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What Causes Fear,poor Sleep And Auditory Hallucinations?

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Posted on Thu, 5 Jun 2014
Question: A 45 year old female was apparently asymptomatic 12 yrs ago..as she works away from home in bangalore(her home is in hyderabad).. she had to live alone away from family since 12 yrs...she was normal for 4 years.. she used to come home to her family in XXXXXXX every week and everything was normal.. later in the 5th year she didnot come home for 2 months.. one day she suddenly came home and was saying that somebody was trying to kill her in XXXXXXX the place where she was working.. her husband went to XXXXXXX and enquired everything, asked the people around, every one said that there is nothing like that.. later after 3-4 years from that date all the symptoms manifested which include she always feels that people around her are trying to harm her,kill her including her family her son,husband and daughter where in the reality there is no one harming her and she always feels that somebody is stealing her belongings.. she always spends her whole time in deep thinking.. she does not even has the sense of her hand burning while cooking.. she spends restless nights that is she doesn't sleep properly( sleeps for only 1-2 hours in a period of 24 hours).. recently from 1 month she is saying that she is hearing voices in absence of anyone.. she doesn't receive any relatives coming home properly..she was operated 3 years back for heamorrhoids.. after surgery she tries to relate everything to heamorrhoids and the symptom constipation.. she can perform her day to day activities well but she performs them slowly..there was no history of trauma or head injury.. her son and daughter completed MBBS IN ANDHRA PRADESH..
doctor
Answered by Dr. Ashish Mittal (45 minutes later)
Brief Answer:
She appears to have schizophrenia.

Detailed Answer:
Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     45 year old female
•     Duration of problem: 8 years
•     Complaints of: Fearfulness, suspiciousness, poor sleep and auditory hallucination.

Female in the description is having following major problem:

*Delusion of persecution: Feeling that others want to kill her. It is a pathological thinking in her case which is called Delusion. These kind of thinking make patient to live in unreal world and change her behavior (as if she want to protect herself from murderer like poor sleep due to fear getting harmed).

*Auditory hallucination: Hearing imaginary voices. Many time patient reply to these voices.

From these major symptoms and change in her behavior/social/occupational, it appear that she is suffering from psychiatric illness called Paranoid Schizophrenia.

In such cases many time patients do not accept that they are ill because of lack of insight and living in imaginary world. In treatment antipsychotic medicines are given after consulting psychiatrist.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Ashish Mittal (7 hours later)
Sir its not exactly somebody trying to kill her but the complaint is someone trying to vacate us from our newly constructed home.. poor sleep is not because of somebody trying to harm her but it is due to excessive overthinking.. she complains someone is talking to her but she is not responding to any of the hallucinations.. previously there was no complaint from the work place but there are complaints now like not responding to the XXXXXXX staff...
Sir, Are there any basic investigations to do? If it is PARANOID SCHIZOPHRENIA is there a definitive treatment? as we cant approach you can u please refer us to any one of your colleagues in Hyderabad? or are there any chances of you coming to XXXXXXX personally?
Sir, Will my mothers health revert back to normal?
doctor
Answered by Dr. Ashish Mittal (14 hours later)
Brief Answer:
Hi

Detailed Answer:
Hello again,
Thanks for follow up.

Delusion of persecution do not only mean somebody trying to kill, it is a broad term. It also include thinking that somebody trying to harm patient or her family members personally, professionally or socially (trying to vacate from house). Main issue is pathological form of thinking.

Somebody talking to her indicate towards presence of auditory hallucination. Many time patient do not respond to voices.

Diagnosis is depend on history and mental status examination of patient. You have given brief history of patient. Now mental status examination is left to confirm diagnosis.

Following routine investigations (not for confirming diagnosis) are required in such cases: CBC, FBS, LFT, Lipid profile. For definitive treatment antipsychotics (like Risperidone and olanzapine) are used and around 70-80% patients respond well to treatment.

As I sit in XXXXXXX NCR, for treatment you can show her in NIMH: http://www.nimhindia.org/

Please accept my answer and give feedback in case there is no further query and you found reply helpful. In case of doubt, I am here to help you.

Wish you good health.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashish Mittal (2 days later)
Sir thanks a lot.. your reply was very helpful.. I have consulted a psychiatrist in XXXXXXX . he has started treatment with olaperidone 4 mg and aripiprazole 10mg.. but still there is no improvement in my mothers behavior..
Sir I would like to know approximately how much time is necessary for my mother to revert back to normal?
doctor
Answered by Dr. Ashish Mittal (19 hours later)
Brief Answer:
Hi

Detailed Answer:
Hello,
Thanks for follow up.

It is good that she is on treatment now. Medicine usually takes 3-4 weeks to show improvement.


Regards
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Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Ashish Mittal

Psychiatrist

Practicing since :2004

Answered : 1859 Questions

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What Causes Fear,poor Sleep And Auditory Hallucinations?

Brief Answer: She appears to have schizophrenia. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 45 year old female • Duration of problem: 8 years • Complaints of: Fearfulness, suspiciousness, poor sleep and auditory hallucination. Female in the description is having following major problem: *Delusion of persecution: Feeling that others want to kill her. It is a pathological thinking in her case which is called Delusion. These kind of thinking make patient to live in unreal world and change her behavior (as if she want to protect herself from murderer like poor sleep due to fear getting harmed). *Auditory hallucination: Hearing imaginary voices. Many time patient reply to these voices. From these major symptoms and change in her behavior/social/occupational, it appear that she is suffering from psychiatric illness called Paranoid Schizophrenia. In such cases many time patients do not accept that they are ill because of lack of insight and living in imaginary world. In treatment antipsychotic medicines are given after consulting psychiatrist. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,