Invisible Voices

Psychotic patient experiencing disturbing auditory hallucinations

Auditory Hallucinations In The Brain

The scientific belief is that when auditory hallucinations are experienced, there is too much dopamine in the mesolimbic tract of the brain. It is not clear why too much dopamine causes auditory hallucinations. But when a patient experiences invisible voices, it feels very real to them even if they have no basis in reality.

These invisible voices may be females, males or both. The voices may talk to each other or directly to the person. Some patients describe hearing voices of other patients on the unit talking directly to them in their head. You may notice when a patient is experiencing voices by the dysphoric appearance on their face; especially when they previously denied hearing voices and never had a dysphoric appearance.

Many psychotic patients, especially chronic ones, do not want to get rid of their auditory hallucinations. Initially, they may have a desire to experience improvement, but over time, many develop tolerance to the invisible voices and don’t mind their persistence.

This is because some psychiatric patients become so used to experiencing auditory hallucinations, that they would not know how it would feel without them. Like any person in life, once you become comfortable with a certain situation, making a change is not on your immediate agenda.

It is important for patients to tell their psychiatrists the truth regarding the content of their auditory hallucinations. Oftentimes, these invisible voices may make the patient feel uncomfortable and even command them to hurt themselves or others. When a patient is most vulnerable, such as being depressed or angry, is when these voices have the greatest chance of influencing the patient.

Antipsychotics do a very good job at alleviating the voices; for some, the voices go away altogether. But it is important to know that as with any medication, there comes the risk of side effects. In the case of antipsychotics, these may include:

  • EPS
  • Metabolic syndrome
  • Diabetes
  • Weight gain
  • Sedation

. . . and the list goes on. But the benefits often outweigh the risks. Who can actually live a normal life experiencing auditory hallucinations? The importance of taking the antipsychotics to help treat the voices trumps the concern of developing weight gain and sedation.

One can live a fairly normal life with weight gain and some sedation neutralized by caffeine. But can one live a normal life with a demonic-animalistic voice yelling at them in their head?

Make the right choice. Seek treatment.

Are you Ready? (This is Defeating Stigma Mindfully)

Medical Implications Of Antipsychotic Treatment

Shallow focus photography of prescription bottle with antipsychotic capsules

The Side Effects Of Antipsychotics

Antipsychotics can be divided into two groups: first-generation and second-generation. The first-generation antipsychotics were the first to be used in psychiatry, followed by the second-generation antipsychotics. Both classes have distinct medical side effects that are important to mention. Patients and their families always need to be properly educated on the the side effects of medications; medical problems can unexpectedly arise and cause confusion and discomfort if not previously warned about.

The first-generation antipsychotics:

  • Haloperidol
  • Loxapine
  • Thioridazine
  • Thiothixene
  • Molindone
  • Fluphenazine
  • Mesoridazine
  • Trifluoperazine
  • Perphenazine
  • Chlorpromazine (the first antipsychotic used)

The unique medical side effects from first-generation antipsychotics are called “extrapyramidal symptoms.” These include:

  • Dystonia (continuous spasms and muscle contractions)
  • Akathisia (motor restlessness)
  • Parkinsonism (rigidity)
  • Bradykinesia (slowness of movement)
  • Tremor
  • Tardive dyskinesia (irregular jerky movements of the mouth and extremities)

As you can see, these motor symptoms can be very disturbing to patients and their families. The benefits and risks must always be weighed when starting or continuing a first-generation antipsychotic. Laryngeal dystonia, for instance, can lead to acute respiratory failure and death if not detected early enough!

The second-generation antipsychotics:

  • Aripiprazole
  • Ziprasidone
  • Risperidone
  • Quetiapine
  • Olanazpine
  • Clozapine (the gold-standard, used as a last resort for treatment-resistant schizophrenia)

The unique medical side effects from second-generation antipsychotics include:

  • Metabolic syndrome
  • Diabetes mellitus
  • Weight gain
  • Hyperlipidemia (high cholesterol)
  • Hypertension (high blood pressure)
  • Cardiovascular disease
  • Tonic-clonic seizures (with clozapine)
  • Agranulocytosis (with clozapine)
  • Myocarditis and dilated cardiomyopathy (with clozapine)

As you can see, a healthy psychiatric patient has the potential of becoming a lifelong diabetic after starting a second-generation antipsychotic. These are very serious side effects that must always be monitored for when a patient is started on a second-generation antipsychotic.

Overall, the side effects listed above do not present in all patients, but they must always be monitored for! Education, teamwork, coordination between different specialities and therapeutic physician-patient relationships are required for careful monitoring of potential side effects as well as successful treatments!

Are you Ready? (This is Defeating Stigma Mindfully)