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Li M, Lebois LAM, Ridgewell C, Palermo CA, Winternitz S, Liu H, Kaufman M, Shinn AK. Functional connectivity of the auditory cortex in women with trauma-related disorders who hear voices. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00167-8. [PMID: 38944384 DOI: 10.1016/j.bpsc.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/06/2024] [Accepted: 06/21/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND 'Voice-hearing' (VH) is a transdiagnostic experience that is common in trauma-related disorders (trauma-D). However, the neural substrates underlying trauma-related VH remain largely unexplored. While auditory perceptual dysfunction is among the abnormalities implicated in schizophrenia VH, whether VH in trauma-D also involves auditory perceptual alterations is unknown. METHODS We investigated auditory cortex (AC)-related functional connectivity (FC) in n=65 women with trauma-D related to childhood abuse with varying severities of VH. Using a novel, computationally-driven and individual-specific method of functionally parcellating the brain, we calculated the FC of two distinct AC subregions-Heschl's gyrus (HG, corresponding to primary AC) and lateral superior temporal gyrus (lSTG, in non-primary AC)- with both the cerebrum and cerebellum. We then measured the association between VH severity and FC using leave-one-out cross validation within the cerebrum, and voxel-wise multiple regression analyses in the cerebellum. RESULTS We found that VH severity positively correlated with left lSTG-frontoparietal network FC, while it negatively correlated with FC between left lSTG and both cerebral and cerebellar representations of the default mode network. VH severity was not predicted by FC of left HG or right AC subregions. CONCLUSIONS Our findings point to altered interactions between auditory perceptual processing and higher-level processes related to self-reference and executive functioning. This is the first study to show alterations in auditory cortical connectivity in trauma-related VH. While VH in trauma-D appears to be mediated by brain networks that are also implicated in schizophrenia VH, the results suggest a unique mechanism that could distinguish VH in trauma-D.
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Affiliation(s)
- Meiling Li
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China
| | - Lauren A M Lebois
- Depression and Anxiety Disorders Division, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Cori A Palermo
- Depression and Anxiety Disorders Division, McLean Hospital, Belmont, MA
| | - Sherry Winternitz
- Depression and Anxiety Disorders Division, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Hesheng Liu
- Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China
| | - Milissa Kaufman
- Depression and Anxiety Disorders Division, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Ann K Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
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Isaacson M, Hazell CM, Cape J, Hickson E, Islam F, Gill A, Simon K, Patel R, Souray J, Raune D. The cognitive-phenomenological assessment of delusions and hallucinations at the early intervention in psychosis service stage: The results of a quality improvement project. Early Interv Psychiatry 2022; 16:1345-1352. [PMID: 35338593 DOI: 10.1111/eip.13283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/11/2022] [Accepted: 03/13/2022] [Indexed: 01/15/2023]
Abstract
AIM Clinical assessments are vital for gaining an understanding of a patients' presenting problem. A priority for Early Intervention in Psychosis Service staff is understanding and supporting their patients' experiences of hallucinations and/or delusions. We aimed to identify what cognitive-phenomenology dimensions of hallucinations and delusions EIPS staff were assessing with their patients. METHODS We developed a brief checklist of cognitive-phenomenological dimensions of hallucinations and delusions called the Lived Experience Symptom Survey (LESS) based on relevant literature. As part of a Quality Improvement Project, we reviewed the health records of a sub-sample of EIPS patients using the LESS identifying whether each dimension was present or absent. RESULTS We found that all patients had been asked about the content of their hallucinations and/or delusions, and the majority had been asked about the valence of this content. Despite patients having experienced psychosis for almost 2 years on average, less than half of patients were asked about the potential or actual harm associated with these symptoms. All other cognitive-phenomenological dimensions were assessed inconsistently. CONCLUSIONS The assessment of hallucination and delusions in our EIPS was inconsistent and incomprehensive. These findings require replication in other EIPS' but may point to a need for guidelines and training around how to conduct a thorough assessment of hallucinations and delusions for current and future EIPS staff. Improved assessment of these symptoms will aid the development of risk assessments and treatment plans.
