Auditory hallucinations are the common symptom of paranoid schizophrenia, which can cause distress and debilitation. Although individuals may experience different symptoms and those symptoms will affect them differently; however auditory hallucination is the most common one that will affect their behaviour, their ability to function and causes them to withdraw from the social life. The following essay will discuss the symptoms and treatment for paranoid schizophrenia, nursing interventions for the symptoms. Additionally, it will also discuss on how the patients and their family are been affected by the symptoms also going to be discussed.
Schizophrenia is a complex and major mental disease (Rigby and Alexander 2008). Schizophrenia is a worldwide disorder which affects between 0.5 and 1 precent (Rigby and Alexander 2008). There are two types of symptoms of schizophrenia, which are negative and positive symptom (Rigby and Alexander 2008). Negative symptoms are social withdrawal, loss of motivation and difficulties in thinking (Rigby and Alexander 2008). Positive symptoms are delusions and auditory hallucinations (Rigby and Alexander 2008). There are five types of schizophrenia, which are paranoid type, disorganized type, catatonic type, undifferentiated type and residual type (DSM-IV-TR 2000). DSM-IV-TR (2000) outlining the symptom of paranoid schizophrenia is preoccupation with one or more delusions or frequent auditory hallucinations. Another diagnosis category for paranoid schizophrenia is that patients do not present with following symptoms such as disorganised speech, disorganised or catatonic behaviour, or flat or inappropriate affect (DSM-IV-TR 2000). The onset of Paranoid schizophrenia is usually later than other types of schizophrenia and more stable than other types over time (DSW-IV-TR 2000). Patients who suffered from paranoid schizophrenia may often show little or no impairment on cognitive function and neuropsychological (DSM-IV-TR 2000). In fact, DSM-IV-TR (2000) suggests that prognosis for paranoid schizophrenia is better than other types. The delusions of patients with paranoid schizophrenia are normally organised around certain subjects, which can be persecutory, grandiose, jealousy, religiosity or somatisation (DSM-IV-TR 2000). The delusions may be multiple and the hallucinations are typically been related to the delusions (DSM-IV-TR 2000). Anxiety, anger, aloofness and argumentativeness can associate with these symptoms (DSM-IV-TR 2000). The individual can have a superior or patronising manner during the conversations (DSM-IV-TR 2000).
Auditory hallucinations can affect patients in many ways. The following paragraph will discuss the effect on patients through a case study. In this case, study, the patient- a 17 years old boy was been brought to the psychiatric unit by his parents because he told them there is a voice telling him to jump out of the window (Kotowski 2012). According to Kotowski (2012), the patient was been diagnosed with paranoid schizophrenia and is affect by auditory hallucinations in the following ways that commonly find in patients with auditory hallucinations. First, when the patient admitted to the psychiatric unit, he was unwashed and malodorous. Thomas, McLeod and Brewin (2009) highlighted that auditory hallucination can cause distress and the patient might be overwhelm by the voices they hear to concern anything else. Secondly, he was talking to himself, mumbling and yelling out. Patients who suffered from auditory hallucinatory, their emotional and behavioural responses are often determined by the voices they heard (Thomas, McLeod and Brewin 2009). There are two types of behavioural responses to auditory hallucination, which are ‘resistance’ and ‘engagement’ (Thomas, McLeod and Brewin 2009). Resistance behaviours include telling the voice to go away and trying to stop the voice, such as yelling out (Thomas, McLeod and Brewin 2009). Engagement behaviours are listening and taking to the voice (Thomas, McLeod and Brewin 2009). Thirdly, the patient may also quit sports and clubs at school and even stop from attending to school. Because auditory hallucinations can cause distress and depression, patients suffering from auditory hallucinations can be too distressed or depressed to engage in their normal social activities (Thomas, McLeod and Brewin 2009). Fourthly, based on the report proved by patient’s patients, he has problem with sleep and lost quite a lot of weight. Auditory hallucinations can cause disturbance on patients and may affect on their normal daily activities.
Several treatments are available for paranoid hallucinations. This essay will discuss one pharmacological treatment and two non-pharmacological treatments. Clozapine is an antipsychotic medication that commonly used for treatment resistant schizophrenia (Tiziani 2010). Weinberger and Harrison (2011) outlined that clozapine was identified and used in Europe in the early 1960s. Clozapine is quite effective for patients who were not responding to other treatments (Weinberger and Harrison 2011). However, clozapine was been raptly tested over the years because it can cause agranulocytosis (Weinberger and Harrison 2011). Like other medication, clozapine has side effects, which include fever, EEG changes, intensified dream activity, elevated liver enzymes and cardiomyopathy. Clozapine is still in use because, despite all side effects, it is the only choice for treatment resistant patients.
The desired implication for clozapine is that it works well for treatment resistant patients and it is the last choice for patients who do not respond to other pharmacological treatments (Weinberger and Harrison 2011). The undesired implication will be the serious side effects, such as, agranulocytosis and cardiomyopathy (Tiziani 2010). In fact, because of the severe side effects, clozapine once was been removed from the market (Weinberger and Harrison 2011). Although it is back to the market because of its benefits, which may be greater than its risks, these side effects can make patients to have second thoughts on taking the clozapine or stop taking medication against doctor advises (Weinberger and Harrison 2011). Moreover, because clozapine is for treatment resistant patients, if they stop taking clozapine, there are no any other pharmacological treatments for them.
