Auditory Hallucinations In Schizophrenia Research Articles

Uniqueness of auditory hallucinations in patients with schizophrenia and depressive disorder

ABSTRACT Background: While over three-quarters of those suffering from schizophrenia and schizophrenia-like illnesses experience auditory hallucinations, 6% of individuals with depressive disorder report the same. Differentiating between auditory hallucinations in these two illnesses is important both diagnostically and prognostically. Aim: To compare the characteristics of auditory hallucinations in patients with schizophrenia and depressive disorder. Materials and Methods: For both schizophrenia and depressive disorder, 110 patients were selected from inpatients of a tertiary care psychiatric center by purposive sampling. They were assessed with a specially designed proforma containing sociodemographic information, information about clinical features, and characteristics of the Auditory Hallucination Scale. Results: Schizophrenia and depressive disorder patients were matched on age, education, occupation, and socioeconomic status. The patients with schizophrenia rated significantly higher on frequency, clarity, tone, intensity, distractibility, self-control, and distress dimensions of auditory hallucinations as compared to patients with depressive disorder. Conclusion: The characteristics of auditory hallucinations in schizophrenia differ significantly than those in depressive disorder, which bears significant transdiagnostic importance. Clinical evaluation of these differentiating characteristics of auditory hallucinations may aid in diagnostic workup in patients.

Sensory Attenuation Deficit and Auditory Hallucinations in Schizophrenia: A Causal Mechanism or a Risk Factor? Evidence From Meta-Analyses on the N1 Event-Related Potential Component

BackgroundSensory attenuation (SA), the dampened perception of self-generated sensory information, is typically associated with reduced event-related potential signals, such as for the N1 component of auditory event-related potentials. SA, together with efficient monitoring of intentions and actions, should facilitate the distinction between self-generated and externally generated sensory events, thereby optimizing interaction with the world. According to many, SA is deficient in schizophrenia. The question arises whether altered SA reflects a sufficient mechanism to explain positive symptoms such as auditory hallucinations. A systematic association of reduced auditory SA in hallucinating patients would support this hypothesis. MethodsWe conducted a series of meta-analyses on 15 studies on auditory SA in which the N1 component of event-related potential–electroencephalogram signals was measured during talking (self-generated sensory signals condition) or when listening to prerecorded vocalizations (externally generated sensory signals condition). ResultsWe found that individuals with schizophrenia did show some auditory SA because their N1 signal was significantly attenuated in talking conditions compared with listening conditions. However, the magnitude of such attenuation was reduced in individuals with schizophrenia compared to healthy control participants. This phenomenon generalizes independently from the stage of the disease, the severity of positive symptoms, and whether patients have auditory hallucinations or not. ConclusionsThese findings suggest that reduced SA cannot be a sufficient mechanism for explaining positive symptoms such as auditory hallucinations in schizophrenia. Because reduced SA was also present in participants at risk of schizophrenia, reduced SA may represent a risk factor for the disorder. We discuss the implications of these results for clinical-cognitive models of schizophrenia.

Sulcal pits of the superior temporal sulcus in schizophrenia patients with auditory verbal hallucinations.

Auditory verbal hallucinations (AVHs) are among the most common and disabling symptoms of schizophrenia. They involve the superior temporal sulcus (STS), which is associated with language processing; specific STS patterns may reflect vulnerability to auditory hallucinations in schizophrenia. STS sulcal pits are the deepest points of the folds in this region and were investigated here as an anatomical landmark of AVHs. This study included 53 patients diagnosed with schizophrenia and past or present AVHs, as well as 100 healthy control volunteers. All participants underwent a 3-T magnetic resonance imaging T1 brain scan, and sulcal pit differences were compared between the two groups. Compared with controls, patients with AVHs had a significantly different distributions for the number of sulcal pits in the left STS, indicating a less complex morphological pattern. The association of STS sulcal morphology with AVH suggests an early neurodevelopmental process in the pathophysiology of schizophrenia with AVHs.

