[18F] Experiencing derealization, auditory hallucinations, and paranoia

Patient Description

An 18-year-old female has been experiencing a profound sense of emptiness and derealization for several years, describing feelings of being 'not actually living' and episodes that make her feel heavy, affect her memory, and impair her ability to speak. She finds some relief in being outdoors. Additionally, she experiences mood swings, auditory hallucinations (hearing bugs and yelling), and paranoia, fearing that something bad will happen to her. These episodes occur at least once a month and are not triggered by specific events or stressors. She has a history of anxiety, depression, and was considered for schizophrenia medication by a previous psychiatrist four years ago but has not been on any medication since. She also has a history of ADHD diagnosed in childhood. The patient has not seen a psychiatrist in the last four years and has not been prescribed any medication recently. She denies any allergies or adverse reactions to medications. The patient has had thoughts of self-harm but has not acted on them.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are a few possibilities:

  • Depersonalization-Derealization Disorder: This is a type of dissociative disorder that consists of persistent or recurrent feelings of being detached (dissociated) from one’s body or mental processes, usually with a feeling of being an outside observer of one's life (depersonalization), or of being detached from one's surroundings (derealization).

    • Treatment typically involves psychotherapy, with a focus on grounding techniques and cognitive behavioral therapy. Medications can be used to help manage any co-occurring conditions, such as depression or anxiety.

  • Schizophrenia: This is a serious mental disorder characterized by a range of problems with thinking (cognition), behavior, and emotions. Symptoms may include hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning.

    • Treatment typically involves a combination of medication, psychotherapy, and coordinated specialty care services.

  • Major Depressive Disorder with Psychotic Features: This is a form of depression that is accompanied by symptoms of psychosis, such as hallucinations or delusions. These symptoms can be mood-congruent (consistent with depressive themes) or mood-incongruent (not consistent with depressive themes).

    • Treatment typically involves a combination of antidepressant and antipsychotic medications, as well as psychotherapy.

Please note that these are potential explanations based on the symptoms you've described, and the actual diagnosis could be different. It's important to consult with a healthcare provider for a formal diagnosis.

What you can do

  1. Seek immediate help if you're feeling suicidal or are making plans to harm yourself. This is a crisis and you don't have to go through it alone. Reach out to a trusted individual in your life and let them know what you're going through so they can provide support.

  2. Schedule an appointment with a mental health professional. This could be a psychiatrist or a psychologist. They can provide a formal diagnosis and start you on the path to treatment.

  3. Try to spend time outside, as you mentioned that this helps you feel better. Physical activity can also be beneficial for mental health, so consider incorporating some form of exercise into your routine.

  4. Consider joining a support group. Connecting with others who are experiencing similar symptoms can provide comfort, reduce feelings of isolation, and provide practical advice.

What you should look out for

  • If your symptoms worsen or if you start to feel suicidal, seek immediate medical attention.

  • If you start to experience new symptoms, such as mania (periods of great excitement, euphoria, delusions, and overactivity), this could indicate a different or additional mental health disorder, such as bipolar disorder.

Remember, it's important to consult with a healthcare provider for a formal diagnosis and treatment.

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7 mo ago

People Also Ask

What is depersonalization-derealization disorder and how is it treated?

Depersonalization-derealization disorder is a dissociative disorder characterized by persistent or recurrent feelings of detachment from one's body or surroundings. Treatment typically involves psychotherapy, such as cognitive behavioral therapy, and may include medications to manage co-occurring conditions like anxiety or depression.

How can schizophrenia be managed effectively?

Schizophrenia is managed through a combination of antipsychotic medications, psychotherapy, and coordinated specialty care services. Early intervention and a comprehensive treatment plan are crucial for improving outcomes.

What are the symptoms of major depressive disorder with psychotic features?

Major depressive disorder with psychotic features includes symptoms of severe depression accompanied by hallucinations or delusions. These psychotic symptoms can be mood-congruent or mood-incongruent. Treatment usually involves a combination of antidepressant and antipsychotic medications, along with psychotherapy.

What steps should someone take if they are experiencing thoughts of self-harm?

If someone is experiencing thoughts of self-harm, it is important to seek immediate help. They should reach out to a trusted individual, contact a mental health professional, or call a crisis hotline for support. It's crucial to not go through this alone and to get professional help as soon as possible.

1 Comments

Brian#93

7 mo ago

I have seen antipsychotic medication work well for many people with hallucinations and paranoia. Did you ever try it and how was your experience?

Unfortunately the "negative symptoms" of feeling heavy and being unable to speak might not improve as much with medication, but everyone's experience is different.

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