Hearing voices

Well I would hope that anyone working in a psychiatric facility has had training on crisis management as a good portion of our patient population is there due to psychosis and auditory/visual hallucinations. The biggest thing is to make sure the voices are not telling the patient to hurt themselves or anyone else (command hallucinations). Apart from that after you determine there are no command hallucinations the biggest thing is the medications. We use antipsychotics to treat patients. Nowadays the atypical antipsychotics like Zyprexa and Risperdal are the go to drugs because of the less intense side effect profile, but the older drugs like Haldol and Prolixin have their place too. Before those kick in, staff are there to let the patient know they are safe and try to re-direct the person, help them to be ther with you instead of the voices but that can be very difficult as its hard for the patient to really connect with you due to the internal chatter. Keeping them safe and as free of distress as possible is our job. And yes in cases of psychosis, the goal is to eliminate the voices. Sometimes that is possible, but with the real chronics, sometimes just getting them stable enough to return to the community is as good as it gets. The meds are usually pretty good at knocking out the hallucinations though, the delusions can sometimes be a tougher nut to crack because they really believe the delusions to be true. It would be pretty damn hard to convince me that the sky is green even with a boatload of meds iykwim. We don't "help" the voices in a psychotic person. I think what you are thinking of is integrating separate personalities in DID formerly known as multiple personality disorder which is not true psychosis.

When I have a patient admit to having AH, first I ask them if they can make out what they are saying ( a lot of times I am told its just mumbling in the background), if they can I ask what the voices are saying and if what they are saying is bothering them. I figure if they are hearing things that arent bothersome or commanding them to do things its their normal. Ive had people come back in to the unit, after stopping their meds, because they were lonely without the voices.

Are you hearing noises or voices other than mine?

Can you understand what they are saying...what are they telling you?

What helps when this happens? Do they ever go away?

Sometimes they don't ever go away, and the goal is to minimize hallucinations, and maximize coping skills

I have found that there are people who hear voices all the time and sometimes they are laughing and talking out loud to them in their rooms and don't really seem distressed. It's noteable and should be brought up when reporting to the psychiatrist but sometimes it takes time to stabilize someone who has been off meds awhile and maybe doesn't require stat medication. If the patient gets loud or becomes angry with "the voices" I will ask them; "Are you ok? What's going on?" and maybe I will offer to call the doctor to get them some extra medication to help them relax. Usually Haldol or Zyprexa, sometimes they will order a cocktail of Haldol, Ativan and Benadryl. Personally, I think Haldol or Thorazine seems to have the most success in a crisis. You can repeat Haldol and give a lot of it if needed in a short amount of time. I like Zyprexa Zydis too because it's hard to cheek it and seems to be pretty effective.

Sometimes a patient will hear something and accuse another patient or staff of calling them a name and it errupts out of nowhere which is more serious and requires immediate intervention. I usually insist the patient walk with me to another area, the quiet room or someplace out of the way and I ask them to tell me what happened. If they are shouting and angry I tell them (not ask them), calmly, I'm going to get them some medication and I ask them if they are willing to take it. The crucial part of your assessment of the situation is trying to determine if the person is able to stay calm and in control of their behavior. If you don't think they will then you need something fast acting and even sedative. People who hear voices may hear them all the time or sometimes. They may be distressed by voices or not. They may be aware of what the voices are saying or just hear whispers. Voices can be loud and commanding causing them to get angry and violent or they can be subtle and upsetting like when a person believes 'God wants me to die'. I will sit with someone like that awhile and keep asking questions; "Are you going to hurt yourself?" "Why do you think it's God who is saying that to you?" etc... I will stay with a patient or get someone to stay with a patient who tells me something like that while I get a doctor to help assess and medicate.

Sometimes it's ok that the medication doesn't stop the voices completely. I've had patients say after a week or so of medication, "I don't really notice them so much anymore" or "they aren't as loud and I can sleep" and that's ok. I have a lady who talks constantly to hers, like they are roommates. Mostly she is happy and laughing but when she starts to get mean with staff (she says things like; 'go on and be a whore if ya want to', as I'm walking away, for instance) and fight loudly, in her room, with her voices, then she needs more medication if for no other reason, because it's upsetting her.