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Stephane M, Dzemidzic M, Yoon G. Altered corollary discharge in the auditory cortex could reflect louder inner voice experience in patients with verbal hallucinations, a pilot fMRI study. Schizophr Res 2024; 265:14-19. [PMID: 38448353 DOI: 10.1016/j.schres.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Wide range of evidence associates auditory verbal hallucinations (AVH) with frontotemporal corollary discharge deficit. AVH likely reflect altered experiences of the inner voice and are phenomenologically diverse. The aspects of hallucinations (and related inner voice experiences) that could be explained by this deficit remain unclear. To address this important subject, we examined the temporal cortex activity during two tasks with and without corollary discharge. METHODS We carried out an event-related BOLD fMRI study to examine temporal cortex activity in seven patients and eight healthy controls during two tasks with and without corollary discharge: reading aloud and hearing, respectively. Data were denoised by removing independent components related to head movement and subsequently processed using finite impulse response basis function to address hemodynamic response variations. To mitigate the small sample size, final analyses were carried out using permutation-based analysis of variance. RESULTS There was a significant group interaction in the Read relative to Hear condition during the early post-stimulus stage in the left Heschl's Gyrus (p<0.01, corrected for multiple comparisons, at peak voxel [-72,53,41]). This effect was driven by a higher activity in the Read relative to the Hear condition in the same area in the patients (p<0.02, corrected). CONCLUSIONS Our results are consistent with prior literature indicating abnormal frontotemporal disconnection in participants with hallucinations. The functional repercussions of this deficit were limited to the primary auditory cortex in early post-stimulus stage, which suggests louder experience of the inner voice in patients and could account for the loudness of their hallucinations.
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Affiliation(s)
- Massoud Stephane
- Department of Psychiatry and Behavioral Sciences, Oregon Health and Science University, and the Portland VA Health Care System, Portland, OR, USA.
| | - Mario Dzemidzic
- Department of Neurology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Gihyun Yoon
- Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
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2
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Kubera KM, Rashidi M, Schmitgen MM, Barth A, Hirjak D, Otte ML, Sambataro F, Calhoun VD, Wolf RC. Functional network interactions in patients with schizophrenia with persistent auditory verbal hallucinations: A multimodal MRI fusion approach using three-way pICA. Schizophr Res 2024; 265:20-29. [PMID: 37024417 DOI: 10.1016/j.schres.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/18/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Abstract
Over the last decade, there have been an increasing number of functional magnetic resonance imaging (fMRI) studies examining brain activity in schizophrenia (SZ) patients with persistent auditory verbal hallucinations (AVH) using either task-based or resting-state fMRI (rs-fMRI) paradigms. Such data have been conventionally collected and analyzed as distinct modalities, disregarding putative crossmodal interactions. Recently, it has become possible to incorporate two or more modalities in one comprehensive analysis to uncover hidden patterns of neural dysfunction not sufficiently captured by separate analysis. A novel multivariate fusion approach to multimodal data analysis, i.e., parallel independent component analysis (pICA), has been previously shown to be a powerful tool in this regard. We utilized three-way pICA to study covarying components among fractional amplitude of low-frequency fluctuations (fALFF) for rs-MRI and task-based activation computed from an alertness and a working memory (WM) paradigm of 15 SZ patients with AVH, 16 non-hallucinating SZ patients (nAVH), and 19 healthy controls (HC). The strongest connected triplet (false discovery rate (FDR)-corrected pairwise correlations) comprised a frontostriatal/temporal network (fALFF), a temporal/sensorimotor network (alertness task), and a frontoparietal network (WM task). Frontoparietal and frontostriatal/temporal network strength significantly differed between AVH patients and HC. Phenomenological features such as omnipotence and malevolence of AVH were associated with temporal/sensorimotor and frontoparietal network strength. The transmodal data confirm a complex interplay of neural systems subserving attentional processes and cognitive control interacting with speech and language processing networks. In addition, the data emphasize the importance of sensorimotor regions modulating specific symptom dimensions of AVH.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mahmoud Rashidi
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mike M Schmitgen
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marie-Luise Otte
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padua, Padua, Italy; Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany.
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Smyth E, Steel C, Ellett L. The prevalence of non-affective psychosis in refugee populations: A systematic review. Schizophr Res 2023; 260:99-112. [PMID: 37634388 DOI: 10.1016/j.schres.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 06/27/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND As we face the largest refugee crisis since World War Two, research is increasingly examining the impact of forced displacement. The risk of non-affective psychosis in refugees is evidenced to be significantly greater than non-refugees, and the role of pre-, peri- and post-migratory trauma and dissociation is increasingly implicated. AIMS To determine the prevalence of non-affective psychosis in refugee populations. METHOD PRISMA guidelines were followed. Three key databases (PubMed, PsychINFO and Web of Science), Google scholar and study references were searched. The full-text of 62 studies were screened and 23 studies were eligible for inclusion. A narrative synthesis was undertaken and the Quality Assessment Tool for Quantitative Studies was used to assess methodological quality. (PROSPERO registration CRD42019152170). RESULTS The results were widely heterogeneous. The combined weighted average prevalence of non-affective psychosis in refugee populations was 0.9 %. Psychosis prevalence for individual psychotic symptoms was 28.4 %; 0.5 % for schizophrenia; 1.0 % for psychosis; 0.6 % for mixed psychotic disorders and 2.9 % for psychotic episodes. CONCLUSIONS Variations in examined populations, diagnostic and prevalence classifications, and study designs and methodologies likely contributed to heterogeneity across the data. The findings highlight a greater need to provide more specialist mental health services and trauma-focused interventions, as well as transculturally sensitive assessment and treatment to address refugee vulnerability to psychosis. Future research should examine psychosis prevalence longitudinally and in refugees-only, address methodological bias and further examine the role of trauma and dissociation in refugee psychosis prevalence.
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Affiliation(s)
- Emily Smyth
- Psychology Department, Royal Holloway, University of London, Egham Hill, Egham TW20 0EX, UK.
| | - Craig Steel
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, University of Oxford, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Lyn Ellett
- School of Psychology, University of Southampton, UK.
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4
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Yehya A, Khaled SM, Sommer IEC, Elhag SF, Hassan MHMO, Woodruff P, Alabdalla M. The Arabic Questionnaire for Psychotic Experiences in patients with psychotic disorders: a clinical validation. BMC Psychiatry 2023; 23:141. [PMID: 36882727 PMCID: PMC9990290 DOI: 10.1186/s12888-023-04649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Psychotic experiences are reported in the general population. The Questionnaire for Psychotic Experiences (QPE) was created to test the phenomenological features of these experiences and compare them with those reported in patients with psychiatric and other medical conditions. The aim of this study was to test the psychometric properties of the Arabic version of the QPE. METHODS We recruited 50 patients with psychotic disorders from the Hamad Medical Hospital in Doha, Qatar. Patients underwent assessment over three sessions with trained interviewees using the Arabic versions of QPE, Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI), and the Global Assessment of Functioning Scale (GAF). Patients were also reassessed using the QPE and GAF after 14-days from the initial assessment in order to test for the stability of the scale. In this respect, this is the first study that assesses the test-retest reliability of the QPE. The psychometric properties including convergent validity, stability, and internal consistency met the benchmarked criteria. RESULTS Results confirmed that the Arabic version of QPE accurately measured the experiences of patients that were also reported using the PANSS, an internationally accepted, well-established scale for measuring psychotic symptom severity. CONCLUSION We propose the use of the QPE to describe the phenomenology of PEs across modalities in Arabic speaking communities.
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Affiliation(s)
- Arij Yehya
- Core Curriculum Program, Deanship of General Studies, Qatar University, P.O. Box 2713, Doha, Qatar.
| | - Salma M Khaled
- Social & Economic Survey Research Institute (SESRI), Qatar University, Doha, Qatar
| | - Iris E C Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Saba F Elhag
- Social & Economic Survey Research Institute (SESRI), Qatar University, Doha, Qatar
| | | | - Peter Woodruff
- Psychiatry Department, Hamad Medical Corporation, Doha, Qatar.,Department of Neuroscience, School of Medicine, University of Sheffield, Sheffield, UK
| | - Majid Alabdalla
- Psychiatry Department, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
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5
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Marschall TM, Koops S, Brederoo SG, Cabral J, Ćurčić-Blake B, Sommer IEC. Time varying dynamics of hallucinations in clinical and non-clinical voice-hearers. Neuroimage Clin 2023; 37:103351. [PMID: 36805417 PMCID: PMC9969260 DOI: 10.1016/j.nicl.2023.103351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Auditory verbal hallucinations (AVH) are frequently associated with psychotic disorders, yet also occur in non-clinical voice-hearers. AVH in this group are similar to those within clinical voice-hearers in terms of several phenomenological aspects, but non-clinical voice-hearers report to have more control over their AVH and attribute less emotional valence to them. These dissimilarities may stem from differences on the neurobiological level, as it is still under debate whether the mechanisms involved in AVH are the same in clinical and non-clinical voice-hearers. In this study, 21 clinical and 21 non-clinical voice-hearers indicated the onset and offsets of AVH during an fMRI scan. Using a method called leading eigenvector dynamics analysis (LEiDA), we examined time-varying dynamics of functional connectivity involved in AVH with a sub-second temporal resolution. We assessed differences between groups, and between hallucination and rest periods in dwell time, switching frequency, probability of occurrence, and transition probabilities of nine recurrent states of functional connectivity with a permutation ANOVA. Deviations in dwell times, switching frequencies, and switch probabilities in the hallucination period indicated more erratic dynamics during this condition regardless of their clinical status. Post-hoc analyses of the dwell times exhibited the most distinct differences between the rest and hallucination condition for the non-clinical sample, suggesting stronger differences between the two conditions in this group. Overall, these findings suggest that the neurobiological mechanisms involved in AVH are similar in clinical and non-clinical individuals.
