Makindo Medical Notes.com

Gustatory(taste) and Olfactory (Smell) hallucinations are associated with temporal lobe epilepsy

About

• It affects 1% of the population
• It is possibly a neuro developmental defect

Aetiology

• Schizophrenic brains are smaller than normal brains, with a tendency toward larger Sulci, lateral, and third ventricles
• There is a relative decrease in the volume of the temporal lobe and of all lobes otherwise
• The disease may be precipitated by exposure to stressors

Positive symptoms

• Auditory hallucinations in the 2nd/3rd person "You or he/she"
• Broadcasting - removal and insertion of thoughts
• Bizarre behaviour at times, thought disorders
• Controlled feelings or emotions or impulses or actions
• Delusional perceptions - the newscaster's tie gives you a message
• Hallucinations and thought disorganization
• Visual, tactile, olfactory, and gustatory hallucinations also occur
• Paranoid delusion: Any delusion that refers back to the self—in practice, most are persecutory delusions.
• Grandiose delusions (such as special powers or missions) occur in schizophrenia and bipolar affective disorder

Negative symptoms

• Emotional withdrawal: flat affect
• Apathy (disinterest) manifested as blunted affect
• Poor self-care
• Social isolation
• Poverty of speech
• Lack of attention to appearance or personal hygiene
• Poor rapport: reduced verbal and non-verbal communication (for example, eye contact)
• Odd or incongruous affect (for example, the patient smiles when recounting sad events, and vice versa)
• Lack of spontaneity and flow of conversation

Management

• Medication: This can help the most disturbing symptoms of the illness but it is not the whole answer. Medication reduces the effects of the symptoms on your life. Medication can help weaken delusions and hallucinations gradually, over a period of a few weeks and help thoughts to be clearer and increase your motivation and ability to look after yourself although too much medication (or the wrong medication for you) can have the opposite effect. As tablets, capsules, or syrup. If compliance is difficult a depot injection can be given every few weeks. Medication is usually given long term. Clozapine does seem to work better than other antipsychotics for some people. However, its side effects can be dangerous, so it can only be prescribed by a specialist after other treatments have failed. If you have had both a 'typical' antipsychotic and an 'atypical' antipsychotic for 8 weeks without real help from either, clozapine may be worth trying
• Others: Other important parts of recovery support from families and friends, psychological treatments and services such as supported housing, daycare and employment schemes. Patients may need help as everyday life is hard to deal with. This may or may not be due to the symptoms. Sometimes you may just get out of the habit of doing things for yourself.
• Cognitive Behavioural Therapy (CBT): This can be done by clinical psychologists, psychiatrists or nurse therapists. It helps you to:
  • Concentrate on the problems that you find most difficult. These could be thoughts, hallucinations or feelings that you are being persecuted.
  • look at how you tend to think about them - your thinking habits.
  • look at how you react to them - your behaving habits.
  • look at how your thinking or behaving habits affect you.
  • work out if any of these thinking or behaving habits are unrealistic or unhelpful.
  • work out more helpful ways of thinking about these things or reacting to them.
  • try out new ways of thinking and behaving.
  • see if these work. If they do, to help you use them regularly. If they don't, to find better ones that do work for you.
  • This kind of therapy can help you to feel better about yourself and to learn new ways of solving problems. We now know that CBT can also help you to control troublesome hallucinations or delusional ideas.
  • Most people have between 8 and 20 sessions, each lasting about 1 hour. To help the symptoms of schizophrenia, you may need to carry on with booster courses from time to time.
• Counselling and supportive psychotherapy: These can help you to: get things off your chest, talk things over in more depth, get some help with the daily problems of life.
• Family meetings: These try to help you and your family cope better with the situation. They can be used to discuss information about schizophrenia, how best to support someone with schizophrenia and how to solve the practical problems that can crop up. Meetings are held over a period of about 6 months.
• Support from the Community Mental Health Team (CMHT) or Early Intervention Team. A mental health worker from your local team (your care coordinator) should see you regularly. Community psychiatric nurses can give you time to talk and can help sort out problems with medication.
• Occupational therapists can: help you to be clear about what your skills are and what you can do show you how to improve things you aren't doing so well work out ways of helping you to do more for yourself help you to improve your social skills (how to get on with other people). There may be help for families, with regular meetings for a while. These can help the family to: learn more about the illness and treatment sort out some of the practical problems of day-to-day living. The psychiatrist will usually organise your medication and take responsibility for your overall care. The care coordinator is responsible for making sure that you get the care you need. Vocational rehabilitation or recovery workers can help you to get back into work, education or some sort of activity that you find rewarding.

References

• Managing the acute psychotic episode