Psychological Disorders and Hallucinations - Essay Example

Psycholigical Disorders by [Click and type [Type number] [Type February 2006 A psychological disorder that is in fact a double edge sword is that of those afflicted with hallucinations. Hallucinations can in fact be representative on their own, or, bundled in with other far worse afflictions such as Schizophrenia, Alzheimer's Disease or Dimentia. This paper will only discuss those individuals who are afflicted with only hallucinations. The scope of the paper is to not only describe in detail what hallucinations are along with the symptoms, but, the medications that not only can help the disorder, but, can actually trigger it. Discussion will also produce possible hospitalization therapies as well as when individuals should be admitted to a hospital based on symptoms. Finally, a brief summary of a case study will round out the discussion. Hallucinations - A Clinical Evaluation One of the main disputes surrounding hallucination therapeutic evaluation is if the disorder is standalone or a side-effect of a much more psychological disorder such as Schizophrenia. The terminology surrounding hallucinations defines it as "a perception in the absence of sensory stimulation that is confused with reality (Psychology: Concepts and Connections, pg 518). As many psychiatrists evaluate their patients in a clinical surrounding, it would be circumspect to immediately label a person who is suffering from hallucinations as being diagnosed with Schizophrenia. One of the more important aspects of the diagnoses as to if the individual is suffering from hallucinations is to follow the same procedural steps in diagnosing any person with an ailment and that is to start with the symptoms Symptoms Symptoms of hallucinations can either result from a traumatic event, results of other medical disorders such as epilepsy, olfactory seizures or from a variety of means of neurological aetiology. To understand the symptoms of these various forms of hallucinations, there is a need to understand the different types of neurological hallucinations that lead to correct diagnosis of symptoms. These include: Gustatory hallucinations: are seldom found as an early sign of cognitive derangement. Clinical evolution could point toward early manifestations of Alzheimer's Dementia. Patients suffering from psychotic depression may also, report the illusion of bad taste in their mouth. Peduncular hallucinations: They originate from lesions of the mid-brain tegmentum. They may be elaborated and complex, rich in color, and depict landscapes, familiar faces, buildings, or lilliputian visions. Feeling tone may be absent, and the patient witnesses them with calm amusement. Auditory and Vertiginous Hallucinations: 1 Auditory: Stimuli of the transverse gyrus of Heschl of the temporal lobe, may elicit auditory events. 2. Vertiginous: Meniere's disease is the cause of severe kinesthetic hallucinations , accompanied by nausea, dizziness, and malaise. It may be also have tinnitus, often described as "chirping", or as the sound of crickets. This must be clinically differentiated from acoustic neuroma, vertebro-basilar artery syndromes, and other posterior fossa entities. Autoscopic hallucinations: These are a blend of visual and proprioceptive hallucinations. In these cases, the vision is of one's double, like in a mirror, sometimes repeating one's gestures, and on occasions busy with other activities, a veritable doppelganger. They may be secondary to hypnopompic hallucinations, migraine, seizure disorders, delirium, encephalitis, post-concussion syndrome, or even non-neurological events such as: transcendental meditation, mystic events, use of hallucinogens, and near death experiences (Boza, 1981) The symptoms, as mentioned above vary from patient to patient depending on their neurological dysfunction. The Merck Manual of Geriatrics entertains hallucinations as an ongoing concern for the elderly patients under doctor's care and suggests that the symptoms of hallucinations in the elderly include: Abnormal suspiciousness: This occurs most times with elderly people who are not in constant communication with health practitioners and develop evidence to the contrary that outside forces are controlling their lives. Many times this includes the belief that their own children are plotting to gain control of finances or property and is usually coupled with an overwhelming feeling of loss of control of their independence and lends to the development of contrived accusations coupled with suspicions that have no merit. Transitional paranoid reactions: Through social isolation that generally occurs with women who live alone, they are of the belief that others are plotting against them. These hallucinations tend to manifest outside