Spencer, Kevin M; Niznikiewicz, Margaret A; Nestor, Paul G; Shenton, Martha E; McCarley, Robert W
Background Oscillatory electroencephalogram (EEG) abnormalities may reflect neural circuit dysfunction in neuropsychiatric disorders. Previously we have found positive correlations between the phase synchronization of beta and gamma oscillations and hallucination symptoms in schizophrenia patients. These findings suggest that the propensity for hallucinations is associated with an increased tendency for neural circuits in sensory cortex to enter states of oscillatory synchrony. Here we tested this hypothesis by examining whether the 40 Hz auditory steady-state response (ASSR) generated in the left primary auditory cortex is positively correlated with auditory hallucination symptoms in schizophrenia. We also examined whether the 40 Hz ASSR deficit in schizophrenia was associated with cross-frequency interactions. Sixteen healthy control subjects (HC) and 18 chronic schizophrenia patients (SZ) listened to 40 Hz binaural click trains. The EEG was recorded from 60 electrodes and average-referenced offline. A 5-dipole model was fit from the HC grand average ASSR, with 2 pairs of superior temporal dipoles and a deep midline dipole. Time-frequency decomposition was performed on the scalp EEG and source data. Results Phase locking factor (PLF) and evoked power were reduced in SZ at fronto-central electrodes, replicating prior findings. PLF was reduced in SZ for non-homologous right and left hemisphere sources. Left hemisphere source PLF in SZ was positively correlated with auditory hallucination symptoms, and was modulated by delta phase. Furthermore, the correlations between source evoked power and PLF found in HC was reduced in SZ for the LH sources. Conclusion These findings suggest that differential neural circuit abnormalities may be present in the left and right auditory cortices in schizophrenia. In addition, they provide further support for the hypothesis that hallucinations are related to cortical hyperexcitability, which is manifested by an increased propensity
Mulert, C; Kirsch, V; Pascual-Marqui, Roberto; McCarley, Robert W; Spencer, Kevin M
Phase locking in the gamma-band range has been shown to be diminished in patients with schizophrenia. Moreover, there have been reports of positive correlations between phase locking in the gamma-band range and positive symptoms, especially hallucinations. The aim of the present study was to use a new methodological approach in order to investigate gamma-band phase synchronization between the left and right auditory cortex in patients with schizophrenia and its relationship to auditory hallucinations. Subjects were 18 patients with chronic schizophrenia (SZ) and 16 healthy control (HC) subjects. Auditory hallucination symptom scores were obtained using the Scale for the Assessment of Positive Symptoms. Stimuli were 40-Hz binaural click trains. The generators of the 40Hz-ASSR were localized using eLORETA and based on the computed intracranial signals lagged interhemispheric phase locking between primary and secondary auditory cortices was analyzed. Current source density of the 40 ASSR response was significantly diminished in SZ in comparison to HC in the right superior and middle temporal gyrus (p<0.05). Interhemispheric phase locking was reduced in SZ in comparison to HC for the primary auditory cortices (p<0.05) but not in the secondary auditory cortices. A significant positive correlation was found between auditory hallucination symptom scores and phase synchronization between the primary auditory cortices (p<0.05, corrected for multiple testing) but not for the secondary auditory cortices. These results suggest that long-range synchrony of gamma oscillations is disturbed in schizophrenia and that this deficit is related to clinical symptoms such as auditory hallucinations. Copyright © 2010 Elsevier B.V. All rights reserved.
Mulert, C.; Kirsch; Pascual-Marqui, Roberto; McCarley, Robert W.; Spencer, Kevin M.
Phase locking in the gamma-band range has been shown to be diminished in patients with schizophrenia. Moreover, there have been reports of positive correlations between phase locking in the gamma-band range and positive symptoms, especially hallucinations. The aim of the present study was to use a new methodological approach in order to investigate gamma-band phase synchronization between the left and right auditory cortex in patients with schizophrenia and its relationship to auditory hallucinations. Subjects were 18 patients with chronic schizophrenia (SZ) and 16 healthy control (HC) subjects. Auditory hallucination symptom scores were obtained using the Scale for the Assessment of Positive Symptoms. Stimuli were 40-Hz binaural click trains. The generators of the 40 Hz-ASSR were localized using eLORETA and based on the computed intracranial signals lagged interhemispheric phase locking between primary and secondary auditory cortices was analyzed. Current source density of the 40 ASSR response was significantly diminished in SZ in comparison to HC in the right superior and middle temporal gyrus (p<0.05). Interhemispheric phase locking was reduced in SZ in comparison to HC for the primary auditory cortices (p<0.05) but not in the secondary auditory cortices. A significant positive correlation was found between auditory hallucination symptom scores and phase synchronization between the primary auditory cortices (p<0.05, corrected for multiple testing) but not for the secondary auditory cortices. These results suggest that long-range synchrony of gamma oscillations is disturbed in schizophrenia and that this deficit is related to clinical symptoms such as auditory hallucinations. PMID:20713096
Shiotsuki, Ippei; Terao, Takeshi; Ishii, Nobuyoshi; Hatano, Koji
A 26-year-old female outpatient presenting with a depressive state suffered from auditory hallucinations at night. Her auditory hallucinations did not respond to blonanserin or paliperidone, but partially responded to risperidone. In view of the possibility that her auditory hallucinations began after starting trazodone, trazodone was discontinued, leading to a complete resolution of her auditory hallucinations. Furthermore, even after risperidone was decreased and discontinued, her auditory hallucinations did not recur. These findings suggest that trazodone may induce auditory hallucinations in some susceptible patients. PMID:24700048
Shiotsuki, Ippei; Terao, Takeshi; Ishii, Nobuyoshi; Hatano, Koji
A 26-year-old female outpatient presenting with a depressive state suffered from auditory hallucinations at night. Her auditory hallucinations did not respond to blonanserin or paliperidone, but partially responded to risperidone. In view of the possibility that her auditory hallucinations began after starting trazodone, trazodone was discontinued, leading to a complete resolution of her auditory hallucinations. Furthermore, even after risperidone was decreased and discontinued, her auditory hallucinations did not recur. These findings suggest that trazodone may induce auditory hallucinations in some susceptible patients.
Inzelberg, R.; Kipervasser, S.; Korczyn, A.
Whereas visual hallucinations are often found among patients with Parkinson's disease, the occurrence of auditory hallucinations has never been systematically documented. The occurrence, past and present, of auditory hallucinations has been studied in 121consecutive patients with Parkinson's disease attending a movement disorders clinic. The cognitive state was evaluated using the short mental test (SMT). Hallucinations were reported for 45patients (37%); 35 (29%) had only visual hallucinations and 10(8%) both visual and auditory hallucinations. No patient reported auditory hallucinations unaccompanied by visual hallucinations. The auditory hallucinations occurred repeatedly, consisting of human voices. They were non-imperative (n=9), non-paranoid (n=9), and often incomprehensible (n=5). They were not obviously influenced by the patients' age, duration of disease, or treatment with levodopa. Cognitive impairment was more common among hallucinating patients (64%, 50%, and 25% among patients with visual hallucinations, auditory hallucinations, and non-hallucinating parkinsonian patients respectively). Depression necessitating antidepressants was present in five of 10 and other psychotic features in six patients with auditory hallucinations. It is concluded that auditory hallucinations occur in Parkinson's disease, particularly in patients who also have visual hallucinations and are cognitively impaired. PMID:9576549
Erkwoh, R; Eming-Erdmann, A; Willmes, K
Command hallucinations are a subtype of auditory verbal hallucinations in schizophrenia. More likely than any other schizophrenic symptom, they may have an impact on the individual's behavior. In the forensic literature, aspects of dangerous actions induced by psychotic motivation have been discussed. From the psychiatric point of view, the main problem is the unpredictability of behavioral consequences. The present study examines psychopathological details of command hallucinations in 31 hospitalized schizophrenic patients, 10 females and 21 males, using a questionnaire including 24 items. The predictive accuracy of a distinct set of signs was rated concerning compliance vs. resistance of hallucinated commands. The predictors are: identifying the hallucinated voice, being affected by emotions after hallucinations, and misregarding the voice as being real. In the presence of these conditions, behavioral consequences are predicted by a value which was 6.7 times higher than that without any information about predictors. In the absence of these conditions, resistance of command voices is predicted by a value of 7.
Valkonen-Korhonen, Minna; Holi, Matti; Therman, Sebastian; Lehtonen, Johannes; Hari, Riitta
Distortion of the sense of reality, actualized in delusions and hallucinations, is the key feature of psychosis but the underlying neuronal correlates remain largely unknown. We studied 11 highly functioning subjects with schizophrenia or schizoaffective disorder while they rated the reality of auditory verbal hallucinations (AVH) during functional magnetic resonance imaging (fMRI). The subjective reality of AVH correlated strongly and specifically with the hallucination-related activation strength of the inferior frontal gyri (IFG), including the Broca's language region. Furthermore, how real the hallucination that subjects experienced was depended on the hallucination-related coupling between the IFG, the ventral striatum, the auditory cortex, the right posterior temporal lobe, and the cingulate cortex. Our findings suggest that the subjective reality of AVH is related to motor mechanisms of speech comprehension, with contributions from sensory and salience-detection-related brain regions as well as circuitries related to self-monitoring and the experience of agency. PMID:19620178
van Oosterhout, Bas; Krabbendam, Lydia; Smeets, Guus; van der Gaag, Mark
This study explores associations between metacognitive beliefs and beliefs about voices in patients with severe auditory verbal hallucinations, and their hypothesized relationship with levels of depression and anxiety. Furthermore, it was hypothesized that metacognitive beliefs are better able to explain differences in levels of depression and anxiety, than beliefs about voices. Cross-sectional data were obtained from baseline measurements of a randomized controlled trial. All patients (N = 77) met the criteria for a DSM-IV diagnosis within the schizophrenia spectrum. A correlation analysis was conducted to explore the associations between metacognitive beliefs and beliefs about voices. Regression analysis was performed to test the second hypothesis. Metacognitive beliefs were measured using the MCQ-30. Beliefs about voices were measured using the BAVQ-R. Furthermore, the Beck Depression Inventory-II and the Beck Anxiety Inventory were applied to measure depression and anxiety. All analyses were a priori controlled for gender and level of education. Significant associations were found between negative beliefs about voices and negative metacognitive beliefs. One of the metacognitive beliefs, that is, perceived uncontrollability and danger of thinking, proved to be a key variable in explaining differences in levels of depression and anxiety and seemed to have greater explanatory value than all of the beliefs about voices when analysed simultaneously. The results offer modest support to models emphasizing the fact that metacognitive beliefs are a core feature in the development and maintenance of depression and anxiety in patients with severe auditory verbal hallucinations. POSITIVE CLINICAL IMPLICATIONS: Further evidence for the importance of metacognitive beliefs. Specific emphasis on anxiety and depression in patients with severe hallucinations. Small sample size. Cross-sectional data only. © 2012 The British Psychological Society.
Font, M; Parellada, E; Fernández-Egea, E; Bernardo, M; Lomeña, F
The neurobiological bases underlying the generation of auditory hallucinations, a distressing and paradigmatic symptom of schizophrenia, are still unknown in spite of in-depth phenomenological descriptions. This work aims to make a critical review of the latest published literature in recent years, focusing on functional neuroimaging studies (PET, SPECT, fMRI) of auditory hallucinations. Thus, the studies are classified according to whether they are sensory activation, trait and state. The two main hypotheses proposed to explain the phenomenon, external speech vs. subvocal or inner speech, are also explained. Finally, the latest unitary theory as well as the limitations the studies published are commented on. The need to continue investigating in this field, that is still underdeveloped, is posed in order to understand better the etiopathogenesis of auditory hallucinations in schizophrenia.
SUMMARY 25 untreated urban living schizophrenics fulfilling the criteria of Feighner et al., having Schneiderian auditory hallucination were studied with the aim of examining the experienced reality of auditory hallucination and the influence on this reality of certain variables. It was found that the hallucinations were more real than unreal. Duration of illness, presence of anxiety prior to hallucination, reality testing ability, duration of each episode of hallucination, and socio-economic status scores influenced the reality negatively. The number of hallucinating days per mouth, position of voice outside sensory range, psychotocism scores, insight scores (higher scores for poorer insight) and duration of hallucination influenced the reality positively. The variables explained 72% of the variations in reality of hallucinations. Findings are discussed and suggestions for future studies are offered. PMID:21965885
Ikuta, Toshikazu; DeRosse, Pamela; Argyelan, Miklos; Karlsgodt, Katherine H.; Kingsley, Peter B.; Szeszko, Philip R.; Malhotra, Anil K.
Hearing perception in individuals with auditory hallucinations has not been well studied. Auditory hallucinations have previously been shown to involve primary auditory cortex activation. This activation suggests that auditory hallucinations activate the terminal of the auditory pathway as if auditory signals are submitted from the cochlea, and that a hallucinatory event is therefore perceived as hearing. The primary auditory cortex is stimulated by some unknown source that is outside of the auditory pathway. The current study aimed to assess the outcomes of stimulating the primary auditory cortex through the auditory pathway in individuals who have experienced auditory hallucinations. Sixteen patients with schizophrenia underwent functional magnetic resonance imaging (fMRI) sessions, as well as hallucination assessments. During the fMRI session, auditory stimuli were presented in one-second intervals at times when scanner noise was absent. Participants listened to auditory stimuli of sine waves (SW) (4 kHz-5.5 kHz), English words (EW), and acoustically reversed English words (arEW) in a block design fashion. The arEW were employed to deliver the sound of a human voice with minimal linguistic components. Patients’ auditory hallucination severity was assessed by the auditory hallucination item of the Brief Psychiatric Rating Scale (BPRS). During perception of arEW when compared with perception of SW, bilateral activation of the globus pallidus correlated with severity of auditory hallucinations. EW when compared with arEW did not correlate with auditory hallucination severity. Our findings suggest that the sensitivity of the globus pallidus to the human voice is associated with the severity of auditory hallucination. PMID:26275927
Dierks, T; Linden, D E; Jandl, M; Formisano, E; Goebel, R; Lanfermann, H; Singer, W
Apart from being a common feature of mental illness, auditory hallucinations provide an intriguing model for the study of internally generated sensory perceptions that are attributed to external sources. Until now, the knowledge about the cortical network that supports such hallucinations has been restricted by methodological limitations. Here, we describe an experiment with paranoid schizophrenic patients whose on- and offset of auditory hallucinations could be monitored within one functional magnetic resonance imaging (fMRI) session. We demonstrate an increase of the blood oxygen level-dependent (BOLD) signal in Heschl's gyrus during the patients' hallucinations. Our results provide direct evidence of the involvement of primary auditory areas in auditory verbal hallucinations and establish novel constraints for psychopathological models.
Solomon, Susan; Singaravelu, Ramanathan
Recurrent hair pulling resulting in hair loss, in the absence of a medical or another mental disorder is a diagnostic feature of trichotillomania. It is commonly seen in depression and many other psychiatric disorders. Trichotillomania rarely occurs as a co morbid condition in patients with schizophrenia. Even rarer is recurrent hair pulling in response to psychotic symptoms in schizophrenia. We present the case of a young adult male who presented with recurrent hair pulling due to command auditory hallucinations and discuss the salient differentiating features of hair pulling seen in our patient and hair pulling in patients with trichotillomania.
Wong, Victoria S S; Adamczyk, Peter; Dahlin, Brian; Richman, David P; Wheelock, Vicki
Cerebral venous sinus thrombosis may present with seizures or neuropsychiatric symptoms, but does not typically present with hallucinations. We present a case of venous thrombosis of the right sigmoid and transverse sinuses that presented with auditory hallucinations and illusions. We describe a 45-year-old woman with a history of myasthenia gravis, stable on oral prednisone and monthly intravenous immunoglobulin infusions, who started on a progesterone/estrogen combination contraceptive pill for menorrhagia 3 weeks before admission and presented with symptoms of headache, fever, and auditory hallucinations and illusions. The patient's cerebrospinal fluid showed lymphocytic pleocytosis. Two electroencephalograms showed significant right temporal lobe slowing. Magnetic resonance venogram of the brain showed venous sinus thrombosis of the right sigmoid and transverse sinuses. Magnetic resonance imaging showed a cortical venous infarct in the right middle temporal gyrus. The patient's auditory hallucinations and illusions resolved spontaneously weeks after presentation. This case suggests that auditory hallucinations and illusions should be added to the already broad spectrum of presenting features of cerebral venous sinus thrombosis. The nondominant right middle temporal gyrus may play a role in such auditory hallucinations.
Ford, Judith M; Roach, Brian J; Faustman, William O; Mathalon, Daniel H
Synchronization of neural activity preceding self-generated actions may reflect the operation of the forward model, which acts to dampen sensations resulting from those actions. If this is true, pre-action synchrony should be related to subsequent sensory suppression. Deficits in this mechanism may be characteristic of schizophrenia and related to positive symptoms, such as auditory hallucinations. If so, schizophrenia patients should have reduced neural synchrony preceding movements, especially patients with severe hallucinations. In 24 patients with schizophrenia or schizoaffective disorder and 25 healthy comparison subjects, the authors related prespeech neural synchrony to subsequent auditory cortical responsiveness to the spoken sound, compared prespeech neural synchrony in schizophrenia patients and healthy comparison subjects, and related prespeech neural synchrony to auditory hallucination severity in patients. To assess neural synchrony, phase coherence of single-trial EEG preceding talking was calculated at a single site across repeated trials. To assess auditory cortical suppression, the N1 event-related brain potentials to speech sound onset during talking and listening were compared. In healthy comparison subjects, prespeech neural synchrony was related to subsequent suppression of responsiveness to the spoken sound, as reflected in reduction of N1 during talking relative to listening. There was greater prespeech synchrony in comparison subjects than in patients, especially those with severe auditory hallucinations. These data suggest that EEG synchrony preceding speech reflects the action of a forward model system, which dampens auditory responsiveness to self-generated speech and is deficient in patients who hallucinate.
E Fischer, Corinne; Marchie, Anthony; Norris, Mireille
Musical hallucinosis is a rare and poorly understood clinical phenomenon. While an association appears to exist between this phenomenon and organic brain pathology, aging and sensory impairment the precise association remains unclear. The authors present two cases of musical hallucinosis, both in elderly patients with mild-moderate cognitive impairment and mild-moderate hearing loss, who subsequently developed auditory hallucinations and in one case command hallucinations. The literature in reference to musical hallucinosis will be reviewed and a theory relating to the development of musical hallucinations will be proposed.
Bohlken, M M; Hugdahl, K; Sommer, I E C
Auditory verbal hallucinations (AVH) are a frequently occurring phenomenon in the general population and are considered a psychotic symptom when presented in the context of a psychiatric disorder. Neuroimaging literature has shown that AVH are subserved by a variety of alterations in brain structure and function, which primarily concentrate around brain regions associated with the processing of auditory verbal stimuli and with executive control functions. However, the direction of association between AVH and brain function remains equivocal in certain research areas and needs to be carefully reviewed and interpreted. When AVH have significant impact on daily functioning, several efficacious treatments can be attempted such as antipsychotic medication, brain stimulation and cognitive-behavioural therapy. Interestingly, the neural correlates of these treatments largely overlap with brain regions involved in AVH. This suggests that the efficacy of treatment corresponds to a normalization of AVH-related brain activity. In this selected review, we give a compact yet comprehensive overview of the structural and functional neuroimaging literature on AVH, with a special focus on the neural correlates of efficacious treatment.
Nagashima, Hideaki; Kobayashi, Toshiyuki
We previously reported two schizophrenic patients with characteristic hallucinations consisting of auditory hallucinations accompanied by visual hallucinations of the speaker's face. The patient sees the face of the hallucinatory speaker in his/her mind and hears the voice talking inwardly. We termed these experiences physiognomy-accompanying auditory hallucinations. In this report, we present 10 patients with schizophrenia showing physiognomy-accompanying auditory hallucinations and evaluate the characteristics of these clinical symptoms. Moreover we consider what the symptoms mean for patients and the metabasis from structural aspects. Lastly, we consider how we can treat these patients living autistic lives with the symptoms. During physiognomy-accompanying auditory hallucinations, the realistic face moves its mouth and talks to the patient expressively. In early onset cases, the faces of various real people appear talking about ordinary things while in late onset cases, the faces can be imaginary but are mainly real people talking about ordinary or delusional things. We suppose that these characteristics of the symptoms unify the schizophrenic world overwhelmed by "a force of non-sense" to "the sense field". "The force of non-sense" is a substantial power but cannot be reduced to the real meaning. And we suppose that not visual reality but the intensity of auditory hallucinations of the face brings about the overwhelming intensity of symptoms and the substantiality of this intensity depends on the states of excessive fullness of "the force of non-sense". With these symptoms patients see the narration of auditory hallucinations through the facial image and the content of auditory hallucinations is compressed into the movement of visual hallucinations of the speaker's face. The form of symptoms is realistic but the speaker's face and voice are beyond ordinary time and space. The symptoms are essentially different from ordinary perception. The visual
Some patients with schizophrenia may suffer from continuous or severe auditory hallucinations that are refractory to antipsychotic drugs, including clozapine. Such patients may benefit from a short trial of once- to twice-daily transcranial direct current stimulation (tDCS) with the cathode placed over the left temporoparietal cortex and the anode over the left dorsolateral prefrontal cortex; negative, cognitive, and other symptoms, if present, may also improve. At present, the case for tDCS treatment of refractory auditory hallucinations rests on 1 well-conducted randomized, sham tDCS-controlled trial and several carefully documented and instructive case reports. Benefits with up to 3 years of maintenance tDCS have also been described. In patients with refractory auditory hallucinations, tDCS has been delivered at 1- to 3-mA current intensity during 20-30 minutes in once- to twice-daily sessions for up to 3 years with no apparent adverse effects. Transcranial direct current stimulation therefore appears to be a promising noninvasive brain stimulation technique for patients with antipsychotic-refractory auditory hallucinations.
Shergill, S; Cameron, L; Brammer, M; Williams, S; Murray, R; McGuire, P
Somatic hallucinations occur in schizophrenia and other psychotic disorders, although auditory hallucinations are more common. Although the neural correlates of auditory hallucinations have been described in several neuroimaging studies, little is known of the pathophysiology of somatic hallucinations. Functional magnetic resonance imaging (fMRI) was used to compare the distribution of brain activity during somatic and auditory verbal hallucinations, occurring at different times in a 36 year old man with schizophrenia. Somatic hallucinations were associated with activation in the primary somatosensory and posterior parietal cortex, areas that normally mediate tactile perception. Auditory hallucinations were associated with activation in the middle and superior temporal cortex, areas involved in processing external speech. Hallucinations in a given modality seem to involve areas that normally process sensory information in that modality. PMID:11606687
Gaser, Christian; Nenadic, Igor; Volz, Hans-Peter; Büchel, Christian; Sauer, Heinrich
Auditory hallucinations are a frequent symptom in schizophrenia. While functional imaging studies have suggested the association of certain patterns of brain activity with sub-syndromes or single symptoms (e.g. positive symptoms such as hallucinations), there has been only limited evidence from structural imaging or post-mortem studies. In this study, we investigated the relation of local brain structural deficits to severity of auditory hallucinations, particularly in perisylvian areas previously reported to be involved in auditory hallucinations. In order to overcome certain limitations of conventional volumetric methods, we used deformation-based morphometry (DBM), a novel automated whole-brain morphometric technique, to assess local gray and white matter deficits in structural magnetic resonance images of 85 schizophrenia patients. We found severity of auditory hallucinations to be significantly correlated (P < 0.001) with volume loss in the left transverse temporal gyrus of Heschl (primary auditory cortex) and left (inferior) supramarginal gyrus, as well as middle/inferior right prefrontal gyri. This demonstrates a pattern of distributed structural abnormalities specific for auditory hallucinations and suggests hallucination-specific alterations in areas of a frontotemporal network for processing auditory information and language.
Ćurčić-Blake, Branislava; Ford, Judith M; Hubl, Daniela; Orlov, Natasza D; Sommer, Iris E; Waters, Flavie; Allen, Paul; Jardri, Renaud; Woodruff, Peter W; David, Olivier; Mulert, Christoph; Woodward, Todd S; Aleman, André
Auditory verbal hallucinations (AVH) occur in psychotic disorders, but also as a symptom of other conditions and even in healthy people. Several current theories on the origin of AVH converge, with neuroimaging studies suggesting that the language, auditory and memory/limbic networks are of particular relevance. However, reconciliation of these theories with experimental evidence is missing. We review 50 studies investigating functional (EEG and fMRI) and anatomic (diffusion tensor imaging) connectivity in these networks, and explore the evidence supporting abnormal connectivity in these networks associated with AVH. We distinguish between functional connectivity during an actual hallucination experience (symptom capture) and functional connectivity during either the resting state or a task comparing individuals who hallucinate with those who do not (symptom association studies). Symptom capture studies clearly reveal a pattern of increased coupling among the auditory, language and striatal regions. Anatomical and symptom association functional studies suggest that the interhemispheric connectivity between posterior auditory regions may depend on the phase of illness, with increases in non-psychotic individuals and first episode patients and decreases in chronic patients. Leading hypotheses involving concepts as unstable memories, source monitoring, top-down attention, and hybrid models of hallucinations are supported in part by the published connectivity data, although several caveats and inconsistencies remain. Specifically, possible changes in fronto-temporal connectivity are still under debate. Precise hypotheses concerning the directionality of connections deduced from current theoretical approaches should be tested using experimental approaches that allow for discrimination of competing hypotheses.
Plaze, Marion; Paillère-Martinot, Marie-Laure; Penttilä, Jani; Januel, Dominique; de Beaurepaire, Renaud; Bellivier, Franck; Andoh, Jamila; Galinowski, André; Gallarda, Thierry; Artiges, Eric; Olié, Jean-Pierre; Mangin, Jean-François; Martinot, Jean-Luc
Auditory verbal hallucinations are a cardinal symptom of schizophrenia. Bleuler and Kraepelin distinguished 2 main classes of hallucinations: hallucinations heard outside the head (outer space, or external, hallucinations) and hallucinations heard inside the head (inner space, or internal, hallucinations). This distinction has been confirmed by recent phenomenological studies that identified 3 independent dimensions in auditory hallucinations: language complexity, self-other misattribution, and spatial location. Brain imaging studies in schizophrenia patients with auditory hallucinations have already investigated language complexity and self-other misattribution, but the neural substrate of hallucination spatial location remains unknown. Magnetic resonance images of 45 right-handed patients with schizophrenia and persistent auditory hallucinations and 20 healthy right-handed subjects were acquired. Two homogeneous subgroups of patients were defined based on the hallucination spatial location: patients with only outer space hallucinations (N = 12) and patients with only inner space hallucinations (N = 15). Between-group differences were then assessed using 2 complementary brain morphometry approaches: voxel-based morphometry and sulcus-based morphometry. Convergent anatomical differences were detected between the patient subgroups in the right temporoparietal junction (rTPJ). In comparison to healthy subjects, opposite deviations in white matter volumes and sulcus displacements were found in patients with inner space hallucination and patients with outer space hallucination. The current results indicate that spatial location of auditory hallucinations is associated with the rTPJ anatomy, a key region of the “where” auditory pathway. The detected tilt in the sulcal junction suggests deviations during early brain maturation, when the superior temporal sulcus and its anterior terminal branch appear and merge. PMID:19666833
Steinmann, Saskia; Leicht, Gregor; Mulert, Christoph
Auditory verbal hallucinations (AVH) are one of the most common and most distressing symptoms of schizophrenia. Despite fundamental research, the underlying neurocognitive and neurobiological mechanisms are still a matter of debate. Previous studies suggested that "hearing voices" is associated with a number of factors including local deficits in the left auditory cortex and a disturbed connectivity of frontal and temporoparietal language-related areas. In addition, it is hypothesized that the interhemispheric pathways connecting right and left auditory cortices might be involved in the pathogenesis of AVH. Findings based on Diffusion-Tensor-Imaging (DTI) measurements revealed a remarkable interindividual variability in size and shape of the interhemispheric auditory pathways. Interestingly, schizophrenia patients suffering from AVH exhibited increased fractional anisotropy (FA) in the interhemispheric fibers than non-hallucinating patients. Thus, higher FA-values indicate an increased severity of AVH. Moreover, a dichotic listening (DL) task showed that the interindividual variability in the interhemispheric auditory pathways was reflected in the behavioral outcome: stronger pathways supported a better information transfer and consequently improved speech perception. This detection indicates a specific structure-function relationship, which seems to be interindividually variable. This review focuses on recent findings concerning the structure-function relationship of the interhemispheric pathways in controls, hallucinating and non-hallucinating schizophrenia patients and concludes that changes in the structural and functional connectivity of auditory areas are involved in the pathophysiology of AVH.
Steinmann, Saskia; Leicht, Gregor; Mulert, Christoph
Auditory verbal hallucinations (AVH) are one of the most common and most distressing symptoms of schizophrenia. Despite fundamental research, the underlying neurocognitive and neurobiological mechanisms are still a matter of debate. Previous studies suggested that “hearing voices” is associated with a number of factors including local deficits in the left auditory cortex and a disturbed connectivity of frontal and temporoparietal language-related areas. In addition, it is hypothesized that the interhemispheric pathways connecting right and left auditory cortices might be involved in the pathogenesis of AVH. Findings based on Diffusion-Tensor-Imaging (DTI) measurements revealed a remarkable interindividual variability in size and shape of the interhemispheric auditory pathways. Interestingly, schizophrenia patients suffering from AVH exhibited increased fractional anisotropy (FA) in the interhemispheric fibers than non-hallucinating patients. Thus, higher FA-values indicate an increased severity of AVH. Moreover, a dichotic listening (DL) task showed that the interindividual variability in the interhemispheric auditory pathways was reflected in the behavioral outcome: stronger pathways supported a better information transfer and consequently improved speech perception. This detection indicates a specific structure-function relationship, which seems to be interindividually variable. This review focuses on recent findings concerning the structure-function relationship of the interhemispheric pathways in controls, hallucinating and non-hallucinating schizophrenia patients and concludes that changes in the structural and functional connectivity of auditory areas are involved in the pathophysiology of AVH. PMID:24574995
Stinson, K; Valmaggia, L R; Antley, A; Slater, M; Freeman, D
It has proved difficult to establish the internal process by which mental events are transformed into auditory hallucinations. The earlier stages of the generation of hallucinations may prove more accessible to research. Cognitions have been reported by patients as a trigger of auditory hallucinations, but the role of these preceding thoughts has not been causally determined. Therefore, the role of cognition in triggering auditory hallucinations was tested in an experimental study. Thirty individuals who experienced auditory hallucinations in social situations entered a neutral social situation presented using virtual reality. Participants randomised to the experimental condition were instructed to think their hallucination-preceding thoughts, and those randomised to the control condition were instructed to think neutral thoughts. Twenty-seven participants (93%) were able to spontaneously identify a cognition which preceded a hallucination. There was no difference between the experimental and control groups in the occurrence or severity of auditory hallucinations in virtual reality. Virtual reality did not lead to physical side effects or an increase in anxiety. The relationship between antecedent cognitions and auditory hallucinations is likely to be more complex than the one tested. It is argued that the effect of cognition on auditory hallucinations may be mediated by affect but this needs to be investigated through further experimental research. (c) 2010 Elsevier Ltd. All rights reserved.
Best, Nicole T; Mertin, Peter
The phenomenon of auditory hallucinations in clinical populations of nonpsychotic children is an intriguing and little understood area. To date, investigations in this area have reported on a range of correlates, including family histories of psychiatric illness, family dysfunction, and significant levels of stress in the children themselves. The current study reported on 10 nonpsychotic children drawn from a number of community-based child and family agencies that provide therapeutic outpatient services. Consistent with previous studies, the present study found strong associations with family dysfunction, specifically family break-up, as well as significant levels of anxiety and depression in the presenting children. In addition, half the children reported the presence of imaginary companions. Despite confirmation of some previous findings, many other features of this phenomenon remain unanswered, including the different psychological functions that hallucinations and imaginary companions may serve for emotionally troubled children.
Ying, Jun; Yan, Zheng; Gao, Xiao-rong
The auditory steady state response (ASSR) may reflect activity from different regions of the brain, depending on the modulation frequency used. In general, responses induced by low rates (≤40 Hz) emanate mostly from central structures of the brain, and responses from high rates (≥80 Hz) emanate mostly from the peripheral auditory nerve or brainstem structures. Besides, it was reported that the gamma band ASSR (30-90 Hz) played an important role in working memory, speech understanding and recognition. This paper investigated the 40 Hz ASSR evoked by modulated speech and reversed speech. The speech was Chinese phrase voice, and the noise-like reversed speech was obtained by temporally reversing the speech. Both auditory stimuli were modulated with a frequency of 40 Hz. Ten healthy subjects and 5 patients with hallucination symptom participated in the experiment. Results showed reduction in left auditory cortex response when healthy subjects listened to the reversed speech compared with the speech. In contrast, when the patients who experienced auditory hallucinations listened to the reversed speech, the auditory cortex of left hemispheric responded more actively. The ASSR results were consistent with the behavior results of patients. Therefore, the gamma band ASSR is expected to be helpful for rapid and objective diagnosis of hallucination in clinic.
Pontillo, Maria; De Crescenzo, Franco; Vicari, Stefano; Pucciarini, Maria Laura; Averna, Roberto; Santonastaso, Ornella; Armando, Marco
AIM To provide an updated of recent findings about efficacy of cognitive-behavior therapy (CBT) in reduction of command hallucinations. METHODS PubMed/MEDLINE, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, ClinicalTrial.gov searches were performed using the keywords “hallucinations”, “behavioural therapy” and “ cognitive therapy” in order to identify relevant articles published during the years of 2011 to 2016. No language limits were used. Studies conducted within control group, reviews, editorials, were excluded. Data on efficacy, acceptability and tolerability were extracted by three authors independently. Disagreements were resolved in a consensus meeting or by another reviewer. RESULTS A total of eight articles were eligible for inclusion. Two are randomized clinical trials (RCTs) and six are observational studies. The two RCTs included showed a greater efficacy of CBT compared to standard care on auditory hallucinations (AHs). Nevertheless, they considered different CBT models, particularly Treatment of Resistant Command Hallucinations and Cognitive Therapy for Command Hallucinations. As regards non RCT-studies, all papers included showed reduction on frequency and severity of AHs and distress related to them. However, the lack of content details within non-RCTs studies decreased their comparability. In terms of predictive variables, our findings show that negative symptoms at baseline appeared to be the strongest predictor of the treatment efficacy. Indeed, negative symptoms showed a significant negative correlation on outcome. CONCLUSION Although more conclusive studies are still needed, we found some preliminary evidence for the efficacy of CBT in the treatment of command hallucinations. PMID:27679778
SUMMARY 30 Schizophrenics having verbal auditory hallucinations and satisfying the criteria of Feighner et al. (1972) were examined for the experienced reality of auditory hallucinations and the influence of certain variables on such reality. Number of hallucinating days per month, fast movement of time during hallucination, presence of running commentary voices, interference in self-care and social activities due to the Voices and degree of success in manipulation and avoidance (coping themes) appreciably influenced the experienced reality. The voices were more real than unreal. PMID:21847275
Mørch-Johnsen, Lynn; Nesvåg, Ragnar; Jørgensen, Kjetil N; Lange, Elisabeth H; Hartberg, Cecilie B; Haukvik, Unn K; Kompus, Kristiina; Westerhausen, René; Osnes, Kåre; Andreassen, Ole A; Melle, Ingrid; Hugdahl, Kenneth; Agartz, Ingrid
Neuroimaging studies have demonstrated associations between smaller auditory cortex volume and auditory hallucinations (AH) in schizophrenia. Reduced cortical volume can result from a reduction of either cortical thickness or cortical surface area, which may reflect different neuropathology. We investigate for the first time how thickness and surface area of the auditory cortex relate to AH in a large sample of schizophrenia spectrum patients. Schizophrenia spectrum (n = 194) patients underwent magnetic resonance imaging. Mean cortical thickness and surface area in auditory cortex regions (Heschl's gyrus [HG], planum temporale [PT], and superior temporal gyrus [STG]) were compared between patients with (AH+, n = 145) and without (AH-, n = 49) a lifetime history of AH and 279 healthy controls. AH+ patients showed significantly thinner cortex in the left HG compared to AH- patients (d = 0.43, P = .0096). There were no significant differences between AH+ and AH- patients in cortical thickness in the PT or STG, or in auditory cortex surface area in any of the regions investigated. Group differences in cortical thickness in the left HG was not affected by duration of illness or current antipsychotic medication. AH in schizophrenia patients were related to thinner cortex, but not smaller surface area of the left HG, a region which includes the primary auditory cortex. The results support that structural abnormalities of the auditory cortex underlie AH in schizophrenia. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: email@example.com.
Badcock, Johanna C.
Auditory hallucinations are generally defined as false perceptions. Recent developments in auditory neuroscience have rapidly increased our understanding of normal auditory perception revealing (partially) separate pathways for the identification (“what”) and localization (“where”) of auditory objects. The current review offers a reexamination of the nature of auditory hallucinations in schizophrenia using this object-based framework. First, the structural and functional organization of auditory what and where pathways is briefly described. Then, using recent functional neuroimaging data from healthy subjects and patients with schizophrenia, key phenomenological features of hallucinations are linked to abnormal processing both within and between these pathways. Finally, current cognitive explanations of hallucinations, based on intrusive cognitions and impaired source memory, are briefly outlined and set within this framework to provide an integrated cognitive neuropsychological model of auditory hallucinations. PMID:18835839
Badcock, Johanna C
Auditory hallucinations are generally defined as false perceptions. Recent developments in auditory neuroscience have rapidly increased our understanding of normal auditory perception revealing (partially) separate pathways for the identification ("what") and localization ("where") of auditory objects. The current review offers a reexamination of the nature of auditory hallucinations in schizophrenia using this object-based framework. First, the structural and functional organization of auditory what and where pathways is briefly described. Then, using recent functional neuroimaging data from healthy subjects and patients with schizophrenia, key phenomenological features of hallucinations are linked to abnormal processing both within and between these pathways. Finally, current cognitive explanations of hallucinations, based on intrusive cognitions and impaired source memory, are briefly outlined and set within this framework to provide an integrated cognitive neuropsychological model of auditory hallucinations.
Auditory verbal hallucinations have attracted a great deal of scientific interest, but despite the fact that they are fundamentally a social experience—in essence, a form of hallucinated communication—current theories remain firmly rooted in an individualistic account and have largely avoided engagement with social cognition. Nevertheless, there is mounting evidence for the role of social cognitive and social neurocognitive processes in auditory verbal hallucinations, and, consequently, it is proposed that problems with the internalisation of social models may be key to the experience. PMID:24311984
Brian, Rachel Marie; Ben-Zeev, Dror
Background Auditory hallucinations (eg, hearing voices) are relatively common and underreported false sensory experiences that may produce distress and impairment. A large proportion of those who experience auditory hallucinations go unidentified and untreated. Traditional engagement methods oftentimes fall short in reaching the diverse population of people who experience auditory hallucinations. Objective The objective of this proof-of-concept study was to examine the viability of leveraging Web-based social media as a method of engaging people who experience auditory hallucinations and to evaluate their attitudes toward using social media platforms as a resource for Web-based support and technology-based treatment. Methods We used Facebook advertisements to recruit individuals who experience auditory hallucinations to complete an 18-item Web-based survey focused on issues related to auditory hallucinations and technology use in American adults. We systematically tested multiple elements of the advertisement and survey layout including image selection, survey pagination, question ordering, and advertising targeting strategy. Each element was evaluated sequentially and the most cost-effective strategy was implemented in the subsequent steps, eventually deriving an optimized approach. Three open-ended question responses were analyzed using conventional inductive content analysis. Coded responses were quantified into binary codes, and frequencies were then calculated. Results Recruitment netted N=264 total sample over a 6-week period. Ninety-seven participants fully completed all measures at a total cost of $8.14 per participant across testing phases. Systematic adjustments to advertisement design, survey layout, and targeting strategies improved data quality and cost efficiency. People were willing to provide information on what triggered their auditory hallucinations along with strategies they use to cope, as well as provide suggestions to others who experience
Crosier, Benjamin Sage; Brian, Rachel Marie; Ben-Zeev, Dror
Auditory hallucinations (eg, hearing voices) are relatively common and underreported false sensory experiences that may produce distress and impairment. A large proportion of those who experience auditory hallucinations go unidentified and untreated. Traditional engagement methods oftentimes fall short in reaching the diverse population of people who experience auditory hallucinations. The objective of this proof-of-concept study was to examine the viability of leveraging Web-based social media as a method of engaging people who experience auditory hallucinations and to evaluate their attitudes toward using social media platforms as a resource for Web-based support and technology-based treatment. We used Facebook advertisements to recruit individuals who experience auditory hallucinations to complete an 18-item Web-based survey focused on issues related to auditory hallucinations and technology use in American adults. We systematically tested multiple elements of the advertisement and survey layout including image selection, survey pagination, question ordering, and advertising targeting strategy. Each element was evaluated sequentially and the most cost-effective strategy was implemented in the subsequent steps, eventually deriving an optimized approach. Three open-ended question responses were analyzed using conventional inductive content analysis. Coded responses were quantified into binary codes, and frequencies were then calculated. Recruitment netted N=264 total sample over a 6-week period. Ninety-seven participants fully completed all measures at a total cost of $8.14 per participant across testing phases. Systematic adjustments to advertisement design, survey layout, and targeting strategies improved data quality and cost efficiency. People were willing to provide information on what triggered their auditory hallucinations along with strategies they use to cope, as well as provide suggestions to others who experience auditory hallucinations. Women, people
Kindler, J; Hubl, D; Strik, W K; Dierks, T; Koenig, T
Abnormal perceptions and cognitions in schizophrenia might be related to abnormal resting states of the brain. Previous research found that a specific class (class D) of sub-second electroencephalography (EEG) microstates was shortened in schizophrenia. This shortening correlated with positive symptoms. We questioned if this reflected positive psychotic traits or present psychopathology. Resting-state EEGs of frequently hallucinating patients, indicating on- and offset of hallucinations by button press, were analyzed. Microstate class D duration was related to spontaneous within-subject fluctuations of auditory hallucinations. Microstate D was significantly shorter in periods with hallucinations. Microstates of class D resemble topographies associated with error monitoring. Its premature termination may facilitate the misattribution of self-generated inner speech to external sources during hallucinations. These results suggest that microstate D represents a biological state marker for hallucinatory experiences. Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
van Lutterveld, Remko; Sommer, Iris E. C.; Ford, Judith M.
Electroencephalography and magnetoencephalography are two techniques that distinguish themselves from other neuroimaging methodologies through their ability to directly measure brain-related activity and their high temporal resolution. A large body of research has applied these techniques to study auditory hallucinations. Across a variety of approaches, the left superior temporal cortex is consistently reported to be involved in this symptom. Moreover, there is increasing evidence that a failure in corollary discharge, i.e., a neural signal originating in frontal speech areas that indicates to sensory areas that forthcoming thought is self-generated, may underlie the experience of auditory hallucinations. PMID:21629768
SUMMARY Thirty untreated urban living Schizophrenics fulfilling the criteria of Feigher et al. (1972) and having Schneiderian hallucinations were studied with the aim of examining the relation of certain variables to their behaviour during auditory hallucinations. For those whose behaviour had no direction, the voices were less real in comparison to those with positive or negative direction. For those with negative direction in behaviour, voice were positioned more outside than within sensory range and the individual episodes of hallucination were of longer duration. The voices were more real for those who had emotional experience without physical activity and those without emotions of physical activity. PMID:21965928
Linden, David E J; Thornton, Katy; Kuswanto, Carissa N; Johnston, Stephen J; van de Ven, Vincent; Jackson, Michael C
Although auditory verbal hallucinations are often thought to denote mental illness, the majority of voice hearers do not satisfy the criteria for a psychiatric disorder. Here, we report the first functional imaging study of such nonclinical hallucinations in 7 healthy voice hearers comparing them with auditory imagery. The human voice area in the superior temporal sulcus was activated during both hallucinations and imagery. Other brain areas supporting both hallucinations and imagery included fronto temporal language areas in the left hemisphere and their contralateral homologues and the supplementary motor area (SMA). Hallucinations are critically distinguished from imagery by lack of voluntary control. We expected this difference to be reflected in the relative timing of prefrontal and sensory areas. Activity of the SMA indeed preceded that of auditory areas during imagery, whereas during hallucinations, the 2 processes occurred instantaneously. Voluntary control was thus represented in the relative timing of prefrontal and sensory activation, whereas the sense of reality of the sensory experience may be a product of the voice area activation. Our results reveal mechanisms of the generation of sensory experience in the absence of external stimulation and suggest new approaches to the investigation of the neurobiology of psychopathology.
Waters, F; Blom, J D; Jardri, R; Hugdahl, K; Sommer, I E C
Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).
Valmaggia, Lucia R.; Bouman, Theo K.; Schuurman, Laura
The case presented in this paper illustrates how Attention Training (ATT; [Wells, A. (1990). "Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment." "Behavior Therapy," 21, 273-280.]) can be applied in an outpatient setting in the treatment of auditory hallucinations. The 25-year-old male…
Bunn, William; Terpstra, Jan
Objective: The authors address the issue of cultivating medical students' empathy for the mentally ill by examining medical student empathy pre- and postsimulated auditory hallucination experience. Methods: At the University of Utah, 150 medical students participated in this study during their 6-week psychiatry rotation. The Jefferson Scale of…
Bunn, William; Terpstra, Jan
Objective: The authors address the issue of cultivating medical students' empathy for the mentally ill by examining medical student empathy pre- and postsimulated auditory hallucination experience. Methods: At the University of Utah, 150 medical students participated in this study during their 6-week psychiatry rotation. The Jefferson Scale of…
Valmaggia, Lucia R.; Bouman, Theo K.; Schuurman, Laura
The case presented in this paper illustrates how Attention Training (ATT; [Wells, A. (1990). "Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment." "Behavior Therapy," 21, 273-280.]) can be applied in an outpatient setting in the treatment of auditory hallucinations. The 25-year-old male…
Pondé, Pedro H; de Sena, Eduardo P; Camprodon, Joan A; de Araújo, Arão Nogueira; Neto, Mário F; DiBiasi, Melany; Baptista, Abrahão Fontes; Moura, Lidia MVR; Cosmo, Camila
Introduction Auditory hallucinations are defined as experiences of auditory perceptions in the absence of a provoking external stimulus. They are the most prevalent symptoms of schizophrenia with high capacity for chronicity and refractoriness during the course of disease. The transcranial direct current stimulation (tDCS) – a safe, portable, and inexpensive neuromodulation technique – has emerged as a promising treatment for the management of auditory hallucinations. Objective The aim of this study is to analyze the level of evidence in the literature available for the use of tDCS as a treatment for auditory hallucinations in schizophrenia. Methods A systematic review was performed, searching in the main electronic databases including the Cochrane Library and MEDLINE/PubMed. The searches were performed by combining descriptors, applying terms of the Medical Subject Headings (MeSH) of Descriptors of Health Sciences and descriptors contractions. PRISMA protocol was used as a guide and the terms used were the clinical outcomes (“Schizophrenia” OR “Auditory Hallucinations” OR “Auditory Verbal Hallucinations” OR “Psychosis”) searched together (“AND”) with interventions (“transcranial Direct Current Stimulation” OR “tDCS” OR “Brain Polarization”). Results Six randomized controlled trials that evaluated the effects of tDCS on the severity of auditory hallucinations in schizophrenic patients were selected. Analysis of the clinical results of these studies pointed toward incongruence in the information with regard to the therapeutic use of tDCS with a view to reducing the severity of auditory hallucinations in schizophrenia. Only three studies revealed a therapeutic benefit, manifested by reductions in severity and frequency of auditory verbal hallucinations in schizophrenic patients. Conclusion Although tDCS has shown promising results in reducing the severity of auditory hallucinations in schizophrenic patients, this technique cannot
García-Martí, Gracián; Aguilar, Eduardo Jesús; Martí-Bonmatí, Luis; Escartí, M José; Sanjuán, Julio
AIM: To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations. METHODS: Twenty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, DSM-IV) criteria for schizophrenia and experiencing persistent hallucinations together with 28 healthy controls were evaluated with structural and functional MR imaging with an auditory paradigm designed to replicate those emotions related to the patients’ hallucinatory experiences. Coincidence maps were obtained by combining structural maps of gray matter reduction with emotional functional increased activation. Abnormal areas were correlated with the brief psychiatric rating scale (BPRS) and the psychotic symptom rating scale (PSYRATS) scales. RESULTS: The coincidence analysis showed areas with coexistence gray matter reductions and emotional activation in bilateral middle temporal and superior temporal gyri. Significant negative correlations between BPRS and PSYRATS scales were observed. BPRS scores were negatively correlated in the middle temporal gyrus (right) (t = 6.86, P = 0.001), while negative PSYRATS correlation affected regions in both the superior temporal gyrus (left) (t = 7.85, P = 0.001) and middle temporal gyrus (left) (t = 4.97, P = 0.002). CONCLUSION: Our data identify left superior and middle temporal gyri as relevant areas for the understanding of auditory hallucinations in schizophrenia. The use of multimodal approaches, sharing structural and functional information, may demonstrate areas specifically linked to the severity of auditory hallucinations. PMID:22590670
Li, Baojuan; Cui, Long-Biao; Xi, Yi-Bin; Friston, Karl J; Guo, Fan; Wang, Hua-Ning; Zhang, Lin-Chuan; Bai, Yuan-Han; Tan, Qing-Rong; Yin, Hong; Lu, Hongbing
Information flow among auditory and language processing-related regions implicated in the pathophysiology of auditory verbal hallucinations (AVHs) in schizophrenia (SZ) remains unclear. In this study, we used stochastic dynamic causal modeling (sDCM) to quantify connections among the left dorsolateral prefrontal cortex (inner speech monitoring), auditory cortex (auditory processing), hippocampus (memory retrieval), thalamus (information filtering), and Broca's area (language production) in 17 first-episode drug-naïve SZ patients with AVHs, 15 without AVHs, and 19 healthy controls using resting-state functional magnetic resonance imaging. Finally, we performed receiver operating characteristic (ROC) analysis and correlation analysis between image measures and symptoms. sDCM revealed an increased sensitivity of auditory cortex to its thalamic afferents and a decrease in hippocampal sensitivity to auditory inputs in SZ patients with AVHs. The area under the ROC curve showed the diagnostic value of these two connections to distinguish SZ patients with AVHs from those without AVHs. Furthermore, we found a positive correlation between the strength of the connectivity from Broca's area to the auditory cortex and the severity of AVHs. These findings demonstrate, for the first time, augmented AVH-specific excitatory afferents from the thalamus to the auditory cortex in SZ patients, resulting in auditory perception without external auditory stimuli. Our results provide insights into the neural mechanisms underlying AVHs in SZ. This thalamic-auditory cortical-hippocampal dysconnectivity may also serve as a diagnostic biomarker of AVHs in SZ and a therapeutic target based on direct in vivo evidence.
Daalman, Kirstin; Verkooijen, Sanne; Derks, Eske M; Aleman, André; Sommer, Iris E C
Auditory verbal hallucinations (AVH) are one of the most prominent symptoms of schizophrenia but have also been reported in the general population. Several cognitive models have tried to elucidate the mechanism behind auditory verbal hallucinations, among which a top-down model. According to this model, perception is biased towards top-down information (e.g., expectations), reducing the influence of bottom-up information coming from the sense organs. This bias predisposes to false perceptions, i.e., hallucinations. The current study investigated this hypothesis in non-psychotic individuals with frequent AVH, psychotic patients with AVH and healthy control subjects by applying a semantic top-down task. In this task, top-down processes are manipulated through the semantic context of a sentence. In addition, the association between hallucination proneness and semantic top-down errors was investigated. Non-psychotic individuals with AVH made significantly more top-down errors compared to healthy controls, while overall accuracy was similar. The number of top-down errors, corrected for overall accuracy, in the patient group was in between those of the other two groups and did not differ significantly from either the non-psychotic individuals with AVH or the healthy controls. The severity of hallucination proneness correlated with the number of top-down errors. These findings confirm that non-psychotic individuals with AVH are stronger influenced by top-down processing (i.e., perceptual expectations) than healthy controls. In contrast, our data suggest that in psychotic patients semantic expectations do not play a role in the etiology of AVH. This finding may point towards different cognitive mechanisms for pathological and nonpathological hallucinations. Copyright © 2012 Elsevier B.V. All rights reserved.
Fannon, Dominic; Hayward, Peter; Thompson, Neil; Green, Nicola; Surguladze, Simon; Wykes, Til
Persistent auditory hallucinations are common, disabling and difficult to treat. Cognitive behavioural therapy is recommended in their treatment though there is limited empirical evidence of the role of cognitive factors in the formation and persistence of voices. Low self-esteem is thought to play a causal and maintaining role in a range of clinical disorders, particularly depression, which is prevalent and disabling in schizophrenia. It was hypothesized that low self-esteem is prominent in, and contributes to, depression in voice hearers. Beliefs about persistent auditory hallucinations were investigated in 82 patients using the Beliefs About Voices Questionnaire--revised in a cross-sectional design. Self-esteem and depression were assessed using standardized measures. Depression and low self-esteem were prominent as were beliefs about the omnipotence and malevolence of auditory hallucinations. Beliefs about the uncontrollability and dominance of auditory hallucinations and low self-esteem were significantly correlated with depression. Low self-esteem did not mediate the effect of beliefs about auditory hallucinations--both acted independently to contribute to depression in this sample of patients with schizophrenia and persistent auditory hallucinations. Low self-esteem is of fundamental importance to the understanding of affective disturbance in voice hearers. Therapeutic interventions need to address both the appraisal of self and hallucinations in schizophrenia. Measures which ameliorate low self-esteem can be expected to improve depressed mood in this patient group. Further elucidation of the mechanisms involved can strengthen existing models of positive psychotic symptoms and provide targets for more effective treatments.
Waters, Flavie; Woodward, Todd; Allen, Paul; Aleman, Andre; Sommer, Iris
Theories about auditory hallucinations in schizophrenia suggest that these experiences occur because patients fail to recognize thoughts and mental events as self-generated. Different theoretical models have been proposed about the cognitive mechanisms underlying auditory hallucinations. Regardless of the cognitive model being tested, however, experimental designs are almost identical in that they require a judgment regarding whether an action was self-originated or not. The aim of the current study was to integrate all available literature for a meta-analysis on this topic and reach conclusions about self-recognition performance in (1) patients with schizophrenia compared with healthy controls and (2) patients with auditory hallucinations compared with patients without these symptoms. A comprehensive literature review identified 23 studies that contrasted the performance of schizophrenia patients with healthy controls (1370 participants) and 9 studies that directly compared patients with and without auditory hallucinations (315 participants). We found significantly reduced self-recognition performance in schizophrenia patients, which was more pronounced in patients with auditory hallucinations compared with patients without. In patients with hallucinations, this pattern of performance was specific to self-recognition processes and not to the recognition of new external information. A striking finding was the homogeneity in results across studies regardless of the action modality, timing delay, and design used to measure self-recognition. In summary, this review of studies from the last 30 years substantiates the view that self-recognition is impaired in patients with schizophrenia and particularly those with auditory hallucinations. This suggests an association, perhaps a causal one, between such deficit and hallucinatory experiences in schizophrenia. PMID:21147895
Rominger, Christian; Bleier, Angelika; Fitz, Werner; Marksteiner, Josef; Fink, Andreas; Papousek, Ilona; Weiss, Elisabeth M
Social cognitive impairments may represent a core feature of schizophrenia and above all are a strong predictor of positive psychotic symptoms. Previous studies could show that reduced inhibitory top-down control contributes to deficits in theory of mind abilities and is involved in the genesis of hallucinations. The current study aimed to investigate the relationship between auditory inhibition, affective theory of mind and the experience of hallucinations in patients with schizophrenia. In the present study, 20 in-patients with schizophrenia and 20 healthy controls completed a social cognition task (the Reading the Mind in the Eyes Test) and an inhibitory top-down Dichotic Listening Test. Schizophrenia patients with greater severity of hallucinations showed impaired affective theory of mind as well as impaired inhibitory top-down control. More dysfunctional top-down inhibition was associated with poorer affective theory of mind performance, and seemed to mediate the association between impairment to affective theory of mind and severity of hallucinations. The findings support the idea of impaired theory of mind as a trait marker of schizophrenia. In addition, dysfunctional top-down inhibition may give rise to hallucinations and may further impair affective theory of mind skills in schizophrenia.
