Auditory Hallucination Subscale Research Articles

Correlation between abnormal N-acetyl-aspartate levels in posterior cingulate cortex and persistent auditory verbal hallucinations in Chinese patients with chronic schizophrenia

The aim of this study was to investigate the relationship between persistent auditory verbal hallucinations (pAVHs) and N-acetyl-aspartate (NAA) levels in posterior cingulate cortex (PCC). 117 schizophrenia (SCZ) patients (61 pAVHs and 56 non-AVHs) and 66 healthy controls were included. The P3 item of the Positive and Negative Syndrome Scale and the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scale were used to assess the severity of pAVHs. NAA levels were significantly lower in the AVHs group, and were negatively correlated with pAVHs. Therefore, increasing the NAA levels in PCC may be helpful in treating pAVHs.

Smartphone-assisted guided self-help cognitive behavioral therapy for young people with distressing voices (SmartVoices): study protocol for a randomized controlled trial

BackgroundThe long-standing view that auditory verbal hallucinations (AVH) or hearing voices is a sign of schizophrenia has been challenged by research demonstrating that they lie on a continuum ranging from normal to pathological experience related to distress and need for care. Hearing voices is more prevalent in adolescence than in later life, and hearing voices during adolescence indicates a risk for severe psychopathology, functional impairments, and suicide later in life. While there is increasing evidence for the efficacy of cognitive behavioral therapy for voices (CBTv) in adults with schizophrenia, research on psychological treatments for youth with distressing voices has been scarce. The aim of the current study is to examine the efficacy of CBTv, delivered using smartphone-based Ecological Momentary Assessment Intervention (EMI) in a transdiagnostic sample of youth.MethodsThis is a superiority randomized controlled trial comparing 8 weeks of CBTv-based EMI in addition to treatment as usual (TAU) versus TAU only. TAU covers both no treatment and any form of psychiatric/psychological treatment. In the EMI condition, participants will be prompted twice a day to complete an EMA survey, and receive one intervention proposal per assessment. One-hundred fifty-four youth aged 14–25 years with distressing voices will be recruited from psychiatric clinics, local private practices, internet forums, and advertisements in print and social media. Before and after the intervention phase, participants will undergo a 9-day EMA. Single-blinded assessments will be conducted at baseline (T0) and at 3-month (T1) and 6-month (T2) follow-up. The primary outcome is the distress dimension of the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scales at T1. Secondary outcomes include perceived hostile intention, power, and dominance of voices, passive, aggressive, and assertive relating to voices, and negative core beliefs about the self.DiscussionAdolescence provides a crucial window of opportunity for early intervention for hearing voices. However, youth are notoriously reluctant help-seekers. This study offers a low-intensity psychological intervention for youth with distressing voices beyond diagnostic boundaries that, using a mobile technology approach, may match the treatment preferences of the generation of “digital natives.”Trial registrationGerman Clinical Trials Register DRKS00026243. Registered on 2 September 2021

P300 Analysis Using High-Density EEG to Decipher Neural Response to rTMS in Patients With Schizophrenia and Auditory Verbal Hallucinations.