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Affiliation(s)
- Theresa M Marschall
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
| | - Sanne Koops
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne G Brederoo
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Joana Cabral
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Branislava Ćurčić-Blake
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Iris E C Sommer
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Brewin CR, Phillips K, Morton J, Mason AJC, Saunders R, Longden E. Multiplicity in the experience of voice-hearing: A phenomenological inquiry. J Psychiatr Res 2022; 156:564-569. [PMID: 36368246 DOI: 10.1016/j.jpsychires.2022.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
Although it is recognized that voice-hearers often report a large number and variety of voices there have been few investigations of this multiplicity. Understanding the phenomenology of voice-hearing can provide a firm foundation for theorizing about its causes. In this international online survey of voice-hearers, details were elicited of the content of up to five utterances associated with up to five voices from each respondent. The contents were independently rated and associated with characteristics of each voice such as its perceived age, whether it had changed over time, and whether it was of a familiar person. We investigated predictors (e.g., diagnoses, voice gender, age first heard) of utterance negativity, length, and whether voices referred to themselves. The average number of voices reported was approximately four. The majority were perceived as male and had negative content. Child-aged voices were significantly less negative than all other voices except those perceived as being elderly. Multi-level analyses indicated that there was significant variability at the level of different utterances within voices but variability was more prominent at the level of different voices within an individual. The data were inconsistent with general cognitive models for hearing voices such as the misattribution of inner speech and were more congruent with a dissociation model of voice-hearing. Our findings support approaches based on subtype or dimensional methods of classifying voices, and additionally indicate that research and clinical assessment may benefit from more systematic assessment of multiplicity.
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Affiliation(s)
| | | | | | | | | | - Eleanor Longden
- Greater Manchester Mental Health NHS Foundation Trust, University of Manchester, UK
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7
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Lorente-Rovira E, Grasa E, Ochoa S, Corripio I, Peláez T, López-Carrilero R, Gutiérrez-Gea Á, Morano-Guillén M, Villagrán JM, Bartels-Velthuis AA, Jenner JA, Sanjuán J. Different measures for auditory hallucinations in populations with psychosis. The Validation of the Spanish versions of the Auditory Vocal Hallucination Rating Scale (AVHRS) and the Positive and Useful Voices Inquiry (PUVI). REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:259-271. [PMID: 36513402 DOI: 10.1016/j.rpsmen.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION An updated summary of the most used instruments assessing auditory hallucinations in population with psychosis, allows us to underline the scarceness and need of Spanish versions of important instruments. The aim of the study is to examine the psychometric characteristics of two different and complementary instruments for assessing auditory hallucinations, the Spanish version of the Auditory Vocal Hallucination Scale (AVHRS) and the Spanish version of the Positive and Useful Voices Inquiry (PUVI). MATERIALS AND METHODS A sample of 68 patients from four different centres, with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder presenting with auditory hallucinations were included. Apart from the AVHRS and the PUVI, the Psychotic Symptom Rating Scales-Auditory Hallucinations subscale (PSYRATS-AH) and the Positive and Negative Syndrome Scale (PANSS) were also administered to all patients, plus an acceptability questionnaire. RESULTS The Spanish version of the AVHRS showed a good internal consistency, a moderate to high inter-rater reliability, a medium to moderate test-retest reliability, and a good convergent and discriminant validity. The Spanish version of the PUVI showed a good internal consistency and a heterogeneous, but in general moderate, test-retest reliability. CONCLUSIONS The Spanish versions of the AVHRS and the PUVI have good psychometric properties and are well accepted among patients.
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Affiliation(s)
- Esther Lorente-Rovira
- Hospital Clínico, Valencia, Spain; INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain.
| | - Eva Grasa
- CIBERSAM, Madrid, Spain; Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU, Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Madrid, Spain
| | - Iluminada Corripio
- CIBERSAM, Madrid, Spain; Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU, Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Spain
| | - Trinidad Peláez
- CIBERSAM, Madrid, Spain; Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | | | | | - José M Villagrán
- Hospital Jerez de la Frontera, Servicio Andaluz de Salud, Cádiz, Spain
| | - Agna A Bartels-Velthuis
- University of Groningen, the Netherlands; University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Jack A Jenner
- Jenner Consult, Haren, the Netherlands Groningen, the Netherlands
| | - Julio Sanjuán
- Hospital Clínico, Valencia, Spain; INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain; Faculty of Medicine, Valencia, Spain
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Cook CCH, Powell A, Alderson-Day B, Woods A. Hearing spiritually significant voices: A phenomenological survey and taxonomy. MEDICAL HUMANITIES 2022; 48:273-284. [PMID: 33288684 PMCID: PMC9411900 DOI: 10.1136/medhum-2020-012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 05/05/2023]
Abstract
Whereas previous research in the medical humanities has tended to neglect theology and religious studies, these disciplines sometimes have a very important contribution to make. The hearing of spiritually significant voices provides a case in point. The context, content and identity of these voices, all of which have typically not been seen as important in the assessment of auditory-verbal hallucinations (AVHs) within psychiatry, are key to understanding their spiritual significance. A taxonomy of spiritually significant voices is proposed, which takes into account frequency, context, affect and identity of the voice. In a predominantly Christian sample of 58 people who reported having heard spiritually significant voices, most began in adult life and were infrequent experiences. Almost 90% reported that the voice was divine in identity and approximately one-third were heard in the context of prayer. The phenomenological characteristics of these voices were different from those in previous studies of voice hearing (AVHs). Most comprised a single voice; half were auditory; and a quarter were more thought-like (the rest being a mixture). Only half were characterful, and one-third included commands or prompts. The voices were experienced positively and as meaningful. The survey has implications for both clinical and pastoral work. The phenomenology of spiritually significant voices may be confused with that of psychopathology, thus potentially leading to misdiagnosis of normal religious experiences. The finding of meaning in content and context may be important in voice hearing more widely, and especially in coping with negative or distressing voices.
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Affiliation(s)
| | - Adam Powell
- Theology and Religion, Durham University, Durham, UK
| | | | - Angela Woods
- Institute for Medical Humanities, Durham University, Durham, UK
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Dellazizzo L, Giguère S, Léveillé N, Potvin S, Dumais A. A systematic review of relational-based therapies for the treatment of auditory hallucinations in patients with psychotic disorders. Psychol Med 2022; 52:2001-2008. [PMID: 35855651 PMCID: PMC9386435 DOI: 10.1017/s003329172200143x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Auditory hallucinations in patients with psychotic disorders may be very distressing. Unfortunately, a large proportion of individuals are resistant to pharmacological interventions and the gold-standard cognitive-behavioral therapy for psychosis offers at best modest effects. To improve therapeutic outcomes, several therapies have been created to establish a relationship between voice-hearers and their voices. With increasing literature, we conducted a systematic review of dialogical therapies and examined the evidence behind their efficacy. METHODS A systematic search was performed in PubMed, PsycINFO, Web of Science, and Google Scholar. Articles were included if they discussed the effects of dialogical interventions for patients with psychotic disorders. RESULTS A total of 17 studies were included within this systematic review. Cumulative evidence from various therapies has shown that entering in a dialog with voices is beneficial to patients, even those who are resistant to current pharmacological treatments. Heightened benefits have been mainly observed with Relating Therapy and Avatar Therapy/Virtual Reality assisted Therapy, with evidence generally of moderate quality. Both these interventions have shown large to very large effects on voices and voice-related distress as well as moderate to large magnitude improvements on affective symptoms. Though, cognitive-behavioral therapy for command hallucinations and making sense of voices noted no improvements on voices. CONCLUSIONS Literature on relational-based interventions with a strong emphasis on the relational aspects of voice hearing has shown positive effects. Results suggest that these dialogical therapies might surpass the efficacy of current gold-standard approaches.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Nayla Léveillé
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
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Dudley R, Dodgson G, Common S, O'Grady L, Watson F, Gibbs C, Arnott B, Fernyhough C, Alderson-Day B, Ogundimu E, Kharatikoopaei E, Patton V, Aynsworth C. Managing Unusual Sensory Experiences in People with First-Episode Psychosis (MUSE FEP): a study protocol for a single-blind parallel-group randomised controlled feasibility trial. BMJ Open 2022; 12:e061827. [PMID: 35577470 PMCID: PMC9114953 DOI: 10.1136/bmjopen-2022-061827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Hallucinations (hearing or seeing things that others do not) are a common feature of psychosis, causing significant distress and disability. Existing treatments such as cognitive-behavioural therapy for psychosis (CBTp) have modest benefits, and there is a lack of CBTp-trained staff. Shorter, targeted treatments that focus on specific symptoms delivered by a non-specialist workforce could substantially increase access to treatment.Managing Unusual Sensory Experiences (MUSE) explains why people have hallucinations and helps the person to develop and use coping strategies to reduce distress. MUSE focuses only on hallucinations, and treatment is short (four to six, 1-hour sessions per week). It is a digital intervention, run on National Health Service (NHS) laptops, which provides information about hallucinations in an engaging way, using audio, video and animated content. Crucially, it is designed for use by non-specialist staff like community psychiatric nurses. METHODS AND ANALYSIS The study is a two-arm feasibility randomised controlled trial comparing MUSE and treatment as usual (TAU) (n=40) to TAU alone (n=40), recruiting across two NHS Trusts, using 1:1 allocation and blind assessments before and after treatment (2 months) and at follow-up (3 months). Quantitative information on recruitment rates, adherence and completion of outcome assessments will be collected. Qualitative interviews will capture service users' experience of therapy and clinicians' experiences of the training and supervision in MUSE. Clinicians will also be asked about factors affecting uptake, adherence and facilitators/barriers to implementation. Analyses will focus on feasibility outcomes and provide initial estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the training, intervention and trial procedures. ETHICS AND DISSEMINATION The trial has received NHS Ethical and Health Research Authority approval. Findings will be disseminated directly to participants and services, as well as through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN16793301.
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Affiliation(s)
- Robert Dudley
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
- Early Intervention in Psychosis service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Guy Dodgson
- Early Intervention in Psychosis service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Stephanie Common
- Early Intervention in Psychosis, Tees Esk and Wear Valley NHS Foundation Trust, Darlington, UK
| | - Lucy O'Grady
- Early Intervention in Psychosis service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Florence Watson
- Research and Development, Tees Esk and Wear Valley NHS Foundation Trust, Darlington, UK
| | - Christopher Gibbs
- Early Intervention in Psychosis service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Bronia Arnott
- Newcastle University Population Health Sciences Institute, Newcastle upon Tyne, UK
| | | | | | - Emmanuel Ogundimu
- Department of Mathematical Sciences, Univeristy of Durham, Durham, UK
| | | | | | - Charlotte Aynsworth
- Early Intervention in Psychosis service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
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Strachan LP, Paulik G, McEvoy PM. A narrative review of psychological theories of post-traumatic stress disorder, voice hearing, and other psychotic symptoms. Clin Psychol Psychother 2022; 29:1791-1811. [PMID: 35578567 PMCID: PMC10084244 DOI: 10.1002/cpp.2754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most voice hearers report childhood trauma. Many voice hearers report comorbid post-traumatic stress symptoms and that the content of their voices (auditory verbal hallucinations) is directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. The factors that maintain trauma-related voices are unknown, and there is limited research in this area. This study aimed to identify potential maintaining factors of trauma-related voices by reviewing models of post-traumatic stress disorder (PTSD) and positive symptoms of psychosis. METHOD Models of PTSD and positive symptoms were reviewed to identify potential factors that are unique and common to both sets of symptoms. RESULTS We reviewed 10 models of PTSD, 4 models of positive symptoms, and 2 trauma-informed models of voice hearing. One model provided a theoretical explanation of different types of trauma-related voices. Twenty-one factors were extracted from 16 theoretical models. No existing model incorporated all these factors. DISCUSSION Existing PTSD and positive symptom models present a range of common and unique factors. There may be value in extending existing integrative models to include a broader range of potential factors that could explain different pathways to, and expressions of, trauma-related voices. A future research agenda is presented to investigate how such an extension could lead to more complete individualized case formulations and targeted treatments.
