Auditory Hallucination in Schizophrenic Illness - Essay Example

Russell Case Study Report There are 50 distinct neurotransmitters that the brain utilises. The neurotransmitters that have been found to be involved to schizophrenia are glutamate and dopamine. Dopamine, which is associated with novelty seeking, is involved with movement and thoughts. It is also associated with reward and interest in new experiences. The feelings of pleasure and well being are also associated with it since drugs like cocaine work by affecting it (Mulert et al., 2011). The highly specialised pathways of dopamine in the brain may influence a variety of behaviour and thoughts. Paranoid thinking or psychotic symptoms which are symptoms of schizophrenia could also be experienced with high levels of dopamine in the brain. When the brain recognises that there is excessive dopamine, symptoms which are schizophrenic appear. Schizophrenic patients also have more dopamine receptors than people without it (Barkus et al., 2007). Glutamate is also associated with schizophrenia. It has a major role in the forming and encoding of memory. It is also thought to have a function in learning. When glutamate receptors are blocked for instance when one takes PCP, there is reported paranoia that is also a symptom of schizophrenia. Schizophrenic patients have been found to possess lower levels of glutamate compared to normal people. The two neurotransmitters interaction is said to be at the core of schizophrenia since production of many dopamine receptors affect the glutamate receptors by blocking them and thus reducing their action (Spencer et al., 2009). The dopamine hypothesis is generally the best explanation for the cause of schizophrenia at the neurotransmitter level. It is the most etiologic theory in psychotherapy. Its proposal that certain pathways of dopamine are overactive in schizophrenia, could be true because when one takes drugs that increase dopamine, they induce positive symptoms but when the drugs that block its receptors are taken they reduce the positive symptoms. In other words, the experiences and behaviours associated with schizophrenia could be fully made clear by the transformations of dopamine function in the brain (Ven, 2006). Auditory hallucinations could be said to be false perception of sound or experiencing internal voices and noises that do not originate from the external world and are seen to be separate from the normal brain processes. The individuals suffering from the hallucinations are extremely convinced of the objective reality of the experience. The auditory hallucinations are disturbing, not intentional and very intrusive. Noticing it will depend on the insight of the patient since a person with insight will refrain from normal activities. This would make one notice a change in behaviour (Spencer et al., 2009). Auditory hallucinations may be experienced in the mind, on the surface of the body, through the ears or anywhere in external space. They also come in different frequencies as some may happen continuous throughout the day while others may happen monthly. Some hallucinations will come in whispers while others will come in shouting. They could come from a single source or from a number of sources depending on the feeling of the patient. The most common auditory hallucination consists of voices (Romme, 1998). The accents and intonations of the voices are basically different from that of the patient and they may be either male or female. Mostly the voices are more than one and come from close people to the patient. The patient can hear voices of close friends, family members or neighbours. The voices could also belong to imaginary characters such as God or the devil. Single words are mostly reported contrary to long clear full sentences (Romme, 1998). Patients may also experience hallucinations from other sounds such as music and animal sounds. It may also happen that a patient will only hear the voices or suffer the hallucinations when a certain sound comes up like the clock alarm or the sound of a certain animal. Though the voices content will vary between individuals, the message is always malicious, negative or a command to do something morally unacceptable. Very few cases are reported to have positive messages. 60%-70% of schizophrenic patients suffer from auditory hallucinations (Ven, 2006). The temporal lobe is the most notable and most prominent area that is associated with the auditory hallucinations. Other areas also affected by the hallucinations are the amygdale, hippocampus and other parts of the limbic system. The other area affected is the left superior temporal lobe which is the language area of the brain. The voices that the patient hears are processed here since it is where all words are processed normally (Dougoud-Chauvin et al., 2009). Whichever language centre area is activated more makes the patient understand or not understand what the voices are saying. This means that a patient could just hear funny voices when a certain part of the language area centre is activated or understand clearly what the voices are saying when another part is activated (Bartels et al., 2011). The effects of cigarette smoking on the brain are centrally mediated like any other drug with the potential for dependence and abuse. Nicotine which is found in the cigarettes mainly has an effect on the central nervous system. It has an effect on the biochemical and physiological functions in a way that strengthens drug taking behaviours. When a cigarette is smoked, there is the rise of plasma nicotine levels, occurrence of neuroendocrine effects and also dose dependent neurotransmitters (Smith, 2007). Thus smoking brings abnormalities