BACKGROUND

In the context of acute psychiatric care characterized by severe hallucinatory symptoms, providing timely and effective interventions poses challenges. Therapy administered by Mental Health Nurses (TKN) emerges as a promising solution to comprehensively address these acute symptoms. This therapeutic approach is designed to alleviate hallucination symptoms during the acute phase.

OBJECTIVES

This study aimed to investigate the effectiveness of Therapy administered by Mental Health Nurses (TKN) as an intervention tailored for individuals facing acute hallucinatory challenges. The overarching goals include exploring the therapeutic dimensions of the intervention, assessing the potential for tailored interventions based on demographic factors, and translating findings into practical implications for mental health professionals.

METHODS

This study used a quasi-experimental design with a one-group pre-post-test structure. A total of 117 participants diagnosed with schizophrenia from outpatient psychiatric wards were selected in community setting, excluding individuals with concurrent mental retardation to maintain sample homogeneity. Data collection, conducted over two months from July to August 2023, included a pre-test assessment before any intervention to establish baseline hallucinatory symptoms. Therapy by Mental Health Nurses (TKN) was administered over two weeks, consisting of four 30- to 45-minute sessions for each participant. After each session, participants underwent reassessment for hallucinatory symptoms, totaling five assessments. Psychotic Syndrome Rating Scale (PSYRAT) was used to measure hallucination scores. The data analysis employed paired t-tests for baseline and post-intervention scores within a two-week period. A Repeated Measures Analysis of Variance (ANOVA) assessed the effect of interventions on hallucination scores, with age, gender, and adherence status as factors. Post hoc analyses, including pairwise comparisons, identified specific subgroup differences and assessed the time effect within the same group.

RESULTS

The study cohort primarily consisted of adults (90.6%), maintaining a balanced gender distribution with 51.3% males and 48.7% females. A substantial portion had low educational backgrounds (59%), and the majority were unemployed (87.2%), with family members serving as the predominant primary caregivers (87.2%). Regarding medication adherence, over half adhered to the prescribed regimen (52.1%). Results demonstrated an improvement in hallucination symptoms for adolescents and the elderly compared to adults. While gender and adherence status did not individually influence symptoms significantly, age category emerged as a significant contributing factor (F = 3.991, p = 0.021). Interaction effects emphasized the substantial influence of time on symptom shifts over the intervention (F = 24.164, p < 0.001). Particularly, the mean difference of 4.636 (p < 0.001) from Time 1 to Time 5 signified a substantial decrease in hallucination scores, highlighting the cumulative impact of the therapy. These findings underscore the effectiveness of Therapy administered by Mental Health Nurses (TKN) across diverse demographic factors, providing valuable insights for tailored interventions in psychiatric emergencies.

CONCLUSION

Therapy administered by Mental Health Nurses (TKN) demonstrates effectiveness in reducing schizophrenia symptoms, especially among adolescents and the elderly. The impact of time on the intervention's effectiveness is notable, with a cumulative effect observed over the intervention period. Sustained and consistent engagement with the therapy leads to more substantial improvements in hallucination symptoms. Therefore, tailored interventions considering age are crucial for optimal effectiveness. This understanding enables practitioners to optimize the therapy schedule, aligning it with the natural progression of symptom alleviation.

Human ; Hallucinations ; Therapeutics ; Therapy ; Mental Health ; Nurses

OBJECTIVES

To present a rare case of recurrent urethral and intravesical foreign body insertion driven by command hallucinations in schizophrenia, to describe the surgical and psychiatric management strategies employed, and to emphasize the importance of interdisciplinary care and treatment adherence in preventing recurrence.

METHODS

Reported here is the case of a 37-year-old male with schizophrenia who presented with multiple episodes of urethral and intravesical foreign body insertion over a six-year period (2018–2025). Inserted objects included metallic wires, electrical cords, and a LED Christmas light rope, each requiring surgical removal via cystoscopy or open cystotomy. Psychiatric evaluation revealed poor adherence to antipsychotic medication, with recurrent episodes associated with command hallucinations. Psychiatric management was reinitiated with olanzapine and structured follow-up to improve treatment compliance.

RESULTS

Six documented episodes of self-inflicted urethral and intravesical trauma required repeated urologic interventions. Despite recurrent instrumentation and foreign body insertion, serial cystoscopic evaluations demonstrated preserved urethral and bladder integrity without evidence of stricture formation. The most recent episode required open cystotomy for removal of a coiled LED light rope, which was successfully extracted without complications. Following coordinated psychiatric management and improved adherence to antipsychotic therapy, the patient remained asymptomatic and free of recurrence at three months follow-up.

CONCLUSION

This case highlights the unusual preservation of urethral integrity despite recurrent traumatic self-insertion. Effective management requires sustained psychiatric stabilization, multidisciplinary collaboration, and strict treatment adherence. Integration of psychiatric and urologic care is essential to prevent recurrence and improve long-term outcomes in patients with schizophrenia-related self-inflicted genitourinary injury.