Schizophrenia is a complex disorder about which much is still unknown. Potential treatments, such as transcranial magnetic stimulation (TMS), have not been exploited, in part because of the variability in behavioral response. This can be overcome with the use of response biomarkers. It has been however shown that repetitive transcranial magnetic stimulation (rTMS) can the relieve positive and negative symptoms of schizophrenia, particularly auditory verbal hallucinations (AVH). This exploratory work aims to establish a quantitative methodological tool, based on high-density electroencephalogram (HD-EEG) data analysis, to assess the effect of rTMS on patients with schizophrenia and AVH. Ten schizophrenia patients with drug-resistant AVH were divided into two groups: the treatment group (TG) received 1 Hz rTMS treatment during 10 daily sessions (900 pulses/session) over the left T3-P3 International 10-20 location. The control group (CG) received rTMS treatment over the Cz (vertex) EEG location. We used the P300 oddball auditory paradigm, known for its reduced amplitude in schizophrenia with AVH, and recorded high-density electroencephalography (HD-EEG, 256 channels), twice for each patient: pre-rTMS and 1 week post-rTMS treatment. The use of HD-EEG enabled the analysis of the data in the time domain, but also in the frequency and source-space connectivity domains. The HD-EEG data were linked with the clinical outcome derived from the auditory hallucinations subscale (AHS) of the Psychotic Symptom Rating Scale (PSYRATS), the Quality of Life Scale (QoLS), and the Depression, Anxiety and Stress Scale (DASS). The general results show a variability between subjects, independent of the group they belong to. The time domain showed a higher N1-P3 amplitude post-rTMS, the frequency domain a higher power spectral density (PSD) in the alpha and beta bands, and the connectivity analysis revealed a higher brain network integration (quantified using the participation coefficient) in the beta band. Despite the small number of subjects and the high variability of the results, this work shows a robust data analysis and an interplay between morphology, spectral, and connectivity data. The identification of a trend post-rTMS for each domain in our results is a first step toward the definition of quantitative neurophysiological parameters to assess rTMS treatment.

Metacognition and Mindfulness Integrated Therapy Reduces Severity of Hallucination in a Patient Not Taking Antipsychotic Medication.

Psychological interventions have proven efficacy in treating psychotic symptoms such as delusions and hallucinations. However, the efficacy of these interventions has primarily been evaluated in the context of their use as an adjunct to antipsychotics or on patients who do not respond to adequate trials of antipsychotics. There is paucity of research about the effectiveness of psychological interventions in patients who do not take antipsychotics either because they are not willing to take medications or are not able to tolerate antipsychotics due to the side effects. We report here the case of a patient who had distressing auditory hallucinations and was not able to take antipsychotic medications because of severe reactions. She responded to metacognition and mindfulness integrated therapy for auditory hallucination. A total of eight sessions of therapy with the major focus on enhancement of metacognitive insight into the mechanisms of genesis and maintenance of hallucinations followed by encouraging the patient to use mindfulness-based strategies and regular self-monitoring of hallucinatory experiences were conducted. The patient was assessed pre-post intervention on the auditory hallucination subscale of the Psychotic Symptom Rating Scale (PSYRATS). There was significant improvement as reflected by more than 50% reduction in the PSYRATS score. This case highlights that metacognition and mindfulness integrated therapy has the potential to help patients with hallucination who do not take antipsychotic medications. The insight building helps in developing a detached approach towards hallucinatory experiences which, in turn, reduces distress caused by the hallucinations.

The Dimensions of Auditory Hallucination in Schizophrenia: Association with Depressive Symptoms and Quality of Life

Introduction: Auditory hallucination (AH) is often unexplored in depth in clinical practice. This study sought to ascertain the relationship between AH, depressive symptoms and quality of life (QOL) and its association with socio-demographic and clinical variables. Methods: This was a cross sectional study done in a psychiatry unit involving 60 schizophrenic patients between 18 to 60 years old. Psychotic Symptom Rating Scale – Auditory Hallucination subscale (PSYRATS-AH), Calgary Depression Scale for Schizophrenia (CDSS) and World Health Organization Quality of Life-Brief scale (WHOQOL-BREF) were used as instruments. Results: Alcohol intake was found to be significantly associated with the severity of AH. A significant moderate positive correlation was found between AH total score and CDSS (r=0.53, p<0.001) and moderately high correlation between emotional characteristics subscale with CDSS (r=0.651, p<0.005). The PSYRATS-AH dimensions; amount of distress (r=0.721, p<0.001) and intensity of distress (r=0.757, p<0.001) showed significant high correlation with CDSS. As for QOL, frequency of AH (r=-0.419, p<0.01) and CDSS (r=0.435, p<0.01) showed significant moderate negative correlation, while duration, loudness, amount and intensity of distress, disruption to life and controllability of voices had significant fair correlation with QOL. Multiple regression analysis revealed that the frequency of AH (p=0.047), controllability of AH (p=0.027) and depressive symptoms (p=0.001) significantly predict QOL. Conclusion: Our results demonstrated that each dimension of AH had different contributions towards depressive symptoms and the QOL in patients with schizophrenia. Therefore, appropriate treatment focusing on the specific dimension of AH not only may reduce depressive symptoms, but may also improve QOL of these patients.