the home to inside resulting in such delusional thinking that there are noises coming from the attic or basement. These hallucinations also move from insignificant and small to more grandiose delusions of physical abuse or molestation by visitors. Paraphrenia: This is a non-distinct disorder where patients with paraphrenia often report plots against them, focusing on family members. In contrast with mild suspiciousness, these plots are persistent, extreme, and elaborate. Usually, cognitive impairment is not present. Although the patient is physically independent (ie, diet and hygiene are rarely compromised), social functioning and cooperation with staff members are greatly impaired. Such persons rarely speak for long without referring to the symptoms of concern. A person that suffers from this form of delusion are female and live alone. Cases point to those sufferers as having difficulty in social interactions early in life and unlike Schizophrenics, these patients are friendly and trusting, especially when they are interviewed in their homes and are not threatened with the diagnosis of a mental disorder. (Merck Manual of Geriatrics, Ch 36) As many patients cope with many of the commonalities found with patients who suffer from hallucinations ranging in all ages, there is continual research and testing of many forms of therapeutic remedies, as well as being able to find out the causes of this neurological disorder. Characteristics of the Disorder Some of the more common reasons for someone to suffer from hallucinations include: some psychiatric disorders dehydration interaction of prescription medications severe lack of sleep use of drugs such as LSD, psilocybin mushrooms, or PCP heavy alcohol use and problems with the brain or nervous system (University of Iowa, 2003) It is important to also differentiate illusions from hallucinations. Generally illusions involve the misinterpretation of something that is real as the human brain has the amiable task of filling in missing gaps of information with what may or may not have happened. Hallucinations, on the other hand, are actually sensory miscues that make the person believe they are living a reality they are actually not. Another distinctive type of hallucination is the belief by some person who have just lost a limb wherein they believe they can feel sensation in the missing "phantom limb". Treatment One of the more important treatment therapies, especially for the elderly, involve nonpharmacological measures that involve "a trusting and supportive relationship." (Merck Manual of Geriatrics, Ch 36). This is also true for any patient with this disorder, as the symptoms of the disorder generally coincide with the feelings of mistrust and anxiety, therefore, the need for health care practitioners to engage in this display of trust is immensely important in treating the symptoms. Another important relationship to form is with the patient's social circle, including the family members, as they will be the first to acknowledge the problem of the deterioration and in turn, help those individuals to understand the full scope of the problem and how to assist in the therapy. For those patients suffering from any psychotic disorder, there is also the need for effective drug therapy management of antipsychotics. Such new atypical antipsychotic drugs (eg, risperidone, olanzapine) are preferred for the agitated or suspicious elderly patient primarily because these drugs have fewer adverse effects (including fewer extrapyramidal adverse effects) compared with conventional antipsychotics (eg, haloperidol, thioridazine). Initial daily oral dosages (in divided doses) are 1 mg of risperidone, 5 mg of olanzapine, 1 to 3 mg of haloperidol, and 10 to 25 mg of thioridazine. Daily doses may be increased significantly (eg, risperidone 5 to 10 mg); however, except in the most acute cases, the lower doses usually suffice. The drugs may be given once daily (at bedtime) in less severe cases." (Merck Manual of Geriatrics, Ch 36) Although many of these drugs are normally determined by what the physician decides is important to avoid. For instance, "Risperidone is somewhat sedating, has very few anticholinergic effects, but leads to moderate orthostatic hypotension. Olanzapine is as sedating as risperidone, has somewhat more anticholinergic effects, but is less likely to lead to orthostatic hypotension. In contrast, thioridazine is especially troublesome for patients with postural hypotension, and haloperidol may cause significant parkinsonian symptoms. In treatment-resistant patients and in those with severe psychosis, clozapine is a possible choice. There has been little cumulative experience with clozapine in the elderly, although evidence indicates a higher incidence of agranulocytosis." (Merck