Auditory hallucinations in schizophrenia: Psychoeducation among caregivers to help patients develop effective coping strategies

Background: Hallucinations are common symptoms experienced by patients with schizophrenia. These hallucinations pose difficulties in control, becoming a burden for caregivers providing care. Meanwhile, psychoeducation utilizing modules and videos to treat auditory hallucinations has not been previously implemented. Psychoeducation is beneficial in managing caregiver burden, yet the psychoeducation content hasn't been specific to auditory hallucinations.Purpose: To determine the influence of psychoeducation using modules and videos to help patients develop effective coping strategies, and burden among caregiversMethod: A quantitative study with a pre-experimental design using a pre-test and post-test approach. This research was conducted to measure caregiver burden before and after the intervention. The intervention involved providing psychoeducation using modules and videos for caring for auditory hallucinations, while the control group received psychoeducation using only modules. The study was conducted at the outpatient clinic of Jambi Regional Mental Hospital from July to September 2023.Results: There was a significant difference in caregiver burden (p-value 0.000) in the intervention group before and after treatment. There was a significant difference in caregiver burden (p-value 0.000) in the control group before and after treatment. There was no significant difference in caregiver burden (p-value 0.161) between the intervention and control groups one month after the intervention.Conclusion: Psychoeducation with modules and videos can reduce caregiver burden in schizophrenia patients. Psychiatric nurses should educate caregivers using modules and videos for caring for auditory hallucinations as part of reducing the caregiving burden.Suggestion: Healthcare professionals should also provide psychoeducation using auditory hallucination care modules and videos to caregivers on managing the caregiving burden for individuals with schizophrenia experiencing auditory hallucinations. Caregivers are encouraged to understand the module book and video on auditory hallucination care as a form of continued care at home for individuals with schizophrenia experiencing auditory hallucinations.

Enhanced Beta2-band Oscillations Denote Auditory Hallucination in Schizophrenia Patients and a Monkey Model of Psychosis.

An electroencephalographic (EEG) signature of auditory hallucinations (AHs) is important for facilitating the diagnosis and treatment of AHs in schizophrenia. We recorded EEG from 25 schizophrenia patients with recurrent AHs. During the period of AHs, EEG recordings exhibited significantly elevated beta2-band power in the temporal region, as compared to those recorded in the absence of AHs or during stimulation with verbal sounds. We further generated methamphetamine-treated rhesus monkeys exhibiting psychosis-like behaviors, including repetitive sudden searching actions in the absence of external intrusion, suggesting the occurrence of AHs. Epidural EEG beta2-band power in the temporal region of these monkeys was enhanced immediately after methamphetamine treatment and positively correlated with the frequency of sudden searching actions. Thus, the enhancement of temporal beta2-band oscillations represents a signature for AHs in both patients and a monkey model of psychosis, and this monkey model can be used for developing closed-loop neuromodulation approaches for the treatment of refractory AHs in schizophrenia.

12. Sensory Attenuation Elicited by Inner Speech and its Role for Auditory Hallucinations in Schizophrenia

12. Sensory Attenuation Elicited by Inner Speech and its Role for Auditory Hallucinations in Schizophrenia

73. Accelerated Low Frequency RTMS for Treatment-Resistant Auditory Hallucinations in Schizophrenia

73. Accelerated Low Frequency RTMS for Treatment-Resistant Auditory Hallucinations in Schizophrenia

Correlation between Negative Life Experiences and Auditory Hallucinations in Schizophrenia

IntroductionAuditory Hallucination(AH) is a core & one of the most common symptom seen in schizophrenia. A prevalence study found that 1yr prevalence of AHs is 70% among patients of schizophrenia. Most theories of AHs discuss biological & psychological factors in phenomenology of voices. There definitely is a role of biological & neuroanatomical basis for occurrence of psychotic phenomenon & AHs, however environment & sociocultural background play important role in their genesis. It has been observed that theme of AHs is usually same, repetitive & associated with past life experiences of patients. The Negative Life Experience(NLE) though not always have significant impact on patient’s psyche, may manifest sooner or later in mental illness. Although AHs may be comforting, helping to cope up with unacceptable unconscious conflict, most patients report them to be negative, distressing & affecting socio-occupational functioning, thus making it important to understand & treat them effectively. Often, AHs stays as a residual symptom with which patient has to deal throughout life. This study is an effort to bridge existing gaps for better understanding of AHs & hence, Schizophrenia. It aims to understand effect of NLE on AHs, & thereby contribute to aetiology & therapeutic services to reduce distress of patients.ObjectivesThis study aims to find presence of history of past NLE in patients with schizophrenia having AHs, find a correlation between NLE & the content of AHs & hence to establish the role of sociocultural factors in phenomenology of AH in patients with schizophrenia.MethodsA longitudinal study of 30 patients diagnosed with Schizophrenia as per DSM-5 having AHs visiting Psychiatry Department of Government Hospital was carried out over a period of 2yrs. A quantitative study to find correlation between presence of NLE & AH in patients and a qualitative study by in-depth interview of 10 patients with help of semi-structured questionnaire to understand phenomenology by procedures of interpretative phenomenological analysis was carried out.ResultsA positive statistically significant correlation between NLE & content of AH was found. Majority of patients experienced AHs based on NLE in past & heard voices related to it. Various themes such as Guilt, Fear, Inadequacy, Anger, Frustration surfaced during the qualitative study.ConclusionsThis study thus strengthens the holistic model where sociocultural factors with biological & psychological factors play a role in pathogenesis of AHs. Treatment weighing on addressing NLE & emotions attached to it may help in foreshortening recovery & deal with residual AHs. This can help in therapeutic management of distress in patients, relieve internal conflict within their psyche, where they would feel more understood and learn to live with persistent AHs.Disclosure of InterestNone Declared