Impact of antipsychotic medication on transcranial direct current stimulation (tDCS) effects in schizophrenia patients

Transcranial direct current stimulation (tDCS) has generated interest as a treatment modality for schizophrenia. Dopamine, a critical pathogenetic link in schizophrenia, is also known to influence tDCS effects. We evaluated the influence of antipsychotic drug type (as defined by dopamine D2 receptor affinity) on the impact of tDCS in schizophrenia. DSM-IV-TR-diagnosed schizophrenia patients [N=36] with persistent auditory hallucinations despite adequate antipsychotic treatment were administered add-on tDCS. Patients were divided into three groups based on the antipsychotic’s affinity to D2 receptors. An auditory hallucinations score (AHS) was measured using the auditory hallucinations subscale of the Psychotic Symptom Rating Scales (PSYRATS). Add-on tDCS resulted in a significant reduction inAHS. Antipsychotic drug type had a significant effect on AHS reduction. Patients treated with high affinity antipsychotics showed significantly lesser improvement compared to patients on low affinity antipsychotics or a mixture of the two. Furthermore, a significant sex-by-group interaction occurred; type of medication had an impact on tDCS effects only in women. Improvement differences could be due to the larger availability of the dopamine receptor system in patients taking antipsychotics with low D2 affinity. Sex-specific differences suggest potential estrogen-mediated effects. This study reports a first-time observation on the clinical utility of antipsychotic drug type in predicting tDCS effects in schizophrenia.

TDCS Improves Antisaccade Task Performance in Schizophrenia

s / Brain Stimulation 8 (2015) 360e377 370 Methods: Treatment was applied to a 25-year-old right-handed married woman having schizophrenia (DSM-IV) predominated by auditory verbal hallucinations that were non-responsive to several antipsychotic treatment trials. In August 2013, she was treated with add-on tDCS that led to near total improvement in hallucinations. Over the next one year, she continued to maintain the clinical improvement and was on treatment with Iloperidone 12mg per day. In august 2014, during the 18th week of her first pregnancy, she presented with relapse of auditory hallucinations for a period of one month despite being on regular treatment with Iloperidone. In view of previous clinical benefit, she was treated with add-on tDCS with written informed consent. tDCS was administered using a standard equipment (TCT device model number M101-R-2012-V1.3; prefrontal anode; temporo-parietal cathode; left-sided; 2-mA; 20-minutes; 5-days twice-daily sessions) with stringent safety measures. The severity of auditory hallucinations was measured using the auditory hallucinations subscale (AHS) of PSYRATS. Results: Baseline AHS score was 29. Immediately after 5-days of tDCS, AHS score was 22. Over the period of the next week, the patient reported progressive reduction in hallucinations. AHS score at one month after tDCS was 2. Discussion: This is likely the first report of successful application of tDCS in a pregnant woman with schizophrenia.Rigorous evaluation of add-on tDCS for the treatment of auditory verbal hallucinations in pregnant patients will facilitate establishment of non-invasive and safer alternative to antipsychotic treatment in this special population.

Clinical Utility of Add-On tDCS in Schizophrenia: An Open Label Study of 50 Patients

s / Brain Stimulation 8 (2015) 360e377 370 Methods: Treatment was applied to a 25-year-old right-handed married woman having schizophrenia (DSM-IV) predominated by auditory verbal hallucinations that were non-responsive to several antipsychotic treatment trials. In August 2013, she was treated with add-on tDCS that led to near total improvement in hallucinations. Over the next one year, she continued to maintain the clinical improvement and was on treatment with Iloperidone 12mg per day. In august 2014, during the 18th week of her first pregnancy, she presented with relapse of auditory hallucinations for a period of one month despite being on regular treatment with Iloperidone. In view of previous clinical benefit, she was treated with add-on tDCS with written informed consent. tDCS was administered using a standard equipment (TCT device model number M101-R-2012-V1.3; prefrontal anode; temporo-parietal cathode; left-sided; 2-mA; 20-minutes; 5-days twice-daily sessions) with stringent safety measures. The severity of auditory hallucinations was measured using the auditory hallucinations subscale (AHS) of PSYRATS. Results: Baseline AHS score was 29. Immediately after 5-days of tDCS, AHS score was 22. Over the period of the next week, the patient reported progressive reduction in hallucinations. AHS score at one month after tDCS was 2. Discussion: This is likely the first report of successful application of tDCS in a pregnant woman with schizophrenia.Rigorous evaluation of add-on tDCS for the treatment of auditory verbal hallucinations in pregnant patients will facilitate establishment of non-invasive and safer alternative to antipsychotic treatment in this special population.

