Auditory Verbal Hallucinations Research Articles

Abnormal effective connectivity of reward network in first-episode schizophrenia with auditory verbal hallucinations

ObjectiveAuditory verbal hallucinations (AVHs) in schizophrenia is proved to be associated with dysfunction of mesolimbic-cortical circuits, especially during abnormal salient and internal verbal resource monitoring processing procedures. However, the information flow among areas involved in coordinated interaction implicated the pathophysiology of AVHs remains unclear. MethodsWe used spectral dynamic causal modeling (DCM) to quantify connections among eight critical hubs of reward network in 86 first-episode drug-naïve schizophrenia patients with AVHs (AVH), 93 patients without AVHs (NAVH), and 88 matched normal controls (NC) using resting-state functional magnetic resonance imaging. Group-level connection coefficients, between-group differences and correlation analysis between image measures and symptoms were performed. ResultDCM revealed weaker effective connectivity (EC) from right ventral striatum (RVS) to ventral tegmental area (VTA) in AVH compared to NAVH. AVH showed stronger EC from left anterior insula (AI) to RVS, stronger EC from RVS to anterior cingulate cortex (ACC), and stronger EC from VTA to posterior cingulate cortex (PCC) compared to NC. The correlation analysis results were mostly visible in the negative correlation between EC from right AI to ACC and positive sub-score, P1 sub-score, and P3 sub-score of PNASS in group-level. ConclusionThese findings suggest that neural causal interactions between the reward network associated with AVHs are disrupted, expanding the evidence for potential neurobiological mechanisms of AVHs. Particularly, dopamine-dependent salience attribution and top-down monitoring impairments and compensatory effects of enhanced excitatory afferents to ACC, which may provide evidence for a therapeutic target based on direct in vivo of AVHs in 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.

Investigating Generalizability of Speech-based Suicidal Ideation Detection Using Mobile Phones

Speech-based diaries from mobile phones can capture paralinguistic patterns that help detect mental illness symptoms such as suicidal ideation. However, previous studies have primarily evaluated machine learning models on a single dataset, making their performance unknown under distribution shifts. In this paper, we investigate the generalizability of speech-based suicidal ideation detection using mobile phones through cross-dataset experiments using four datasets with N=786 individuals experiencing major depressive disorder, auditory verbal hallucinations, persecutory thoughts, and students with suicidal thoughts. Our results show that machine and deep learning methods generalize poorly in many cases. Thus, we evaluate unsupervised domain adaptation (UDA) and semi-supervised domain adaptation (SSDA) to mitigate performance decreases owing to distribution shifts. While SSDA approaches showed superior performance, they are often ineffective, requiring large target datasets with limited labels for adversarial and contrastive training. Therefore, we propose sinusoidal similarity sub-sampling (S3), a method that selects optimal source subsets for the target domain by computing pair-wise scores using sinusoids. Compared to prior approaches, S3 does not use labeled target data or transform features. Fine-tuning using S3 improves the cross-dataset performance of deep models across the datasets, thus having implications in ubiquitous technology, mental health, and machine learning.

Are visual pseudohallucinations and auditory verbal hallucinations equivalents?

Are visual pseudohallucinations and auditory verbal hallucinations equivalents?

FMRI-based neurofeedback strategies and the way forward to treating phasic psychiatric symptoms.

Auditory verbal hallucinations (AVH) are the perfect illustration of phasic symptoms in psychiatric disorders. For some patients and in some situations, AVH cannot be relieved by standard therapeutic approaches. More advanced treatments are needed, among which neurofeedback, and more specifically fMRI-based neurofeedback, has been considered. This paper discusses the different possibilities to approach neurofeedback in the specific context of phasic symptoms, by highlighting the strengths and weaknesses of the available neurofeedback options. It concludes with the added value of the recently introduced information-based neurofeedback. Although requiring an online fMRI signal classifier, which can be quite complex to implement, this neurofeedback strategy opens a door toward an alternative treatment option for complex phasic symptomatology.