Accelerated (twice daily) low frequency rTMS for treatment-resistant auditory hallucinations in schizophrenia

Accelerated (twice daily) low frequency rTMS for treatment-resistant auditory hallucinations in schizophrenia

Auditory Cortex Thickness Is Associated With N100 Amplitude in Schizophrenia Spectrum Disorders

Abstract Background and Hypothesis The auditory cortex (AC) may play a central role in the pathophysiology of schizophrenia and auditory hallucinations (AH). Previous schizophrenia studies report thinner AC and impaired AC function, as indicated by decreased N100 amplitude of the auditory evoked potential. However, whether these structural and functional alterations link to AH in schizophrenia remain poorly understood. Study Design Patients with a schizophrenia spectrum disorder (SCZspect), including patients with a lifetime experience of AH (AH+), without (AH−), and healthy controls underwent magnetic resonance imaging (39 SCZspect, 22 AH+, 17 AH−, and 146 HC) and electroencephalography (33 SCZspect, 17 AH+, 16 AH−, and 144 HC). Cortical thickness of the primary (AC1, Heschl’s gyrus) and secondary (AC2, Heschl’s sulcus, and the planum temporale) AC was compared between SCZspect and controls and between AH+, AH−, and controls. To examine if the association between AC thickness and N100 amplitude differed between groups, we used regression models with interaction terms. Study Results N100 amplitude was nominally smaller in SCZspect (P = .03, d = 0.42) and in AH− (P = .020, d = 0.61), while AC2 was nominally thinner in AH+ (P = .02, d = 0.53) compared with controls. AC1 thickness was positively associated with N100 amplitude in SCZspect (t = 2.56, P = .016) and AH− (t = 3.18, P = .008), while AC2 thickness was positively associated with N100 amplitude in SCZspect (t = 2.37, P = .024) and in AH+ (t = 2.68, P = .019). Conclusions The novel findings of positive associations between AC thickness and N100 amplitude in SCZspect, suggest that a common neural substrate may underlie AC thickness and N100 amplitude alterations.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Disrupted auditory N1, theta power and coherence suppression to willed speech in people with schizophrenia

The phenomenon of sensory self-suppression - also known as sensory attenuation - occurs when a person generates a perceptible stimulus (such as a sound) by performing an action (such as speaking). The sensorimotor control system is thought to actively predict and then suppress the vocal sound in the course of speaking, resulting in lowered cortical responsiveness when speaking than when passively listening to an identical sound. It has been hypothesized that auditory hallucinations in schizophrenia result from a reduction in self-suppression due to a disruption of predictive mechanisms required to anticipate and suppress a specific, self-generated sound. It has further been hypothesized that this suppression is evident primarily in theta band activity. Fifty-one people, half of whom had a diagnosis of schizophrenia, were asked to repeatedly utter a single syllable, which was played back to them concurrently over headphones while EEG was continuously recorded. In other conditions, recordings of the same spoken syllables were played back to participants while they passively listened, or were played back with their onsets preceded by a visual cue. All participants experienced these conditions with their voice artificially shifted in pitch and also with their unaltered voice. Suppression was measured using event-related potentials (N1 component), theta phase coherence and power. We found that suppression was generally reduced on all metrics in the patient sample, and when voice alteration was applied. We additionally observed reduced theta coherence and power in the patient sample across all conditions. Visual cueing affected theta coherence only. In aggregate, the results suggest that sensory self-suppression of theta power and coherence is disrupted in schizophrenia.

Different Modalities of Transcranial Magnetic Stimulation to Manage Schizophrenia.