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Affiliation(s)
- Laura P Strachan
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia.,Perth Voices Clinic, Murdoch, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- School of Population Health, Curtin University, Perth, Western Australia, Australia.,enAble Institute, Curtin University, Perth, Western Australia, Australia.,Centre for Clinical Interventions, Perth, Western Australia, Australia
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12
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Stephane M, Dzemidzic M, Yoon G. Altered corollary discharge in the auditory cortex could reflect louder inner voice experience in patients with verbal hallucinations, a pilot fMRI study. Schizophr Res 2022; 243:475-480. [PMID: 35277315 DOI: 10.1016/j.schres.2022.02.007] [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: 10/19/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Wide range of evidence associates auditory verbal hallucinations (AVH) with frontotemporal corollary discharge deficit. AVH likely reflect altered experiences of the inner voice and are phenomenologically diverse. The aspects of hallucinations (and related inner voice experiences) that could be explained by this deficit remain unclear. To address this important subject, we examined the temporal cortex activity during two tasks with and without corollary discharge. METHODS We carried out an event-related BOLD fMRI study to examine temporal cortex activity in seven patients and eight healthy controls during two tasks with and without corollary discharge: reading aloud and hearing, respectively. Data were denoised by removing independent components related to head movement and subsequently processed using finite impulse response basis function to address hemodynamic response variations. To mitigate the small sample size, final analyses were carried out using permutation-based analysis of variance. RESULTS There was a significant group interaction in the Read relative to Hear condition during the early post-stimulus stage in the left Heschl's Gyrus (p < 0.01, corrected for multiple comparisons, at peak voxel [-72,53,41]). This effect was driven by a higher activity in the Read relative to the Hear condition in the same area in the patients (p < 0.02, corrected). CONCLUSIONS Our results are consistent with prior literature indicating abnormal frontotemporal disconnection in participants with hallucinations. The functional repercussions of this deficit were limited to the primary auditory cortex in early post-stimulus stage, which suggests louder experience of the inner voice in patients and could account for the loudness of their hallucinations.
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Affiliation(s)
- Massoud Stephane
- Department of Psychiatry and Behavioral Sciences, Oregon Health and Science University, and the Portland VA Health Care System, Portland, OR, USA.
| | - Mario Dzemidzic
- Department of Neurology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Gihyun Yoon
- Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
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13
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Corona-Hernández H, Brederoo SG, de Boer JN, Sommer IEC. A data-driven linguistic characterization of hallucinated voices in clinical and non-clinical voice-hearers. Schizophr Res 2022; 241:210-217. [PMID: 35151122 DOI: 10.1016/j.schres.2022.01.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) are heterogeneous regarding phenomenology and etiology. This has led to the proposal of AVHs subtypes. Distinguishing AVHs subtypes can inform AVHs neurocognitive models and also have implications for clinical practice. A scarcely studied source of heterogeneity relates to the AVHs linguistic characteristics. Therefore, in this study we investigate whether linguistic features distinguish AVHs subtypes, and whether linguistic AVH-subtypes are associated with phenomenology and voice-hearers' clinical status. METHODS Twenty-one clinical and nineteen non-clinical voice-hearers participated in this study. Participants were instructed to repeat verbatim their AVHs just after experiencing them. AVH-repetitions were audio-recorded and transcribed. AVHs phenomenology was assessed using the Auditory Hallucinations Rating Scale of the Psychotic Symptom Rating Scales. Hierarchical clustering analyses without a priori group dichotomization were performed using quantitative measures of sixteen linguistic features to distinguish sets of AVHs. RESULTS A two-AVHs-cluster solution best partitioned the data. AVHs-clusters significantly differed in linguistic features (p < .001); AVHs phenomenology (p < .001); and distribution of clinical voice-hearers (p < .001). The "expanded-AVHs" cluster was characterized by more determiners, more prepositions, longer utterances (all p < .01), and mainly contained non-clinical voice-hearers. The "compact-AVHs" cluster had fewer determiners and prepositions, shorter utterances (all p < .01), more negative content, higher degree of negativity (both p < .05), and predominantly came from clinical voice-hearers. DISCUSSION Two voice-speech clusters were recognized, differing in syntactic-grammatical complexity and negative phenomenology. Our results suggest clinical voice-hearers often hear negative, "compact-voices", understandable under Broca's right hemisphere homologue and memory-based mechanisms. Conversely, non-clinical voice-hearers experience "expanded-voices", better accounted by inner speech AVHs models.
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Affiliation(s)
- H Corona-Hernández
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - S G Brederoo
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, the Netherlands
| | - J N de Boer
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Psychiatry, University Medical Center Utrecht, Utrecht University & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - I E C Sommer
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, the Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, the Netherlands
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14
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Hardy A, O'Driscoll C, Steel C, van der Gaag M, van den Berg D. A network analysis of post-traumatic stress and psychosis symptoms. Psychol Med 2021; 51:2485-2492. [PMID: 32419682 DOI: 10.1017/s0033291720001300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Understanding the interplay between trauma-related psychological mechanisms and psychotic symptoms may improve the effectiveness of interventions for post-traumatic stress reactions in psychosis. Network theory assumes that mental health problems persist not because of a common latent variable, but from dynamic feedback loops between symptoms, thereby addressing the heterogeneous and overlapping nature of traumagenic and psychotic diagnoses. This is a proof-of-concept study examining interactions between post-traumatic stress symptoms, which were hypothesized to reflect trauma-related psychological mechanisms, and auditory hallucinations and delusions. METHOD Baseline data from two randomised controlled trials (N = 216) of trauma-focused therapy in people with post-traumatic stress symptoms (87.5% met diagnostic criteria for PTSD) and psychotic disorder were analysed. Reexperiencing, hyperarousal, avoidance, trauma-related beliefs, auditory hallucinations and delusional beliefs were used to estimate a Gaussian graphical model along with expected node influence and predictability (proportion of explained variance). RESULTS Trauma-related beliefs had the largest direct influence on the network and, together with hypervigilance, were implicated in the shortest paths from flashbacks to delusions and auditory hallucinations. CONCLUSIONS These findings are in contrast to previous research suggesting a central role for re-experiencing, emotional numbing and interpersonal avoidance in psychosis. Trauma-related beliefs were the psychological mechanism most associated with psychotic symptoms, although not all relevant mechanisms were measured. This work demonstrates that investigating multiple putative mediators may clarify which processes are most relevant to trauma-related psychosis. Further research should use network modelling to investigate how the spectrum of traumatic stress reactions play a role in psychotic symptoms.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Ciaran O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Craig Steel
- The Oxford Institute of Clinical Psychology Training, Oxford, UK
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Health Research, VU University, van der Boehorsttraat 7, 1081 BTAmsterdam, The Netherlands
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HNDen Haag, Netherlands
| | - David van den Berg
- Department of Clinical Psychology and Amsterdam Public Health Research, VU University, van der Boehorsttraat 7, 1081 BTAmsterdam, The Netherlands
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HNDen Haag, Netherlands
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15
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Longden E, Corstens D, Morrison AP, Larkin A, Murphy E, Holden N, Steele A, Branitsky A, Bowe S. A treatment protocol to guide the delivery of dialogical engagement with auditory hallucinations: Experience from the Talking With Voices pilot trial. Psychol Psychother 2021; 94:558-572. [PMID: 33629816 DOI: 10.1111/papt.12331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To present a treatment protocol for delivering Talking With Voices, a novel intervention for people with psychosis that involves dialogical engagement with auditory hallucinations. METHOD This paper presents a manualized approach to therapy employed in the Talking With Voices trial, a feasibility and acceptability randomized control trial of 50 adult participants. A rationale for following a treatment manual is provided, followed by the theoretical underpinnings of the intervention and its principles and values, including the main tenet that voices can often be understood as dissociated parts of the self which serve a protective function by indicating social-emotional vulnerabilities. The four therapy phases for improving the relationship between the voice-hearer and their voices are outlined: (1) engagement and psychoeducation, (2) creating a formulation, (3) dialoguing with voices, and (4) consolidating outcomes, including key milestones at each phase. Implementation issues are discussed, as well as recommendations for best practice and future research. RESULTS The Talking With Voices treatment protocol indicates that it is feasible to manualize a dissociation-based approach to support service users who are distressed by hearing voices. CONCLUSION For some individuals, it is possible to engage in productive dialogue with even extremely hostile or distressing voices. Developing coping strategies, creating a formulation, and ultimately establishing a dialogue with voices has the potential to improve the relationship between voice(s) and voice-hearer. Further research is now required to evaluate feasibility, acceptability, and efficacy. PRACTITIONER POINTS It is feasible to integrate a dissociation model of voice-hearing within a psychological intervention for people with psychosis. Combining psychosocial education, formulation and direct dialogue can be used to facilitate a more peaceful relationship between clients and their voices. Practitioners trained in other therapeutic modalities can draw on existing transferrable skills to dialogue with their clients' voices. The input of those with lived experience of mental health difficulties has an important role in guiding treatment design and delivery.
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Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK.,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Dirk Corstens
- GGZ Noord-Holland Noord, Texel/den Helder, The Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK.,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK
| | - Amanda Larkin
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Elizabeth Murphy
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Natasha Holden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Ann Steele
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK.,Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
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16
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Hayward M, Jones AM, Strawson WH, Quadt L, Larsson DEO, Silva M, Davies G, Fielding-Smith S, Hazell CM, Critchley HD, Garfinkel SN. A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder. Clin Psychol Psychother 2021; 29:631-641. [PMID: 34322956 DOI: 10.1002/cpp.2655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The presence of auditory verbal hallucinations (AVHs) does not currently feature in the main diagnostic criteria for borderline personality disorder (BPD). However, there is accumulating evidence that a high proportion of BPD patients report longstanding and frequent AVHs which constitute a significant risk factor for suicide plans and attempts, and hospitalization. AIM This study addressed questions about the validity and phenomenology of AVHs in the context of BPD. The longer-term aim is to facilitate the development and translation of treatment approaches to address the unmet need of this population. METHOD This was a cross-sectional study, combining phenomenological and psychological assessments administered in person and online. We explored the experiences of 48 patients with a diagnosis of BPD who were hearing AVHs. RESULTS Participants gave 'consistent' reports on the measure of AVH phenomenology, suggesting that these experiences were legitimate. Similar to AVHs in a psychosis context, AVHs were experienced as distressing and appraised as persecutory. AVHs were found to be weakly associated with BPD symptoms. AVHs were also rated highly as a treatment priority by the majority of participants. CONCLUSION The findings suggest that AVH is a legitimate and distressing symptom of BPD and a treatment priority for some patients. The relative independence of AVHs from other BPD symptoms and emotional states suggests that psychological treatment may need to be targeted specifically at the symptom of AVHs. This treatment could be adapted from cognitive behaviour therapy, the psychological intervention that is recommended for the treatment of AVHs in the context of psychosis.