Rolland, Benjamin; Amad, Ali; Poulet, Emmanuel; Bordet, Régis; Vignaud, Alexandre; Bation, Rémy; Delmaire, Christine; Thomas, Pierre; Cottencin, Olivier; Jardri, Renaud
Both auditory hallucinations (AH) and visual hallucinations may occur in schizophrenia. One of the main hypotheses underlying their occurrence involves the increased activity of the mesolimbic pathway, which links the ventral tegmental area (VTA) and the nucleus accumbens (NAcc). However, the precise contribution of the mesolimbic pathway in hallucinations across various sensory modalities has not yet been explored. We compared the resting-state functional connectivity (rs-FC) of the NAcc among 16 schizophrenia patients with pure AH, 15 with both visuoauditory hallucinations (VAH), and 14 without hallucinations (NoH). A between-group comparison was performed using random-effects ANCOVA (rs-FC of the bilateral NAcc as the dependent variable, groups as the between-subjects factor, age and Positive and Negative Syndrome Scale scores as covariates; q(false discovery rate [FDR]) < .05). Compared to the NoH group, the AH group exhibited significantly enhanced NAcc rs-FC with the left temporal superior gyrus, the cingulate gyri, and the VTA, whereas the VAH group, compared to the AH group, exhibited significantly enhanced NAcc rs-FC with the bilateral insula, putamen, parahippocampal gyri, and VTA. The strength in rs-FC between the NAcc and the VTA appeared to be positively associated with the presence of hallucinations, but the NAcc FC patterns changed with the complexity of these experiences (ie, 0, 1, or 2 sensory modalities), rather than with severity. This might support the aberrant salience hypothesis of schizophrenia. Moreover, these findings suggest that future clinical and neurobiological studies of hallucinations should evaluate not only the global severity of symptoms but also their sensorial features. PMID:25053649
de la Iglesia-Vaya, Maria; Escartí, Maria José; Molina-Mateo, Jose; Martí-Bonmatí, Luis; Gadea, Marien; Castellanos, Francisco Xavier; Aguilar García-Iturrospe, Eduardo J.; Robles, Montserrat; Biswal, Bharat B.; Sanjuan, Julio
Auditory hallucinations (AH) are the most frequent positive symptoms in patients with schizophrenia. Hallucinations have been related to emotional processing disturbances, altered functional connectivity and effective connectivity deficits. Previously, we observed that, compared to healthy controls, the limbic network responses of patients with auditory hallucinations differed when the subjects were listening to emotionally charged words. We aimed to compare the synchrony patterns and effective connectivity of task-related networks between schizophrenia patients with and without AH and healthy controls. Schizophrenia patients with AH (n = 27) and without AH (n = 14) were compared with healthy participants (n = 31). We examined functional connectivity by analyzing correlations and cross-correlations among previously detected independent component analysis time courses. Granger causality was used to infer the information flow direction in the brain regions. The results demonstrate that the patterns of cortico-cortical functional synchrony differentiated the patients with AH from the patients without AH and from the healthy participants. Additionally, Granger-causal relationships between the networks clearly differentiated the groups. In the patients with AH, the principal causal source was an occipital–cerebellar component, versus a temporal component in the patients without AH and the healthy controls. These data indicate that an anomalous process of neural connectivity exists when patients with AH process emotional auditory stimuli. Additionally, a central role is suggested for the cerebellum in processing emotional stimuli in patients with persistent AH. PMID:25379429
Hugdahl, Kenneth; Løberg, Else-Marie; Nygård, Merethe
In this article, we have reviewed recent findings from our laboratory, originally presented in Hugdahl et al. (2008). These findings reveal that auditory hallucinations in schizophrenia should best be conceptualized as internally generated speech mis-representations lateralized to the left superior temporal gyrus and sulcus, not cognitively suppressed due to enhanced attention to the ‘voices’ and failure of fronto-parietal executive control functions. An overview of diagnostic questionnaires for scoring of symptoms is presented together with a review of behavioral, structural, and functional MRI data. Functional imaging data have either shown increased or decreased activation depending on whether patients have been presented an external stimulus during scanning. Structural imaging data have shown reduction of grey matter density and volume in the same areas in the temporal lobe. We have proposed a model for the understanding of auditory hallucinations that trace the origin of auditory hallucinations to neuronal abnormality in the speech areas in the left temporal lobe, which is not suppressed by volitional cognitive control processes, due to dysfunctional fronto-parietal executive cortical networks. PMID:19753095
de la Iglesia-Vaya, Maria; Escartí, Maria José; Molina-Mateo, Jose; Martí-Bonmatí, Luis; Gadea, Marien; Castellanos, Francisco Xavier; Aguilar García-Iturrospe, Eduardo J; Robles, Montserrat; Biswal, Bharat B; Sanjuan, Julio
Auditory hallucinations (AH) are the most frequent positive symptoms in patients with schizophrenia. Hallucinations have been related to emotional processing disturbances, altered functional connectivity and effective connectivity deficits. Previously, we observed that, compared to healthy controls, the limbic network responses of patients with auditory hallucinations differed when the subjects were listening to emotionally charged words. We aimed to compare the synchrony patterns and effective connectivity of task-related networks between schizophrenia patients with and without AH and healthy controls. Schizophrenia patients with AH (n = 27) and without AH (n = 14) were compared with healthy participants (n = 31). We examined functional connectivity by analyzing correlations and cross-correlations among previously detected independent component analysis time courses. Granger causality was used to infer the information flow direction in the brain regions. The results demonstrate that the patterns of cortico-cortical functional synchrony differentiated the patients with AH from the patients without AH and from the healthy participants. Additionally, Granger-causal relationships between the networks clearly differentiated the groups. In the patients with AH, the principal causal source was an occipital-cerebellar component, versus a temporal component in the patients without AH and the healthy controls. These data indicate that an anomalous process of neural connectivity exists when patients with AH process emotional auditory stimuli. Additionally, a central role is suggested for the cerebellum in processing emotional stimuli in patients with persistent AH.
Kompus, Kristiina; Falkenberg, Liv E.; Bless, Josef J.; Johnsen, Erik; Kroken, Rune A.; Kråkvik, Bodil; Larøi, Frank; Løberg, Else-Marie; Vedul-Kjelsås, Einar; Westerhausen, René; Hugdahl, Kenneth
Auditory verbal hallucinations (AVHs) are a subjective experience of “hearing voices” in the absence of corresponding physical stimulation in the environment. The most remarkable feature of AVHs is their perceptual quality, that is, the experience is subjectively often as vivid as hearing an actual voice, as opposed to mental imagery or auditory memories. This has lead to propositions that dysregulation of the primary auditory cortex (PAC) is a crucial component of the neural mechanism of AVHs. One possible mechanism by which the PAC could give rise to the experience of hallucinations is aberrant patterns of neuronal activity whereby the PAC is overly sensitive to activation arising from internal processing, while being less responsive to external stimulation. In this paper, we review recent research relevant to the role of the PAC in the generation of AVHs. We present new data from a functional magnetic resonance imaging (fMRI) study, examining the responsivity of the left and right PAC to parametrical modulation of the intensity of auditory verbal stimulation, and corresponding attentional top-down control in non-clinical participants with AVHs, and non-clinical participants with no AVHs. Non-clinical hallucinators showed reduced activation to speech sounds but intact attentional modulation in the right PAC. Additionally, we present data from a group of schizophrenia patients with AVHs, who do not show attentional modulation of left or right PAC. The context-appropriate modulation of the PAC may be a protective factor in non-clinical hallucinations. PMID:23630479
Horga, Guillermo; Fernández-Egea, Emilio; Mané, Anna; Font, Mireia; Schatz, Kelly C.; Falcon, Carles; Lomeña, Francisco; Bernardo, Miguel; Parellada, Eduard
Auditory verbal hallucinations (AVH) in schizophrenia are typically characterized by rich emotional content. Despite the prominent role of emotion in regulating normal perception, the neural interface between emotion-processing regions such as the amygdala and auditory regions involved in perception remains relatively unexplored in AVH. Here, we studied brain metabolism using FDG-PET in 9 remitted patients with schizophrenia that previously reported severe AVH during an acute psychotic episode and 8 matched healthy controls. Participants were scanned twice: (1) at rest and (2) during the perception of aversive auditory stimuli mimicking the content of AVH. Compared to controls, remitted patients showed an exaggerated response to the AVH-like stimuli in limbic and paralimbic regions, including the left amygdala. Furthermore, patients displayed abnormally strong connections between the amygdala and auditory regions of the cortex and thalamus, along with abnormally weak connections between the amygdala and medial prefrontal cortex. These results suggest that abnormal modulation of the auditory cortex by limbic-thalamic structures might be involved in the pathophysiology of AVH and may potentially account for the emotional features that characterize hallucinatory percepts in schizophrenia. PMID:24416328
Horga, Guillermo; Fernández-Egea, Emilio; Mané, Anna; Font, Mireia; Schatz, Kelly C; Falcon, Carles; Lomeña, Francisco; Bernardo, Miguel; Parellada, Eduard
Auditory verbal hallucinations (AVH) in schizophrenia are typically characterized by rich emotional content. Despite the prominent role of emotion in regulating normal perception, the neural interface between emotion-processing regions such as the amygdala and auditory regions involved in perception remains relatively unexplored in AVH. Here, we studied brain metabolism using FDG-PET in 9 remitted patients with schizophrenia that previously reported severe AVH during an acute psychotic episode and 8 matched healthy controls. Participants were scanned twice: (1) at rest and (2) during the perception of aversive auditory stimuli mimicking the content of AVH. Compared to controls, remitted patients showed an exaggerated response to the AVH-like stimuli in limbic and paralimbic regions, including the left amygdala. Furthermore, patients displayed abnormally strong connections between the amygdala and auditory regions of the cortex and thalamus, along with abnormally weak connections between the amygdala and medial prefrontal cortex. These results suggest that abnormal modulation of the auditory cortex by limbic-thalamic structures might be involved in the pathophysiology of AVH and may potentially account for the emotional features that characterize hallucinatory percepts in schizophrenia.
Penn, David L; Meyer, Piper S; Evans, Elizabeth; Wirth, R J; Cai, Karen; Burchinal, Margaret
There has been little research examining group cognitive-behavioral therapy (CBT) for schizophrenia, especially compared to an active control treatment. The purpose of this study was to investigate the effectiveness of group CBT for auditory hallucinations compared to an enhanced supportive therapy (ST). Sixty five participants with schizophrenia spectrum disorders and persistent hallucinations were randomly assigned to group CBT or enhanced group ST. Primary outcomes focused on beliefs about voices and global auditory hallucinations severity. Secondary outcomes included psychotic symptoms, self-esteem, social functioning, insight, depression, and hospitalization. Controlling for baseline levels, these outcomes were evaluated across post-treatment, 3 month and 12 month follow-ups. Participants who received enhanced ST were less likely to both resist voices and to rate them as less malevolent through 12-month follow-up relative to participants who received CBT. Group CBT was associated with lower general and total symptom scores on the PANSS through 12-month-followup relative to participants who received enhanced ST. Outcomes improved through 12-month follow-up in both therapy groups, with enhanced ST having more specific impact on auditory hallucinations, and CBT impacting general psychotic symptoms.
Brébion, Gildas; Stephan-Otto, Christian; Usall, Judith; Huerta-Ramos, Elena; Perez del Olmo, Mireia; Cuevas-Esteban, Jorge; Haro, Josep Maria; Ochoa, Susana
A number of cognitive underpinnings of auditory hallucinations have been established in schizophrenia patients, but few have, as yet, been uncovered for visual hallucinations. In previous research, we unexpectedly observed that auditory hallucinations were associated with poor recognition of color, but not black-and-white (b/w), pictures. In this study, we attempted to replicate and explain this finding. Potential associations with visual hallucinations were explored. B/w and color pictures were presented to 50 schizophrenia patients and 45 healthy individuals under 2 conditions of visual context presentation corresponding to 2 levels of visual encoding complexity. Then, participants had to recognize the target pictures among distractors. Auditory-verbal hallucinations were inversely associated with the recognition of the color pictures presented under the most effortful encoding condition. This association was fully mediated by working-memory span. Visual hallucinations were associated with improved recognition of the color pictures presented under the less effortful condition. Patients suffering from visual hallucinations were not impaired, relative to the healthy participants, in the recognition of these pictures. Decreased working-memory span in patients with auditory-verbal hallucinations might impede the effortful encoding of stimuli. Visual hallucinations might be associated with facilitation in the visual encoding of natural scenes, or with enhanced color perception abilities. (c) 2015 APA, all rights reserved).
Woods, Angela; Jones, Nev; Bernini, Marco; Callard, Felicity; Alderson-Day, Ben; Badcock, Johanna C.; Bell, Vaughan; Cook, Chris C. H.; Csordas, Thomas; Humpston, Clara; Krueger, Joel; Larøi, Frank; McCarthy-Jones, Simon; Moseley, Peter; Powell, Hilary; Raballo, Andrea; Smailes, David; Fernyhough, Charles
Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations (AVHs), the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH at 3 contextual levels: (1) cultural, social, and historical; (2) experiential; and (3) biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include (1) informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; (2) “front-loading” research in cognitive neuroscience; and (3) suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences. PMID:24903416
Woods, Angela; Jones, Nev; Bernini, Marco; Callard, Felicity; Alderson-Day, Ben; Badcock, Johanna C; Bell, Vaughan; Cook, Chris C H; Csordas, Thomas; Humpston, Clara; Krueger, Joel; Larøi, Frank; McCarthy-Jones, Simon; Moseley, Peter; Powell, Hilary; Raballo, Andrea; Smailes, David; Fernyhough, Charles
Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations (AVHs), the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH at 3 contextual levels: (1) cultural, social, and historical; (2) experiential; and (3) biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include (1) informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; (2) "front-loading" research in cognitive neuroscience; and (3) suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences.
Chadwick, P; Birchwood, M
We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices-fear, reassurance, engagement and resistance-reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either 'benevolent' or 'malevolent'. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31% of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.
Thomas, F; Moulier, V; Valéro-Cabré, A; Januel, D
Auditory verbal hallucinations (AVH) are among the most characteristic symptoms of schizophrenia and have been linked to likely disturbances of structural and functional connectivity within frontal, temporal, parietal and subcortical networks involved in language and auditory functions. Resting-state functional magnetic resonance imaging (fMRI) has shown that alterations in the functional connectivity activity of the default-mode network (DMN) may also subtend hallucinations. Noninvasive neurostimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) have the ability to modulate activity of targeted cortical sites and their associated networks, showing a high potential for modulating altered connectivity subtending schizophrenia. Notwithstanding, the clinical benefit of these approaches remains weak and variable. Further studies in the field should foster a better understanding concerning the status of networks subtending AVH and the neural impact of rTMS in relation with symptom improvement. Additionally, the identification and characterization of clinical biomarkers able to predict response to treatment would be a critical asset allowing better care for patients with schizophrenia. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Shinn, Ann K.; Heckers, Stephan; Öngür, Dost
The presence of a single first-rank auditory hallucination (FRAH) or bizarre delusion (BD) is sufficient to satisfy the symptom criterion for a DSM-IV-TR diagnosis of schizophrenia. We queried two independent databases to investigate how prevalent FRAH and BD are in schizophrenia spectrum disorders and whether the diagnosis depends on them. FRAH was common in both datasets (42.2% and 55.2%) and BD was present in the majority of patients (62.5% and 69.7%). However, FRAH and BD rarely determined the diagnosis. In the first database, we found only seven cases among 325 patients (2.1%) and in the second database we found only one case among 201 patients (0.5%) who were diagnosed based on FRAH or BD alone. Among patients with FRAH, 96% had delusions, 14–42% had negative symptoms, 15–21% had disorganized or catatonic behavior, and 20–23% had disorganized speech. Among patients with BD, 88–99% had hallucinations, 17–49% had negative symptoms, 20–27% had disorganized or catatonic behavior, and 21–25% had disorganized speech. We conclude that FRAH and BD are common features of schizophrenia spectrum disorders, typically occur in the context of other psychotic symptoms, and very rarely constitute the sole symptom criterion for a DSM-IV-TR diagnosis of schizophrenia. PMID:23523693
Schreiber, Shaul; Dannon, Pinhas N; Goshen, Elinor; Amiaz, Revital; Zwas, Tzila S; Grunhaus, Leon
Auditory command hallucinations probably arise from the patient's failure to monitor his/her own 'inner speech', which is connected to activation of speech perception areas of the left cerebral cortex and to various degrees of dysfunction of cortical circuits involved in schizophrenia as supported by functional brain imaging. We hypothesized that rapid transcranial magnetic stimulation (rTMS), by increasing cortical activation of the right prefrontal brain region, would bring about a reduction of the hallucinations. We report our first schizophrenic patient affected with refractory command hallucinations treated with 10 Hz rTMS. Treatment was performed over the right dorsolateral prefrontal cortex, with 1200 magnetic stimulations administered daily for 20 days at 90% motor threshold. Regional cerebral blood flow changes were monitored with neuroSPECT. Clinical evaluation and scores on the Positive and Negative Symptoms Scale and the Brief Psychiatric Rating Scale demonstrated a global improvement in the patient's condition, with no change in the intensity and frequency of the hallucinations. NeuroSPECT performed at intervals during and after treatment indicated a general improvement in cerebral perfusion. We conclude that right prefrontal rTMS may induce a general clinical improvement of schizophrenic brain function, without directly influencing the mechanism involved in auditory command hallucinations.
Ford, Judith M.
In this paper, I explain why I adopted an RDoC approach to study the neurobiology of auditory verbal hallucinations (AVH), or voices. I explain that the RDoC construct of “Agency” fits well with AVH phenomenology. To the extent that voices sound non-self, voice hearers lack a sense of agency over the voices. Using a vocalization paradigm like those used with non-human primates to study mechanisms subserving the sense of agency, we find that the auditory N1 ERP is suppressed during vocalization, that EEG synchrony preceding speech onset is related to N1 suppression, and that both are reduced in patients with schizophrenia. Reduced cortical suppression is also seen across multiple psychotic disorders and in clinically high-risk youth. The motor activity preceding talking and connectivity between frontal and temporal lobes during talking have both proved sensitive to AVH, suggesting neural activity and connectivity associated with intentions to act may be a better way to study agency and predictions based on agency. PMID:26877116
This special theme issue of Schizophrenia Bulletin presents a series of related articles focusing on auditory hallucinations, prepared by members of the International Consortium on Hallucination Research [InCoHR] working groups. The InCoHR is a large collaborative framework that serves as a platform for researchers to meet and collaborate on multidisciplinary projects relating to auditory hallucinations [AH] and discuss methodological issues facing transdiagnostic research. Laroi et al. observe the similarities in characteristic features of AHs in different clinical and nonclinical groups, but they also note that differences exist, reflecting the contribution of disease-related process. Waters et al. use findings of shared cognitive impairments across different diagnostic groups with AHs to propose a novel theoretical cognitive framework. Allen et al. describe that the neurobiological substrates of AHs include neural systems involved in language processing, as well as sensory and nonsensory brain regions and that studies are increasingly using fine-grain analysis of patients' characteristics in analyzing neuroimaging data. Ford et al. discuss different neurophysiological approaches and describes hallucination-related alterations in activity in temporal and frontal regions of the brain and particularly in auditory cortical areas. Finally, Sommer et al. review different treatment options for AHs in schizophrenia and other disorders, including pharmacological treatment, cognitive-behavioral therapy [CBT] and acceptance and commitment therapy [ACT], transcranial magnetic stimulation [TMS], and electroconvulsive therapy [ECT]. These related publications describe the current substance and direction of research on AHs across different diagnostic groups.
Hoffman, Ralph E
Auditory/verbal hallucinations (AVHs) are comprised of spoken conversational speech seeming to arise from specific, nonself speakers. One hertz repetitive transcranial magnetic stimulation (rTMS) reduces excitability in the brain region stimulated. Studies utilizing 1-Hz rTMS delivered to the left temporoparietal cortex, a brain area critical to speech perception, have demonstrated statistically significant improvements in AVHs relative to sham simulation. A novel mechanism of AVHs is proposed whereby dramatic pre-psychotic social withdrawal prompts neuroplastic reorganization by the "social brain" to produce spurious social meaning via hallucinations of conversational speech. Preliminary evidence supporting this hypothesis includes a very high rate of social withdrawal emerging prior to the onset of frank psychosis in patients who develop schizophrenia and AVHs. Moreover, reduced AVHs elicited by temporoparietal 1-Hz rTMS are likely to reflect enhanced long-term depression. Some evidence suggests a loss of long-term depression following experimentally-induced deafferentation. Finally, abnormal cortico-cortical coupling is associated with AVHs and also is a common outcome of deafferentation. Auditory/verbal hallucinations (AVHs) of spoken speech or "voices" are reported by 60-80% of persons with schizophrenia at various times during the course of illness. AVHs are associated with high levels of distress, functional disability, and can lead to violent acts. Among patients with AVHs, these symptoms remain poorly or incompletely responsive to currently available treatments in approximately 25% of cases. For patients with AVHs who do respond to antipsychotic drugs, there is a very high likelihood that these experiences will recur in subsequent episodes. A more precise characterization of underlying pathophysiology may lead to more efficacious treatments.
Borruat, F X
Visual hallucinations or illusions are not a rare symptom. However, they are often unrecognized. Unawareness of the meaning of these symptoms often mislead both the patient and his physician. To define and describe the types of visual illusions and hallucinations which can be commonly encountered in neuro-ophthalmological practice. Overview article. Hallucinations are a perception not based on sensory input, whereas illusions are a misinterpretation of a correct sensory input. Both phenomenon can be due to medication or drug, or to an altered mental status. Visual hallucinations can be formed (objects, people) or unformed (light, geometric figures). They can be generated either by a lesion on the antechiasmatic pathway, by a seizure phenomenon, by a migrainous phenomenon, or by a release phenomenon secondary to visual differentiation. Investigations will be directed towards a retinopathy, an optic neuropathy, a chiasmal or retrochiasmal lesion, or a bilateral antechiasmal lesion (Charles Bonnet syndrome). Visual illusions include meta-morphopsias, micro- macropsias, polyopia, palinopsia (visual perseveration), achromatopsia, Pulfrich phenomenon, or subjective vertical deviation. Illusions can be due to lesions of the retina, the optic nerve, the visual cortex (primary or associative), or the graviceptive pathways. As most patients do not spontaneously mention their symptoms, history taking is essential. The first step is to rule out medication or an altered mental status as the possible cause of these symptoms. Then, careful visual function examination should provide a good insight in the location of the lesion.
Santos, Rosa Maria Rodrigues dos; Sanchez, Tanit Ganz; Bento, Ricardo Ferreira; Lucia, Mara Cristina Souza de
Summary Introduction: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. Aims: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. Method: Ten subjects (8 women; mean age = 65.7 years) were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. Results: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. Conclusions: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective. PMID:25991952
Steenhuis, Laura A; Bartels-Velthuis, Agna A; Jenner, Jack A; Aleman, André; Bruggeman, Richard; Nauta, Maaike H; Pijnenborg, Gerdina H M
The current exploratory study examined the associations between auditory vocal hallucinations (AVH) and delusions and religiosity in young adolescents. 337 children from a population-based case-control study with and without AVH, were assessed after five years at age 12 and 13, on the presence and appraisal of AVH, delusions and religiosity. AVH status (persistent, remittent, incident or control) was examined in relationship to religiosity. Results demonstrated a non-linear association between AVH and religiosity. Moderately religious adolescents were more likely to report AVH than non-religious adolescents (O.R.=2.6). Prospectively, moderately religious adolescents were more likely to have recently developed AVH than non-religious adolescents (O.R.=3.6) and strongly religious adolescents (O.R.=7.9). Of the adolescents reporting voices in this sample (16.3%), more than half reported positive voices. Religious beliefs were often described as supportive, useful or neutral (82%), regardless of the level of religiosity, for both adolescents with and without AVH. Co-occurrence of AVH and delusions, and severity of AVH were not related to religiosity. The present findings suggest there may be a non-linear association between religiosity and hearing voices in young adolescents. A speculative explanation may be that religious practices were adopted in response to AVH as a method of coping. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Spanos, Nicholas P.; And Others
The effects of several attitudinal, cognitive skill, and personality variables in response to auditory and visual hallucination suggestions to hypnotic subjects are assessed. Cooperative attitudes toward hypnosis and involvement in everyday imaginative activities (absorption) correlated with response to auditory and visual hallucination…
Spanos, Nicholas P.; And Others
The effects of several attitudinal, cognitive skill, and personality variables in response to auditory and visual hallucination suggestions to hypnotic subjects are assessed. Cooperative attitudes toward hypnosis and involvement in everyday imaginative activities (absorption) correlated with response to auditory and visual hallucination…
Tucker, Rachel; Farhall, John; Thomas, Neil; Groot, Christopher; Rossell, Susan L.
Research on auditory verbal hallucinations (AVHs) indicates that AVH schizophrenia patients show greater abnormalities on tasks requiring recognition of affective prosody (AP) than non-AVH patients. Detecting AP requires accurate perception of manipulations in pitch, amplitude and duration. Schizophrenia patients with AVHs also experience difficulty detecting these acoustic manipulations; with a number of theorists speculating that difficulties in pitch, amplitude and duration discrimination underlie AP abnormalities. This study examined whether both AP and these aspects of auditory processing are also impaired in first degree relatives of persons with AVHs. It also examined whether pitch, amplitude and duration discrimination were related to AP, and to hallucination proneness. Unaffected relatives of AVH schizophrenia patients (N = 19) and matched healthy controls (N = 33) were compared using tone discrimination tasks, an AP task, and clinical measures. Relatives were slower at identifying emotions on the AP task (p = 0.002), with secondary analysis showing this was especially so for happy (p = 0.014) and neutral (p = 0.001) sentences. There was a significant interaction effect for pitch between tone deviation level and group (p = 0.019), and relatives performed worse than controls on amplitude discrimination and duration discrimination. AP performance for happy and neutral sentences was significantly correlated with amplitude perception. Lastly, AVH proneness in the entire sample was significantly correlated with pitch discrimination (r = 0.44) and pitch perception was shown to predict AVH proneness in the sample (p = 0.005). These results suggest basic impairments in auditory processing are present in relatives of AVH patients; they potentially underlie processing speed in AP tasks, and predict AVH proneness. This indicates auditory processing deficits may be a core feature of AVHs in schizophrenia, and are worthy of further study as a potential endophenotype
In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the “VOICE” ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the “voices” having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app. PMID:26110121
Stanghellini, Giovanni; Cutting, John
Auditory verbal hallucinations (AVHs) are usually defined as perceptions of speech that occur in the absence of any appropriate external stimulus. This definition, we argue, is false. We maintain that AVHs are disorders of self-consciousness that are best understood as the becoming conscious of inner dialogue. Normally, subconscious interior conversations are experienced as a sense of partnership between distinct parts: we feel these parts as distinct, but also integrated and collaborating with each other in decision-making and in self-representation. AVHs attest to a breakdown in this process of interior conversation: the feeling of unity in duality falls apart, and the dialectic partnership on which self-representation is grounded shatters into a mere dichotomy. There is a fracture in self-consciousness. If ipseity (i.e. the prereflective modality of self-awareness, the self-feeling of one's own self in which the one who feels and what is felt is but one thing) is lacking, the sense of unity weakens, and the sense of duality increases. This crisis of ipseity is accompanied by an increase of reflexivity (i.e. the process through which I take a part of myself as a focal object of awareness). Hyperreflexivity contributes to the objectification of the sense of duality and to the loss of the sense of 'myness' of inner speech. In schizophrenics, inner dialogue becomes anomalously manifest. Whereas in normal conditions, inner dialogue is the medium for self-representation, AVHs arise through its morbid objectification: inner speech comes to the foreground in the concrete fashion of alien 'voices'. Copyright 2003 S. Karger AG, Basel
Thomas, Neil; Hayward, Mark; Peters, Emmanuelle; van der Gaag, Mark; Bentall, Richard P.; Jenner, Jack; Strauss, Clara; Sommer, Iris E.; Johns, Louise C.; Varese, Filippo; García-Montes, José Manuel; Waters, Flavie; Dodgson, Guy; McCarthy-Jones, Simon
This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. PMID:24936081
So, Suzanne Ho-Wai; Begemann, Marieke J H; Gong, Xianmin; Sommer, Iris E
Neuroticism has been shown to adversely influence the development and outcome of psychosis. However, how this personality trait associates with the individual's responses to psychotic symptoms is less well known. Auditory verbal hallucinations (AVHs) have been reported by patients with psychosis and non-clinical individuals. There is evidence that voice-hearers who are more distressed by and resistant against the voices, as well as those who appraise the voices as malevolent and powerful, have poorer outcome. This study aimed to examine the mechanistic association of neuroticism with the cognitive-affective reactions to AVH. We assessed 40 psychotic patients experiencing frequent AVHs, 135 non-clinical participants experiencing frequent AVHs, and 126 healthy individuals. In both clinical and non-clinical voice-hearers alike, a higher level of neuroticism was associated with more distress and behavioral resistance in response to AVHs, as well as a stronger tendency to perceive voices as malevolent and powerful. Neuroticism fully mediated the found associations between childhood trauma and the individuals' cognitive-affective reactions to voices. Our results supported the role of neurotic personality in shaping maladaptive reactions to voices. Neuroticism may also serve as a putative mechanism linking childhood trauma and psychological reactions to voices. Implications for psychological models of hallucinations are discussed.
So, Suzanne Ho-wai; Begemann, Marieke J. H.; Gong, Xianmin; Sommer, Iris E.
Neuroticism has been shown to adversely influence the development and outcome of psychosis. However, how this personality trait associates with the individual’s responses to psychotic symptoms is less well known. Auditory verbal hallucinations (AVHs) have been reported by patients with psychosis and non-clinical individuals. There is evidence that voice-hearers who are more distressed by and resistant against the voices, as well as those who appraise the voices as malevolent and powerful, have poorer outcome. This study aimed to examine the mechanistic association of neuroticism with the cognitive-affective reactions to AVH. We assessed 40 psychotic patients experiencing frequent AVHs, 135 non-clinical participants experiencing frequent AVHs, and 126 healthy individuals. In both clinical and non-clinical voice-hearers alike, a higher level of neuroticism was associated with more distress and behavioral resistance in response to AVHs, as well as a stronger tendency to perceive voices as malevolent and powerful. Neuroticism fully mediated the found associations between childhood trauma and the individuals’ cognitive-affective reactions to voices. Our results supported the role of neurotic personality in shaping maladaptive reactions to voices. Neuroticism may also serve as a putative mechanism linking childhood trauma and psychological reactions to voices. Implications for psychological models of hallucinations are discussed. PMID:27698407
Slotema, C W; Daalman, K; Blom, J D; Diederen, K M; Hoek, H W; Sommer, I E C
Auditory verbal hallucinations (AVH) in patients with borderline personality disorder (BPD) are frequently claimed to be brief, less severe and qualitatively different from those in schizophrenia, hence the term 'pseudohallucinations'. AVH in BPD may be more similar to those experienced by healthy individuals, who experience AVH in a lower frequency and with a more positive content than AVH in schizophrenia. In this study the phenomenology of AVH in BPD patients was compared to that in schizophrenia and to AVH experienced by non-patients. In a cross-sectional setting, the phenomenological characteristics of AVH in 38 BPD patients were compared to those in 51 patients with schizophrenia/schizoaffective disorder and to AVH of 66 non-patients, using the Psychotic Symptom Rating Scales (PSYRATS). BPD patients experienced AVH for a mean duration of 18 years, with a mean frequency of at least daily lasting several minutes or more. The ensuing distress was high. No differences in the phenomenological characteristics of AVH were revealed among patients diagnosed with BPD and those with schizophrenia/schizoaffective disorder, except for 'disruption of life', which was higher in the latter group. Compared to non-patients experiencing AVH, BPD patients had higher scores on almost all items. AVH in BPD patients are phenomenologically similar to those in schizophrenia, and different from those in healthy individuals. As AVH in patients with BPD fulfil the criteria of hallucinations proper, we prefer the term AVH over 'pseudohallucinations', so as to prevent trivialization and to promote adequate diagnosis and treatment.
The aim of this study was to determine if simulation aided by media technology contributes towards an increase in knowledge, empathy, and a change in attitudes in regards to auditory hallucinations for nursing students. A convenience sample of 60 second-year undergraduate nursing students from an Australian university was invited to be part of the study. A pre-post-test design was used, with data analysed using a paired samples t-test to identify pre- and post-changes on nursing students' scores on knowledge of auditory hallucinations. Nine of the 11 questions reported statistically-significant results. The remaining two questions highlighted knowledge embedded within the curriculum, with therapeutic communication being the core work of mental health nursing. The implications for practice are that simulation aided by media technology increases the knowledge of students in regards to auditory hallucinations.
Johnston, Olwyn; Gallagher, Anthony G; McMahon, Patrick J; King, David J
This article presents preliminary findings from the first participant to complete an experiment assessing the efficacy of the personal stereo in treating auditory hallucinations. O.C., a 50-year-old woman, took part in a controlled treatment trial in which 1-week baseline, personal stereo, and control treatment (nonfunctioning hearing aid) stages were alternated for 7 weeks. The Positive and Negative Syndrome Scale, Clinical Global Impression Scales, Beliefs About Voices Questionnaire, Rosenberg Self-Esteem Scale, and Topography of Voices Rating Scale were used. The personal stereo led to a decrease in the severity of O.C.'s auditory hallucinations. For example, she rated her voices as being fairly distressing during baseline and control treatment stages but neutral during personal stereo stages. A slight decrease in other psychopathology also occurred during personal stereo stages. Use of the personal stereo did not lead to a decrease in self-esteem, contradicting suggestions that counterstimulation treatments for auditory hallucinations may be disempowering.
While several hypotheses about the neural mechanisms underlying auditory verbal hallucinations (AVH) have been suggested, the exact role of the recently highlighted intrinsic resting state activity of the brain remains unclear. Based on recent findings, we therefore developed what we call the 'resting state hypotheses' of AVH. Our hypothesis suggest that AVH may be traced back to abnormally elevated resting state activity in auditory cortex itself, abnormal modulation of the auditory cortex by anterior cortical midline regions as part of the default-mode network, and neural confusion between auditory cortical resting state changes and stimulus-induced activity. We discuss evidence in favour of our 'resting state hypothesis' and show its correspondence with phenomenal, i.e., subjective-experiential features as explored in phenomenological accounts. Therefore I speak of a 'neurophenomenal resting state hypothesis' of auditory hallucinations in schizophrenia. PMID:25598821
Suryani, Suryani; Welch, Anthony; Cox, Leonie
This study was a phenomenological inquiry of the experience of auditory hallucinations as described by 13 Indonesian people diagnosed with schizophrenia. The interviewees included 6 men and 7 women and they were aged between 19 and 56 years. Four themes emerged from this study: feeling more like a robot than a human being; voices of contradiction--a point of confusion; tattered relationships and family disarray; and normalizing the presence of voices as part of everyday life. The findings of this study have the potential to contribute to new understandings of how people live with and manage auditory hallucinations and so enhance client-centered nursing care. © 2013.
Horacek, Jiri; Brunovsky, Martin; Novak, Tomas; Skrdlantova, Lucie; Klirova, Monika; Bubenikova-Valesova, Vera; Krajca, Vladimir; Tislerova, Barbora; Kopecek, Milan; Spaniel, Filip; Mohr, Pavel; Höschl, Cyril
Auditory hallucinations are characteristic symptoms of schizophrenia with high clinical importance. It was repeatedly reported that low frequency (
Langer, Alvaro I; Cangas, Adolfo J; Serper, Mark
Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a
Alderson-Day, Ben; Diederen, Kelly; Fernyhough, Charles; Ford, Judith M; Horga, Guillermo; Margulies, Daniel S; McCarthy-Jones, Simon; Northoff, Georg; Shine, James M; Turner, Jessica; van de Ven, Vincent; van Lutterveld, Remko; Waters, Flavie; Jardri, Renaud
In recent years, there has been increasing interest in the potential for alterations to the brain's resting-state networks (RSNs) to explain various kinds of psychopathology. RSNs provide an intriguing new explanatory framework for hallucinations, which can occur in different modalities and population groups, but which remain poorly understood. This collaboration from the International Consortium on Hallucination Research (ICHR) reports on the evidence linking resting-state alterations to auditory hallucinations (AH) and provides a critical appraisal of the methodological approaches used in this area. In the report, we describe findings from resting connectivity fMRI in AH (in schizophrenia and nonclinical individuals) and compare them with findings from neurophysiological research, structural MRI, and research on visual hallucinations (VH). In AH, various studies show resting connectivity differences in left-hemisphere auditory and language regions, as well as atypical interaction of the default mode network and RSNs linked to cognitive control and salience. As the latter are also evident in studies of VH, this points to a domain-general mechanism for hallucinations alongside modality-specific changes to RSNs in different sensory regions. However, we also observed high methodological heterogeneity in the current literature, affecting the ability to make clear comparisons between studies. To address this, we provide some methodological recommendations and options for future research on the resting state and hallucinations.
Alderson-Day, Ben; Diederen, Kelly; Fernyhough, Charles; Ford, Judith M.; Horga, Guillermo; Margulies, Daniel S.; McCarthy-Jones, Simon; Northoff, Georg; Shine, James M.; Turner, Jessica; van de Ven, Vincent; van Lutterveld, Remko; Waters, Flavie; Jardri, Renaud
In recent years, there has been increasing interest in the potential for alterations to the brain’s resting-state networks (RSNs) to explain various kinds of psychopathology. RSNs provide an intriguing new explanatory framework for hallucinations, which can occur in different modalities and population groups, but which remain poorly understood. This collaboration from the International Consortium on Hallucination Research (ICHR) reports on the evidence linking resting-state alterations to auditory hallucinations (AH) and provides a critical appraisal of the methodological approaches used in this area. In the report, we describe findings from resting connectivity fMRI in AH (in schizophrenia and nonclinical individuals) and compare them with findings from neurophysiological research, structural MRI, and research on visual hallucinations (VH). In AH, various studies show resting connectivity differences in left-hemisphere auditory and language regions, as well as atypical interaction of the default mode network and RSNs linked to cognitive control and salience. As the latter are also evident in studies of VH, this points to a domain-general mechanism for hallucinations alongside modality-specific changes to RSNs in different sensory regions. However, we also observed high methodological heterogeneity in the current literature, affecting the ability to make clear comparisons between studies. To address this, we provide some methodological recommendations and options for future research on the resting state and hallucinations. PMID:27280452
Shinn, Ann K.; Baker, Justin T.; Cohen, Bruce M.; Öngür, Dost
Background Schizophrenia is a heterogeneous disorder that may consist of multiple etiologies and disease processes. Auditory hallucinations (AH), which are common and often disabling, represent a narrower and more basic dimension of psychosis than schizophrenia. Previous studies suggest that abnormal primary auditory cortex activity is associated with AH pathogenesis. We thus investigated functional connectivity, using a seed in primary auditory cortex, in schizophrenia patients with and without AH and healthy controls, to examine neural circuit abnormalities associated more specifically with AH than the myriad other symptoms that comprise schizophrenia. Methods Using resting-state fMRI (rsfMRI), we investigated functional connectivity of the primary auditory cortex, located on Heschl’s gyrus, in schizophrenia spectrum patients with AH. Participants were patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder with lifetime AH (n=27); patients with the same diagnoses but no lifetime AH (n=14); and healthy controls (n=28). Results Patients with AH vulnerability showed increased left Heschl’s gyrus functional connectivity with left frontoparietal regions and decreased functional connectivity with right hippocampal formation and mediodorsal thalamus compared to patients without lifetime AH. Furthermore, among AH patients, left Heschl’s gyrus functional connectivity covaried positively with AH severity in left inferior frontal gyrus (Broca’s area), left lateral STG, right pre- and postcentral gyri, cingulate cortex, and orbitofrontal cortex. There were no differences between patients with and without lifetime AH in right Heschl’s gyrus seeded functional connectivity. Conclusions Abnormal interactions between left Heschl’s gyrus and regions involved in speech/language, memory, and the monitoring of self-generated events may contribute to AH vulnerability. PMID:23287311
Moseley, Peter; Smailes, David; Ellison, Amanda; Fernyhough, Charles
Cognitive models have suggested that auditory hallucinations occur when internal mental events, such as inner speech or auditory verbal imagery (AVI), are misattributed to an external source. This has been supported by numerous studies indicating that individuals who experience hallucinations tend to perform in a biased manner on tasks that require them to distinguish self-generated from non-self-generated perceptions. However, these tasks have typically been of limited relevance to inner speech models of hallucinations, because they have not manipulated the AVI that participants used during the task. Here, a new paradigm was employed to investigate the interaction between imagery and perception, in which a healthy, non-clinical sample of participants were instructed to use AVI whilst completing an auditory signal detection task. It was hypothesized that AVI-usage would cause participants to perform in a biased manner, therefore falsely detecting more voices in bursts of noise. In Experiment 1, when cued to generate AVI, highly hallucination-prone participants showed a lower response bias than when performing a standard signal detection task, being more willing to report the presence of a voice in the noise. Participants not prone to hallucinations performed no differently between the two conditions. In Experiment 2, participants were not specifically instructed to use AVI, but retrospectively reported how often they engaged in AVI during the task. Highly hallucination-prone participants who retrospectively reported using imagery showed a lower response bias than did participants with lower proneness who also reported using AVI. Results are discussed in relation to prominent inner speech models of hallucinations. PMID:26435050
Kataoka, Hiroshi; Ueno, Satoshi
Auditory musical hallucinations (AMHs) are rare complex auditory hallucinations in Parkinson's disease (PD) that have been limited previously. The characteristics of AMHs in PD remain uncertain. We describe a 72-year-old woman with PD who presented with AMHs. The AMHs occurred after immediate-release pramipexole was switched to extended-release pramipexole. The AMHs were a quiet piano or often songs on a loud radio or background music over other sounds. The music was unpleasant, but not objectionable, threatening, or ego-syntonic, and it did not interrupt her daily activities. AMHs in PD were non-threatening, and dopaminergic treatment may predispose patients to AMHs or be a unique possible cause of AMHs. The hallucinations can occur after immediate-release pramipexole was switched to extended-release pramipexole.
Kataoka, Hiroshi; Ueno, Satoshi
Abstract Auditory musical hallucinations (AMHs) are rare complex auditory hallucinations in Parkinson's disease (PD) that have been limited previously. The characteristics of AMHs in PD remain uncertain. We describe a 72-year-old woman with PD who presented with AMHs. The AMHs occurred after immediate-release pramipexole was switched to extended-release pramipexole. The AMHs were a quiet piano or often songs on a loud radio or background music over other sounds. The music was unpleasant, but not objectionable, threatening, or ego-syntonic, and it did not interrupt her daily activities. AMHs in PD were non-threatening, and dopaminergic treatment may predispose patients to AMHs or be a unique possible cause of AMHs. The hallucinations can occur after immediate-release pramipexole was switched to extended-release pramipexole. PMID:25501095
Zhu, Jiajia; Wang, Chunli; Liu, Feng; Qin, Wen; Li, Jie; Zhuo, Chuanjun
Background: There have been many attempts at explaining the underlying neuropathological mechanisms of auditory verbal hallucinations (AVH) in schizophrenia on the basis of regional brain changes, with the most consistent findings being that AVH are associated with functional and structural impairments in auditory and speech-related regions. However, the human brain is a complex network and the global topological alterations specific to AVH in schizophrenia remain unclear. Methods: Thirty-five schizophrenia patients with AVH, 41 patients without AVH, and 50 healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). The whole-brain functional and structural networks were constructed and analyzed using graph theoretical approaches. Inter-group differences in global network metrics (including small-world properties and network efficiency) were investigated. Results: We found that three groups had a typical small-world topology in both functional and structural networks. More importantly, schizophrenia patients with and without AVH exhibited common disruptions of functional networks, characterized by decreased clustering coefficient, global efficiency and local efficiency, and increased characteristic path length; structural networks of only schizophrenia patients with AVH showed increased characteristic path length compared with those of healthy controls. Conclusion: Our findings suggest that less “small-worldization” and lower network efficiency of functional networks may be an independent trait characteristic of schizophrenia, and regularization of structural networks may be the underlying pathological process engaged in schizophrenic AVH symptom expression. PMID:27014042
Rapin, Lucile; Dohen, Marion; Polosan, Mircea; Perrier, Pascal; Loevenbruck, Hélène
Purpose: "Auditory verbal hallucinations" (AVHs) are speech perceptions in the absence of external stimulation. According to an influential theoretical account of AVHs in schizophrenia, a deficit in inner-speech monitoring may cause the patients' verbal thoughts to be perceived as external voices. The account is based on a…
Rapin, Lucile; Dohen, Marion; Polosan, Mircea; Perrier, Pascal; Loevenbruck, Hélène
Purpose: "Auditory verbal hallucinations" (AVHs) are speech perceptions in the absence of external stimulation. According to an influential theoretical account of AVHs in schizophrenia, a deficit in inner-speech monitoring may cause the patients' verbal thoughts to be perceived as external voices. The account is based on a…
DeVylder, Jordan E; Hilimire, Matthew R
Individuals with subthreshold psychotic experiences are at increased risk for suicidal thoughts and behavior, similar to those with schizophrenia and other psychotic disorders. This may be explained by shared risk factors such as heightened stress sensitivity or low self-esteem. Understanding the nature of this relationship could inform suicide prevention in social work practice. In this study, authors examined the relationship between self-reported auditory hallucinations and suicidal thoughts, plans, and attempts, in a nonclinical sample of young adults, controlling for scores on the Psychological Stress Index and Rosenberg Self-Esteem Scale. Auditory hallucinations were associated with approximately double the odds of suicidal ideation and plans and four times the odds for suicide attempts. This relationship was not explained by stress sensitivity or self-esteem, which were independently related to hallucinations and suicidality, respectively. Subthreshold auditory hallucinations may be a useful indicator of suicide risk. This association may represent a clinically significant relationship that may be addressed through social work interventions intended to alleviate stress sensitivity or improve self-esteem.
Buccheri, Robin Kay; Trygstad, Louise Nigh; Buffum, Martha D; Lyttle, Kathleen; Dowling, Glenna
Patients hearing command hallucinations to harm whose only self-management strategies are to obey these commands, can represent serious safety concerns on inpatient psychiatric units. A comprehensive evidence-based program teaching self-management of auditory hallucinations on inpatient psychiatric units is described that includes five components: suggestions for staff education; patient self-assessment tools; an interview guide and safety protocol; a course to teach strategies for managing distressing voices and commands to harm; suggestions to improve staff communication; and a plan to extend the program from inpatient care settings into the community by sharing materials with community case managers and caregivers when patients are discharged.
Benjamin, L S
Thirty psychiatric inpatients each rated their relationship with their auditory hallucination using the Structural Analysis of Social Behavior questionnaires which assess partnerships in terms of interpersonal focus, love-hate, and enmeshment-differentiation. Results showed that all subjects had integrated, interpersonally coherent relationships with their voice. Qualitative differences in the nature of the relationships related meaningfully to diagnosis. Selected clinical excerpts suggested that the relationship with the hallucination may serve an adaptive function. Chronicity may be dependent on the nature of that adaptation.
SUMMARY 30 schizophrenics who met the criteria of Feighner et al and were having verbal auditory hallucinations, with or without hallucinations of other varieties were chosen for the study. The relation between neuroticism scale of Eysenck's Personality Questionnaire and different aspects of the voice was examined. Neuroticism scores were positively related to the level of anxiety prior to the voice, anticipation of the voice, intensity of anger during the voice and interference with occupation and social activities of patients by the voice. PMID:21927144
Koops, Sanne; van Dellen, Edwin; Schutte, Maya J. L.; Nieuwdorp, Wendy; Neggers, Sebastiaan F. W.; Sommer, Iris E. C.
Background. Auditory verbal hallucinations (AVH) in schizophrenia are resistant to antipsychotic medication in approximately 25% of patients. Treatment with repetitive transcranial magnetic stimulation (rTMS) for refractory AVH has shown varying results. A stimulation protocol using continuous theta burst rTMS (TB-rTMS) showed high efficacy in open label studies. We tested TB-rTMS as a treatment strategy for refractory AVH in a double-blind, placebo-controlled trial. Methods. Seventy-one patients with AVH were randomly allocated to TB-rTMS or placebo treatment. They received 10 TB-rTMS or sham treatments over the left temporoparietal cortex in consecutive days. AVH severity was assessed at baseline, end of treatment and follow-up using the Psychotic Symptom Rating Scale (PSYRATS) and the Auditory Hallucinations Rating Scale (AHRS). Other schizophrenia-related symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Results. Seven patients dropped out before completing the study. In the remaining 64, AVH improved significantly after treatment in both groups as measured with both PSYRATS and AHRS. PANSS positive and general subscores also decreased, but the negative subscores did not. However, improvement did not differ significantly between the TB-rTMS and the placebo group on any outcome measure. Conclusions. Symptom reduction could be achieved in patients with medication-resistant hallucinations, even within 1 week time. However, as both groups showed similar improvement, effects were general (ie, placebo-effects) rather than specific to treatment with continuous TB-rTMS. Our findings highlight the importance of double-blind trials including a sham-control condition to assess efficacy of new treatments such as TMS. PMID:26221051
Dyck, Miriam S; Mathiak, Krystyna A; Bergert, Susanne; Sarkheil, Pegah; Koush, Yury; Alawi, Eliza M; Zvyagintsev, Mikhail; Gaebler, Arnim J; Shergill, Sukhi S; Mathiak, Klaus
Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients' emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region - even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations' severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state - with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients' symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous hallucinations for
de Leede-Smith, Saskia; Barkus, Emma
Over the years, the prevalence of auditory verbal hallucinations (AVHs) have been documented across the lifespan in varied contexts, and with a range of potential long-term outcomes. Initially the emphasis focused on whether AVHs conferred risk for psychosis. However, recent research has identified significant differences in the presentation and outcomes of AVH in patients compared to those in non-clinical populations. For this reason, it has been suggested that auditory hallucinations are an entity by themselves and not necessarily indicative of transition along the psychosis continuum. This review will examine the presentation of auditory hallucinations across the life span, as well as in various clinical groups. The stages described include childhood, adolescence, adult non-clinical populations, hypnagogic/hypnopompic experiences, high schizotypal traits, schizophrenia, substance induced AVH, AVH in epilepsy, and AVH in the elderly. In children, need for care depends upon whether the child associates the voice with negative beliefs, appraisals and other symptoms of psychosis. This theme appears to carry right through to healthy voice hearers in adulthood, in which a negative impact of the voice usually only exists if the individual has negative experiences as a result of their voice(s). This includes features of the voices such as the negative content, frequency, and emotional valence as well as anxiety and depression, independently or caused by voices presence. It seems possible that the mechanisms which maintain AVH in non-clinical populations are different from those which are behind AVH presentations in psychotic illness. For example, the existence of maladaptive coping strategies in patient populations is one significant difference between clinical and non-clinical groups which is associated with a need for care. Whether or not these mechanisms start out the same and have differential trajectories is not yet evidenced. Future research needs to focus on the
Badcock, Johanna C; Waters, Flavie A V; Maybery, Murray
Previous studies have linked intrusive cognitions (hallucinations and obsessions) with inhibitory dysregulation. Combined deficits in intentional inhibition and context memory have been proposed to explain the intrusive nature and perceived nonself origin of auditory hallucinations (Waters et al., 2006). This study tested the prediction, from this model, that individuals with obsessive-compulsive disorder (OCD), who do not mistake the origin of their intrusive thoughts, will show a deficit of intentional inhibition but intact contextual memory. The performance of 14 individuals with OCD and 24 healthy controls was compared on two measures of intentional cognitive inhibition and on a context memory task.Results. Participants with OCD were significantly impaired on both measures of inhibition but were not significantly different from controls in any condition of the context memory task. The predictions were confirmed. Individuals with OCD, like schizophrenia patients with auditory hallucinations, showed impaired intentional inhibition. This impairment might be responsible for the intrusive thoughts reported in both disorders, and might also partially account for the high rates of comorbidity of OCD and schizophrenia. Finally, intact context memory abilities in OCD may contribute to an efficient memory system, and may differentiate this group from those with hallucinations.
Buccheri, Robin K; Trygstad, Louise Nigh; Buffum, Martha D; Ju, Dau-Shen; Dowling, Glenna A
High levels of anxiety were found to interfere with voice hearers' ability to benefit from a 10-Session Behavioral Management of Auditory Hallucinations Course. The 10-session course was revised, adding anxiety reduction strategies to the first four classes and reinforcing those strategies in the remaining eight classes. A multi-site study (N = 27) used repeated measures to determine whether the new 12-session course would significantly reduce anxiety. Ten course leaders were trained and taught the course six times at three different outpatient mental health sites. Three measures of anxiety were used. The 12-session course was found to significantly reduce anxiety after the first four classes with further reduction at the end of the course. Eighty-eight percent of course participants reported the course was moderately to extremely helpful. They also reported that being in a group with others with similar symptoms was valuable. Course leaders reported learning about the prevalence and importance of treating voice hearers' anxiety. [Journal of Psychosocial Nursing and Mental Health Services, 55(5), 29-39.]. Copyright 2017, SLACK Incorporated.
Taylor, Joseph J; Krystal, John H; D'Souza, Deepak C; Gerrard, Jason Lee; Corlett, Philip R
The debilitating and refractory nature of auditory hallucinations (AH) in schizophrenia and other psychiatric disorders has stimulated investigations into neuromodulatory interventions that target the aberrant neural networks associated with them. Internal or invasive forms of brain stimulation such as deep brain stimulation (DBS) are currently being explored for treatment-refractory schizophrenia. The process of developing and implementing DBS is limited by symptom clustering within psychiatric constructs as well as a scarcity of causal tools with which to predict response, refine targeting or guide clinical decisions. Transcranial magnetic stimulation (TMS), an external or non-invasive form of brain stimulation, has shown some promise as a therapeutic intervention for AH but remains relatively underutilized as an investigational probe of clinically relevant neural networks. In this editorial, we propose that TMS has the potential to inform DBS by adding individualized causal evidence to an evaluation processes otherwise devoid of it in patients. Although there are significant limitations and safety concerns regarding DBS, the combination of TMS with computational modeling of neuroimaging and neurophysiological data could provide critical insights into more robust and adaptable network modulation. Copyright © 2017 Elsevier B.V. All rights reserved.
Kubera, Katharina M.; Barth, Anja; Hirjak, Dusan; Thomann, Philipp A.; Wolf, Robert C.
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes. PMID:26528145
Lai, C; Okada, Y; Sadoshima, S; Saku, Y; Kuwabara, Y; Fujishima, M
A 46-year-old businessman suddenly became to behave curiously on the morning, September 1, 1988. He forgot how to go through an automatic ticket gate, which he used every day. In his company, he also forgot how to open the cash box, and he wrote a meaningless report for his business. From the night on that day, he had experienced auditory hallucination in which whispering words of some criticism to his performance for a few days. On the next day, he was admitted to a psychiatric hospital because he was suggested to have schizophrenia. By day 6 after the onset, his curious symptoms completely disappeared. However, slight verbal memory disturbance and cognitive dysfunction still remained. Because the brain CT on day 6 showed a small localized subcortical infarction in the left hemisphere he was transferred to our clinic on day 20 to elucidate the relation between the abnormal behavior and the infarction. His blood pressure was 116/64 mmHg and pulse was regular 63/min. He was clear and did not have any neurological deficit. He kept his episodic memory regarding the events at the onset and could almost recall them precisely. Results of standard blood tests, electrocardiogram, ultrasound cardiogram, electroencephalogram as well as cerebral angiography were normal. Computed tomography and magnetic resonance imaging showed an infarcted lesion in the genu of the left caudate nucleus, adjacent to the anterior part of the thalamus.(ABSTRACT TRUNCATED AT 250 WORDS)
SUMMARY 30 schizophrenics who met the criteria of Feighner et al. and were having verbal auditory hallucination with or without hallucinations of other varieties were chosen for the study. Psychoticism was measured with the help of Eysenck's Personality Questionnaire. The relation of psychoticism scores to different aspects of auditory hallucinations was examined. High psychoticism scores seemed to be associated with a greater number of languages of the voice, known living ‘speakers’ and less fear and passive listening during the voice. PMID:21965978
Li, Haibin; Wang, Yiran; Jiang, Jiangling; Li, Wei; Li, Chunbo
Transcranial direct current stimulation (tDCS) is a non-invasion brain stimulation, which has been suggested as a safe and promising treatment for auditory hallucinations, however, no systematic review has been conducted to evaluate the effects of tDCS on auditory hallucinations (AH). To investigate the efficacy and safety of tDCS for auditory hallucinations among patients with schizophrenia. We searched relevant randomized controlled trials (RCTs) from PubMed, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, and Taiwan Electronic Periodical Services (TEPS) before February 13, 2016. Studies were selected based on pre-defined inclusion and exclusion criteria. The quality of each included study was assessed by the risk of bias table. The levels of evidence of primary outcomes were evaluated using GRADE criteria. Data synthesis was conducted using RevMan 5.3. 304 papers were screened. Finally, three studies with a combined sample size of 87 patients were included in the meta-analysis. Two studies were classified as having 'low risk of bias', one study was classified as having 'unclear'. Inconsistent results and the overall level of evidence of primary outcome was graded as 'low'. The sample sizes of the published studies were small and the results were inconsistent. We could not draw any strong conclusions from these trials. Further high quality RCTs with large sample sizes are needed to assess the efficacy of tDCS for auditory hallucinations in patients with schizophrenia.
Skoy, Elizabeth T; Eukel, Heidi N; Frenzel, Jeanne E; Werremeyer, Amy; McDaniel, Becky
Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness.
Eukel, Heidi N.; Frenzel, Jeanne E.; Werremeyer, Amy; McDaniel, Becky
Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness. PMID:27899838
Sugimori, Eriko; Asai, Tomohisa; Tanno, Yoshihiko
This study investigated the effects of imagining speaking aloud, sensorimotor feedback, and auditory feedback on respondents' reports of having spoken aloud and examined the relationship between responses to "spoken aloud" in the reality-monitoring task and the sense of agency over speech. After speaking aloud, lip-synching, or imagining speaking, participants were asked whether each word had actually been spoken. The number of endorsements of "spoken aloud" was higher for words spoken aloud than for those lip-synched and higher for words lip-synched than for those imagined as having been spoken aloud. When participants were prevented by white noise from receiving auditory feedback, the discriminability of words spoken aloud decreased, and when auditory feedback was altered, reports of having spoken aloud decreased even though participants had actually done so. It was also found that those who have had auditory hallucination-like experiences were less able than were those without such experiences to discriminate the words spoken aloud, suggesting that endorsements of having "spoken aloud" in the reality-monitoring task reflected a sense of agency over speech. These results were explained in terms of the source-monitoring framework, and we proposed a revised forward model of speech in order to investigate auditory hallucinations.