Objective: To analyze all current literature related to different transcranial magnetic stimulation (TMS) modalities in the management of schizophrenia symptoms and compare the main controversies in the outcome measures. Data Sources: A comprehensive search in Ovid MEDLINE, APA PsycINFO, and PubMed was conducted (1996 to present) to identify all articles using the search terms schizophrenia and single pulse TMS, schizophrenia and paired pulse TMS, schizophrenia and repetitive TMS, schizophrenia and deep TMS, and schizophrenia and TBS. Data Selection: Search results were limited to the English language and human subjects. Unrelated articles were excluded after the initial review. Nineteen studies fulfilled the eligibility criteria. These studies included 531 schizophrenia patients and 283 healthy controls. Results: While some adverse effects of TMS are reported, the process is generally considered safe. However, discrepancies exist regarding the length of the cortical silent period. The cortical silent period is thought to be mediated by γ-aminobutyric acid (GABA) receptors and is considered a useful probe to assess motor cortical inhibition. It is generally believed that patients with schizophrenia present changes in the cortical silent period due to GABA abnormalities. A few physiologic studies utilized TMS to study motor cortical excitability in schizophrenia and reported longer, and some shorter, cortical silent periods compared with healthy controls. Also, some studies reported a shorter cortical silent period for unmedicated versus medicated patients, while others reported no differences. Conclusion: TMS treatment is commonly reported to improve auditory hallucination in schizophrenia. Advantage of use of deep TMS over repetitive TMS, however, is controversial.

Altered brain responses to emotional auditory stimuli in AVH subjects: an fMRI study

Purpose: Auditory verbal hallucinations (AVH) are a frequently occurring phenomenon in which subjects hear verbal sounds in the absence of any external stimuli. The prevalence of auditory hallucinations in schizophrenia has been revealed in many studies. Healthy subjects may also experience auditory hallucinations without accompanying psychological or neurological disorders, and in rare cases they seek clinical assistance for this emotionally disturbing condition. The aim of this study was to investigate the neural basis of emotional disturbance in auditory hallucinating subjects who do not suffer from any psychological or neurological disorder. Materials and Methods: Fourteen subjects suffering from auditory hallucinations and 15 age- and sex-matched healthy controls were recruited in this study. All participants underwent fMRI in two experimental sessions. In the first experimental session, all participants from both groups listened to pleasant auditory stimuli. In the second session, both groups listened to unpleasant auditory stimuli. The auditory stimuli were obtained from the International Affective Digitized Sounds (IADS). Results: Compared with the healthy control group, AVH subjects exhibited significantly increased activation in limbic, auditory, and frontal regions. Conclusion: Current results suggest that AVH may induce functional reorganization in emotion-related brain regions.

Adjunctive tDCS for treatment-refractory auditory hallucinations in schizophrenia: A meta-analysis of randomized, double-blinded, sham-controlled studies.

Treatment-refractory auditory hallucinations (TRAH) in schizophrenia often do not improve with pharmacotherapy. We performed a meta-analysis of randomized, double-blind, sham-controlled clinical trials (RCTs) that systematically examined the therapeutic effects and tolerability of adjunctive active versus sham active transcranial direct current stimulation (tDCS) for auditory hallucinations as measured by the Auditory Hallucination Rating Scale (AHRS) in schizophrenia patients with TRAH. Relevant data were extracted, checked and analyzed using the Review Manager, Version 5.3 by three independent investigators. Eight double-blind RCTs covering 329 schizophrenia patients (168 in active tDCS group, 161 in sham tDCS group) were included. Although no advantage of active tDCS on auditory hallucinations [7 RCTs, n=224; standardized mean difference (SMD): -0.33 (95% confidence interval (CI): -0.71, 0.05), P=0.09; I2 =46%] was found compared to sham, subgroup analyses revealed that active tDCS with twice-daily stimulation [6 RCTs, n=198; SMD: -0.42 (95%CI: -0.82, -0.02), P=0.04; I2 =44%] and active tDCS with ≥10 stimulation sessions [6 RCTs, n=198; SMD: -0.42 (95%CI: -0.82, -0.02), P=0.04; I2 =44%] showed a significantly better therapeutic effect than sham in improving auditory hallucinations symptoms. Meta-analyses of total psychopathology and discontinuation due to any reason were not significantly different between the active and sham tDCS groups. This meta-analysis demonstrated that the effects of tDCS for auditory hallucinations symptoms were influenced by the tDCS parameters. Twice-daily stimulation and ≥10 stimulation sessions may be needed to improve auditory hallucinations symptoms in schizophrenia with TRAH.