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Affiliation(s)
- Mark Hayward
- Sussex Partnership NHS Foundation Trust, Brighton, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Will H Strawson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK.,Leverhulme Trust, London, UK
| | - Marta Silva
- Cognition and Brain Plasticity Unit, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Cassie M Hazell
- Social Sciences Department, University of Westminster, London, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
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17
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Musiek FE, Morris S, Ichiba K, Clark L, Davidson AJ. Auditory Hallucinations: An Audiological Horizon? J Am Acad Audiol 2021; 32:195-210. [PMID: 34062609 DOI: 10.1055/s-0041-1722989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Interesting data and theories have emerged regarding auditory hallucinations (AHs) in patients with schizophrenia. The possibility that these patients may have changes in the anatomy of the auditory cortex and/or subcortical structures of the central auditory nervous system and present with deficits on audiological tests is important information to the audiology community. However, it seems clear that, in general, audiologists are not sufficiently aware of these findings. PURPOSE There are two main purposes of this article: (1) to educate audiologists about AHs related to schizophrenia and related issues, and (2) to encourage audiologists and hearing scientists to become involved in the evaluation and research of AHs. This fascinating disorder is one in which audiologists/hearing scientists are well suited to make a significant contribution. RESEARCH DESIGN A review and synthesis of the literature was conducted. Relevant literature was identified through PubMed, Google Scholar, as well as independent book chapters and article searches. Keywords driving the searches were AHs, auditory illusions, verbal and musical hallucinations, schizophrenia, and central auditory disorders. Given the currency of the topic, the information collected was primarily between 1990 and 2020. STUDY SAMPLE The review is organized around categorization, prevalence, models, mechanisms, anatomy, pathophysiology, and audiological correlates related to AHs. DATA COLLECTION AND ANALYSIS Searches were conducted using well-known search engines and manual searches by each author. This information on AHs was then analyzed collectively by the authors for useful background and relevance, as well as important for the field of audiology. RESULTS Several anatomical, physiological, and functional imaging studies have shown compromise of the auditory cortex in those with schizophrenia and AHs. Potentially related to this, are studies that demonstrated sub-par performance on behavioral audiologic measures for this unique clinical population. These findings align well with the kind of hearing disorder for which audiologists are well-trained to make significant contributions. CONCLUSION Neurobiological and audiological evidence is accumulating on patients with schizophrenia and AH potentially rendering it as both an auditory and psychiatric disorder. Audiologists should consider expanding their horizon and playing a role in the clinical investigation of this disorder.
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Affiliation(s)
- Frank E Musiek
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Sarah Morris
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Kayla Ichiba
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Liza Clark
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Alyssa J Davidson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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18
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Peach N, Alvarez-Jimenez M, Cropper SJ, Sun P, Halpin E, O'Connell J, Bendall S. Trauma and the content of hallucinations and post-traumatic intrusions in first-episode psychosis. Psychol Psychother 2021; 94 Suppl 2:223-241. [PMID: 32154644 DOI: 10.1111/papt.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Increasing evidence suggests experiences of childhood trauma may be causally related to the development of hallucinations. Cognitive theories of psychosis suggest post-traumatic intrusions to be a primary mechanism in this relationship. These theories predict that the content of hallucinations will be related to traumatic experiences; however, few studies have investigated this. This study examined the relationship between childhood trauma, the content of hallucinations, and the content of post-traumatic intrusions in a sample with first-episode psychosis. METHODS Sixty-six young people aged 15-25 experiencing a first episode of psychosis were recruited from an early intervention service. Participants completed assessments of traumatic experiences, hallucination content, and post-traumatic intrusion content using a systematic coding frame. The coding frame assessed for three types of relationships between traumatic experiences, the content of hallucinations, and the content of post-traumatic intrusions: direct relationships (hallucination content exactly matching the trauma/intrusion), thematic relationships (hallucinations with the same themes as the trauma/intrusion), and no relationship (hallucination and trauma/intrusion content unrelated). RESULTS Of those people who reported trauma and hallucinations (n = 36), 22 of these (61%) experienced post-traumatic intrusions, and of these, 16 (73%) experienced hallucinations that were directly or thematically related to their post-traumatic intrusions. Twelve people experienced hallucination content directly related to their trauma, six of whom (50%) also had intrusions relating to the same traumatic event as their hallucinations. CONCLUSIONS The finding that some people experience hallucinations and post-traumatic intrusions relating to the same traumatic event supports theories proposing a continuum of memory intrusion fragmentation. These results indicate that early intervention services for young people with psychosis should provide assessment and intervention for trauma and PTSD and should consider the impact of past traumatic events on the content of current hallucinatory experience. PRACTITIONER POINTS Trauma and post-traumatic stress disorder should be assessed in those experiencing a first episode of psychosis. Interventions for trauma should be offered in early intervention for psychosis services. In a notable proportion of people, hallucination content is related to traumatic experiences. Clinical assessment and formulation of hallucinations requires consideration of how past traumatic events may be contributing to hallucinatory experience. It is important for clinicians to have an understanding of the phenomenological differences between hallucinations and post-traumatic intrusions when conducting clinical assessments with people with comorbid psychosis and PTSD.
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Affiliation(s)
- Natalie Peach
- School of Psychological Sciences, The University of Melbourne, Vic., Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic., Australia.,The Centre for Youth Mental Health, The University of Melbourne, Vic., Australia
| | - Simon J Cropper
- School of Psychological Sciences, The University of Melbourne, Vic., Australia
| | - Pamela Sun
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
| | - Emma Halpin
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic., Australia.,The Centre for Youth Mental Health, The University of Melbourne, Vic., Australia
| | - Jessica O'Connell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic., Australia.,The Centre for Youth Mental Health, The University of Melbourne, Vic., Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic., Australia.,The Centre for Youth Mental Health, The University of Melbourne, Vic., Australia
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19
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Dellazizzo L, Potvin S, Phraxayavong K, Dumais A. One-year randomized trial comparing virtual reality-assisted therapy to cognitive-behavioral therapy for patients with treatment-resistant schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:9. [PMID: 33580033 PMCID: PMC7881089 DOI: 10.1038/s41537-021-00139-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023]
Abstract
The gold-standard cognitive-behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | | | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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20
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Bloomfield MA, Chang T, Woodl MJ, Lyons LM, Cheng Z, Bauer‐Staeb C, Hobbs C, Bracke S, Kennerley H, Isham L, Brewin C, Billings J, Greene T, Lewis G. Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis. World Psychiatry 2021; 20:107-123. [PMID: 33432756 PMCID: PMC7801841 DOI: 10.1002/wps.20841] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.
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Affiliation(s)
- Michael A.P. Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK,Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation TrustLondonUK,NIHR University College London Hospitals Biomedical Research CentreUniversity College HospitalLondonUK,National Hospital for Neurology and NeurosurgeryUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Tinya Chang
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK
| | - Maximillian J. Woodl
- Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation TrustLondonUK
| | - Laura M. Lyons
- Traumatic Stress Clinic, St. Pancras Hospital, Camden and Islington NHS Foundation TrustLondonUK
| | - Zhen Cheng
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK
| | - Clarissa Bauer‐Staeb
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK,Department of PsychologyUniversity of BathBathUK
| | - Catherine Hobbs
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK,Department of PsychologyUniversity of BathBathUK
| | - Sophie Bracke
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Division of PsychiatryUniversity College LondonLondonUK
| | - Helen Kennerley
- University of OxfordOxfordUK,Oxford Centre for Cognitive TherapyWarneford Hospital, Oxford Health NHS Foundation TrustOxfordUK
| | - Louise Isham
- Oxford Centre for Cognitive TherapyWarneford Hospital, Oxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryUniversity of OxfordOxfordUK
| | - Chris Brewin
- Research Department of Clinical, Health and Educational PsychologyUniversity College LondonLondonUK
| | - Jo Billings
- Division of PsychiatryUniversity College LondonLondonUK
| | - Talya Greene
- Division of PsychiatryUniversity College LondonLondonUK,Community Mental Health DepartmentUniversity of HaifaHaifaIsrael
| | - Glyn Lewis
- Division of PsychiatryUniversity College LondonLondonUK
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21
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Rogers S, Keogh R, Pearson J. Hallucinations on demand: the utility of experimentally induced phenomena in hallucination research. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200233. [PMID: 33308076 PMCID: PMC7741072 DOI: 10.1098/rstb.2020.0233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 01/20/2023] Open
Abstract
Despite the desire to delve deeper into hallucinations of all types, methodological obstacles have frustrated development of more rigorous quantitative experimental techniques, thereby hampering research progress. Here, we discuss these obstacles and, with reference to visual phenomena, argue that experimentally induced phenomena (e.g. hallucinations induced by flickering light and classical conditioning) can bring hallucinations within reach of more objective behavioural and neural measurement. Expanding the scope of hallucination research raises questions about which phenomena qualify as hallucinations, and how to identify phenomena suitable for use as laboratory models of hallucination. Due to the ambiguity inherent in current hallucination definitions, we suggest that the utility of phenomena for use as laboratory hallucination models should be represented on a continuous spectrum, where suitability varies with the degree to which external sensory information constrains conscious experience. We suggest that existing strategies that group pathological hallucinations into meaningful subtypes based on hallucination characteristics (including phenomenology, disorder and neural activity) can guide extrapolation from hallucination models to other hallucinatory phenomena. Using a spectrum of phenomena to guide scientific hallucination research should help unite the historically separate fields of psychophysics, cognitive neuroscience and clinical research to better understand and treat hallucinations, and inform models of consciousness. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.
