I work in a group home and one of the individuals there has made 2-3 references to hearing voices; however, she always states it like this: "You don't know what it is like hearing voices in your head." "I hear voices in my head that tell me to do bad things." She has just said this 3 times within the past 3 weeks. When asked specifically what the voices say...she just says bad things. She is taking Concerta, Prolixin, Ritalin, Lactimal, Effexor to name a few drugs....I have heard that it could be a side effect of anticonvulsants to "hear voices"....the other thing is that if she reads or hears about something, she commonly imitates it and lives vicariously so to speak through others experiences. Anyway, she has a history of abuse and had just gotten an audio book, The boy called it, which after listening to, she became started talking about suicide and had "a behavioral incident"........Her physician increased her dosage of Prolixin and said he was not overly concerned about it. I guess I am wondering if anyone has heard of concerta or lactimal causing such a reaction and if she truly was hearing voices in her head, would it just be 3 times .....or would it be more continuous? After she makes these statements, almost immediately, she is fine and just goes on as usual. I also find that she made these statements when she 1. didn't want to go to work, 2. was having an argument with another staff, and 3. was on her way to a dr. appt. that she didn't want to go to...........I guess I am just looking for any input that anyone may have.........thanks in advance!
Dec 18, '04
If you are talking about drug abuse it could be drug induced schizophrenia. Just a thought.
Dec 18, '04
History of abuse, maladaptive behavior, questionable if present any Personality Disorder traits? Hard to say without further info regarding her psych history. She is not on those meds for no reason. What was the symptom picture prior to the initiation of each med from a psychiatric standpoint? Voices "in" the head (the key word is "in") is not indicative usually of a psychotic process. Psychotic demonstration is usually with voices heard "outside" the head...but, don't tell the patient that....may change the symptom picture purposely if it is manipulative behavior, as it could be here as you indicate. Could you explain more regarding "living vicariously through others experiences"...this may also help us to understand what you observe. The boy, the audio book, the topic of suicide, and the behavioral incident is very unclear...could you describe this better?...it may be relevant. What type of persons does she gravitate to and from? Abuse...how long ago, type, severity, and by who? Also, what is the person's age and if there are any physical health problems, like head injury or diagnosed seizure disorder? Does menses play a role in any way? Any other meds the patient takes for physical health conditions present? Any substance abuse issues or concerns? Very interesting post. Any drug can induce side effects...just monitor if certain behaviors/symptoms increase with the induction/reduction of the med...look for trends. You may want to ask the doc his/her impression as to why "certain things" are of little concern at this point and which concerns need to be reported. Lastly, you may simply want to contact your nearest pharmacy for additional info if needed. Thanks for the post.
Dec 18, '04
Well, she is 29 yrs old, and her history is sketchy but as far as I can ascertain, she has had physical and sexual abuse from someone in her immediate family. She is not abusing any "street" drugs or otherwise because she is monitored 24/7. Also she does not have a seizure disorder so I am unclear as to why she is on the anticonvulsant.... "The Boy Called It" is a book about a child who was severely abused by his mother as a child, and after listening to that audiotape is when she started acting particularly upset, talking about suicide, etc.
By living vicariously through others, I mean that if you tell her "I don't feel good; I have an earache." That day or a day later, she, too, will "have an earache".........So what I am thinking is that she heard that phrase, "You don't know what it's like hearing voices in your head." I hear voices that tell me to do bad things".........and is saying it (whether she is hearing voices in her head or not) at times when she wants attention or wants to get out of doing something she finds undesirable.........also the staff that she was closest too just got transferred to another home so I am sure that has something to do with her behavior as well. She is mostly drawn to females who are older than her and "motherly" towards her.
Management is concluding that she is, in fact, hearing voices in her head, but like you say, they wouldn't be IN her head....they would be from outside, no? That is probably why her physician is not too worried about it because he probably figures the same thing. She has myotonic muscular dystrophy but is completely mobile and if you didn't know it, you wouldn't think she had a physical impairment of any type.
I do know she does do a lot of "staff splitting" and she has "mood disorder" as well as adhd for a formal diagnosis but would that include borderline?
Thanks for the input...
Dec 18, '04
This is more helpful. Antiseizure meds are often used in conjunction with antidepressants for folks who have mood lability...or mood swings. Her being on stimulants also coincides with the dx of ADHD. Hearing voices "IN" the head usually coincides with folks of past abuse and Borderline PD, maybe even PTSD. The behaviors you mention highly suggest Borderline PD or traits thereof. The stimulus for acting out for most PD types is usually interpersonal relations...the salt of their wounds. I would suggest not working on abuse issues in the home environment by lay staff which could stir up a pot of hornets, especially staff who have no training in working with abuse or Borderline PD...you ask for trouble if you do. This person needs a "skilled" counselor/therapist/nurse. Discuss it with the doc if you think it may be needed. If genuine abuse issues are present and are the source of current difficulty, the home needs to be a safe, benign place...home is where you "rest and reside"...and not the place to work on the abuse. Management is management and are not clinicians. Enough said on that note. When you say doc, what type of doc?...psych or nonpsych?
I hope this was helpful.
Dec 18, '04
She has a regular dr. prescribing these meds for her but she also has a therapist that she sees twice a month (I think it would be beneficial if she saw him more often).....I also agree that neither staff nor management should be discussing certain things with her; however, we have recently gotten a new staff member who seems to goad her on and I have mentioned this to the asst manager so hopefully she will be spoken to. She really just doesn't understand the problems she is causing at all. She addresses her like she is just some person on the street that says something to her she doesn't like and starts talking about too much personal stuff with her.
Anyway, it was helpful, thanks.......I am just going to bring everything up at staff meeting and suggest that she get more frequent counseling sessions as well as the be able to call her therapist if she feels she needs to talk about an issue that is not good for the staff to discuss with her.
Dec 18, '04
I am glad I was able to help. Sounds like you're doing the right thing. Regarding that one staff member, monitor it. The key word of the day here is "boundaries"...it keeps the environment a safe place for both resident and staff. Good luck. I wish you well.
Last edit by Thunderwolf on Dec 18, '04
Feb 15, '05
Thunderwolf knows his/her stuff. Voices that a patient can clearly identify without prompting as being inside her head suggest dissociative process. Voices experienced by the patient as being external to herself suggest psychotic process.
One helpful trick in management of this type behavior is to limit the number of staff the patient may talk with about sensitive subjects. One each on the day and evening shifts. All other staff are to be instructed to say, "You will have to talk to ---- about that". The patient will hate this of course. So what? You are not there to have her like you.
The 3 most important issuses in dealing with the abuse survivor/borderline/dissociative population are bounderies, bounderies, boundries. Paste your back firmly against your facility's policy book and keep it there. If you go out on a limb for a borderline, she will cut it off. Remember that your co workers are competent professionals. Trust them. Even if they are wrong, trust them over anything an borderline says about them!
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