Randomized comparative study of 1-Hz transcranial magnetic stimulation (TMS), continuous theta-burst stimulation (cTBS) and sham-TMS for treatment-refractory auditory hallucinations (AH) in schizophrenia

IntroductionInsufficient efficacy of conventional treatment of auditory hallucinations (AH) in schizophrenia supports rising interest to brain stimulation techniques including transcranial magnetic stimulation (TMS). Left temporo-parietal cortex (TP3) is involved in emergence of AH, thus neuromodulation of this area might be reasonable.ObjectivesComparison of efficacy and tolerability of 2 protocols of TMS (1 Hz and cTBS) over TP3 and sham-TMS for treatment resistant AH in schizophrenia.Methods76 schizophrenia (ICD-10 - F20) patients with prominent AH (PANSS P3 ≥ 4, AHRS ≥ 15), who had failed to respond to previous antipsychotic treatment, were randomized into 3 groups: 1) 1 Hz TMS (30 patients); 2) cTBS (25 patients); 3) Sham-TMS (21 patients). Sessions were performed 5 days a week for 3 weeks. Antipsychotic medication was continued throughout the study. Patients were assessed weekly with PANSS, AHRS, CDSS, CGI-S by blinded raters. The criterion of efficacy was 30% AHRS score reduction after 3 weeks of treatment.ResultsThe number of responders were 13 (43,3%) in 1 Hz TMS group, 14 (56%) – in cTBS group, 4 (19,1%) in sham-TMS group. There was no statistically significant difference in efficacy between 1 Hz TMS and cTBS, but each of the active protocols was more effective than sham-TMS. Treatment was generally well tolerated in all groups, nobody was discontinued the study due to adverse events.ConclusionsBoth protocols of TMS (1 Hz and cTBS) over TP3 are safe and effective in the treatment of schizophrenic patients with pharmacotherapy resistant AH. Further studies are needed.DisclosureNo significant relationships.

From Symptom-Capture Neuroimaging to Imaging Biomarker Development: The Challenge of Auditory Hallucinations in Schizophrenia

Psychiatric brain imaging has matured. We are now able to reliably localize and characterize brain function and structure associated with psychiatric disorders with magnetic resonance imaging (MRI). Functional MRI (fMRI) provides systems-level measures of brain activity, which allows for the direct correlation of brain states and mental states not provided by complementary techniques that give valuable cellular and molecular or temporal information. Psychiatric disorders are currently defined descriptively and categorically, however, based upon subjective reports and observations of behavior.

The Etiology of Auditory Hallucinations in Schizophrenia: From Multidimensional Levels.

Enormous efforts have been made to unveil the etiology of auditory hallucinations (AHs), and multiple genetic and neural factors have already been shown to have their own roles. Previous studies have shown that AHs in schizophrenia vary from those in other disorders, suggesting that they have unique features and possibly distinguishable mechanisms worthy of further investigation. In this review, we intend to offer a comprehensive summary of current findings related to AHs in schizophrenia from aspects of genetics and transcriptome, neurophysiology (neurometabolic and electroencephalogram studies), and neuroimaging (structural and functional magnetic resonance imaging studies and transcriptome–neuroimaging association study). Main findings include gene polymorphisms, glutamate level change, electroencephalographic alterations, and abnormalities of white matter fasciculi, cortical structure, and cerebral activities, especially in multiple regions, including auditory and language networks. More solid and comparable research is needed to replicate and integrate ongoing findings from multidimensional levels.

Resting-state Brain Network Analysis of Auditory Hallucinations in Schizophrenia

Resting-state Brain Network Analysis of Auditory Hallucinations in Schizophrenia

Mismatch Negativity to Multiple Deviants are Associated With Different Features of Auditory Hallucinations in Schizophrenia

Auditory hallucinations (AHs) are a key symptom of schizophrenia (SZ) that cause functional impairment and distress. Even with antipsychotic medication interventions, 25% of patients continue to experience AHs. Research into the underlying neuronal mechanisms of AHs may aid in developing alternative treatments. The mismatch negativity (MMN) is an auditory event-related potential that represents preattentive detection of stimulus deviance. MMN deficits are prominent in SZ and have been associated with greater AH frequency. MMN deficits may be related to specific features of AHs, which have yet to be extensively assessed.