Chyzhyk, Darya; Graña, Manuel; Öngür, Döst; Shinn, Ann K
Auditory hallucinations (AH) are a symptom that is most often associated with schizophrenia, but patients with other neuropsychiatric conditions, and even a small percentage of healthy individuals, may also experience AH. Elucidating the neural mechanisms underlying AH in schizophrenia may offer insight into the pathophysiology associated with AH more broadly across multiple neuropsychiatric disease conditions. In this paper, we address the problem of classifying schizophrenia patients with and without a history of AH, and healthy control (HC) subjects. To this end, we performed feature extraction from resting state functional magnetic resonance imaging (rsfMRI) data and applied machine learning classifiers, testing two kinds of neuroimaging features: (a) functional connectivity (FC) measures computed by lattice auto-associative memories (LAAM), and (b) local activity (LA) measures, including regional homogeneity (ReHo) and fractional amplitude of low frequency fluctuations (fALFF). We show that it is possible to perform classification within each pair of subject groups with high accuracy. Discrimination between patients with and without lifetime AH was highest, while discrimination between schizophrenia patients and HC participants was worst, suggesting that classification according to the symptom dimension of AH may be more valid than discrimination on the basis of traditional diagnostic categories. FC measures seeded in right Heschl's gyrus (RHG) consistently showed stronger discriminative power than those seeded in left Heschl's gyrus (LHG), a finding that appears to support AH models focusing on right hemisphere abnormalities. The cortical brain localizations derived from the features with strong classification performance are consistent with proposed AH models, and include left inferior frontal gyrus (IFG), parahippocampal gyri, the cingulate cortex, as well as several temporal and prefrontal cortical brain regions. Overall, the observed findings suggest that
CHYZHYK, DARYA; GRAÑA, MANUEL; ÖNGÜR, DÖST; SHINN, ANN K
Auditory hallucinations (AH) are a symptom that is most often associated with schizophrenia, but patients with other neuropsychiatric conditions, and even a small percentage of healthy individuals, may also experience AH. Elucidating the neural mechanisms underlying AH in schizophrenia may offer insight into the pathophysiology associated with AH more broadly across multiple neuropsychiatric disease conditions. In this paper, we address the problem of classifying schizophrenia patients with and without a history of AH, and healthy control subjects. To this end, we performed feature extraction from resting state functional magnetic resonance imaging (rsfMRI) data and applied machine learning classifiers, testing two kinds of neuroimaging features: (a) functional connectivity measures computed by lattice auto-associative memories (LAAM), and (b) local activity measures, including regional homogeneity (ReHo) and fractional amplitude of low frequency fluctuations (fALFF). We show that it is possible to perform classification within each pair of subject groups with high accuracy. Discrimination between patients with and without lifetime AH was highest, while discrimination between schizophrenia patients and healthy control participants was worst, suggesting that classification according to the symptom dimension of AH may be more valid than discrimination on the basis of traditional diagnostic categories. Functional connectivity measures seeded in right Heschl’s gyrus consistently showed stronger discriminative power than those seeded in left Heschl’s gyrus, a finding that appears to support AH models focusing on right hemisphere abnormalities. The cortical brain localizations derived from the features with strong classification performance are consistent with proposed AH models, and include left inferior frontal gyrus, parahippocampal gyri, the cingulate cortex, as well as several temporal and prefrontal cortical brain regions. Overall, the observed findings suggest
Powers, Albert R; Gancsos, Mark G; Finn, Emily S; Morgan, Peter T; Corlett, Philip R
Ketamine, the NMDA glutamate receptor antagonist drug, is increasingly employed as an experimental model of psychosis in healthy volunteers. At subanesthetic doses, it safely and reversibly causes delusion-like ideas, amotivation and perceptual disruptions reminiscent of the aberrant salience experiences that characterize first-episode psychosis. However, auditory verbal hallucinations, a hallmark symptom of schizophrenia, have not been reported consistently in healthy volunteers even at high doses of ketamine. Here we present data from a set of healthy participants who received moderately dosed, placebo-controlled ketamine infusions in the reduced stimulation environment of the magnetic resonance imaging (MRI) scanner. We highlight the phenomenological experiences of 3 participants who experienced particularly vivid hallucinations. Participants in this series reported auditory verbal and musical hallucinations at a ketamine dose that does not induce auditory hallucination outside of the scanner. We interpret the observation of ketamine-induced auditory verbal hallucinations in the context of the reduced perceptual environment of the MRI scanner and offer an explanation grounded in predictive coding models of perception and psychosis - the brain fills in expected perceptual inputs, and it does so more in situations of altered perceptual input. The altered perceptual input of the MRI scanner creates a mismatch between top-down perceptual expectations and the heightened bottom-up signals induced by ketamine. Such circumstances induce aberrant percepts, including musical and auditory verbal hallucinations. We suggest that these circumstances might represent a useful experimental model of auditory verbal hallucinations and highlight the impact of ambient sensory stimuli on psychopathology. © 2015 S. Karger AG, Basel.
Homan, P; Kindler, J; Hauf, M; Hubl, D; Dierks, T
Auditory hallucinations comprise a critical domain of psychopathology in schizophrenia. Repetitive transcranial magnetic stimulation (TMS) has shown promise as an intervention with both positive and negative reports. The aim of this study was to test resting-brain perfusion before treatment as a possible biological marker of response to repetitive TMS. Twenty-four medicated patients underwent resting-brain perfusion magnetic resonance imaging with arterial spin labeling (ASL) before 10 days of repetitive TMS treatment. Response was defined as a reduction in the hallucination change scale of at least 50%. Responders (n=9) were robustly differentiated from nonresponders (n=15) to repetitive TMS by the higher regional cerebral blood flow (CBF) in the left superior temporal gyrus (STG) (P<0.05, corrected) before treatment. Resting-brain perfusion in the left STG predicted the response to repetitive TMS in this study sample, suggesting this parameter as a possible bio-marker of response in patients with schizophrenia and auditory hallucinations. Being noninvasive and relatively easy to use, resting perfusion measurement before treatment might be a clinically relevant way to identify possible responders and nonresponders to repetitive TMS. PMID:23168989
Wahass, S; Kent, G
The successful introduction of community interventions is partly dependent on public beliefs about the aetiology and treatment of psychiatric difficulties and tolerance of community integration. This study examined community attitudes towards auditory hallucinations in Saudi Arabia (SA) and the United Kingdom (UK) concerning (a) causes of auditory hallucinations, (b) the efficacy of interventions and (c) levels of social rejection. Responses from 281 patients attending their general practitioners indicated that those living in Saudi Arabia were most likely to believe that hallucinations are caused by Satan or due to magic, while the UK sample were more likely to cite schizophrenia or brain damage. While the Saudi sample believed that religious assistance would be most effective, the UK sample supported medication and psychological therapies. Beliefs about aetiology and treatment were unrelated to educational attainment. There was a greater degree of social rejection of patients in Saudi Arabia, but here educational attainment was of significance. These results suggest that beliefs about aetiology are related to treatment recommendations and social distancing, and thus have implications for the care of Arabic patients living in Western countries as well as for the use of Western interventions in non-Western cultures.
Chang, Xiao; Xi, Yi-Bin; Cui, Long-Biao; Wang, Hua-Ning; Sun, Jin-Bo; Zhu, Yuan-Qiang; Huang, Peng; Collin, Guusje; Liu, Kang; Xi, Min; Qi, Shun; Tan, Qing-Rong; Miao, Dan-Min; Yin, Hong
Evidence from behavioral, electrophysiological and diffusion-weighted imaging studies suggest that schizophrenia patients suffer from deficiencies in bilateral brain communication, and this disruption may be related to the occurrence of auditory verbal hallucinations (AVH). To increase our understanding of aberrant inter-hemispheric communication in relation to AVH, we recruited two groups of first-episode schizophrenia patients: one group with AVH (N = 18 AVH patients) and one without hallucinations (N = 18 Non-AVH patients), and 20 healthy controls. All participants received T1 structural imaging and resting-state fMRI scanning. We adopted a newly developed index, voxel-mirrored homotopic connectivity (VMHC), to quantitatively describe bilateral functional connectivity. The whole-brain VMHC measure was compared among the three groups and correlation analyses were conducted between symptomology scores and neurological measures. Our findings suggest all patients shared abnormalities in parahippocampus and striatum. Aberrant bilateral connectivity of default mode network (DMN), inferior frontal gyrus and cerebellum only showed in AVH patients, whereas aberrances in superior temporal gyrus and precentral gyrus were specific to Non-AVH patients. Meanwhile, inter-hemispheric connectivity of DMN correlated with patients’ symptomatology scores. This study corroborates that schizophrenia is characterized by inter-hemispheric dysconnectivity, and suggests the localization of such abnormalities may be crucial to whether auditory verbal hallucinations develop. PMID:26053998
Ying, Jun; Zhou, Dan; Lin, Ke; Gao, Xiaorong
The auditory steady-state response (ASSR) may reflect activity from different regions of the brain. Particularly, it was reported that the gamma-band ASSR plays an important role in working memory, speech understanding, and recognition. Traditionally, the ASSR has been determined by power spectral density analysis, which cannot detect the exact overall distributed properties of the ASSR. Functional network analysis has recently been applied in electroencephalography studies. Previous studies on resting or working state found a small-world organization of the brain network. Some researchers have studied dysfunctional networks caused by diseases. The present study investigates the brain connection networks of schizophrenia patients with auditory hallucinations during an ASSR task. A directed transfer function is utilized to estimate the brain connectivity patterns. Moreover, the structures of brain networks are analyzed by converting the connectivity matrices into graphs. It is found that for normal subjects, network connections are mainly distributed at the central and frontal-temporal regions. This indicates that the central regions act as transmission hubs of information under ASSR stimulation. For patients, network connections seem unordered. The finding that the path length was larger in patients compared to that in normal subjects under most thresholds provides insight into the structures of connectivity patterns. The results suggest that there are more synchronous oscillations that cover a long distance on the cortex but a less efficient network for patients with auditory hallucinations.
Zanello, Adriano; Mohr, Sylvia; Merlo, Marco C G; Huguelet, Philippe; Rey-Bellet, Philippe
The current study investigated the effectiveness of a group cognitive behavioral therapy for auditory verbal hallucinations (AVHs), the Voices Group. This consists of seven specific sessions. Forty-one participants with schizophrenic or schizoaffective disorders completed a battery of questionnaires. The severity of psychiatric symptoms, beliefs about voices, quality of life, self-esteem, clinical global impression, and functioning were assessed at baseline, before and after intervention, and at the 6-month follow-up. After intervention, there was a statistically significant reduction in the severity of AVHs. This result remained stable at follow-up. The dropout rate was high. Some differences were found in subjective experience of AVHs between the patients who completed the intervention and those who dropped out. Altogether, these findings suggest that a brief intervention has some positive benefits in patients struggling with voices, which remain stable over time.
Gilabert-Juan, Javier; Sáez, Ana Rosa; Lopez-Campos, Guillermo; Sebastiá-Ortega, Noelia; González-Martínez, Rocio; Costa, Juan; Haro, Josep María; Callado, Luis F; Meana, J Javier; Nacher, Juán; Sanjuán, Julio; Moltó, María Dolores
Auditory hallucinations (AH) are clinical hallmarks of schizophrenia, however little is known about molecular genetics of these symptoms. In this study, gene expression profiling of postmortem brain samples from prefrontal cortex of schizophrenic patients without AH (SNA), patients with AH (SA) and control subjects were compared. Genome-wide expression analysis was conducted using samples of three individuals of each group and the Affymetrix GeneChip Human-Gene 1.0 ST-Array. This analysis identified the Axon Guidance pathway as one of the most differentially expressed network among SNA, SA and CNT. To confirm the transcriptome results, mRNA level quantification of seventeen genes involved in this pathway was performed in a larger sample. PLXNB1, SEMA3A, SEMA4D and SEM6C were upregulated in SNA or SA patients compared to controls. PLXNA1 and SEMA3D showed down-regulation in their expression in the patient's samples, but differences remained statistically significant between the SNA patients and controls. Differences between SNA and SA were found in PLXNB1 expression which is decreased in SA patients. This study strengthens the contribution of brain plasticity in pathophysiology of schizophrenia and shows that non-hallucinatory patients present more alterations in frontal regions than patients with hallucinations concerning neural plasticity.
Bernini, Marco; Woods, Angela
In this article, we advocate a bottom-up direction for the methodological modeling of interdisciplinary research based on concrete interactions among individuals within interdisciplinary projects. Drawing on our experience in Hearing the Voice (a cross-disciplinary project on auditory verbal hallucinations running at Durham University), we focus on the dynamic if also problematic integration of cognitive science (neuroscience, cognitive psychology, and of mind), phenomenology, and humanistic disciplines (literature, narratology, history, and theology). We propose a new model for disciplinary integration which brings to the fore an under-investigated dynamic of interdisciplinary projects, namely their being processes of distributed cognition and cognitive integration. PMID:26005512
Bernini, Marco; Woods, Angela
In this article, we advocate a bottom-up direction for the methodological modeling of interdisciplinary research based on concrete interactions among individuals within interdisciplinary projects. Drawing on our experience in Hearing the Voice (a cross-disciplinary project on auditory verbal hallucinations running at Durham University), we focus on the dynamic if also problematic integration of cognitive science (neuroscience, cognitive psychology, and of mind), phenomenology, and humanistic disciplines (literature, narratology, history, and theology). We propose a new model for disciplinary integration which brings to the fore an under-investigated dynamic of interdisciplinary projects, namely their being processes of distributed cognition and cognitive integration.
Fernyhough, Charles; Waters, Flavie
This Special Supplement presents reports from 11 working groups of the interdisciplinary International Consortium on Hallucination Research meeting in Durham, UK, September 2013. Topics include psychological therapies for auditory hallucinations, culture and hallucinations, hallucinations in children and adolescents, visual hallucinations, interdisciplinary approaches to the phenomenology of auditory verbal hallucinations (AVHs), AVHs in persons without need for care, a multisite study of the PSYRATS instrument, subtypes of AVHs, the Hearing Voices Movement, Research Domain Criteria for hallucinations, and cortical specialization as a route to understanding hallucinations. PMID:24936079
Curcic-Blake, Branislava; Liemburg, Edith; Vercammen, Ans; Swart, Marte; Knegtering, Henderikus; Bruggeman, Richard; Aleman, André
Auditory-verbal hallucinations (AVHs) are frequently associated with activation of the left superior temporal gyrus (including Wernicke's area), left inferior frontal gyrus (including Broca's area), and the right hemisphere homologs of both areas. It has been hypothesized that disconnectivity of both interhemispheric transfer and frontal and temporal areas may underlie hallucinations in schizophrenia. We investigated reduced information flow in this circuit for the first time using dynamic causal modeling, which allows for directional inference. A group of healthy subjects and 2 groups of schizophrenia patients-with and without AVH-performed a task requiring inner speech processing during functional brain scanning. We employed connectivity models between left hemispheric speech-processing areas and their right hemispheric homologs. Bayesian model averaging was used to estimate the connectivity strengths and evaluate group differences. Patients with AVH showed significantly reduced connectivity from Wernicke's to Broca's area (97% certainty) and a trend toward a reduction in connectivity from homologs of Broca's and Wernicke's areas to Broca's area (93% and 94% certainty). The connectivity magnitude in patients without hallucinations was found to be intermediate. Our results point toward a reduced input from temporal to frontal language areas in schizophrenia patients with AVH, suggesting that Broca's activity may be less constrained by perceptual information received from the temporal cortex. In addition, a lack of synchronization between Broca and its homolog may lead to the erroneous interpretation of emotional speech activity from the right hemisphere as coming from an external source.
Baumeister, David; Sedgwick, Ottilie; Howes, Oliver; Peters, Emmanuelle
Recent decades have seen a surge of research interest in the phenomenon of healthy individuals who experience auditory verbal hallucinations, yet do not exhibit distress or need for care. The aims of the present systematic review are to provide a comprehensive overview of this research and examine how healthy voice-hearers may best be conceptualised in relation to the diagnostic versus 'quasi-' and 'fully-dimensional' continuum models of psychosis. A systematic literature search was conducted, resulting in a total of 398 article titles and abstracts that were scrutinised for appropriateness to the present objective. Seventy articles were identified for full-text analysis, of which 36 met criteria for inclusion. Subjective perceptual experience of voices, such as loudness or location (i.e., inside/outside head), is similar in clinical and non-clinical groups, although clinical voice-hearers have more frequent voices, more negative voice content, and an older age of onset. Groups differ significantly in beliefs about voices, control over voices, voice-related distress, and affective difficulties. Cognitive biases, reduced global functioning, and psychiatric symptoms such as delusions, appear more prevalent in healthy voice-hearers than in healthy controls, yet less than in clinical samples. Transition to mental health difficulties is increased in HVHs, yet only occurs in a minority and is predicted by previous mood problems and voice distress. Whilst healthy voice-hearers show similar brain activity during hallucinatory experiences to clinical voice-hearers, other neuroimaging measures, such as mismatch negativity, have been inconclusive. Risk factors such as familial and childhood trauma appear similar between clinical and non-clinical voice-hearers. Overall the results of the present systematic review support a continuum view rather than a diagnostic model, but cannot distinguish between 'quasi' and 'fully' dimensional models. Healthy voice-hearers may be a key
Musical hallucinations have been described in numerous neurologic and psychiatric patients, but their pathophysiologic background is not understood. Analyzing the published cases, five subgroups can be separated according to their etiology: hypacusis, psychiatric disorders, focal brain lesions, epilepsy, and intoxication. There is a female preponderance of about 70%. Musical hallucinations most often occur in patients over age 60 years, although patients whose hallucinations are caused by focal brain lesions are significantly younger. Hemispheric dominance seems to play no major role in the pathogenesis of musical hallucinations, but hypacusis is present in the majority of all patients. Anticonvulsant and antidepressive agents have been effective in the treatment of some musical hallucinations. The discussion on the pathophysiology of musical hallucinations comprises theories of deafferentation (including auditory Charles Bonnet syndrome), of sensory auditory deprivation, of parasitic memory, and of spontaneous activity in a cognitive network module.
Zhuo, Chuan-Jun; Zhu, Jia-Jia; Wang, Chun-Li; Wang, Li-Na; Li, Jie; Qin, Wen
Background: Auditory verbal hallucinations (AVHs) of schizophrenia have been associated with structural and functional alterations of some brain regions. However, the brain regional homogeneity (ReHo) alterations specific to AVHs of schizophrenia remain unclear. In the current study, we aimed to investigate ReHo alterations specific to schizophrenic AVHs. Methods: Thirty-five schizophrenic patients with AVH, 41 schizophrenic patients without AVHs, and fifty healthy subjects underwent resting-state functional magnetic resonance imaging. ReHo differences across the three groups were tested using a voxel-wise analysis. Results: Compared with the healthy control group, the two schizophrenia groups showed significantly increased ReHo in the right caudate and inferior temporal gyrus and decreased ReHo in the bilateral postcentral gyrus and thalamus and the right inferior occipital gyrus (false discovery rate corrected, P < 0.05). More importantly, the AVH group exhibited significantly increased ReHo in the left precuneus compared with the non-AVH group. However, using correlation analysis, we did not find any correlation between the auditory hallucination rating scale score and the ReHo of brain regions. Conclusions: Our results suggest that increased ReHo in the left precuneus may be a pathological feature exclusive to schizophrenic AVHs. PMID:26996476
de Weijer, Antoin D; Sommer, Iris E C; Lotte Meijering, Anne; Bloemendaal, Mirjam; Neggers, Sebastiaan F W; Daalman, Kirstin; Boezeman, Eduard H J F
The great majority of studies on repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool for auditory verbal hallucinations (AVH) have used 1-Hz stimulation with inconsistent results. Recently, it has been suggested that 20-Hz rTMS has strong therapeutic effects. It is conceivable that this 20-Hz stimulation is more effective than 1-Hz stimulation. The aim of this preliminary study is to investigate the efficacy of 20-Hz rTMS compared with 1-Hz rTMS as a treatment for AVH. Eighteen schizophrenia patients with medication-resistant AVH were randomized over two treatment groups. Each group received either 20 min of 1-Hz rTMS or 13 trains of 20-Hz rTMS daily over 1 week. After week 1, patients received a follow-up treatment once a week for 3 weeks. Stimulation location was based on individual AVH-related activation patterns identified with functional magnetic resonance imaging. Severity of AVH was monitored with the Auditory Hallucination Rating Scale (AHRS). Both groups showed a decrease in AVH after week 1 of rTMS. This decrease was significant for the 20-Hz group and the 1-Hz group. When the two treatment types were compared, no treatment type was superior. Based on these results we cannot conclude whether high frequency rTMS is more effective against AVH than is traditional 1-Hz rTMS. More research is needed to optimize stimulation parameters and to investigate potential target locations for stimulation.
García-Montes, José M; Cangas, Adolfo; Pérez-Alvarez, M; Fidalgo, Angel M; Gutiérrez, Olga
This study examines the relationship between a predisposition to hallucinations and meta-cognitive variables and thought-control techniques, controlling for the possible effect of anxiety. In order to do so, we start out with the hypothesis that anxiety does not, in itself, explain the association between meta-cognitions and a predisposition to auditory and visual hallucinations. A within-participants correlational design was employed. Four psychometric tests relating to predisposition to hallucinations, anxiety, meta-cognitions and thought-control techniques were administered to 150 participants. It was found that, after controlling for participants' anxiety levels, the 'loss of cognitive confidence' factor predicted the score on the scale of predisposition to both auditory and visual hallucinations. Thought-control strategies based on worry were also found to be predictive of a greater predisposition to hallucinations, regardless of whether or not participants' anxiety level was controlled. Meta-cognitive variables of cognitive confidence and thought control through worry are positively associated with a predisposition to hallucinations. The correlational nature of the design does not allow inferences about causal relationships.
Auditory hallucination is a key characteristic of schizophrenia that seriously debilitates the patient, with consequences for social engagement with others. Hallucinatory experiences are also observed in healthy individuals in the general population who report "hearing voices" in the absence of an external acoustic input. A view on auditory hallucinations and "hearing voices" is presented that regards such phenomena as perceptual processes, originating from speech perception areas in the left temporal lobe. Healthy individuals "hearing voices" are, however, often aware that the experience comes from inner thought processes, which is not reported by hallucinating patients. A perceptual model can therefore, not alone explain the difference in the phenomenology of how the "voices heard" are attributed to either an inner or outer cause. An expanded model is thus presented which takes into account top-down cognitive control, localized to prefrontal cortical areas, to inhibit and re-attribute the perceptual mis-representations. The expanded model is suggested to be empirically validated using a dichotic listening speech perception paradigm with instructions for top-down control of attention focus to either the right or left side in auditory space. It is furthermore suggested to use fMRI to validate the temporal and frontal lobe neuronal correlates of the cognitive processes involved in auditory hallucinations.
Kubera, Katharina M; Sambataro, Fabio; Vasic, Nenad; Wolf, Nadine D; Frasch, Karel; Hirjak, Dusan; Thomann, Philipp A; Wolf, R Christian
Abnormal structure of frontal and temporal brain regions has been suggested to occur in patients with schizophrenia who have frequent auditory verbal hallucinations (AVH). However, it is unknown whether this is specific to this patient subgroup. This study tested the hypothesis that frontotemporal gray matter volume changes would characterize patients with persistent AVH (pAVH) in contrast to healthy controls and patients without AVH. Using structural magnetic resonance imaging at 3T, we studied 20 patients with schizophrenia and 14 matched healthy controls. Ten patients were classified as having chronic and treatment resistant AVH, whereas the remaining 10 patients either never had AVH in the past or were in full remission with regard to AVH (nAVH). Using a multivariate statistical technique for structural data, i.e. "source-based morphometry" (SBM), we investigated naturally grouping patterns of gray matter volume variation among individuals, the magnitude of their expression between-groups and the relationship between gray matter volume and AVH-specific measures. SBM identified a reduction of medial and inferior frontal, insular and bilateral temporal gray matter volume between pAVH and nAVH. This pattern did not differ between nAVH patients and controls and was associated with "physical" AVH characteristics (such as symptom duration, location, frequency and intensity) in the pAVH patient group. These results suggest that a pattern of lower gray matter volume in medial frontal, insular and bilateral temporal cortical regions differentiates between patients with persistent AVH and non-hallucinating patients. Moreover, the data support a specific role of this neural pattern in AVH symptom expression.
Sobanski, T; Sieb, J P; Laux, G; Möller, H J
This 52-year-old man suffered from auditory hallucinations that occurred during brief episodes of sleep paralysis at the end of REM sleep periods. During these episodes the patient experienced a dissociated state of consciousness with REM sleep intrusions into wakefulness. The occurrence of this mixed state, and of excessive sleep-onset REM periods during daytime polysomnography (MSLT = Multiple Sleep Latency Test), point to a disorder of REM sleep generation. The existence of narcolepsy could be ruled out. The observation of REM sleep-associated hallucinations has been reported earlier. In the presented polysomnographic sleep studies the existence of a REM sleep associated parasomnia characterised by hallucinations and sleep paralysis could be confirmed.
Zhuo, Chuanjun; Zhu, Jiajia; Qin, Wen; Qu, Hongru; Ma, Xiaolei; Yu, Chunshui
BackgroundAuditory verbal hallucinations (AVHs) have been associated with deficits in auditory and speech-related networks. However, the resting-state cerebral blood flow (CBF) alterations specific to AVHs in schizophrenia remain unknown.AimsTo explore AVH-related CBF alterations in individuals with schizophrenia.MethodIn total, 35 individuals with schizophrenia with AVHs, 41 individuals with schizophrenia without AVHs and 50 controls underwent arterial spin labelling magnetic resonance imaging. The CBF differences were voxel-wise compared across the three groups.ResultsWe found AVH-specific CBF increase in the right superior temporal gyrus and caudate, and AVH-specific CBF decrease in the bilateral occipital and left parietal cortices. We also observed consistent CBF changes in both schizophrenia subgroups (i.e. those with and without AVHs) including decreased CBF in the bilateral occipital regions, the left lateral prefrontal and insular cortices, and the right anterior cingulate cortex and increased CBF in the bilateral lateral temporal regions and putamen, the left middle cingulate cortex and the right thalamus.ConclusionsThe AVH-specific CBF increases in the auditory and striatal areas and CBF reductions in the visual and parietal areas suggest that there exists a CBF redistribution associated with AVHs. © The Royal College of Psychiatrists 2017.
Kompus, Kristiina; Løberg, Else-Marie; Posserud, Maj-Britt; Lundervold, Astri Johansen
Knowing the prevalence and characteristics of auditory verbal hallucinations (AVH) in adolescents is important for estimations of need for mental health care and assessment of psychosis risk. In this report we assess the prevalence of AVH in a population-based sample of 16–19 years old Norwegian adolescents (n = 9,646, 46.4% male) using two items assessing AVH (from the extended Launay-Slade Hallucination Scale). The prevalence of hearing a voice speaking thoughts aloud was 10.6%. The prevalence of being troubled by voices was 5.3%, showing that negative emotionality about AVH is less frequent than the experience of hearing voices. Female respondents had slightly increased risk for being troubled by voices than males (odds ratio = 1.3), while age did not modulate prevalence. This AVH prevalence is in line with earlier reports in smaller samples of adolescents and indicates that AVH are not uncommon in this period of life. Further longitudinal studies are needed to investigate the value of AVH in predicting psychiatric disorder. PMID:25968251
Mou, Xiaodong; Bai, Feng; Xie, Chunming; Shi, Jiabo; Yao, Zhijian; Hao, Guifeng; Chen, Ning; Zhang, Zhijun
Auditory verbal hallucination (AVH) is a pathological hallmark of schizophrenia; however, their neural basis is unclear. Voice identity is an important phenomenological feature of AVHs. Certain voice identity recognition deficits are specific to schizophrenic patients with AVHs. We tested our hypothesis that among schizophrenia patients with hallucination, dysfunctional voice identity recognition is associated with poor functional integration in the neural networks involved in the evaluation of voice identity. Using functional magnetic resonance imaging (fMRI) during a voice recognition task, we examined the modulation of neural network connectivity in 26 schizophrenic patients with or without AVHs, and 13 healthy controls. Our results showed that the schizophrenic patients with AVHs had altered frontotemporal connectivity compared to the schizophrenic patients without AVHs and healthy controls. The latter two groups did not show any differences in functional connectivity. In addition, the strength of frontotemporal connectivity was correlated with the accuracy of voice recognition. These findings provide preliminary evidence that impaired functional integration may contribute to the faulty appraisal of voice identity in schizophrenic patients with AVHs.
Vercammen, Ans; Knegtering, Henderikus; Bruggeman, Richard; Aleman, André
One of the most influential cognitive models of auditory verbal hallucinations (AVH) suggests that a failure to adequately monitor the production of one's own inner speech leads to verbal thought being misidentified as an alien voice. However, it is unclear whether this theory can explain the phenomenological complexity of AVH. We aimed to assess whether subjective perceptual and experiential characteristics may be linked to neural activation in the inner speech processing network. Twenty-two patients with schizophrenia and AVH underwent a 3-T functional magnetic resonance imaging scan, while performing a metrical stress evaluation task, which has been shown to activate both inner speech production and perception regions. Regions of interest (ROIs) comprising the putative inner speech network were defined using the Anatomical Automatic Labeling system. Correlations were calculated between scores on the "loudness" and "reality" subscales of the Auditory Hallucination Rating Scale (AHRS) and activation in these ROIs. Second, the AHRS subscales, and general AVH severity, indexed by the Positive and Negative Syndrome Scale, were correlated with a language lateralization index. Louder AVH were associated with reduced task-related activity in bilateral angular gyrus, anterior cingulate gyrus, left inferior frontal gyrus, left insula, and left temporal cortex. This could potentially be due to a competition for shared neural resources. Reality on the other hand was found to be associated with reduced language lateralization. Strong activation of the inner speech processing network may contribute to the subjective loudness of AVH. However, a relatively increased contribution from right hemisphere language areas may be responsible for the more complex experiential characteristics, such as the nonself source or how real AVH are.
Waters, Flavie; Woods, Angela; Fernyhough, Charles
This article presents a report on the 2nd meeting of the International Consortium on Hallucination Research, held on September 12th and 13th 2013 at Durham University, UK. Twelve working groups involving specialists in each area presented their findings and sought to summarize the available knowledge, inconsistencies in the field, and ways to progress. The 12 working groups reported on the following domains of investigation: cortical organisation of hallucinations, nonclinical hallucinations, interdisciplinary approaches to phenomenology, culture and hallucinations, subtypes of auditory verbal hallucinations, a Psychotic Symptoms Rating Scale multisite study, visual hallucinations in the psychosis spectrum, hallucinations in children and adolescents, Research Domain Criteria behavioral constructs and hallucinations, new methods of assessment, psychological therapies, and the Hearing Voices Movement approach to understanding and working with voices. This report presents a summary of this meeting and outlines 10 hot spots for hallucination research, which include the in-depth examination of (1) the social determinants of hallucinations, (2) translation of basic neuroscience into targeted therapies, (3) different modalities of hallucination, (4) domain convergence in cross-diagnostic studies, (5) improved methods for assessing hallucinations in nonclinical samples, (6) using humanities and social science methodologies to recontextualize hallucinatory experiences, (7) developmental approaches to better understand hallucinations, (8) changing the memory or meaning of past trauma to help recovery, (9) hallucinations in the context of sleep and sleep disorders, and (10) subtypes of hallucinations in a therapeutic context.
Clos, Mareike; Diederen, Kelly M J; Meijering, Anne Lotte; Sommer, Iris E; Eickhoff, Simon B
Auditory verbal hallucinations (AVH) are a hallmark of psychotic experience. Various mechanisms including misattribution of inner speech and imbalance between bottom-up and top-down factors in auditory perception potentially due to aberrant connectivity between frontal and temporo-parietal areas have been suggested to underlie AVH. Experimental evidence for disturbed connectivity of networks sustaining auditory-verbal processing is, however, sparse. We compared functional resting-state connectivity in 49 psychotic patients with frequent AVH and 49 matched controls. The analysis was seeded from the left middle temporal gyrus (MTG), thalamus, angular gyrus (AG) and inferior frontal gyrus (IFG) as these regions are implicated in extracting meaning from impoverished speech-like sounds. Aberrant connectivity was found for all seeds. Decreased connectivity was observed between the left MTG and its right homotope, between the left AG and the surrounding inferior parietal cortex (IPC) and the left inferior temporal gyrus, between the left thalamus and the right cerebellum, as well as between the left IFG and left IPC, and dorsolateral and ventrolateral prefrontal cortex (DLPFC/VLPFC). Increased connectivity was observed between the left IFG and the supplementary motor area (SMA) and the left insula and between the left thalamus and the left fusiform gyrus/hippocampus. The predisposition to experience AVH might result from decoupling between the speech production system (IFG, insula and SMA) and the self-monitoring system (DLPFC, VLPFC, IPC) leading to misattribution of inner speech. Furthermore, decreased connectivity between nodes involved in speech processing (AG, MTG) and other regions implicated in auditory processing might reflect aberrant top-down influences in AVH.
Zhang, Z-J; Hao, G-F; Shi, J-B; Mou, X-D; Yao, Z-J; Chen, N
Auditory hallucinations (AVHs), like real auditory perceptions, are often perceived as familiar voices. Given that neural correlates of AVHs involve the auditory cortex, it is likely that those brain regions responsible for recognition of voice identity are invoked during AVHs. Schizophrenic patients with (n = 13) and without (n = 13) auditory hallucinations, and 13 healthy subjects performed a voice recognition task during functional magnetic resonance imaging at 1.5 T. In the task using prerecorded vocal stimuli, they classified voice as familiar and unfamiliar. Under the familiar minus unfamiliar contrasts, cerebral activation pattern is different in the three groups and patients with auditory hallucinations showed less activation in the right temporal lobe than controls. Voice recognition was impaired in patients with AVHs. Our results support that auditory association cortices play a role in the perception of AVHs.
While Auditory Verbal Hallucinations (AVH) refer to specific experiences shared by all subjects who have AVH—the perception of auditory speech without corresponding external stimuli, the characteristics of these experiences differ from one subject to another. These characteristics include aspects such as the location of AVH (inside or outside the head), the linguistic complexity of AVH (hearing words, sentences, or conversations), the range of content of AVH (repetitive or systematized content), and many other variables. In another word, AVH are phenomenologically heterogeneous experiences. After decades of research focused on a few explanatory mechanisms for AVH, it is apparent that none of these mechanisms alone explains the wide phenomenological range of AVH experiences. To date, our phenomenological understanding of AVH remains largely disjointed from our understanding of the mechanisms of AVH. For a cohesive understanding of AVH, I review the phenomenology and the cognitive and neural basis of AVH. This review indicates that the phenomenology of AVH is not a pointless curiosity. How a subject describes his AVH experiences could inform about the neural events that resulted in AVH. I suggest that a subject-specific combinatoric associations of different neural events result in AVH experiences phenomenologically diverse across subjects. PMID:23755004
Thoma, Robert J; Chaze, Charlotte; Lewine, Jeffrey David; Calhoun, Vince D; Clark, Vincent P; Bustillo, Juan; Houck, Jon; Ford, Judith; Bigelow, Rose; Wilhelmi, Corbin; Stephen, Julia M; Turner, Jessica A
Functional MRI studies have identified a distributed set of brain activations to be associated with auditory verbal hallucinations (AVH). However, very little is known about how activated brain regions may be linked together into AVH-generating networks. Fifteen volunteers with schizophrenia or schizoaffective disorder pressed buttons to indicate onset and offset of AVH during fMRI scanning. When a general linear model was used to compare blood oxygenation level dependence signals during periods in which subjects indicated that they were versus were not experiencing AVH ("AVH-on" versus "AVH-off"), it revealed AVH-related activity in bilateral inferior frontal and superior temporal regions; the right middle temporal gyrus; and the left insula, supramarginal gyrus, inferior parietal lobule, and extranuclear white matter. In an effort to identify AVH-related networks, the raw data were also processed using independent component analyses (ICAs). Four ICA components were spatially consistent with an a priori network framework based upon published meta-analyses of imaging correlates of AVH. Of these four components, only a network involving bilateral auditory cortices and posterior receptive language areas was significantly and positively correlated to the pattern of AVH-on versus AVH-off. The ICA also identified two additional networks (occipital-temporal and medial prefrontal), not fully matching the meta-analysis framework, but nevertheless containing nodes reported as active in some studies of AVH. Both networks showed significant AVH-related profiles, but both were most active during AVH-off periods. Overall, the data suggest that AVH generation requires specific and selective activation of auditory cortical and posterior language regions, perhaps coupled to a release of indirect influence by occipital and medial frontal structures.
Thoma, Robert. J.; Chaze, Charlotte; Lewine, Jeffrey David; Calhoun, Vince D.; Clark, Vincent P.; Bustillo, Juan; Houck, Jon; Ford, Judith; Bigelow, Rose; Wilhelmi, Corbin; Stephen, Julia M.; Turner, Jessica A.
Functional MRI studies have identified a distributed set of brain activations to be associated with auditory verbal hallucinations (AVH). However, very little is known about how activated brain regions may be linked together into AVH-generating networks. Fifteen volunteers with schizophrenia or schizoaffective disorder pressed buttons to indicate onset and offset of AVH during fMRI scanning. When a general linear model was used to compare blood oxygenation level dependence signals during periods in which subjects indicated that they were versus were not experiencing AVH (“AVH-on” versus “AVH-off”), it revealed AVH-related activity in bilateral inferior frontal and superior temporal regions; the right middle temporal gyrus; and the left insula, supramarginal gyrus, inferior parietal lobule, and extranuclear white matter. In an effort to identify AVH-related networks, the raw data were also processed using independent component analyses (ICAs). Four ICA components were spatially consistent with an a priori network framework based upon published meta-analyses of imaging correlates of AVH. Of these four components, only a network involving bilateral auditory cortices and posterior receptive language areas was significantly and positively correlated to the pattern of AVH-on versus AVH-off. The ICA also identified two additional networks (occipital–temporal and medial prefrontal), not fully matching the meta-analysis framework, but nevertheless containing nodes reported as active in some studies of AVH. Both networks showed significant AVH-related profiles, but both were most active during AVH-off periods. Overall, the data suggest that AVH generation requires specific and selective activation of auditory cortical and posterior language regions, perhaps coupled to a release of indirect influence by occipital and medial frontal structures. PMID:27065889
Alonso-Solís, Anna; Vives-Gilabert, Yolanda; Grasa, Eva; Portella, Maria J; Rabella, Mireia; Sauras, Rosa Blanca; Roldán, Alexandra; Núñez-Marín, Fidel; Gómez-Ansón, Beatriz; Pérez, Víctor; Alvarez, Enric; Corripio, Iluminada
To understand the neural mechanism that underlies treatment resistant auditory verbal hallucinations (AVH), is still an important issue in psychiatric research. Alterations in functional connectivity during rest have been frequently reported in patients with schizophrenia. Though the default mode network (DN) appears to be abnormal in schizophrenia patients, little is known about its role in resistant AVH. We collected resting-state functional magnetic resonance imaging (R-fMRI) data with a 3T scanner from 19 schizophrenia patients with chronic AVH resistant to pharmacological treatment, 14 schizophrenia patients without AVH and 20 healthy controls. Using seed-based correlation analysis, we created spherical seed regions of interest (ROI) to examine functional connectivity of the two DN hub regions (posterior cingulate cortex and anteromedial prefrontal cortex) and the two DN subsystems: dorsomedial prefrontal cortex subsystem and medial temporal lobe subsystem (p<0.0045 corrected). Patients with hallucinations exhibited higher FC between dMPFC ROI and bilateral central opercular cortex, bilateral insular cortex and bilateral precentral gyrus compared to non hallucinating patients and healthy controls. Additionally, patients with hallucinations also exhibited lower FC between vMPFC ROI and bilateral paracingulate and dorsal anterior cingulate cortex. As the anterior cingulate cortex and the insula are two hubs of the salience network, our results suggest cross-network abnormalities between DN and salience system in patients with persistent hallucinations.
Pettersson-Yeo, William; Allen, Paul; Catani, Marco; Williams, Steven; Barsaglini, Alessio; Kambeitz-Ilankovic, Lana M.; McGuire, Philip; Mechelli, Andrea
Neuroimaging studies of schizophrenia have indicated that the development of auditory verbal hallucinations (AVHs) is associated with altered structural and functional connectivity within the perisylvian language network. However, these studies focussed mainly on either structural or functional alterations in patients with chronic schizophrenia. Therefore, they were unable to examine the relationship between the 2 types of measures and could not establish whether the observed alterations would be expressed in the early stage of the illness. We used diffusion tensor imaging and functional magnetic resonance imaging to examine white matter integrity and functional connectivity within the left perisylvian language network of 46 individuals with an at risk mental state for psychosis or a first episode of the illness, including 28 who had developed AVH group and 18 who had not (nonauditory verbal hallucination [nAVH] group), and 22 healthy controls. Inferences were made at P < .05 (corrected). The nAVH group relative to healthy controls showed a reduction of both white matter integrity and functional connectivity as well as a disruption of the normal structure−function relationship along the fronto-temporal pathway. For all measures, the AVH group showed intermediate values between healthy controls and the nAVH group. These findings seem to suggest that, in the early stage of the disorder, a significant impairment of fronto-temporal connectivity is evident in patients who do not experience AVHs. This is consistent with the hypothesis that, whilst mild disruption of connectivity might still enable the emergence of AVHs, more severe alterations may prevent the occurrence of the hallucinatory experience. PMID:24361862
Benetti, Stefania; Pettersson-Yeo, William; Allen, Paul; Catani, Marco; Williams, Steven; Barsaglini, Alessio; Kambeitz-Ilankovic, Lana M; McGuire, Philip; Mechelli, Andrea
Neuroimaging studies of schizophrenia have indicated that the development of auditory verbal hallucinations (AVHs) is associated with altered structural and functional connectivity within the perisylvian language network. However, these studies focussed mainly on either structural or functional alterations in patients with chronic schizophrenia. Therefore, they were unable to examine the relationship between the 2 types of measures and could not establish whether the observed alterations would be expressed in the early stage of the illness. We used diffusion tensor imaging and functional magnetic resonance imaging to examine white matter integrity and functional connectivity within the left perisylvian language network of 46 individuals with an at risk mental state for psychosis or a first episode of the illness, including 28 who had developed AVH group and 18 who had not (nonauditory verbal hallucination [nAVH] group), and 22 healthy controls. Inferences were made at P < .05 (corrected). The nAVH group relative to healthy controls showed a reduction of both white matter integrity and functional connectivity as well as a disruption of the normal structure-function relationship along the fronto-temporal pathway. For all measures, the AVH group showed intermediate values between healthy controls and the nAVH group. These findings seem to suggest that, in the early stage of the disorder, a significant impairment of fronto-temporal connectivity is evident in patients who do not experience AVHs. This is consistent with the hypothesis that, whilst mild disruption of connectivity might still enable the emergence of AVHs, more severe alterations may prevent the occurrence of the hallucinatory experience.
Kingdon, David G; Ashcroft, Katie; Bhandari, Bharathi; Gleeson, Stefan; Warikoo, Nishchint; Symons, Matthew; Taylor, Lisa; Lucas, Eleanor; Mahendra, Ravi; Ghosh, Soumya; Mason, Anthony; Badrakalimuthu, Raja; Hepworth, Claire; Read, John; Mehta, Raj
This study investigated similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma in schizophrenia and borderline personality disorder (BPD). Patients with clinical diagnoses of schizophrenia or BPD were interviewed using the Structured Clinical Interviews for DSM-IV. Axes 1 and 2 and auditory hallucinations, paranoia, and childhood trauma were assessed. A total of 111 patients participated; 59 met criteria for schizophrenia, 33 for BPD, and 19 for both. The groups were similar in their experiences of voices, including the perceived location of them, but they differed in frequency of paranoid delusions. Those with a diagnosis of BPD, including those with schizophrenia comorbidity, reported more childhood trauma, especially emotional abuse. BPD and schizophrenia frequently coexist, and this comorbidity has implications for diagnostic classification and treatment. Levels of reported childhood trauma are especially high in those with a BPD diagnosis, whether they have schizophrenia or not, and this requires assessment and appropriate management.
Seok, Jeong-Ho; Park, Hae-Jeong; Chun, Ji-Won; Lee, Seung-Koo; Cho, Hyun Sang; Kwon, Jun Soo; Kim, Jae-Jin
White matter (WM) abnormalities in schizophrenia may offer important clues to a better understanding of the disconnectivity associated with the disorder. The aim of this study was to elucidate a WM basis of auditory hallucinations in schizophrenia through the simultaneous investigation of WM tract integrity and WM density. Diffusion tensor images (DTIs) and structural T1 magnetic resonance images (MRIs) were taken from 15 hallucinating schizophrenic patients, 15 non-hallucinating schizophrenic patients and 22 normal controls. Voxel-based analyses and post-hoc region of interest analyses were obtained to compare the three groups on fractional anisotropy (FA) derived from DTI as well as WM density derived from structural MRIs. In both the hallucinating and non-hallucinating groups, FA of the WM regions was significantly decreased in the left superior longitudinal fasciculus (SLF), whereas WM density was significantly increased in the left inferior longitudinal fasciculus (ILF). The mean FA value of the left frontal part of the SLF was positively correlated with the severity score of auditory hallucinations in the hallucinating patient group. Our findings show that WM changes were mainly observed in the frontal and temporal areas, suggesting that disconnectivity in the left fronto-temporal area may contribute to the pathophysiology of schizophrenia. In addition, pathologic WM changes in this region may be an important step in the development of auditory hallucinations in schizophrenia.
Powers, A.R.; Gancsos, M.G.; Finn, E.S.; Morgan, P.T.; Corlett, P.R.
Background Ketamine, the NMDA glutamate receptor antagonist drug, is increasingly employed as an experimental model of psychosis in healthy volunteers. At sub-anesthetic doses, it safely and reversibly causes delusion-like ideas, amotivation, and perceptual disruptions reminiscent of the aberrant salience experiences that characterize first-episode psychosis. However, auditory verbal hallucinations (AVHs), a hallmark symptom of schizophrenia, have not been reported consistently in healthy volunteers even at high doses of ketamine. Methods Here we present data from a set of healthy participants who received moderately dosed, placebo controlled ketamine infusions in the reduced stimulation environment of the magnetic resonance imaging scanner. We highlight the phenomenological experiences of three participants who experienced particularly vivid hallucinations. Results Participants in this series reported auditory verbal and musical hallucinations at a ketamine dose that does not induce auditory hallucination outside of the scanner. Discussion We interpret the observation of ketamine-induced AVHs in the context of the reduced perceptual environment of the magnetic resonance scanner, and offer an explanation grounded in predictive coding models of perception and psychosis: the brain fills in expected perceptual inputs and it does so more in situations of reduced perceptual input. The reduced perceptual input of the MRI scanner creates a mismatch between top-down perceptual expectations and the heightened bottom-up signals induced by ketamine; such circumstances induce aberrant percepts including musical and auditory verbal hallucinations. We suggest that these circumstances might represent a useful experimental model of AVHs and highlight the impact of ambient sensory stimuli on psychopathology. PMID:26361209
Xu, You; Chai, Hao; Zhang, Bingren; Gao, Qianqian; Fan, Hongying; Zheng, Leilei; Mao, Hongjing; Zhang, Yonghua; Wang, Wei
The exact cerebral structural and functional mechanisms under the auditory verbal hallucinations (AVHs) in schizophrenia are still unclear. The Deutsch "high-low" word illusion might trigger attentional responses mimicking those under AVHs. We therefore have invited 16 patients with first-episode, paranoid schizophrenia, and 16 age- and gender-matched healthy volunteers to undergo the "oddball" event-related potentials elicited by the illusion. The clinical characteristics of patients were measured with the positive and negative symptom scale. Besides the longer reaction time to the illusion, the standard P2 latency was shortened, the N2 latency was prolonged, and both N1 and P3 amplitudes were reduced in patients. The P3 source analyses showed the activated bilateral temporal lobes, parietal lobe and cingulate cortex in both groups, left inferior temporal gyrus in controls, and left postcentral gyrus in schizophrenia. Moreover, the N1 amplitude was positively correlated with the paranoid score in patients. Our results were in line with previous neurophysiological and neuroimaging reports of hallucination or auditory processing in schizophrenia, and illustrated a whole process of cerebral information processing from N1 to P3, indicating this illusion had triggered a dynamic cerebral response similar to that of the AVHs had engaged.
Ng, Petrus; Chun, Ricky W. K.; Tsun, Angela
Auditory hallucination is a positive symptom of schizophrenia and has significant impacts on the lives of individuals. People with auditory hallucination require considerable assistance from mental health professionals. Apart from medications, they may apply different lay methods to cope with their voice hearing. Results from qualitative interviews showed that people with schizophrenia in the Chinese sociocultural context of Hong Kong were coping with auditory hallucination in different ways, including (a) changing social contacts, (b) manipulating the voices, and (c) changing perception and meaning towards the voices. Implications for recovery from psychiatric illness of individuals with auditory hallucinations are discussed. PMID:23304082
Dyck, Miriam S.; Mathiak, Krystyna A.; Bergert, Susanne; Sarkheil, Pegah; Koush, Yury; Alawi, Eliza M.; Zvyagintsev, Mikhail; Gaebler, Arnim J.; Shergill, Sukhi S.; Mathiak, Klaus
Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients’ emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region – even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations’ severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state – with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients’ symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous
Morokuma, Yoko; Endo, Kaori; Nishida, Atushi; Yamasaki, Syudo; Ando, Shuntaro; Morimoto, Yuko; Nakanishi, Miharu; Okazaki, Yuji; Furukawa, Toshi A; Morinobu, Shigeru; Shimodera, Shinji
Women have higher rates of auditory verbal hallucinations (AVH) than men; however, less is known about sex differences in the prevalence of AVH in early, middle and late adolescence. We sought to elucidate the differences in the prevalence of AVH and to examine the degree to which these differences could be explained by differences in levels of depressive symptoms. We used a cross-sectional design and a self-reported questionnaire. Participants were recruited from public junior and senior high schools in Tsu, Mie Prefecture and Kochi Prefecture, Japan. In total, 19 436 students were contacted and 18 250 participated. Responses from 17 451 students with no missing data were analysed (aged 12-18 years, Mage=15.2 years (SD=1.7), 50.6% girls). AVH were assessed through one of four items adopted from the schizophrenia section of the Japanese version of the Diagnostic Interview Schedule for Children. Depressive symptoms were assessed using the 12-item General Health Questionnaire. The prevalence of AVH was 7.0% among early adolescents (aged 12-13 years), 6.2% among middle adolescents (aged 14-15 years) and 4.8% among late adolescents (aged 16-18 years). Being female was significantly associated with a higher prevalence of AVH through adolescence (OR=1.71, 95% CI 1.31 to 2.23 in early adolescence; OR=1.42, 95% CI 1.14 to 1.76 in middle adolescence; OR=1.52, 95% CI 1.23 to 1.87 in late adolescence); however, these differences became non-significant after adjusting for depressive symptoms (OR=1.21, 95% CI 0.92 to 1.60; OR=1.00, 95% CI 0.80 to 1.25; OR=1.16, 95% CI 0.93 to 1.44, respectively). Sex differences in auditory hallucinations are seen in both adult and youth populations. The higher rates of auditory verbal hallucinations seen in girls may be secondary to the differences in the rate of depressive symptoms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is
Blom, Jan Dirk; Looijestijn, Jasper; Goekoop, Rutger; Diederen, Kelly M J; Rijkaart, Anne-Marije; Slotema, Christina W; Sommer, Iris E C
Alice in Wonderland syndrome (AIWS) is a rare cluster of CNS symptoms characterized by visual distortions (i.e. metamorphopsias), body image distortions, time distortions, and déjà experiences. Verbal auditory hallucinations (VAHs) are the most prevalent type of hallucination in adults with or without a history of psychiatric illness. Here, we report the case of a woman with AIWS, long-lasting VAHs, and various additional perceptual and mood symptoms. Semi-structured interviews were used to assess symptoms, and functional MRI (fMRI) was employed to localize cerebral activity during self-reported VAHs. Treatment consisted of repetitive transcranial magnetic stimulation (rTMS) at a frequency of 1 Hz at T3P3, overlying Brodmann's area 40. Activation during VAHs was observed bilaterally in the basal ganglia, the primary auditory cortex, the association auditory cortex, the temporal poles, and the anterior cingulated gyrus. The left and right inferior frontal gyri (Broca's area and its contralateral homologue) were involved, along with the dorsolateral prefrontal cortex. Interestingly, synchronized activation was observed in the primary visual cortex (areas V1 and V2), and the bilateral dorsal visual cortex. The higher visual association cortex also showed significant, but less prominent, activation. During the second week of rTMS treatment, not only the VAHs, but also the other sensory deceptions/distortions and mood symptoms showed complete remission. The patient remained free of any symptoms during a 4-month follow-up phase. After 8 months, when many of the original symptoms had returned, a second treatment phase with rTMS was again followed by complete remission. This case indicates that VAHs and metamorphopsias in AIWS are associated with synchronized activation in both auditory and visual cortices. It also indicates that local rTMS treatment may have global therapeutic effects, suggesting an effect on multiple brain regions in a distributed network. Although a
McCarthy-Jones, Simon; Krueger, Joel; Larøi, Frank; Broome, Matthew; Fernyhough, Charles
One of the leading cognitive models of auditory verbal hallucinations (AVHs) proposes such experiences result from a disturbance in the process by which inner speech is attributed to the self. Research in this area has, however, proceeded in the absence of thorough cognitive and phenomenological investigations of the nature of inner speech, against which AVHs are implicitly or explicitly defined. In this paper we begin by introducing philosophical phenomenology and highlighting its relevance to AVHs, before briefly examining the evolving literature on the relation between inner experiences and AVHs. We then argue for the need for philosophical phenomenology (Phenomenology) and the traditional empirical methods of psychology for studying inner experience (phenomenology) to mutually inform each other to provide a richer and more nuanced picture of both inner experience and AVHs than either could on its own. A critical examination is undertaken of the leading model of AVHs derived from phenomenological philosophy, the ipseity disturbance model. From this we suggest issues that future work in this vein will need to consider, and examine how interdisciplinary methodologies may contribute to advances in our understanding of AVHs. Detailed suggestions are made for the direction and methodology of future work into AVHs, which we suggest should be undertaken in a context where phenomenology and physiology are both necessary, but neither sufficient. PMID:23576974
Johns, Louise C.; Kompus, Kristiina; Connell, Melissa; Humpston, Clara; Lincoln, Tania M.; Longden, Eleanor; Preti, Antonio; Alderson-Day, Ben; Badcock, Johanna C.; Cella, Matteo; Fernyhough, Charles; McCarthy-Jones, Simon; Peters, Emmanuelle; Raballo, Andrea; Scott, James; Siddi, Sara; Sommer, Iris E.; Larøi, Frank
Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research. PMID:24936085
Løberg, Else-Marie; Jørgensen, Hugo A; Hugdahl, Kenneth
Auditory hallucinations (AH) in schizophrenia have been found to be related to both functional and structural brain abnormalities of left temporal lobe language areas. We do not know if these rain abnormalities are state or trait markers for AH. This study tested these alternatives by contrasting schizophrenic patients with ongoing AH and with a previous history of AH. A heterogeneous group of 26 schizophrenic patients was compared with a healthy control group matched for education and age. We used a verbal dichotic listening (DL) test with consonant-vowel syllables to study hemispheric asymmetry and the functional integrity of the left temporal lobe language areas. All subjects were tested during a divided and two focused attention conditions. Our data suggest that abnormal DL asymmetry for language stimuli is a state marker for AH, seen during the perception of AH. In contrast, problems of modulating DL performance by means of attentional control are a trait marker, seen both in patients with ongoing AH and only a history of AH.
Johns, Louise C; Kompus, Kristiina; Connell, Melissa; Humpston, Clara; Lincoln, Tania M; Longden, Eleanor; Preti, Antonio; Alderson-Day, Ben; Badcock, Johanna C; Cella, Matteo; Fernyhough, Charles; McCarthy-Jones, Simon; Peters, Emmanuelle; Raballo, Andrea; Scott, James; Siddi, Sara; Sommer, Iris E; Larøi, Frank
Auditory verbal hallucinations (AVH) are complex experiences that occur in the context of various clinical disorders. AVH also occur in individuals from the general population who have no identifiable psychiatric or neurological diagnoses. This article reviews research on AVH in nonclinical individuals and provides a cross-disciplinary view of the clinical relevance of these experiences in defining the risk of mental illness and need for care. Prevalence rates of AVH vary according to measurement tool and indicate a continuum of experience in the general population. Cross-sectional comparisons of individuals with AVH with and without need for care reveal similarities in phenomenology and some underlying mechanisms but also highlight key differences in emotional valence of AVH, appraisals, and behavioral response. Longitudinal studies suggest that AVH are an antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficulties and poor coping, plus family history of psychosis, and environmental exposures such as childhood adversity. However, their predictive value for specific psychiatric disorders is not entirely clear. The theoretical and clinical implications of the reviewed findings are discussed, together with directions for future research.
Hartigan, Nicky; McCarthy-Jones, Simon; Hayward, Mark
Despite an increasing volume of cross-sectional work on auditory verbal hallucinations (hearing voices), there remains a paucity of work on how the experience may change over time. The first aim of this study was to attempt replication of a previous finding that beliefs about voices are enduring and stable, irrespective of changes in the severity of voices, and do not change without a specific intervention. The second aim was to examine whether voice-hearers' interrelations with their voices change over time, without a specific intervention. A 12-month longitudinal examination of these aspects of voices was undertaken with hearers in routine clinical treatment (N = 18). We found beliefs about voices' omnipotence and malevolence were stable over a 12-month period, as were styles of interrelating between voice and hearer, despite trends towards reductions in voice-related distress and disruption. However, there was a trend for beliefs about the benevolence of voices to decrease over time. Styles of interrelating between voice and hearer appear relatively stable and enduring, as are beliefs about the voices' malevolent intent and power. Although there was some evidence that beliefs about benevolence may reduce over time, the reasons for this were not clear. Our exploratory study was limited by only being powered to detect large effect sizes. Implications for clinical practice and future research are discussed.
A comprehensive understanding of the phenomenology of auditory hallucinations (AHs) is essential for developing accurate models of their causes. Yet, only 1 detailed study of the phenomenology of AHs with a sample size of N ≥ 100 has been published. The potential for overreliance on these findings, coupled with a lack of phenomenological research into many aspects of AHs relevant to contemporary neurocognitive models and the proposed (but largely untested) existence of AH subtypes, necessitates further research in this area. We undertook the most comprehensive phenomenological study of AHs to date in a psychiatric population (N = 199; 81% people diagnosed with schizophrenia), using a structured interview schedule. Previous phenomenological findings were only partially replicated. New findings included that 39% of participants reported that their voices seemed in some way to be replays of memories of previous conversations they had experienced; 45% reported that the general theme or content of what the voices said was always the same; and 55% said new voices had the same content/theme as previous voices. Cluster analysis, by variable, suggested the existence of 4 AH subtypes. We propose that there are likely to be different neurocognitive processes underpinning these experiences, necessitating revised AH models. PMID:23267192
Moseley, Peter; Alderson-Day, Ben; Ellison, Amanda; Jardri, Renaud; Fernyhough, Charles
Auditory verbal hallucinations (AVHs) are the experience of hearing a voice in the absence of any speaker. Results from recent attempts to treat AVHs with neurostimulation (rTMS or tDCS) to the left temporoparietal junction have not been conclusive, but suggest that it may be a promising treatment option for some individuals. Some evidence suggests that the therapeutic effect of neurostimulation on AVHs may result from modulation of cortical areas involved in the ability to monitor the source of self-generated information. Here, we provide a brief overview of cognitive models and neurostimulation paradigms associated with treatment of AVHs, and discuss techniques that could be explored in the future to improve the efficacy of treatment, including alternating current and random noise stimulation. Technical issues surrounding the use of neurostimulation as a treatment option are discussed (including methods to localize the targeted cortical area, and the state-dependent effects of brain stimulation), as are issues surrounding the acceptability of neurostimulation for adolescent populations and individuals who experience qualitatively different types of AVH. PMID:26834541
Ives, Jonathan; Broome, Matthew R.; Caldwell, Kimberly; Wood, Stephen J.; Oyebode, Femi
Background In dimensional understanding of psychosis, auditory verbal hallucinations (AVH) are unitary phenomena present on a continuum from non-clinical voice hearing to severe mental illness. There is mixed evidence for this approach and a relative absence of research into subjective experience of AVH in early psychosis. Aims To conduct primary research into the nature of subjective experience of AVH in first-episode psychosis. Method A phenomenological study using diary and photo-elicitation qualitative techniques investigating the subjective experience of AVH in 25 young people with first-episode psychosis. Results AVH are characterised by: (a) entity, as though from a living being with complex social interchange; and (b) control, exerting authority with ability to influence. AVH are also received with passivity, often accompanied by sensation in other modalities. Conclusions A modern detailed phenomenological investigation, without presupposition, gives results that echo known descriptive psychopathology. However, novel findings also emerge that may be features of AVH in psychosis not currently captured with standardised measures. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703759
Demjén, Zsófia; Semino, Elena
The book Henry's Demons (2011) recounts the events surrounding Henry Cockburn's diagnosis of schizophrenia from the alternating perspectives of Henry himself and his father Patrick. In this paper, we present a detailed linguistic analysis of Henry's first-person accounts of experiences that could be described as auditory verbal hallucinations. We first provide a typology of Henry's voices, taking into account who or what is presented as speaking, what kinds of utterances they produce and any salient stylistic features of these utterances. We then discuss the linguistically distinctive ways in which Henry represents these voices in his narrative. We focus on the use of Direct Speech as opposed to other forms of speech presentation, the use of the sensory verbs hear and feel and the use of 'non-factive' expressions such as I thought and as if. We show how different linguistic representations may suggest phenomenological differences between the experience of hallucinatory voices and the perception of voices that other people can also hear. We, therefore, propose that linguistic analysis is ideally placed to provide in-depth accounts of the phenomenology of voice hearing and point out the implications of this approach for clinical practice and mental healthcare.
Zheng, Leilei; Chai, Hao; Yu, Shaohua; Xu, You; Chen, Wanzhen; Wang, Wei
The exact mechanism behind auditory hallucinations in schizophrenia remains unknown. A corollary discharge dysfunction hypothesis has been put forward, but it requires further confirmation. Electroencephalography (EEG) of the Deutsch octave illusion might offer more insight, by demonstrating an abnormal cerebral activation similar to that under auditory hallucinations in schizophrenic patients. We invited 23 first-episode schizophrenic patients with auditory hallucinations and 23 healthy participants to listen to silence and two sound sequences, which consisted of alternating 400- and 800-Hz tones. EEG spectral power and coherence values of different frequency bands, including theta rhythm (3.5-7.5 Hz), were computed using 32 scalp electrodes. Task-related spectral power changes and task-related coherence differences were also calculated. Clinical characteristics of patients were rated using the Positive and Negative Syndrome Scale. After both sequences of octave illusion, the task-related theta power change values of frontal and temporal areas were significantly lower, and the task-related theta coherence difference values of intrahemispheric frontal-temporal areas were significantly higher in schizophrenic patients than in healthy participants. Moreover, the task-related power change values in both hemispheres were negatively correlated and the task-related coherence difference values in the right hemisphere were positively correlated with the hallucination score in schizophrenic patients. We only tested the Deutsch octave illusion in primary schizophrenic patients with acute first episode. Further studies might adopt other illusions or employ other forms of schizophrenia. Our results showed a lower activation but higher connection within frontal and temporal areas in schizophrenic patients under octave illusion. This suggests an oversynchronized but weak frontal area to exert an action to the ipsilateral temporal area, which supports the corollary discharge
Wolf, Nadine Donata; Sambataro, Fabio; Vasic, Nenad; Frasch, Karel; Schmid, Markus; Schönfeldt-Lecuona, Carlos; Thomann, Philipp Arthur; Wolf, Robert Christian
Background Functional neuroimaging studies on schizophrenia have suggested abnormal task-related functional connectivity in patients with schizophrenia who have auditory verbal hallucinations (AVHs). However, little is known about intrinsic functional connectivity in these patients. Methods Between January 2009 and February 2010, we studied patients with schizophrenia who had persistent and treatment-refractory AVHs in comparison with healthy controls. Using functional magnetic resonance imaging, we studied the functional connectivity of multiple resting state networks (RSNs) and their relation to symptom severity. We analyzed the data using a spatial group independent component analysis, and we used random-effects t tests to compare spatial components between groups. Results There were 10 patients and 14 controls enrolled in this study. In total, 16 RSNs were identified, from which we selected 4 networks of interest for further analyses. Within a speech-related network, patients showed increased connectivity in bilateral temporal regions and decreased connectivity in the cingulate cortex. Within 2 additional RSNs associated with attention and executive control, respectively, patients exhibited abnormal connectivity in the precuneus and right lateral prefrontal areas. We found correlations between measures of AVH severity and functional connectivity of the left anterior cingulate, left superior temporal gyrus and right lateral prefrontal cortex. Limitations The relatively small sample size, the patients’ use of antipsychotic medication and the lack of a clinical control group have to be considered as potential limitations. Conclusion Our findings indicate that disrupted intrinsic connectivity of a speech-related network could underlie persistent AVHs in patients with schizophrenia. In addition, the occurrence of hallucinatory symptoms seems to modulate RSNs associated with attention and executive control. PMID:21791169
Granholm, Eric; Ben-Zeev, Dror; Link, Peter C; Bradshaw, Kristen R; Holden, Jason L
Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning, and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduced in MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia.
Granholm, Eric; Ben-Zeev, Dror; Bradshaw, Kristen R.; Holden, Jason L.
Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning, and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduced in MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia. PMID:22080492
This article presents a report on the 2nd meeting of the International Consortium on Hallucination Research, held on September 12th and 13th 2013 at Durham University, UK. Twelve working groups involving specialists in each area presented their findings and sought to summarize the available knowledge, inconsistencies in the field, and ways to progress. The 12 working groups reported on the following domains of investigation: cortical organisation of hallucinations, nonclinical hallucinations, interdisciplinary approaches to phenomenology, culture and hallucinations, subtypes of auditory verbal hallucinations, a Psychotic Symptoms Rating Scale multisite study, visual hallucinations in the psychosis spectrum, hallucinations in children and adolescents, Research Domain Criteria behavioral constructs and hallucinations, new methods of assessment, psychological therapies, and the Hearing Voices Movement approach to understanding and working with voices. This report presents a summary of this meeting and outlines 10 hot spots for hallucination research, which include the in-depth examination of (1) the social determinants of hallucinations, (2) translation of basic neuroscience into targeted therapies, (3) different modalities of hallucination, (4) domain convergence in cross-diagnostic studies, (5) improved methods for assessing hallucinations in nonclinical samples, (6) using humanities and social science methodologies to recontextualize hallucinatory experiences, (7) developmental approaches to better understand hallucinations, (8) changing the memory or meaning of past trauma to help recovery, (9) hallucinations in the context of sleep and sleep disorders, and (10) subtypes of hallucinations in a therapeutic context. PMID:24282321
Ćurčić-Blake, Branislava; Bais, Leonie; Sibeijn-Kuiper, Anita; Pijnenborg, Hendrika Maria; Knegtering, Henderikus; Liemburg, Edith; Aleman, André
Glutamatergic models of psychosis propose that dysfunction of N-methyl-d-aspartate (NMDA) receptors, and associated excess of glutamate, may underlie psychotic experiences in people with schizophrenia. However, little is known about the specific relation between glutamate and auditory verbal hallucinations (AVH) in patients with psychosis. In this study, levels of glutamate+glutamine (Glx) in the left lateral prefrontal lobe were determined using proton magnetic resonance spectroscopy ((1)H MRS) to calculate their association with AVH. Sixty-seven patients with schizophrenia and thirty healthy control participants (HC) underwent magnetic resonance spectroscopy (MRS) to estimate levels of Glx in the white matter of the left prefrontal lobe. The spectrum was estimated from an 8mm(3) voxel placed in the left lateral prefrontal region, belonging to both the cingulum and forceps minor. Patients with lifetime AVH (AVH group; n=45) and patients without lifetime AVH were compared (NoAVH group; n=22) to control participants. Levels of Glx were significantly different between the groups (F(2,94)=5.27, p=0.007). Planned comparisons showed that higher Glx levels were found in control participants than in the total patient group (p=0.010). However, patients with lifetime AVH had higher levels of Glx compared to patients without lifetime AVH (p=0.019). Creatin levels were similar in all three groups. We found no association between Glx and the severity of symptoms (item P3 of the PANSS or PANSS positive subscale). The higher Glx levels in patients with lifetime AVH as compared to patients without lifetime AVH suggest a mediating role for Glx in AVH. Our results are consistent with a previous study that found similar decreased levels of Glx in patients with schizophrenia, and increased levels in an AVH group as compared to a NoAVH group. The role of the glutamatergic system deserves further investigation, for example in different brain regions and in relation to clinical
Chouinard, G; Miller, R
The authors present a new rating scale for the psychotic symptoms of schizophrenia and related psychoses. The scale links specific symptoms of psychopathology to dysfunction and overactivity of dopaminergic mechanisms underlying the processes of reward and selective attention. The Rating Scale for Psychotic Symptoms (RSPS) is a 44-item rating instrument with a seven-point severity scale for each item. Psychotic symptoms are classified into three groups: Pathological amplification of mental images (perception symptoms) (subscale 1), Distraction symptoms (including catatonia and passivity experiences) (subscale 2), and Delusions (subscale 3). A dimensional, rather than a categorical, conceptualization of psychosis is assumed. Rating is accomplished through a manual and a semi-structured interview (SSCI-RSPS). In this first of two papers, general issues about the construction of the scale and the derivation of symptom groups are discussed. Dopamine-mediated modification of cortico-striatal synapses is seen as being of critical importance in all three groups of symptoms. In this first paper, we present subscale I (perception symptoms), which includes both amplified perceptual images (illusions) and hallucinations. A total of seven illusions and 11 hallucinations are rated as individual items.
Kimhy, David; Wall, Melanie M; Hansen, Marie C; Vakhrusheva, Julia; Choi, C Jean; Delespaul, Philippe; Tarrier, Nicholas; Sloan, Richard P; Malaspina, Dolores
Auditory Hallucinations (AH) cause substantial suffering and dysfunction, yet remain poorly understood and modeled. Previous reports have linked AH to increases in negative emotions, suggesting a role for the autonomic nervous system (ANS) in underlying this link. Employing an Experience Sampling Method (ESM) approach, 40 individuals with schizophrenia completed a 36-hour ambulatory assessment of AH and cardiac autonomic regulation. Participants carried mobile electronic devices that prompted them to report 10 times/d the severity of their momentary AH, along with a Holter monitor that continuously recorded their cardiac autonomic regulation. The clocks of the devices and monitors were synchronized, allowing for high time-resolution temporal linking of the AH and concurrent autonomic data. Power spectral analysis was used to determine the relative vagal (parasympathetic) contribution to autonomic regulation during 5 minutes prior to each experience sample. The participants also completed interview-based measures of AH (SAPS; PSYRATS). The ESM-measured severity of AH was significantly correlated with the overall SAPS-indexed AH severity, along with the PSYRATS-indexed AH frequency, duration, loudness, degree of negative content, and associated distress. A mixed-effect regression model indicated that momentary increases in autonomic arousal, characterized by decreases in vagal input, significantly predicted increases in ESM-measured AH severity. Vagal input averaged over the 36-hour assessment displayed a small but significant inverse correlation with the SAPS-indexed AH. The results provide preliminary support for a link between ANS regulation and AH. The findings also underscore the highly dynamic nature of AH and the need to utilize high time-resolution methodologies to investigate AH. © The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Llorca, P. M.; Pereira, B.; Jardri, R.; Chereau-Boudet, I.; Brousse, G.; Misdrahi, D.; Fénelon, G.; Tronche, A.-M.; Schwan, R.; Lançon, C.; Marques, A.; Ulla, M.; Derost, P.; Debilly, B.; Durif, F.; de Chazeron, I.
Hallucinations have been described in various clinical populations, but they are neither disorder nor disease specific. In schizophrenia patients, hallucinations are hallmark symptoms and auditory ones are described as the more frequent. In Parkinson’s disease, the descriptions of hallucination modalities are sparse, but the hallucinations do tend to have less negative consequences. Our study aims to explore the phenomenology of hallucinations in both hallucinating schizophrenia patients and Parkinson’s disease patients using the Psycho-Sensory hAllucinations Scale (PSAS). The main objective is to describe the phenomena of these clinical symptoms in those two specific populations. Each hallucinatory sensory modality significantly differed between Parkinson’s disease and schizophrenia patients. Auditory, olfactory/gustatory and cœnesthetic hallucinations were more frequent in schizophrenia than visual hallucinations. The guardian angel item, usually not explored in schizophrenia, was described by 46% of these patients. The combination of auditory and visual hallucinations was the most frequent for both Parkinson’s disease and schizophrenia. The repercussion index summing characteristics of each hallucination (frequency, duration, negative aspects, conviction, impact, control and sound intensity) was always higher for schizophrenia. A broader view including widespread characteristics and interdisciplinary works must be encouraged to better understand the complexity of the process involved in hallucinations. PMID:27905557
Llorca, P M; Pereira, B; Jardri, R; Chereau-Boudet, I; Brousse, G; Misdrahi, D; Fénelon, G; Tronche, A-M; Schwan, R; Lançon, C; Marques, A; Ulla, M; Derost, P; Debilly, B; Durif, F; de Chazeron, I
Hallucinations have been described in various clinical populations, but they are neither disorder nor disease specific. In schizophrenia patients, hallucinations are hallmark symptoms and auditory ones are described as the more frequent. In Parkinson's disease, the descriptions of hallucination modalities are sparse, but the hallucinations do tend to have less negative consequences. Our study aims to explore the phenomenology of hallucinations in both hallucinating schizophrenia patients and Parkinson's disease patients using the Psycho-Sensory hAllucinations Scale (PSAS). The main objective is to describe the phenomena of these clinical symptoms in those two specific populations. Each hallucinatory sensory modality significantly differed between Parkinson's disease and schizophrenia patients. Auditory, olfactory/gustatory and cœnesthetic hallucinations were more frequent in schizophrenia than visual hallucinations. The guardian angel item, usually not explored in schizophrenia, was described by 46% of these patients. The combination of auditory and visual hallucinations was the most frequent for both Parkinson's disease and schizophrenia. The repercussion index summing characteristics of each hallucination (frequency, duration, negative aspects, conviction, impact, control and sound intensity) was always higher for schizophrenia. A broader view including widespread characteristics and interdisciplinary works must be encouraged to better understand the complexity of the process involved in hallucinations.
Maïza, Olivier; Hervé, Pierre-Yve; Etard, Olivier; Razafimandimby, Annick; Montagne-Larmurier, Aurélie; Dollfus, Sonia
Several cross-sectional functional Magnetic Resonance Imaging (fMRI) studies reported a negative correlation between auditory verbal hallucination (AVH) severity and amplitude of the activations during language tasks. The present study assessed the time course of this correlation and its possible structural underpinnings by combining structural, functional MRI and repetitive Transcranial Magnetic Stimulation (rTMS). Methods: Nine schizophrenia patients with AVH (evaluated with the Auditory Hallucination Rating scale; AHRS) and nine healthy participants underwent two sessions of an fMRI speech listening paradigm. Meanwhile, patients received high frequency (20 Hz) rTMS. Results: Before rTMS, activations were negatively correlated with AHRS in a left posterior superior temporal sulcus (pSTS) cluster, considered henceforward as a functional region of interest (fROI). After rTMS, activations in this fROI no longer correlated with AHRS. This decoupling was explained by a significant decrease of AHRS scores after rTMS that contrasted with a relative stability of cerebral activations. A voxel-based-morphometry analysis evidenced a cluster of the left pSTS where grey matter volume negatively correlated with AHRS before rTMS and positively correlated with activations in the fROI at both sessions. Conclusion: rTMS decreases the severity of AVH leading to modify the functional correlate of AVH underlain by grey matter abnormalities. PMID:24961421
Kanemoto, Mari; Asai, Tomohisa; Sugimori, Eriko; Tanno, Yoshihiko
Previous studies have suggested that a tendency to externalize internal thought is related to auditory hallucinations or even proneness to auditory hallucinations (AHp) in the general population. However, although auditory hallucinations are related to emotional phenomena, few studies have investigated the effect of emotional valence on the aforementioned relationship. In addition, we do not know what component of psychotic phenomena relate to externalizing bias. The current study replicated our previous research, which suggested that individual differences in auditory hallucination-like experiences are strongly correlated with the external misattribution of internal thoughts, conceptualized in terms of false memory, using the Deese-Roediger-McDermott (DRM) paradigm. We found a significant relationship between experimental performance and total scores on the Launay-Slade Hallucination Scale (LSHS). Among the LSHS factors, only vivid mental image, which is said to be a predictor of auditory hallucinations, was significantly related to experimental performance. We then investigated the potential effect of emotional valence using the DRM paradigm. The results indicate that participants with low scores on the LSHS (the low-AHp group in the current study) showed an increased discriminability index (d') for positive words and a decreased d' for negative words. However, no effects of emotional valence were found for participants with high LSHS scores (high-AHp group). This study indicated that external misattribution of internal thoughts predicts AHp, and that the high-AHp group showed a smaller emotional valence effect in the DRM paradigm compared with the low-AHp group. We discuss this outcome from the perspective of the dual-process activation-monitoring framework in the DRM paradigm in regard to emotion-driven automatic thought in false memory.
Kanemoto, Mari; Asai, Tomohisa; Sugimori, Eriko; Tanno, Yoshihiko
Previous studies have suggested that a tendency to externalize internal thought is related to auditory hallucinations or even proneness to auditory hallucinations (AHp) in the general population. However, although auditory hallucinations are related to emotional phenomena, few studies have investigated the effect of emotional valence on the aforementioned relationship. In addition, we do not know what component of psychotic phenomena relate to externalizing bias. The current study replicated our previous research, which suggested that individual differences in auditory hallucination-like experiences are strongly correlated with the external misattribution of internal thoughts, conceptualized in terms of false memory, using the Deese–Roediger–McDermott (DRM) paradigm. We found a significant relationship between experimental performance and total scores on the Launay–Slade Hallucination Scale (LSHS). Among the LSHS factors, only vivid mental image, which is said to be a predictor of auditory hallucinations, was significantly related to experimental performance. We then investigated the potential effect of emotional valence using the DRM paradigm. The results indicate that participants with low scores on the LSHS (the low-AHp group in the current study) showed an increased discriminability index (d′) for positive words and a decreased d′ for negative words. However, no effects of emotional valence were found for participants with high LSHS scores (high-AHp group). This study indicated that external misattribution of internal thoughts predicts AHp, and that the high-AHp group showed a smaller emotional valence effect in the DRM paradigm compared with the low-AHp group. We discuss this outcome from the perspective of the dual-process activation-monitoring framework in the DRM paradigm in regard to emotion-driven automatic thought in false memory. PMID:23847517
Tracy, Derek K; de Sousa de Abreu, Maria; Nalesnik, Natasza; Mao, Lan; Lage, Claudia; Shergill, Sukhwinder S
Repetitive transcranial magnetic stimulation (rTMS) has attracted attention as a putative clinical neuromodulatory tool, including for ameliorating hallucinations, although existing clinical data are inconsistent. There is a notable paucity of research on its physiological effects on normal neuronal functioning. We neuroimaged 24 healthy adult volunteers undertaking a variable loading passive auditory task, randomized into 2 matched and double-masked groups: half received a 17-minute 1 Hz right temporoparietal rTMS paradigm and half sham rTMS. One hertz rTMS led to attenuation of the underlying auditory cortex response to the stimulus and a contralateral increase in cortical activity. Subanalysis of the auditory tasks demonstrated that rTMS effects varied with stimulus frequency and differences between the active and sham conditions were lost at the highest frequency. This work is, to the best of our knowledge, the first to neuroimage the effects of a "hallucinatory rTMS protocol" on basic auditory processing in healthy controls. Our data demonstrated that a so-called "inhibitory paradigm" can also produce distal neuronal activation and that effects can vary with neural loading. These results highlight the insufficient knowledge of the effects of rTMS on normal physiology, and this, combined with a lack of consensus on clinical trial parameters, may be contributing to the ambivalent data in therapeutic trials.
Leroy, Arnaud; Foucher, Jack R; Pins, Delphine; Delmaire, Christine; Thomas, Pierre; Roser, Mathilde M; Lefebvre, Stéphanie; Amad, Ali; Fovet, Thomas; Jaafari, Nemat; Jardri, Renaud
Our purpose was to validate a reliable method to capture brain activity concomitant with hallucinatory events, which constitute frequent and disabling experiences in schizophrenia. Capturing hallucinations using functional magnetic resonance imaging (fMRI) remains very challenging. We previously developed a method based on a two-steps strategy including (1) multivariate data-driven analysis of per-hallucinatory fMRI recording and (2) selection of the components of interest based on a post-fMRI interview. However, two tests still need to be conducted to rule out critical pitfalls of conventional fMRI capture methods before this two-steps strategy can be adopted in hallucination research: replication of these findings on an independent sample and assessment of the reliability of the hallucination-related patterns at the subject level. To do so, we recruited a sample of 45 schizophrenia patients suffering from frequent hallucinations, 20 schizophrenia patients without hallucinations and 20 matched healthy volunteers; all participants underwent four different experiments. The main findings are (1) high accuracy in reporting unexpected sensory stimuli in an MRI setting; (2) good detection concordance between hypothesis-driven and data-driven analysis methods (as used in the two-steps strategy) when controlled unexpected sensory stimuli are presented; (3) good agreement of the two-steps method with the online button-press approach to capture hallucinatory events; (4) high spatial consistency of hallucinatory-related networks detected using the two-steps method on two independent samples. By validating the two-steps method, we advance toward the possible transfer of such technology to new image-based therapies for hallucinations. Hum Brain Mapp 38:4966-4979, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.
Solesvik, Martine; Joa, Inge; Larsen, Tor Ketil; Langeveld, Johannes; Johannessen, Jan Olav; Bjørnestad, Jone; Anda, Liss Gøril; Gisselgård, Jens; Hegelstad, Wenche ten Velden
Background Hallucinations are a core diagnostic criterion for psychotic disorders and have been investigated with regard to its association with childhood trauma in first-episode psychosis samples. Research has largely focused on auditory hallucinations, while specific investigations of visual hallucinations in first-episode psychosis remain scarce. Objectives The aims of this study were to describe the prevalence of visual hallucinations, and to explore the association between visual hallucination and childhood trauma in a first-episode psychosis sample. Methods Subjects were included from TIPS-2, a first episode psychosis study in south Rogaland, Norway. Based on the medical journal descriptions of the Positive and Negative Symptoms Scale (PANSS), a separate score for visual and auditory hallucinations was created (N = 204). Patients were grouped according to hallucination severity (none, mild, and psychotic hallucinations) and multinomial logistic regression was performed to identify factors associated with visual hallucination group. Results Visual hallucinations of a psychotic nature were reported by 26.5% of patients. The experience of childhood interpersonal trauma increased the likelihood of having psychotic visual hallucinations. Conclusion Visual hallucinations are common in first-episode psychosis, and are related to childhood interpersonal trauma. PMID:27144681
Fovet, Thomas; Orlov, Natasza; Dyck, Miriam; Allen, Paul; Mathiak, Klaus; Jardri, Renaud
Auditory-verbal hallucinations (AVHs) are frequent and disabling symptoms, which can be refractory to conventional psychopharmacological treatment in more than 25% of the cases. Recent advances in brain imaging allow for a better understanding of the neural underpinnings of AVHs. These findings strengthened transdiagnostic neurocognitive models that characterize these frequent and disabling experiences. At the same time, technical improvements in real-time functional magnetic resonance imaging (fMRI) enabled the development of innovative and non-invasive methods with the potential to relieve psychiatric symptoms, such as fMRI-based neurofeedback (fMRI-NF). During fMRI-NF, brain activity is measured and fed back in real time to the participant in order to help subjects to progressively achieve voluntary control over their own neural activity. Precisely defining the target brain area/network(s) appears critical in fMRI-NF protocols. After reviewing the available neurocognitive models for AVHs, we elaborate on how recent findings in the field may help to develop strong a priori strategies for fMRI-NF target localization. The first approach relies on imaging-based “trait markers” (i.e., persistent traits or vulnerability markers that can also be detected in the presymptomatic and remitted phases of AVHs). The goal of such strategies is to target areas that show aberrant activations during AVHs or are known to be involved in compensatory activation (or resilience processes). Brain regions, from which the NF signal is derived, can be based on structural MRI and neurocognitive knowledge, or functional MRI information collected during specific cognitive tasks. Because hallucinations are acute and intrusive symptoms, a second strategy focuses more on “state markers.” In this case, the signal of interest relies on fMRI capture of the neural networks exhibiting increased activity during AVHs occurrences, by means of multivariate pattern recognition methods. The fine
Auditory-verbal hallucinations (AVHs) are frequently associated with activation of the left superior temporal gyrus (including Wernicke’s area), left inferior frontal gyrus (including Broca’s area), and the right hemisphere homologs of both areas. It has been hypothesized that disconnectivity of both interhemispheric transfer and frontal and temporal areas may underlie hallucinations in schizophrenia. We investigated reduced information flow in this circuit for the first time using dynamic causal modeling, which allows for directional inference. A group of healthy subjects and 2 groups of schizophrenia patients—with and without AVH—performed a task requiring inner speech processing during functional brain scanning. We employed connectivity models between left hemispheric speech-processing areas and their right hemispheric homologs. Bayesian model averaging was used to estimate the connectivity strengths and evaluate group differences. Patients with AVH showed significantly reduced connectivity from Wernicke’s to Broca’s area (97% certainty) and a trend toward a reduction in connectivity from homologs of Broca’s and Wernicke’s areas to Broca’s area (93% and 94% certainty). The connectivity magnitude in patients without hallucinations was found to be intermediate. Our results point toward a reduced input from temporal to frontal language areas in schizophrenia patients with AVH, suggesting that Broca’s activity may be less constrained by perceptual information received from the temporal cortex. In addition, a lack of synchronization between Broca and its homolog may lead to the erroneous interpretation of emotional speech activity from the right hemisphere as coming from an external source. PMID:23070537
[The Effects of Auditory Hallucination Simulation on Empathy, Knowledge, Social Distance, and Attitudes Toward Patients With Mental Illness Among Undergraduate Students: A Systemic Review and Meta-Analysis].
Lee, Ming-Feng; Lin, Ching-Lan Esther
The negative attitudes of the general public toward mental illness frequently influence the integration of mental illness patients into the community. Auditory hallucination simulation may be considered as a creative teaching strategy to improve the attitudes of learners toward mental illness. However, the empirical effects of auditory hallucination simulation to change the negative attitudes toward mental illness remains uncertain. To compare and analyze, using a systematic review and meta-analysis, the effectiveness of auditory hallucination simulation in improving empathy, knowledge, social distance, and attitudes toward mental illness in undergraduates. A search using the keywords "auditory hallucination" and "simulation" and the 4 outcome indicators of empathy, knowledge, social distance, and attitudes toward mental illness was conducted to identify related articles published between 2008 and 2016 in 6 Chinese and English electronic databases, including Cochrane Library, EBSCO-CINAHL, MEDLINE, PsycINFO, PubMed, and Airiti Library. Research quality was appraised using the Modified Jadad Scale (MJS), the Oxford Centre for Evidence-Based Medicine Level of Evidence (OCEBM LoE), and the Cochrane Risk of Bias tool. Eleven studies were recruited, and 7 studies with sufficient data were included in the meta-analysis. The meta-analysis showed that hallucination simulation significantly improved the empathy and knowledge of participants, with respective effect sizes of 0.63 (95% CI [0.21, 1.05]) and 0.69 (95% CI [0.43-0.94]). However, this intervention also increased social distance, with an effect size of 0.60 (95% CI [0.01, 1.19]), and did not change attitudes toward mental illness significantly, with an effect size of 0.33 (95% CI [-0.11, 0.77]). Auditory hallucination simulation is an effective teaching strategy for improving the empathy and knowledge of undergraduates. However, related evidence for the effects of social distance and attitudes toward mental illness
Briend, F; Leroux, E; Delcroix, N; Razafimandimby, A; Etard, O; Dollfus, S
This exploratory study investigated the functional connectivity (FC) in the language network in schizophrenia patients (SZ) with auditory verbal hallucinations (AVHs), and the therapeutic efficacy of rTMS on it. Eleven SZ with AVHs and 10 healthy controls (HC) underwent two fMRI sessions using a speech listening paradigm. SZ received 20Hz rTMS following the first fMRI session. Compared to HC, SZ showed a reduced FC in the language network. While AVHs improved after 12days, no changes in FC were observed. This suggests the efficacy of high-frequency rTMS on AVH without any impact for rTMS on FC within the language network.
de Sousa, Paulo; Sellwood, William; Spray, Amy; Fernyhough, Charles; Bentall, Richard P.
Abstract Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations. PMID:27898489
de Sousa, Paulo; Sellwood, William; Spray, Amy; Fernyhough, Charles; Bentall, Richard P
Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.
Rogers, R; Nussbaum, D; Gillis, R
Clinical literature on the role of command hallucinations in producing antisocial behavior is sparse and fragmented. This article reviews exploratory models of auditory hallucinations and the prevalence of command hallucinations in clinical and forensic settings. In addition, clinical guidelines are offered for assessing the authenticity of command hallucinations and their relevance to criminal behavior within the context of forensic evaluations.
Varese, F; Barkus, E; Bentall, R P
It has been proposed that the relationship between childhood trauma and hallucinations can be explained by dissociative processes. The present study examined whether the effect of childhood trauma on hallucination-proneness is mediated by dissociative tendencies. In addition, the influence of dissociative symptoms on a cognitive process believed to underlie hallucinatory experiences (i.e. reality discrimination; the capacity to discriminate between internal and external cognitive events) was also investigated. Patients with schizophrenia spectrum disorders (n=45) and healthy controls (with no history of hallucinations; n=20) completed questionnaire measures of hallucination-proneness, dissociative tendencies and childhood trauma, as well as performing an auditory signal detection task. Compared to both healthy and non-hallucinating clinical controls, hallucinating patients reported both significantly higher dissociative tendencies and childhood sexual abuse. Dissociation positively mediated the effect of childhood trauma on hallucination-proneness. This mediational role was particularly robust for sexual abuse over other types of trauma. Signal detection abnormalities were evident in hallucinating patients and patients with a history of hallucinations, but were not associated with pathological dissociative symptoms. These results are consistent with dissociative accounts of the trauma-hallucinations link. Dissociation, however, does not affect reality discrimination. Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g. deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.
McCarthy-Jones, Simon; Castro Romero, Maria; McCarthy-Jones, Roseline; Dillon, Jacqui; Cooper-Rompato, Christine; Kieran, Kathryn; Kaufman, Milissa; Blackman, Lisa
This paper explores the experiences of women who “hear voices” (auditory verbal hallucinations). We begin by examining historical understandings of women hearing voices, showing these have been driven by androcentric theories of how women’s bodies functioned leading to women being viewed as requiring their voices be interpreted by men. We show the twentieth century was associated with recognition that the mental violation of women’s minds (represented by some voice-hearing) was often a consequence of the physical violation of women’s bodies. We next report the results of a qualitative study into voice-hearing women’s experiences (n = 8). This found similarities between women’s relationships with their voices and their relationships with others and the wider social context. Finally, we present results from a quantitative study comparing voice-hearing in women (n = 65) and men (n = 132) in a psychiatric setting. Women were more likely than men to have certain forms of voice-hearing (voices conversing) and to have antecedent events of trauma, physical illness, and relationship problems. Voices identified as female may have more positive affect than male voices. We conclude that women voice-hearers have and continue to face specific challenges necessitating research and activism, and hope this paper will act as a stimulus to such work. PMID:26779041
McCarthy-Jones, Simon; Thomas, Neil; Strauss, Clara; Dodgson, Guy; Jones, Nev; Woods, Angela; Brewin, Chris R.; Hayward, Mark; Stephane, Massoud; Barton, Jack; Kingdon, David; Sommer, Iris E.
The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer’s own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool. PMID:24936087
McCarthy-Jones, Simon; Thomas, Neil; Strauss, Clara; Dodgson, Guy; Jones, Nev; Woods, Angela; Brewin, Chris R; Hayward, Mark; Stephane, Massoud; Barton, Jack; Kingdon, David; Sommer, Iris E
The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Koutsoukos, Elias; Angelopoulos, Elias; Maillis, Antonis; Papadimitriou, George N; Stefanis, Costas
Electroencephalographic oscillations, with different spectral contents, recorded in various brain sites are assumed to play an important role in the information processes underlying cognition as well as the abnormal brain functioning observed in nosological entities that affect neuronal connectivity such as schizophrenia. In the present study we investigated the interaction of EEG rhythms during the experience of auditory verbal hallucinations (AVHs). For this purpose we analyzed data obtained from patients suffering from persistent AVHs, focusing on the mode that the phase of theta oscillations modulate the amplitude of the broad gamma EEG oscillations. Our results indicate increased phase coupling between theta and gamma rhythms observed in the left frontotemporal cortices during AVHs, under eyes closed condition. The average differences of theta-gamma coupling between hallucinatory and resting stages in the left temporal area were found to be statistically significant. These results suggest that a theta-gamma interaction may be involved in the production and experience of AVHs in patients suffering from schizophrenia.
Alderson-Day, Ben; McCarthy-Jones, Simon; Bedford, Sarah; Collins, Hannah; Dunne, Holly; Rooke, Chloe; Fernyhough, Charles
Inner speech is a commonly experienced but poorly understood phenomenon. The Varieties of Inner Speech Questionnaire (VISQ; McCarthy-Jones & Fernyhough, 2011) assesses four characteristics of inner speech: dialogicality, evaluative/motivational content, condensation, and the presence of other people. Prior findings have linked anxiety and proneness to auditory hallucinations (AH) to these types of inner speech. This study extends that work by examining how inner speech relates to self-esteem and dissociation, and their combined impact upon AH-proneness. 156 students completed the VISQ and measures of self-esteem, dissociation and AH-proneness. Correlational analyses indicated that evaluative inner speech and other people in inner speech were associated with lower self-esteem and greater frequency of dissociative experiences. Dissociation and VISQ scores, but not self-esteem, predicted AH-proneness. Structural equation modelling supported a mediating role for dissociation between specific components of inner speech (evaluative and other people) and AH-proneness. Implications for the development of "hearing voices" are discussed. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.
Moseley, Peter; Fernyhough, Charles; Ellison, Amanda
Auditory verbal hallucinations (AVHs) are the experience of hearing voices in the absence of any speaker, often associated with a schizophrenia diagnosis. Prominent cognitive models of AVHs suggest they may be the result of inner speech being misattributed to an external or non-self source, due to atypical self- or reality monitoring. These arguments are supported by studies showing that people experiencing AVHs often show an externalising bias during monitoring tasks, and neuroimaging evidence which implicates superior temporal brain regions, both during AVHs and during tasks that measure verbal self-monitoring performance. Recently, efficacy of noninvasive neurostimulation techniques as a treatment option for AVHs has been tested. Meta-analyses show a moderate effect size in reduction of AVH frequency, but there has been little attempt to explain the therapeutic effect of neurostimulation in relation to existing cognitive models. This article reviews inner speech models of AVHs, and argues that a possible explanation for reduction in frequency following treatment may be modulation of activity in the brain regions involving the monitoring of inner speech. PMID:24125858
Alderson-Day, Ben; McCarthy-Jones, Simon; Bedford, Sarah; Collins, Hannah; Dunne, Holly; Rooke, Chloe; Fernyhough, Charles
Inner speech is a commonly experienced but poorly understood phenomenon. The Varieties of Inner Speech Questionnaire (VISQ; McCarthy-Jones & Fernyhough, 2011) assesses four characteristics of inner speech: dialogicality, evaluative/motivational content, condensation, and the presence of other people. Prior findings have linked anxiety and proneness to auditory hallucinations (AH) to these types of inner speech. This study extends that work by examining how inner speech relates to self-esteem and dissociation, and their combined impact upon AH-proneness. 156 students completed the VISQ and measures of self-esteem, dissociation and AH-proneness. Correlational analyses indicated that evaluative inner speech and other people in inner speech were associated with lower self-esteem and greater frequency of dissociative experiences. Dissociation and VISQ scores, but not self-esteem, predicted AH-proneness. Structural equation modelling supported a mediating role for dissociation between specific components of inner speech (evaluative and other people) and AH-proneness. Implications for the development of “hearing voices” are discussed. PMID:24980910
Jones, Simon R.
The causes of auditory verbal hallucinations (AVHs) are still unclear. The evidence for 2 prominent cognitive models of AVHs, one based on inner speech, the other on intrusions from memory, is briefly reviewed. The fit of these models, as well as neurological models, to the phenomenology of AVHs is then critically examined. It is argued that only a minority of AVHs, such as those with content clearly relating to verbalizations experienced surrounding previous trauma, are consistent with cognitive AVHs-as-memories models. Similarly, it is argued that current neurological models are only phenomenologically consistent with a limited subset of AVHs. In contrast, the phenomenology of the majority of AVHs, which involve voices attempting to regulate the ongoing actions of the voice hearer, are argued to be more consistent with inner speech–based models. It is concluded that subcategorizations of AVHs may be necessary, with each underpinned by different neurocognitive mechanisms. The need to study what is termed the dynamic developmental progression of AVHs is also highlighted. Future empirical research is suggested in this area. PMID:18820262
Patel, Anjali N; Lee, Seonjoo; Andrews, Howard F; Pelton, Gregory H; Schultz, Susan K; Sultzer, David L; Mintzer, Jacobo; de la Pena, Danilo; Gupta, Sanjay; Colon, Sylvia; Schimming, Corbett; Levin, Bruce; Devanand, D P
In Alzheimer's disease, antipsychotic medications are often used for a period, with relief of symptoms, and then discontinued, after which relapse may occur. The authors sought to determine which neuropsychiatric symptoms predict relapse. In the Antipsychotic Discontinuation in Alzheimer's Disease trial, 180 patients with Alzheimer's disease and symptoms of agitation or psychosis were treated with risperidone for 16 weeks, after which patients who responded (N=110) were randomly assigned to continue risperidone for 32 weeks, to continue risperidone for 16 weeks followed by switch to placebo for 16 weeks, or to receive placebo for 32 weeks. As reported previously, discontinuation of risperidone was associated with a two- to fourfold increased risk of relapse over 16-32 weeks. In planned post hoc analyses, the authors examined associations between the 12 symptom domains in the Neuropsychiatric Inventory (NPI) and relapse in the first 16-week phase after randomization. Compared with patients with mild hallucinations or no hallucinations, patients with severe hallucinations as a presenting symptom at baseline had a higher likelihood of relapse (hazard ratio=2.96, 95% CI=1.52, 5.76). This effect was present for the subgroup with auditory hallucinations, but not the subgroup with visual hallucinations. Among patients with baseline hallucinations, 13 of 17 (76.5%) who discontinued risperidone relapsed, compared with 10 of 26 (38.5%) who continued risperidone (p<0.02). This group difference remained significant for severe (77.8%) compared with mild (36%) hallucinations. NPI domain scores after the initial open-treatment phase were not associated with relapse. Patients with severe baseline hallucinations were more likely to relapse after randomization, and the presence of baseline hallucinations was associated with a higher risk of relapse after discontinuation of risperidone compared with continued risperidone treatment. For patients with hallucinations, particularly
Zhang, Yingli; Liang, Wei; Yang, Shichang; Dai, Ping; Shen, Lijuan; Wang, Changhong
Objective: This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hallucination of patients with schizophrenia spectrum disorders. Data Sources: Online literature retrieval was conducted using PubMed, ISI Web of Science, EMBASE, Medline and Cochrane Central Register of Controlled Trials databases from January 1985 to May 2012. Key words were “transcranial magnetic stimulation”, “TMS”, “repetitive transcranial magnetic stimulation”, and “hallucination”. Study Selection: Selected studies were randomized controlled trials assessing therapeutic efficacy of repetitive transcranial magnetic stimulation for hallucination in patients with schizophrenia spectrum disorders. Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hallucination in schizophrenia spectrum disorders. Control groups received sham stimulation. Main Outcome Measures: The primary outcome was total scores of Auditory Hallucinations Rating Scale, Auditory Hallucination Subscale of Psychotic Symptom Rating Scale, Positive and Negative Symptom Scale-Auditory Hallucination item, and Hallucination Change Scale. Secondary outcomes included response rate, global mental state, adverse effects and cognitive function. Results: Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened, with controls receiving sham stimulation. All data were completely effective, involving 398 patients. Overall mean weighted effect size for repetitive transcranial magnetic stimulation versus sham stimulation was statistically significant (MD = –0.42, 95%CI: –0.64 to –0.20, P = 0.000 2). Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation (OR = 2.94, 95%CI: 1.39 to 6.24, P = 0.005). No significant differences were
Chen, Cheng; Wang, Hui-Ling; Wu, Shi-Hao; Huang, Huan; Zou, Ji-Lin; Chen, Jun; Jiang, Tian-Zi; Zhou, Yuan; Wang, Gao-Hua
Background: Dysconnectivity hypothesis of schizophrenia has been increasingly emphasized. Recent researches showed that this dysconnectivity might be related to occurrence of auditory hallucination (AH). However, there is still no consistent conclusion. This study aimed to explore intrinsic dysconnectivity pattern of whole-brain functional networks at voxel level in schizophrenic with AH. Methods: Auditory hallucinated patients group (n = 42 APG), no hallucinated patients group (n = 42 NPG) and normal controls (n = 84 NCs) were analyzed by resting-state functional magnetic resonance imaging. The functional connectivity metrics index (degree centrality [DC]) across the entire brain networks was calculated and evaluated among three groups. Results: DC decreased in the bilateral putamen and increased in the left superior frontal gyrus in all the patients. However, in APG, the changes of DC were more obvious compared with NPG. Symptomology scores were negatively correlated with the DC of bilateral putamen in all patients. AH score of APG positively correlated with the DC in left superior frontal gyrus but negatively correlated with the DC in bilateral putamen. Conclusion: Our findings corroborated that schizophrenia was characterized by functional dysconnectivity, and the abnormal DC in bilateral putamen and left superior frontal gyrus might be crucial in the occurrence of AH. PMID:26612293
Schnakenberg Martin, Ashley M; Bartolomeo, Lisa; Howell, Josselyn; Hetrick, William P; Bolbecker, Amanda R; Breier, Alan; Kidd, Gary; O'Donnell, Brian F
Schizophrenia spectrum disorder (SZ) is associated with deficits in auditory perception as well as auditory verbal hallucinations (AVH). However, the relationship between auditory feature perception and auditory verbal hallucinations (AVH), one of the most commonly occurring symptoms in psychosis, has not been well characterized. This study evaluated perception of a broad range of auditory features in SZ and determined whether current AVHs relate to auditory feature perception. Auditory perception, including frequency, intensity, duration, pulse-train and temporal order discrimination, as well as an embedded tone task, was assessed in both AVH (n = 20) and non-AVH (n = 24) SZ individuals and in healthy controls (n = 29) with the Test of Basic Auditory Capabilities (TBAC). The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) was used to assess the experience of auditory hallucinations in patients with SZ. Findings suggest that compared to controls, the SZ group had greater deficits on an array of auditory features, with non-AVH SZ individuals showing the most severe degree of abnormality. IQ and measures of cognitive processing were positively associated with performance on the TBAC for all SZ individuals, but not with the HPSVQ scores. These findings indicate that persons with SZ demonstrate impaired auditory perception for a broad range of features. It does not appear that impaired auditory perception is associated with recent auditory verbal hallucinations, but instead associated with the degree of intellectual impairment in SZ.
Fénelon, G; Mahieux, F; Huon, R; Ziégler, M
Hallucinations, mainly of a visual nature, are considered to affect about one-quarter of patients with Parkinson's disease. They are commonly viewed as a side-effect of antiparkinsonian treatment, but other factors may be involved. The aim of this study was to determine the phenomenology, prevalence and risk factors of hallucinations in Parkinson's disease. Two-hundred and sixteen consecutive patients fulfilling clinical criteria for Parkinson's disease were studied. Demographic and clinical variables were recorded, including motor and cognitive status, depressive symptoms and sleep-wake disturbances. Patients with and without hallucinations were compared using non-parametric tests, and logistic regression was applied to significant data. Hallucinations had been present during the previous 3 months in 39.8% of the patients, and fell into three categories: minor forms, consisting of a sensation of a presence (person), a sideways passage (commonly of an animal) or illusions were present in 25.5% of the patients (an isolated occurrence in 14.3%), formed visual hallucinations were present in 22.2% (isolated in 9.3%) and auditory hallucinations were present in 9.7% (isolated in 2.3%). Patients with minor hallucinations had a higher depression score than non-hallucinators but did not differ in other respects. Logistic regression analysis identified three factors independently predictive of formed visual hallucinations: severe cognitive disorders, daytime somnolence and a long duration of Parkinson's disease. These findings indicate that, when minor hallucinations are included, the total prevalence is much higher than previously reported. A simple side-effect of dopaminergic treatment is not sufficient to explain the occurrence of all visual hallucinations. The main risk factor in treated patients is cognitive impairment, although sleep-wake cycle disturbances, and possibly other factors related to the duration of the disease, act as cofactors.
McCarthy-Jones, Simon; Longden, Eleanor
Auditory verbal hallucinations (AVH: ‘hearing voices’) are found in both schizophrenia and post-traumatic stress disorder (PTSD). In this paper we first demonstrate that AVH in these two diagnoses share a qualitatively similar phenomenology. We then show that the presence of AVH in schizophrenia is often associated with earlier exposure to traumatic/emotionally overwhelming events, as it is by definition in PTSD. We next argue that the content of AVH relates to earlier traumatic events in a similar way in both PTSD and schizophrenia, most commonly having direct or indirect thematic links to emotionally overwhelming events, rather than being direct re-experiencing. We then propose, following cognitive models of PTSD, that the reconstructive nature of memory may be able to account for the nature of these associations between trauma and AVH content, as may threat-hypervigilance and the individual’s personal goals. We conclude that a notable subset of people diagnosed with schizophrenia with AVH are having phenomenologically and aetiologically identical experiences to PTSD patients who hear voices. As such we propose that the iron curtain between AVH in PTSD (often termed ‘dissociative AVH’) and AVH in schizophrenia (so-called ‘psychotic AVH’) needs to be torn down, as these are often the same experience. One implication of this is that these trauma-related AVH require a common trans-diagnostic treatment strategy. Whilst antipsychotics are already increasingly being used to treat AVH in PTSD, we argue for the centrality of trauma-based interventions for trauma-based AVH in both PTSD and in people diagnosed with schizophrenia. PMID:26283997
Ray, Prasenjit; Sinha, Vinod Kumar; Tikka, Sai Krishna
Repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing frequency and duration of auditory verbal hallucinations (AVH). Priming stimulation, which involves high-frequency rTMS stimulation followed by low-frequency rTMS, has been shown to markedly enhance the neural response to the low-frequency stimulation train. However, this technique has not been investigated in recent onset schizophrenia patients. The aim of this randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS in recent onset schizophrenia patients. Forty recent onset schizophrenia patients completed the study. Patients were randomized over two groups: one receiving low-frequency rTMS preceded by priming and another receiving low-frequency rTMS without priming. Both treatments were directed at the left temporo-parietal region. The severity of AVH and other psychotic symptoms were assessed with the auditory hallucination subscale (AHRS) of the Psychotic Symptom Rating Scales (PSYRATS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI). We found that all the scores of these ratings significantly reduced over time (i.e. baseline through 1, 2, 4 and 6 weeks) in both the treatment groups. We found no difference between the two groups on all measures, except for significantly greater improvement on loudness of AVH in the group with priming stimulation during the follow-ups (F = 2.72; p < .05). We conclude that low-frequency rTMS alone and high-frequency priming of low-frequency rTMS do not elicit significant differences in treatment of overall psychopathology, particularly AVH when given in recent onset schizophrenia patients. Add on priming however, seems to be particularly better in faster reduction in loudness of AVH.
Servilha, Emilse Aparecida Merlin; Delatti, Marina de Almeida
To investigate the correlation between noise in the work environment and auditory and extra-auditory symptoms referred by university professors. Eighty five professors answered a questionnaire about identification, functional status, and health. The relationship between occupational noise and auditory and extra-auditory symptoms was investigated. Statistical analysis considered the significance level of 5%. None of the professors indicated absence of noise. Responses were grouped in Always (A) (n=21) and Not Always (NA) (n=63). Significant sources of noise were both the yard and another class, which were classified as high intensity; poor acoustic and echo. There was no association between referred noise and health complaints, such as digestive, hormonal, osteoarticular, dental, circulatory, respiratory and emotional complaints. There was also no association between referred noise and hearing complaints, and the group A showed higher occurrence of responses regarding noise nuisance, hearing difficulty and dizziness/vertigo, tinnitus, and earache. There was association between referred noise and voice alterations, and the group NA presented higher percentage of cases with voice alterations than the group A. The university environment was considered noisy; however, there was no association with auditory and extra-auditory symptoms. The hearing complaints were more evident among professors in the group A. Professors' health is a multi-dimensional product and, therefore, noise cannot be considered the only aggravation factor.
Schatz, Kelly C.; Abi-Dargham, Anissa
The neural mechanisms that produce hallucinations and other psychotic symptoms remain unclear. Previous research suggests that deficits in predictive signals for learning, such as prediction error signals, may underlie psychotic symptoms, but the mechanism by which such deficits produce psychotic symptoms remains to be established. We used model-based fMRI to study sensory prediction errors in human patients with schizophrenia who report daily auditory verbal hallucinations (AVHs) and sociodemographically matched healthy control subjects. We manipulated participants' expectations for hearing speech at different periods within a speech decision-making task. Patients activated a voice-sensitive region of the auditory cortex while they experienced AVHs in the scanner and displayed a concomitant deficit in prediction error signals in a similar portion of auditory cortex. This prediction error deficit correlated strongly with increased activity during silence and with reduced volumes of the auditory cortex, two established neural phenotypes of AVHs. Furthermore, patients with more severe AVHs had more deficient prediction error signals and greater activity during silence within the region of auditory cortex where groups differed, regardless of the severity of psychotic symptoms other than AVHs. Our findings suggest that deficient predictive coding accounts for the resting hyperactivity in sensory cortex that leads to hallucinations. PMID:24920613
Sommer, Iris E. C.; Slotema, Christina W.; Daskalakis, Zafiris J.; Derks, Eske M.; Blom, Jan Dirk; van der Gaag, Mark
This article reviews the treatment of hallucinations in schizophrenia. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2–4 weeks of treatment. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. Blood levels should be above 350–450 μg/ml for maximal effect. For relapse prevention, medication should be continued in the same dose. Depot medication should be considered for all patients because nonadherence is high. Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. Several meta-analyses found significantly better symptom reduction for low-frequency repetitive TMS as compared with placebo. Consequently, TMS currently has the status of a potentially useful treatment method for auditory hallucinations, but only in combination with state of the art antipsychotic treatment. Electroconvulsive therapy (ECT) is considered a last resort for treatment-resistant psychosis. Although several studies showed clinical improvement, a specific reduction in hallucination severity has never been demonstrated. PMID:22368234
Ffytche, Dominic H
The hodotopic framework is a recent revision of Geschwind's disconnection paradigm incorporating advances in functional and white matter imaging. Its intention is to help clinico-pathological correlations across a range of neurological and psychiatric conditions and generate novel research questions. Here I consider hallucinations within this framework. The paper is divided into three parts. The first reviews the auditory and visual hallucination literature from the dual perspectives of dysfunction localised to specific brain regions (topological) and dysfunction related to connections between brain regions (hodological), combining evidence from tractography, functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) studies. Patients prone to hallucinations have complex, task-specific hodological abnormalities that persist between hallucination episodes. During hallucinations, topological increases in activity are found whose location defines hallucination content and modality. Whether these activity increases are accompanied by transient hodological change is unclear. The second part of the paper addresses this issue in EEG and fMRI studies of a 200-year-old paradigm. Photic stimulation within a specific frequency and luminance range induces hallucinations of geometrical patterns, colours and motion in normal subjects. By comparing hallucination-inducing with control stimulation, topological activity increases were identified in visual areas whose specialisations matched the induced hallucination contents. During hallucinations, fMRI connectivity between LGN and cortex changed from a positive to negative relationship while EEG connectivity between occipital and other brain regions increased. The complex and dynamic topological and hodological changes during induced hallucinations are consistent with a shift in thalamocortical circuitry from tonic to burst mode and may have direct relevance to the Charles Bonnet Syndrome. The third part of the
Furushima, Wakana; Kaga, Makiko; Nakamura, Masako; Gunji, Atsuko; Inagaki, Masumi
To investigate detailed auditory features in patients with auditory impairment as the first clinical symptoms of childhood adrenoleukodystrophy (CSALD). Three patients who had hearing difficulty as the first clinical signs and/or symptoms of ALD. Precise examination of the clinical characteristics of hearing and auditory function was performed, including assessments of pure tone audiometry, verbal sound discrimination, otoacoustic emission (OAE), and auditory brainstem response (ABR), as well as an environmental sound discrimination test, a sound lateralization test, and a dichotic listening test (DLT). The auditory pathway was evaluated by MRI in each patient. Poor response to calling was detected in all patients. Two patients were not aware of their hearing difficulty, and had been diagnosed with normal hearing by otolaryngologists at first. Pure-tone audiometry disclosed normal hearing in all patients. All patients showed a normal wave V ABR threshold. Three patients showed obvious difficulty in discriminating verbal sounds, environmental sounds, and sound lateralization and strong left-ear suppression in a dichotic listening test. However, once they discriminated verbal sounds, they correctly understood the meaning. Two patients showed elongation of the I-V and III-V interwave intervals in ABR, but one showed no abnormality. MRIs of these three patients revealed signal changes in auditory radiation including in other subcortical areas. The hearing features of these subjects were diagnosed as auditory agnosia and not aphasia. It should be emphasized that when patients are suspected to have hearing impairment but have no abnormalities in pure tone audiometry and/or ABR, this should not be diagnosed immediately as psychogenic response or pathomimesis, but auditory agnosia must also be considered. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.
Brébion, Gildas; Stephan-Otto, Christian; Ochoa, Susana; Roca, Mercedes; Nieto, Lourdes; Usall, Judith
Background: Previous research has shown that various memory errors reflecting failure in the self-monitoring of speech were associated with auditory/verbal hallucinations in schizophrenia patients and with proneness to hallucinations in non-clinical individuals. Method: We administered to 57 schizophrenia patients and 60 healthy participants a verbal memory task involving free recall and recognition of lists of words with different structures (high-frequency, low-frequency, and semantically organisable words). Extra-list intrusions in free recall were tallied, and the response bias reflecting tendency to make false recognitions of non-presented words was computed for each list. Results: In the male patient subsample, extra-list intrusions were positively associated with verbal hallucinations and inversely associated with negative symptoms. In the healthy participants the extra-list intrusions were positively associated with proneness to hallucinations. A liberal response bias in the recognition of the high-frequency words was associated with verbal hallucinations in male patients and with proneness to hallucinations in healthy men. Meanwhile, a conservative response bias for these high-frequency words was associated with negative symptoms in male patients and with social anhedonia in healthy men. Conclusion: Misattribution of inner speech to an external source, reflected by false recollection of familiar material, seems to underlie both clinical and non-clinical hallucinations. Further, both clinical and non-clinical negative symptoms may exert on verbal memory errors an effect opposite to that of hallucinations. PMID:27683568
Crow, Timothy J
A theory of the evolutionary origins of language is built around: (1) the notion that language is a sapiens-specific capacity that arose in the speciation event that separated modern Homo sapiens from a prior hominid species, and (2) Broca's concept of asymmetry (subsequently recognised as a "torque" from right frontal to left occipital cortices) as the defining characteristic of the human brain. The four chambers of human association cortex thus created allow the separation of "thought" from the speech output and "meaning" from the speech input, these abstractions representing the associations in the nondominant hemisphere of the motor and sensory phonological representations in the dominant hemisphere. The nuclear symptoms of schizophrenia are conceived as manifestations of the breakdown of the boundaries between these four compartments, and as indicating the necessity of the separation of motor and sensory speech engrams as the basis for the speaker-hearer distinction. They further illustrate a requirement for a "deictic core" to the cerebral organisation of language as Mueller and Buehler proposed. In this sense the nuclear symptoms are disorders of the syntax of universal grammar.
Terao, T; Matsunaga, K
So far, little attention has been paid to the similarities between musical hallucinations and palinacousis. Since the authors found a 75-year-old woman suffering from both symptoms, the similarities were investigated. As a result, musical hallucinations have all the four components of palinacousis structurally, although there are some differences in content. Thus, there exist substantial similarities. Moreover, both symptoms are often associated with seizure activity and there have been several case reports where anticonvulsants were successfully used to treat both symptoms. These findings indicate the possibility that there may exist a common pathway generating musical hallucinations and palinacousis.
Pinto, Denzil; Safeekh, A.T.; Trivedi, Mohit
Various psychiatric symptoms have been reported in patients with acromegaly. Most of them are personality changes characterized by lack of initiative and spontaneity. There are few case reports of the presence of auditory and visual hallucinations, and delusions in patients with acromegaly. We report a patient with acromegaly who had psychotic symptoms including Schneiderian first-rank symptoms.
Angelopoulos, Elias; Koutsoukos, Elias; Maillis, Antonis; Papadimitriou, George N; Stefanis, Costas
Thought blocks (TBs) are characterized by regular interruptions in the stream of thought. Outward signs are abrupt and repeated interruptions in the flow of conversation or actions while subjective experience is that of a total and uncontrollable emptying of the mind. In the very limited bibliography regarding TB, the phenomenon is thought to be conceptualized as a disturbance of consciousness that can be attributed to stoppages of continuous information processing due to an increase in the volume of information to be processed. In an attempt to investigate potential expression of the phenomenon on the functional properties of electroencephalographic (EEG) activity, an EEG study was contacted in schizophrenic patients with persisting auditory verbal hallucinations (AVHs) who additionally exhibited TBs. In this case, we hypothesized that the persistent and dense AVHs could serve the role of an increased information flow that the brain is unable to process, a condition that is perceived by the person as TB. Phase synchronization analyses performed on EEG segments during the experience of TBs showed that synchrony values exhibited a long-range common mode of coupling (grouped behavior) among the left temporal area and the remaining central and frontal brain areas. These common synchrony-fluctuation schemes were observed for 0.5 to 2s and were detected in a 4-s window following the estimated initiation of the phenomenon. The observation was frequency specific and detected in the broad alpha band region (6-12Hz). The introduction of synchrony entropy (SE) analysis applied on the cumulative synchrony distribution showed that TB states were characterized by an explicit preference of the system to be functioned at low values of synchrony, while the synchrony values are broadly distributed during the recovery state. Our results indicate that during TB states, the phase locking of several brain areas were converged uniformly in a narrow band of low synchrony values and in a
Hellerstein, D; Frosch, W; Koenigsberg, H W
Patients with command hallucinations (voices ordering particular acts, often violent or destructive ones) are commonly assumed to be at high risk for dangerous behavior. The authors reviewed 789 consecutive inpatient admissions. Of 151 patients with auditory hallucinations, 58 (38.4%) heard commands. The presence of auditory hallucinations was significantly associated with diagnosis, demographic variables, and use of maximal observation and seclusion. However, patients with command hallucinations were not significantly different from patients without commands on demographic and behavioral variables, including suicidal ideation or behavior and assaultiveness. These findings suggest that command hallucinations alone may not imply greater risk for acute, life-threatening behavior.
Hersh, K; Borum, R
Command hallucinations are auditory hallucinations that instruct a patient to act in specific ways; these commands can range in seriousness from innocuous to life-threatening. This article summarizes two areas of research regarding command hallucinations: rates of compliance with command hallucinations; and factors associated with compliance. Researchers have reported rates of compliance ranging from 39.2 percent to 88.5 percent. Compliance has not been consistently related to dangerousness of commands. Instead, research suggests that Individuals are more likely to comply with commands if they recognize the hallucinated voice and if their hallucinations are related to a delusion. Implications for risk assessment are discussed in light of the research.
Winawer, Melodie R.; Hauser, W. Allen; Pedley, Timothy A.
The authors previously reported linkage to chromosome 10q22-24 for autosomal dominant partial epilepsy with auditory features. This study describes seizure semiology in the original linkage family in further detail. Auditory hallucinations were most common, but other sensory symptoms (visual, olfactory, vertiginous, and cephalic) were also reported. Autonomic, psychic, and motor symptoms were less common. The clinical semiology points to a lateral temporal seizure origin. Auditory hallucinations, the most striking clinical feature, are useful for identifying new families with this synome. PMID:10851389
Subramaniam, Aditi; Agarwal, Sri Mahavir; Kalmady, Sunil; Shivakumar, Venkataram; Chhabra, Harleen; Bose, Anushree; Damodharan, Dinakaran; Narayanaswamy, Janardhanan C; Hutton, Sam B; Venkatasubramanian, Ganesan
Deficient prefrontal cortex inhibitory control is of particular interest with regard to the pathogenesis of auditory hallucinations (AHs) in schizophrenia. Antisaccade task performance is a sensitive index of prefrontal inhibitory function and has been consistently found to be abnormal in schizophrenia. This study investigated the effect of transcranial direct current stimulation (tDCS) on antisaccade performance in 13 schizophrenia patients. The tDCS resulted in significant reduction in antisaccade error percentage (t = 3.4; P = 0.005), final eye position gain (t = 2.3; P = 0.042), and AHs severity (t = 4.1; P = 0.003). Our results raise the possibility that improvement in antisaccade performance and severity of AH may be mechanistically related.
Larøi, Frank; Sommer, Iris E.; Blom, Jan Dirk; Fernyhough, Charles; ffytche, Dominic H.; Hugdahl, Kenneth; Johns, Louise C.; McCarthy-Jones, Simon; Preti, Antonio; Raballo, Andrea; Slotema, Christina W.; Stephane, Massoud; Waters, Flavie
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson’s disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review. PMID:22499783
Larøi, Frank; Sommer, Iris E; Blom, Jan Dirk; Fernyhough, Charles; Ffytche, Dominic H; Hugdahl, Kenneth; Johns, Louise C; McCarthy-Jones, Simon; Preti, Antonio; Raballo, Andrea; Slotema, Christina W; Stephane, Massoud; Waters, Flavie
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson's disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review.
Gras, A; Amad, A; Thomas, P; Jardri, R
Hallucinations constitute understudied symptoms in borderline personality disorders (BPD), which can be observed in about 30% of the patients, essentially in the auditory modality. Most of these experiences are transitory, triggered by intermittent stressors, but chronicity remains a major cause of concern. In order to better circumscribe hallucinations in BPD, we summarized the literature on this particular phenomenon. We conducted a review using Medline, Scopus and Google Scholar databases up to March 2013, using the following keywords combinations: "borderline personality disorder", "hallucinat*" and "psychotic symptoms". Papers were included in the review if they were published in an English or French language peer-reviewed journal; the study enrolled patients with BPD; and the diagnosis was made according to the Diagnostic and Statistical Manual (DSM) criteria. Fifteen studies published between 1985 and 2012, merging a total of 635 patients, were retained. The hallucinatory experiences observed in BPD appeared phenomenologically similar to those described in the schizophrenia spectrum in terms of vividness, duration, spatial localization, beliefs about malevolence or omnipotence. Conversely, the hallucinatory content appeared more negative and potentially more distressful. Crucially, this literature search also revealed that these symptoms have long been regarded as "pseudo-hallucinations" (or "hallucination-like symptoms"). This concept was judged of poor scientific validity, inducing stigma for BPD patients in that it casts doubt on the authenticity of these experiences while disqualifying the related distress. This situation points out that research should focus more on understanding hallucinations in BPD than questioning their existence. Interestingly, recent comorbidity studies reopened a 40-year debate on the potential links that may exist between BPD and psychosis. Initially considered as a para-psychotic disorder, BPD was effectively redefined as an
Bais, Leonie; Liemburg, Edith; Vercammen, Ans; Bruggeman, Richard; Knegtering, Henderikus; Aleman, André
Efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) targeting the temporo-parietal junction (TPJ) for the treatment of auditory verbal hallucinations (AVH) remains under debate. We assessed the influence of a 1Hz rTMS treatment on neural networks involved in a cognitive mechanism proposed to subserve AVH. Patients with schizophrenia (N=24) experiencing medication-resistant AVH completed a 10-day 1Hz rTMS treatment. Participants were randomized to active stimulation of the left or bilateral TPJ, or sham stimulation. The effects of rTMS on neural networks were investigated with an inner speech task during fMRI. Changes within and between neural networks were analyzed using Independent Component Analysis. rTMS of the left and bilateral TPJ areas resulted in a weaker network contribution of the left supramarginal gyrus to the bilateral fronto-temporal network. Left-sided rTMS resulted in stronger network contributions of the right superior temporal gyrus to the auditory-sensorimotor network, right inferior gyrus to the left fronto-parietal network, and left middle frontal gyrus to the default mode network. Bilateral rTMS was associated with a predominant inhibitory effect on network contribution. Sham stimulation showed different patterns of change compared to active rTMS. rTMS of the left temporo-parietal region decreased the contribution of the left supramarginal gyrus to the bilateral fronto-temporal network, which may reduce the likelihood of speech intrusions. On the other hand, left rTMS appeared to increase the contribution of functionally connected regions involved in perception, cognitive control and self-referential processing. These findings hint to potential neural mechanisms underlying rTMS for hallucinations but need corroboration in larger samples. Copyright © 2017 Elsevier Inc. All rights reserved.
Hare, Stephanie M; Ford, Judith M; Ahmadi, Aral; Damaraju, Eswar; Belger, Aysenil; Bustillo, Juan; Lee, Hyo Jong; Mathalon, Daniel H; Mueller, Bryon A; Preda, Adrian; van Erp, Theo G M; Potkin, Steven G; Calhoun, Vince D; Turner, Jessica A
Prior resting-state functional magnetic resonance imaging (fMRI) analyses have identified patterns of functional connectivity associated with hallucinations in schizophrenia (Sz). In this study, we performed an analysis of the mean amplitude of low-frequency fluctuations (ALFF) to compare resting state spontaneous low-frequency fluctuations in patients with Sz who report experiencing hallucinations impacting different sensory modalities. By exploring dynamics across 2 low-frequency passbands (slow-4 and slow-5), we assessed the impact of hallucination modality and frequency range on spatial ALFF variation. Drawing from a sample of Sz and healthy controls studied as part of the Functional Imaging Biomedical Informatics Research Network (FBIRN), we replicated prior findings showing that patients with Sz have decreased ALFF in the posterior brain in comparison to controls. Remarkably, we found that patients that endorsed visual hallucinations did not show this pattern of reduced ALFF in the back of the brain. These patients also had elevated ALFF in the left hippocampus in comparison to patients that endorsed auditory (but not visual) hallucinations. Moreover, left hippocampal ALFF across all the cases was related to reported hallucination severity in both the auditory and visual domains, and not overall positive symptoms. This supports the hypothesis that dynamic changes in the ALFF in the hippocampus underlie severity of hallucinations that impact different sensory modalities. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2016.
Inability to enjoy normally pleasurable experiences (anhedonia) is a symptom common both to major depression and schizophrenia. It also regularly accompanies and follows stress, and its presence in the two mental illnesses could depend on the fact that both are facilitated and often preceded by stressful events. Anhedonia might possibly accompany stress because the loss of the pleasure of aiming for a goal and achieving it (including defending oneself and escaping from a danger) could lead to immobility, and immobility (playing dead) offers the extreme chance of safety when an animal is facing the worst possible stressful situation--being seized by a predator--as in this case any movement can further stimulate the predator's aggressiveness. Perceiving and connecting sensory information also gives pleasure, and this appears to enhance the clarity of sensations and is an important factor in learning. We propose that anhedonia, by reducing or eliminating the pleasure, might jeopardize the usual appearance of the environment, which must not only be clearly perceived but also continuously interpreted (for instance a foreshortening, or something far off seen as small, must not be seen as a real deformation; the same holds for words, where the meaning has to be grasped from the single letters, and so on). Consequently, anhedonia could in some cases make the environment's image strange, distorted and frightening, and this could cause anxiety, confusion, and give problems in contacts with people and things. As correct information about images and sounds can inhibit visual and auditory hallucinations (considering them, like delusions, as attempts to reconstruct and make sense again of a world that is becoming confused and alien), we propose that anhedonia, interfering with the correct perceiving and processing of sensations, may facilitate them.
Bauer, Susanne M; Schanda, Hans; Karakula, Hanna; Olajossy-Hilkesberger, Luiza; Rudaleviciene, Palmira; Okribelashvili, Nino; Chaudhry, Haroon R; Idemudia, Sunday E; Gscheider, Sharon; Ritter, Kristina; Stompe, Thomas
Besides demographic, clinical, familial, and biographical factors, culture and ethnicity may plausibly influence the manifestation of hallucinations. The purpose of this study was to investigate the influence of culture on the frequency of different kinds of hallucinations in schizophrenia. Patients with a clinical diagnosis of schizophrenia were diagnosed by means of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Seven independent samples were consecutively recruited in Austria, Lithuania, Poland, Georgia, Ghana, Nigeria, and Pakistan using identical inclusion/exclusion criteria and assessment procedures (N = 1080 patients total). The association of key demographic factors (sex and age), clinical factors (age at onset and duration of illness), and country of origin with hallucinations of different kinds was examined. The prevalence of various kinds of hallucinations was substantially different in the samples; however, the rank order of their occurrence was similar. Auditory hallucinations were relatively infrequent in Austria and Georgia and more prevalent in patients with an early age at onset of disease. Visual hallucinations were more frequently reported by the West African patients compared with subjects from the other 5 countries. Cenesthetic hallucinations were most prevalent in Ghana and in patients with a long duration of illness. We hypothesize that the prevalence of the different kinds of hallucinations in schizophrenia is the result of the interaction of a variety of factors like cultural patterns as well as clinical parameters. According to our study, culture seems to play a decisive role and should be taken into account to a greater extent in considerations concerning the pathogenesis of psychotic symptoms. Copyright © 2011 Elsevier Inc. All rights reserved.
Focseneanu, B E; Marian, G
Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge.
Modinos, Gemma; Vercammen, Ans; Mechelli, Andrea; Knegtering, Henderikus; McGuire, Philip K.; Aleman, André
Background Neuroimaging studies have indicated that a number of cortical regions express altered patterns of structural covariance in schizophrenia. The relation between these alterations and specific psychotic symptoms is yet to be investigated. We used voxel-based morphometry to examine regional grey matter volumes and structural covariance associated with severity of auditory verbal hallucinations. Methods We applied optimized voxel-based morphometry to volumetric magnetic resonance imaging data from 26 patients with medication-resistant auditory verbal hallucinations (AVHs); statistical inferences were made at p < 0.05 after correction for multiple comparisons. Results Grey matter volume in the left inferior frontal gyrus was positively correlated with severity of AVHs. Hallucination severity influenced the pattern of structural covariance between this region and the left superior/middle temporal gyri, the right inferior frontal gyrus and hippocampus, and the insula bilaterally. Limitations The results are based on self-reported severity of auditory hallucinations. Complementing with a clinician-based instrument could have made the findings more compelling. Future studies would benefit from including a measure to control for other symptoms that may covary with AVHs and for the effects of antipsychotic medication. Conclusion The results revealed that overall severity of AVHs modulated cortical intercorrelations between frontotemporal regions involved in language production and verbal monitoring, supporting the critical role of this network in the pathophysiology of hallucinations. PMID:19949723
Diederich, Nico J; Fénelon, Gilles; Stebbins, Glenn; Goetz, Christopher G
Patients with Parkinson disease (PD) can experience hallucinations (spontaneous aberrant perceptions) and illusions (misinterpretations of real perceptual stimuli). Of such phenomena, visual hallucinations (VHs) and illusions are the most frequently encountered, although auditory, olfactory and tactile hallucinations can also occur. In cross-sectional studies, VHs occur in approximately one-third of patients, but up to three-quarters of patients might develop VHs during a 20-year period. Hallucinations can have substantial psychosocial effects and, historically, were the main reason for placing patients in nursing homes. Concomitant or overlapping mechanisms are probably active during VHs, and these include the following: central dopaminergic overactivity and an imbalance with cholinergic neurotransmission; dysfunction of the visual pathways, including specific PD-associated retinopathy and functional alterations of the extrastriate visual pathways; alterations of brainstem sleep-wake and dream regulation; and impaired attentional focus. Possible treatments include patient-initiated coping strategies, a reduction of antiparkinson medications, atypical neuroleptics and, potentially, cholinesterase inhibitors. Evidence-based studies, however, only support the use of one atypical neuroleptic, clozapine, and only in patients without dementia. Better phenomenological discrimination, combined with neuroimaging tools, should refine therapeutic options and improve prognosis. The aim of this Review is to present epidemiological, phenomenological, pathophysiological and therapeutic aspects of hallucinations in PD.
Waters, Flavie; Fernyhough, Charles
Hallucinations constitute one of the 5 symptom domains of psychotic disorders in DSM-5, suggesting diagnostic significance for that group of disorders. Although specific featural properties of hallucinations (negative voices, talking in the third person, and location in external space) are no longer highlighted in DSM, there is likely a residual assumption that hallucinations in schizophrenia can be identified based on these candidate features. We investigated whether certain featural properties of hallucinations are specifically indicative of schizophrenia by conducting a systematic review of studies showing direct comparisons of the featural and clinical characteristics of (auditory and visual) hallucinations among 2 or more population groups (one of which included schizophrenia). A total of 43 articles were reviewed, which included hallucinations in 4 major groups (nonclinical groups, drug- and alcohol-related conditions, medical and neurological conditions, and psychiatric disorders). The results showed that no single hallucination feature or characteristic uniquely indicated a diagnosis of schizophrenia, with the sole exception of an age of onset in late adolescence. Among the 21 features of hallucinations in schizophrenia considered here, 95% were shared with other psychiatric disorders, 85% with medical/neurological conditions, 66% with drugs and alcohol conditions, and 52% with the nonclinical groups. Additional differences rendered the nonclinical groups somewhat distinctive from clinical disorders. Overall, when considering hallucinations, it is inadvisable to give weight to the presence of any featural properties alone in making a schizophrenia diagnosis. It is more important to focus instead on the co-occurrence of other symptoms and the value of hallucinations as an indicator of vulnerability. PMID:27872259
Waters, Flavie; Fernyhough, Charles
Hallucinations constitute one of the 5 symptom domains of psychotic disorders in DSM-5, suggesting diagnostic significance for that group of disorders. Although specific featural properties of hallucinations (negative voices, talking in the third person, and location in external space) are no longer highlighted in DSM, there is likely a residual assumption that hallucinations in schizophrenia can be identified based on these candidate features. We investigated whether certain featural properties of hallucinations are specifically indicative of schizophrenia by conducting a systematic review of studies showing direct comparisons of the featural and clinical characteristics of (auditory and visual) hallucinations among 2 or more population groups (one of which included schizophrenia). A total of 43 articles were reviewed, which included hallucinations in 4 major groups (nonclinical groups, drug- and alcohol-related conditions, medical and neurological conditions, and psychiatric disorders). The results showed that no single hallucination feature or characteristic uniquely indicated a diagnosis of schizophrenia, with the sole exception of an age of onset in late adolescence. Among the 21 features of hallucinations in schizophrenia considered here, 95% were shared with other psychiatric disorders, 85% with medical/neurological conditions, 66% with drugs and alcohol conditions, and 52% with the nonclinical groups. Additional differences rendered the nonclinical groups somewhat distinctive from clinical disorders. Overall, when considering hallucinations, it is inadvisable to give weight to the presence of any featural properties alone in making a schizophrenia diagnosis. It is more important to focus instead on the co-occurrence of other symptoms and the value of hallucinations as an indicator of vulnerability.
Vaou, Okeanis; Saint-Hilaire, Marie; Friedman, Joseph
Visual hallucinations are reported in 16-37% of drug-treated patients with Parkinson's disease (PD) and are the most common hallucinations in PD. We report two patients with PD with symptoms that uniquely integrate visual hallucinations and delusions. We report two cases of patients with PD with visual hallucinations who saw the persistence of these hallucinations in photographs. These pictures were taken to prove the absence of these hallucinations. We believe this is the first description of this peculiar phenomenon, in which hallucinations or illusions could be replicated in photographs. Both patients had delusions associated with the images and we speculate that the images they saw in the photographs represent a further delusion, hence a 'delusional hallucination' or 'delusional illusion.' We believe that delusions fostering hallucinations are rare.
Alvarez Perez, Purificacion; Garcia-Antelo, Maria Jose; Rubio-Nazabal, Eduardo
Auditory hallucinations are defined as the abnormal perception of sound in the absence of an external auditory stimulus. Musical hallucinations constitute a complex type of auditory hallucination characterized by perception of melodies, music, or songs. Musical hallucinations are infrequent and have been described in 0.16% of a general hospital population. The auditory hallucinations are popularly associated with psychiatric disorders or degenerative neurological diseases but there may be other causes in which the patient evolves favorably with treatment. With this clinical case we want to stress the importance of knowing the causes of musical hallucinations due to the unpredictable social consequences that they can have. PMID:28567134
Östling, Svante; Bäckman, Kristoffer; Waern, Margda; Marlow, Thomas; Braam, Arjan W; Fichter, Manfred; Lawlor, Brian A; Lobos, Antonio; Reischies, Friedel M; Copeland, John R M; Skoog, Ingmar
It is not clear whether the prevalence of psychosis increases with age. We studied the age-specific prevalence of psychotic symptoms in older people in Western Europe. Older people without dementia (age 65-104 years, N = 8762) from the western part of Europe in the EURODEP concerted action took part in psychiatric examinations. In total, 2.4% of the men and 2.9% of the women had psychotic symptoms. Using a multilevel logistic regression model that included gender and age as a continuous variable, we found that a 5-year increase in age increased the prevalence of psychotic symptoms (odds ratio 1.2 95% confidence interval 1.06-1.3, p = 0.001). A second multilevel regression model showed that wishing to be dead, depressed mood, functional disability, not being married and cognitive impairment measured with Mini mental state examination were all associated with psychotic symptoms whereas gender was not. The prevalence of psychotic symptoms in non-demented older people increases with age, and these symptoms are associated with other psychopathology, social isolation and problems with daily living. Copyright © 2012 John Wiley & Sons, Ltd.
Dorahy, Martin J; Shannon, Ciarán; Seagar, Lenaire; Corr, Mary; Stewart, Kellie; Hanna, Donncha; Mulholland, Ciaran; Middleton, Warwick
Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.
Swiney, Lauren; Sousa, Paulo
The comparator account holds that processes of motor prediction contribute to the sense of agency by attenuating incoming sensory information and that disruptions to this process contribute to misattributions of agency in schizophrenia. Over the last 25 years this simple and powerful model has gained widespread support not only as it relates to bodily actions but also as an account of misattributions of agency for inner speech, potentially explaining the etiology of auditory verbal hallucination (AVH). In this paper we provide a detailed analysis of the traditional comparator account for inner speech, pointing out serious problems with the specification of inner speech on which it is based and highlighting inconsistencies in the interpretation of the electrophysiological evidence commonly cited in its favor. In light of these analyses we propose a new comparator account of misattributed inner speech. The new account follows leading models of motor imagery in proposing that inner speech is not attenuated by motor prediction, but rather derived directly from it. We describe how failures of motor prediction would therefore directly affect the phenomenology of inner speech and trigger a mismatch in the comparison between motor prediction and motor intention, contributing to abnormal feelings of agency. We argue that the new account fits with the emerging phenomenological evidence that AVHs are both distinct from ordinary inner speech and heterogeneous. Finally, we explore the possibility that the new comparator account may extend to explain disruptions across a range of imagistic modalities, and outline avenues for future research. PMID:25221502
Singh, Amardeep; Mortzos, Panteleimon; Sørensen, Torben Lykke
A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the underlying mechanism.
Singh, Amardeep; Mortzos, Panteleimon; Sørensen, Torben Lykke
A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the underlying mechanism. PMID:25473403
Vaou, Okeanis; Saint-Hilaire, Marie; Friedman, Joseph
Visual hallucinations are reported in 16–37% of drug-treated patients with Parkinson's disease (PD) and are the most common hallucinations in PD. We report two patients with PD with symptoms that uniquely integrate visual hallucinations and delusions. We report two cases of patients with PD with visual hallucinations who saw the persistence of these hallucinations in photographs. These pictures were taken to prove the absence of these hallucinations. We believe this is the first description of this peculiar phenomenon, in which hallucinations or illusions could be replicated in photographs. Both patients had delusions associated with the images and we speculate that the images they saw in the photographs represent a further delusion, hence a ‘delusional hallucination’ or ‘delusional illusion.’ We believe that delusions fostering hallucinations are rare. PMID:23704424
Effects of Fronto-Temporal Transcranial Direct Current Stimulation on Auditory Verbal Hallucinations and Resting-State Functional Connectivity of the Left Temporo-Parietal Junction in Patients With Schizophrenia
Mondino, Marine; Jardri, Renaud; Suaud-Chagny, Marie-Françoise; Saoud, Mohamed; Poulet, Emmanuel; Brunelin, Jérôme
Auditory verbal hallucinations (AVH) in patients with schizophrenia are associated with abnormal hyperactivity in the left temporo-parietal junction (TPJ) and abnormal connectivity between frontal and temporal areas. Recent findings suggest that fronto-temporal transcranial Direct Current stimulation (tDCS) with the cathode placed over the left TPJ and the anode over the left prefrontal cortex can alleviate treatment-resistant AVH in patients with schizophrenia. However, brain correlates of the AVH reduction are unclear. Here, we investigated the effect of tDCS on the resting-state functional connectivity (rs-FC) of the left TPJ. Twenty-three patients with schizophrenia and treatment-resistant AVH were randomly allocated to receive 10 sessions of active (2 mA, 20min) or sham tDCS (2 sessions/d for 5 d). We compared the rs-FC of the left TPJ between patients before and after they received active or sham tDCS. Relative to sham tDCS, active tDCS significantly reduced AVH as well as the negative symptoms. Active tDCS also reduced rs-FC of the left TPJ with the left anterior insula and the right inferior frontal gyrus and increased rs-FC of the left TPJ with the left angular gyrus, the left dorsolateral prefrontal cortex and the precuneus. The reduction of AVH severity was correlated with the reduction of the rs-FC between the left TPJ and the left anterior insula. These findings suggest that the reduction of AVH induced by tDCS is associated with a modulation of the rs-FC within an AVH-related brain network, including brain areas involved in inner speech production and monitoring. PMID:26303936
Delespaul, Philippe; deVries, Marten; van Os, Jim
Data related to the dynamics of hallucinatory experiences of patients suffering from schizophrenia are scarce. Detecting antecedent conditions and coping strategies may aid development of targeted psychological interventions. We studied hallucinating and non-hallucinating patients suffering from schizophrenia spectrum disorder (n = 57), and non-schizophrenic severe mentally ill patients with depression (n = 37). Data were collected using the Experience Sampling Method (ESM) over a period of 1 week. Contingent on a randomly signalling beep, subjects filled in reports of ongoing hallucinations as well as thought, mood, current activity, social circumstances and places frequented. More subjects suffering from schizophrenia reported hallucinations, but for all hallucinating subjects the qualities of hallucination episodes were quite similar. More subjects reported visual hallucinations at least once. In contrast, the intensity of auditory hallucinations was higher. Anxiety was the most prominent emotion during hallucinations and reports of anxiety intensity exceeded baseline levels before the first report of auditory hallucinations. Context modified hallucination intensity over the course of an episode. Social withdrawal resulted in a decrease of hallucinatory intensity (AH > VH), while social engagement slightly raised intensity levels (VH > AH). Doing nothing (VH > AH) and work activities (AH > VH) led to decreases in intensity levels over time, while passive leisure activities (watching TV) resulted in increases in intensity levels of hallucinations (AH > VH). The results suggest that hallucinating experiences are subject to a host of contextual influences. Understanding variation offers useful insights for therapy.
Bose, Anushree; Shivakumar, Venkataram; Agarwal, Sri Mahavir; Kalmady, Sunil V; Shenoy, Sonia; Sreeraj, Vanteemar S; Narayanaswamy, Janardhanan C; Venkatasubramanian, Ganesan
Persistent auditory verbal hallucinations (AVH) that are refractory to antipsychotic medications are reported in about 20-30% of schizophrenia patients. Transcranial Direct Current Stimulation (tDCS), a non-invasive and safe neuromodulatory technique, has attracted significant interest as an add-on treatment for refractory AVH in schizophrenia. Studies examining the efficacy of tDCS for refractory AVH in schizophrenia have reported inconsistent findings. In this study, using a randomized, double-blind, sham-controlled design (RCT), we sought to examine the effect of add-on tDCS [anode corresponding to left dorsolateral prefrontal cortex and cathode to left temporo-parietal junction; 2-mA, twice-daily sessions for 5-days] to treat refractory AVH in schizophrenia patients (N=25); following this RCT phase, patients that had <30% reduction in AVH severity were offered an open-label extension (OLE) active stimulation to evaluate the effect of cross-over to verum tDCS. In the RCT phase, repeated measures ANOVA with tDCS type [verum (N=12) vs. sham (N=13)] as between subjects factor demonstrated a significant tDCS-type X time-point interaction [F=21.5, p<0.001, partial-η2=0.48] with significantly greater reduction of AVH score in verum tDCS group as compared to sham group. In the OLE phase, sham-to-verum crossed over patients (N=13) showed significantly greater reduction in AVH severity than their corresponding change during RCT phase (t=2.9; p=0.01). Together, these observations add further support to the beneficial effects of add-on tDCS to treat refractory AVH schizophrenia. Copyright © 2017 Elsevier B.V. All rights reserved.
de Boer, J N; Heringa, S M; van Dellen, E; Wijnen, F N K; Sommer, I E C
Auditory verbal hallucinations (AVH) in psychotic patients are associated with activation of right hemisphere language areas, although this hemisphere is non-dominant in most people. Language generated in the right hemisphere can be observed in aphasia patients with left hemisphere damage. It is called "automatic speech", characterized by low syntactic complexity and negative emotional valence. AVH in nonpsychotic individuals, by contrast, predominantly have a neutral or positive emotional content and may be less dependent on right hemisphere activity. We hypothesize that right hemisphere language characteristics can be observed in the language of AVH, differentiating psychotic from nonpsychotic individuals. 17 patients with a psychotic disorder and 19 nonpsychotic individuals were instructed to repeat their AVH verbatim directly upon hearing them. Responses were recorded, transcribed and analyzed for total words, mean length of utterance, proportion of grammatical utterances, proportion of negations, literal and thematic perseverations, abuses, type-token ratio, embeddings, verb complexity, noun-verb ratio, and open-closed class ratio. Linguistic features of AVH overall differed between groups F(13,24)=3.920, p=0.002; Pillai's Trace 0.680. AVH of psychotic patients compared with AVH of nonpsychotic individuals had a shorter mean length of utterance, lower verb complexity, and more verbal abuses and perseverations (all p<0.05). Other features were similar between groups. AVH of psychotic patients showed lower syntactic complexity and higher levels of repetition and abuses than AVH of nonpsychotic individuals. These differences are in line with a stronger involvement of the right hemisphere in the origination of AVH in patients than in nonpsychotic voice hearers. Copyright © 2016 Elsevier Inc. All rights reserved.
Cran, Alison; Kiely, Fiona; O'Brien, Tony
Neuropsychiatric and gastrointestinal side effects of opioids are well documented, but self-reported hearing disturbance from opioids is often unrecognized. Two cases are presented illustrating a possible association between auditory symptoms and opioid toxicity. Possible mechanisms are discussed.
Ratcliffe, Matthew; Wilkinson, Sam
Verbal hallucinations are often associated with pronounced feelings of anxiety, and it has also been suggested that anxiety somehow triggers them. In this paper, we offer a phenomenological or ‘personal-level’ account of how it does so. We show how anxious anticipation of one’s own thought contents can generate an experience of their being ‘alien’. It does so by making an experience of thinking more like one of perceiving, resulting in an unfamiliar kind of intentional state. This accounts for a substantial subset of verbal hallucinations, which are experienced as falling within one’s psychological boundaries and lacking in auditory qualities. PMID:26683229
Telles-Correia, Diogo; Moreira, Ana L.; Gama Marques, João; Saraiva, Sérgio; Moreira, Cátia A.; Antunes, Filipa; Almeida, Carolina; Rocha, Nuno B.
In psychiatric classifications, hallucinations (mainly auditory hallucinations) are one of the fundamental criteria for establishing a schizophrenia diagnosis or any of the related psychotic disorder's diagnoses. The conceptual proximity between delusions and hallucinations was maintained until the end of the XIX century, with several supporters during the XX century. Their limits were not yet definitely defined in terms of Descriptive Psychopathology, and much less so in terms of biochemical and anatomical models. In this article we aimed to analyse the dimensions of both hallucinations and delusions in a sample of patients with schizophrenia and schizoaffective disorder. We also intend to find the determinants of the main dimensions of hallucinations. One hundred patients with schizophrenia (80) or schizoaffective disorder (20), 64% males, mean age 39.75, from the outpatient and inpatient units of the Psychiatry Department of Hospital de Santa Maria and the Centro Hospitalar Psiquiátrico de Lisboa were assessed by means of the Psychotic Symptom Rating Scales (PSYRATS) and a structured interview. In this study we designed an empirical based model by means of bivariate Spearman's rank correlation coefficient, and multivariate statistics (linear regression and multiple multivariate linear regression), where the main dimensions of hallucinations are determined by the central dimensions of delusions. PMID:27877142
Intrusive, uncontrollable and bizarre thoughts occur in both obsessive-compulsive disorder (OCD) and psychosis. The origin of these mental phenomena and the relationship between them is unclear. A case is described in which long-standing compulsions and the associated resistance temporarily developed the characteristics of command hallucinations, in the absence of any other psychotic symptoms. The implications for psychopathological theories of hallucinations are discussed.
Buccheri, Robin; Trygstad, Louise; Dowling, Glenna
The study objective was to evaluate changes in prevalence of command hallucinations to harm self or others, characteristics and intensity of auditory hallucinations, and levels of anxiety and depression after attendance at a 10-session course teaching behavioral strategies for managing persistent auditory hallucinations to adult outpatients with schizophrenia. Prevalence of command hallucinations to harm self or others was measured at baseline, end of course, and 1-year post-course. Pre-course scores on the Characteristics of Auditory Hallucinations Questionnaire, Unpleasant Voices Scale, tension-anxiety subscale of Profile of Mood States, and Beck Depression Inventory-II were compared with scores immediately post-course and 1 year later. The prevalence rate of command hallucinations to harm self of 44% at baseline decreased to 24% immediately after attending the 10-session course and remained at 24% 1-year post-course. The prevalence rate for command hallucinations to harm others of 21% at baseline decreased to 16% at end of course and 17% 1-year post-course. People who attended the course perceived it as helpful, and improvement was seen in all seven characteristics of auditory hallucinations, intensity of auditory hallucinations, and anxiety and depression immediately after the course and 1-year post-course.
Larøi, Frank; Luhrmann, Tanya Marie; Bell, Vaughan; Christian, William A; Deshpande, Smita; Fernyhough, Charles; Jenkins, Janis; Woods, Angela
A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient's cultural background needs to be taken into account when assessing and treating hallucinations. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Larøi, Frank; Luhrmann, Tanya Marie; Bell, Vaughan; Christian, William A.; Deshpande, Smita; Fernyhough, Charles; Jenkins, Janis; Woods, Angela
A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient’s cultural background needs to be taken into account when assessing and treating hallucinations. PMID:24936082
The relationship between hallucinations and life events is a topic of significant clinical importance. This review discusses the extent to which auditory and visual hallucinations may be directly related to traumatic events. Evidence suggests that intrusive images occur frequently within individuals who also report hallucinatory experiences. However, there has been limited research specifically investigating the extent to which hallucinations are the re-experiencing of a traumatic event. Our current theoretical understanding of these relationships, along with methodological difficulties associated with research in this area, are considered. Recent clinical studies, which adopt interventions aimed at the symptoms of posttraumatic stress disorder in people diagnosed with a psychotic disorder, are reviewed. There is a need for the development of evidence-based interventions in this area. PMID:26441698
Erkwoh, R; Willmes, K; Eming-Erdmann, A; Kunert, H J
The impact of auditory command hallucinations on the behaviour of schizophrenic patients sometimes appears to be unpredictable. In order to tackle this problem, the psychopathological characteristics of command hallucinations in 31 schizophrenic patients were assessed using a 24-item questionnaire. Using binary data and relative risk analysis methods, predictors were determined for obeying or resisting command hallucinations. Characteristics of voices and the attitude toward the voices appear equally important for prediction. A set of three psychopathological characteristics comprising a voice known to the patient, emotional involvement during the hallucinations, and seeing the voice as real provides significant predictivity of behaviour following command hallucinations. These results are interesting for clinical and forensic psychiatrists.
Akman, Cigdem I; Goodkin, Howard P; Rogers, Donald P; Riviello, James J
Zonisamide is a broad-spectrum antiepileptic drug used to treat various types of seizures. Although visual hallucinations have not been reported as an adverse effect of this agent, we describe three patients who experienced complex visual hallucinations and altered mental status after zonisamide treatment was begun or its dosage increased. All three had been diagnosed earlier with epilepsy, and their electroencephalogram (EEG) findings were abnormal. During monitoring, visual hallucinations did not correlate with EEG readings, nor did video recording capture any of the described events. None of the patients had experienced visual hallucinations before this event. The only recent change in their treatment was the introduction or increased dosage of zonisamide. With either discontinuation or decreased dosage of the drug the symptoms disappeared and did not recur. Further observations and reports will help clarify this adverse effect. Until then, clinicians need to be aware of this possible complication associated with zonisamide.
Focseneanu, BE; Marian, G
Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge. PMID:26664485
de Maindreville, Anne Doé; Fénelon, Gilles; Mahieux, Florence
To study prevalence of hallucinations in patients with Parkinson's disease (PD) during a 1-year period, and identify factors predictive of the onset of hallucinations in patients who were hallucination-free at baseline, 141 unselected outpatients with PD were evaluated prospectively for a set of demographic, clinical, and therapeutic variables and the presence of hallucinations during the previous 3 months. Patient groups were compared with nonparametric tests, and logistic regression was applied to significant data. Follow-up data were available for 127 patients. The hallucination prevalence rates (%) at the first and second evaluation were, respectively, 41.7 and 49.6 for hallucinations of all types (NS), 29.1 and 40.2 for minor hallucinations (i.e., presence or passage hallucinations, and illusions) (P = 0.02), 22.8 and 21.2 for formed visual hallucinations (NS), and 8.7 and 8.7 for auditory hallucinations (NS). Hallucinations rarely started or ceased during the study. The most labile forms were minor hallucinations, which developed in 20% of patients and ceased in 9%. During follow-up, 15% of patients started to hallucinate. Three factors, all present at the first evaluation, independently predicted the onset of hallucinations in patients previously free of hallucinations at baseline (odds ratio; 95% confidence interval): severe sleep disturbances (14.3; 2.5-80.9), ocular disorders (9.1; 1.6-52.0), and a high axial motor score (5.7; 1.2-27.4). Hallucinations have a chronic course in most parkinsonian patients. Factors predicting the onset of hallucinations point to a role of extranigral brainstem involvement and a nonspecific, facilitating role of ocular disorders. Copyright 2004 Movement Disorder Society.
Kumar, Vijaya; Bagewadi, Virupakshappa; Sagar, Dayanand; Varambally, Shivarama
A cluster of symptoms including hallucinations characterizes schizophrenia. Hallucinations that occur in more than one modality simultaneously and emanate from a single source are called multimodal hallucinations (MMHs). The occurrence of simultaneous hallucinations as the major manifestations of a psychiatric disorder often was dismissed as factitious disorder or malingering. Conversely, MMHs have been reported in severe mental disorders including schizophrenia. Here, we report MMH in two patients of treatment-resistant schizophrenia and its successful management with clozapine. The significance of MMH on the course, prognosis, and treatment resistance of schizophrenia needs to be elucidated. Further systematic research is needed to address these issues. PMID:28250565
Ffytche, D H; Lappin, J M; Philpot, M
Around 25% of patients with visual hallucinations secondary to eye disease report hallucinations of text. The hallucinated text conveys little if any meaning, typically consisting of individual letters, words, or nonsense letter strings (orthographic hallucinations). A patient is described with textual visual hallucinations of a very different linguistic content following bilateral occipito-temporal infarcts. The hallucinations consisted of grammatically correct, meaningful written sentences or phrases, often in the second person and with a threatening and command-like nature (syntacto-semantic visual hallucinations). A detailed phenomenological interview and visual psychophysical testing were undertaken. The patient showed a classical ventral occipito-temporal syndrome with achromatopsia, prosopagnosia, and associative visual agnosia. Of particular significance was the presence of pure alexia. Illusions of colour induced by monochromatic gratings and a novel motion-direction illusion were also observed, both consistent with the residual capacities of the patient's spared visual cortex. The content of orthographic visual hallucinations matches the known specialisations of an area in the left posterior fusiform gyrus--the visual word form area (VWFA)--suggesting the two are related. The VWFA is unlikely to be responsible for the syntacto-semantic hallucinations described here as the patient had a pure alexic syndrome, a known consequence of VWFA lesions. Syntacto-semantic visual hallucinations may represent a separate category of textual hallucinations related to the cortical network implicated in the auditory hallucinations of schizophrenia.
ffytche, D; Lappin, J; Philpot, M
Around 25% of patients with visual hallucinations secondary to eye disease report hallucinations of text. The hallucinated text conveys little if any meaning, typically consisting of individual letters, words, or nonsense letter strings (orthographic hallucinations). A patient is described with textual visual hallucinations of a very different linguistic content following bilateral occipito-temporal infarcts. The hallucinations consisted of grammatically correct, meaningful written sentences or phrases, often in the second person and with a threatening and command-like nature (syntacto-semantic visual hallucinations). A detailed phenomenological interview and visual psychophysical testing were undertaken. The patient showed a classical ventral occipito-temporal syndrome with achromatopsia, prosopagnosia, and associative visual agnosia. Of particular significance was the presence of pure alexia. Illusions of colour induced by monochromatic gratings and a novel motion–direction illusion were also observed, both consistent with the residual capacities of the patient's spared visual cortex. The content of orthographic visual hallucinations matches the known specialisations of an area in the left posterior fusiform gyrus—the visual word form area (VWFA)—suggesting the two are related. The VWFA is unlikely to be responsible for the syntacto-semantic hallucinations described here as the patient had a pure alexic syndrome, a known consequence of VWFA lesions. Syntacto-semantic visual hallucinations may represent a separate category of textual hallucinations related to the cortical network implicated in the auditory hallucinations of schizophrenia. PMID:14707313
Maddox, W. Todd; Chandrasekaran, Bharath; Smayda, Kirsten; Yi, Han-Gyol; Koslov, Seth; Beevers, Christopher G.
In vision an extensive literature supports the existence of competitive dual-processing systems of category learning that are grounded in neuroscience and are partially-dissociable. The reflective system is prefrontally-mediated and uses working memory and executive attention to develop and test rules for classifying in an explicit fashion. The reflexive system is striatally-mediated and operates by implicitly associating perception with actions that lead to reinforcement. Although categorization is fundamental to auditory processing, little is known about the learning systems that mediate auditory categorization and even less is known about the effects of individual difference in the relative efficiency of the two learning systems. Previous studies have shown that individuals with elevated depressive symptoms show deficits in reflective processing. We exploit this finding to test critical predictions of the dual-learning systems model in audition. Specifically, we examine the extent to which the two systems are dissociable and competitive. We predicted that elevated depressive symptoms would lead to reflective-optimal learning deficits but reflexive-optimal learning advantages. Because natural speech category learning is reflexive in nature, we made the prediction that elevated depressive symptoms would lead to superior speech learning. In support of our predictions, individuals with elevated depressive symptoms showed a deficit in reflective-optimal auditory category learning, but an advantage in reflexive-optimal auditory category learning. In addition, individuals with elevated depressive symptoms showed an advantage in learning a non-native speech category structure. Computational modeling suggested that the elevated depressive symptom advantage was due to faster, more accurate, and more frequent use of reflexive category learning strategies in individuals with elevated depressive symptoms. The implications of this work for dual-process approach to auditory
Schaffer, Yael; Ben Zeev, Bruria; Cohen, Roni; Shuper, Avinoam; Geva, Ronny
Idiopathic epilepsies are considered to have relatively good prognoses and normal or near normal developmental outcomes. Nevertheless, accumulating studies demonstrate memory and psychosocial deficits in this population, and the prevalence, severity and relationships between these domains are still not well defined. We aimed to assess memory, psychosocial function, and the relationships between these two domains among children with idiopathic epilepsy syndromes using an extended neuropsychological battery and psychosocial questionnaires. Cognitive abilities, neuropsychological performance, and socioemotional behavior of 33 early adolescent children, diagnosed with idiopathic epilepsy, ages 9-14years, were assessed and compared with 27 age- and education-matched healthy controls. Compared to controls, patients with stabilized idiopathic epilepsy exhibited higher risks for short-term memory deficits (auditory verbal and visual) (p<0.0001), working memory deficits (p<0.003), auditory verbal long-term memory deficits (p<0.0021), and more frequent psychosocial symptoms (p<0.0001). The severity of auditory verbal memory deficits was related to severity of psychosocial symptoms among the children with epilepsy but not in the healthy controls. Results suggest that deficient auditory verbal memory may be compromising psychosocial functioning in children with idiopathic epilepsy, possibly underscoring that cognitive variables, such as auditory verbal memory, should be assessed and treated in this population to prevent secondary symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.
Elliott, Brent; Joyce, Eileen; Shorvon, Simon
The purpose of this paper and its pair is to provide a comprehensive review, from the different perspectives of neurology and neuropsychiatry, of the phenomenology and mechanisms of hallucinatory experience in epilepsy. We emphasise the clinical and electrophysiological features, and make comparisons with the primary psychoses. In this paper, we consider definitions and elementary hallucinatory phenomena. Regarding definition, there is a clearly divergent evolution in meaning of the terms delusion, illusion and hallucination in the separate traditions of neurology and psychiatry. Psychiatry makes clear distinctions between the terms and has focussed on the empirical use of descriptive psychopathology in order to delineate the various psychiatric syndromes, including those in epilepsy. These distinctions in psychiatry have stood the test of time and are useful in clinical descriptive terms, but do not help to understand the basic mechanisms. The focus of neurology has been to regard delusions, illusions and hallucinations in epilepsy as a result of localised or network based neuronal epileptic activity that can be investigated especially using intracranial stereoelectroencephalography (SEEG). The neurological approach leads to a more synoptical definition of 'hallucination' than in psychiatry and to the conclusion that there is little point in differentiating hallucination from illusion or delusion in view of the overlap in the physiological bases of the phenomena. The semiologically derived differentiation of these terms in psychiatry is not supported by similarly discrete electrophysiological signatures. However, as discussed in the second paper, some psychotic states are associated with similar electrophysiological changes. The wide range of hallucinatory symptoms occurring during epileptic seizures recorded during intracranial SEEG and brain stimulation are reviewed here, including: experiential and interpretive phenomena, affective symptoms, as well as auditory
Lavigne, Katie M.; Rapin, Lucile A.; Metzak, Paul D.; Whitman, Jennifer C.; Jung, Kwanghee; Dohen, Marion; Lœvenbruck, Hélène; Woodward, Todd S.
Background: Task-based functional neuroimaging studies of schizophrenia have not yet replicated the increased coordinated hyperactivity in speech-related brain regions that is reported with symptom-capture and resting-state studies of hallucinations. This may be due to suboptimal selection of cognitive tasks. Methods: In the current study, we used a task that allowed experimental manipulation of control over verbal material and compared brain activity between 23 schizophrenia patients (10 hallucinators, 13 nonhallucinators), 22 psychiatric (bipolar), and 27 healthy controls. Two conditions were presented, one involving inner verbal thought (in which control over verbal material was required) and another involving speech perception (SP; in which control verbal material was not required). Results: A functional connectivity analysis resulted in a left-dominant temporal-frontal network that included speech-related auditory and motor regions and showed hypercoupling in past-week hallucinating schizophrenia patients (relative to nonhallucinating patients) during SP only. Conclusions: These findings replicate our previous work showing generalized speech-related functional network hypercoupling in schizophrenia during inner verbal thought and SP, but extend them by suggesting that hypercoupling is related to past-week hallucination severity scores during SP only, when control over verbal material is not required. This result opens the possibility that practicing control over inner verbal thought processes may decrease the likelihood or severity of hallucinations. PMID:24553150
David, Christopher N.; Greenstein, Deanna; Clasen, Liv; Gochman, Pete; Miller, Rachel; Tossell, Julia W.; Mattai, Anand A.; Gogtay, Nitin; Rapoport, Judith L.
Objective: To document high rates and clinical correlates of nonauditory hallucinations in childhood onset schizophrenia (COS). Method: Within a sample of 117 pediatric patients (mean age 13.6 years), diagnosed with COS, the presence of auditory, visual, somatic/tactile, and olfactory hallucinations was examined using the Scale for the Assessment…
David, Christopher N.; Greenstein, Deanna; Clasen, Liv; Gochman, Pete; Miller, Rachel; Tossell, Julia W.; Mattai, Anand A.; Gogtay, Nitin; Rapoport, Judith L.
Objective: To document high rates and clinical correlates of nonauditory hallucinations in childhood onset schizophrenia (COS). Method: Within a sample of 117 pediatric patients (mean age 13.6 years), diagnosed with COS, the presence of auditory, visual, somatic/tactile, and olfactory hallucinations was examined using the Scale for the Assessment…
Stewart, Claire R; Sanchez, Sandra S; Grenesko, Emily L; Brown, Christine M; Chen, Colleen P; Keehn, Brandon; Velasquez, Francisco; Lincoln, Alan J; Müller, Ralph-Axel
Atypical sensory responses are common in autism spectrum disorder (ASD). While evidence suggests impaired auditory-visual integration for verbal information, findings for nonverbal stimuli are inconsistent. We tested for sensory symptoms in children with ASD (using the Adolescent/Adult Sensory Profile) and examined unisensory and bisensory processing with a nonverbal auditory-visual paradigm, for which neurotypical adults show bisensory facilitation. ASD participants reported more atypical sensory symptoms overall, most prominently in the auditory modality. On the experimental task, reduced response times for bisensory compared to unisensory trials were seen in both ASD and control groups, but neither group showed significant race model violation (evidence of intermodal integration). Findings do not support impaired bisensory processing for simple nonverbal stimuli in high-functioning children with ASD.
Stewart, Claire R.; Sanchez, Sandra S.; Grenesko, Emily L.; Brown, Christine M.; Chen, Colleen P.; Keehn, Brandon; Velasquez, Francisco; Lincoln, Alan J.; Müller, Ralph-Axel
Atypical sensory responses are common in autism spectrum disorder (ASD). While evidence suggests impaired auditory-visual integration for verbal information, findings for nonverbal stimuli are inconsistent. We tested for sensory symptoms in children with ASD (using the Adolescent/Adult Sensory Profile) and examined unisensory and bisensory…
Stewart, Claire R.; Sanchez, Sandra S.; Grenesko, Emily L.; Brown, Christine M.; Chen, Colleen P.; Keehn, Brandon; Velasquez, Francisco; Lincoln, Alan J.; Müller, Ralph-Axel
Atypical sensory responses are common in autism spectrum disorder (ASD). While evidence suggests impaired auditory-visual integration for verbal information, findings for nonverbal stimuli are inconsistent. We tested for sensory symptoms in children with ASD (using the Adolescent/Adult Sensory Profile) and examined unisensory and bisensory…
Taylor, P; Fleminger, J J
An awareness of symptoms being lateralized was established in almost half of a series of 60 acutely ll schizophrenics and is reported in a further series of 16 patients with this disorder. Case illustrations are given. The symptoms most commonly showing this phenomenon were hypochondriacal delusions and hallucinations, usually of an auditory kind. Possible mechanisms underlying the phenomenon are discussed. Some evidence was found for a difference between the sexes in the direction of lateralization symptoms.
Prabhu, Prashanth; Jamuar, Pratyasha
Summary The objective of the study was to retrospectively determine the prevalence of vestibular symptoms in individuals with auditory neuropathy spectrum disorder (ANSD). It was also attempted to determine the prevalence of vestibular symptoms and factors (gender and age of reported hearing loss) that could affect the prevalence in individuals with ANSD. The vestibular symptoms reported in the case history were analyzed in individuals diagnosed with ANSD. The symptoms reported by a total of 316 individuals (185 females and 131 males) with ANSD were analyzed. The result of the study showed that one in five individuals with ANSD reported at least one of the vestibular symptom. The vestibular symptoms were in more females and in individuals with earlier onset of hearing loss. The result of the study supports that there is a vestibular damage in individuals with ANSD. However, it is essential to carry out prospective studies validating these vestibular symptoms with objective vestibular tests before generalizing the results. PMID:28357181
Kasper, B S; Kasper, E M; Pauli, E; Stefan, H
In partial epilepsy, a localized hypersynchronous neuronal discharge evolving into a partial seizure affecting a particular cortical region or cerebral subsystem can give rise to subjective symptoms, which are perceived by the affected person only, that is, ictal hallucinations, illusions, or delusions. When forming the beginning of a symptom sequence leading to impairment of consciousness and/or a classic generalized seizure, these phenomena are referred to as an epileptic aura, but they also occur in isolation. They often manifest in the fully awake state, as part of simple partial seizures, but they also can be associated to different degrees of disturbed consciousness. Initial ictal symptoms often are closely related to the physiological functions of the cortical circuit involved and, therefore, can provide localizing information. When brain regions related to sensory integration are involved, the seizure discharge can cause specific kinds of hallucinations, for example, visual, auditory, gustatory, olfactory, and cutaneous sensory sensations. In addition to these elementary sensory perceptions, quite complex hallucinations related to a partial seizure can arise, for example, perception of visual scenes or hearing music. By involving psychic and emotional spheres of human perception, many seizures also give rise to hallucinatory emotional states (e.g., fear or happiness) or even more complex hallucinations (e.g., visuospatial phenomena), illusions (e.g., déjà vu, out-of-body experience), or delusional beliefs (e.g., identity change) that often are not easily recognized as epileptic. Here we suggest a classification into elementary sensory, complex sensory, and complex integratory seizure symptoms. Epileptic hallucinations, illusions, and delusions shine interesting light on the physiology and functional anatomy of brain regions involved and their functions in the human being. This article, in which 10 cases are described, introduces the fascinating
Girard, T A; Cheyne, J A
Individual differences were investigated in the lateralisation of two general categories of hypnagogic and hypnopompic hallucinations associated with sleep paralysis: (1) Vestibular-motor (V-M) hallucinations; comprising sensations of floating, flying, illusory locomotion and postural adjustments, out-of-body experiences (OBE), and autoscopy; and (2) Intruder hallucinations; incorporating a sense of the presence, and visual and auditory hallucinations of external, alien agents. Left-right lateralisation of such hallucinations, as well as handedness and footedness, were assessed in a diverse, nonclinical sample of 201 subjects participating in a web-based survey of sleep paralysis experiences. V-M hallucinations, but not Intruder hallucinations were predicted, based on the hypothesised distinctive neural sources of the different hallucinations, to be positively associated with handedness and footedness. Specifically, the predictions were based on the hypothesis that the activation of components of a vestibular, motor, and kinaesthetic bodily-self neuromatrix underlies V-M hallucinations, whereas a threat-activated vigilance system is responsible for Intruder hallucinations. As predicted, limb preferences were consistently found to be significantly and positively associated with a side bias of V-M, but not Intruder, hallucinations.
García-Ptacek, S; García Azorín, D; Sanchez Salmador, R; Cuadrado, M L; Porta-Etessam, J
Hallucinations are frequent in clinical practice, with an incidence of up to 38.7% in the general population. We aim to determine the prevalence of hallucinations among healthy young adults in our environment. We designed an observational study, using as subjects 3rd to 6th year medical students at the Universidad Complutense de Madrid who complete clinical rotations in the Hospital Clínico San Carlos. After a screening questionnaire, an individual interview was conducted via telephone or e-mail to those students who reported hallucinations. We obtained clinical and epidemiological data through a semi-structured clinical interview performed by a third year neurology resident. N=134 (average age was 22.1 years; 77.6% were women). 74 respondents answered affirmatively to one or more screening questions, and 54 completed the follow-up interview. 22.2% described visual phenomena and 64.8%, auditory. The majority reported sleep-related experiences and auditory perceptions related to hyper vigilance, such as hearing the telephone or the doorbell ring when in fact it had not (38.8%). All subjects had good insight into their experiences and none had psychotic symptoms. Two cases were associated with substance abuse. Hallucinations are frequent among the general population. Traditionally, auditory phenomena have been associated with psychotic pathology, and other studies show a low population incidence (0.6%). However, in our sample, short auditory perceptions with immediate analysis were frequent and not pathological. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Kasper, M E; Rogers, R; Adams, P A
Forensic consultations with psychotic inpatients frequently include issues of risk management, such as dangerousness and civil commitment. An important dimension of these consultations is the role of command hallucinations in producing an increased risk of aggressive behavior. In the present study, psychotic patients with command hallucinations (N = 27) were compared with patients with other hallucinations (N = 27) and with other psychotic patients (N = 30). The groups did not differ on aggressive behavior or most nonhallucinatory symptoms. However, most patients (84.0%) with command hallucinations had recently obeyed them. Among those with command hallucinations, almost one-half had heard and attempted to obey messages of self-harm during the last month.
Cheung, P; Schweitzer, I; Crowley, K; Tuckwell, V
The study examines the relationship between hallucinations/delusions and violent behaviour in a sample of long-stay inpatients with chronic schizophrenia. Thirty-one subjects defined as violent and meeting DSM-111-R criteria for schizophrenia were compared with 31 matched non-violent schizophrenia patients with respect to detailed phenomenologies of auditory hallucinations using the Mental Health Research Institute Unusual Perceptions Schedule (Carter and Copolov, 1993; Carter et al., 1995) and delusions using the Maudsley Assessment of Delusions Schedule (Taylor et al., 1994). Patients in the violent groups were significantly more likely to experience negative emotions, tone and content related to their voices than those in the non-violent group, whilst patients in the non-violent group were more likely to experience positive emotions, tone and content related to their voices. Patients in the non-violent group were significantly more likely to report success in coping with their voices. There was no association between command hallucinations and violent behaviour. Patients in the violent group were more likely to hold persecutory delusional beliefs than those in the non-violent group, while patients in the non-violent group were likely to hold grandiose delusions than those in the violent group. Patients in the violent group were also more likely to report that the delusion made them feel angry, while those in the non-violent group were more likely to report that the delusion made them feel elated. The results suggest specific aspects of the phenomenologies of hallucinations and delusions that should be clinically assessed to determine the likelihood of violence as a result of such psychotic symptoms.
Auditory dysfunction is a common clinical symptom that can induce profound effects on the quality of life of those affected. Cerebrovascular disease (CVD) is the most prevalent neurological disorder today, but it has generally been considered a rare cause of auditory dysfunction. However, a substantial proportion of patients with stroke might have auditory dysfunction that has been underestimated due to difficulties with evaluation. The present study reviews relationships between auditory dysfunction and types of CVD including cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, cerebrovascular malformation, moyamoya disease, and superficial siderosis. Recent advances in the etiology, anatomy, and strategies to diagnose and treat these conditions are described. The numbers of patients with CVD accompanied by auditory dysfunction will increase as the population ages. Cerebrovascular diseases often include the auditory system, resulting in various types of auditory dysfunctions, such as unilateral or bilateral deafness, cortical deafness, pure word deafness, auditory agnosia, and auditory hallucinations, some of which are subtle and can only be detected by precise psychoacoustic and electrophysiological testing. The contribution of CVD to auditory dysfunction needs to be understood because CVD can be fatal if overlooked. PMID:25401133
Brandwein, Alice B; Foxe, John J; Butler, John S; Frey, Hans-Peter; Bates, Juliana C; Shulman, Lisa H; Molholm, Sophie
Atypical processing and integration of sensory inputs are hypothesized to play a role in unusual sensory reactions and social-cognitive deficits in autism spectrum disorder (ASD). Reports on the relationship between objective metrics of sensory processing and clinical symptoms, however, are surprisingly sparse. Here we examined the relationship between neurophysiological assays of sensory processing and (1) autism severity and (2) sensory sensitivities, in individuals with ASD aged 6-17. Multiple linear regression indicated significant associations between neural markers of auditory processing and multisensory integration, and autism severity. No such relationships were apparent for clinical measures of visual/auditory sensitivities. These data support that aberrant early sensory processing contributes to autism symptoms, and reveal the potential of electrophysiology to objectively subtype autism.
Brandwein, A.B.; Foxe, J.J.; Butler, J.S.; Frey, H.P.; Bates, J.C.; Shulman, L.; Molholm, S.
Atypical processing and integration of sensory inputs are hypothesized to play a role in unusual sensory reactions and social-cognitive deficits in autism spectrum disorder (ASD). Reports on the relationship between objective metrics of sensory processing and clinical symptoms, however, are surprisingly sparse. Here we examined the relationship between neurophysiological assays of sensory processing and 1) autism severity and 2) sensory sensitivities, in individuals with ASD aged 6–17. Multiple linear regression indicated significant associations between neural markers of auditory processing and multisensory integration, and autism severity. No such relationships were apparent for clinical measures of visual/auditory sensitivities. These data support that aberrant early sensory processing contributes to autism symptoms, and reveal the potential of electrophysiology to objectively subtype autism. PMID:25245785
Chhabra, Harleen; Sowmya, Selvaraj; Sreeraj, Vanteemar S; Kalmady, Sunil V; Shivakumar, Venkataram; Amaresha, Anekal C; Narayanaswamy, Janardhanan C; Venkatasubramanian, Ganesan
Auditory hallucinations constitute an important symptom component in 70-80% of schizophrenia patients. These hallucinations are proposed to occur due to an imbalance between perceptual expectation and external input, resulting in attachment of meaning to abstract noises; signal detection theory has been proposed to explain these phenomena. In this study, we describe the development of an auditory signal detection task using a carefully chosen set of English words that could be tested successfully in schizophrenia patients coming from varying linguistic, cultural and social backgrounds. Schizophrenia patients with significant auditory hallucinations (N=15) and healthy controls (N=15) performed the auditory signal detection task wherein they were instructed to differentiate between a 5-s burst of plain white noise and voiced-noise. The analysis showed that false alarms (p=0.02), discriminability index (p=0.001) and decision bias (p=0.004) were significantly different between the two groups. There was a significant negative correlation between false alarm rate and decision bias. These findings extend further support for impaired perceptual expectation system in schizophrenia patients. Copyright © 2016 Elsevier B.V. All rights reserved.
