Correlation between the severity level of the symptom and the distress of patient halucination
Mahnum Lailan Nasution
, Wardiyah Daulay, Sri Eka Wahyuni
Corresponding author
Faculty of Nursing, Universitas Sumatera Utara, Indonesia
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The average prevalence of severe and chronic psychiatric or schizophrenic disorders suffered by Indonesians without age limit suggests that people with severe mental disorders in Indonesia are 1.7 per 1000 people. The same study noted the total population at risk of 1,093,150 people, only 3.5% or 38,260 people are served with adequate care at various health facilities.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are two types of mental disorders that can be found in the community. Mild mental illness for example is an emotional mental disorder. Severe mental disorder is one of them is schizophrenia. Most of the patients treated in mental hospitals are patients with severe mental disorder schizophrenia. Schizophrenia is a neurological disease that affects the perception, way of thinking, language, emotions, and social behavior of the patient.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> The factors that cause hallucinations are predisposing and precipitation factors.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Patients who have auditory hallucinations in paranoid schizophrenia may mention in detail the content of hallucinations that are heard, can remember the time the sound is heard, and the duration of the sound, and the intensity of the sound that appears. At the time of the sound of responses made by talking themselves respond to hallucinations and some respond to actions such as sleeping.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">American Psychiatric</span>. States that hearing hallucination is a psychosis symptom which mostly happens. Also affirm that the hallucination description happening on patients with schizophrenia is there are 20% patients experiencing two simultaneous hallucinations, namely hearing hallucination and sight hallucination, 70% patients with hearing hallucination, 20% patients experiencing sight hallucination and 10% patients facing other hallucinations such as smelling, groping and tasting hallucination. This explains that hallucination is the prime problem in patients with schizophrenia and therefore, they should get fine treatment from health officers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Hallucination often contains a command to hurt the patients themselves or even the people around them.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> The research result also showed that hallucination causes distress or nuisance to patient's life and daily activity. The distress is due to frequent hallucination which happens every day and very loud voices until they disturb the patient. The hallucination content is also scary, bothersome and influential to the patient's belief.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Distress is a stress that is perceived or perceived as too heavy and difficult to overcome. There are two types of distress, namely acute and chronic stress. Acute stress is an intense stress that appears and disappears quickly. Chronic stress is a stress that lasts for a long time, can be weeks, months, or even years.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Videbeck<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> says the psychological response that occurs with patient mental disorders is caused by anxiety that occurs continuously causing stress on the patient self where the psychological symptoms in the form of: anxiety, depression, loss of motivation, young forget, fatigue, loss of price self, changes in eating habits, sleep, and patterns of activity, mental exhaustion, and inadequate feelings. States that 40% patients with schizophrenia experience depression caused by hearing hallucination. Affirm that 9 until 13% patients with schizophrenia commit suicide because of the hallucination containing the command to hurt themselves. Prevalence of the patients with schizophrenia committing suicide is 20–50%. This is due to the hallucination had by them.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Results of research conducted by Shioda<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> showed the results that 73% of people with schizophrenia experience higher levels of loneliness. Focusing on self-perception, out-of-home social perception, and family perception of socialization interventions, feelings of loneliness may affect the patient's readiness to participate in following interventions for healing.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Mental disorders with schizophrenia are still considered as an embarrassing disease and become a disgrace for the sufferer or the family. Due to misperception in society, many families of mental illness patients do not want to receive family members after medically recovering. This negative public perception resulted in the patient not often get treatment that does not support his recovery.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Prof. Ildrem Asylum is the biggest asylum. It is also a reference hospital for patients with mental issues in North Sumatra. It provides 350 beds with 90% BOR (<span class="elsevierStyleItalic">Bed Occupation Rate</span>). The result of the exordium study indicates that the majority of schizophrenic patients treated at Prof. Ildrem Asylum with the problem of hallucinatory nursing. This research aims to identify the correlation between the severity level of hallucination symptom and distress of patients with hallucination at Prof. Ildrem Asylum.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0050" class="elsevierStylePara elsevierViewall">This research uses descriptive design, whose purpose is to present a complete picture of social setting by way of describing a number of variables related to the problem and the unit under study between the phenomenon tested. The sampling technique in this research uses purposive sampling method, with the sample amount of 99 patients with hallucination at Prof. Ildrem Asylum.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The instrument modified from <span class="elsevierStyleItalic">Psychotic Syndrome Rating Scale</span> (PSYRAT), which was created.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> Moreover, its validity and reliability have been tested as well. <span class="elsevierStyleItalic">Psychotic Syndrome Rating Scale</span> (PSYRAT) had been tested validity and realibility with <span class="elsevierStyleItalic">r</span> value<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.482 and Cronbach's alpha<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.7631.</p><p id="par0060" class="elsevierStylePara elsevierViewall">This research has been through an ethical clearance from the ethics commission, Faculty of Nursing Universitas Sumatera Utara. All respondents were given an explanation of the aims and procedures of the study, and they stated their willingness to take part in the study by signing informed consent.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Based on the data identification result of 99 patients with hallucination at Prof. Ildrem Asylum were recruited for this study. The majority of the patient's age was 18–40 years (45.5%), most of them are Muslim (57.6%), male (64.6%), duration of treatment <1 year (68.7%).</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that the severity level of symptom had by the patients are categorized low (67.7%) and heavy (70.7%).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that distress caused hallucination had by the patients are categorized low (29.3%) and heavy (70.7%).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows that the relationship between severity level of symptom and distress caused hallucination is 0.175.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Research result signifies that there is no difference in distress level between patients with low and heavy severity of hallucination symptom (<span class="elsevierStyleItalic">p</span>-value 0.175, <span class="elsevierStyleItalic">α</span> 0.05). OR obtained is 2.265, meaning that patients with the heavy severity level of hallucination symptom have 2.26 more chances to experience distress compared with patients with low level of hallucination.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Meaning that although the hallucination had by patients in low level, the distress encountered by them is heavy. This is due to bothersome hallucination content because almost all patients convey that the hallucination contents are teasing, underestimating and asking them to do destructive to themselves, other people and their environment. This is in accordance with Singh<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> stating that patients with hallucination are related to the severity level of their hallucination.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Hawari<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> said auditory hallucinations in paranoid schizophrenic patients occur alertness and awareness that include feelings of worry, uneasy, anxious, rowdy, pacing not necessarily direction. Individuals feel threatened with the sound and feel annoyed because the sound often appears. As for the notion that excessive vigilance is characterized as an ongoing effort to investigate the danger sign and its environment or impose undue control and the individual feels unable to relax, unease, restlessness and tension due to a sense of threat to himself.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Joseph's research says that feeling sad after listening to the voice because of the fear of disturbing the safety of the individual, disturbed by the sound that often arises, and anxious with the sound. This research is in line with Singh, Sharan and Kurihara's research result. It shows that distress of patients with hallucination is related to the severity level of the hallucination suffered by them and also the strategy coping had by the patients to control their hallucination. Dunn and Birchwood also mentioned 40% of schizophrenic clients experienced depression due to auditory hallucinations experienced.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Besides, the distress is also influenced by the content of the hallucination. The majority of the patients suffered the hallucination which contains commands to harm themselves.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> Their research, state that the participants who listen to the commands asking them to harm others and self often experience the distress due to the hallucination heard by them. In addition, 20–50% of schizophrenic clients attempt suicide. It is these things that cause hallucinations to be dealt with as soon as possible because their impact will create greater problems for both clients and others.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Related to the strategy coping used by patients when hallucinating. The research result shows that 57.6% patients with hallucination in less than 3 years have not had optimal strategy coping with overcoming the hallucination. Buccheri<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> also signifies that there is no excellent strategy coping in controlling patients’ hallucination. Schizophrenic patients need the nearest person to change their perceptions. It appears that the importance of the nearest person to provide information related to the knowledge of schizophrenic patients in order to achieve adaptive coping strategies.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Another factor which influences research result is the fact that patients’ treatment period also affects distress. This research shows that 66.7% patients are treated less than 3 months have less optimal in controlling hallucination. This research result is different with Wahyuni<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> which shows that patients treated less than one month have an ability in controlling their hallucination. This is because, in her research, she uses <span class="elsevierStyleItalic">Cognitive Behaviour Therapy</span> in controlling patients’ hallucination. The British Association for Behavioral and Cognitive Psychotherapies states that cognitive behavior therapy is a therapy that helps individuals change their ways of thinking and behavior so that it makes individuals feel better.