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Affiliation(s)
| | | | - Joel Pearson
- School of Psychology, The University of New South Wales, Sydney, Australia
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22
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Berry C, Newcombe H, Strauss C, Rammou A, Schlier B, Lincoln T, Hayward M. Validation of the Hamilton Program for Schizophrenia Voices Questionnaire: Associations with emotional distress and wellbeing, and invariance across diagnosis and sex. Schizophr Res 2021; 228:336-343. [PMID: 33540145 DOI: 10.1016/j.schres.2020.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Voice-hearing is a transdiagnostic experience with evident negative effects on patients. Good quality measurement is needed to further elucidate the nature, impact and treatment of voice-hearing experiences across patient groups. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is a brief self-report measure which requires further psychometric evaluation. METHODS Using data from a transdiagnostic sample of 401 adult UK patients, the fit of a conceptual HPSVQ measurement model, proposing a separation between physical and emotional voice-hearing characteristics, was tested. A structural model was examined to test associations between voice-hearing, general emotional distress (depression, anxiety, stress) and wellbeing. The invariance of model parameters was examined across diagnosis and sex. RESULTS The final measurement model comprised two factors named 'voice severity' and 'voice-related distress'. The former comprised mainly physical voice characteristics and the latter mainly distress and other negative impacts. Structural model results supported voice-related distress as mediating the associations between voice severity and emotional distress and wellbeing. Model parameters were invariant across psychosis versus non-psychosis diagnosis and partially invariant across sex. Females experienced more severe and distressing voices and a more direct association between voice severity and general anxiety was evident. CONCLUSIONS The HPSVQ is a useful self-report measure of voice-hearing with some scope for further exploration and refinement. Voice-related distress appears a key mechanism by which voice severity predicts general distress and wellbeing. Whilst our data broadly support interventions targeting voice-related distress for all patients, females may benefit especially from interventions targeting voice severity and strategies for responding.
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Affiliation(s)
- C Berry
- Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, Brighton, BN1 9PH, United Kingdom of Great Britain and Northern Ireland; School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland.
| | - H Newcombe
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland
| | - C Strauss
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland; Research & Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital, Nevill Avenue, Hove, BN3 7HZ, United Kingdom of Great Britain and Northern Ireland
| | - A Rammou
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland
| | - B Schlier
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Fakultät für Psychologie und Bewegungswissenschaft, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - T Lincoln
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Fakultät für Psychologie und Bewegungswissenschaft, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - M Hayward
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom of Great Britain and Northern Ireland; Research & Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital, Nevill Avenue, Hove, BN3 7HZ, United Kingdom of Great Britain and Northern Ireland
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23
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Koreki A, Koizumi T, Ogyu K, Onaya M. Case Report: Culture-Dependent Postures in Japanese Patients With Schizophrenia. Front Psychiatry 2021; 12:686817. [PMID: 34421673 PMCID: PMC8374077 DOI: 10.3389/fpsyt.2021.686817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Cross-cultural understanding of psychiatric symptoms is important in the current globalised society. Lack of knowledge regarding culture-dependent manifestations of psychiatric illnesses may lead to misjudgement by clinicians, resulting in inappropriate treatment. We present the cases of two patients with schizophrenia who showed Japanese-culture-dependent postures (seiza and dogeza). Seiza is a Japanese style of formal floor sitting. Dogeza includes bowing and touching the forehead to the floor while sitting in a kneeling position. When patients with schizophrenia perform these postures in a clinical setting, clinicians receive plenty of information regarding the patients' clinical states, including schizophrenia-related fear/tension, accusatory auditory verbal hallucinations, and pathological guilt.
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Affiliation(s)
- Akihiro Koreki
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Teruki Koizumi
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Kamiyu Ogyu
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Mitsumoto Onaya
- Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
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24
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Pinheiro AP, Schwartze M, Kotz SA. Cerebellar circuitry and auditory verbal hallucinations: An integrative synthesis and perspective. Neurosci Biobehav Rev 2020; 118:485-503. [DOI: 10.1016/j.neubiorev.2020.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
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25
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Kamp KS, Steffen EM, Alderson-Day B, Allen P, Austad A, Hayes J, Larøi F, Ratcliffe M, Sabucedo P. Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review. Schizophr Bull 2020; 46:1367-1381. [PMID: 33099644 PMCID: PMC7707065 DOI: 10.1093/schbul/sbaa113] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bereaved people often report having sensory and quasi-sensory experiences of the deceased (SED), and there is an ongoing debate over whether SED are associated with pathology, such as grief complications. Research into these experiences has been conducted in various disciplines, including psychiatry, psychology, and anthropology, without much crossover. This review brings these areas of research together, drawing on the expertise of an interdisciplinary working group formed as part of the International Consortium for Hallucination Research (ICHR). It examines existing evidence on the phenomenology, associated factors, and impact of SED, including the role of culture, and discusses the main theories on SED and how these phenomena compare with unusual experiences in other contexts. The review concludes that the vast majority of these experiences are benign and that they should be considered in light of their biographical, relational, and sociocultural contexts.
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Affiliation(s)
- Karina Stengaard Kamp
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark,To whom correspondence should be addressed; Department of Psychology and Behavioural Science, Aarhus University, Bartholins Allé 11, Aarhus C, DK, 8000, Denmark; tel: 0045-30-11-75-59, e-mail:
| | | | | | - Paul Allen
- Department of Psychology, University of Roehampton, London, UK,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Anne Austad
- Faculty of Theology, Diaconia and Leadership Studies, VID Specialized University, Oslo, Norway
| | | | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium,Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | | | - Pablo Sabucedo
- Department of Psychology, University of Roehampton, London, UK
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26
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Schutte MJL, Linszen MMJ, Marschall TM, Ffytche DH, Koops S, van Dellen E, Heringa SM, Slooter AJC, Teunisse R, van den Heuvel OA, Lemstra AW, Foncke EMJ, Slotema CW, de Jong J, Rossell SL, Sommer IEC. Hallucinations and other psychotic experiences across diagnoses: A comparison of phenomenological features. Psychiatry Res 2020; 292:113314. [PMID: 32731082 DOI: 10.1016/j.psychres.2020.113314] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 01/19/2023]
Abstract
Although psychotic experiences are prevalent across many psychiatric, neurological, and medical disorders, investigation of these symptoms has largely been restricted to diagnostic categories. This study aims to examine phenomenological similarities and differences across a range of diagnoses. We assessed frequency, severity and phenomenology of psychotic experiences in 350 outpatients including; participants with schizophrenia spectrum disorders, hearing impairment, Parkinson's disease, Lewy Body Dementia, Alzheimer's disease, visual impairment, posttraumatic stress disorder, borderline personality disorder, and participants with recent major surgery. Psychotic phenomena were explored between these groups using the Questionnaire for Psychotic Experiences (QPE). Participants with major psychiatric disorders reported a combination of several psychotic experiences, and more severe experiences compared to all other disorders. Participants with recent major surgery or visual impairment experienced isolated visual hallucinations. Participants with hearing impairment reported isolated auditory hallucinations, whereas the neurodegenerative disorders reported visual hallucinations, occasionally in combination with hallucinations in another modality or delusions. The phenomenology between neurodegenerative disorders, and within major psychiatric disorders showed many similarities. Our findings indicate that the phenomenology of psychotic experiences is not diagnosis specific, but may rather point to the existence of various subtypes across diagnoses. These subtypes could have a different underlying etiology requiring specific treatment.
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Affiliation(s)
- Maya J L Schutte
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
| | - Mascha M J Linszen
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
| | - Theresa M Marschall
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands.
| | - Dominic H Ffytche
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sanne Koops
- Department of Neurology, University Medical Center Utrecht & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, University Medical Center Utrecht & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Sophie M Heringa
- Department of Psychiatry, University Medical Center Utrecht & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob Teunisse
- Department of Geriatric Psychiatry, Dimence, Deventer, the Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry and Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Afina W Lemstra
- Department of Neurology, VU university medical center, Amsterdam, the Netherlands
| | - Elisabeth M J Foncke
- Department of Neurology, VU university medical center, Amsterdam, the Netherlands
| | | | - Joop de Jong
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University & Voices Clinic, Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
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27
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Tailoring cognitive behavioural therapy to subtypes of voice-hearing using a novel tabletised manual: a feasibility study. Behav Cogn Psychother 2020; 49:287-301. [PMID: 32972483 DOI: 10.1017/s1352465820000661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive behavioural therapy for psychosis (CBTp) is a recommended treatment for psychotic experiences, but its effectiveness has been questioned. One way of addressing this may be to tailor therapy materials to the phenomenology of specific psychotic experiences. AIM In this study, we investigated the acceptability of a novel treatment manual for subtypes of 'voice-hearing' experiences (i.e. auditory verbal hallucinations). An uncontrolled, single-arm design was used to assess feasibility and acceptability of using the manual in routine care for people with frequent voice-hearing experiences. METHOD The manual was delivered on a smart tablet and incorporated recent research evidence and theory into its psychoeducation materials. In total, 24 participants completed a baseline assessment; 19 started treatment, 15 completed treatment and 12 participants completed a follow-up assessment (after 10 sessions of using the manual). RESULTS Satisfaction with therapy scores and acceptability ratings were high, while completion rates suggested that the manual may be more appropriate for help with participants from Early Intervention in Psychosis services rather than Community Mental Health Teams. CONCLUSION Within-group changes in symptom scores suggested that overall symptom severity of hallucinations - but not other psychosis features, or beliefs about voices - are likely to be the most appropriate primary outcome for further evaluation in a full randomised controlled trial.
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28
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Ward T, Rus-Calafell M, Ramadhan Z, Soumelidou O, Fornells-Ambrojo M, Garety P, Craig TKJ. AVATAR Therapy for Distressing Voices: A Comprehensive Account of Therapeutic Targets. Schizophr Bull 2020; 46:1038-1044. [PMID: 32372082 PMCID: PMC7505185 DOI: 10.1093/schbul/sbaa061] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AVATAR therapy represents an effective new way of working with distressing voices based on face-to-face dialogue between the person and a digital representation (avatar) of their persecutory voice. To date, there has been no complete account of AVATAR therapy delivery. This article presents, for the first time, the full range of therapeutic targets along with information on acceptability and potential side effects. Interest in the approach is growing rapidly and this report acts as a necessary touchstone for future development.
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Affiliation(s)
- Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | | | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tom K J Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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29
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Rus-Calafell M, Ward T, Zhang XC, Edwards CJ, Garety P, Craig T. The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy. J Clin Med 2020; 9:jcm9092748. [PMID: 32854387 PMCID: PMC7564300 DOI: 10.3390/jcm9092748] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time "face-to-face" dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest that improvements in voice severity and frequency at post AVATAR therapy may be influenced by the combination of feeling less anxious in the context of a realistic simulation of the voice, while voice-related distress may involve additional cognitive and relational processes.