Soulas, Thierry; Cleret de Langavant, Laurent; Monod, Valérie; Fénelon, Gilles
Psychotic phenomena can occur in non-clinical subjects. The goals of this study were to assess the prevalence of delusions, hallucinations and minor 'psychotic' phenomena (visual illusions, feeling of presence and passage hallucinations) and to describe the characteristics of the latter in a non-clinical older population. Three hundred and thirteen individuals aged 60 years and older, without cognitive deficits (according to mini-mental state examination scores) or patent psychotic disease, answered a structured questionnaire focusing on delusions, hallucinations and minor phenomena that they had experienced in the previous month. The study sample was stratified by age and gender according to French demographic characteristics. Twenty per cent of participants reported one or more psychotic phenomena. These subjects did not differ from those without psychotic symptoms as regards their age, mini-mental state examination scores or education. Minor phenomena were the most common (13%). Hallucinations, in any sensory modality, occurred in 9% of participants. No verbal auditory hallucinations or delusions were reported. The prevalence of minor phenomena increased with age and was associated with the use of psychoactive drugs. By extending the spectrum of psychotic symptoms to minor phenomena, we found that psychotic symptoms were common in a non-clinical older population. Whether the increasing prevalence of minor phenomena with age is due to prodromal neurodegenerative disease or to other factors remains to be investigated. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Longden, Eleanor; House, Allan O; Waterman, Mitch G
Although repeated associations have been found between adversity exposure (particularly exposure to childhood sexual abuse), dissociation, and auditory hallucinations in the context of psychosis, there is little comparable research examining hallucinations in other modalities. This study aimed to determine whether cumulative adversity exposure influences the likelihood of experiencing visual, tactile, olfactory, and gustatory hallucinations among psychosis patients and whether measures of dissociation are significantly associated with nonauditory hallucinations when exposure to childhood adversity and psychological distress are adjusted for. Self-report measures and a retrospective case-control design were applied to assess nonauditory hallucinations, dissociation, psychological distress, and childhood adversity exposure in a sample of first-episode psychosis patients reporting nonauditory hallucinations (n = 36) and controls from the same clinical population without nonauditory hallucinations (n = 31). Case participants reported higher levels of dissociation, psychological distress, and exposure to childhood rape than the control group. Dissociation remained significantly associated with nonauditory hallucinations when we adjusted for childhood sexual abuse, other types of childhood adversity, and a combined measure of emotional distress. Indication of a dose-response relationship was detected, in that total number of adversities was significantly associated with reporting more than one modality of nonauditory hallucination. Observed associations between auditory hallucinations and dissociation in psychosis may extend to other hallucination modalities. It is suggested that more research attention be paid to the etiology and impact of nonauditory hallucinations in psychosis samples.
Smith, R A; Wright, B; Bennett, Sophie
A prospective observational study over 1 year. A District General Hospital, and Child and Adolescent Mental Health Department. Children aged 8-18 years living in the catchment area of a district hospital service with any type of unexplained hallucinations or illusions associated with or without an established diagnosis of migraine. The study identified nine children with a combination of migraine and a variety of hallucinations and illusions, including illusions of size, time, colour, body shape, movement and visual and auditory hallucination. An average of 10 symptoms (range 7-15) were reported. None. None. It is important to recognise these symptoms to enable appropriate history taking and diagnosis. These symptoms are common and currently seem to go unrecognised and may pose diagnostic difficulties if onset is before typical migraine headaches occur. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
David, R R; Fernandez, H H
Musical release hallucinations are complex auditory phenomena, affecting mostly the deaf geriatric population, in which individuals hear vocal or instrumental music. Progressive hearing loss from otosclerosis disrupts the usual external sensory stimuli necessary to inhibit the emergence of memory traces within the brain, thereby "releasing" previously recorded perceptions. Responses to conventional antipsychotic agents have been variable and extrapyramidal and other side effects have limited their use. We report the first case of hypnogogic release hallucinations successfully treated with the atypical antipsychotic quetiapine. The patient is an 88-year-old woman with progressive deafness who complained of hearing the piano, drums, or a full orchestra every time she was about to fall asleep. She accused her neighbor of hosting loud parties. Physical, neurologic, and psychiatric examination and work-up were unremarkable. She was treated with low-dose quetiapine affording near total resolution of hallucinations without adverse effects.
Blom, Jan Dirk; Coebergh, Jan Adriaan F.; Lauw, René; Sommer, Iris E. C.
Musical hallucinations are relatively rare auditory percepts which, due to their intrusive nature and the accompanying fear of impending mental decline, tend to cause significant distress and impairment. Although their etiology and pathophysiology appear to be heterogeneous and no evidence-based treatment methods are available, case reports indicate that acetylcholinesterase inhibitors may yield positive results in patients with comorbid hearing loss. We present two female patients (aged 76 and 78 years) both of whom suffered from hearing impairment and practically incessant musical hallucinations. Both patients were successfully treated with the acetylcholinesterase inhibitor rivastigmine. Based on these two case descriptions and an overview of studies describing the use of acetylcholinesterase inhibitors in similar patients, we discuss possible mechanisms and propose further research on the use of acetylcholinesterase inhibitors for musical hallucinations experienced in concordance with hearing loss. PMID:25904872
Blom, Jan Dirk; Coebergh, Jan Adriaan F; Lauw, René; Sommer, Iris E C
Musical hallucinations are relatively rare auditory percepts which, due to their intrusive nature and the accompanying fear of impending mental decline, tend to cause significant distress and impairment. Although their etiology and pathophysiology appear to be heterogeneous and no evidence-based treatment methods are available, case reports indicate that acetylcholinesterase inhibitors may yield positive results in patients with comorbid hearing loss. We present two female patients (aged 76 and 78 years) both of whom suffered from hearing impairment and practically incessant musical hallucinations. Both patients were successfully treated with the acetylcholinesterase inhibitor rivastigmine. Based on these two case descriptions and an overview of studies describing the use of acetylcholinesterase inhibitors in similar patients, we discuss possible mechanisms and propose further research on the use of acetylcholinesterase inhibitors for musical hallucinations experienced in concordance with hearing loss.
Hazif-Thomas, C; Stephan, F; Walter, M; Thomas, P
Negative hallucinations are characterized by a defect in perception of an object or a person, or a denial of the existence of their perception. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. They have a close relationship with Cotard's syndrome, delusional theme of organ denial observed in melancholic syndromes in the elderly. Phenomenological approach. The phenomenology of negative hallucinations provides quite an amount of information on the origin of the psychotic symptoms when one is rather old. The connections between hallucinations, mood disorders and negative symptoms are often difficult to live with for the nearest and dearest. Negative hallucinations require a strict approach to identify their expression that is crucial because a wide heterogeneity exists within the pathological pictures, as in Cotard's syndrome. Although the negative hallucination has an anti traumatic function in elderly people fighting against mental pain, it still represents a deficiency in symbolization. The prevalence of this symptom is without doubt underestimated, although its presence often underlines thymic suffering that is more striking. These hallucinatory symptoms have an important impact on the patients' daily life, and they appear to be prisoners of a suffering, which cannot be revealed. We propose in this article to review the clinical symptoms of negative hallucinations in the elderly and the way to manage them. The medicinal approaches are not always effective. A greater place must be given to what is in connection with the body, aiming at a strong impact and thus to offer non-pharmacological approaches, such as somatic ones, which can be either invasive (electroconvulsive therapy) or not (transcranial magnetic stimulation). Copyright © 2014. Published by Elsevier Masson SAS.
Shannahoff-Khalsa, David; Golshan, Shahrokh
Nasal dominance, at the onset of hallucinations, was studied as a marker of both the lateralized ultradian rhythm of the autonomic nervous system and the tightly coupled ultradian rhythm of alternating cerebral hemispheric dominance in a single case study of a schizophrenic female. Over 1086 days, 145 hallucination episodes occurred with left nostril dominance significantly greater than the right nostril dominant phase of the nasal cycle. A right nostril breathing exercise, that primarily stimulates the left hemisphere, reduces symptoms more quickly for hallucinations.
Szechtman, Henry; Woody, Erik; Bowers, Kenneth S.; Nahmias, Claude
An auditory hallucination shares with imaginal hearing the property of being self-generated and with real hearing the experience of the stimulus being an external one. To investigate where in the brain an auditory event is “tagged” as originating from the external world, we used positron emission tomography to identify neural sites activated by both real hearing and hallucinations but not by imaginal hearing. Regional cerebral blood flow was measured during hearing, imagining, and hallucinating in eight healthy, highly hypnotizable male subjects prescreened for their ability to hallucinate under hypnosis (hallucinators). Control subjects were six highly hypnotizable male volunteers who lacked the ability to hallucinate under hypnosis (nonhallucinators). A region in the right anterior cingulate (Brodmann area 32) was activated in the group of hallucinators when they heard an auditory stimulus and when they hallucinated hearing it but not when they merely imagined hearing it. The same experimental conditions did not yield this activation in the group of nonhallucinators. Inappropriate activation of the right anterior cingulate may lead self-generated thoughts to be experienced as external, producing spontaneous auditory hallucinations. PMID:9465124
Scott, Charles L; Resnick, Phillip J
This article reviews important components to consider when evaluating the relationship of psychotic and mood disorder symptoms to violence. Particular attention is given to assessing persecutory delusions and command auditory hallucinations. Clinical implications of research findings to evaluating violence risk in psychiatric patients are reviewed.
Rees, W. Dewi
227 widows and 66 widowers were interviewed to determine the extent to which they had hallucinatory experiences of their dead spouse. The people interviewed formed 80·7% of all widowed people resident within a defined area, in mid-Wales, and 94·2% of those suitable, through the absence of incapacitating illness, for interview. Almost half the people interviewed had hallucinations or illusions of the dead spouse. The proportion of men and women who had these experiences was similar. The hallucinations often lasted many years but were most common during the first 10 years of widowhood. Social isolation did not affect the incidence of hallucination, nor was it related to the incidence of known depressive illness. There was no variation within cultural groups and there was no variation with place of residence, whether this was within town, country, or village, or within England and Wales. Young people were less likely to be hallucinated than those widowed after the age of 40. The incidence of hallucination increased with length of marriage and was particularly associated with a happy marriage and parenthood. Members of the “professional and managerial” group were particularly likely to be hallucinated, while widows of “non-manual and sales workers” were the ones least likely to be hallucinated. The incidence was greater with hysteroid than obsessoid people. It was unusual for the hallucinations to have been disclosed, even to close friends or relatives. These hallucinations are considered to be normal and helpful accompaniments of widowhood. PMID:5096884
Htun, H M; Mui, S L; Williams, C; Hans, P S
To determine the frequency of incidental findings found on magnetic resonance imaging scans of the internal auditory meatus performed to investigate audiovestibular symptoms, and to determine how to best manage these when found. A retrospective review was conducted of internal auditory meatus magnetic resonance imaging scans during a three-month period in the radiology department at a UK district general hospital. A total of 109 scans were reviewed. Of these, 92.7 per cent showed no retrocochlear pathology, 0.9 per cent showed vestibular schwannoma, 6.4 per cent revealed vascular loops, and 2.8 per cent showed incidental findings that warranted further action and investigation. Of the scans, 40.4 per cent showed other incidental pathologies such as age-related ischaemic changes, and sinus disease that required no further intervention. Of the magnetic resonance imaging scans reviewed, 49.5 per cent were entirely normal. Almost half of the scans investigating audiovestibular symptoms showed incidental findings. Otolaryngologists should have an understanding of the significance of the most commonly encountered incidental findings, and should counsel patients appropriately and refer them onward when necessary.
de Chazeron, I; Pereira, B; Chereau-Boudet, I; Brousse, G; Misdrahi, D; Fénelon, G; Tronche, A-M; Schwan, R; Lançon, C; Marques, A; Debilly, B; Durif, F; Llorca, P M
If hallucinations are the most common of schizophrenic symptoms, they have been described in other pathologies such as Parkinson's disease (PD) but may differ considerably in their phenomenology. However, no multi-modal clinical scale with a transnosographic approach has been developed today. The purpose of this study was to create and validate a new tool for the hetero-assessment of all sensory modalities of hallucinations schizophrenia (SCZ) and in PD. Scale items were generated by literature review and validated by medical board. A study was then made to evaluate psychometric properties of the Psycho-Sensory hAllucinations Scale (PSAS) that include four domains (auditory, visual, olfactory and gustatory, cenesthetic modalities) and one specific item 'guardian angel'. It was then validated in 137 patients: 86 PD (53.5% male; mean age=53.3years) and 51 SCZ (64.7% male; mean age=38.5years). Factorial analysis of the PSAS found four factors. The PSAS showed good internal consistency [Kuder-Richardson alpha coefficient 0.49 to 0.77] and good test-retest reliability [Agreement %=0.75 to 0.97] and inter-rater reliability [Agreement %=0.78 to 1.0]. The convergent validity illustrates the concomitant evaluation of the concept between PSAS and PANSS P3 and UPDRS1 I2. The PSAS can be useful to describe the whole hallucination and its evolution during the course of the disease and treatment in schizophrenia and PD. Moreover, it can allow us to undertake a clinic-pathological comparison of hallucination modalities between these two diseases, to enhance our understanding of their precise neurological mechanisms. Copyright © 2014 Elsevier B.V. All rights reserved.
Gerlock, April A; Buccheri, Robin; Buffum, Martha D; Trygstad, Louise; Dowling, Glenna A
Command hallucinations are relatively common in voice hearers and are taken seriously because of the potential threat to self and others. Many variables mediate the relationship between hearing commands and acting on them. This article describes the implementation of the Harm Command Safety Protocol and the Unpleasant Voices Scale to respond to command hallucinations to harm in the context of the dissemination of a multisite, evidence-based behavioral management course for patients with auditory hallucinations.
Park, Mi-Sook; Byun, Ki-Won; Park, Yong-Kyung; Kim, Mi-Han; Jung, Sung-Hwa; Kim, Hong
We investigated the effects of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. Forty-seven male children (7–13 yr old), who were clinically diagnosed with ADHD at the Balance Brain Center in Seoul, Korea, were included in this study. The complex treatment consisted of visual and auditory stimuli, core muscle exercise, targeting ball exercise, ocular motor exercise, and visual motor integration. All subjects completed the complex treatment for 60 min/day, 2–3 times/week for more than 12 weeks. Data regarding visual and auditory reaction time and cognitive function were obtained using the Neurosync program, Stroop Color-Word Test, and test of nonverbal intelligence (TONI) at pre- and post-treatment. The complex treatment significantly decreased the total reaction time, while it increased the number of combo actions on visual and auditory stimuli (P< 0.05). The Stroop color, word, and color-word scores were significantly increased at post-treatment compared to the scores at pretreatment (P< 0.05). There was no significant change in the TONI scores, although a tendency toward an increase in these scores was observed. In conclusion, complex treatment using visual and auditory stimuli alleviated the symptoms of ADHD and improved cognitive function in children. In addition, visual and auditory function might be possible indicators for demonstrating effective ADHD intervention. PMID:24278878
Park, Mi-Sook; Byun, Ki-Won; Park, Yong-Kyung; Kim, Mi-Han; Jung, Sung-Hwa; Kim, Hong
We investigated the effects of complex treatment using visual and auditory stimuli on the symptoms of attention deficit/hyperactivity disorder (ADHD) in children. Forty-seven male children (7-13 yr old), who were clinically diagnosed with ADHD at the Balance Brain Center in Seoul, Korea, were included in this study. The complex treatment consisted of visual and auditory stimuli, core muscle exercise, targeting ball exercise, ocular motor exercise, and visual motor integration. All subjects completed the complex treatment for 60 min/day, 2-3 times/week for more than 12 weeks. Data regarding visual and auditory reaction time and cognitive function were obtained using the Neurosync program, Stroop Color-Word Test, and test of nonverbal intelligence (TONI) at pre- and post-treatment. The complex treatment significantly decreased the total reaction time, while it increased the number of combo actions on visual and auditory stimuli (P< 0.05). The Stroop color, word, and color-word scores were significantly increased at post-treatment compared to the scores at pretreatment (P< 0.05). There was no significant change in the TONI scores, although a tendency toward an increase in these scores was observed. In conclusion, complex treatment using visual and auditory stimuli alleviated the symptoms of ADHD and improved cognitive function in children. In addition, visual and auditory function might be possible indicators for demonstrating effective ADHD intervention.
Bruder, Gerard E.; Alschuler, Daniel M.; Kroppmann, Christopher J.; Fekri, Shiva; Gil, Roberto; Jarskog, Lars F.; Harkavy-Friedman, Jill M.; Goetz, Raymond; Kayser, Jürgen; Wexler, Bruce E.
The heterogeneity of schizophrenia remains an obstacle for understanding its pathophysiology. Studies using a tone discrimination screening test to classify patients have found evidence for two subgroups having either a specific deficit in verbal working memory (WM) or deficits on both verbal and nonverbal memory tests. This study aimed to: (1) replicate in larger samples differences between these subgroups on the word serial position test (WSPT); (2) further evaluate their performance on additional tests of verbal WM, explicit memory, and sustained attention; (3) determine the relation of verbal WM deficits to auditory hallucinations and other symptoms; and (4) examine medication effects. WSPT of verbal WM and tone discrimination performance did not differ between medicated (n=45) and unmedicated (n=38) patients. Patients with schizophrenia who passed the auditory screening test (discriminators, n=60) were compared to those who did not (nondiscriminators, n=23), and healthy controls (n=47). The discriminator subgroup showed poorer verbal WM than controls and a deficit in verbal but not visual memory on Wechsler Memory Scale-Revised, whereas the nondiscriminator subgroup showed overall poorer performance on both verbal and nonverbal tests and a marked deficit in sustained attention. Verbal WM deficits in discriminators on WSPT were correlated with auditory hallucinations but not with negative symptoms. The results are consistent with a verbal memory deficit in a subgroup of schizophrenia having intact auditory perception, which may stem from dysfunction of language-related cortical regions, and a more generalized cognitive deficit in a subgroup having auditory perceptual and attentional dysfunction. PMID:21319926
Yellowlees, Peter M.; Cook, James N.
Objective: The authors evaluate an Internet virtual reality technology as an education tool about the hallucinations of psychosis. Method: This is a pilot project using Second Life, an Internet-based virtual reality system, in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients…
The literature on hallucinations is reviewed, including its occurrence in different psychiatric disorders, neurological disorders and normal persons. The diagnostic significance of hallucinations is also discussed. Reports of hallucinations in normal people are reviewed. The different modes of the management of hallucinations are briefly discussed. PMID:21694785
Kinoshita, Yoshihiro; Tsuchiya, Masao; Kawakami, Norito; Furukawa, Toshi A; Kingdon, David
Charles Bonnet syndrome (CBS) is by complex visual hallucinations and ocular pathology causing vision loss. It has been considered that CBS occurs frequently in elderly visually handicapped patients and the hallucinations are limited to the visual modality. Three hypotheses we examined were: (1) whether visual impairments are associated with visual hallucinations (2) whether visual impairments are associated with auditory hallucinations (3) whether the development of visual and auditory hallucinations in patients with visual impairments is associated with age. Data from the National Comorbidity Survey Replication (NCS-R) in the United States were used to examine whether associations between visual impairments and visual hallucinations can be found in the general population, and whether such influences of visual impairments are limited to the visual modality and to specific age groups. Prevalence of visual and auditory hallucinations in respondents with visual impairments were 12.8% (95% Confidence Interval (CI)=3.4-22.2%) and 7.1% (95%CI=2.6-11.6%) respectively. Although the point estimates were substantive, the odds ratios between visual impairments and existence of visual hallucinations or auditory hallucinations were not statistically significant (odds ratio (OR)=2.43, 95%CI=0.92-6.44, P=0.07 and OR=2.16, 95%CI=0.87-5.33, P=0.10, respectively) in the whole sample. Association between visual impairments and visual hallucination was significant (OR=3.09, 95%CI=1.06-8.99, P<0.05) only in the elderly (age group 60-), while significant association was found between visual impairments and auditory hallucinations in a younger age group (age group 18-39, OR=13.25, 95%CI=2.99-58.75, P<0.001). Visual impairments act as a trigger for both visual and auditory hallucinations. In patients with visual impairments, the presence of visual hallucinations was associated with an age over 60, while the existence of auditory hallucinations was associated with an age under 39.
Fénelon, G; Mahieux, F
Hallucinations are a common feature of certain degenerative diseases with a risk of dementia such as Alzheimer's disease, Lewy body dementia, and Parkinson's disease. Obtaining valid epidemiological data is nevertheless quite difficult because of methodological problems. As a rule, hallucinations are more prevalent in Lewy body disease than Parkinson's disease or Alzheimer's disease. The prevalence in parkinsonian dementia is about the same as in Lewy body disease. Complex visual hallucinations predominate, auditory or tactile hallucinations are more exceptional. Minor forms (illusions, sensation of presence) are also observed. Recurrence is common, mainly in the evening or at night. Patients with advanced mental impairment generally take the hallucinations for reality. The hallucinations can be associated with psychological and behavioral disorders such as delusionnal idea or identification disorders. It is important to search for other causes of hallucinations such as drugs, ocular disorders, or depression, but many of these disorders are common comorbidities in elderly patients with degenerative disease. There is no unique model fitting all the hypothesized pathogenic mechanisms. Complex visual hallucinations most likely arise from abnormal activation of the extra-striat temporal associative regions, but only hypothetical mechanisms have been proposed. Genetic studies and functional imaging have not provided convincing evidence. Current focus is placed on an imbalance between deficient cholinergic transmission and preserved or augmented monoaminergic transmission at the cortical level, but other neurotransmission systems could be involved. The dream dysregulation mechanism proposed in Parkinson's disease cannot be generalized. The link between cognitive disorders and hallucination is also poorly understood: hallucinations are associated with more severe cognitive impairments or more rapid cognitive deline in Parkinson's disease and Alzheimer's disease, but the
... of objects or events and is sensory in nature. When individuals with Alzheimer’s have a hallucination, they ... frightening, and not all delusions are paranoid in nature. See the doctor. When helping someone who is ...
Hallucinations of musical notation may occur in a variety of conditions, including Charles Bonnet syndrome, Parkinson's disease, fever, intoxications, hypnagogic and hypnopompic states. Eight cases are described here, and their possible cerebral mechanisms discussed.
Ffytche, Dominic H
After dividing clinicians for almost 70 years, Charles Bonnet syndrome has reached an impasse. Defined by a neurologist in the 1930s, the syndrome was intended to eponymize the association of visual hallucinations with age, but evolved into one describing their association with eye disease or, more recently, an etiologically neutral phenomenologic description. Each tradition has its merits but none has defined a specific clinical entity or accounted for visual hallucinations across the spectrum of associated clinical conditions. Recent insights into the neurobiology of vision have shed new light on the problem. Viewed from a neuro-phenomenologic perspective, clinical evidence reveals two distinct hallucination syndromes: one directly related to visual system pathology, the other to pathology in the brainstem or ascending neurotransmitter pathways. The implication is of two independent but interacting pathophysiologic mechanisms and of a need to reassess the classification and management of this common psychopathologic symptom.
Aynsworth, Charlotte; Collerton, Daniel; Dudley, Robert
Studies designed to investigate visual hallucinations (VH) require reliable and valid measures that can appropriately capture peoples' experiences. This review aimed to assess the psychometric rigour and usefulness of VH measures. A systematic literature search was carried out against inclusion criteria (e.g. more than one specific question on VH, measures for adults in clinical and non-clinical populations). Eighteen measures were identified and rated against an adapted evaluation grid, which included essential criteria such as clear purpose and definition, psychometric properties including reliability and validity, and appropriate exploration of visual hallucinations. Measures could be categorised into 3 groups; those for general psychotic symptoms, those for all hallucinations, or those specifically for visual hallucinations. With one exception (the North East Visual Hallucinations Inventory), the measures were considered to be limited as they often targeted one population and hence lacked generalisability, or were limited in the characteristics of the visions that were described, or that psychometric properties were not adequately evaluated. Measures of VH require further development. The need to establish a clearer definition of VH is essential to provide clarity and consistency within research and practice. Measures need to demonstrate good psychometric properties to indicate robustness whilst being sensitive to change to help in the evaluation of treatments. Other recommendations include developing cross-cultural measures and involving service users in item development. Copyright © 2017 Elsevier Ltd. All rights reserved.
García-Montes, José M; Pérez-Alvarez, Marino; Soto Balbuena, Cristina; Perona Garcelán, Salvador; Cangas, Adolfo J
On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.
Vitorovic, Danilo; Biller, José
Musical hallucinations represent a specific form of auditory hallucinations whereby patients experience formed music without an external source. We describe a 60-year-old woman with history of bilateral hearing impairment and tinnitus who experienced both recognizable and non-recognizable songs. Curiously, she was able to reproduce non-recognizable songs in a way that could be recognized by others. This phenomenon is in line with current understanding that musical hallucinations represent abnormal activity in the auditory associative cortices, raising intriguing questions regarding memory, forgetting, and access to lost memories. PMID:23964264
McKetin, Rebecca; Baker, Amanda L; Dawe, Sharon; Voce, Alexandra; Lubman, Dan I
We examined the lifetime experience of hallucinations and delusions associated with transient methamphetamine-related psychosis (MAP), persistent MAP and primary psychosis among a cohort of dependent methamphetamine users. Participants were classified as having (a) no current psychotic symptoms, (n=110); (b) psychotic symptoms only when using methamphetamine (transient MAP, n=85); (c) psychotic symptoms both when using methamphetamine and when abstaining from methamphetamine (persistent MAP, n=37), or (d) meeting DSM-IV criteria for lifetime schizophrenia or mania (primary psychosis, n=52). Current psychotic symptoms were classified as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content in the past month. Lifetime psychotic diagnoses and symptoms were assessed using the Composite International Diagnostic Interview. Transient MAP was associated with persecutory delusions and tactile hallucinations (compared to the no symptom group). Persistent MAP was additionally associated with delusions of reference, thought interference and complex auditory, visual, olfactory and tactile hallucinations, while primary psychosis was also associated with delusions of thought projection, erotomania and passivity. The presence of non-persecutory delusions and hallucinations across various modalities is a marker for persistent MAP or primary psychosis in people who use methamphetamine. Copyright © 2017. Published by Elsevier B.V.
Pearse, Laura J; Dibben, Claire; Ziauddeen, Hisham; Denman, Chess; McKenna, Peter J
Patients with borderline personality disorder (BPD) report psychotic symptoms, but it has been questioned whether they are intrinsic to BPD. Thirty patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for BPD were drawn from a specialist personality disorder service. Exclusion criteria included a preexisting clinical diagnosis of nonaffective psychotic disorder. Participants underwent structured psychiatric interview using the Present State Examination (PSE), lifetime version. Approximately 60% of the patients reported psychotic symptoms unrelated to drugs or affective disorder. Auditory hallucinations were the most common symptom (50%), which were persistent in the majority of cases. A fifth of the patients reported delusions, half of whom (three patients) also met DSM-IV criteria for schizophrenia, who were previously undiagnosed. The form of auditory hallucinations was similar to that in schizophrenia; the content was predominantly negative and critical. Persistent auditory hallucinations are intrinsic symptoms of BPD. This may inform current diagnostic criteria and have implications for approaches to treatment, both pharmacological and psychological. The presence of delusions may indicate a comorbid axis I disorder.
Jan, Tiffany; Del Castillo, Jorge
The following is a case of Charles Bonnet syndrome in an 86-year-old woman who presented with visual hallucinations. The differential diagnosis of visual hallucinations is broad and emergency physicians should be knowledgeable of the possible etiologies.
Castiajo, Paula; Pinheiro, Ana P.
The experience of hallucinations is a hallmark of psychotic disorders, but they are also present in other psychiatric and medical conditions, and may be reported in nonclinical individuals. Despite the increased number of studies probing the incidence of nonclinical hallucinations, the underlying phenomenological characteristics are still poorly understood. This study aimed to examine the psychometrics proprieties of the Portuguese adaptation of the 16-item Launay-Slade Hallucinations Scale (LSHS), the phenomenological characteristics of nonclinical hallucinatory experiences in a Portuguese sample, and the relationship between clinical symptoms and hallucination predisposition. Three-hundred-and-fifty-four European Portuguese college students completed the LSHS. Of those, 16 participants with high LSHS scores and 14 with low LSHS scores were further screened for clinical symptoms. A three-factor solution for the LSHS Portuguese version proved to be the most adequate. Intrusive or vivid thoughts and sleep-related hallucinations were the most common. Although, fundamentally perceived as positive experiences, all types of hallucinations were described as uncontrollable and dominating. However, the more pleasant they were perceived, the more controllable they were assessed. In addition, hallucination predisposition was associated with increased clinical symptoms. These results corroborate the lower severity of hallucinations in the general population compared to psychotic individuals. Further, they support an association between clinical symptoms and increased vulnerability to hallucinations. Specifically, increased schizotypal tendencies and negative mood (anxiety and depression) may be related to increased psychotic risk. PMID:28744234
Castiajo, Paula; Pinheiro, Ana P
The experience of hallucinations is a hallmark of psychotic disorders, but they are also present in other psychiatric and medical conditions, and may be reported in nonclinical individuals. Despite the increased number of studies probing the incidence of nonclinical hallucinations, the underlying phenomenological characteristics are still poorly understood. This study aimed to examine the psychometrics proprieties of the Portuguese adaptation of the 16-item Launay-Slade Hallucinations Scale (LSHS), the phenomenological characteristics of nonclinical hallucinatory experiences in a Portuguese sample, and the relationship between clinical symptoms and hallucination predisposition. Three-hundred-and-fifty-four European Portuguese college students completed the LSHS. Of those, 16 participants with high LSHS scores and 14 with low LSHS scores were further screened for clinical symptoms. A three-factor solution for the LSHS Portuguese version proved to be the most adequate. Intrusive or vivid thoughts and sleep-related hallucinations were the most common. Although, fundamentally perceived as positive experiences, all types of hallucinations were described as uncontrollable and dominating. However, the more pleasant they were perceived, the more controllable they were assessed. In addition, hallucination predisposition was associated with increased clinical symptoms. These results corroborate the lower severity of hallucinations in the general population compared to psychotic individuals. Further, they support an association between clinical symptoms and increased vulnerability to hallucinations. Specifically, increased schizotypal tendencies and negative mood (anxiety and depression) may be related to increased psychotic risk.
Of 44 patients who experienced command hallucinations, those with hallucination-related delusions and hallucinatory voices they could identify were more likely to comply with the commands. The danger of the behaviors specified by the hallucinations did not appear to be a factor in compliance.
Dahoun, Tarik; Eliez, Stephan; Chen, Fei; Badoud, Deborah; Schneider, Maude; Larøi, Frank; Debbane, Martin
Theoretical and empirical accounts suggest that impairments in self-other discrimination processes are likely to promote the expression of hallucinations. Studies using a variety of paradigms involving self-performed actions argue in favor of perspective taking confusion in hallucination-prone subjects. However, our understanding of such processes during adolescence is still at an early stage. The present study thus aims (1) to delineate the neural correlates sustaining mental simulation of actions involving self-performed actions (first-person perspective; 1PP) and other-performed actions (third-person perspective; 3PP) during adolescence (2) to identify atypical activation patterns during 1PP/3PP mental simulation of actions in hallucination-prone adolescents (3) to examine whether differential risk for schizophrenia (clinical vs. genetic) is also associated with differential impairments in the 1PP/3PP mental simulation of actions during adolescence. Twenty-two typically developing controls (Control group; 6 females), 12 hallucination-prone adolescents [auditory hallucination (AH) group; 7 females] and 13 adolescents with 22q11.2 Deletion Syndrome (22q11.2DS group; 4 females) were included in the study. During the fMRI task, subjects were presented with a cue (self-other priming cues) indicating to perform the task using either a first person perspective (“you”-1PP) or a third person perspective (“best friend”-3PP) and then they were asked to mentally simulate actions based on the type of cue. Hallucination-proneness was assessed using a self-report questionnaire [Cardiff Anomalous Perception Scale (CAPS)]. Our results indicated that atypical patterns of cerebral activation, particularly in the key areas of self-other distinction, were found in both groups at risk for auditory hallucinations (AHs and 22q11.2DS). More precisely, adolescents in the AH group presented decreased activations in the right middle occipital gyrus BA19, left cingulate gyrus BA31
Kölmel, H W
Visual illusions and hallucinations may accompany a wide variety of disorders with many different aetiologies; therefore, they are non-specific phenomena. Lesions in the visual pathway may be associated with visual misperceptions. In these cases more exact information about the misperceptions--whether they are monocular or binocular, present in the whole visual field or a hemifield--may contribute to diagnostic accuracy and to a more comprehensive understanding of the patient and his state of mind. Illusions such as perseveration, monocular diplopia and polyopia, and dysmorphopsia may also occur in healthy individuals, but they are found most often in patients with epilepsy, migraine and stroke. These phenomena do not permit exact localization and definition of an aetiology, but lesions in the occipital and occipitotemporal regions near the visual pathway are involved in most cases. Hallucinations always represent a pathological form of perception. They are classified as unformed (photopsias) or formed (complex). Photopsias may be described in terms of colour, shape and brightness. Their wide variety makes it difficult, if not impossible, to arrive at an exact description of their aetiology, but it is possible to define their anatomical origin in some cases. Complex hallucinations suggest an occipitotemporal locus. Whether they appear in the whole visual field or in the hemifield may prove decisive in determining pathogenesis. A number of characteristics permit a rough classification of these phenomena. Complex hallucinations accompany physical illness and are susceptible to psychodynamic interpretation.
Wolf, Daniel H.; Turetsky, Bruce I.; Loughead, James; Elliott, Mark A.; Pratiwadi, Ramapriyan; Gur, Raquel E.; Gur, Ruben C.
Schizophrenia is associated with abnormal processing of salient stimuli, which may contribute to clinical symptoms. We used fMRI and a standard auditory 3-stimulus task to examine attention processing. Target stimuli and novel distractors were presented to 17 patients and 21 healthy controls and activation was correlated with negative and positive symptoms. To targets, patients overactivated multiple regions including premotor cortex, anterior cingulate, temporal cortex, insula, and hippocampus, and also showed attenuated deactivation within occipital cortex. To distractors, patients overactivated left ventrolateral prefrontal cortex. This overactivation may reflect hypersensitivity to salient stimuli in schizophrenia. Patients also exhibited an inverse correlation between negative symptom severity and activation to novel distractors in the dorsolateral prefrontal cortex, premotor area, and ventral striatum. Novelty-induced activity within prefrontal cortex and ventral striatum may represent a useful intermediate phenotype for studies of negative symptoms. PMID:19756228
García-Montes, José M; Pérez-Álvarez, Marino; Odriozola-González, Paula; Vallina-Fernández, Oscar; Perona-Garcelán, Salvador
Magical thinking consists of accepting the possibility that events that, according to the causal concepts of a culture, cannot have any causal relationship, but might somehow nevertheless have one. Magical thinking has been related to both obsessive-compulsive disorder and schizophrenia. The purpose of this study was to investigate the role of magical thinking in hallucinations of patients diagnosed with schizophrenia. Four groups were recruited for this purpose from a clinical population (hallucinating schizophrenic patients, patients diagnosed with psychoses who had never hallucinated, obsessive-compulsive disorder patients and a clinical control group) and a non-clinical control group, who were given the Magical Ideation Scale. The results show that magical ideation differentiates the group of schizophrenic patients with auditory hallucinations from the rest of the groups that participated in the design. Items related to "mind reading", to the presence of auditory illusions in response to sound stimuli, and to the sense of sometimes being accompanied by an evil presence are the most closely related to the presence of auditory hallucinations. Magical thinking, understood as beliefs in non-consensual modes of causation, is closely linked to auditory hallucinations in patients diagnosed with schizophrenia.
Bucci, Sandra; Birchwood, Max; Twist, Laura; Tarrier, Nicholas; Emsley, Richard; Haddock, Gillian
Command hallucinations are experienced by 33-74% of people who experience voices, with varying levels of compliance reported. Compliance with command hallucinations can result in acts of aggression, violence, suicide and self-harm; the typical response however is non-compliance or appeasement. Two factors associated with such dangerous behaviours are anger and impulsivity, however few studies have examined their relationship with compliance to command hallucinations. The current study aimed to examine the roles of anger and impulsivity on compliance with command hallucinations in people diagnosed with a psychotic disorder. The study was a cross-sectional design and included individuals who reported auditory hallucinations in the past month. Subjects completed a variety of self-report questionnaire measures. Thirty-two people experiencing command hallucinations, from both in-patient and community settings, were included. The tendency to appraise the voice as powerful, to be impulsive, to experience anger and to regulate anger were significantly associated with compliance with command hallucinations to do harm. Two factors emerged as significant independent predictors of compliance with command hallucinations; omnipotence and impulsivity. An interaction between omnipotence and compliance with commands, via a link with impulsivity, is considered and important clinical factors in the assessment of risk when working with clients experiencing command hallucinations are recommended. The data is highly suggestive and warrants further investigation with a larger sample.
Fujimoto, So; Komura, Yutaka
Brodmann areas 41 and 42 are located in the superior temporal gyrus and regarded as auditory cortices. The fundamental function in audition is frequency analysis; however, the findings on tonotopy maps of the human auditory cortex were not unified until recently when they were compared to the findings on inputs and outputs of the monkey auditory cortex. The auditory cortex shows plasticity after conditioned learning and surgery of cochlear implant. It is also involved in speech perception, music appreciation, and auditory hallucination in schizophrenia through interactions with other brain areas, such as the thalamus, frontal cortex, and limbic systems.
Singh, Rani K; Glynn, Simon M; Garton, Hugh J; Shellhaas, Renée A
The localizing value of experiential phenomena in temporal and occipital lobe epilepsy has become increasingly elucidated. We describe complex visual and auditory hallucinations in a right-handed adolescent and review the localization value of ictal visual and auditory auras in partial epilepsy. A 15-year-old right-handed girl with 2 previous secondarily generalized seizures manifested a new semiology of complex visual and auditory hallucinations, characterized by seeing a school bus full of children and then hearing a male voice tell her to "feed the children." Feeling compelled, she "fed" the children, and they reboarded the bus and the bus drove away. Video electroencephalogram monitoring demonstrated fluent language during her seizures. Magnetic resonance imaging was compatible with left mesial temporal sclerosis. Fluorodeoxyglucose positron emission tomography demonstrated left temporal hypometabolism. An ictal single-photon emission computed tomography study demonstrated left anterior temporal hyperperfusion; Wada testing revealed reversed cerebral dominance. The patient underwent left anterior temporal lobectomy without complication and remains seizure-free. Complex auditory and visual hallucinations can occur in occipitotemporal and anteromedial temporal epilepsy. Reversed cerebral dominance is more common in children than adults and should be considered in any dextral person with fluent ictal speech with a left-sided epileptogenic lesion.
Leu-Semenescu, Smaranda; De Cock, Valerie Cochen; Le Masson, Valerie Dauriac; Debs, Rachel; Lavault, Sophie; Roze, Emmanuel; Vidailhet, Marie; Arnulf, Isabelle
Narcolepsy and Parkinson's disease (PD) are associated with hallucinations, excessive daytime sleepiness, REM sleep behavior disorder (RBD), as well as complete (narcolepsy with cataplexy) vs. partial (PD, narcolepsy without cataplexy) hypocretin-1 deficiency. To compare the hallucinations associated with narcolepsy to those of PD. One hundred patients with narcolepsy (with and without cataplexy) and 100 patients with PD were consecutively interviewed about their hallucinations (frequency, phenomenology, insight into unreality and association with sleep) as well as their risk factors. Hallucinations occurred more frequently and with more motor and multimodal aspects in narcolepsy with cataplexy (59%) than in narcolepsy without cataplexy (28%) and PD (26%). Compared to PD, the hallucinations in narcolepsy were less frequently of the passage/presence type (passage: brief visions of a person or animal passing sideways; presence: perception that a living character or an animal is behind or near the subject, without the subject actually seeing, hearing or touching it), more frequently auditory and more often associated with sleep. However, in 40% of the patients with narcolepsy and 54% of the patients with PD, the hallucinations occurred while the patients were wide awake. Patients with cataplexy had reduced immediate insight into the unreality of their hallucinations compared to patients with PD, but the delusions were exceptional (2%), transient and based on hallucinations in both groups. The risk factors for hallucinations were sleep paralysis and RBD in narcolepsy and motor disability and sleepiness in PD. The multimodal, dreamlike aspect of hallucinations in narcolepsy with cataplexy could transiently impair the patients' insight. The high frequency of these hallucinations (compared to those in narcolepsy without cataplexy or PD) suggests that complete (more than partial) hypocretin-1 deficiency promotes hallucinations. Copyright © 2011 Elsevier B.V. All rights
Ford, Judith M.; Morris, Sarah E.; Hoffman, Ralph E.; Sommer, Iris; Waters, Flavie; McCarthy-Jones, Simon; Thoma, Robert J.; Turner, Jessica A.; Keedy, Sarah K.; Badcock, Johanna C.; Cuthbert, Bruce N.
We explore how hallucinations might be studied within the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) framework, which asks investigators to step back from diagnoses based on symptoms and focus on basic dimensions of functioning. We start with a description of the objectives of the RDoC project and its domains and constructs. Because the RDoC initiative asks investigators to study phenomena across the wellness spectrum and different diagnoses, we address whether hallucinations experienced in nonclinical populations are the same as those experienced by people with psychotic diagnoses, and whether hallucinations studied in one clinical group can inform our understanding of the same phenomenon in another. We then discuss the phenomenology of hallucinations and how different RDoC domains might be relevant to their study. We end with a discussion of various challenges and potential next steps to advance the application of the RDoC approach to this area of research. PMID:24847862
ABSTRACT Charles Bonnet Syndrome is a condition where visual hallucinations occur as a result of damage along the visual pathway. Patients with Charles Bonnet Syndrome maintain partial or full insight that the hallucinations are not real, absence of psychological conditions, and absence of hallucinations affecting other sensory modalities, while maintaining intact intellectual functioning. Charles Bonnet Syndrome has been well documented in neurologic, geriatric medicine, and psychiatric literature, but there is lack of information in optometric and ophthalmologic literature. Therefore, increased awareness of signs and symptoms associated with Charles Bonnet Syndrome is required among practicing clinicians. This review of the literature will also identify other etiologies of visual hallucinations, pathophysiology of Charles Bonnet Syndrome, and effective management strategies. PMID:27529611
D'Aleo, Giangaetano; Cammaroto, Simona; Rifici, Carmela; Marra, Giuseppe; Sessa, Edoardo; Bramanti, Placido; Di Bella, Paolo
Since 1977 several cases of hallucinations after abrupt withdrawal of oral baclofen have been described. There are no reports of hallucinations after gradual withdrawal of oral baclofen. No one has ever described visual hallucinations after abrupt interruption of intrathecal baclofen therapy. We describe five personally observed cases of visual hallucinations occurring after sudden interruption of baclofen (in two of these cases, intrathecal baclofen) therapy. The patients were immediately submitted to routine EEG, visual evoked potentials and standard brain magnetic resonance imaging (MRI). A few days later they also underwent polysomnography, fundus oculi examination and brain MRI of the temporal lobe. All these examinations were normal. We hypothesise that these symptoms could be due to biochemical and molecular changes, chiefly in glutamatergic n-methyl-d-aspartate, GABA-A, and GABA-B receptor response, leading to increased excitability and spontaneous activity as a result of chronic use of baclofen.
Burns, A; Jacoby, R; Levy, R
Behavioral abnormalities and psychiatric symptoms were assessed in 178 patients diagnosed as having Alzheimer's disease by NINCDS/ADRDA criteria. The subjects were selected from a defined catchment area and therefore were representative of a group of patients with Alzheimer's disease of varying severity. Auditory hallucinations were found in 10%, visual hallucinations in 13%, and delusions in 16%. Symptoms suggestive of depression were reported by 39% of the patients and features of depression observed in 25%. Twenty percent were aggressive, and 7% were sexually disinhibited. Nineteen percent exhibited excessive walking behavior and 10% binge eating. Nearly 50% of the sample were incontinent. Patients in the hospital were more often aggressive, incontinent, and seemingly less depressed. Patients with severe dementia displayed excessive walking behavior, were more likely to be incontinent, and reported less depressive symptoms than those with moderate or mild dementia.
Florindo, Irene; Bisulli, Francesca; Pittau, Francesca; Naldi, Ilaria; Striano, Pasquale; Striano, Salvatore; Michelucci, Roberto; Testoni, Stefania; Baruzzi, Agostino; Tinuper, Paolo
To describe the semiological features of auditory aura and to assess their possible lateralizing value in partial epilepsy. Out of a series of 8,000 patients with epilepsy, we investigated 121 cases with partial seizures in whom auditory features were the first ictal symptom. According to the dominant type of aura, patients were divided into four subgroups-1A (67 cases), 1B (22 cases), 2A (14 cases), and 2B (18 cases)-corresponding to the presence of simple or complex hallucinations and positive or negative illusions, respectively. The side of the epileptic zone (EZ) was defined based on available data: surgical/presurgical study or presence of a neuroradiological lesion, corresponding interictal epileptiform EEG and ictal semiology (level 1); a left EZ was also hypothesized in right-handed patients with ictal aphasia plus a left neuroradiological lesion or a left interictal EEG focus (level 2). Forty-five patients (37%) described the aura as unilateral. The side of epileptogenic zone (EZ) was definable in 36 patients (level 1: 24; level 2: 12). Overall, a unilateral auditory aura was contralateral to the EZ in half of the cases (8/16), but always contralateral in patients studied for presurgical evaluation (4/4). Simple hallucinations lateralized seizure onset on the right side in nine cases, on the left in 12. Among 1B patients (either musical and verbal contents), the EZ was on the left side in all cases (5/5). Positive illusions were associated with right foci in two cases, and left foci in two. Negative illusions always lateralized seizure onset to the dominant hemisphere (6/6). Auditory aura is a rare symptom in partial epilepsy. The perception of the auditory sensation referred to one ear is not a unique lateralizing sign for the contralateral temporal neocortex. Complex hallucinations with verbal content and negative illusion may lateralize seizure onset in the dominant hemisphere. The role of laterality for musical hallucinations remains unclear as it
Urwyler, Prabitha; Nef, Tobias; Killen, Alison; Collerton, Daniel; Thomas, Alan; Burn, David; McKeith, Ian; Mosimann, Urs Peter
Visual symptoms are common in Parkinson's disease (PD) and are frequently under-diagnosed. The detection of visual symptoms is important for differential diagnosis and patient management. To establish the prevalence of recurrent visual complaints (RVC) and recurrent visual hallucinations (RVH) and to investigate their interaction in PD patients and controls. This cross-sectional study included 88 PD patients and 90 controls. RVC and RVH were assessed with a visual symptom questionnaire and the North-East-Visual-Hallucinations-Interview (NEVHI). Double vision (PD vs. 18.2% vs. 1.3%; p < 0.001), misjudging objects when walking (PD vs. 12.5% vs. 1.3%; p < 0.01), words moving whilst reading (PD vs. 17.0% vs. 1.3%; p < 0.001) and freezing in narrow spaces (PD vs. 30.7% vs. 0%; p < 0.001) were almost exclusively found in PD patients. The same was true for recurrent complex visual hallucinations and illusions (PD vs. both 17.0% vs. 0%; p < 0.001). Multiple RVC (43.2% vs. 15.8%) and multiple RVH (29.5% vs. 5.6%) were also more common in PD patients (both p < 0.001). RVC did not predict recurrent complex visual hallucinations; but double vision (p = 0.018, R(2) = 0.302) and misjudging objects (p = 0.002, R(2) = 0.302) predicted passage hallucinations. Misjudging objects also predicted the feeling of presence (p = 0.010, R(2) = 0.321). Multiple and recurrent visual symptoms are common in PD. RVC emerged as risk factors predictive of the minor forms of hallucinations, but not recurrent complex visual hallucinations. Copyright © 2013 Elsevier Ltd. All rights reserved.
Bernardini, Francesco; Attademo, Luigi; Blackmon, Karen; Devinsky, Orrin
Musical hallucinations are uncommon phenomena characterized by intrusive and frequently distressful auditory musical percepts without an external source, often associated with hypoacusis, psychiatric illness, focal brain lesion, epilepsy, and intoxication/pharmacology. Their physiological basis is thought to involve diverse mechanisms, including "release" from normal sensory or inhibitory inputs as well as stimulation during seizures, or they can be produced by functional or structural disorders in diverse cortical and subcortical areas. The aim of this review is to further explore their pathophysiology, describing the functional neuroimaging findings regarding musical hallucinations. A literature search of the PubMed electronic database was conducted through to 29 December 2015. Search terms included "musical hallucinations" combined with the names of specific functional neuroimaging techniques. A total of 18 articles, all clinical case reports, providing data on 23 patients, comprised the set we reviewed. Diverse pathological processes and patient populations with musical hallucinations were included in the studies. Converging data from multiple studies suggest that the superior temporal sulcus is the most common site and that activation is the most common mechanism. Further neurobiological research is needed to clarify the pathophysiology of musical hallucinations.
Saba, P R; Keshavan, M S
The discussion of auditory hallucinations in schizophrenia has traditionally focused on verbal auditory hallucinations, or 'voices'. Little attention, on the other hand, has been given to the phenomenon of musical hallucinations. In an effort to characterize the prevalence and phenomenology of musical hallucinations, 100 consecutive schizophrenic inpatients were examined for the presence of musical hallucinations and musical imagery. Sixteen patients responded positively, and were engaged in a more thorough interview. They were then divided into two groups: those with musical hallucinations, and those experiencing musical imagery. This determination was made based on the absence or presence, respectively, of volitional control, hypothesizing that lack of volitional control implies a true hallucinatory experience. When lack of volitional control was compared to the various other aspects of the experience, an association with religious content was demonstrated. Religious musical hallucinations also tended to be experienced as distressing, further supporting the hypothesis that the experience was hallucinatory rather than a product of volitional imagery. A selection of sample case vignettes is presented as well.
Slevc, L Robert; Shell, Alison R
Auditory agnosia refers to impairments in sound perception and identification despite intact hearing, cognitive functioning, and language abilities (reading, writing, and speaking). Auditory agnosia can be general, affecting all types of sound perception, or can be (relatively) specific to a particular domain. Verbal auditory agnosia (also known as (pure) word deafness) refers to deficits specific to speech processing, environmental sound agnosia refers to difficulties confined to non-speech environmental sounds, and amusia refers to deficits confined to music. These deficits can be apperceptive, affecting basic perceptual processes, or associative, affecting the relation of a perceived auditory object to its meaning. This chapter discusses what is known about the behavioral symptoms and lesion correlates of these different types of auditory agnosia (focusing especially on verbal auditory agnosia), evidence for the role of a rapid temporal processing deficit in some aspects of auditory agnosia, and the few attempts to treat the perceptual deficits associated with auditory agnosia. A clear picture of auditory agnosia has been slow to emerge, hampered by the considerable heterogeneity in behavioral deficits, associated brain damage, and variable assessments across cases. Despite this lack of clarity, these striking deficits in complex sound processing continue to inform our understanding of auditory perception and cognition.
Abad, Nazir Hashemi; Doulatabad, Najafi Shala; Mohammadi, Ali
Schizophrenia and various neurological disorders have some signs and symptoms. Visual hallucinations are one of such disorders. The related studies in some diseases for example Parkinson Disease and Lewy Body Dementia indicate that Acetylcholine (Ach) plays a significant role in neuropsychiatric manifestation and its association with visual hallucination; therefore, visual hallucinations occur due to the depletion of Ach. Drug therapies such as Cholinesterase inhibitors (ChEIs) for increasing Ach level may be beneficial in treating visual hallucination. AchEI's have been used in the treatment of visual hallucinations in Dementia and Parkinson's Disease. We thought that a similar Ach depletion may cause visual hallucinations in patients with schizophrenia and may provide a target for drug treatment. We had a patient with schizophrenia whose psychotic symptoms responded to the treatment plan, but her visual hallucination did not. However, the patient's visual hallucination successfully responded to Rivastigmine (AchEI). This case illustrates the use of an AchEI in the treatment of refractory visual hallucinations in a patient with schizophrenia. PMID:22952543
Shevlin, Mark; Murphy, Jamie; Read, John; Mallett, John; Adamson, Gary; Houston, James Edward
Numerous studies of both clinical and large-scale population based samples have demonstrated that adverse childhood events are risk factors for subsequent psychosis. This study assessed the relationships between adverse childhood events and auditory and visual hallucinatory experiences. The study analysed data from the National Comorbidity Survey Replication conducted in the US that assessed (all before age 16) rape, sexual assault and physical assault. Psychosis symptomatology was represented by lifetime experience of auditory and visual hallucinations. Control variables included gender, age, urbanity, ethnicity, marital status, education, employment status, alcohol dependence and drug dependence. All three adverse events were significantly related to both types of hallucinations. Those who had been raped as children were 3.3 times more likely to have experienced visual hallucinations and 3.5 times more likely to have experienced auditory hallucinations compared to those who had not been raped in childhood. Both rape and physical assault significantly predicted visual and auditory hallucinations. A significant dose-response relationship was also found. Previous findings indicating that adverse events in childhood may be causally related to subsequent psychosis are supported. The psychological and biological mechanisms underlying the relationship are already the subject of investigation. Repeated recommendations concerning routine enquiry about adverse experiences in childhood in order to facilitate comprehensive formulations and appropriate treatment, also receive support from these findings.
Nevins, M A
Musical hallucinations developed in a healthy 57-year-old man after using hypnotic triazolam (Halcion) for eight nights; the hallucinations continued for over one year. Although a causal relationship to triazolam cannot be proved, use of this drug has been associated with other bizarre alterations of memory.
Ellett, Lyn; Luzon, Olga; Birchwood, Max; Abbas, Zarina; Harris, Abi; Chadwick, Paul
Command hallucinations are considered to be one of the most distressing and disturbing symptoms of schizophrenia. Building on earlier studies, we compare key attributes in the symptomatic, affective, and cognitive profiles of people diagnosed with schizophrenia and hearing voices that do (n = 77) or do not (n = 74) give commands. The study employed a cross-sectional design, in which we assessed voice severity, distress and control (PSYRATs), anxiety and depression (HADS), beliefs about voices (BAVQ-R), and responsibility beliefs (RIQ). Clinical and demographic variables were also collected. Command hallucinations were found to be more distressing and controlling, perceived as more omnipotent and malevolent, linked to higher anxiety and depression, and resisted more than hallucinations without commands. Commanding voices were also associated with higher conviction ratings for being personally responsible for preventing harm. The findings suggest key differences in the affective and cognitive profiles of people who hear commanding voices, which have important implications for theory and psychological interventions. Command hallucinations are associated with higher distress, malevolence, and omnipotence. Command hallucinations are associated with higher responsibility beliefs for preventing harm. Responsibility beliefs are associated with voice-related distress. Future psychological interventions for command hallucinations might benefit from focussing not only on omnipotence, but also on responsibility beliefs, as is done in psychological therapies for obsessive compulsive disorder. Limitations The cross-sectional design does not assess issues of causality. We did not measure the presence or severity of delusions. © 2017 The British Psychological Society.
El Haj, Mohamad; Roche, Jean; Jardri, Renaud; Kapogiannis, Dimitrios; Gallouj, Karim; Antoine, Pascal
Due to their prevalence, hallucinations are considered as one of the most frequent psychotic symptoms in Alzheimer's disease (AD). These psychotic manifestations reduce patients' well-being, increase the burden of caregivers, contribute to early institutionalization, and are related with the course of cognitive decline in AD. Considering their consequences, we provide a comprehensive account of the current state of knowledge about the prevalence and characteristics of hallucinations in AD. We propose a comprehensive and testable theoretical model about hallucinations in AD: the ALZHA (ALZheimer and HAllucinations) model. In this model, neurological, genetic, cognitive, affective, and iatrogenic factors associated with hallucinations in AD are highlighted. According to the ALZHA model, hallucinations in AD first involve trait markers (i.e., cognitive deficits, neurological deficits, genetic predisposition and/or sensory deficits) to which state markers that may trigger these experiences are added (e.g., psychological distress and/or iatrogenic factors). Finally, we provide recommendations for assessment and management of these psychotic manifestations in AD, with the aim to benefit patients, caregivers, and health professionals.
Kuga, Hironori; Onitsuka, Toshiaki; Hirano, Yoji; Nakamura, Itta; Oribe, Naoya; Mizuhara, Hiroaki; Kanai, Ryota; Kanba, Shigenobu; Ueno, Takefumi
Recent MRI studies have shown that schizophrenia is characterized by reductions in brain gray matter, which progress in the acute state of the disease. Cortical circuitry abnormalities in gamma oscillations, such as deficits in the auditory steady state response (ASSR) to gamma frequency (>30-Hz) stimulation, have also been reported in schizophrenia patients. In the current study, we investigated neural responses during click stimulation by BOLD signals. We acquired BOLD responses elicited by click trains of 20, 30, 40 and 80-Hz frequencies from 15 patients with acute episode schizophrenia (AESZ), 14 symptom-severity-matched patients with non-acute episode schizophrenia (NASZ), and 24 healthy controls (HC), assessed via a standard general linear-model-based analysis. The AESZ group showed significantly increased ASSR-BOLD signals to 80-Hz stimuli in the left auditory cortex compared with the HC and NASZ groups. In addition, enhanced 80-Hz ASSR-BOLD signals were associated with more severe auditory hallucination experiences in AESZ participants. The present results indicate that neural over activation occurs during 80-Hz auditory stimulation of the left auditory cortex in individuals with acute state schizophrenia. Given the possible association between abnormal gamma activity and increased glutamate levels, our data may reflect glutamate toxicity in the auditory cortex in the acute state of schizophrenia, which might lead to progressive changes in the left transverse temporal gyrus.
[A theory explaining the relation between "egorrhea symptoms" and "symptoms of being influenced" more efficiently than the existing theories--from the viewpoint of "experiencial type" as opposed to symptomatological direction].
