Volume alterations of the hippocampus and amygdala in patients with schizophrenia and persistent auditory hallucinations

INTRODUCTION

Auditory hallucinations (AH) are one of the most prevalent symptoms of schizophrenia. They might cause several brain alterations, especially changes in the volumes of hippocampus and amygdala, regions related to the relay and processing of auditory cues and emotional memories.

MATERIAL AND METHODS

We have recruited 41 patients with schizophrenia and persistent AH, 35 patients without AH, and 55 healthy controls. Using their MRIs, we have performed semiautomatic segmentations of the hippocampus and amygdala using Freesurfer. We have also performed bilateral correlations between the total PSYRATS score and the volumes of affected subregions and nuclei.

RESULTS

In the hippocampus, we found bilateral increases in the volume of its hippocampal fissure and decreases in the right fimbria in patients with and without AH. The volume of the right hippocampal tail and left head of the granule cell layer from the dentate gyrus were decreased in patients with AH. In the amygdala, we found its left total volume was shrunk, and there was a decrease of its left accessory basal nucleus in patients with AH.

CONCLUSIONS

We have detected volume alterations of different limbic structures likely due to the presence of AH. The volumes of the right hippocampal tail and left head of the granule cell layer from the dentate gyrus, and total volume of the amygdala and its accessory basal nucleus, were only affected in patients with AH. Bilateral volume alterations in the hippocampal fissure and right fimbria seem inherent of schizophrenia and due to traits not contemplated in our research.

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)

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.

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)

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.

Auditory hallucinations in cognitive neurology

INTRODUCTION

Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH).

METHOD

These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded.

RESULTS

Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n=2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n=3), traumatic brain injury (n=1), and surgical brainstem lesion (n=1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n=6), a predisposing drug (n=9), and polypharmacy (n=9).

CONCLUSIONS

Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum.