Drawing And Journaling To Reduce Auditory Hallucination In A Schizoaffective Patient At West Java Mental Hospital: Case Report
DOI:
https://doi.org/10.70963/jm.v2i4.716Keywords:
Auditory Hallucination, Drawing, Journaling, Schizoaffective DisorderAbstract
Schizoaffective disorders is a mental disorder characterized by a combination of psychotic and affective symptoms, one of which is auditory hallucinations. Untreated hallucinations can interfere with daily functioning and may pose risks to the individual and others. The management of hallucinations is not limited to pharmacological therapy but can also be supported by complementary interventions such as drawing and journaling. This study aimed to evaluate the implementation of drawing and journaling interventions in reducing auditory hallucinations in a patient with manic-type schizoaffective disorder. This study employed a clinical case report design with a descriptive approach involving a 23-year-old male patient diagnosed with schizoaffective disorder, manic type, at the West Java Provincial Mental Hospital. The interventions were conducted over four consecutive days, with a duration of 15–20 minutes per session. Data were collected through observation and interviews based on the Mental Health Nursing Care Standards and were analyzed using a qualitative descriptive approach. The results showed a gradual decrease in the frequency and intensity of hallucinations, from 5–6 times per day to complete absence in the final session. In addition, the patient demonstrated improved focus, cooperativeness, and ability to express emotions. The combination of drawing and journaling interventions was effective in reducing hallucinations by helping the patient divert attention, express emotions, and enhance self-awareness. These interventions are effective as complementary therapies in reducing auditory hallucinations and improving psychological well-being in patients with schizoaffective disorder.
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References
American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 5th ed. 2013, Washington, DC.
Agusta, D., Yunitasari, P., Istiqomah, Sulistyowati, E. T., & Putri, N. A. (2024). Penerapan Terapi Okupasi Menggambar Pada Pasien Halusinasi Pendengaran. Indonesian Journal of Nursing and Health Sciences, 1(1), 37–48.
Aisy, R., Jannah, R. S., & Marthoenis. (2024). Penerapan Terapi Menulis Ekspresif pada Pasien Halusinasi Pendengaran: Suatu Studi Kasus. Jurnal Ilmiah Mahasiswa Fakultas Keperawatan, 8(2), 118–125.
Amelia, G. S., Rafiyah, I., & Widianti, E. (2025). Penerapan Intervensi Menggambar Pada Pasien Skizofrenia Dengan Halusinasi Penglihatan Dan Pendengaran : Case Report. Jurnal Riset Ilmiah, 2(2), 730–742. https://doi.org/https://doi.org/10.62335 ABSTRACT
Avizani, D. S., & Suparwi, S. (2024). The Schizophrenia in Adolescents: Risk Factors and Prevention Management Strategies. SAMaJ (Sultan Agung Management Journal), 1(4), 263.
Barnett, K. S., & Vasiu, F. (2024). How the arts heal: a review of the neural mechanisms behind the therapeutic effects of creative arts on mental and physical health. Frontiers in Behavioral Neuroscience, 18, 1422361. https://doi.org/10.3389/fnbeh.2024.1422361
Benedetti, A., Pini, S., DE Girolamo, G., Berrocal, C., Tundo, A., Morosini, P., & Cassano, G. B. (2009). The psychotic spectrum: a community-based study. World psychiatry : official journal of the World Psychiatric Association (WPA), 8(2), 110–114. https://doi.org/10.1002/j.2051-5545.2009.tb00224.x
Cintai, R. A., Riyana, A., Cahyati, P., & Somantri, I. (2025). Application of Drawing Therapy to Reduce Signs and Symptoms of Hallucinations in Nursing Care for Auditory Hallucination. Asy-Syifa : Journal of Science and Technology Nursing, 3(1), 1–11. https://doi.org/10.52221/asyjstn.v3i1.724
Cleveland Clinic. (2023, July 17). Schizophrenia vs. schizoaffective disorder: What’s the difference? Retrieved from https://health.clevelandclinic.org/schizoaffective-disorder-vs-schizophrenia
DiMenichi, B. C., Ceceli, A. O., Bhanji, J. P., & Tricomi, E. (2019). Effects of expressive writing on neural processing during learning. Frontiers in Human Neuroscience, 13, 389. https://doi.org/10.3389/fnhum.2019.00389
Erlando, R. P. A., Wuryaningsih, E. W., Kusumaningsih, A., & Hikmah, F. (2025). The effectiveness of drawing occupation therapy on auditory hallucinations among patients with schizophrenia. MHC: Journal of Mental Health Concern, 4(4), 217–224. https://doi.org/10.56922/mhc.v4i4.1590
El-Gilany, A.-H. (2018). What is case report?. Asploro Journal of Biomedical and Clinical Case Reports, 1(1), 7–9.
Fauzania, S. N., Hendrawati, H., & Amira, I. (2025). Intervensi terapi generalis pada pasien skizoafektif dengan gangguan persepsi sensori: halusinasi pendengaran: Case Report. Journal of Multidisciplinary Research, 1(4), 229–236.
Firmawati, Syamsuddin, F., & Botutihe, R. (2023). Terapi Okupasi Menggambar Terhadap Perubahan Tanda Dan Gejala Halusinasi Pada Pasien Dengan Gangguan Presepsi Sensori Halusinasi Di Rsud Tombulilato. Jurnal Medika Nusantara, 1(2), 15–24.
Goghari, V. M., & Harrow, M. (2016). Twenty year multi follow up of different types of hallucinations in schizophrenia, schizoaffective disorder, bipolar disorder, and depression. Schizophrenia Research, 176(2 3), 371 377. https://doi.org/10.1016/j.schres.2016.06.027
Harrow, M., Grossman, L. S., Herbener, E. S., & Davies, E. W. (2000). Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms. British Journal of Psychiatry, 177(5), 421–426. doi:10.1192/bjp.177.5.421
Joshi, K., & Sood, A. (2016). Treatment patterns and antipsychotic medication adherence among commercially insured patients with schizoaffective disorder. Journal of Psychiatric Practice, 22(2), 137-145.
Latifah, R. A., Yolanda, Y., & Indriati, T. (2019). Indonesian Journal of Global Health Research. Indonesian Journal of Global Health Research, 2(4), 985–992. https://doi.org/10.37287/ijghr.v2i4.250
Mayo Clinic. (2024, June 5). Schizoaffective disorder – Symptoms & causes. Retrieved from https://www.mayoclinic.org/diseases conditions/schizoaffective disorder/symptoms causes/syc 20354504
Mental Health UK. (n.d.). Symptoms of schizoaffective disorder. Retrieved from https://mentalhealth-uk.org/help-and-information/conditions/schizoaffective-disorder/symptoms/
Memarian, N., Torre, J. B., Haltom, K. E., Stanton, A. L., & Lieberman, M. D. (2017). Neural activity during affect labeling predicts expressive writing effects on well-being: GLM and SVM approaches. Social cognitive and affective neuroscience, 12(9), 1437–1447. https://doi.org/10.1093/scan/nsx084
Nabilah, Z., R, F. D., & Martina. (2024). Pendekatan Terapi Menulis Ekspresif Terhadap Pasien Halusinasi Pendengaran. 2(2), 109–119.
National Alliance on Mental Illness. (2023). Schizoaffective disorder. Retrieved from https://www.nami.org/about mental illness/mental health conditions/schizoaffective disorder/
Nurjannah, S. (2024). Expressive writing therapy pada pasien gangguan persepsi sensori: Halusinasi. Surya Medika: Jurnal Ilmiah Ilmu Keperawatan dan Ilmu Kesehatan Masyarakat, 9(3), 176-181. https://journal.stikessuryaglobal.ac.id/index.php/SM/article/view/1003/483
Oktaviani, S., Hasanah, U., & Utami, I. T. (2022). Penerapan Terapi Menghardik dan Menggambar Pada Pasien Halusinasi Pendengaran (Application Of Rebuke And Drawing Therapy In Hearing Hallucination Patients. Jurnal Cendikia Muda, 2(3), 407–415. http://jurnal.akperdharmawacana.ac.id/index.php/JWC/article/view/365
Schimmelmann, B. G., Conus, P., Edwards, J., McGorry, P. D., & Lambert, M. (2005). Diagnostic stability 18 months after treatment initiation for first-episode psychosis. Journal of Clinical Psychiatry, 66(10), 1239–1246. https://doi.org/10.4088/JCP.v66n1006
Septiana, V., Putri, Y. S. E., & Tungtrongvisolkit, N. (2022). Expressive Writing Therapy (EWT) pada pasien dengan low self esteem, halusinasi, dan post traumatic syndrome. Innovation in Health for Society, 2(1), 12 17. https://doi.org/10.31603/ihs.6717
Shinn, A. K., Pfaff, D., Young, S., Lewandowski, K. E., Cohen, B. M., & Öngür, D. (2012). Auditory hallucinations in a cross-diagnostic sample of psychotic disorder patients: a descriptive, cross-sectional study. Comprehensive psychiatry, 53(6), 718–726. https://doi.org/10.1016/j.comppsych.2011.11.003
Sugiyono. (2016). Metode penelitian kuantitatif, kualitatif, dan R&D. Alfabeta.
Syafwan, R. A. (2025). Skizofrenia. KLINIK: Jurnal Ilmiah Kedokteran Dan Kesehatan, 4(2), 420–431. https://doi.org/https://doi.org/10.55606/klinik.v4i2.4095
Thakur, T., & Gupta, V. (2023, February 13). Auditory hallucinations. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557633/
White, R., & McGrane A. (2014). Nonadherence and antipsychotic polypharmacy in patients with schizophrenia. Psychiatry Research, 216(2-3), 324-329. https://doi.org/10.1016/j.psychres.2014.01.026
Widyawati, “Kemenkes Beberkan Permasalahan Kesehatan Jiwa di Indonesia”, (Kemenkes RI, 07 Oktober 2021) URL: https://kemkes.go.id/id/kemenkes-beberkan-masalah-permasalahan-kesehatan-jiwa-di-indonesia.
World Health Organization. (2019). ICD 10: F25.2 – Schizoaffective disorder [Online version]. Retrieved from https://icd.who.int/browse10/2019/en#F25.2
World Health Organization. (2025, October 6). Schizophrenia [Fact sheet]. Retrieved from https://www.who.int/news room/fact sheets/detail/schizophrenia
World Health Organization. (2025, September 30). Mental disorders [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/mental-disorders
Wy, T. J. P., & Saadabadi, A. (2023, March 27). Schizoaffective disorder. In StatPearls [Internet]. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK541012/
Yang, C.-Y., Lee, T.-H., Lo, S.-C., & Beckstead, J.W. (2015). The effects of auditory hallucination symptom management programme for people with schizophrenia: A quasi-experimental design. Journal of Advanced Nursing, 71(12), 2886-2897. https://doi.org/10.1111/jan.12754
Yuliana, S., & Herriyanti, N. (2024). The effectiveness of drawing occupation therapy on auditory hallucinations among patients with schizophrenia. Journal of Public Health Concerns, 4(4), 217-224.
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