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Affiliation(s)
- Maria Isaacson
- Division of Psychology and Language Sciences, University College London, London, UK.,Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Cassie M Hazell
- Department of Psychology, University of Westminster, London, UK
| | - John Cape
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Emily Hickson
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Faaizah Islam
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Amber Gill
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Kathleen Simon
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Ruchit Patel
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
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Liang N, Liu S, Li X, Wen D, Li Q, Tong Y, Xu Y. A Decrease in Hemodynamic Response in the Right Postcentral Cortex Is Associated With Treatment-Resistant Auditory Verbal Hallucinations in Schizophrenia: An NIRS Study. Front Neurosci 2022; 16:865738. [PMID: 35692414 PMCID: PMC9177139 DOI: 10.3389/fnins.2022.865738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background Treatment-resistant auditory verbal hallucinations (TRAVHs) might cause an increased risk of violence, suicide, and hospitalization in patients with schizophrenia (SCZ). Although neuroimaging studies have identified the neural correlation to the symptom of AVH, functional brain activity that correlates particularly in patients with TRAVH remains limited. Functional near-infrared spectroscopy (fNIRS) is a portable and suitable measurement, particularly in exploring brain activation during related tasks. Hence, our researchers aimed to explore the differences in the cerebral hemodynamic function in SCZ-TRAVH, patients with schizophrenia without AVH (SCZ-nAVH), and healthy controls (HCs), to examine neural abnormalities associated more specifically with TRAVH. Methods A 52-channel functional near-infrared spectroscopy system was used to monitor hemodynamic changes in patients with SCZ-TRAVH (n = 38), patients with SCZ-nAVH (n = 35), and HC (n = 30) during a verbal fluency task (VFT). VFT performance, clinical history, and symptom severity were also noted. The original fNIRS data were analyzed using MATLAB to obtain the β values (the brain cortical activity response during the VFT task period); these were used to calculate Δβ (VFT β minus baseline β), which represents the degree of change in oxygenated hemoglobin caused by VFT task. Result Our results showed that there were significant differences in Δβ values among the three groups at 26 channels (ch4, ch13-15, 18, 22, ch25–29, 32, ch35–39, ch43–51, F = 1.70 to 19.10, p < 0.043, FDR-corrected) distributed over the prefrontal–temporal cortical regions. The further pairwise comparisons showed that the Δβ values of 24 channels (ch13–15, 18, 22, 25, ch26–29, ch35–39, ch43–49, ch50–51) were significantly lower in the SCZ group (SCZ-TRAVH and/or SCZ-nAVH) than in the HC group (p < 0.026, FDR-corrected). Additionally, the abnormal activation in the ch22 of right postcentral gyrus was correlated, in turn, with severity of TRAVH. Conclusion Our findings indicate that specific regions of the prefrontal cortex may be associated with TRAVH, which may have implications for early intervention for psychosis.
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Affiliation(s)
- Nana Liang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Wen
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qiqi Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yujie Tong
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Mental Health, Shanxi Medical University, Taiyuan, China
- *Correspondence: Yong Xu
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Zanello A, Dugré JR. Preliminary Evidence for Heterogeneity of Beliefs About Auditory Verbal Hallucinations Intent. J Nerv Ment Dis 2021; 209:872-878. [PMID: 34846355 DOI: 10.1097/nmd.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Perceptions of patient's auditory verbal hallucinations (AVHs), commonly termed voices, have important impacts on their everyday lives. Despite research emphasizing the consequences of malevolent voices, preliminary results suggest that beliefs about voices may not be mutually exclusive. As such, we aimed to characterize the heterogeneity of beliefs about AVHs and describe their clinical correlates. We recruited 78 patients referred to a Voices group therapy for refractory and distressing voices. Based on the Revised Beliefs About Voices Questionnaire, clustering analysis yielded four subgroups of patients with distinct pattern of beliefs about AVHs. These subgroups differed significantly in terms of affective disturbances, engagement, and resistance to their voices. Furthermore, no significant changes in beliefs about voices were observed after 6 weeks. Results of the current study suggest that the heterogeneity regarding the beliefs about AVHs should be targeted in treatment to reduce their associated negative outcomes.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Hwang M, Roh YS, Talero J, Cohen BM, Baker JT, Brady RO, Öngür D, Shinn AK. Auditory hallucinations across the psychosis spectrum: Evidence of dysconnectivity involving cerebellar and temporal lobe regions. Neuroimage Clin 2021; 32:102893. [PMID: 34911197 PMCID: PMC8636859 DOI: 10.1016/j.nicl.2021.102893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/29/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Auditory hallucinations (AH) are typically associated with schizophrenia (SZ), but they are also prevalent in bipolar disorder (BD). Despite the large body of research on the neural correlates of AH in SZ, the pathophysiology underlying AH remains unclear. Few studies have examined the neural substrates associated with propensity for AH in BD. Investigating AH across the psychosis spectrum has the potential to inform about the neural signature associated with the trait of AH, irrespective of psychiatric diagnosis. METHODS We compared resting state functional magnetic resonance imaging data in psychosis patients with (n = 90 AH; 68 SZ, 22 BD) and without (n = 55 NAH; 16 SZ, 39 BD) lifetime AH. We performed region of interest (ROI)-to-ROI functional connectivity (FC) analysis using 91 cortical, 15 subcortical, and 26 cerebellar atlas-defined regions. The primary aim was to identify FC differences between patients with and without lifetime AH. We secondarily examined differences between AH and NAH within each diagnosis. RESULTS Compared to the NAH group, patients with AH showed higher FC between cerebellum and frontal (left precentral gyrus), temporal [right middle temporal gyrus (MTG), left inferior temporal gyrus (ITG), left temporal fusiform gyrus)], parietal (bilateral superior parietal lobules), and subcortical (left accumbens, left palldium) brain areas. AH also showed lower FC between temporal lobe regions (between right ITG and right MTG and bilateral superior temporal gyri) relative to NAH. CONCLUSIONS Our findings suggest that dysconnectivity involving the cerebellum and temporal lobe regions may be common neurofunctional elements associated with AH propensity across the psychosis spectrum. We also found dysconnectivity patterns that were unique to lifetime AH within SZ or bipolar psychosis, suggesting both common and distinct mechanisms underlying AH pathophysiology in these disorders.