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Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany;
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- Correspondence:
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany;
| | - Clementine J. Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Tom Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
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30
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Paulik G, Newman-Taylor K, Steel C, Arntz A. Managing Dissociation in Imagery Rescripting for Voice Hearers With Trauma: Lessons From a Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Lorente-Rovira E, Grasa E, Ochoa S, Corripio I, Peláez T, López-Carrilero R, Gutiérrez-Gea Á, Morano-Guillén M, Villagrán JM, Bartels-Velthuis AA, Jenner JA, Sanjuán J. Different measures for auditory hallucinations in populations with psychosis. The Validation of the Spanish versions of the Auditory Vocal Hallucination Rating Scale (AVHRS) and the Positive and Useful Voices Inquiry (PUVI). REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 15:S1888-9891(20)30027-6. [PMID: 32493672 DOI: 10.1016/j.rpsm.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/08/2019] [Accepted: 03/11/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION An updated summary of the most used instruments assessing auditory hallucinations in population with psychosis, allows us to underline the scarceness and need of Spanish versions of important instruments. The aim of the study is to examine the psychometric characteristics of two different and complementary instruments for assessing auditory hallucinations, the Spanish version of the Auditory Vocal Hallucination Scale (AVHRS) and the Spanish version of the Positive and Useful Voices Inquiry (PUVI). MATERIALS AND METHODS A sample of 68 patients from four different centres, with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder presenting with auditory hallucinations were included. Apart from the AVHRS and the PUVI, the Psychotic Symptom Rating Scales-Auditory Hallucinations subscale (PSYRATS-AH) and the Positive and Negative Syndrome Scale (PANSS) were also administered to all patients, plus an acceptability questionnaire. RESULTS The Spanish version of the AVHRS showed a good internal consistency, a moderate to high inter-rater reliability, a medium to moderate test-retest reliability, and a good convergent and discriminant validity. The Spanish version of the PUVI showed a good internal consistency and a heterogeneous, but in general moderate, test-retest reliability. CONCLUSIONS The Spanish versions of the AVHRS and the PUVI have good psychometric properties and are well accepted among patients.
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Affiliation(s)
- Esther Lorente-Rovira
- Hospital Clínico, Valencia, Spain; INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain.
| | - Eva Grasa
- CIBERSAM, Madrid, Spain; Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU, Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; CIBERSAM, Madrid, Spain
| | - Iluminada Corripio
- CIBERSAM, Madrid, Spain; Department of Psychiatry, Biomedical Research Institute Sant Pau (IIB-SANT PAU, Hospital Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Spain
| | - Trinidad Peláez
- CIBERSAM, Madrid, Spain; Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | | | | | - José M Villagrán
- Hospital Jerez de la Frontera, Servicio Andaluz de Salud, Cádiz, Spain
| | - Agna A Bartels-Velthuis
- University of Groningen, the Netherlands; University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Jack A Jenner
- Jenner Consult, Haren, the Netherlands Groningen, the Netherlands
| | - Julio Sanjuán
- Hospital Clínico, Valencia, Spain; INCLIVA, Valencia, Spain; CIBERSAM, Madrid, Spain; Faculty of Medicine, Valencia, Spain
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32
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Jones A, Read J, Wood L. A retrospective case study of the thematic content of psychotic experiences in a first episode psychosis population. J Ment Health 2020; 30:509-517. [PMID: 32339004 DOI: 10.1080/09638237.2020.1755024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Historically, the content of psychotic experiences has tended to be of little importance to biological psychiatry, with hallucinations and delusions being seen as symptoms of mental illness rather than meaningful experiences or responses to life circumstances. AIMS This study aims to explore the thematic content of psychotic phenomena in a sample of clients with a first episode of psychosis. METHODS The electronic medical records of 160 services users of two Early Intervention for Psychosis Services were comprehensively reviewed. A thematic analysis was used to explore the thematic content of psychotic symptoms recorded by healthcare professionals. RESULTS The results illustrate 30 themes and 85 sub-themes. This includes delusional beliefs (e.g. "being harmed, attacked or killed", "being monitored or followed by others", "special powers or abilities") and hallucinations (e.g. "commanding voice", "derogatory/critical voice", "commentary"). CONCLUSIONS The results illustrate the extensive and varied experience of psychosis within this sample. Based on the findings of this study, it is hoped that future research studies and mental health services will attend to the meaning and content of psychotic experiences.
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Affiliation(s)
- Amy Jones
- Bromley Early Intervention for Psychosis Service, Oxleas NHS Foundation Trust, Orpington, UK
| | - John Read
- School of Psychology, University of East London, London, UK
| | - Lisa Wood
- North East London NHS Foundation Trust, Ilford, UK.,Division of Psychiatry, University College London, London, UK
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33
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Fosse R, Larøi F. Quantifying auditory impressions in dreams in order to assess the relevance of dreaming as a model for psychosis. PLoS One 2020; 15:e0230212. [PMID: 32163491 PMCID: PMC7067405 DOI: 10.1371/journal.pone.0230212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/24/2020] [Indexed: 01/29/2023] Open
Abstract
A long noted hypothesis is that mechanisms of dreaming play a role in psychotic hallucinations. One challenge for this hypothesis is that while psychotic hallucinations primarily are auditory, dreaming most characteristically is visual. At the same time, previous studies have not explicitly examined auditory impressions in dreaming. Here, we mapped the prevalence and characteristics of auditory impressions in 130 dreams reported after spontaneous awakenings from sleep in 13 normal, healthy people. We instructed participants to report any dream they could recall and to pay particular attention to possible auditory impressions. The participants reported auditory impressions in 93.9% of their dreams on average. The most prevalent auditory type was other people speaking (83.9% of participants’ dreams), followed by the dreamer speaking (60.0%), and other types of sounds (e.g. music, 33.1%). Of altogether 407 instances of auditory impressions in the 130 dreams, auditory quality was judged comparable to waking in 46.4%, indeterminate in 50.6%, and absent or only thought-like in 2.9%. The results suggest that also internally generated auditory (verbal) sensations are a central component of dreaming, typically occurring several times every night in normal, healthy people.
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Affiliation(s)
- Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
- * E-mail:
| | - Frank Larøi
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- NORMENT – Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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Brand RM, Bendall S, Hardy A, Rossell SL, Meyer D, Thomas N. Moment-to-moment associations between posttraumatic stress symptoms and auditory hallucinations in the flow of daily life. Psychiatry Res 2020; 285:112838. [PMID: 32044599 DOI: 10.1016/j.psychres.2020.112838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
Traumatic events are associated with increased risk of auditory hallucinations (AHs) and posttraumatic stress symptoms have been implicated in this relationship. We aimed to explore the moment-to-moment relationship between posttraumatic stress symptoms and AHs in daily-life. Twenty-eight people with persistent AHs and a history of traumatic events completed six-days of ecological momentary assessment. We assessed AHs, trauma memory intrusions, avoidance, and hyperarousal at ten time points each day. Multi-level modelling showed that the severity of trauma memory intrusions (but not avoidance or hyperarousal) within the preceding hour was associated with the occurrence of AHs. This relationship was significantly stronger for people with a direct link between the content of their AHs and trauma history. In time-lagged analyses, main effects of trauma memory intrusions, avoidance, and hyperarousal on AHs were not significant. Trauma memory intrusions have momentary associations with AHs and this relationship is stronger and more enduring for those with a direct link between their AH and the trauma. Our findings are in keeping with the proposal that intrusive trauma memories are associated with the occurrence of (some) AHs.
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Affiliation(s)
- Rachel M Brand
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia.
| | - Sarah Bendall
- Orygen: The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia; The Centre for Youth Mental Health, The University of Melbourne, VIC 3010, Australia
| | - Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London & Maudsley NHS Foundation Trust, UK
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia
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Allé MC, Berna F, Danion JM, Berntsen D. Seeing or hearing one's memories: Manipulating autobiographical memory imagery in schizophrenia. Psychiatry Res 2020; 286:112835. [PMID: 32062523 DOI: 10.1016/j.psychres.2020.112835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 11/15/2022]
Abstract
The prevalence of auditory hallucinations in schizophrenia, and theories suggesting a link between autobiographical memory and hallucination, raise the possibility of a dominant role of auditory imagery in autobiographical remembering in patients with schizophrenia, whereas visual imagery is dominant in autobiographical memory of healthy adults. The present study explored this possibility by comparing autobiographical memory characteristics, according to sensory modality, in patients with schizophrenia versus healthy controls. Twenty-eight patients and 28 matched controls were asked to retrieve autobiographical memories that were dominated by auditory, visual, gustatory-olfactory, or tactile imagery. ANOVA analysis showed that patients rated their memories lower on specificity, contextual information, feeling of reliving, overall vividness, coherence and autobiographical me-ness (i.e. whether an autobiographical memory is experienced as belonging to the self), ps < 0.03, compared with control participants. The effects of sensory modality imagery were largely similar for patients and controls, as no interaction effects were observed. The findings did not support a dominance of auditory imagery in patients' autobiographical memory. In the patient group, reduced autobiographical me-ness was predicted by lower ratings of contextual information related to the setting of the event. Future research should examine whether these effects extend to involuntary autobiographical memory in schizophrenia.
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Affiliation(s)
- Mélissa C Allé
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Denmark.
| | - Fabrice Berna
- Inserm U1114, Strasbourg University, University Hospital of Strasbourg, France
| | - Jean-Marie Danion
- Inserm U1114, Strasbourg University, University Hospital of Strasbourg, France
| | - Dorthe Berntsen
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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Fernandes HCD, Zanello V. Hearing voices: From the Experience Qualification to the Possibility of Care. PSICOLOGIA: TEORIA E PESQUISA 2020. [DOI: 10.1590/0102.3772e3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This article aimed to analyze hearing voices experiences in patients of a Psychosocial Care Center. In this regard, ten people were interviewed. The qualitative method was used, with content analysis. Four categories were chosen: “origin” of voices, phenomenology of voices, coping strategies, and family support. Hallucinatory experiences have emerged in contexts of violence and isolation. Topographic variables of the voices indicate possibilities of understanding the phenomenon. The movement is a basic condition to deal with the experiences. Family support is key to cope with difficulties. It is necessary to qualify the auditory hallucination as a meaningful experience, which must be respected in any intervention that intends care.