Human ; Male ; Adult: 25-44 Yrs Old ; Schizophrenia ; Cystoscopy ; Self-injurious Behavior ; Psychotic Disorders ; Antipsychotic Agents ; Olanzapine ; Constriction, Pathologic ; Hallucinations ; Urinary Bladder ; Foreign Bodies

Humans ; Cerebral Cortex ; Hallucinations/pathology* ; Neurodegenerative Diseases/pathology* ; Atrophy/pathology* ; Magnetic Resonance Imaging

Wernekink commissure syndrome is a rare midbrain syndrome with bilateral cerebellar dysfunction,eye movement disorder,and palatal myoclonus.Few cases of this syndrome have been reported in China,let alone those combined with hallucinations and involuntary groping.This paper reports the diagnosis and treatment of a case of Wernekink commissure syndrome with hallucinations and involuntary groping,aiming to enrich the knowledge about this disease for clinicians.
Humans ; Mesencephalon ; Ocular Motility Disorders/diagnosis* ; Spinal Cord ; Syndrome ; Hallucinations

Adult ; Brain ; diagnostic imaging ; physiopathology ; Diffusion Tensor Imaging ; Female ; Hallucinations ; diagnostic imaging ; physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; White Matter ; diagnostic imaging ; physiopathology ; Young Adult

Dementia ; pathology ; Hallucinations ; pathology ; Humans ; Lewy Body Disease ; pathology ; Nerve Net ; pathology

Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (α), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak D₂ receptor bindings with strong binding to the 5-HT(2A) receptor, while typical antipsychotics block long-lasting, tight D₂ receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.
Affective Symptoms ; Analgesics ; Antidepressive Agents ; Antipsychotic Agents ; Delusions ; Dopamine ; Drug-Related Side Effects and Adverse Reactions ; Dystonia ; Hallucinations ; Histamine ; Humans ; Movement Disorders ; Norepinephrine ; Pain Management ; Prolactin ; Psychomotor Agitation ; Psychotic Disorders ; Receptor, Serotonin, 5-HT2A ; Receptors, Neurotransmitter ; Serotonin ; Weight Gain

Opioids are important drugs for the management of severe cancer pain without a ceiling effect. However, opioid administration leads to dose-limiting complications including drowsiness, hallucinations, delirium, respiratory depression, cognitive impairment, seizure, myoclonus, and hyperalgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical phenomenon as opioid exposure increases pain sensitivity. Reducing or stopping opioids, opioid rotation, or co-administration of N-methyl-D-aspartate (NMDA) antagonists have been suggested for the management of OIH. In this study, we report two clinical cases of successful management of OIH in cancer pain patients that were treated with opioids.
Analgesics, Opioid ; Cognition Disorders ; Delirium ; Hallucinations ; Humans ; Hyperalgesia ; Myoclonus ; N-Methylaspartate ; Pain Management ; Respiratory Insufficiency ; Seizures ; Sleep Stages

We aim to investigate the effect of fronto-temporal transcranial direct current stimulation (tDCS) on the interactions among functional networks and its association with psychotic symptoms. In this pilot study, we will determine possible candidate functional networks and an adequate sample size for future research. Seven schizophrenia patients with treatment-refractory auditory hallucinations underwent tDCS twice daily for 5 days. Resting-state fMRI data and measures of the severity of psychotic symptoms were acquired at baseline and after completion of the tDCS sessions. At baseline, decreased functional network interaction was negatively correlated with increased hallucinatory behavior. After tDCS, the previously reduced functional network connectivity significantly increased. Our results showed that fronto-temporal tDCS could possibly remediate aberrant hallucination-related functional network interactions in patients with schizophrenia.
Hallucinations ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Pilot Projects ; Sample Size ; Schizophrenia ; Transcranial Direct Current Stimulation

This study explored long-term changes in self-report auditory verbal hallucinations (AVHs) among patients with schizophrenia taking clozapine. Forty-four patients who were evaluated more than twice and were above the mild severity category on the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) were enrolled. The mean observation period was 492.5±350.1 days (median, 452 days). The mean total, physical, and emotional factor scores on the HPSVQ were significantly reduced from baseline to the final observations except for one item “interference with life,” which was not significantly reduced. Regarding the time-dependent longitudinal changes modeled using linear mixed-effect regression, the total and physical factor scores showed significant changes during the first year, but the emotional factor score did not satisfy a more stringent level of significance. Female gender was negatively associated with the reduction in total and physical factor scores. The duration of treatment with clozapine also had a negative relationship with the reductions in all three scores.
Clozapine ; Female ; Hallucinations ; Humans ; Schizophrenia ; Voice