Insight-related beliefs and controllability appraisals contribute little to hallucinated voices: a transdiagnostic network analysis study

Elisavet Pappa,Vaughan Bell,Emmanuelle Peters

doi:10.1007/s00406-020-01166-3

Abstract

Hallucinated voices cause high levels of distress and disability. Current theories suggest that insight-related beliefs, about internal or external origin, perceived source location, and appraisals of controllability are important in mediating the impact of these experiences but previous findings have been mixed. We report two open code and open data network analytic studies of items in the Psychotic Symptoms Ratings Scale for auditory verbal hallucinations (PSYRATS-AH) in a large sample of patients with hallucinated voices to examine the network structure of items at (1) first assessment, and (2) differences over two consecutive assessments during a wait-list period. Networks were generated using least absolute shrinkage and selection operator (LASSO) and extended Bayesian information criterion (EBIC) with node predictability. In Study 1 (N = 386), we report that insight-related items made a negligible contribution to hallucinated voices and the controllability appraisal made at most a modest contribution. Items relating to distress and negative content were the most central and most predicted by the wider network. In Study 2 (N = 204), we tested the longitudinal stability of the structure of hallucinated voices over a period of several months, finding a small change in total hallucination score and global strength but no clear evidence for an alteration in the structural relationship. The insight-related and controllability items remained as least influential over time. Insight-related beliefs and controllability appraisals may contribute less than previously thought to distressing hallucinated voices although we do not discount that other appraisals may remain important.

Highlights

Auditory verbal hallucinations are present in up to 70% of patients with a diagnosis of schizophrenia, almost a quarter of patients with bipolar disorder, and contribute to both distress and disability in affected people [1]
One of the most important appraisals relates to the perceived origin of voices, with ‘insight’ ascribed to the voice hearer if they believe the voices are generated within the self and ‘lack of insight’ ascribed to the voice hearer if they believe the voices originate from external sources [3]
Stephane et al [6] found that patients with schizophrenia who heard hallucinations inside their head were more likely to demonstrate memory source monitoring deficits, while Docherty et al [7] found that internally located hallucinations were more intrusive and distressing

Summary

Introduction

Auditory verbal hallucinations are present in up to 70% of patients with a diagnosis of schizophrenia, almost a quarter of patients with bipolar disorder, and contribute to both distress and disability in affected people [1]. No reliable associations were found by Copolov et al [4] in large sample of patients with psychotic disorders, neither were they found by Oulis et al.’s [8] study on patients admitted with acute psychosis, and they were only associated with number of hallucinated words and utterances in a study by Nayani and David [9]. Despite these mixed results, these characteristics are still cited in contemporary psychiatric textbooks as unequivocal markers of clinical severity [10, 11]

Methods

Results

Conclusion