Adjuvant low-frequency rTMS in treating auditory hallucinations in recent-onset schizophrenia: a randomized controlled study investigating the effect of high-frequency priming stimulation.

BackgroundRepetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing frequency and duration of auditory verbal hallucinations (AVH). Priming stimulation, which involves high-frequency rTMS stimulation followed by low-frequency rTMS, has been shown to markedly enhance the neural response to the low-frequency stimulation train. However, this technique has not been investigated in recent onset schizophrenia patients. The aim of this randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS in recent onset schizophrenia patients.MethodsForty recent onset schizophrenia patients completed the study. Patients were randomized over two groups: one receiving low-frequency rTMS preceded by priming and another receiving low-frequency rTMS without priming. Both treatments were directed at the left temporo-parietal region. The severity of AVH and other psychotic symptoms were assessed with the auditory hallucination subscale (AHRS) of the Psychotic Symptom Rating Scales (PSYRATS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI).ResultsWe found that all the scores of these ratings significantly reduced over time (i.e. baseline through 1, 2, 4 and 6 weeks) in both the treatment groups. We found no difference between the two groups on all measures, except for significantly greater improvement on loudness of AVH in the group with priming stimulation during the follow-ups (F = 2.72; p < .05).ConclusionsWe conclude that low-frequency rTMS alone and high-frequency priming of low-frequency rTMS do not elicit significant differences in treatment of overall psychopathology, particularly AVH when given in recent onset schizophrenia patients. Add on priming however, seems to be particularly better in faster reduction in loudness of AVH.

Repetitive transcranial magnetic stimulation for hallucination in schizophrenia spectrum disorders: A meta-analysis.

Objective:This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hallucination of patients with schizophrenia spectrum disorders.Data Sources:Online literature retrieval was conducted using PubMed, ISI Web of Science, EMBASE, Medline and Cochrane Central Register of Controlled Trials databases from January 1985 to May 2012. Key words were “transcranial magnetic stimulation”, “TMS”, “repetitive transcranial magnetic stimulation”, and “hallucination”.Study Selection:Selected studies were randomized controlled trials assessing therapeutic efficacy of repetitive transcranial magnetic stimulation for hallucination in patients with schizophrenia spectrum disorders. Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hallucination in schizophrenia spectrum disorders. Control groups received sham stimulation.Main Outcome Measures:The primary outcome was total scores of Auditory Hallucinations Rating Scale, Auditory Hallucination Subscale of Psychotic Symptom Rating Scale, Positive and Negative Symptom Scale-Auditory Hallucination item, and Hallucination Change Scale. Secondary outcomes included response rate, global mental state, adverse effects and cognitive function.Results:Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened, with controls receiving sham stimulation. All data were completely effective, involving 398 patients. Overall mean weighted effect size for repetitive transcranial magnetic stimulation versus sham stimulation was statistically significant (MD = –0.42, 95%CI: –0.64 to –0.20, P = 0.000 2). Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation (OR = 2.94, 95%CI: 1.39 to 6.24, P = 0.005). No significant differences were found between active repetitive transcranial magnetic stimulation and sham stimulation for positive or negative symptoms. Compared with sham stimulation, active repetitive transcranial magnetic stimulation had equivocal outcome in cognitive function and commonly caused headache and facial muscle twitching.Conclusion:Repetitive transcranial magnetic stimulation is a safe and effective treatment for auditory hallucination in schizophrenia spectrum disorders.