Manual of Geriatrics, Ch 36) As a result of these findings from the physician, it is extremely vital that the side effects don't outweigh the anticipated outcome of relieving the many symptoms and varying degrees of hallucinations. Medications can also perform the opposite of what their intention is and actually contribute to hallucations. These possible medications or substances mentioned on WrongDiagnosis.com (May, 2003) include: Certain illicit drugs Marijuana LSD Amphetamines Cocaine Certain medications Antihistamines Anticonvulsants Antidepressants Antibiotics Tranquilizers Steroids Pain medications Cardiovascular medications Case Study A case study involving Gillian Haddock, Nicholas Tarrier, William Spaulding, Lawrence Yusupoff, Caroline Kinney and Eilis McCarthy, from both the University of Manchester (Tameside General and Withington Hospital) and the University of Manchester in 1998 entitled Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: A review involved "describing and evaluating the research on the cognitive-behavioral treatment of hallucinations and delusions and describes the cognitive models from which the treatments have developed" (Haddock, et al, 1998) and came to the conclusion that there is "fairly strong evidence for the efficacy of cognitive-behavioral approaches in the management of chronic psychotic disorders and associated symptoms, although there are a number of areas where further development is necessary." (Haddock, et al. 1998). This type of analysis proves excellent in the study of cognitive therapy behavior in the neurological psychology field. Neurological psychology One of the many interesting attributes to the study of hallucinations is the tie-in between many facets of patients who have hallucinations that in fact suffer neurological traumas. For instance, a patient who is a war veteran may have gustatory hallucinations that "begin by complaining of having a bad taste in his mouth. Eventually, he believed that a pocket of poison has been implanted in his teeth by his dentist, and that he could bite himself and die. Further decline and clinical evolution pointed toward early manifestations of Alzheimer's Dementia" (Boza, 1981) Many of the patients that clearly only suffer from hallucinations and not necessarily a precursor to such other neurological disorders such as Alzheimer's or Schizophrenia, generally have a leaning toward a neurological dysfunction that is surfacing through these non-existent illusions. Conclusion The immediacy of diagnosing those that are symptomatic sufferers of hallucinations needs to be at the forefront of those closest to the patient in question. Although this is a relatively grey area in diagnosing a purely hallucinogenic sufferer from those that have the early onset of either Schizophrenia or Alzheimer's, it is important to recognize the symptoms being observed carefully. Many sufferers of hallucinations are indeed women who live alone and tend to be social outcasts or socially intimidated. These are the most probable target group of this form of delusion that those in the close circle of these people should be most aware of potential risk. Once a person is aware of who is at risk, it is important for that person to access appropriate help be it a practitioner, general or geriatric, or a therapist who is properly trained to recognize the symptoms and provide adequate non-pharmaceutical or pharmaceutical treatment. References Boza, Ramon A, M.D (1981). Hallucinations and illusions of non-psychiatric aetiologies. Retrieved February 28, 2006, from http://www.priory.com/halluc.htm Haddock, Gillian, Tarrier, Nicholas, Spaulding, William, Yusupoff, Lawrence, Kinney Caroline, McCarthy, Eilis (1998). Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: A review. University of Manchester, Tameside General Hospital, UK, University of Manchester, Withington Hospital, UK, University of Nebraska, USA. Retrieved February 28, 2006, from http://www.sciencedirect.com/science_ob=ArticleURL&_udi=B6VB8-3V545G0-3&_coverDate=11%2F30%2F1998&_alid=371945377&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=5920&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=29a7e77207f02620595d3f3534841561 Psychology: Concepts and Connections. Hallucinations. Pg. 518 The Merck Manual of Geriatrics (n.d.). Section 4: Psychiatric Disorders, Chapter 36:Psychotic Disorders. Retrieved February 28, 2006, from http://www.merck.com/mrkshared/mmg/sec4/ch36/ch36a.jsp University of Iowa Hospitals and Clinics.(2005). Hallucinations. Retrieved February 28, 2006, from http://www.uihealthcare.com/topics/mentalemotionalhealth/ment3147.html WrongDiagnosis.com (2003). Causes of Hallucination. Retrieved February 28, 2006, from http://www.wrongdiagnosis.com/h/hallucination/causes.htm Read More