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Kim SH, Hwang SS, Jung HY, Kim Y, Ahn YM, Chung IW, Kim YS. Differences between self-reported and clinician-rated evaluations of 1-year changes in auditory verbal hallucinations among schizophrenia patients. Prog Neuropsychopharmacol Biol Psychiatry 2019; 95:109671. [PMID: 31220520 DOI: 10.1016/j.pnpbp.2019.109671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 12/25/2022]
Abstract
Auditory verbal hallucinations (AVHs) constitute a frequent and distressing symptom of schizophrenia, associated with physical, emotional, and cognitive challenges. Despite their clinical importance, changes in the multiple dimensions of AVHs during treatment have rarely been examined, and subjective views thereof have received minimal attention. Here, we evaluated 87 patients with schizophrenia-related AVHs using the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ; a self-report questionnaire) and the Psychotic Symptom Rating Scales-Auditory Hallucination Subscale (PSYRATS-AH; a clinician-rated scale) at baseline and after 6 months and 1 year of treatment. We explored dimensions that changed from the perspectives of both clinicians and patients and the relationships between these perceptions over the year. The test-retest reliabilities of the HPSVQ and PSYRATS-AH were generally fair. Improvements in AVHs were evident over the first 6 months; the PSYRATS-AH revealed a broader range of symptom improvement than did the HPSVQ. The "interference with life" dimension on the HPSVQ was not reduced, but the "disruption to life" score on the PSYRATS-AH was. At both baseline and 6 months, the physical characteristics of AVHs (frequency, duration, and loudness) were significantly correlated with both distress and life interference/disruption; all correlations except that for frequency were reduced at 1 year. The clinician-rated and self-reported personal perspectives on AVHs exhibited both differences and similarities; physical AVH components and subjective distressful experiences changed in different ways in those with chronic, persistent AVHs. The HPSVQ and PSYRATS-AH data were complementary, improving our understanding of the clinical implications of AVHs and subjective patient distress.
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Affiliation(s)
- Se Hyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Samuel S Hwang
- Department of Psychology, Chonnam National University, Gwangju, Republic of Korea
| | - Hee Yeon Jung
- Department of Psychiatry and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yeni Kim
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry and Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - In Won Chung
- Department of Psychiatry, Dongguk University International Hospital, Dongguk University Medical School, Goyang, Republic of Korea
| | - Yong Sik Kim
- Department of Psychiatry, Dongguk University International Hospital, Dongguk University Medical School, Goyang, Republic of Korea.
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38
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Phenomenology of Voice-Hearing in Psychosis Spectrum Disorders: a Review of Neural Mechanisms. Curr Behav Neurosci Rep 2019. [DOI: 10.1007/s40473-019-00196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosen C, Chase KA, Perona-Garcelán S, Marvin RW, Sharma RP. The psychometric properties of the DAIMON Scale, a translation from Spanish to English: An instrument to measure the relationship with and between voices. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2019; 12:45-56. [PMID: 32983256 DOI: 10.1080/17522439.2019.1652843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Kayla A Chase
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Salvador Perona-Garcelán
- University Hospital Virgen del Rocío, and University of Seville Personality, Evaluation and Psychological Treatment Department, Spain
| | - Robert W Marvin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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Pinheiro AP, Farinha-Fernandes A, Roberto MS, Kotz SA. Self-voice perception and its relationship with hallucination predisposition. Cogn Neuropsychiatry 2019; 24:237-255. [PMID: 31177920 DOI: 10.1080/13546805.2019.1621159] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Auditory verbal hallucinations (AVH) are a core symptom of psychotic disorders such as schizophrenia but are also reported in 10-15% of the general population. Impairments in self-voice recognition are frequently reported in schizophrenia and associated with the severity of AVH, particularly when the self-voice has a negative quality. However, whether self-voice processing is also affected in nonclinical voice hearers remains to be specified. Methods: Thirty-five nonclinical participants varying in hallucination predisposition based on the Launay-Slade Hallucination Scale, listened to prerecorded words and vocalisations differing in identity (self/other) and emotional quality. In Experiment 1, participants indicated whether words were spoken in their own voice, another voice, or whether they were unsure (recognition task). They were also asked whether pairs of words/vocalisations were uttered by the same or by a different speaker (discrimination task). In Experiment 2, participants judged the emotional quality of the words/vocalisations. Results: In Experiment 1, hallucination predisposition affected voice discrimination and recognition, irrespective of stimulus valence. Hallucination predisposition did not affect the evaluation of the emotional valence of words/vocalisations (Experiment 2). Conclusions: These findings suggest that nonclinical participants with high HP experience altered voice identity processing, whereas HP does not affect the perception of vocal emotion. Specific alterations in self-voice perception in clinical and nonclinical voice hearers may establish a core feature of the psychosis continuum.
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Affiliation(s)
- Ana P Pinheiro
- a Faculdade de Psicologia, Universidade de Lisboa , Lisboa , Portugal
| | | | - Magda S Roberto
- a Faculdade de Psicologia, Universidade de Lisboa , Lisboa , Portugal
| | - Sonja A Kotz
- b Faculty of Psychology and Neuroscience, Maastricht University , Maastricht , Netherlands.,c Max Planck Institute for Human and Cognitive Sciences , Leipzig , Germany
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Heriot-Maitland C, McCarthy-Jones S, Longden E, Gilbert P. Compassion Focused Approaches to Working With Distressing Voices. Front Psychol 2019; 10:152. [PMID: 30774614 PMCID: PMC6367219 DOI: 10.3389/fpsyg.2019.00152] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/16/2019] [Indexed: 12/22/2022] Open
Abstract
This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate – hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.
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Affiliation(s)
- Charles Heriot-Maitland
- Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Gilbert
- Centre for Compassion Research and Training, University of Derby, Derby, United Kingdom
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Rossell SL, Schutte MJL, Toh WL, Thomas N, Strauss C, Linszen MMJ, van Dellen E, Heringa SM, Teunisse R, Slotema CW, Sommer IEC. The Questionnaire for Psychotic Experiences: An Examination of the Validity and Reliability. Schizophr Bull 2019; 45:S78-S87. [PMID: 30715541 PMCID: PMC6357974 DOI: 10.1093/schbul/sby148] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Psychotic experiences are prevalent across a wide variety of psychiatric, neurological, and medical conditions. Yet current assessments are often designed for one disorder, or are limited in their examination of phenomenological features; this has hindered transdiagnostic research. This article describes an examination of the validity and reliability of the English version of a new assessment, the Questionnaire for Psychotic Experiences (QPE). This study aimed to use the QPE to examine hallucinations and delusions across a number of different conditions, and to ensure that the QPE had acceptable psychometric properties. An International Consortium on Hallucination Research working group, along with consumer groups, developed the 50-item QPE to assess the presence, severity, and phenomenology of hallucinations and delusions. Participants in the study who reported psychotic experiences included those with schizophrenia, schizoaffective disorder, bipolar affective disorder, and major depressive disorder, and those without a need for care (ie, nonclinical participants). There were 173 participants in total. Convergent and discriminant validity were assessed. Reliability was examined in terms of stability, equivalence, and internal consistency. The data confirmed that the QPE had good psychometric properties and could be put forward as an accepted measure of the transdiagnostic evaluation of psychotic experiences. Further validation is recommended with neurological and medical populations. Given its validity and reliability, comprehensive evaluation of psychotic phenomena, and relatively quick administration time, we propose that the QPE is a valuable instrument for both clinical and research settings.
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Affiliation(s)
- Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia,Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia,To whom correspondence should be addressed; Centre for Mental Health, Swinburne University of Technology, John St., Hawthorn, Melbourne, VIC 3122, Australia, tel: +61 3 9214 8173, fax: +61 3 9214 8173, e-mail:
| | - Maya J L Schutte
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The Netherlands,Department of Psychiatry, University Medical Center Utrecht and Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Clara Strauss
- School of Psychology, University of Sussex and Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Mascha M J Linszen
- Department of Psychiatry, University Medical Center Utrecht and Brain Center Rudolf Magnus, Utrecht, The Netherlands,Alzheimer Center, Department of Neurology, Neuroscience Campus, VU University Medical Center, Amsterdam, The Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, University Medical Center Utrecht and Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Sophie M Heringa
- Department of Psychiatry, University Medical Center Utrecht and Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Rob Teunisse
- Department of Geriatric Psychiatry, Dimence, Deventer, The Netherlands
| | - Christina W Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Iris E C Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The Netherlands,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Thomas N, Bless JJ, Alderson-Day B, Bell IH, Cella M, Craig T, Delespaul P, Hugdahl K, Laloyaux J, Larøi F, Lincoln TM, Schlier B, Urwyler P, van den Berg D, Jardri R. Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations. Schizophr Bull 2019; 45:S32-S42. [PMID: 30715539 PMCID: PMC6357981 DOI: 10.1093/schbul/sby103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.
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Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Josef J Bless
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | | | - Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychosis Early Intervention, South London and Maudsley NHS Trust, London, UK
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Trust, Heerlen, The Netherlands
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
- Institute of Neuroscience, Newcastle University, Newcastle-Upon-Tyne, UK
| | - David van den Berg
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Renaud Jardri
- PsyCHIC Team, SCALab CNRS UMR-9193, Lille University, Lille, France
- CURE Platform, CHU Lille, Fontan Hospital, Lille, France
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44
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Linszen MMJ, van Zanten GA, Teunisse RJ, Brouwer RM, Scheltens P, Sommer IE. Auditory hallucinations in adults with hearing impairment: a large prevalence study. Psychol Med 2019; 49:132-139. [PMID: 29554989 DOI: 10.1017/s0033291718000594] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Similar to visual hallucinations in visually impaired patients, auditory hallucinations are often suggested to occur in adults with hearing impairment. However, research on this association is limited. This observational, cross-sectional study tested whether auditory hallucinations are associated with hearing impairment, by assessing their prevalence in an adult population with various degrees of objectified hearing impairment. METHODS Hallucination presence was determined in 1007 subjects aged 18-92, who were referred for audiometric testing to the Department of ENT-Audiology, University Medical Center Utrecht, the Netherlands. The presence and severity of hearing impairment were calculated using mean air conduction thresholds from the most recent pure tone audiometry. RESULTS Out of 829 participants with hearing impairment, 16.2% (n = 134) had experienced auditory hallucinations in the past 4 weeks; significantly more than the non-impaired group [5.8%; n = 10/173; p < 0.001, odds ratio 3.2 (95% confidence interval 1.6-6.2)]. Prevalence of auditory hallucinations significantly increased with categorized severity of impairment, with rates up to 24% in the most profoundly impaired group (p < 0.001). The corrected odds of hallucination presence increased 1.02 times for each dB of impairment in the best ear. Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%). CONCLUSIONS Our findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Although more research on potential confounding factors is necessary, clinicians should be aware of this phenomenon, by inquiring after hallucinations in hearing-impaired patients and, conversely, assessing hearing impairment in patients with auditory hallucinations, since it may be a treatable factor.