Electro-acupuncture versus sham electro-acupuncture for auditory hallucinations in patients with schizophrenia: a randomized controlled trial

Objective: To compare the efficacy of electro-acupuncture with that of sham electro-acupuncture for auditory hallucinations in patients with schizophrenia partially responsive or non-responsive to risperidone. Design: Patient- and assessor-blinded randomized controlled trial. Setting: Hospital-based practice. Participants: Schizophrenia patients with auditory hallucinations who are partially responsive or non-responsive to risperidone monotherapy (n = 60). Interventions: All patients were randomly allocated to a real electro-acupuncture group or a sham electro-acupuncture group and treated for 30 sessions within six weeks. Main outcome measures: The primary outcome measure was the Psychotic Symptom Rating Scales Auditory Hallucination Subscale. Secondary outcomes included the Positive and Negative Syndrome Scale and side-effects. A clinical response was defined as >20% reduction score (from baseline) on the total score of the Psychotic Symptom Rating Scales Auditory Hallucination Subscale. Results: Sixty patients were selected for randomized real electro-acupuncture treatment (n = 30) or sham electro-acupuncture treatment (n = 30). Patients in the real electro-acupuncture group experienced greater improvement in the Psychotic Symptom Rating Scales Auditory Hallucination Subscale total score, physical characteristics factor score and the Positive and Negative Syndrome Scale positive symptom score than the sham electro-acupuncture group at both week 4 and week 6. The clinical response rates in the real electro-acupuncture group and sham electro-acupuncture group were 43.3% (n = 30) and 13.3% (n = 30), respectively (χ2 = 6.648, P =0.027). There was no significance between-group difference in side-effects. Conclusion: Electro-acupuncture might provide improvement in auditory hallucinations and positive symptom for patients with schizophrenia partially responsive or non-responsive to risperidone monotherapy.

Stabilization of the Internal Structure of Persistent Auditory Verbal Hallucinations in Schizophrenia

Numerous studies have been conducted to investigate the phenomenological characteristics of auditory verbal hallucinations in schizophrenia. Difficulties in understanding the clinical significance of auditory verbal hallucinations may be attributed to the changes in symptom structure over the long-term course of the illness. The purpose of the present study was therefore to investigate the longitudinal changes in the phenomenological dimensions of auditory verbal hallucinations in patients with schizophrenia. Using the Psychotic Symptom Rating Scales-Auditory Hallucination Subscale, 40 patients meeting DSM-IV criteria for schizophrenia (drug-naive first-episode schizophrenia, n=21; and drug-free chronic schizophrenia, n=19) who reported persistent auditory verbal hallucinations were assessed before the initiation of antipsychotic treatment and after 6 months of treatment. To detect the changes in underlying clusters of phenomenological variables, hierarchical clustering and multidimensional analysis were performed. The phenomenological variables of auditory verbal hallucinations formed two main clusters with 6 month treatment: emotional and cognitive. Physical characteristics failed to indicate a stable cluster. Psychosocial disruption, which initially formed a cluster with cognitive variables, congregated with emotional variables at 6 months. Subgroup analysis indicated that the cluster structure of the first-episode group showed more dynamic changes than did that of the chronic schizophrenia group. Phenomenological variables characterizing persistent auditory verbal hallucinations can be differentiated into emotional and cognitive clusters with achievement of symptom stabilization, and the changes in physical characteristics may not be the sole sign of clinical improvement.

Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS).

Scales to measure the severity of different dimensions of auditory hallucinations and delusions are few. Biochemical and psychological treatments target dimensions of symptoms and valid and reliable measures are necessary to measure these. The inter-rater reliability and validity of the Psychotic Symptom Rating Scales (PSYRATS: auditory hallucination subscale and delusions subscale), which measure several dimensions of auditory hallucinations and delusions were examined in this study. The two scales were found to have excellent inter-rater reliability. Their validity as compared with the KGV scale (Krawiecka et al. 1977) was explored. It is concluded that the PSYRATS are useful assessment instruments and can complement existing measures.