have the thought to finish himself for avoiding this unnatural and strange feeling of background voices (Thomas et al., 2014).

RATIONALE FOR CHOSEN ISSUE: The rationale for choosing the issue is that Proper nutrition, intake of fluids, constructive activities and an environment of solitude with the aid of the nurses can help to improve the cognitive status of the patient. Hearing of voices can be related to bipolar disorders, psychotic depressions and other mental health problems that can be due to the nutritional status or the surrounding factors.

GOAL/S: The Asian boy will be able to sustain the optimum health through nutritional and therapeutic management. Patient will remain hydrated, patient will spend time in a quite environment, patient will take short periods of rest within the day, and patient will be free from any kind of mental or physical agitation or motor activities that is purposeless.

INTERVENTIONS –  1.    To provide the patient, structured solitary activity. To provide frequent periods of rest for the patient. Social rhythm therapy can be used to maintain a regular sleep pattern (Thomas et al., 2014). . 2.    The patient should be provided with high calorigenic food and diets rich in omega-3- fatty acids

RATIONALES  1.    A proper structure would help to provide him focus and attention (Shinn et al., 2012). 2.    This will prevent over exhaustion of his brain and hence preventing sleeping disorders (waking up by hallucinations or voices). This would improve his nutritional status and foods rich in omega-3- fatty acids are good for the functioning of the brain (Thomas et al., 2014).

CLINICAL ISSUE: Impaired social interaction. It is the state where an individual display an ineffective quality of the social exchange.

RATIONALE FOR CHOSEN ISSUE: Impaired social interaction can be due to the biochemical imbalances, excessive agitation and hyperactivity and disturbed thought process.

GOAL/S: Patient will be able to initiate and maintain a goal directed activities without being distracted by the voices. The patient would display less anxiety in presence of the nurse or the occupational therapist. The plans will not demonstrate inappropriate behaviors on discharge.

INTERVENTIONS –  1.  The nurse can join two or more other patients in non-stimulating activities such as drawings, cards) 2. Nurses should engage the patient in short solitary activities such as walking with the staffs, taking photographs. 3. To asses and indentify the early symptoms of the manipulative attitudes and intervene accordingly, such as pitting one caregiver against another.

RATIONALES  1. This can help to improve the focus and social contact. Stimulating activities, such as competitive activities can increase the psychomotor activity and failure can again develop a sense of self-resentment in the patient (for example the voices might tell him that he is bad at sports as well) (Hepworth et al., 2012). 2. Solitary activities generally help to minimize the stimuli and help to release tensions constructively (Thomas et al., 2014). 3. Setting limits for the patients with psychotic disorders is necessary.

RATIONALE FOR CHOSEN ISSUE: Non adherence to the psychotic medications can be dangerous as the patient has already said that he remains aright with the medications but the symptoms worsens as he stops the medications. Non adherence to mediations has been linked to increase of clinical depression, stress and anxiety in patients. Non adherence to medications has also shown increase violence and agitation the patients.

GOAL/S: To adhere to the antipsychotic medications, to develop the sense of self care in the patient, to participate in the decision making process and problem solving, family members would be able to understand the risk factors, the need for adherence to the medications.

INTERVENTIONS 1.    During the initial period of hospitalization the nurses should spend some time with the family members for identifying the needs of the patient (Thomas et al., 2014). 2.    The nurses should educate the patient and his families about the need for adherence to the medications, the side effects and the correct dosages. 3.    To provide knowledge regarding the different community supports available to address the patients having the bipolar disorders.

RATIONALES  1.    This is a clinical problem that can destroy some of the families. The family members suffer from a great deal of confusion and disruption when the one of the family members starts acting bizarrely. Hence, spending time with the nurses would help the family to understand about the disease, the strategies to manage the symptoms (Dillon & Hornstein, 2013).   2.    Proper knowledge of the treatment regimen including the dosages and the timing of the medications will prevent any misses regarding the uptake of the medications.   3.    Knowledge regarding the community support would help the families to understand where they have to go for help for their individual issues (Dillon & Hornstein, 2013).

 

RATIONALE FOR CHOSEN ISSUE: Learning disability due to psychotic disorder in adolescent boys can develop self discontent and can be the cause of humiliation among his peers. Mood shifts can be due to the distraction caused by the hallucination that he was having due to his cognitive dysfunction.