Fujinawa, A. and his co-researchers have categorized symptoms of ego disorder into two opposing symptoms; "egorrhea symptoms" having the direction of "Inside to Outside" in their symptomatological structure and "symptoms of being influenced" having the direction of "Outside to Inside". They have also proposed, for ideal cases, the following: (1) "Egorrhea symptoms" are schizophrenic ego disorders. (2) These two types of symptoms are independent and opposing series of ego disorder. (3) There exists a new entity named "egorrhea type of schizophrenia" which is mainly characterized by "egorrhea symptoms" and opposed to the common type of schizophrenia which is mainly characterized by "symptoms of being influenced". The author, however, indicated several faults in their propositions and revised them from their same viewpoint. The author then proposed, from the viewpint of intentionality, the following: (1) Any symptom exhibits one of two opposite direction of intentionality; one exhibits intentionality to an object ("object experiencial type") and the other exhibits intentionality to the subject itself ("subject experiencial type"). (2) Symptoms of each "experiencial type" are related to each other and therefore make the state be composed mainly of them. The author attempted to compare his theory with Fujinawa. A. and his co-researchers theory and the revised one. 58 hallucinatory-delusional cases (29 schizophrenic cases, 29 non-schizophrenic cases) were examined. Some results were as follows: (1) "Egorrhea symptoms" are not peculiar to schizophrenia. (2) A special type of auditory hallucination, which occurs when the patient sees others, is statistically related to "egorrhea symptoms". (3) The other common type of auditory hallucination, which occurs when the patient cannot see others, is statistically related to "symptoms of being influenced". The theory proposed by the author explains these results satisfactorily compared with the former two theories. That is, (1) is
Golden, Erin C; Josephs, Keith A
The phenomenon of musical hallucinations, in which individuals perceive music in the absence of an external auditory stimulus, has been described sparingly in the literature through small case reports and series. Musical hallucinations have been linked to multiple associated conditions, including psychiatric and neurologic disease, brain lesions, drug effect, and hearing impairment. This study aimed to review the demographics of subjects with musical hallucinations and to determine the prevalence of neurological disorders, particularly neurodegenerative disease. Through the Mayo medical record, 393 subjects with musical hallucinations were identified and divided into five categories based on comorbid conditions that have been associated with musical hallucinations: neurological, psychiatric, structural, drug effect and not otherwise classifiable. Variables, including hearing impairment and the presence of visual and other auditory hallucinations, were evaluated independently in all five groups. The mean age at onset of the hallucinations was 56 years, ranging from 18 to 98 years, and 65.4% of the subjects were female. Neurological disease and focal brain lesions were found in 25% and 9% of the total subjects, respectively. Sixty-five subjects were identified with a neurodegenerative disorder, with the Lewy body disorders being the most common. Visual hallucinations were more common in the group with neurological disease compared to the psychiatric, structural, and not otherwise classifiable groups (P < 0.001), whereas auditory hallucinations were more common in the psychiatric group compared to all other groups (P < 0.001). Structural lesions associated with musical hallucinations involved both hemispheres with a preference towards the left, and all but two included the temporal lobe. Hearing impairment was common, particularly in the not otherwise classifiable category where 67.2% had documented hearing impairment, more than in any other group (P < 0.001). Those
Krzystanek, Marek; Krysta, Krzysztof; Klasik, Adam; Krupka-Matuszczyk, Irena
Different environmental factors are thought to be responsible for 15-20% of schizophrenia pathogenesis. Religion has long been considered a major force in human life, regardless of economic, social or political affiliation. How the perception of religion has changed over time, especially in the context of mental illness, was the focal point of this long-term comparative study. A random selection of 100 case histories from the years 1932, 1952, 1972 and 1992 was selected. By reviewing the subject history and medical notes, information on the presence of religious hallucinations and/or delusions were collected and grouped. Religious topics were demonstrated in 46.8% of the test population. Whereas there was a clear diversity of religious-themed delusions, "God", "Christ", "Mary", "Satan/devil" and "hell" all figured prominently across all reviewed years. There is a progressive decrease in the number of religious topics in paranoid schizophrenia. The transfer of holiness from historical saints onto a subject was observed. Evil dominates over good in productive symptoms in paranoid schizophrenia. The phenomenon of apocalyptic subjects in paranoid hallucinations and delusions increased after the Second World War. Religious topics of hallucinations and delusions change over time and relate to objective historical events and reflect changes in religiosity in society.
de Brito, Marcelo Houat; Lopes, Beatriz Noele Azevedo; de Campos, Fernando Peixoto Ferraz
Syphilis still remains a major health concern worldwide because of the possibility of serious medical and psychological consequences, long-term disability, and death. Neurosyphilis (NS) may occur at any stage of infection. Its clinical presentation has been changing over recent years including psychiatric and neurocognitive symptoms. Several recent studies have described cases with these symptoms as the principal signs of NS. We present the case of neurosyphilis with a psychiatric presentation characterized by mood disturbance and auditory and visual hallucinations. PMID:26558247
Borelli, Paolo; Vedovello, Marcella; Braga, Massimiliano; Pederzoli, Massimo; Beretta, Sandro
Musical hallucination is a disorder of complex sound processing of instrumental music, songs, choirs, chants, etc. The underlying pathologies include moderate to severe acquired hearing loss (the auditory equivalent of Charles Bonnet syndrome), psychiatric illnesses (depression, schizophrenia), drug intoxication (benzodiazepines, salicylate, pentoxifylline, propranolol), traumatic lesions along the acoustic pathways, and epilepsy. The hallucinations are most likely to begin late in life; 70% of patients are women. Musical hallucination has no known specific therapy. Treating the underlying cause is the most effective approach; neuroleptic and antidepressant medications have only rarely succeeded.Musical hallucination in epilepsy typically presents as simple partial seizures originating in the lateral temporal cortex. To our knowledge, no formal report of musical hallucination in the interictal state has been published before. In contrast, other interictal psychotic features are a relatively common complication, especially in patients with long-standing drug-resistant epilepsy.We describe a 62-year-old woman with a long history of mesial temporal lobe epilepsy whose musical hallucination was solely interictal. We speculate on the possible link between temporal epilepsy and her hallucination. We hypothesize that, as a result of her epileptic activity-induced damage, an imbalance developed between the excitatory and inhibitory projections connecting the mesial temporal cortex to the other auditory structures. These structures may have generated hyperactivity in the lateral temporal cortex through a "release" mechanism that eventually resulted in musical hallucination.
Aboraya, Ahmed; Stevenson, James; Jacoby, Katherine; Abdallah, Ehab; Barnhart, Jason
The article reports the case of a 39-year-old male who was diagnosed with and treated for bipolar disorder. Over the past 18 months, the patient has experienced new onset of auditory hallucinations and worsening of his psychotic symptoms. The treating psychiatrists changed the diagnosis from bipolar disorder to schizoaffective disorder. The authors discuss hierarchical and nonhierarchical approaches to psychiatric diagnosis in relation to this case report.
Bowman, Alan Robert; Bruce, Vicki; Colbourn, Christopher J; Collerton, Daniel
Visual hallucinations are a common, distressing, and disabling symptom of Lewy body and other diseases. Current models suggest that interactions in internal cognitive processes generate hallucinations. However, these neglect external factors. Pareidolic illusions are an experimental analogue of hallucinations. They are easily induced in Lewy body disease, have similar content to spontaneous hallucinations, and respond to cholinesterase inhibitors in the same way. We used a primed pareidolia task with hallucinating participants with Lewy body disorders (n = 16), non-hallucinating participants with Lewy body disorders (n = 19), and healthy controls (n = 20). Participants were presented with visual "noise" that sometimes contained degraded visual objects and were required to indicate what they saw. Some perceptions were cued in advance by a visual prime. Results showed that hallucinating participants were impaired in discerning visual signals from noise, with a relaxed criterion threshold for perception compared to both other groups. After the presentation of a visual prime, the criterion was comparable to the other groups. The results suggest that participants with hallucinations compensate for perceptual deficits by relaxing perceptual criteria, at a cost of seeing things that are not there, and that visual cues regularize perception. This latter finding may provide a mechanism for understanding the interaction between environments and hallucinations.
Aleman, André; Böcker, Koen B E; Hijman, Ron; de Haan, Edward H F; Kahn, René S
Hallucinations in schizophrenia have been regarded to result from the erroneous attribution of internally generated information to an external source. Distortions in mental imagery may underlie such confusions. We investigated performance of 77 subjects on multiple behavioral measures of auditory and visual mental imagery and perception, and a measure of reality monitoring. Comparisons were made between performance of schizophrenia patients with (N=22) and without (N=35) hallucinations and matched normal comparison subjects (N=20), after controlling for attentional factors. No differences emerged on any of the mental imagery measures, nor on reality monitoring accuracy. This suggests that there is no stable disposition towards abnormal mental imagery associated with hallucinations. However, for patients with active hallucinations (N=12), hallucination severity correlated positively with a measure of imagery-perception interaction in the auditory modality, r=0.70, p=0.01. Although preliminary, this finding is consistent with recent theoretical proposals in which hallucinations have been suggested to result from an increased influence of top-down sensory expectations on conscious perception.
Kertesz, Andrew; Ang, Lee Cyn; Jesso, Sarah; MacKinley, Julia; Baker, Matt; Brown, Patricia; Shoesmith, Christen; Rademakers, Rosa; Finger, Elizabeth C.
OBJECTIVE To describe in detail the presenting symptoms and clinical course of a cohort of patients with Frontotemporal dementia and the recently described C9ORF72 repeat expansion. BACKGROUND Recent discovery of the C9ORF72 repeat expansion linked to familial frontotemporal dementia and ALS has permitted retrospective evaluation of potential defining clinical characteristics that may distinguish C9ORF72 mutation carriers from other patients with FTD. Prior reports have identified a subset of patients with an increased incidence of psychosis, specifically delusions, though the detailed nature of these symptoms is not yet well described. METHODS We conducted a retrospective chart review of to report the detailed case histories of 7 patients with C9ORF72 mutations from a cohort of 61 patients with FTD. Results Detailed histories available from these patients reveal an increased incidence of psychosis, including visual and auditory hallucinations and delusions compared to sporadic FTD patients in our cohort. CONCLUSIONS This cohort confirms and adds symptom-related details to prior reports of increased incidence of psychotic phenomenon in FTD and ALS patients with C9ORF72 mutations, to enhance future clinical identification and diagnosis of patients presenting with these symptoms. PMID:24077574
McLean, Duncan; Barrett, Robert; Loa, Peter; Thara, Rangaswamy; John, Sujit; McGrath, John; Gratten, Jake; Mowry, Bryan
The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations. We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration. We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations. Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology. Copyright © 2013 Wiley Publishing Asia Pty Ltd.
Brandwein, Alice B.; Foxe, John J.; Butler, John S.; Frey, Hans-Peter; Bates, Juliana C.; Shulman, Lisa H.; Molholm, Sophie
Atypical processing and integration of sensory inputs are hypothesized to play a role in unusual sensory reactions and social-cognitive deficits in autism spectrum disorder (ASD). Reports on the relationship between objective metrics of sensory processing and clinical symptoms, however, are surprisingly sparse. Here we examined the relationship…
Atkinson, Joanna R.
The study of voice-hallucinations in deaf individuals, who exploit the visuomotor rather than auditory modality for communication, provides rare insight into the relationship between sensory experience and how “voices” are perceived. Relatively little is known about the perceptual characteristics of voice-hallucinations in congenitally deaf people who use lip-reading or sign language as their preferred means of communication. The existing literature on hallucinations in deaf people is reviewed, alongside consideration of how such phenomena may fit into explanatory subvocal articulation hypotheses proposed for auditory verbal hallucinations in hearing people. It is suggested that a failure in subvocal articulation processes may account for voice-hallucinations in both hearing and deaf people but that the distinct way in which hallucinations are experienced may be due to differences in a sensory feedback component, which is influenced by both auditory deprivation and language modality. This article highlights how the study of deaf people may inform wider understanding of auditory verbal hallucinations and subvocal processes generally. PMID:16510696
Balsavar, Anuradha; Deshpande, Smita N
The ancient Indian system of medicine "Ayurveda" is a compendium of various health related theories and practices and explained the abnormal state of mind, i.e., psychopathology in various contexts. Hallucinations were deemed abnormal. In Ayurvedic classics, hallucinations were called false perceptions (mithyajnana), illusions (maya), infatuations (moha), or confusion (bhrama). Hallucinations were not independent but a symptom of mental disorder (manasa roga). Hallucinations of different sensory organs were observed and explained. These symptoms could be observed in patients suffering from any illness of tridosha origin, organic disease or psychiatric disorder. False perceptions observed in patients were used as tools to understand the prognosis of the condition. This article may help provide preliminary insight and encourage interdisciplinary study toward understanding one of the main symptoms of schizophrenia.
Balsavar, Anuradha; Deshpande, Smita N.
The ancient Indian system of medicine “Ayurveda” is a compendium of various health related theories and practices and explained the abnormal state of mind, i.e., psychopathology in various contexts. Hallucinations were deemed abnormal. In Ayurvedic classics, hallucinations were called false perceptions (mithyajnana), illusions (maya), infatuations (moha), or confusion (bhrama). Hallucinations were not independent but a symptom of mental disorder (manasa roga). Hallucinations of different sensory organs were observed and explained. These symptoms could be observed in patients suffering from any illness of tridosha origin, organic disease or psychiatric disorder. False perceptions observed in patients were used as tools to understand the prognosis of the condition. This article may help provide preliminary insight and encourage interdisciplinary study toward understanding one of the main symptoms of schizophrenia. PMID:25568471
Brébion, G; David, A S; Bressan, R A; Ohlsen, R I; Pilowsky, L S
Previous research has demonstrated that various types of verbal source memory error are associated with positive symptoms in patients with schizophrenia. Notably, intrusions in free recall have been associated with hallucinations and delusions. We tested the hypothesis that extra-list intrusions, assumed to arise from poor monitoring of internally generated words, are associated with verbal hallucinations and that intra-list intrusions are associated with global hallucination scores. A sample of 41 patients with schizophrenia was administered four lists of words, followed by free recall. The number of correctly recalled words and the number of extra- and intra-list intrusions were tallied. The verbal hallucination score was significantly correlated with the number of extra-list intrusions, whereas it was unrelated to the number of correctly recalled words. The number of intra-list intrusions was significantly correlated with the global, but not with the verbal, hallucination score in the subsample of hallucinating patients. It was marginally significantly correlated with the delusion score in delusional patients. The data corroborate the view that verbal hallucinations are linked to defective monitoring of internal speech, and that errors in context processing are involved in hallucinations and delusions.
Weber, P; Ruof, H; Jourdan, S
Visual hallucinations in children need a differential diagnostic effort. In a retrospective cohort study we identified all children, admitted to the Department of Neuropediatrics of a University Hospital between 1.1.2001 and 31.12.2003 suffering from visual hallucinations. All children underwent neurologic examination and electroencephalography (EEG). 14 children with visual hallucinations were identified. Disturbed perception of the size (9 of 14 cases), of the form (5 of 14 cases), and irregular perceptions of movements (5 of 14 cases) were most frequently reported. One child showed a transient hemihypesthesia, the only pathologic finding in the neurologic examination. Three children had features of hypersynchronic activity in EEG: one child undergoing immunosuppressive drug therapy and with a visual hallucination in context of a reversible posterior leucoencephalopathy showed a focal slow background activity, whereas three children had a sharp wave activity. Two of these children fulfilled the criteria for a focal epilepsy, one of them of the frontal lobe, one of the temporal lobe. Recurrent visual hallucinations are frequently transient and show clinical and pathophysiologic features reminiscent of infantile migraine. Psychic etiology, focal epilepsy and, under special circumstances, a reversible posterior leucoencephalopathy have to be considered when making a differential diagnosis.
Ettinger, B; Telerand, A; Kronenberg, Y; Gaoni, B
"Verbal hallucinations" are sentences that psychotic patients may say repeatedly throughout a conversation which are out of context or unconnected to the topic of conversation. These hallucinations are not the outcome of a remembrance of an experience or an event and do not bring about any emotional relief or catharsis, but they supply valuable information. They resemble Jacques Lacan's description of the psychotic mechanism "Forclusion." This mechanism relates to experiences that did not undergo the process of primary symbolization through language, and experiences where words were attached but were not bound to the language structure. The result being that these experiences did not enter into the unconscious discourse of the subject. This information can reappear as verbal hallucinations in the psychotic patient. In such cases, the therapist, with the assistance of the patient's family, must investigate the meaning of the verbal hallucinations through research into the patient's and family's history in the phase prior to language development. When such a connection is discovered, the therapist must then bridge the hallucinations with the events unknown to the patient but contained in his subconscious. The therapist's role in such cases resembles that of a parent with a child: To translate the subject's experience through language from the physical schema to the body image and symbolic plane and in so doing, give meaning to meaninglessness. In our paper three short clinical cases are presented.
González-Rodríguez, Alexandre; Molina-Andreu, Oriol; Penadés, Rafael; Bernardo, Miquel; Catalán, Rosa
The presence of nonprominent hallucinations in delusional disorder (DD) has been accepted by the current Diagnostic and Statistical Manual of Mental Disorders, 5th ed. A recent meta-analysis revealed that patients with schizophrenia treated with long-acting atypical antipsychotics showed a significant improvement in psychotic symptoms. However, little research has been conducted on DD. Our goal was to investigate demographic and clinical differences between two subgroups of DD patients, those with nonprominent hallucinations and those without hallucinations, and to determine treatment effectiveness of long-acting antipsychotics in these patients. We conducted a longitudinal observational study with a 6-month follow-up period in a clinical group of 45 DD outpatients. Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale, and Hamilton Rating Scale for Depression-17 (HRSD-17) were used for assessment. Age at onset of DD, scores in baseline assessment scales, and drug compliance were included in the analysis as potential confounders. When uncorrected for influencing factors, patients treated with long-acting antipsychotics showed lower scores in PANSS positive and negative subscales. There were no statistically significant clinical subgroup×treatment group interactions for any of the scores in assessment scales at 6 months. After adjustment, patients treated with long-acting antipsychotics showed lower scores in the PANSS negative subscale and a tendency toward improvement in scores in the PANSS positive subscale. Our study suggests that risperidone long-acting injection and paliperidone palmitate long-acting injection may be useful in the treatment of DD patients, specifically those with nonprominent hallucinations.
Waters, Flavie; Aleman, André; Fernyhough, Charles; Allen, Paul
This article presents a report on the first meeting of the International Consortium on Hallucination Research, which took place on September 13–14, 2011 at the Institute of Psychiatry, London. The first day of the meeting served to reflect on the current state of knowledge regarding auditory hallucinations in different diagnostic groups, based on the presentations from the phenomenology, cognition, emotion, electrophysiology, neurochemical, neuroimaging, genetics, treatment, and computational modeling working groups. The second day comprised a discussion forum where the most important and urgent questions for future research were identified. The meeting recognized that a lot has been achieved in auditory hallucination research but that much still remains to be done. Here, we outline the top 16 goals for research on auditory hallucinations, which cover topics of conceptual importance, academic and treatment issues, scientific rigor, and cross-disciplinary collaboration. Concerted and coordinated actions will be required to make substantial research progress. PMID:22223735
Louiz, H; Ben Nasr, S; Salhi, J E; Ghaoui, S; Ben Hadj Ali, B
Study of depression in North-Africa and Sub-Saharan Africa has shown that, since the seventies, the clinical expression of depression is markedly different from that of depression in the West. Several authors have noted the rareness of guilt themes and the frequency of persecution themes and somatic complaints in depressed Africans, even those living in the West. More recent studies have shown an evolution in depressive symptoms in North-Africa with an increase in guilt and a decrease in persecution and somatic complaints. This shift in symptoms brings the expression of depression closer to that observed in the West. Our study addresses delusional depression: in 73 cases of delusional depression, delusions of guilt were present in 31% of cases, persecution in 48% and hallucinations in 31.5%. A comparison of the sub-groups consulting in 1991 and a second sub-group consulting in 1998 shows a marked increase in guilt (23.5 versus 39%).
Kölmel, H W
From 120 patients with an homonymous hemianopia 16 experienced complex visual hallucinations in the hemianopic field. The brain lesion was located in the occipital lobe, though damage was not limited to this area. Complex hallucinations appeared after a latent period. They were weak in colour and stereotypical in appearance, which allowed differentiation from visual hallucinations of other causes. Different behaviour after saccadic eye movement differentiated between complex visual hallucinations in the hemianopic field and visual auras of an epileptic origin. PMID:3973619
Takaoka, K; Takata, T
The present paper describes a patient who exhibited 'Alice in Wonderland' (AIW) syndrome as well as Lilliputian hallucinations. The patient regularly consumed a cough syrup that contained dihydrocodein phosphate and dl-methylephedrine hydrochloride over 3 years. At the age of 46, he developed AIW syndrome. The patient ingested a large dose of triazolam and exhibited delirium. Even after the disappearance of symptoms associated with AIW syndrome and delirium, the patient continued to experience Lilliputian hallucinations. We believe that these hallucinations were caused by some of the components of the cough syrup.
Alam, Abdulkader; Patel, Rachit; Locicero, Briana; Rivera, Nicole
Neuromyelitis optica (NMO) is an aggressive disease characteristically affecting the spinal cord and optic nerves that has recently been differentiated from multiple sclerosis. We present a case of a 16-year-old Antiguan female previously diagnosed with NMO who presented with a 1-week history of confusion and agitation. She had symptoms of psychosis, including delusional thinking and auditory and visual hallucinations, and scored 11/23 on the Bush-Francis Catatonia Scale. This case demonstrates an NMO exacerbation that presented with psychotic symptoms and catatonia.
Bentall, Richard P.; Wickham, Sophie; Shevlin, Mark; Varese, Filippo
Previous studies have reported associations between childhood adversities, eg, loss of a parent, being raised in institutional care, sexual and other kinds of abuse by adults and bullying by peers, and psychosis in adulthood. However, the mechanisms by which these adversities lead to psychotic experiences are poorly understood. From models of the psychological processes involved in positive symptoms, it was predicted that childhood sexual abuse would be specifically associated with auditory hallucinations in adulthood, and that disruption of early attachment relations and more chronic forms of victimization such as bullying would be specifically associated with paranoid ideation. We therefore examined the associations between sexual trauma, physical abuse, bullying, and being brought up in institutional or local authority care and reports of auditory hallucinations and paranoid beliefs in the 2007 Adult Psychiatric Morbidity Survey. All simple associations between childhood adversities and the two symptom types were significant. Childhood rape was associated only with hallucinations (OR 8.9, CI = 1.86–42.44) once co-occurring paranoia was controlled for. Being brought up in institutional care (OR = 11.08, CI = 3.26–37.62) was specifically associated with paranoia once comorbid hallucinations had been controlled for. For each symptom, dose-response relationships were observed between the number of childhood traumas and the risk of the symptom. The specific associations observed are consistent with current psychological theories about the origins of hallucinations and paranoia. Further research is required to study the psychological and biological mediators of these associations. PMID:22496540
Tandon, Rajiv; Bruijnzeel, Dawn; Rankupalli, Babu
Psychotic symptoms are a central element in the diagnosis of schizophrenia, although their precise definition has varied through the multiple iterations of DSM and the ICD. Schneiderian first-rank symptoms (FRS) have received a particularly prominent position in the diagnostic criteria of schizophrenia since ICD-9 and DSM-III. In the current iteration of DSM (DSM-IV-TR), whereas two characteristic symptoms are ordinarily required to meet criterion A, only a single symptom is necessary if the psychotic symptom happens to be a FRS, notably a bizarre delusion or auditory hallucination of a running commentary or 'conversing voices'. Because of limited data in support of the special treatment of FRS, DSM-5 has made changes to criterion A, requiring that at least two psychotic symptoms be present in all cases with at least one of these symptoms being a delusion, hallucination, or disorganized speech. To assess the impact of these changes on the prevalence of schizophrenia, we examined a research dataset of 221 individuals with DSM-IV schizophrenia to study the prevalence and co-occurrence of various criterion A symptoms. Although bizarre delusions and/or Schneiderian hallucinations were present in 124 patients (56.1%), they were singly determinative of diagnosis in only one patient (0.46%). Additionally, only three of the 221 patients (1.4%) with DSM-IV schizophrenia did not have a delusion, hallucination, or disorganized speech. DSM-5 changes in criteria A should have a negligible effect on the prevalence of schizophrenia, with over 98% of individuals with DSM-IV schizophrenia continuing to receive a DSM-5 diagnosis of schizophrenia in this dataset.
Kurotori, Isaku; Kato, Satoshi
Auditory or visual hallucinations of a deceased person are well known in the normal course of the bereavement process. According to DSM-5, this symptom is included in the associated features supporting diagnosis of persistent complex bereavement disorder. In Japan, however, little is known about these hallucinatory experiences during grieving, and few reports on their prevalence are available. Here, we have reported a clinical case of such experiences following the loss of a spouse. A 66-year-old patient presented to the outpatient department with insomnia after her husband's death. She was preoccupied with a sense of loss and absolute loneliness. One day, she confessed to regularly encountering her husband's ghost at night; the ghost was distinguishable from a dream and provided the bereaved wife with some degree of comfort. The appearances lasted for 15 months and occurred several times a week without disturbing her social functioning. She gradually became aware that her husband was returning from the spirit world to give her solace. Her treatment was focused on resolving her conflicting feelings concerning her grief at his death and her relief at his no longer suffering from disease. While accepting her experiences, she started to review the days they spent together and appreciated his attachment. Therefore she completed the work of mourning and the ghost no longer appeared. One year after the departure of the ghost, she still attends the hospital regularly and there has been no recurrence. A reconstruction of her internal world leads us to conclude that the support of normal grief with such hallucinations prevents the intense experience of loss from generating pathological grief. Furthermore, we suggest reconsidering the importance of the mourning work and the inclusion of both the bereaved and deceased person in the medical context.
Background Visual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinson's disease and schizophrenia. The lifetime prevalence of visual hallucinations in patients with schizophrenia is much more common than conventionally thought and ranges from 24% to 72%. Cortical acetylcholine (ACh) depletion has been associated with visual hallucinations; the level of depletion being related directly to the severity of the symptoms. Current understanding of neurobiological visual processing and research in diseases with reduced cholinergic function, suggests that AChEI's may prove beneficial in treating visual hallucinations. This offers the potential for targeted drug therapy of clinically symptomatic visual hallucinations in patients with schizophrenia using acetylcholinesterase inhibition. Methods A systematic review was carried out investigating the evidence for the effects of AChEI's in treating visual hallucinations in Schizophrenia. Results No evidence was found relating to the specific role of AChEI's in treating visual hallucinations in this patient group. Discussion Given the use of AChEI's in targeted, symptom specific treatment in other neuropsychiatric disorders, it is surprising to find no related literature in schizophrenia patients. The use of AChEI's in schizophrenia has investigated effects on cognition primarily with non cognitive effects measured more broadly. Conclusions We would suggest that more focused research into the effects of AChEI's on positive symptoms of schizophrenia, specifically visual hallucinations, is needed. PMID:20822517
Wyss, Christine; Hitz, Konrad; Hengartner, Michael P.; Theodoridou, Anastasia; Obermann, Caitriona; Uhl, Idun; Roser, Patrik; Grünblatt, Edna; Seifritz, Erich
Besides the influence of dopaminergic neurotransmission on negative symptoms in schizophrenia, there is evidence that alterations of serotonin (5-HT) system functioning also play a crucial role in the pathophysiology of these disabling symptoms. From post mortem and genetic studies on patients with negative symptoms a 5-HT dysfunction is documented. In addition atypical neuroleptics and some antidepressants improve negative symptoms via serotonergic action. So far no research has been done to directly clarify the association between the serotonergic functioning and the extent of negative symptoms. Therefore, we examined the status of brain 5-HT level in negative symptoms in schizophrenia by means of the loudness dependence of auditory evoked potentials (LDAEP). The LDAEP provides a well established and non-invasive in vivo marker of the central 5-HT activity. We investigated 13 patients with schizophrenia with predominant negative symptoms treated with atypical neuroleptics and 13 healthy age and gender matched controls with a 32-channel EEG. The LDAEP of the N1/P2 component was evaluated by dipole source analysis and single electrode estimation at Cz. Psychopathological parameters, nicotine use and medication were assessed to control for additional influencing factors. Schizophrenic patients showed significantly higher LDAEP in both hemispheres than controls. Furthermore, the LDAEP in the right hemisphere in patients was related to higher scores in scales assessing negative symptoms. A relationship with positive symptoms was not found. These data might suggest a diminished central serotonergic neurotransmission in patients with predominant negative symptoms. PMID:23874705
Cederlöf, M; Ostberg, P; Pettersson, E; Anckarsäter, H; Gumpert, C; Lundström, S; Lichtenstein, P
Psychotic-like experiences (PLEs) and juvenile mania in adolescence index risk for severe psychopathology in adulthood. The importance of childhood problems with communication, reading, speech and mathematics for the development of PLEs and juvenile mania is not well understood. Through the Child and Adolescent Twin Study in Sweden, we identified 5812 children. The parents were interviewed about their children's development at age 9 or 12 years. At age 15 or 18 years, children and parents completed questionnaires targeting current PLEs and juvenile mania symptoms. Logistic regressions were used to assess associations between problems with communication, reading, speech and mathematics and PLEs/juvenile mania symptoms. To evaluate the relative importance of genes and environment in these associations, we used bivariate twin analyses based on structural equation models. Children with parent-endorsed childhood problems with communication, reading and mathematics had an increased risk of developing auditory hallucinations and parental-reported juvenile mania symptoms in adolescence. The most consistent finding was that children with childhood problems with communication, reading and mathematics had an increased risk of developing auditory hallucinations [for example, the risk for self-reported auditory hallucinations at age 15 was increased by 96% for children with communication problems: OR (odds ratio) 1.96, 95% confidence interval (CI) 1.33-2.88]. The twin analyses showed that genetic effects accounted for the increased risk of PLEs and juvenile mania symptoms among children with communication problems. Childhood problems with communication, reading and mathematics predict PLEs and juvenile mania symptoms in adolescence. Similar to the case for schizophrenia and bipolar disorder, PLEs and juvenile mania may share genetic aetiological factors.
Whitfield, C.L.; Dube, S.R.; Felitti, V.J.; Anda, R.F.
Objective:: Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. We used data from the ACE study to assess this relationship. Methods:: We conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health…
Bennett A O, Maxwell R
Consciousness takes two forms, transitive and intransitive. Transitive consciousness is a matter of being conscious of something or other whereas intransitive consciousness has no object, as being conscious or awake. Of the different forms of transitive consciousness, perceptual, somatic, kinaesthetic and so on, cognitive neuroscience has concentrated on determining the neural concomitants of perceptual consciousness. To be conscious of a percept is to be aware of it and this requires attending to it. This work sets out a hypothesis as to what brain areas are involved in a schizophrenia subject attending and becoming aware of hallucinations. First, the different areas of cortex that support different visual and auditory illusions of percepts are considered. Next it is argued that endogenous activity in these areas of cortex give rise to hallucinations of percepts that are similar to the percepts that these same areas support during illusions. The basis of such endogenous activity, it is suggested, is to be found in the paucity of afferent synapses to these cortical areas. This may occur as a consequence of loss and regression of synapses due to a degenerative disease or because of abnormal synapse formation and regression during childhood and adolescence, as is likely to be the case in schizophrenia. Finally the neural basis of attention and awareness of these hallucinations are considered for subjects suffering from schizophrenia, and a set of important questions posed that await elucidation through future experimental studies.
Fabisch, K; Fabisch, H; Langs, G; Macheiner, H; Fitz, W; Hönigl, D
One hundred and fifty male inpatients - 128 patients with DSM-IV schizophrenia and 22 patients with DSM-IV schizoaffective disorder - were investigated, over the course of their acute psychosis, on whether there were differences in the extent of basic symptoms (measured by the Bonn Scale for the Assessment of Basic Symptoms) according to their diagnostic subtype. Another aim was to find out if the diagnostic subtypes could be discriminated by means of basic symptoms and if clusters gained from basic symptoms were in accordance with the diagnostic subtypes. Differences in basic symptoms were found between the subtypes, but a clear discrimination of diagnostic subtypes by means of basic symptoms could not be achieved. There was indication that patients with prominent delusions or auditory hallucinations reported more basic symptoms than patients with exclusively prominent disorganization.
Norton, J W; Corbett, J J
Visual perceptual abnormalities may be caused by diverse etiologies which span the fields of psychiatry and neurology. This article reviews the differential diagnosis of visual perceptual abnormalities from both a neurological and a psychiatric perspective. Psychiatric etiologies include mania, depression, substance dependence, and schizophrenia. Common neurological causes include migraine, epilepsy, delirium, dementia, tumor, and stroke. The phenomena of palinopsia, oscillopsia, dysmetropsia, and polyopia among others are also reviewed. A systematic approach to the many causes of illusions and hallucinations may help to achieve an accurate diagnosis, and a more focused evaluation and treatment plan for patients who develop visual perceptual abnormalities. This article provides the practicing neurologist with a practical understanding and approach to patients with these clinical symptoms.
De Masi, Franco; Davalli, Cesare; Giustino, Gabriella; Pergami, Andrea
In this contribution, which takes account of important findings in neuroscientific as well as psychoanalytic research, the authors explore the meaning of the deep-going distortions of psychic functioning occurring in hallucinatory phenomena. Neuroscientific studies have established that hallucinations distort the sense of reality owing to a complex alteration in the balance between top-down and bottom-up brain circuits. The present authors postulate that hallucinatory phenomena represent the outcome of a psychotic's distorted use of the mind over an extended period of time. In the hallucinatory state the psychotic part of the personality uses the mind to generate auto-induced sensations and to achieve a particular sort of regressive pleasure. In these cases, therefore, the mind is not used as an organ of knowledge or as an instrument for fostering relationships with others. The hallucinating psychotic decathects psychic (relational) reality and withdraws into a personal, bodily, and sensory space of his own. The opposing realities are not only external and internal but also psychic and sensory. Visual hallucinations could thus be said to originate from seeing with the 'eyes' of the mind, and auditory hallucinations from hearing with the mind's 'ears'. In these conditions, mental functioning is restricted, cutting out the more mature functions, which are thus no longer able to assign real meaning to the surrounding world and to the subject's psychic experience. The findings of the neurosciences facilitate understanding of how, in the psychotic hallucinatory process, the mind can modify the working of a somatic organ such as the brain. Copyright © 2014 Institute of Psychoanalysis.
Lijffijt, Marijn; Cox, Blake; Acas, Michelle D; Lane, Scott D; Moeller, F Gerard; Swann, Alan C
Limited information is available on the relationship between antisocial personality disorder (ASPD) and early filtering, or gating, of information, even though this could contribute to the repeatedly reported impairment in ASPD of higher-order information processing. In order to investigate early filtering in ASPD, we compared electrophysiological measures of auditory sensory gating assessed by the paired-click paradigm in males with ASPD (n = 37) to healthy controls (n = 28). Stimulus encoding was measured by P50, N100, and P200 auditory evoked potentials; auditory sensory gating (ASG) was measured by a reduction in amplitude of evoked potentials following click repetition. Effects were studied of co-existing past alcohol or drug use disorders, ASPD symptom counts, and trait impulsivity. Controls and ASPD did not differ in P50, N100, or P200 amplitude or ASG. Past alcohol or drug use disorders had no effect. In controls, impulsivity related to improved P50 and P200 gating. In ASPD, P50 or N100 gating was impaired with more symptoms or increased impulsivity, respectively, suggesting impaired early filtering of irrelevant information. In controls the relationship between P50 and P200 gating and impulsivity was reversed, suggesting better gating with higher impulsivity scores. This could reflect different roles of ASG in behavioral regulation in controls versus ASPD. Published by Elsevier Ltd.
Lijffijt, Marijn; Cox, Blake; Acas, Michelle D.; Lane, Scott D.; Moeller, F. Gerard; Swann, Alan C.
Limited information is available on the relationship between antisocial personality disorder (ASPD) and early filtering, or gating, of information, even though this could contribute to the repeatedly reported impairment in ASPD of higher-order information processing. In order to investigate early filtering in ASPD, we compared electrophysiological measures of auditory sensory gating assessed by the paired-click paradigm in males with ASPD (n = 37) to healthy controls (n = 28). Stimulus encoding was measured by P50, N100, and P200 auditory evoked potentials; auditory sensory gating (ASG) was measured by a reduction in amplitude of evoked potentials following click repetition. Effects were studied of co-existing past alcohol or drug use disorders, ASPD symptom counts, and trait impulsivity. Controls and ASPD did not differ in P50, N100, or P200 amplitude or ASG. Past alcohol or drug use disorders had no effect. In controls, impulsivity related to improved P50 and P200 gating. In ASPD, P50 or N100 gating was impaired with more symptoms or increased impulsivity, respectively, suggesting impaired early filtering of irrelevant information. In controls the relationship between P50 and P200 gating and impulsivity was reversed, suggesting better gating with higher impulsivity scores. This could reflect different roles of ASG in behavioral regulation in controls versus ASPD. PMID:22464943
Holroyd, S; Rabins, P V; Finkelstein, D; Nicholson, M C; Chase, G A; Wisniewski, S C
This study was undertaken to determine the prevalence of visual hallucinations in patients with macular degeneration, describe such hallucinations phenomenologically, and possibly determine factors predisposing to their development. Using a case-control design, the authors screened 100 consecutive patients with age-related macular degeneration for visual hallucinations. Each patient with visual hallucinations was matched to the next three patients without hallucinations. The patients and comparison subjects were compared in terms of scores on the Beck Depression Inventory, Eysenck Personality Questionnaire, Telephone Interview for Cognitive Status, and a structured questionnaire including demographic characteristics, family history, and medical and psychiatric history. Ophthalmologic data were obtained by chart review. Of the 100 patients, 13 experienced visual hallucinations. Four variables were significantly associated with having hallucinations: living alone, lower cognition score, history of stroke, and bilaterally worse visual acuity. Hallucinations were not associated with family or personal history of psychiatric disorder or with personality traits. In 11 (84.6%) of the 13 patients, the hallucinations had begun in association with an acute change in vision. These results indicate that visual hallucinations are prevalent among patients with macular degeneration. They appear unrelated to primary psychiatric disorder. The predisposing factors of bilaterally worse vision and living alone support an association with sensory deprivation, while history of stroke and worse cognition support a decreased cortical inhibition theory.
Muenzenmaier, Kristina H; Seixas, Azizi A; Schneeberger, Andres R; Castille, Dorothy M; Battaglia, Joseph; Link, Bruce G
The association between stressful childhood experiences (SCE) and psychotic symptoms is still not clearly understood, and different causal pathways have been proposed. Generalized estimating equation modeling was used to test the dose-response relationship between SCE and delusions and hallucinations at baseline and follow-up periods and the possible confounding effects of dissociation on this relationship. The prevalence of SCE in individuals with psychotic disorders was high, with more co-occurring SCE categories being positively associated with more types of delusions and hallucinations. Each additional SCE was associated with a 1.20 increase in the incidence rate ratio (95% confidence interval [CI; 1.09, 1.32]) for hallucinations and a 1.19 increase (CI [1.09, 1.29]) for delusions, supporting a dose-response association. After we controlled for the mediating effects of dissociative symptoms at follow-up, SCE remained independently associated with delusions. We propose that cumulative SCE can result in complex trauma reactions that present with a broad range of symptomatology, including dissociative, posttraumatic stress disorder, and psychotic symptoms.
Lee, Angela H; Weintraub, Daniel
Psychosis in Parkinson's disease (PD) is common and associated with a range of negative outcomes. Dementia and psychosis are highly correlated in PD, but the frequency and correlates of psychosis in patients without cognitive impairment are not well understood. One hundred and ninety-one non-demented PD patients at two movement disorders centers participated in a study of neuropsychiatric complications in PD and completed a detailed neurological and neuropsychiatric assessment, including the rater-administered Parkinson Psychosis Rating Scale for hallucinations, delusions, and minor symptoms of psychosis (illusions and misidentification of persons). Psychotic symptoms were present in 21.5% of the sample. Visual hallucinations were most common (13.6%), followed by auditory hallucinations (6.8%), illusions or misidentification of people (7.3%), and paranoid ideation (4.7%). Visual hallucinations and illusions or misidentification of people were the most common comorbid symptoms (3.1%). Depression (P = 0.01) and rapid eye movement behavior disorder symptoms (P = 0.03) were associated with psychosis in a multivariable model. The odds of experiencing psychotic symptoms were approximately five times higher in patients with comorbid disorders of depression and sleep-wakefulness. Even in patients without global cognitive impairment, psychosis in PD is common and most highly correlated with other non-motor symptoms. Screening for psychosis should occur at all stages of PD as part of a broad non-motor assessment. In addition, these findings suggest a common neural substrate for disturbances of perception, mood, sleep-wakefulness, and incipient cognitive decline in PD. Copyright © 2012 Movement Disorder Society.
Shelly, James; Uhlmann, Anne; Sinclair, Heidi; Howells, Fleur M; Sibeko, Goodman; Wilson, Don; Stein, Dan J; Temmingh, Henk
Methamphetamine psychosis (MAP) symptomatology has been described as indistinguishable from that of schizophrenia (SZ), yet research comparing these two disorders on specific psychotic symptoms such as schneiderian first-rank symptoms (FRS) is lacking. We aimed to determine and compare the occurrence and associations of FRS in patients diagnosed with MAP and with SZ. Data from SCID-I interviews performed on patients with either a diagnosis of SZ or MAP were compared. We calculated the prevalence of different FRS between MAP and SZ patients and used logistic regression to assess the association between FRS and diagnosis. 102 patients were included in the study (MAP = 33, SZ = 69). Thought broadcasting occurred significantly more often in SZ (42%) than in MAP (24.2%) patients (adjusted OR = 3.02; 95% CI: 1.12-8.15; p = 0.028), while auditory hallucinations (voices conversing) were significantly higher in MAP (48.5%) than in SZ (20.3%) patients (adjusted OR = 0.27; 95% CI: 0.10-0.66; p = 0.004). However, there was no significant difference in the occurrence of one or more FRS in MAP and SZ, with most FRS showing overlap. We found that first-rank auditory hallucinations were more prevalent in MAP, whereas first-rank delusions of thought broadcasting were more prevalent in SZ. However, there was a substantial overlap in MAP and SZ for most FRS. This is consistent with the finding that FRS may have limited diagnostic specificity and that there is significant overlap in the symptoms of MAP and SZ. Future research into the neurobiology of delusions and hallucinations needs to take FRS into account. © 2016 S. Karger AG, Basel.
9,24,29,30), or for causing auditory hallucinations (2,23,31,32). Thus, compounds which alter cho- linergic transmission, in particular anticholinesterases...the upper auditory system. Thus, attending to and understanding verbal messages in humans, irrespective of the particular voice which speaks them, may...00, AD ACETYLCHOLINESTERASE INHIBITION AND INFORMATION PROCESSING IN THE AUDITORY CORTEX ANNUAL SUMMARY REPORT DTIC ELECTENORMAN M
Kennel, Susan; Taylor, Ann Gill; Lyon, Debra; Bourguignon, Cheryl
The purpose of this pilot study was to explore the potential for the use of binaural auditory beat stimulation to reduce the symptom of inattention in children and adolescents with attention-deficit/hyperactivity disorder. This pilot study had a randomized, double-blind, placebo-controlled design. Twenty participants were randomly assigned to listen to either an audio program on compact disk that contained binaural auditory beats or a sham audio program that did not have binaural beats for 20 minutes, three times a week for 3 weeks. The Children's Color Trails Test, the Color Trails Test, the Test of Variables of Attention (TOVA), and the Homework Problem Checklist were used to measure changes in inattention pre- and postintervention. Repeated measures analysis of variance was used to analyze pre- and postintervention scores on the Color Trails Tests, Homework Problem Checklist, and the TOVA. The effect of time was significant on the Color Trails Test. However, there were no significant group differences on the Color Trails Test or the TOVA scores postintervention. Parents reported that the study participants had fewer homework problems postintervention. The results from this study indicate that binaural auditory beat stimulation did not significantly reduce the symptom of inattention in the experimental group. However, parents and adolescents stated that homework problems due to inattention improved during the 3-week study. Parents and participants stated that the modality was easy to use and helpful. Therefore, this modality should be studied over a longer time frame in a larger sample to further its effectiveness to reduce the symptom of inattention in those diagnosed with attention-deficit/hyperactivity disorder. Copyright 2010 Elsevier Inc. All rights reserved.
Reduced structural integrity and functional lateralization of the dorsal language pathway correlate with hallucinations in schizophrenia: a combined diffusion spectrum imaging and functional magnetic resonance imaging study.
Wu, Chen-Hao; Hwang, Tzung-Jeng; Chen, Pin-Jane; Chou, Tai-Li; Hsu, Yung-Chin; Liu, Chih-Min; Wang, Hsiao-Lan; Chen, Chung-Ming; Hua, Mau-Sun; Hwu, Hai-Gwo; Tseng, Wen-Yih Isaac
Recent studies suggest that structural and functional alterations of the language network are associated with auditory verbal hallucinations (AVHs) in schizophrenia. However, the ways in which the underlying structure and function of the network are altered and how these alterations are related to each other remain unclear. To elucidate this, we used diffusion spectrum imaging (DSI) to reconstruct the dorsal and ventral pathways and employed functional magnetic resonance imaging (fMRI) in a semantic task to obtain information about the functional activation in the corresponding regions in 18 patients with schizophrenia and 18 matched controls. The results demonstrated decreased structural integrity in the left ventral, right ventral and right dorsal tracts, and decreased functional lateralization of the dorsal pathway in schizophrenia. There was a positive correlation between the microstructural integrity of the right dorsal pathway and the functional lateralization of the dorsal pathway in patients with schizophrenia. Additionally, both functional lateralization of the dorsal pathway and microstructural integrity of the right dorsal pathway were negatively correlated with the scores of the delusion/hallucination symptom dimension. Our results suggest that impaired structural integrity of the right dorsal pathway is related to the reduction of functional lateralization of the dorsal pathway, and these alterations may aggravate AVHs in schizophrenia. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Rabey, Josè Martin
Although Parkinson's disease (PD) is considered mainly a movement disorder, robust information accumulated during the last 30 years has shown that about 30% of PD patients may also suffer from psychosis, which deeply affects their quality of life and eventually brings them to permanent hospitalization in nursing homes. PD psychosis (PDPsy) mainly occurs after 10 or more years of treatment. The main features of PDPsy include recurrent and continuous hallucinations and delusions for at least 1 month. In addition, a recent consensus of the National Institute of Neurological Disorders and Stroke and National Institute of Mental Health Working Group also included illusions and a false sense of presence as "minor symptoms" supporting the diagnosis. In addition, accumulated clinical data have shown that "minor symptoms" and benign hallucinations also imply a bad prognosis with time. In the diagnostic criteria for PDPsy, it is considered that patients suffer from PD for at least more than 1 year before psychosis develops. If this is not the case, there is an unsolved problem of an overlapping diagnosis with Dementia with Lewy Bodies. Most clinicians consider that the main cause of psychosis is chronic exposure to dopaminergic medication. However, from an operational point of view there remain difficulties in defining a specific time of exposure and dose of treatment and the occurrence of PDPsy. Specific rating scales have been developed for the evaluation of PDPsy, such as the Parkinson Psychosis Rating Scale. The Scale for the Assessment of Positive Symptoms usually applied in schizophrenic patients has also proved useful for scoring psychotic symptomatology in PD. Clozapine in low doses has been proven to be the most effective antipsychotic medication for PDPsy. However, its use may cause neutropenia. Therefore, new atypical antipsychotic drugs with serotonin 5-HT2A receptor inverse agonist properties have been developed. Recently, pimavanserin--a 5-HT2A inverse agonist
Background Visual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach) plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEI's have been used in the targeted treatment of visual hallucinations in dementia and Parkinson's Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatment Case Presentation We present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully. Conclusions This case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field. PMID:20822516
Mamiya, Yasuyuki; Nishio, Yoshiyuki; Watanabe, Hiroyuki; Yokoi, Kayoko; Uchiyama, Makoto; Baba, Toru; Iizuka, Osamu; Kanno, Shigenori; Kamimura, Naoto; Kazui, Hiroaki; Hashimoto, Mamoru; Ikeda, Manabu; Takeshita, Chieko; Shimomura, Tatsuo; Mori, Etsuro
Background Visual hallucinations are a core clinical feature of dementia with Lewy bodies (DLB), and this symptom is important in the differential diagnosis and prediction of treatment response. The pareidolia test is a tool that evokes visual hallucination-like illusions, and these illusions may be a surrogate marker of visual hallucinations in DLB. We created a simplified version of the pareidolia test and examined its validity and reliability to establish the clinical utility of this test. Methods The pareidolia test was administered to 52 patients with DLB, 52 patients with Alzheimer’s disease (AD) and 20 healthy controls (HCs). We assessed the test-retest/inter-rater reliability using the intra-class correlation coefficient (ICC) and the concurrent validity using the Neuropsychiatric Inventory (NPI) hallucinations score as a reference. A receiver operating characteristic (ROC) analysis was used to evaluate the sensitivity and specificity of the pareidolia test to differentiate DLB from AD and HCs. Results The pareidolia test required approximately 15 minutes to administer, exhibited good test-retest/inter-rater reliability (ICC of 0.82), and moderately correlated with the NPI hallucinations score (rs = 0.42). Using an optimal cut-off score set according to the ROC analysis, and the pareidolia test differentiated DLB from AD with a sensitivity of 81% and a specificity of 92%. Conclusions Our study suggests that the simplified version of the pareidolia test is a valid and reliable surrogate marker of visual hallucinations in DLB. PMID:27171377
Jardri, Renaud; Hugdahl, Kenneth; Hughes, Matthew; Brunelin, Jérôme; Waters, Flavie; Alderson-Day, Ben; Smailes, Dave; Sterzer, Philipp; Corlett, Philip R.; Leptourgos, Pantelis; Debbané, Martin; Cachia, Arnaud; Denève, Sophie
This review from the International Consortium on Hallucinations Research intends to question the pertinence of the excitatory-to-inhibitory (E/I) imbalance hypothesis as a model for hallucinations. A large number of studies suggest that subtle impairments of the E/I balance are involved in neurological and psychiatric conditions, such as schizophrenia. Emerging evidence also points to a role of the E/I balance in maintaining stable perceptual representations, suggesting it may be a plausible model for hallucinations. In support, hallucinations have been linked to inhibitory deficits as shown with impairment of gamma-aminobutyric acid transmission, N-methyl-d-aspartate receptor plasticity, reductions in gamma-frequency oscillations, hyperactivity in sensory cortices, and cognitive inhibition deficits. However, the mechanisms by which E/I dysfunctions at the cellular level might relate to clinical symptoms and cognitive deficits remain unclear. Given recent data advances in the field of clinical neuroscience, it is now possible to conduct a synthesis of available data specifically related to hallucinations. These findings are integrated with the latest computational frameworks of hallucinations, and recommendations for future research are provided. PMID:27261492
Mamiya, Yasuyuki; Nishio, Yoshiyuki; Watanabe, Hiroyuki; Yokoi, Kayoko; Uchiyama, Makoto; Baba, Toru; Iizuka, Osamu; Kanno, Shigenori; Kamimura, Naoto; Kazui, Hiroaki; Hashimoto, Mamoru; Ikeda, Manabu; Takeshita, Chieko; Shimomura, Tatsuo; Mori, Etsuro
Visual hallucinations are a core clinical feature of dementia with Lewy bodies (DLB), and this symptom is important in the differential diagnosis and prediction of treatment response. The pareidolia test is a tool that evokes visual hallucination-like illusions, and these illusions may be a surrogate marker of visual hallucinations in DLB. We created a simplified version of the pareidolia test and examined its validity and reliability to establish the clinical utility of this test. The pareidolia test was administered to 52 patients with DLB, 52 patients with Alzheimer's disease (AD) and 20 healthy controls (HCs). We assessed the test-retest/inter-rater reliability using the intra-class correlation coefficient (ICC) and the concurrent validity using the Neuropsychiatric Inventory (NPI) hallucinations score as a reference. A receiver operating characteristic (ROC) analysis was used to evaluate the sensitivity and specificity of the pareidolia test to differentiate DLB from AD and HCs. The pareidolia test required approximately 15 minutes to administer, exhibited good test-retest/inter-rater reliability (ICC of 0.82), and moderately correlated with the NPI hallucinations score (rs = 0.42). Using an optimal cut-off score set according to the ROC analysis, and the pareidolia test differentiated DLB from AD with a sensitivity of 81% and a specificity of 92%. Our study suggests that the simplified version of the pareidolia test is a valid and reliable surrogate marker of visual hallucinations in DLB.
Kjelby, E; Sinkeviciute, I; Gjestad, R; Kroken, R A; Løberg, E-M; Jørgensen, H A; Hugdahl, K; Johnsen, E
Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders. One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation. Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans. The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk. ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Jardri, Renaud; Hugdahl, Kenneth; Hughes, Matthew; Brunelin, Jérôme; Waters, Flavie; Alderson-Day, Ben; Smailes, Dave; Sterzer, Philipp; Corlett, Philip R; Leptourgos, Pantelis; Debbané, Martin; Cachia, Arnaud; Denève, Sophie
This review from the International Consortium on Hallucinations Research intends to question the pertinence of the excitatory-to-inhibitory (E/I) imbalance hypothesis as a model for hallucinations. A large number of studies suggest that subtle impairments of the E/I balance are involved in neurological and psychiatric conditions, such as schizophrenia. Emerging evidence also points to a role of the E/I balance in maintaining stable perceptual representations, suggesting it may be a plausible model for hallucinations. In support, hallucinations have been linked to inhibitory deficits as shown with impairment of gamma-aminobutyric acid transmission, N-methyl-d-aspartate receptor plasticity, reductions in gamma-frequency oscillations, hyperactivity in sensory cortices, and cognitive inhibition deficits. However, the mechanisms by which E/I dysfunctions at the cellular level might relate to clinical symptoms and cognitive deficits remain unclear. Given recent data advances in the field of clinical neuroscience, it is now possible to conduct a synthesis of available data specifically related to hallucinations. These findings are integrated with the latest computational frameworks of hallucinations, and recommendations for future research are provided. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: email@example.com.
Suárez-González, Aida; Crutch, Sebastian J; Franco-Macías, Emilio; Gil-Néciga, Eulogio
Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome characterized by early progressive visual dysfunction in the context of relative preservation of memory and a pattern of atrophy mainly involving the posterior cortex. The aim of the present study is to characterize the neuropsychiatric profile of PCA. The Neuropsychiatric Inventory was used to assess 12 neuropsychiatric symptoms (NPS) in 28 patients with PCA and 34 patients with typical Alzheimer disease (AD) matched by age, disease duration, and illness severity. The most commonly reported NPS in both groups were depression, anxiety, apathy, and irritability. However, aside from a trend toward lower rates of apathy in patients with PCA, there were no differences in the percentage of NPS presented in each group. All those patients presenting visual hallucinations in the PCA group also met diagnostic criteria for dementia with Lewy bodies (DLB). Auditory hallucinations were only present in patients meeting diagnosis criteria for DLB. Prevalence of the 12 NPS examined was similar between patients with PCA and AD. Hallucinations in PCA may be helpful in the differential diagnosis between PCA-AD and PCA-DLB. © The Author(s) 2015.
Crutch, Sebastian J.; Franco-Macías, Emilio; Gil-Néciga, Eulogio
Background: Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome characterized by early progressive visual dysfunction in the context of relative preservation of memory and a pattern of atrophy mainly involving the posterior cortex. The aim of the present study is to characterize the neuropsychiatric profile of PCA. Methods: The Neuropsychiatric Inventory was used to assess 12 neuropsychiatric symptoms (NPS) in 28 patients with PCA and 34 patients with typical Alzheimer disease (AD) matched by age, disease duration, and illness severity. Results: The most commonly reported NPS in both groups were depression, anxiety, apathy, and irritability. However, aside from a trend toward lower rates of apathy in patients with PCA, there were no differences in the percentage of NPS presented in each group. All those patients presenting visual hallucinations in the PCA group also met diagnostic criteria for dementia with Lewy bodies (DLB). Auditory hallucinations were only present in patients meeting diagnosis criteria for DLB. Conclusion: Prevalence of the 12 NPS examined was similar between patients with PCA and AD. Hallucinations in PCA may be helpful in the differential diagnosis between PCA-AD and PCA-DLB. PMID:26404166
Cassano, Paolo; Chang, Trina; Trinh, Nhi-Ha; Baer, Lee; Fava, Maurizio; Mischoulon, David
To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. We analyzed data from STAR*D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. Among 2597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49/1928), 11.3% in Blacks (n=45/398) 6.3% in Latinos (n=17/270) (χ(2)=64.9; df=2; p<0.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299/1927), 31.5% in Blacks (n=126/400), and 21.1% in Latinos (n=57/270) (χ(2)=57.3; df=2; p<0.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. The STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks. Copyright © 2013 Elsevier B.V. All rights reserved.
Cassano, Paolo; Chang, Trina; Trinh, Nhi-Ha; Baer, Lee; Fava, Maurizio; Mischoulon, David
Objective To determine whether isolated psychotic symptoms are more likely to be endorsed by depressed Latinos as opposed to other ethnic-racial groups; whether these symptoms affect Latinos similarly to other ethnic-racial groups in terms of treatment response; and whether they are more likely to be associated with anxiety disorders in depressed Latinos. Methods We analyzed data from STAR*D subjects who self identified as White, Black, or Latino. Rates of isolated psychotic symptoms were assessed by the self-rated Psychiatric Diagnostic Screening Questionnaire (PDSQ) and compared between ethnic-racial groups. Depressive remission outcomes were compared within each ethnic-racial group between subjects who endorsed psychotic symptoms versus no psychotic symptoms. Associations between isolated psychotic symptoms and anxiety disorders were also examined. Results Among 2,597 eligible subjects with at least one post-baseline assessment and available PDSQ data excluding first-rank symptoms, the prevalence of auditory-visual hallucination was 2.5% in Whites (n=49 /1,928), 11.3% in Blacks (n=45 /398) 6.3% in Latinos (n=17 /270) (χ2=64.9; df=2; p<.001). Prevalence of paranoid ideation was 15.5% in Whites (n=299 /1927), 31.5% in Blacks (n=126 /400), and 21.1% in Latinos (n=57 /270) (χ2=57.3; df=2; p<.001). Among Whites and Blacks but not Latinos, depressive remission rates were worse in subjects with auditory-visual hallucinations compared to those without them. Paranoid ideation had a significant negative impact on remission in Whites only. In all ethnic-racial groups, a significant association was found between auditory-visual hallucinations and PTSD and panic disorder. Limitations the STAR*D study did not include any structured clinician-based assessment of psychotic symptoms. Conclusion Latinos do not appear to have worse outcomes when treated for MDD with auditory-visual hallucinations, differently from Whites and Blacks. PMID:23489398
Ahmmed, Ansar Uddin
To compare the sensitivity and specificity of Auditory Figure Ground sub-tests of the SCAN-3 battery, using signal to noise ratio (SNR) of +8 dB (AFG+8) and 0 dB (AFG0), in identifying auditory processing disorder (APD). A secondary objective was to evaluate any difference in auditory processing (AP) between children with symptoms of inattention versus combined sub-types of Attention Deficit Hyperactivity Disorder (ADHD). Data from 201 children, aged 6 to 16 years (mean: 10 years 6 months, SD: 2 years 8 months), who were assessed for suspected APD were reviewed retrospectively. The outcomes of the SCAN-3 APD test battery, Swanson Nolan and Pelham-IV parental rating (SNAP-IV) and Children's Communication Checklist-2 (CCC-2) were analysed. AFG0 had a sensitivity of 56.3% and specificity of 100% in identifying children performing poorly in at least two of six SCAN-3 sub-tests or one of the two questionnaires, in contrast to 42.1% and 80% respectively for AFG+8. Impaired AP was mostly associated with symptoms of ADHD and /or language impairment (LI). LI was present in 92.9% of children with ADHD symptoms. Children with symptoms of combined ADHD plus LI performed significantly poorly (p < 0.05) compared to inattention ADHD plus LI in Filtered Words (FW) sub-test, but not in the rest of the SCAN-3 sub-tests. Speech in noise tests using SNR of 0 dB is better than +8 dB in assessing APD. The better FW performance of the inattention ADHD plus LI group can be speculated to be related to known difference in activity in a neural network between different sub-types of ADHD. The findings of the study and existing literature suggest that neural networks connecting the cerebral hemispheres, basal ganglia and cerebellum are involved in APD, ADHD and LI. Copyright © 2017 Elsevier B.V. All rights reserved.
Pinheiro, Ana P; Rezaii, Neguine; Rauber, Andréia; Nestor, Paul G; Spencer, Kevin M; Niznikiewicz, Margaret
Abnormalities in self-other voice processing have been observed in schizophrenia, and may underlie the experience of hallucinations. More recent studies demonstrated that these impairments are enhanced for speech stimuli with negative content. Nonetheless, few studies probed the temporal dynamics of self versus nonself speech processing in schizophrenia and, particularly, the impact of semantic valence on self-other voice discrimination. In the current study, we examined these questions, and additionally probed whether impairments in these processes are associated with the experience of hallucinations. Fifteen schizophrenia patients and 16 healthy controls listened to 420 prerecorded adjectives differing in voice identity (self-generated [SGS] versus nonself speech [NSS]) and semantic valence (neutral, positive, and negative), while EEG data were recorded. The N1, P2, and late positive potential (LPP) ERP components were analyzed. ERP results revealed group differences in the interaction between voice identity and valence in the P2 and LPP components. Specifically, LPP amplitude was reduced in patients compared with healthy subjects for SGS and NSS with negative content. Further, auditory hallucinations severity was significantly predicted by LPP amplitude: the higher the SAPS "voices conversing" score, the larger the difference in LPP amplitude between negative and positive NSS. The absence of group differences in the N1 suggests that self-other voice processing abnormalities in schizophrenia are not primarily driven by disrupted sensory processing of voice acoustic information. The association between LPP amplitude and hallucination severity suggests that auditory hallucinations are associated with enhanced sustained attention to negative cues conveyed by a nonself voice. © 2017 Society for Psychophysiological Research.
Goetz, Christopher G.; Ouyang, Bichun; Negron, Alice; Stebbins, Glenn T.
Objective: To assess prospectively progression and relationship of hallucinations and sleep disorders over a 10-year longitudinal study of patients with Parkinson disease (PD). Methods: Eighty-nine patients with PD were recruited to fill cells of normal sleep without hallucinations (n = 20), sleep fragmentation only (n = 20), vivid dreams/nightmares (n = 20), hallucinations with insight (n = 20), and hallucinations without insight (n = 9). At baseline, 0.5, 1.5, 4, 6, and 10 years, sleep disorders and hallucinations were assessed by standardized scales with the longitudinal data analyzed by generalized estimating equations with assumptions of linearity in time. Results: At 10 years, we could account for all subjects (27 interviewed, 61 deceased, and 1 too ill for interview). Hallucination prevalence and severity increased over time (p < 0.0001, p = 0.0001). Acting out dreams also increased over time (p = 0.001). In contrast, presence of vivid dreams/nightmares or sleep fragmentation did not increase over time. For all visits, the prevalence of sleep fragmentation did not differ between subjects with vs without hallucinations (odds ratio [OR] = 1.50, p = 0.09). However, severe sleep fragmentation was associated with concurrent hallucinations (OR 2.01, p = 0.006). The presence of hallucinations was also highly associated with concurrent vivid dreams/nightmares (OR = 2.60, p < 0.0001) and with concurrent acting out dreams (OR = 2.38, p = 0.0004). Among the baseline nonhallucinators, no sleep abnormalities at study entry predicted future development of hallucinations. Conclusions: Hallucinations and sleep abnormalities follow very different patterns of progression in PD over 10 years. Whereas patients with hallucinations often have concurrent sleep aberrations, no sleep problem is predictive of future hallucinations. GLOSSARY CI = confidence interval; GEE = generalized estimating equation; MMSE = Mini-Mental State Examination; OR = odds ratio; PD = Parkinson disease
Ford, Judith M.; Palzes, Vanessa A.; Roach, Brian J.; Potkin, Steven G.; van Erp, Theo G. M.; Turner, Jessica A.; Mueller, Bryon A.; Calhoun, Vincent D.; Voyvodic, Jim; Belger, Aysenil; Bustillo, Juan; Vaidya, Jatin G.; Preda, Adrian; McEwen, Sarah C.; Mathalon, Daniel H.
Introduction: While auditory verbal hallucinations (AH) are a cardinal symptom of schizophrenia, people with a diagnosis of schizophrenia (SZ) may also experience visual hallucinations (VH). In a retrospective analysis of a large sample of SZ and healthy controls (HC) studied as part of the functional magnetic resonance imaging (fMRI) Biomedical Informatics Research Network (FBIRN), we asked if SZ who endorsed experiencing VH during clinical interviews had greater connectivity between visual cortex and limbic structures than SZ who did not endorse experiencing VH. Methods: We analyzed resting state fMRI data from 162 SZ and 178 age- and gender-matched HC. SZ were sorted into groups according to clinical ratings on AH and VH: SZ with VH (VH-SZ; n = 45), SZ with AH but no VH (AH-SZ; n = 50), and SZ with neither AH nor VH (NoH-SZ; n = 67). Our primary analysis was seed based, extracting connectivity between visual cortex and the amygdala (because of its role in fear and negative emotion) and visual cortex and the hippocampus (because of its role in memory). Results: Compared with the other groups, VH-SZ showed hyperconnectivity between the amygdala and visual cortex, specifically BA18, with no differences in connectivity among the other groups. In a voxel-wise, whole brain analysis comparing VH-SZ with AH-SZ, the amygdala was hyperconnected to left temporal pole and inferior frontal gyrus in VH-SZ, likely due to their more severe thought broadcasting. Conclusions: VH-SZ have hyperconnectivity between subcortical areas subserving emotion and cortical areas subserving higher order visual processing, providing biological support for distressing VH in schizophrenia. PMID:24619536
... periods of deep sleep) Mental disorders, such as schizophrenia and psychotic depression Sensory problem, such as blindness ... Freudenriech O, Brown HE, Holt DJ. Psychosis and schizophrenia. In: Stern TA, Fava M, Wilens TE, Rosenbaum ...
Bourguignon, A; Manus, A
In this paper, the authors intended to outline the history of three psychiatric and psycho-analytical concepts (negative hallucination, disavowal and scotomisation) and to analyse the psychic processes that they stand for. Historical study: Bernheim coined the expression negative hallucination in 1884. Freud used it from 1895 until 1917 when he discarded it. Freud put forward the concept of disavowal in 1914. In its wider meaning it is equivalent to negative hallucination. In its more specific meaning it designates the simultaneous acknowledgement and non-acknowledgement of a traumatic perception. Scotomisation, introduced by Pichon and Laforgue, is identical to negative hallucination. Freud and Laforgue had a long and polemical discussion about it. Psychological, metapsychological and psychopathological study: Only the concepts of negative hallucination and disavowal, in their more specific meaning, ought to be considered here. In their first phases, both processes are identical. The first phase is a "preliminary position", a conception of things, related to wishes and the pleasure principle. The second phase is marked by a stimulus which is unconsciously perceived as "unbearable". During the third phase, perception is suspended by various processes. It is with the fourth phase that the mechanisms differ. In the negative hallucination, the ego keeps the perception unconscious whereas in disavowal (in its specific meaning) it is split, one part acknowledges the perception, the other disavows it. The authors stress the importance of the negative hallucination and disavowal for psychopathology and psychoanalysis.
Wible, Cynthia G.; Preus, Alexander P.; Hashimoto, Ryuichiro
We will review converging evidence that language related symptoms of the schizophrenic syndrome such as auditory verbal hallucinations arise at least in part from processing abnormalities in posterior language regions. These language regions are either adjacent to or overlapping with regions in the (posterior) temporal cortex and temporo-parietal occipital junction that are part of a system for processing social cognition, emotion, and self representation or agency. The inferior parietal and posterior superior temporal regions contain multi-modal representational systems that may also provide rapid feedback and feed-forward activation to unimodal regions such as auditory cortex. We propose that the over-activation of these regions could not only result in erroneous activation of semantic and speech (auditory word) representations, resulting in thought disorder and voice hallucinations, but could also result in many of the other symptoms of schizophrenia. These regions are also part of the so-called “default network”, a network of regions that are normally active; and their activity is also correlated with activity within the hippocampal system. PMID:19809534
Rogalsky, Corianne; Poppa, Tasha; Chen, Kuan-Hua; Anderson, Steven W.; Damasio, Hanna; Love, Tracy; Hickok, Gregory
For more than a century, speech repetition has been used as an assay for gauging the integrity of the auditory-motor pathway in aphasia, thought classically to involve a linkage between Wernicke’s area and Broca’s area via the arcuate fasciculus. During the last decade, evidence primarily from functional imaging in healthy individuals has refined this picture both computationally and anatomically, suggesting the existence of a cortical hub located at the parietal-temporal boundary (area Spt) that functions to integrate auditory and motor speech networks for both repetition and spontaneous speech production. While functional imaging research can pinpoint the regions activated in repetition/auditory-motor integration, lesion-based studies are needed to infer causal involvement. Previous lesion studies of repetition have yielded mixed results with respect to Spt’s critical involvement in speech repetition. The present study used voxel-based lesion symptom mapping (VLSM) to investigate the neuroanatomy of repetition of both real words and non-words in a sample of 47 patients with focal left hemisphere brain damage. VLSMs identified a large voxel cluster spanning gray and white matter in the left temporal-parietal junction, including area Spt, where damage was significantly related to poor non-word repetition. Repetition of real words implicated a very similar dorsal network including area Spt. Cortical regions including Spt were implicated in repetition performance even when white matter damage was factored out. In addition, removing variance associated with speech perception abilities did not alter the overall lesion pattern for either task. Together with past functional imaging work, our results suggest that area Spt is integral in both word and non-word repetition, that its contribution is above and beyond that made by white matter pathways, and is not driven by perceptual processes alone. These findings are highly consistent with the claim that Spt is an area
Rogalsky, Corianne; Poppa, Tasha; Chen, Kuan-Hua; Anderson, Steven W; Damasio, Hanna; Love, Tracy; Hickok, Gregory
For more than a century, speech repetition has been used as an assay for gauging the integrity of the auditory-motor pathway in aphasia, thought classically to involve a linkage between Wernicke's area and Broca's area via the arcuate fasciculus. During the last decade, evidence primarily from functional imaging in healthy individuals has refined this picture both computationally and anatomically, suggesting the existence of a cortical hub located at the parietal-temporal boundary (area Spt) that functions to integrate auditory and motor speech networks for both repetition and spontaneous speech production. While functional imaging research can pinpoint the regions activated in repetition/auditory-motor integration, lesion-based studies are needed to infer causal involvement. Previous lesion studies of repetition have yielded mixed results with respect to Spt's critical involvement in speech repetition. The present study used voxel-based lesion symptom mapping (VLSM) to investigate the neuroanatomy of repetition of both real words and non-words in a sample of 47 patients with focal left hemisphere brain damage. VLSMs identified a large voxel cluster spanning gray and white matter in the left temporal-parietal junction, including area Spt, where damage was significantly related to poor non-word repetition. Repetition of real words implicated a very similar dorsal network including area Spt. Cortical regions including Spt were implicated in repetition performance even when white matter damage was factored out. In addition, removing variance associated with speech perception abilities did not alter the overall lesion pattern for either task. Together with past functional imaging work, our results suggest that area Spt is integral in both word and non-word repetition, that its contribution is above and beyond that made by white matter pathways, and is not driven by perceptual processes alone. These findings are highly consistent with the claim that Spt is an area of
Singh, Amardeep; Sørensen, Torben Lykke
Charles Bonnet syndrome is characterized by vivid, complex and recurrent visual hallucinations occurring in psychologically normal people. Though not related to any specific eye condition, it commonly affects visually impaired elderly persons and is thus an important differential diagnosis to many conditions which cause visual hallucinations. Patients usually retain insight into the unreal nature of their hallucination. The hallucinatory experiences are generally not distressing, but patients may fear impending insanity. There is no specific treatment for this condition which in most cases is self-limiting.
Adebimpe, Victor R.; Klein, Helen E.; Fried, Jeffrey
A higher incidence of hallucinations has been previously reported among blacks, as compared to whites, in both psychiatric and nonpsychiatric populations. In contrast to these reports, which relied on hospital records, the present study utilized standardized research rating scales, and confirmed the above observation among schizophrenic patients. Some blacks, irrespective of diagnosis, probably experience a variety of non-schizophrenic hallucinations, may lead to erroneous diagnoses of schizophrenia. Current ignorance regarding the content of hallucinations in normal and non-schizophrenic, and in schizophrenic blacks is a source of diagnostic confusion which may have dire consequences for many individuals. PMID:7241610
Gangdev, Prakash; Dua, Varinder; Desjardins, Nina
Usually remembered in the context of Narcolepsy-Cataplexy syndrome, isolated sleep paralysis (SP) and hypnic hallucination are widely prevalent and because of the overlap of symptoms with schizophrenia, their identification is important but unrecognized. To determine the presence of SP and hypnic hallucinations (HH) in people with schizophrenia and schizoaffective disorder. Cross-sectional survey. Participants were patients receiving follow-up care for schizophrenia from Assertive Community Treatment Team. A screening questionnaire was administered during their routine follow-up visits. Of 71 respondents (49 males, 22 females) only 11 (10 males and 1 female), that is, 15% reported SP, and 12 (7 males and 5 females), that is, 16.9% reported HH, a considerably low prevalence. It is difficult to study the presence of SP and HH in patients with active or residual symptoms of schizophrenia, and more refined studies and appropriate questionnaires are required. The possibility of SP and HH confounding or being misdiagnosed as psychotic symptoms needs to be borne in mind.
A 57-year-old man presenting with profound visual hallucinations was found to have severe hypomagnesaemia and hypocalcaemia with a normal level of parathyroid hormone (PTH). Magnesium is essential to the release of PTH so the suspected pathophysiology was thought to be: low Mg → inappropriately low PTH → low Ca. He commenced supplementation and his symptoms resolved. Causes of hypomagnesaemia are discussed.
Berrios, G E
A brief historical analysis of the general concept of hallucination is presented and the suggestion is made that it emerged as the unwarranted generalisation of a perceptual model that was meant to apply only to vision and the "distance senses". Against this background the evolution of tactile hallucinations is considered and its interaction with 19th century psychological theory explored. It is concluded that tactile hallucinations are sui generis phenomena which do not fit the conventional model and whose clinical identification rests on criteria so far unclear. A brief review of their taxonomy and diagnostic usefulness is presented. Some wider implications are drawn which should be relevant to the general concept of hallucination. PMID:7042917
Halevy, Ayelet; Shuper, Avinoam
A 15-year-old boy with attention-deficit hyperactivity disorder (ADHD) presented with complex visual hallucinations of rats running around and touching and smelling him soon after receiving a first low dose of methylphenidate. The hallucinations resolved upon discontinuation of the drug. Reintroduction of the drug 7 years later at an even lower dose had the same effect. Other cases of vivid complex hallucinations of living creatures associated with methylphenidate have been reported in the literature. The pathogenetic mechanism is still unknown. In our case, the occurrence of hallucinations after a very low dose of the drug on 2 occasions may suggest an idiosyncratic reaction. The phenomenon might also be explained by a drug-induced dysfunction of the monoamine transmitters. Given the wide use of methylphenidate, clinicians should be aware of this possible side effect.
Coebergh, Jan A. F.; Lauw, R. F.; Bots, R.; Sommer, I. E. C.; Blom, J. D.
Background: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. Objective: To review the effects of published treatment methods for musical hallucinations. Methods: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. Results: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the
Coebergh, Jan A F; Lauw, R F; Bots, R; Sommer, I E C; Blom, J D
Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. To review the effects of published treatment methods for musical hallucinations. A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication
A 78-year-old hearing-impaired woman who presented to hospital with a stroke and a subsequent epileptic seizure later developed unilateral musical hallucinations in her better hearing (right) ear. She was found to have a left-sided temporal epileptic focus and the music ceased after a second anti-convulsant was introduced. Comments are made on unusual features of the hallucination and its probable causation.
Braun, Claude M.J.; Dumont, Mathieu; Duval, Julie; Hamel-Hébert, Isabelle; Godbout, Lucie
We systematically reviewed the localization of focal brain lesions that cause isolated hallucination in a single sensory modality. Case reports of post-lesion nonparoxysmal hallucination in 1 (and only 1) of 3 sensory modalities (i.e., visual, auditory, somatic) were reviewed, and the content of the qualitative descriptions was analyzed for each modality. The lesion is practically always located in the brain pathway of the sensory modality of the hallucination. There seem to exist localized sensory brain circuits that in healthy people diminish the intensity of internal sensory representation. After a lesion, hallucinosis seems to be caused also by compensatory overactivation of tissue in the nearby brain sensory pathway. This type of hallucination may indeed be termed a “release” form, whereby patients are aware of the hallucinatory nature of their experience, but not usually of “dream centres” as proposed by Lhermitte. Instead, we propose that it is dreaming that should be considered a special case of neural “release.” Nous avons passé en revue systématiquement l'emplacement des lésions cérébrales focales qui causent des hallucinations isolées dans un seul mode sensoriel. On a analysé des rapports de cas portant sur l'hallucination non paroxystique postlésionnelle dans un mode sensoriel (et un seulement) sur trois (c.-à-d. visuel, auditif, somatique), et on a analysé le contenu des descriptions qualitatives de chaque mode. La lésion est presque toujours située dans la voie cérébrale du mode sensoriel de l'hallucination. Il semble y avoir des circuits cérébraux sensoriels localisés qui, chez les gens en bonne santé, «atténuent» l'intensité de la représentation sensorielle interne. Après une lésion, l'hallucinose semble être causée aussi par une suractivation compensatoire de tissus de la voie sensorielle cérébrale voisine. On peut en fait qualifier ce type d'hallucination de forme de «libération», dans laquelle les
Nguyen, Ngoc-Diem; Osterweil, Dan; Hoffman, Janice
Charles Bonnet syndrome (CBS) is characterized by recurrent or persistent complex visual hallucinations that occur in visually impaired individuals with intact cognition and no evidence of psychiatric illness. Patients usually retain insight into the unreal nature of their hallucinations.3,4 CBS is often misdiagnosed, and predominantly affects elderly patients with vision changes (e.g., age-related macular degeneration, glaucoma, and cataract). While many require only the assurance of the benign nature of the hallucinations, nonpharmacological and pharmacological interventions have been reported to be useful in the treatment of CBS. This case involves an 83-year-old female, with a two-year history of CBS, who presented to the clinic with worsening visual hallucinations over the past few months. She was starting to lose insight into her hallucinations secondary to her new diagnosis of dementia. Several pharmacological agents were explored to determine the most appropriate choice for our patient. Ultimately, this patient was started on donepezil (reported to be successful in a CBS case report), which helped improve her cognitive function. At future follow-up visits, her hallucinations improved and her cognitive function stabilized. Pharmacists should be aware of CBS and its treatment options to properly assist physicians in the medication-selection process to alleviate distress experienced by patients with CBS. In patients who may benefit from pharmacological treatment, physicians should weigh the risks and benefits of the different treatment options. Donepezil can be a favorable option in CBS patients with Alzheimer's type dementia.
Nishio, Yoshiyuki; Yokoi, Kayoko; Uchiyama, Makoto; Mamiya, Yasuyuki; Watanabe, Hiroyuki; Gang, Miyeong; Baba, Toru; Takeda, Atsushi; Hirayama, Kazumi; Mori, Etsuro
Patients with Lewy body disease develop a variety of psychotic and misperception symptoms, including visual hallucinations and delusions, as well as 'minor hallucinations', that is, a sense of presence, passage hallucinations and visual illusions. Although these symptoms have been suggested to have common underlying mechanisms, the commonalities and differences among them have not been systematically investigated at the neural level. Sixty-seven patients with Parkinson's disease underwent neuropsychological and behavioural assessments, volumetric MRI and 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). A factor analysis was performed to discover correlations among psychotic and misperception symptoms, other behavioural symptoms and neuropsychological performances. Partial least-squares correlation analysis was used to investigate the relationship between these symptoms and the joint features of MRI and FDG-PET. A sense of presence, passage hallucinations and visual illusions constituted a single behavioural factor (minor hallucinations/illusions). Visual hallucinations formed another behavioural factor along with delusions, depression and fluctuating cognition (psychosis/dysphoria). Three distinct brain-behaviour correlation patterns were identified: (1) posterior cortical atrophy/hypometabolism associated with minor hallucinations/illusions and visuospatial impairment; (2) upper brainstem and thalamic atrophy/hypometabolism associated with psychosis/dysphoria and (3) frontal cortical atrophy/hypometabolism associated with non-visual cognition. No significant differences in neuroimaging findings were identified between patients who had minor hallucinations/illusions alone and patients who also had visual hallucinations. Our findings suggest that combined damage to the upper brainstem/thalamus and the posterior neocortex underlies both minor hallucinations/illusions and visual hallucinations and that the former pathology is more associated with visual
Rogers, R; Gillis, J R; Turner, R E; Frise-Smith, T
In a forensic population, patients with command hallucinations (N = 25) were compared to two groups of psychotic patients: those with noncommand hallucinations (N = 24) and those without hallucinations (N = 16). The three groups did not differ in overall impairment as measured by the Global Assessment Scale and the Social Behavior Rating Schedule. However, the group with command hallucinations differed in the content of their hallucinations (more aggression, dependency, and self-punishment themes), and nearly one-half did not report or denied their command hallucinations to the assessment team. Many patients (N = 11, 44%) reported that they frequently responded to hallucinatory commands with unquestioning obedience.
Brown, Seth A; Evans, Yolanda; Espenschade, Kelly; O'Connor, Maureen
Mental illness stigma is quite prevalent with dire consequences. A number of interventions to decrease stigma have been formulated, but have variable effectiveness and limited dissemination. This research examined the impact of two brief interventions: a film depicting individuals with schizophrenia (filmed contact) and a simulation of auditory hallucinations. Participants (N = 143) were randomly assigned to one of three interventions: (1) filmed contact, (2) simulation, or (3) no intervention, and completed two stigma measures prior to, immediately after, and 1 week after the intervention. The filmed contact intervention led to decreases in stigma which persisted across 1 week. However, the simulation led to increases in stigma. The results suggest that a filmed contact intervention may decrease two aspects of mental illness stigma (social distance and negative emotions), which has implications for wide dissemination. The efficacy of a hallucination simulations intervention remains dubious.
Perelberg, Rosine Jozef
This paper explores the meaning of a patient's hallucinatory experiences in the course of a five times a week analysis. I will locate my understanding within the context of André Green's ideas on the role of the framing structure and the negative hallucination in the structuring of the mind. The understanding of the transference and countertransference was crucial in the creation of meaning and enabling the transformations that took place in the analytic process. Through a detailed analysis of a clinical example the author examines Bion's distinction between hysterical hallucinations and psychotic hallucinations and formulates her own hypothesis about the distinctions between the two. The paper suggests that whilst psychotic hallucinations express a conflict between life and death, in the hysterical hallucination it is between love and hate. The paper also contains some reflections on the dramatic nature of the analytic encounter.
ffytche, Dominic H.; Wible, Cynthia G.
The content, modality, and perceptual attributes of hallucinations and other psychotic symptoms may be related to neural representation at a single cell and population level in the cerebral cortex. A brief survey of some principles and examples of cortical representation and organization will be presented together with evidence for a correspondence between the neurobiology of brain areas activated at the time of a hallucination and the content of the corresponding hallucinatory and psychotic experiences. Contrasting the hallucinations of schizophrenia with other conditions, we highlight phenomenological aspects of hallucinations that are ignored in clinical practice but carry potentially important information about the brain regions and dysfunctions underlying them. Knowledge of cortical representation and organization are being used to develop animal models of hallucination and to test treatments that are now beginning to translate to the clinical domain. PMID:24936089
Mendez, M F; Geehan, G R
The symptoms of two patients with bilateral cortical auditory lesions evolved from cortical deafness to other auditory syndromes: generalised auditory agnosia, amusia and/or pure word deafness, and a residual impairment of temporal sequencing. On investigation, both had dysacusis, absent middle latency evoked responses, acoustic errors in sound recognition and matching, inconsistent auditory behaviours, and similarly disturbed psychoacoustic discrimination tasks. These findings indicate that the different clinical syndromes caused by cortical auditory lesions form a spectrum of related auditory processing disorders. Differences between syndromes may depend on the degree of involvement of a primary cortical processing system, the more diffuse accessory system, and possibly the efferent auditory system. Images PMID:2450968
Skewes, Joshua C.; Gebauer, Line
Convergent research suggests that people with ASD have difficulties localizing sounds in space. These difficulties have implications for communication, the development of social behavior, and quality of life. Recently, a theory has emerged which treats perceptual symptoms in ASD as the product of impairments in implicit Bayesian inference; as…
Skewes, Joshua C.; Gebauer, Line
Convergent research suggests that people with ASD have difficulties localizing sounds in space. These difficulties have implications for communication, the development of social behavior, and quality of life. Recently, a theory has emerged which treats perceptual symptoms in ASD as the product of impairments in implicit Bayesian inference; as…
Cochen, V; Arnulf, I; Demeret, S; Neulat, M L; Gourlet, V; Drouot, X; Moutereau, S; Derenne, J P; Similowski, T; Willer, J C; Pierrot-Deseiligny, C; Bolgert, F
We conducted a prospective controlled study of the clinical and biological determinants of the mental status abnormalities in 139 patients with Guillain-Barré syndrome (GBS) and 55 patients without GBS placed in the intensive care unit (ICU controls). There were mental status changes in 31% of GBS patients and in 16% of controls (odds ratio = 2.3; P = 0.04). In GBS patients, they included vivid dreams (19%), illusions (30%, including an illusory body tilt), hallucinations (60%, mainly visual) and delusions (70%, mostly paranoid). They appeared a median 9 days after disease onset (range 1-40 days, during the progression or the plateau of the disease), and lasted a median 8 days. Seven (16%) patients experienced the symptoms before their admission to the ICU. Hallucinations were frequently hypnagogic, occurring as soon as the patients closed their eyes. Autonomic dysfunction, assisted ventilation and high CSF protein levels were significant risk factors for abnormal mental status in GBS patients. CSF hypocretin-1 (a hypothalamic neuropeptide deficient in narcolepsy) levels, measured in 20 patients, were lower in GBS patients with hallucinations (555 +/- 132 pg/ml) than in those without (664 +/- 71 pg/ml, P = 0.03). Since the mental status abnormalities had dream-like aspects, we examined their association with rapid eye movement sleep (REM sleep) using continuous sleep monitoring in 13 GBS patients with (n = 7) and without (n = 6) hallucinations and 6 tetraplegic ICU controls without hallucinations. Although sleep was short and fragmented in all groups, REM sleep latency was shorter in GBS patients with hallucinations (56 +/- 115 min) than in GBS patients without hallucinations (153 +/- 130 min) and in controls (207 +/- 179 min, P < 0.05). In addition, sleep structure was highly abnormal in hallucinators, with sleep onset in REM sleep periods (83%), abnormal eye movements during non-REM sleep (57%), high percentages of REM sleep without atonia (92 +/- 22%), REM
Baldo, Juliana V.; Katseff, Shira; Dronkers, Nina F.
Background A deficit in the ability to repeat auditory-verbal information is common among individuals with aphasia. The neural basis of this deficit has traditionally been attributed to the disconnection of left posterior and anterior language regions via damage to a white matter pathway, the arcuate fasciculus. However, a number of lesion and imaging studies have called this notion into question. Aims The goal of this study was to identify the neural correlates of repetition and a related process, auditory-verbal short-term memory (AVSTM). Both repetition and AVSTM involve common elements such as auditory and phonological analysis and translation to speech output processes. Based on previous studies, we predicted that both repetition and AVSTM would be most dependent on posterior language regions in left temporo-parietal cortex. Methods & Procedures We tested 84 individuals with left hemisphere lesions due to stroke on an experimental battery of repetition and AVSTM tasks. Participants were tested on word, pseudoword, and number-word repetition, as well as digit and word span tasks. Brain correlates of these processes were identified using a statistical, lesion analysis approach known as voxel-based lesion symptom mapping (VLSM). VLSM allows for a voxel-by-voxel analysis of brain areas most critical to performance on a given task, including both grey and white matter regions. Outcomes & Results The VLSM analyses showed that left posterior temporo-parietal cortex, not the arcuate fasciculus, was most critical for repetition as well as for AVSTM. The location of maximal foci, defined as the voxels with the highest t values, varied somewhat among measures: Word and pseudoword repetition had maximal foci in the left posterior superior temporal gyrus, on the border with inferior parietal cortex, while word and digit span, as well as number-word repetition, were centered on the border between the middle temporal and superior temporal gyri and the underlying white matter
Woodward, Todd S.; Jung, Kwanghee; Hwang, Heungsun; Yin, John; Taylor, Laura; Menon, Mahesh; Peters, Emmanuelle; Kuipers, Elizabeth; Waters, Flavie; Lecomte, Tania; Sommer, Iris E.; Daalman, Kirstin; van Lutterveld, Remko; Hubl, Daniela; Kindler, Jochen; Homan, Philipp; Badcock, Johanna C.; Chhabra, Saruchi; Cella, Matteo; Keedy, Sarah; Allen, Paul; Mechelli, Andrea; Preti, Antonio; Siddi, Sara; Erickson, David
The Psychotic Symptom Rating Scales (PSYRATS) is an instrument designed to quantify the severity of delusions and hallucinations and is typically used in research studies and clinical settings focusing on people with psychosis and schizophrenia. It is comprised of the auditory hallucinations (AHS) and delusions subscales (DS), but these subscales do not necessarily reflect the psychological constructs causing intercorrelation between clusters of scale items. Identification of these constructs is important in some clinical and research contexts because item clustering may be caused by underlying etiological processes of interest. Previous attempts to identify these constructs have produced conflicting results. In this study, we compiled PSYRATS data from 12 sites in 7 countries, comprising 711 participants for AHS and 520 for DS. We compared previously proposed and novel models of underlying constructs using structural equation modeling. For the AHS, a novel 4-dimensional model provided the best fit, with latent variables labeled Distress (negative content, distress, and control), Frequency (frequency, duration, and disruption), Attribution (location and origin of voices), and Loudness (loudness item only). For the DS, a 2-dimensional solution was confirmed, with latent variables labeled Distress (amount/intensity) and Frequency (preoccupation, conviction, and disruption). The within-AHS and within-DS dimension intercorrelations were higher than those between subscales, with the exception of the AHS and DS Distress dimensions, which produced a correlation that approached the range of the within-scale correlations. Recommendations are provided for integrating these underlying constructs into research and clinical applications of the PSYRATS. PMID:24936086
About one third of patients with Parkinson's disease (PD) experience hallucinations, mostly of a complex visual type, less often auditory or tactile. Minor hallucinatory phenomena, including sense of presence, passage hallucinations and visual illusions are frequent. Hallucinations primarily occur in a context of clear sensorium in patients with longstanding PD. They are more frequent in the evening or during the night. Insight in the hallucinatory nature of the phenomenon may be retained, partial, fluctuating, or abolished. An altered insight is common when cognitive impairment is present, and may be associated with delusions and (or) delusional misidentifications. Pharmacological factors such as dopaminergic treatment clearly trigger or increase the occurence of hallucinations in PD. However, in the recent years, emphasis has been made on disease-related factors including cognitive impairment, diurnal somnolence, visual disorders (either contrast and color discrimination impairment due to PD, or coincident ocular disorders), long duration of PD, late onset, severe axial impairment and autonomic dysfunction. The pathophysiology of hallucinations of PD is poorly understood but is likely to be multifactorial. The first steps of the treatment consist in giving information and reassurance to the patient and his/her caregiver, re-evaluating the antiparkinsonian treatment and associated medications, and evaluating the patient for mood disorder, visual impairment, and cognitive impairment. Cholinesterase inhibitors, when prescribed for associated cognitive impairment, may be beneficial on hallucinations. In the more severe forms, clozapine has been proved to be safe and effective.
Joe, Soohyun; Park, Jangho; Lim, Jongseok; Park, Choongman
To provide a description of musical hallucination associated with hybrid cochlear implantation. Case report. We report a case of musical hallucination secondary to hybrid cochlear implantation. Activation of electrical stimulation was closely related to onset of musical hallucination and deactivation was associated with attenuation of hallucination. Persistent musical hallucination severely impaired speech discrimination in spite of 2 years of listening rehabilitation. The hybrid cochlear implant is a relatively new surgical method, and its side effects have not been well documented. This is the first report of musical hallucination after a hybrid cochlear implantation. Also we provide evidence of the peripheral origin of musical hallucination by reporting lateralization and intensity change of hallucination by activation status of cochlear implant. Copyright © 2015 Elsevier Inc. All rights reserved.
Hall, D C; Lawson, B Z; Wilson, L G
An unusual case is presented of a psychotic young man who experienced command auditory hallucinations which directed him to amputate his right hand and distal penis to atone for a "terrible sexual transgression." The existing literature on genital self-mutilation is reviewed as well as some recent work on factors that might be used to predict an episode of self-mutilation. In patients who are felt to be at extremely high risk, careful monitoring and rapid medication schedules might be effective in preventing such an incident.
Tsuang, D; DiGiacomo, L; Lipe, H; Bird, T D
An increased incidence of schizophrenia-like symptoms in Huntington's disease (HD) has been well-documented in the past. The reasons for this association, however, have never been explained. At the University of Washington Medical Genetics Clinic, we had the opportunity to evaluate a unique juvenile-onset HD proband who had schizophrenia-like symptoms. This patient was referred to our clinic because of new onset of somatic delusions and command auditory hallucinations early in the course of her illness. Since we had already evaluated other affected individuals in her family, we selected another family with a nonpsychotic juvenile-onset proband for comparison. Using these two families in a small case-control study, we investigated the following hypotheses which could explain the association between schizophrenia-like symptoms and HD: first, schizophrenia-like symptoms may be related to the number of CAG repeats in the HD gene; second, schizophrenia-like symptoms may segregate in certain HD families, for unknown reasons; and third, there may coincidentally be an unrelated gene for schizophrenia in certain HD families. Comparisons of clinical characteristics and the HD genotype showed that family history of schizophrenia-like symptoms segregated with the HD gene; however, age of onset of HD, size of CAG repeat, and sex of the transmitting parent were not associated with psychotic symptoms. Further genetic and neurobiological studies are necessary to investigate the potential mechanism underlying this association.
Waters, Flavie; Collerton, Daniel; ffytche, Dominic H.; Jardri, Renaud; Pins, Delphine; Dudley, Robert; Blom, Jan Dirk; Mosimann, Urs Peter; Eperjesi, Frank; Ford, Stephen; Larøi, Frank
Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VHs in the psychosis phenotype and contrast this data with the literature drawn from neurodegenerative disorders and eye disease. The evidence challenges the traditional views that VHs are atypical or uncommon in psychosis. The weighted mean for VHs is 27% in schizophrenia, 15% in affective psychosis, and 7.3% in the general community. VHs are linked to a more severe psychopathological profile and less favorable outcome in psychosis and neurodegenerative conditions. VHs typically co-occur with auditory hallucinations, suggesting a common etiological cause. VHs in psychosis are also remarkably complex, negative in content, and are interpreted to have personal relevance. The cognitive mechanisms of VHs in psychosis have rarely been investigated, but existing studies point to source-monitoring deficits and distortions in top-down mechanisms, although evidence for visual processing deficits, which feature strongly in the organic literature, is lacking. Brain imaging studies point to the activation of visual cortex during hallucinations on a background of structural and connectivity changes within wider brain networks. The relationship between VHs in psychosis, eye disease, and neurodegeneration remains unclear, although the pattern of similarities and differences described in this review suggests that comparative studies may have potentially important clinical and theoretical implications. PMID:24936084
Fisher, C M
Visual hallucinations of remarkable intensity began shortly after intravenous atropine and persisted for 11 days. They were present only when the eyes were closed and were associated with heightened dreaming and disturbed sleep. The patient remained lucid and described his experiences to his attendants. Our patient's hallucinations bore some resemblance to hypnagogic hallucinations and this became the basis for the hypothesis that the hallucinations originated in the sleep-dream system of the brain stem. It is speculated that a similar site--a metabolic locus minoris resistentiae may play a part in other types of visual hallucinations and in delirium.
Jang, Hyun; Kim, Sang Hoon; Park, Sang Hag; Choo, Il Han
A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients. PMID:25866531
Caputo, Giovanni B
Interpersonal gazing in dyads, when the two individuals in the dyad stare at each other in the eyes, is investigated in 20 healthy young individuals at low illumination for 10-min. Results indicate dissociative symptoms, dysmorphic face perceptions, and hallucination-like strange-face apparitions. Dissociative symptoms and face dysmorphia were correlated. Strange-face apparitions were non-correlated with dissociation and dysmorphia. These results indicate that dissociative symptoms and hallucinatory phenomena during interpersonal-gazing under low illumination can involve different processes. Strange-face apparitions may characterize the rebound to "reality" (perceptual reality caused by external stimulus and hallucinatory reality caused by internal input) from a dissociative state induced by sensory deprivation. These phenomena may explain psychodynamic projections of the subject's unconscious meanings into the other's face. The results indicate that interpersonal gazing in dyads can be an effective tool for studying experimentally-induced dissociative symptoms and hallucinatory-like apparitions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Cruz, Silvia L; Domínguez, Mario
This work describes the solvent-induced hallucinatory experiences of 10 male and seven female teenagers in Mexico City from 1998 to 2000. The youth were recruited from public schools through a combined snowball and convenience sampling procedure. Inclusion criteria were: 13-18 years of age, school attendance, living with family, and weekly toluene-based solvent misuse. Interested students were interviewed and transcripts were analyzed. Hallucinations and illusions were common, including changes in color perception, visual, somatic, auditory, and tactile hallucinations. Some users described their hallucinatory experience as being able to be shared by a group and modulated by their environment. The pharmacological linkages with hallucinations are discussed. The study's limitations are noted.
Kompanje, E J O
Hypnagogic and hypnopompic hallucinations are visual, tactile, auditory or other sensory events, usually brief but sometimes prolonged, that occur at the transition from wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic). Hypnagogic and hypnopompic hallucinations are often associated with sleep paralysis. Sleep paralysis occurs immediately prior to falling asleep (hypnagogic paralysis) or upon waking (hypnopompic paralysis). In 1664, the Dutch physician Isbrand Van Diemerbroeck (1609-1674) published a collection of case histories. One history with the title 'Of the Night-Mare' describes the nightly experiences of the 50-year-old woman. This case report is subject of this article. The experiences in this case could without doubt be diagnosed as sleep paralysis accompanied by hypnagogic hallucinations. This case from 1664 should be cited as the earliest detailed account of sleep paralysis associated with hypnagogic illusions and as the first observation that sleep paralysis and hypnagogic experiences occur more often in supine position of the body.
This article presents an updated review of studies on the relation between command hallucinations and dangerous behavior. The author reviewed all studies published between 1966 and 1997 according to MEDLINE and between 1974 and 1997 according to PSYCLIT. Forty-one studies were found, of which 82.9 percent dealt with the relation between command hallucinations and dangerous behavior. Of these studies, 32.3 percent were controlled, and they were grouped into three partially overlapping classes: those concerned with violent behavior, those concerned with suicidal behavior, and those concerned with mediating variables. Most of these studies agreed on the non-existence of an immediate relation between command hallucinations and dangerous (violent or suicidal) behavior. Even though the studies were divided about the existence of a relation between severity/dangerousness of command content and compliance with the commands, there was agreement about the existence of a direct relation between compliance with commands and both benevolence and familiarity of commanding voice. It seems that the research and knowledge available to date on this subject is both scant and methodologically weak. Future study should probably concentrate on mediating factors, such as appraisal and coping attitudes and behaviors.
Zhou, Huiling; Lam, Kin-Man
A two-step face-hallucination framework is proposed to reconstruct a high-resolution (HR) version of a face from an input low-resolution (LR) face, based on learning from LR-HR example face pairs using orthogonal canonical correlation analysis (orthogonal CCA) and linear mapping. In the proposed algorithm, face images are first represented using principal component analysis (PCA). Canonical correlation analysis (CCA) with the orthogonality property is then employed, to maximize the correlation between the PCA coefficients of the LR and the HR face pairs to improve the hallucination performance. The original CCA does not own the orthogonality property, which is crucial for information reconstruction. We propose using orthogonal CCA, which is proven by experiments to achieve a better performance in terms of global face reconstruction. In addition, in the residual-compensation process, a linear-mapping method is proposed to include both the inter- and intrainformation about manifolds of different resolutions. Compared with other state-of-the-art approaches, the proposed framework can achieve a comparable, or even better, performance in terms of global face reconstruction and the visual quality of face hallucination. Experiments on images with various parameter settings and blurring distortions show that the proposed approach is robust and has great potential for real-world applications.
Eng, Marty L; Welty, Timothy E
Hallucinations and psychosis are common in patients with Parkinson's disease (PD), with reported prevalences of up to 48% and 80%, respectively. However, few randomized, double-blind, placebo-controlled trials evaluating the treatment options have appeared in the literature. The studies that have been published were complicated by lack of agreement on the diagnosis of psychosis in PD, poor completion rates, mixed populations that included dementia, and other issues. Several reviews, guidelines, and consensus statements have sought to establish standards for treating these symptoms of PD. In 2006, the American Academy of Neurology (AAN) published a practice guideline (based on articles published up to 2004) for management of depression, psychosis, and dementia in patients with PD. Since then, a number of relevant studies have been published. The purpose of this article was to review data that have appeared in the literature since publication of the AAN guideline regarding the management of hallucinations and psychosis in PD. A literature search of the PubMed, CINAHL, and PsychInfo databases was conducted for human studies published in English from January 2004 to June 2010. All clinical studies were included except case reports and case series. Studies with <20 participants were also excluded. Search terms included psychosis, hallucinosis, hallucination, delusion, Parkinson, atypical antipsychotic, neuroleptic, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. Thirteen studies were included in the review: 3 studies of clozapine, 7 studies of quetiapine, 2 head-to-head trials comparing quetiapine and clozapine, and 1 noncomparative trial of clozapine or quetiapine interventions. Most of the studies included participants with a mean age in the early to mid 70s and a mean duration of PD typically >10 years. Results of the identified studies suggested that patients with PD might benefit from long-term clozapine therapy. Results of the
Clarke, Dave F; Boop, Frederick A; McGregor, Amy L; Perkins, F Frederick; Brewer, Vickie R; Wheless, James W
Ear plugging (placing fingers in or covering the ears) is a clinical seizure semiology that has been described as a response to an unformed, auditory hallucination localized to the superior temporal neocortex. The localizing value of ear plugging in more complex auditory hallucinations may have more involved circuitry. We report on one child, whose aura was a more complex auditory phenomenon, consisting of a door opening and closing, getting louder as the ictus persisted. This child presented, at four years of age, with brief episodes of ear plugging followed by an acute emotional change that persisted until surgical resection of a left mesial frontal lesion at 11 years of age. Scalp video-EEG, magnetic resource imaging, magnetoencephalography, and invasive video-EEG monitoring were carried out. The scalp EEG changes always started after clinical onset. These were not localizing, and encompassed a wide field over the bi-frontal head regions, the left side predominant over the right. Intracranial video-EEG monitoring with subdural electrodes over both frontal and temporal regions localized the seizure-onset to the left mesial frontal lesion. The patient has remained seizure-free since the resection on June 28, 2006, approximately one and a half years ago. Ear plugging in response to simple auditory auras localize to the superior temporal gyrus. If the patient has more complex, formed auditory auras, not only may the secondary auditory areas in the temporal lobe be involved, but one has to entertain the possibility of ictal-onset from the frontal cortex.
Heitz, Camille; Noblet, Vincent; Cretin, Benjamin; Philippi, Nathalie; Kremer, Laurent; Stackfleth, Mélanie; Hubele, Fabrice; Armspach, Jean Paul; Namer, Izzie; Blanc, Frédéric
The aim of this study was to investigate the association between visual hallucinations in dementia with Lewy bodies (DLB) and brain perfusion using single-photon emission computed tomography. We retrospectively included 66 patients with DLB, 36 of whom were having visual hallucinations (DLB-hallu) and 30 of whom were not (DLB-c). We assessed visual hallucination severity on a 3-point scale of increasing severity: illusions, simple visual hallucinations and complex visual hallucinations. We performed voxel-level comparisons between the two groups and assessed correlations between perfusion and visual hallucinations severity. We found a significant decrease in perfusion in the left anterior cingulate cortex, the left orbitofrontal cortex and the left cuneus in the DLB-hallu group compared with the DLB-c group. We also found a significant correlation between decreased bilateral anterior cingulate cortex, left orbitofrontal cortex, right parahippocampal gyrus, right inferior temporal cortex and left cuneus perfusion with the severity of hallucinations. Visual hallucinations seem to be associated with the impairment of anterior and posterior regions (secondary visual areas, orbitofrontal cortex and anterior cingulate cortex) involved in a top-down and bottom-up mechanism, respectively. Furthermore, involvement of the bilateral anterior cingulate cortex and right parahippocampal gyrus seems to lead to more complex hallucinations.
Schneemilch, C; Schiltz, K; Meinshausen, E; Hachenberg, T
Dreams and hallucinations under sedation or anesthesia have been well known phenomena since the introduction of anesthesia. Sexual hallucinations may lead to allegations of sexual molestation or assault by medical doctors or professional nursing staff. Hallucinations under the influence of sedative or hypnotic drugs may be very vivid and as misinterpreted as being real and it is therefore often difficult to disprove the resulting false allegations. In this report the terms drug-induced dreams and hallucinations are defined and the probable mechanism described. By a historical review and case reports the medicolegal consequences are demonstrated and procedures recommended to avoid allegations of sexual assault.
Colon-Rivera, Hector A; Oldham, Mark A
Musical hallucinations (MH) have been labeled Oliver Sacks syndrome, and in the majority of cases, they occur in the context of a hearing loss. In these instances, they have been described as auditory Charles Bonnet syndrome because they are thought to represent a cortical release phenomenon. Patients with MH tend to have intact reality testing, and as such, the condition may also be described as musical hallucinosis. The temporal course of MH is variable, but given that they may improve or remit with time, education on their benign nature is often sufficient. MH also may improve when hearing loss is reversed. The use of ambient noise potentially ameliorates mild to moderate MH; however, where this is insufficient, somatic treatments may be considered. Case reports have documented successful use of low-dose antiepileptics, atypical antipsychotics and donepezil. We present a case of a 52-year-old man who received only partial relief from serial treatment with several psychotropic agents. He developed major depression with suicidal ideation in the context of persistent, intrusive MH that were refractory to several medication trials, and whereas a course of electroconvulsive therapy led to remission of depressive and suicidal symptoms, it provided only transient relief of his MH. In this article, we also provide a review of the literature on the neurobiology and treatment of MH.
Creese, Byron; Ballard, Clive; Aarsland, Dag; Londos, Elisabet; Sharp, Sally; Jones, Emma
To determine whether the 5HTTLPR serotonin transporter polymorphism is associated with delusions and hallucinations in people with dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD). Prospective cohort study. A total of 187 individuals, recruited from centres in Norway, Sweden, and the United Kingdom were included in this study; 97 with clinically or neuropathologically diagnosed DLB/PDD and 90 cognitively normal individuals as a comparison group. All participants with dementia underwent serial evaluation of neuropsychiatric symptoms to assess the presence of persistent delusions and hallucinations using the Columbia University Scale for Psychopathology in Alzheimer disease, the Neuropsychiatric Inventory, or the Present Behavioural Examination. Severity of cognitive impairment was measured using the Mini Mental State Examination (MMSE). Individuals were genotyped for the 5HTTLPR polymorphism. Logistic regression demonstrated that homozygosity for the L/L genotype and lower MMSE were associated with an increased risk for delusions (odds ratio: 11.5 and 1.16, respectively). Neither was significantly associated with hallucinations. This study is the first to demonstrate the 5HTTLPR polymorphism is associated with delusions in Lewy body dementias, with important implications regarding the mechanisms underlying this symptom across the AD/DLB/PDD spectrum. Further studies are warranted to investigate this relationship further and examine treatment opportunities. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
Um, Yoo Hyun; Kim, Tae-Won; Jeong, Jong-Hyun; Seo, Ho-Jun; Han, Jin-Hee; Hong, Seung-Chul; Jung, Won-Sang; Choi, Woo Hee; Lee, Chang-Uk; Lim, Hyun Kook
Parkinson's disease dementia (PDD) is notorious for its debilitating clinical course and high mortality rates. Consequently, various attempts to investigate predictors of cognitive decline in Parkinson's disease (PD) have been made. Here we report a case of a 75-year-old female patient with PD who visited the clinic with complaints of recurrent visual hallucinations and cognitive decline, whose symptoms were ameliorated by the titration of rivastigmine. Imaging results showed pronounced diffuse cortical amyloid deposition evidenced by 18F-florbetaben amyloid positron emission tomography (PET) imaging. This observation suggests that pronounced amyloid deposition and visual hallucinations in PD patients could be clinically significant predictors of cognitive decline in PD patients. Future research should concentrate on accumulating more evidence for possible predictors of cognitive decline and their association with PD pathology that can enable an early intervention and standardized treatment in PDD patients.
Auditory imagination is used in this paper to describe a number of issues and activities related to sound and having to do with listening, thinking, recalling, imagining, reshaping, creating, and uttering sounds and words. Examples of auditory imagination in religious and literary works are cited that indicate a belief in an imagined, expected, or…
Hunter, Michael D; Griffiths, Timothy D; Farrow, Tom F D; Zheng, Ying; Wilkinson, Iain D; Hegde, Nakul; Woods, William; Spence, Sean A; Woodruff, Peter W R
We used functional imaging of normal subjects to identify the neural substrate for the perception of voices in external auditory space. This fundamental process can be abnormal in psychosis, when voices that are not true external auditory objects (auditory verbal hallucinations) may appear to originate in external space. The perception of voices as objects in external space depends on filtering by the outer ear. Psychoses that distort this process involve the cerebral cortex. Functional magnetic resonance imaging was carried out on 12 normal subjects using an inside-the-scanner simulation of 'inside head' and 'outside head' voices in the form of typical auditory verbal hallucinations. Comparison between the brain activity associated with the two conditions allowed us to test the hypothesis that the perception of voices in external space ('outside head') is subserved by a temperoparietal network comprising association auditory cortex posterior to Heschl's gyrus [planum temporale (PT)] and inferior parietal lobule. Group analyses of response to 'outside head' versus 'inside head' voices showed significant activation solely in the left PT. This was demonstrated in three experiments in which the predominant lateralization of the stimulus was to the right, to the left or balanced. These findings suggest a critical involvement of the left PT in the perception of voices in external space that is not dependent on precise spatial location. Based on this, we suggest a model for the false perception of externally located auditory verbal hallucinations.
Park, Hee Kyung; Kim, Jae Seung; Im, Ki Chun; Kim, Mi Jung; Lee, Jae-Hong; Lee, Myoung C; Kim, Juhan; Chung, Sun Ju
Visual hallucination (VH) is a common psychotic symptom in patients with Parkinson's disease (PD) and may be a significant predictor of cognitive impairment (CI) in such patients. This study aimed to investigate the pattern of glucose metabolism of VH and the relationship between VH and CI in PD. We studied 28 PD patients, including 15 with VH (PD-VH) and 13 without VH (PD-NVH). Of the 15 PD-VH patients, 8 patients had cognitive impairment (PD-VHCI) whereas 7 did not (PD-VHNCI). All patients underwent [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) followed by statistical parametric mapping (SPM) analyses. Compared to the patients with PDNVH, PD-VHNCI patients showed glucose hypometabolism in the inferior and middle temporal cortices, fusiform gyri, and frontal areas, suggesting the involvement of the ventral visual pathway. Compared to the patients with PDNVH, PD-VHCI patients showed glucose hypometabolism in the temporoparietal association cortices with scattered frontal areas. Dysfunction of ventral visual pathway involving the temporal lobe may play a key role in VH development in PD patients. The evolving distribution from the ventral visual pathway to more extensive posterior cortices in PD-VHCI patients suggests that VH may be a prodromal symptom occurring prior to CI in PD patients.
Gadit, Amin A Muhammad
This report describes a 26-year-old man who was so emotionally attached to his mother that the mere thought of separating from her caused immense anxiety. The death of his mother after a brief illness resulted in prolonged bereavement. However, the patient started seeing and talking to his mother after her death, which led to huge improvement in his mood and social functioning. His wife brought him in for consultation but no obvious psychopathology was detected. This gave rise to the dilemma of whether to consider this a real psychopathology and treat it, or to disregard this reported hallucination. No active treatment is being given to this patient at the moment.
Barnes, J; Boubert, L
The occurrences of visual hallucinations seem to be more prevalent in low light and hallucinators tend to be more prone to false positive type errors in memory tasks. Here we investigated whether the richness of stimuli does indeed affect recognition differently in hallucinating and nonhallucinating participants, and if so whether this difference extends to identifying spatial context. We compared 36 Parkinson's disease (PD) patients with visual hallucinations, 32 Parkinson's patients without hallucinations, and 36 age-matched controls, on a visual memory task where color and black and white pictures were presented at different locations. Participants had to recognize the pictures among distracters along with the location of the stimulus. Findings revealed clear differences in performance between the groups. Both PD groups had impaired recognition compared to the controls, but those with hallucinations were significantly more impaired on black and white than on color stimuli. In addition, the group with hallucinations was significantly impaired compared to the other two groups on spatial memory. We suggest that not only do PD patients have poorer recognition of pictorial stimuli than controls, those who present with visual hallucinations appear to be more heavily reliant on bottom up sensory input and impaired on spatial ability.
Schultz, G; Needham, W; Taylor, R; Shindell, S; Melzack, R
Complex visual hallucinations are known to occur in individuals with impaired vision yet whose emotional and intellectual functions are within the normal range. These hallucinations, which were first reported by Charles Bonnet in 1760, have been described in many case studies, but have not been analyzed empirically to determine their major properties. In the present study, sixty complex hallucinators labeled as Charles Bonnet hallucinators were administered a questionnaire to determine the properties of their hallucinations. Combined use of multiple-correspondence analysis and hierarchical cluster analysis reveals a set of features that characterize the 'typical' Charles Bonnet hallucinatory experience: the hallucinators' experience occurs while they are alert and with the eyelids open; a sharply focused image appears suddenly, without any apparent trigger or voluntary control; the hallucination is present for seconds, does not move during this time, then suddenly vanishes. These features are discussed in terms of a 'dimension' of hallucinatory/perceptual experience, which ranges from discrete perceptual experiences to multiple, changing experiences. Possible mechanisms that underlie the Charles Bonnet hallucinations are discussed.
Pearson, Joel; Chiou, Rocco; Rogers, Sebastian; Wicken, Marcus; Heitmann, Stewart; Ermentrout, Bard
Hallucinations occur in both normal and clinical populations. Due to their unpredictability and complexity, the mechanisms underlying hallucinations remain largely untested. Here we show that visual hallucinations can be induced in the normal population by visual flicker, limited to an annulus that constricts content complexity to simple moving grey blobs, allowing objective mechanistic investigation. Hallucination strength peaked at ~11 Hz flicker and was dependent on cortical processing. Hallucinated motion speed increased with flicker rate, when mapped onto visual cortex it was independent of eccentricity, underwent local sensory adaptation and showed the same bistable and mnemonic dynamics as sensory perception. A neural field model with motion selectivity provides a mechanism for both hallucinations and perception. Our results demonstrate that hallucinations can be studied objectively, and they share multiple mechanisms with sensory perception. We anticipate that this assay will be critical to test theories of human consciousness and clinical models of hallucination. DOI: http://dx.doi.org/10.7554/eLife.17072.001 PMID:27726845
Background Hallucinations are prevalent in schizophrenia and related psychotic disorders and may have severe consequences for the affected patients. Antipsychotic drug trials that specifically address the anti-hallucinatory effectiveness of the respective drugs in representative samples are rare. The aims of the present study were to investigate the rate and severity of hallucinations in acutely admitted psychotic patients at hospital admission and discharge or after 6 weeks at the latest, if not discharged earlier (discharge/6 weeks); and to compare the anti-hallucinatory effectiveness of risperidone, olanzapine, quetiapine, and ziprasidone with up to 2 years’ follow-up. Methods Adult patients acutely admitted to an emergency ward for psychosis were consecutively randomized to risperidone, olanzapine, quetiapine, or ziprasidone and followed for up to 2 years in a pragmatic design. Participants were assessed repeatedly using the hallucinatory behavior item of the Positive and Negative Syndrome Scale (PANSS). Results A total of 226 patients, 30.5% of those assessed for eligibility, were randomized and 68% were hallucinating at baseline. This proportion was reduced to 33% at discharge/6 weeks. In the primary analyses based on intention to treat groups of patients experiencing frequent hallucinations, the quetiapine and ziprasidone groups both had faster decreases of the mean hallucination scores than the risperidone group. Conclusions Hallucinations are fairly responsive to antipsychotic drug treatment and differential anti-hallucinatory effectiveness may be found among existing antipsychotic drugs. If replicated, this could pave the way for a more targeted pharmacotherapy based on individual symptom profiles, rather than on the diagnostic category. Trial registration ClinicalTrials.gov ID; NCT00932529 PMID:24079855
Objectives: To describe the hallucinations occurring as a result of a macular hole in each eye and to investigate the neural basis. Methods: Psychophysical observations including sketches of the hallucinations calibrated for size. Results: All the hallucinations