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Affiliation(s)
- Melissa Hwang
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
| | - Youkyung S Roh
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
| | - Jessica Talero
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
| | - Bruce M Cohen
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Justin T Baker
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Roscoe O Brady
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Dost Öngür
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Ann K Shinn
- Schizophrenia and Bipolar Disorder Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
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Chan HW, Huang CY, Yen YC. Clinical outcomes of paliperidone long-acting injection in patients with schizophrenia: a 1-year retrospective cohort study. BMC Psychiatry 2021; 21:507. [PMID: 34654391 PMCID: PMC8518212 DOI: 10.1186/s12888-021-03513-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Schizophrenia is a severe psychiatric disorder. Poor medical adherence increases relapse rate. Long-acting injection of antipsychotic agent is developed for improving medical adherence. In this study, we examined the effect of paliperidone long-acting injection (PLAI) treatment in patients with schizophrenia in a real-world setting. METHODS In this retrospective cohort study, 467 patients with schizophrenia were enrolled, treated with risperidone PLAI or oral antipsychotics, and followed for 1 year. Concomitant medication, namely anticonvulsants, antidepressants, anxiolytics, sedatives or hypnotics, anticholinergics, and beta-blockers, were administered. Patients were classified into 2 groups: the LAI group (patients received LAI for treatment) and the NLAI group (patients taking only oral antipsychotics). The incidence of hospitalization, the length of hospitalization, and the incidence of emergency room visits were assessed. RESULTS The LAI group had a higher incidence of psychiatric acute ward admission (NLAI group = 4.8%; LAI = 30.3%) and emergency room visits (NLAI group = 7.3%; LAI group = 36.0%) before enrolment. During the one-year follow-up, the incidence of acute ward admission and emergency room visit did not differ in the NLAI group (P = .586 and .241) compared with before enrolment, whereas both incidences were significantly decreased in the LAI group (P < .0001 in both of them). CONCLUSIONS PLAI reduces the incidence of admission and emergency room visits.
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Affiliation(s)
- Hsue-Wei Chan
- grid.414686.90000 0004 1797 2180Department of Psychiatry, E-Da Hospital, 1 Yi-Da Road, Yan-Chau District, Kaohsiung, 824 Taiwan
| | - Chin-Yu Huang
- grid.414686.90000 0004 1797 2180Department of Psychiatry, E-Da Hospital, 1 Yi-Da Road, Yan-Chau District, Kaohsiung, 824 Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, 1 Yi-Da Road, Yan-Chau District, Kaohsiung, 824, Taiwan. .,School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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The Vision of Blindness-Sight Versus Insight: A Case Report and Literature Review of Self-enucleation (Oedipism). J Psychiatr Pract 2021; 27:333-337. [PMID: 34398585 DOI: 10.1097/pra.0000000000000558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Self-enucleation or "Oedipism" is a rare ophthalmic and psychiatric emergency. Given the severity of its consequences, it requires proper medical management and that clinicians understand and be aware of the psychiatric presentation. Important clinical considerations include identification of various etiologies leading to self-enucleation, awareness of possible complications, and provision of appropriate care. We present a case of bilateral self-enucleation by a young male patient in the context of his first episode of psychosis and review the literature on this clinical entity. Ocular damage interferes significantly with activities of daily living and is associated with decreased quality of life so that identifying risk factors is of major importance to prevent this dangerous behavior.
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Zhuo C, Fang T, Chen C, Chen M, Sun Y, Ma X, Li R, Tian H, Ping J. Brain imaging features in schizophrenia with co-occurring auditory verbal hallucinations and depressive symptoms-Implication for novel therapeutic strategies to alleviate the reciprocal deterioration. Brain Behav 2021; 11:e01991. [PMID: 33305913 PMCID: PMC7882177 DOI: 10.1002/brb3.1991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) and depressive symptoms are highly prevalent in schizophrenia, and recent progress has been made in understanding the reciprocal deterioration of both symptoms through structural and functional brain imaging studies. To date, there is limited literature on this topic. In this review, we synthesized the recent literature on the neuroimaging features of schizophrenia patients with concurrent AVHs and depressive symptoms. METHODS A literature search was conducted with the major databases using the keywords, mainly including schizophrenia, AVHs, depression, neuropsychiatric disorders, brain imaging, and magnetic resonance imaging. RESULTS The existing studies have shown that AVHs and depressive symptoms reciprocally deteriorate in patients with schizophrenia, which has challenged the conventional treatment of the disease. Interestingly, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) therapies have emerged as two efficacious brain stimulation treatments that can normalize the brain regions associated with the symptoms, as shown through functional and structural brain imaging studies. In light of these important findings, there is an urgent need to conduct in-depth neuronal mechanistic studies to identify targets for stimulation therapy. CONCLUSIONS These new findings may elucidate the pathological mechanisms underlying schizophrenia with concurrent AVHs and depressive symptoms. Furthermore, this review has important clinical implications for developing novel therapeutic strategies to alleviate the reciprocal deterioration AVHs and depressive symptoms of schizophrenia patients.
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Affiliation(s)
- Chuanjun Zhuo
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab)Tianjin Fourth Center HospitalTianjin Medical Affiliated Tianjin Fourth Central HospitalNankai University Affiliated Tianjin Fourth Center HospitalTianjinChina
- Department of PsychiatryWenzhou Seventh People’s HospitalWenzhouChina
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Tao Fang
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab)Tianjin Fourth Center HospitalTianjin Medical Affiliated Tianjin Fourth Central HospitalNankai University Affiliated Tianjin Fourth Center HospitalTianjinChina
| | - Ce Chen
- Department of PsychiatryWenzhou Seventh People’s HospitalWenzhouChina
| | - Min Chen
- Department of PsychiatrySchool of Mental HealthyJining Medical UniversityJiningChina
| | - Yun Sun
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Xiaoyan Ma
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Ranli Li
- Psychiatric‐Neuroimaging‐Genetics‐Comorbidity (PNGC) LaboratoryTianjin Mental Health CenterTianjin Anding HospitalNankai University Affiliated Anding HospitalTianjinChina
| | - Hongjun Tian
- Key Laboratory of Real Time Brain Circuits Tracing of Neurology and Psychiatry (RTBNB_Lab)Tianjin Fourth Center HospitalTianjin Medical Affiliated Tianjin Fourth Central HospitalNankai University Affiliated Tianjin Fourth Center HospitalTianjinChina
| | - Jing Ping
- Department of PsychiatryWenzhou Seventh People’s HospitalWenzhouChina
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Dugré JR, West ML. Disentangling compliance with command hallucinations: Heterogeneity of voice intents and their clinical correlates. Schizophr Res 2019; 212:33-39. [PMID: 31451299 DOI: 10.1016/j.schres.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/10/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Earlier studies suggested that perceptions of voice intents (benevolence, malevolence) are associated with different psychological and behavioral responses including compliance with command hallucinations (CH). However, to our knowledge, no studies have examined the clinical differences between subgroups of clients with different perceptions of the intents of their CH. In order to better understand the risk for compliance with CH, our objectives were 1) to compare sociodemographic and clinical profiles of subgroups of clients (based on perceptions of CH intents); and 2) to investigate their specific associated risk factors for compliance with CH. METHOD We analyzed the MacArthur Violence Risk Assessment Study, focusing on 181 participants with psychosis reporting CH. Group comparisons and within-group ordinal logistic regression analyses were performed using sociodemographic and clinical measures such as the BPRS, BIS-11 and NAS-PI. RESULTS Of the 181 participants, 102 (56.4%) reported having only malevolent voices, 14 (7.7%) rated them as benevolent only, 58 (32.03%) as benevolent and malevolent, and only 7 (3.86%) as neutral only. Results showed that individuals with malevolent voices had more emotional disturbance while those with benevolent CH had more severe positive psychotic symptoms and were more certain that they would comply in the future. Moreover, childhood physical abuse, belief about having to obey as well as psychotic symptoms significantly predict compliance with malevolent CH in a multivariate model. CONCLUSIONS Our results suggest that researchers and clinicians should consider perceptions of voice intents when both assessing risk of compliance with CH and developing relevant intervention targets.
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Affiliation(s)
- Jules R Dugré
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, H1N 3V2, Canada; Department of Psychiatry, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, Montreal H3T 1J4, Canada.
| | - Michelle L West
- CEDAR Clinic and Research Program, Boston, United States; Public Psychiatry Division of Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA 02115, United States
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