Chinese medicine, especially acupuncture, can be effective treatment for symptoms of schizophrenia, which include auditory hallucinations (Bloch et al. 2010). According to Bloch et al (2010), acupuncture has been effective on treating symptoms of schizophrenia after patients received a course of 16 treatments. A large research is been conducted by the research team that include the authors of Bloch et al. (2010) to encourage use acupuncture alongside with anti-psychotic medication. Bloch et al. (2010) also mentioned that Chinese herb could be helpful to treat symptoms of schizophrenia but the effectiveness needs to be study in the future.
The advantage of acupuncture therapy is that besides the discomfort there is no other side effect (Bloch et al. 2010). In addition, it is a non-invasive treatment and cause minimum physical damage. The disadvantage of acupuncture therapy is that it takes a long time to start showing effects, which means it might appears to be invalid when the treatment first starts (Bloch et al. 2010). Therefore, patients can stop the treatment because they think it is ineffective or even cause frustration and agitation. In addition, based on Bloch et al. (2010), most available studies and case reports of using acupuncture to treating schizophrenia are from China, which means that other countries are not using or believe in acupuncture therapy as a treatment for schizophrenia.
According to England (2007) cognitive behavioural therapy are using a variety of strategies in patients in changing faulty beliefs and dysfunctional thinking. Cognitive behavioural therapy does not aim to cure auditory hallucinations but decrease the frequency and duration of auditory hallucinations (Wilson 2007). Also it helps to reduce the distress cause by auditory hallucinations and gain patients more control over them (Wilson 2007). The strategies include distraction techniques, normalizing rationales and rational responding (Wilson 2007). Distraction techniques are to keep patients busy, regular activity scheduling and competing stimuli (Wilson 2007). The goal of distraction techniques is to distract patients from auditory hallucinations (Wilson 2007). Normalising rationale is attempting to explain the auditory hallucinations to reduce the anxiety and alienation (Wilson 2007). Rational responding helps patients to deal with the automatic negative thoughts cause by auditory hallucinations (Wilson 2007).
The benefit of cognitive nursing intervention is that it is easy to perform by nurses, because all the strategies are based on communication with patients. The drawback of cognitive nursing intervention is the limitations. According to England (2007), cognitive nursing intervention can only provide by trained nurses in hospitals or community settings. Thus, not all patients suffered auditory hallucinations have the opportunity to benefit from cognitive nursing intervention. Moreover, because of the indeterminacy of human mind, cognitive nursing intervention may not be effective every time.
Nursing interventions can help with distress that cause by auditory hallucinations. The interventions include self-assessment tools for patients; advising patients to talk with someone, listen to music and watch TV; teaching patients using relaxation techniques and encourage patients to communicate with staff (Buccheri et al. 2010). Buccheri et al. (2010) outlined that nurses need to know every experience of distressing auditory hallucination of each patient and the information can be gather by using a self-assessment tools on admission. These tools include unpleasant voices scale-inpatient version, command to harm safety protocol, characteristics of auditory hallucinations questionnaire and auditory hallucinations interview guide-inpatient version (Buccheri et al. 2010). The nurse can encourage patients to talk with someone, listen to music and watch TV, especially when they are distress by the hallucinations, because these activities can distract patients from the hallucinations (Buccheri et al. 2010). Auditory hallucinations can cause distress and anxiety. Therefore, teaching patients to use relaxation techniques can help patients to relax (Buccheri et al. 2010). Additionally, distress and anxiety can lead to self-harm or endanger others so using relaxation techniques to relax the patients can prevent them from harming themselves and others (Buccheri et al. 2010). Communicating with the patients can allow the nurses to assess the patients, gather information and build a relationship with the patients (Buccheri et al. 2010).
According to Weinberger and Harrison (2011), patients with full family support have a lower relapse rate of psychosis. It also mention that patients who live with their family members show much more improvement than those who live alone (Weinberger and Harrison 2011). ‘Family intervention’ treatment programs are programs, which allow patients’ family members to continue the nursing intervention after patients being discharge to home (Weinberger and Harrison 2011). The programs include how to assess the patients, provide information of paranoid schizophrenia and intervention strategies to address areas of conflict and concern (Weinberger and Harrison 2011). Educating patients and their families are also important. Providing with exact information about paranoid schizophrenia can help families to understand the illness and know what symptoms they may be dealing with (Weinberger and Harrison 2011). Supporting patients’ families are important as well. Because looking after patients with paranoid schizophrenia can be difficult and frustrating, their families need help and support as well (Weinberger and Harrison 2011).
Paranoid schizophrenia is a very complex mental disorder and auditory hallucinations are one of the most disturbing conditions of paranoid schizophrenia. Auditory hallucinations can affect patients’ life in many ways and lead to violent behaviours. Several treatment options are been discussed, but those treatments can only maintain the condition. The implications of these treatments are also been discussed. Nursing interventions such as taking, listening to music and relaxation techniques can reduce the distress and anxiety. At last, support from patients’ families and supporting patients’ families are equally important.
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