GOAL/S: The patient will not show frustration or hopelessness, on not being able to solve mathematical problems. The patient will be focused in his work and will not be distracted by the voices; the therapies will improve the quality of life of the patient.

INTERVENTIONS –  1.  The caregivers would apply the behavioral reinforcement in the patient 2. Interpersonal therapies can be applied with the help of the family and the friends as the patient has already stated that his friends lived in the suburbs. 3. Cognitive therapies can be useful for the patients with cognitive hallucinations. Use of earplugs or headphones and other distraction techniques can be used (Thomas et al., 2014).

RATIONALES  1. This therapy focuses on the behavior that increases the amount of stress. 2. The therapy involves relationships and helps the patient get encouraged, learn the coping skills, share concerns and feel less isolated (Thomas et al., 2014). 3. Sensory input can be manipulated by using head phones or ear plugs that can be useful for managing the auditory hallucinations.

1. While reflecting on the positive interaction between the patient and the nurse, it was commendable on part of the nurse to initiate the conversation with open ended questions. Closed ended questions can frighten the patient and the patient might not feel it comfortable to disclose all his feelings at a go (Chaffin & Adams, 2013).
2. While interacting with patients having psychotic disorders it is necessary to keep a watch on the non verbal mode of communication as it is the tone of the voice, facial expression and the eye contact that actually helps a nurse to assess what the other person is thinking (Chaffin & Adams, 2013). The nurse was successful in assessing the fact that the boy avoided eye contact. Avoiding eye contact is one of the main features in people with psychotic disorders. The nurse gave him enough chance to establish the rapport.
3. It is evident from the video that the nurse talked with the boy in a calm and compassionate way. Relationships and families can often become the precipitating factors behind the unusual behaviors. Hence it was wise on the nurse’s part to enquire about his friends.
4. The nurse in the video have showed active listening process and without much interrupting the flow of the conversations. Laughing or ignoring their thoughts can break the curative relationship between the nurse and the patient. (Daalman et al., 2012).

1. At the end of the conversation, the nurses did not ask the patient if he had any questions.
2. The nurse did a friendly patting, without asking him if he is comfortable with touching. Patients consent is required, may be orally before touching him.

References

Chaffin, A. J., & Adams, C. (2013). Creating empathy through use of a hearing voices simulation. Clinical Simulation in Nursing, 9(8), e293-e304.

Daalman, K., Diederen, K. M. J., Derks, E. M., van Lutterveld, R., Kahn, R. S., & Sommer, I. E. (2012). Childhood trauma and auditory verbal hallucinations. Psychological medicine, 42(12), 2475-2484.

Dillon, J., & Hornstein, G. A. (2013). Hearing voices peer support groups: a powerful alternative for people in distress. Psychosis, 5(3), 286-295.

Hepworth, C. R., Ashcroft, K., & Kingdon, D. (2013). Auditory hallucinations: a comparison of beliefs about voices in individuals with schizophrenia and borderline personality disorder. Clinical psychology & psychotherapy, 20(3), 239-245.

Johns, L. C., Kompus, K., Connell, M., Humpston, C., Lincoln, T. M., Longden, E., … & Fernyhough, C. (2014). Auditory verbal hallucinations in persons with and without a need for care. Schizophrenia bulletin, 40(Suppl_4), S255-S264.

McCarthy-Jones, S. (2012). Hearing voices: The histories, causes and meanings of auditory verbal hallucinations. Cambridge University Press.

Shinn, A. K., Pfaff, D., Young, S., Lewandowski, K. E., Cohen, B. M., & Öngür, D. (2012). Auditory hallucinations in a cross-diagnostic sample of psychotic disorder patients: a descriptive, cross-sectional study. Comprehensive psychiatry, 53(6), 718-726.

Thomas, N., Hayward, M., Peters, E., van der Gaag, M., Bentall, R. P., Jenner, J., … McCarthy-Jones, S. (2014). Psychological Therapies for Auditory Hallucinations (Voices): Current Status and Key Directions for Future Research. Schizophrenia Bulletin, 40(Suppl 4), S202–S212. https://doi.org/10.1093/schbul/sbu037

Waters, F., Allen, P., Aleman, A., Fernyhough, C., Woodward, T. S., Badcock, J. C., … & Vercammen, A. (2012). Auditory hallucinations in schizophrenia and nonschizophrenia populations: a review and integrated model of cognitive mechanisms. Schizophrenia bulletin, 38(4), 683-693.