in the brain morphology, cerebral blood flow, neurochemistry and neurocognition. As age advances, chronic smoking also brings about increased generalised brain atrophy. GABA (Gamma Aminobutyric Acid) is also modulated in concentration by nicotine. There is also a lower global cerebral flow and limbic system blood flow in non smokers than in smokers. Chronic smokers have a specific dysfunction in auditory verbal learning and memory. There is a lack of active memory with smokers and especially those that started earlier in life. Various forms of dementia are also linked to smoking. Smoking is also very harmful to the lungs as it traps cancer causing chemicals in the lungs and also damages the lungs cleaning and repair systems. The cilium, which protects infections and lines the upper airways, are destroyed by smoking. When cilia or the small hairs in the breathing tubes are destroyed, the germs and chemicals from the smoke stay in the lungs leaving one at the risk of chronic coughs, lung cancer or chest infections. The alveoli or the air sacs present in the lungs are damaged by smoking completely making it hard to stretch and get rid of carbon dioxide or absorb in oxygen. This leaves one fully short of breath and tired and gives the heart an extra job to pump much harder in order to supply enough oxygen in the body. This damage could lead to a possible heart disease or COPD. We should consider the smoking program of Russel before deciding the amount of nicotine replacement to give him. Since Russel smokes 20 cigarettes, has smoked for 6 years and enjoys the morning cigarette, the replacement required if it is a nicotine gum is a higher gum dose (4 mg) and if it is nicotine patch, a 24-hour 15-22 mg of nicotine. Russel finds it difficult to cut down or cease cigarette smoking because schizophrenic patients start smoking early in their lives like the case of Russel which makes it difficult to quit. They also smoke at heavier rates than the general population which brings the addictive rates higher. Their rate of smoking is also two or three times that of other people. There is an immense connection between schizophrenia and smoking. The aspects of the illness might be the ones that lead the patients to smoke or smoking might be an aetiological factor in schizophrenia. There could also be environmental or genetic factors leading to the same. The dopamine neurons of the ventral segmental area have also been shown to increase burst activity when nicotine is introduced. When Russel is transferred to the less secure unit, there is an increase in auditory hallucination. This first of all could be as a result of a relapse since the disease itself has a pattern of relapse and recovery. With full or partial remissions the hallucinations are characterised by alternating relapses. Some antipsychotic medications are effective in reducing the rates of the relapses but about 30-40% of the patients always relapse within a year after discharge. This happens even when they are receiving care and maintenance medication (Meaden, 2013). The other reason is the fact that smoking is intimately connected to schizophrenic illness. We have positive and negative effects of nicotine to a schizophrenic or the development of the disease itself. Though the patients are said to self-medicate themselves with nicotine, the cigarettes are harmful during medication since they also interfere with the response of the antipsychotic drugs (McCarthy-Jones, 2012). Since Russel was not smoking when he started the medication, he needs a higher dose of the anti psychotic drugs now that he is smoking. The fact that Russel was being treated with Olanzapine is another cause for the hallucination increase. This is because of the reduced levels of plasma Olanzapine whose effect is same as an increased consumption of cigarettes. Enzymes involved in Olanzapine metabolism are induced bringing this effect. Doctors should therefore be very careful in monitoring the medication dosage and the responses of the patients who try to quit or who start to smoke again. References Barkus, J., Stirling, D., Hopkins, S., McKier, S. & Lewis, S. (2007). Cognitive and neural processes in non-clinical auditory hallucinations. British journal of psychiatry,191 (51): 76-81. Bartels, A., Van de Willige, G., Jenner, J., Wiersma, D. & van Os, J. (2011). Auditory hallucinations in childhood. Psychol Med., 42(3):583-93. Dougoud-Chauvin, V. Hubl, D., Zeller, M., Federspiel, A., Boesch, C, Strik, W., Dierks, T. & Koenig, T. (2009). Structural analysis of Heschl's gyrus in schizophrenia patients with auditory hallucinations. Neuropsychobiology , 61:1–9 McCarthy-Jones, S. (2012). Hearing voices: The histories, causes, and meanings of auditory verbal hallucinations. Cambridge: Cambridge University Press. Meaden, A. (2013). Cognitive therapy for command hallucinations: An advanced practical companion. London: Routledge. Mulert, C, Kirsch, V, Pascual-Marqui, R, McCarley, R W, & Spencer, K M. (2011). Long-range synchrony of gamma oscillations and auditory hallucination symptoms in schizophrenia. New Jersey: Elsevier. Romme, M. (1998). Understanding voices: Coping with auditory hallucinations and confusing realities. Runcorn, Cheshire England: Handsell Pub. Smith, D. (2007). Muses, madmen, and prophets: Rethinking the history, science, and meaning of auditory hallucination. New York: Penguin Press. Spencer, M., Niznikiewicz, A., Nestor, G., Shenton, E. & McCarley,W. (2009). Left auditory cortex gamma synchronization and auditory hallucination symptoms in schizophrenia. London: BioMed Central Ltd. Ven, V. (2006). Connectivity and auditory verbal hallucinations. Netherlands: Universiteit Maastricht. Read More