[38F] Experiencing auditory hallucinations and severe nightmares

Question

Do I have schizophrenia

Patient Description

A 38-year-old female has been experiencing auditory hallucinations, specifically hearing voices saying her name, since she was 14 years old. Additionally, she has been having nightmares involving harming others for the past 3 years, which occur almost every night and have significantly impacted her sleep quality. She also mentioned experiencing blackouts triggered by emotional distress, a condition present since she was 10 years old. The patient has a history of depression diagnosed 3 years ago, coinciding with the onset of her nightmares. Her mood has worsened over time, and she has had thoughts of harming herself or others. She is currently taking Zoloft 200mg daily in the morning to manage her depression. No allergies or adverse reactions to medications have been reported. The patient is seeking help to understand and manage these symptoms.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Schizophrenia: This is a serious mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior. Auditory hallucinations, such as hearing voices, are a common symptom. Your family history of schizophrenia (your aunt) could potentially increase your risk.

    • Treatment typically involves a combination of medication, psychotherapy, and coordinated specialty care services.
  • Post-Traumatic Stress Disorder (PTSD): This is a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event. Your history of witnessing domestic violence and the resulting blackouts could be indicative of PTSD.

    • Treatment usually involves psychotherapy (such as cognitive-behavioral therapy, eye movement desensitization and reprocessing, and exposure therapy), medications, or both.
  • Major Depressive Disorder (MDD): This is a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You've mentioned being diagnosed with depression and your worsening mood could be a sign of uncontrolled depression.

    • Treatment typically involves a combination of medication (like your Zoloft), psychotherapy, and lifestyle changes.

What you can do

  1. Continue taking your Zoloft as prescribed by your doctor.
  2. Seek immediate medical attention. The symptoms you're experiencing are serious and require professional help. You may need to be evaluated by a psychiatrist who can provide a more accurate diagnosis and treatment plan.
  3. Reach out to trusted friends, family members, or mental health professionals if you're feeling distressed or if your symptoms worsen.
  4. Try to maintain a regular sleep schedule. Poor sleep can exacerbate mental health symptoms.

What you should look out for

  • If your symptoms worsen or if you start to have thoughts of harming yourself or others, seek immediate medical attention.
  • If you notice any side effects from your medication, such as nausea, vomiting, diarrhea, dry mouth, increased sweating, feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia), contact your doctor.
  • If your mood continues to worsen or if you start to lose interest in activities you once enjoyed, reach out to a mental health professional.

Remember, I'm an artificial intelligence and while I strive to provide accurate and helpful information, I'm not a substitute for professional medical advice. Please consult with a healthcare provider for a formal diagnosis and treatment.

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7 mo ago


People Also Ask


What are auditory hallucinations and what causes them?

Auditory hallucinations involve hearing sounds, such as voices, that are not present. They can be caused by mental health disorders like schizophrenia, severe stress, or substance abuse. Treatment often involves medication and therapy.


How can nightmares affect mental health and sleep quality?

Nightmares can lead to poor sleep quality, increased anxiety, and stress, which can exacerbate mental health issues. They may be linked to PTSD or other anxiety disorders. Addressing the underlying cause through therapy and medication can help.


What are the common symptoms and treatments for PTSD?

PTSD symptoms include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about a traumatic event. Treatment typically involves psychotherapy, such as cognitive-behavioral therapy, and sometimes medication.


How does Zoloft help in managing depression?

Zoloft is an antidepressant that helps balance chemicals in the brain, improving mood, sleep, and energy levels. It is commonly used to treat depression and anxiety disorders. It may take several weeks to notice its full effects.

1 Comments


Leo#17

7 mo ago

I'm so sorry you've been experiencing this for so long. I'm not a psychiatrist but I am a medical student that recently completed a psychiatry rotation. Schizophrenia is the most famous condition associated with hallucinations, but it's not the only one. Specifically, the DSM-5 requires more than just hallucinations to diagnose schizophrenia. Some other conditions include schizoaffective or major depressive episodes with a psychotic component.

In any case, cognitive behavioral therapy and antipsychotic medication tend to work well for suppressing hallucinations. You may also need a higher dose or alternate antidepressant if Zoloft isn't working well. Something to talk to your psychiatrist about.

As for your nightmares, one treatment is called imagery rehearsal therapy: it involves modifying a recurrent nightmare by writing it down and rehearsing new endings that make nightmares less frightening when they occur again https://psychcentral.com/blog/a-brief-guide-to-imagery-rehearsal-therapy-irt-for-nightmare-disorders-for-clinicians-and-patients

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