An elderly house wife lost her husband who died suddenly of myocardial infarction couple of years ago. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard the voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. This however, provoked anxiety and sadness of mood when she would remain preoccupied with thoughts about him. She should be treated with:
In this case, death happened "couple of years ago". The first time she had auditory hallucinations was after a week of his death and since then it has been happening. Now, in grief "brief hallucinations" can occur however here the hallucinations are often and patient is even discussing the daily matters with the "voice". This clearly shows presence of psychotic symptoms which should be diagnosed separately. Please remember patient can develop all kind of psychiatric disorders like depression, anxiety, PTSD in association with grief and if the symptoms are severe enough, they should receive separate diagnosis. This patient has psychotic symptoms (i.e. hallucinations) and should be treated with an antipsychotic, haloperidol. The treatment depends on symptoms, in case of occasional anxiety, Alprazolam could have been used. In case of significant depressive symptoms antidepressant could have been used, but since the psychotic symptoms are prominent, we must use an antipsychotic.
Clomipramine
Alprazolam
Electroconvulsive therapy
Haloperidol
Neurotic, Stress Related and Somatoform Disorders