Mental Health Monday–Character Analysis: I Hear Voices…No, Really

Stina Lindenblatt asked me to give a run down of treatment for her character. He hears voices, but they are real (in a paranormal way). They end up driving him to cut his wrists. And Stina wants to know what would happen next.

In the state of New York (where I live), someone can be admitted to a psychiatric facility on an Emergency Admission. Also known as an Involuntary admission, people who are a danger to themselves or others can be admitted for treatment, even if they don’t want to be. (We also admit people voluntarily, of course.) I bring this up because not all states have this law.

So, if Stina’s character showed up in my ER, let’s say, and has cut his wrists and reports hearing voices, I’d recommend inpatient hospitalization for his safety and stabilization. Treatment would include keeping him in a safe environment (in the hospital), offering him medication, individualized therapy, and group programming.

Medication varies by diagnosis and symptoms, but someone experiencing auditory hallucinations (voices) would be given an anti-psychotic. “First-generation anti-psychotics” (so called because they were identified and produced first) include Haldol, Thorazine, and Prolixin. They are fast and effective, and though Stina’s character would likely be sleepy for the first few days he’s on them, he’d also note resolution of symptoms within a few days to a couple of weeks. “Second=generation anti-psychotics” (so called because they were developed after the first generation ones and were touted to have less side effects (despite causing other side effects like metabolic changes)) include Risperdal, Seroquel, Zyprexa, and Abilify. Also quick-acting, these agents would resolve Stina’s character’s symptoms within a few days.

One may assume cutting of wrists indicates a suicide attempt and therefore means the person is depressed. (This isn’t always the case, but let’s go with that assumption here, okay?) So, in addition to the antipsychotic, Stina’s character would be offered an anti-depressant like Zoloft, Prozac, Celexa, Wellbutrin, or Effexor. These medications take several weeks to kick in. A person doesn’t have to stay in the hospital for that length of time, by any means. We just need to see their mood begin to stabilize out.

Before leaving the hospital, it would be important for Stina’s character to have follow up treatment with a psychiatrist and counselor scheduled. This would allow for outpatient monitoring of his medications and symptoms. Antipsychotics (if symptoms are resolved and thought to be part of a depressive episode) can be discontinued within a few weeks or months. Anti-depressants should be taken for at least a year to fully treat the current episode and prevent future ones.

If someone has chronic symptoms and history of depressive episodes, they’d more than likely need to stay on medications long-term. If someone has chronic psychosis, they’d need to stay on the medications long-term as well.

Stina’s character is 17, which may alter his management a bit…however, in this case, he’d likely be given the same medications as an adult.

Based on Stina’s description of her character’s clinical presentation, I’d diagnose him with Psychotic Disorder Not Otherwise Specified (he doesn’t necessarily meet criteria for DSM-IV diagnosis) and perhaps Depressive Disorder Not Otherwise Specified.

Other potential diagnoses include: Brief Psychotic Episode, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, and Major Depressive Disorder with Psychotic Features. Any medical conditions or drug use would have to be considered as well.

I hope this is helpful, Stina!

I’d be happy to answer any follow up questions as well. There’s a lot of information in this post and I could certainly go on, but I won’t cause your eyes will start crossing soon. 😉

Be sure to check out Lydia’s Medical Monday post about what plant in your garden could kill you.

Remember, these posts are for WRITING PURPOSES ONLY and are NOT to be construed as medical treatment or advice. Happy writing!