</p><p id="par0120" class="elsevierStylePara elsevierViewall">This research result also signifies that not all patients obtain atypical antipsychotic treatment because 45.5% of them still use typical antipsychotic. This influences the severity of hallucination symptom encountered by patients. This statement is in accordance with Wahyuni<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> which shows that atypical medical therapy is better at improving the implementation of the way to control hallucination compared with giving typical medical therapy. This is concluded after the patients’ being controlled in long treatment and <span class="elsevierStyleItalic">cognitive behavior therapy</span>.</p><p id="par0125" class="elsevierStylePara elsevierViewall">According Wong<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> who states that majority of patients with hearing hallucination encounter very heavy distress due to the hallucination content. Moreover, the hallucination content also contains negative things and commands to conduct something until the patients feel bothered and become unable to control the hallucination. Hallucinations are becoming more complicated and clients experience disruption in assessing their environment.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Rahmadani explains that after hearing the hallucinations, the feelings of anxiety, worry, anxiety, feelings of restlessness, and pacing. The theory explains that patients with schizophrenia who undergo hallucinations contain pursuit or greatness, natural disturbance of feelings, unstable anxiety behavior, increased emotion, argument, debate, and violent behavior.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> In addition, other incomes explain signs and symptoms associated with hallucinatory signs of increased sensitivity, irritability, increased emotion, panic behavior, motor agitation, suspicion, hostility, and fear.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">Based on the research above, nurses are advised to be able to provide intervention to patients with hallucination in low category and heavy one in order to prevent behavior and actions which can harm patients, their family, and others, to reduce the level of distress in patients and health workers are also expected to maintain and increase participation in the community in providing information in the form of counseling to the family about factors and activities that support patients to interact well.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1329575" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusion" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Recommandations" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1225150" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack459098" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-27" "fechaAceptado" => "2019-12-16" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1225150" "palabras" => array:3 [ 0 => "Severity" 1 => "Distress" 2 => "Hallucination" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to identify the severity level of the symptom and the distress of patients with hallucination at Prof. Ildrem Asylum in Medan.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study used descriptive method. The sample were 99 respondents, taken by using consecutive sampling technique. The data were gathered by using questionnaires on demographic data, severity level of symptom, and distress. The result of univariate analysis showed that 67 respondents (67.7%) had low level symptom hallucination and 70 respondents (70.7%) had heavy distress. The result of bivariate analysis, using Chi-Square statistic test, showed that <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.175.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">No difference of the distress level proportion among patients who are having a severity of heavy hallucination symptom.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Recommandations</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nurses are expected to be able to help patients using constructive coping in controlling the hallucination in order to decrease the symptoms and its effects on patients and other people.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusion" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Recommandations" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Conference of Indonesian National Nurses Association (ICINNA 2019). Full-text and the content of it is under responsibility of authors of the article.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Severity level \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fr \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heavy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2279027.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The severity level of symptom.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Severity level \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fr \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heavy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2279028.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Distress caused hallucination.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hallucination</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"><span class="elsevierStyleItalic">p</span>-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Low</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Heavy</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Fr \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fr \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fr \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Distress</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="middle">2,2650.816–6.288</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="middle">0.175</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heavy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="9" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Total</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2279029.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cross table between the severity level of sympton and the distress of patient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychiatric nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.W. 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