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Affiliation(s)
- M M J Linszen
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - G A van Zanten
- Department of Otorhinolaryngology and Head & Neck Surgery and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - R J Teunisse
- Department of Geriatric Psychiatry,Dimence, Deventer,The Netherlands
| | - R M Brouwer
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
| | - P Scheltens
- Alzheimer Center and Department of Neurology,Neuroscience Campus Amsterdam,VU University Medical Center,Amsterdam,The Netherlands
| | - I E Sommer
- Department of Psychiatry and Brain Center Rudolf Magnus,University Medical Center Utrecht,Utrecht University,Utrecht,The Netherlands
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45
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Nathou C, Etard O, Dollfus S. Auditory verbal hallucinations in schizophrenia: current perspectives in brain stimulation treatments. Neuropsychiatr Dis Treat 2019; 15:2105-2117. [PMID: 31413576 PMCID: PMC6662171 DOI: 10.2147/ndt.s168801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/24/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This review reports the current perspectives of brain stimulation techniques in the treatment of auditory verbal hallucinations (AVH) in schizophrenia. METHODS A systematic search of the literature in the PubMed database revealed that the most studied techniques are noninvasive techniques (NIBS), including electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS). RESULTS The results showed that ECT could have great clinical efficacy but is currently underused in practice perhaps due to the costs associated with its limited implementation and potential associated risks. tDCS is still poorly studied and does not demonstrate sufficiently homogeneous or conclusive results yet to prove its efficacy in the treatment of AVH. However, its safe and simple implementation allows us to recommend it to patients who are refractory to other stimulation techniques. Finally, rTMS seems to be the most efficacious NIBS to offer patients with persistent AVH as an add-on therapeutic strategy. Its implementation has a non negligible cost but can be performed by a single practitioner. Great evolution in these techniques with technological progress, robotics and computer science are currently being tested and will undoubtedly improve the clinical efficacy of these procedures, particularly towards more personalized treatments such as individual rTMS targets and intensities. There are also new techniques for deep brain stimulation based on focused ultrasound that could provide much insight into the treatment of AVH in schizophrenia. CONCLUSION This review suggests that add-on brain stimulation treatments could play a key role among the therapeutic strategies for auditory hallucinations reduction in schizophrenia.
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Affiliation(s)
- Clément Nathou
- Normandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte , Caen, F-14000, France.,Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France
| | - Olivier Etard
- Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France.,Normandie Univ, UNICAEN, CHU de Caen, Service des Explorations Fonctionnelles du Système Nerveux, CHU de Caen, Caen, F-14000, France
| | - Sonia Dollfus
- Normandie Univ, UNICAEN, CHU de Caen, Service de Psychiatrie Adulte , Caen, F-14000, France.,Normandie Univ, UNICAEN, ISTS, EA 7466 , GIP Cyceron, Caen 14000, France
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Rosen C, McCarthy-Jones S, Jones N, Chase KA, Sharma RP. Negative voice-content as a full mediator of a relation between childhood adversity and distress ensuing from hearing voices. Schizophr Res 2018; 199:361-366. [PMID: 29580740 PMCID: PMC6151289 DOI: 10.1016/j.schres.2018.03.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 01/12/2023]
Abstract
A key predictor of whether or not an individual who hears voices (auditory verbal hallucinations; AVH) meets criteria for a psychiatric diagnosis is the level of negative content of the voices (e.g., threats, criticism, abuse). Yet the factors that contribute to negative voice-content are still not well understood. This study aimed to test the hypotheses that levels of childhood adversity would predict levels of negative voice-content, and that negative voice-content would partially mediate a relation between childhood adversity and voice-related distress. These hypotheses were tested in a clinical sample of 61 patients with formally diagnosed psychotic disorders (48 schizophrenia, 13 bipolar). We found evidence consistent with negative voice-content fully (not partially) mediating the relation between childhood adversity and voice-related distress. Although bivariate analyses found depression to be associated with both negative voice-content and voice-related distress, we found no evidence of an indirect effect of childhood adversity on either negative voice-content or voice-related distress via depression. Alternative study designs are now needed to test if our findings are replicable and causal. Should they be, it will be necessary for psychological therapies to devise ways to reduce negative voice-content itself, rather than just changing beliefs about voices. A number of techniques are discussed (Avatar Therapy, Compassion Focused Therapy, voice-dialogue) that already show promise for this.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | | | - Nev Jones
- Department of Mental Health Law & Policy, University of South Florida, Florida, USA
| | - Kayla A Chase
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA; Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
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Rosen C, McCarthy-Jones S, Chase KA, Humpston C, Melbourne JK, Kling L, Sharma RP. The tangled roots of inner speech, voices and delusions. Psychiatry Res 2018; 264:281-289. [PMID: 29660570 PMCID: PMC5972053 DOI: 10.1016/j.psychres.2018.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
The role of inner speech in the experience of auditory verbal hallucinations (AVH) and delusions remains unclear. This exploratory study tested for differences in inner speech (assessed via self-report questionnaire) between 89 participants with psychosis and 37 non-clinical controls. We also tested for associations of inner speech with, i) state/trait AVH, ii) AVH-severity; iii) patients' relations with their voices, and; iv) delusion-severity. Persons with psychosis had greater levels of dialogic inner speech, other people in inner speech, and evaluative/motivational inner speech than non-clinical controls. Those with state, but not trait AVH had greater levels of dialogic and evaluative/motivational inner speech than non-clinical controls. After controlling for delusions, there was a positive relation between AVH-severity and both evaluative/motivational inner speech and other people in inner speech. Participants with greater levels of dialogic inner speech reported better relations both with and between their voices. There was no association between delusion-severity and inner speech. These results highlight the importance of better understanding relations between inner speech and AVH, provide avenues for future research, and underscore the need for research into the interrelatedness of inner speech, voices and delusions, and the complexities involved in disentangling these experiences.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor, Suite 489, Chicago, IL 60612, United States.
| | | | - Kayla A. Chase
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United
States
| | - Clara Humpston
- School of Psychology, Cardiff University, United Kingdom
| | - Jennifer K. Melbourne
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States
| | - Leah Kling
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States
| | - Rajiv P. Sharma
- Department of Psychiatry, University of Illinois at Chicago,
Chicago, IL, United States,Jesse Brown Veterans Affairs Medical Center, Chicago, IL, United
States
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Zanello A, Badan Bâ M, Sentissi O. Are there clinical differences between inner, outer or dual spatial locations of auditory verbal hallucinations? Psychiatry Res 2018; 264:124-130. [PMID: 29631244 DOI: 10.1016/j.psychres.2018.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 02/11/2018] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
The aim of the present exploratory study was to examine the clinical differences of Auditory Verbal Hallucinations (AVHs) according to their spatial localization. Sixty-six outpatients were divided into three separate groups: inner, external and dual AVHs. The three groups were compared on sociodemographic variables (age, gender, education, marital status, living situation, employment, social disability), on clinical psychiatric characteristics (diagnosis, medication, comorbidities, illness onset, illness duration and hospitalizations) and on the measure yielded by the clinical assessments (Brief Psychiatric Rating Scale-Expanded, version 4.0; Maastricht Voices Interview for Adults; Belief About Voices Questionnaire Revised, the Clinical Global Impression, the Global Assessment Functioning Self-Esteem Rating Short Form, the World Health Organisation Quality of Life-Bref). Gender, living situation, social quality of life and some items regarding beliefs about AVHs raised significant difference, however most of the other comparisons failed to reach significance. Taken together, our findings suggest that all AVHs subtypes have equal clinical significance in patients presenting a chronic mental illness. However, the power of the study limits the generalization of the findings. Clinical implications of the findings are proposed.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Belle-Idée, ch. Petit Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
| | - Maryse Badan Bâ
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Belle-Idée, ch. Petit Bel-Air 2, 1226 Thônex, Geneva, Switzerland
| | - Othman Sentissi
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Belle-Idée, ch. Petit Bel-Air 2, 1226 Thônex, Geneva, Switzerland
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Abstract
Hearing voices in the absence of another speaker-what psychiatry terms an auditory verbal hallucination-is often associated with a wide range of negative emotions. Mainstream clinical research addressing the emotional dimensions of voice-hearing has tended to treat these as self-evident, undifferentiated and so effectively interchangeable. But what happens when a richer, more nuanced understanding of specific emotions is brought to bear on the analysis of distressing voices? This article draws findings from the 'What is it like to hear voices' study conducted as part of the interdisciplinary Hearing the Voice project into conversation with philosopher Dan Zahavi's Self and Other: Exploring Subjectivity, Empathy and Shame to consider how a focus on shame can open up new questions about the experience of hearing voices. A higher-order emotion of social cognition, shame directs our attention to aspects of voice-hearing which are understudied and elusive, particularly as they concern the status of voices as other and the constitution and conceptualisation of the self.
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Smith LM, Johns LC, Mitchell R. Characterizing the experience of auditory verbal hallucinations and accompanying delusions in individuals with a diagnosis of bipolar disorder: A systematic review. Bipolar Disord 2017; 19:417-433. [PMID: 28804990 DOI: 10.1111/bdi.12520] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/06/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of the current study was to inform ongoing attempts to identify clinically meaningful subcategories of auditory verbal hallucination (AVH), and to evaluate evidence that might pertain to the suitability of current psychological interventions for people with bipolar disorder (BD) who experience psychotic symptoms. METHODS A comprehensive synthesis of findings on the phenomenology of AVH and delusions in BD is included, alongside a critical review of clinical and cognitive correlates. Studies published in the previous 20 years, until December 2016, were retrieved from the following databases: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. Thirty-two articles were reviewed after applying a set of predetermined inclusion criteria. RESULTS Psychotic symptoms were common in both manic and depressive phases, although higher frequencies were indicated in mania. Few detailed characterizations of AVH phenomenology were identified. Delusions with persecutory, grandiose and referential themes were the most common in BD. AVHs were associated with delusions and there was evidence to suggest that delusion subtype may vary according to mood state and type of AVH. Data on clinical correlates of AVH in BD were sparse. However, the results indicated that cognitive appraisals or interpretations of voices might be different in BD from those established to be predictive of clinical outcomes in schizophrenia spectrum disorders. CONCLUSIONS Clear gaps exist in our current understanding of the first-person experience of AVH in BD and the potential relationship to co-occurring symptoms, including delusions. Further research into cognitive interpretations of AVH in BD might inform adapted psychological interventions for psychotic symptoms in this population.
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Affiliation(s)
- L M Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - L C Johns
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, UK
| | - Rlc Mitchell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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