40-Hz auditory steady-state response deficits are correlated with the severity of persistent auditory verbal hallucination in patients with schizophrenia

BackgroundAbnormal 40 Hz auditory steady-state response (ASSR) has been observed in some psychiatric disorders. Nevertheless, the role of 40 Hz ASSR in persistent auditory verbal hallucinations (pAVHs) schizophrenia (SCZ) is still unknown. This study aims to investigate whether the 40 Hz ASSR impairment is related to pAVHs and can detect pAVHs severity. MethodsWe analyzed high-density electroencephalography data that from 43 pAVHs patients (pAVH group), 20 moderate auditory verbal hallucinations patients (mid-AVH group), and 24 without auditory verbal hallucinations patients (non-AVH group). Event-related spectral perturbation and inter-trial phase coherence (ITPC) were calculated to quantify dynamic changes of the 40 Hz ASSR power and ITPC, respectively. ResultsFrontal-central, the 40 Hz ASSR power, and ITPC were significantly lower in the pAVH group than in the non-AVH group; There was no significant difference between the pAVH and mid-AVH group. The 40 Hz ASSR was significantly negatively correlated with the severity of pAVHs. The 40 Hz ASSR power, and ITPC could be used as a combinational marker to detect SCZ patients with and without pAVHs. ConclusionOur findings have shed light on the pathological mechanism of pAVHs in SCZ patients. These results can provide potential avenues for therapeutic intervention of pAVHs.

Executive control of language in schizophrenia patients with history of auditory verbal hallucinations: A neuropsychological and resting-state fMRI study

BackgroundAs demonstrated by a plethora of studies, compromised executive functions (EF) and language are implicated in mechanisms of auditory verbal hallucinations (AVH), but the contribution of their interaction to AVH remains unclear. We hypothesized that schizophrenia patients with history of AVH (AVHh+) vs. without history of AVH (AVHh˗) have a specific deficit of executive control of language and alterations in functional connectivity (FC) between the brain regions involved in EF and language, and these neuropsychological and neurophysiological traits are associated with each other. MethodsTo explore the executive control of language and its contribution to AVH, we used an integrative approach involving analysis of neuropsychological and resting-state fMRI data of 34 AVHh+, 16 AVHh˗, and 40 healthy controls. We identified the neuropsychological and FC measures that differentiated between AVHh+, AVHh˗, and HC, and tested the associations between them. ResultsAVHh+ were characterized by decreased category and phonological verbal fluency, utterance length, productivity in the planning tasks, and poorer retelling. AVHh+ had decreased FC between the left inferior frontal gyrus and the anterior cingulate cortex. Productivity in category verbal fluency was associated with the FC between these regions. ConclusionsPoor executive control of word retrieval and deficient programming of sentence and narrative related to more general deficits of planning may be the neuropsychological traits specific for AVHh+. A neurophysiological trait specific for AVHh+ may be a decreased FC between regions involved in language production and differentiation between alien- vs. self-generated speech and between language production vs. comprehension.

Emotional and non-emotional mental imagery and auditory verbal hallucinations (hearing voices): A systematic review of imagery assessment tools.

It is unknown to what extent mental imagery and auditory verbal hallucinations (AVHs) are related. Trials evaluating this issue used both emotional and non-emotional mental imagery tools, thereby complicating outcomes comparisons. Therefore, the present study aimed to systematically review the literature on mental imagery in individuals with AVHs to (1) inventory imagery assessment tools used in this population, (2) to collect information on the relation between emotional and non-emotional mental imagery in all sensory domains and AVHs and (3) to integrate the outcomes of this systematic review in a model of different mental imagery domains and related assessment tools. We conducted a systematic literature search in the PubMed Database. After full-text screening, 17 papers were included. Findings showed that a variety of assessment methods have been used to assess various aspects of mental imagery in people with AVHs, suggesting that there is a lack of agreed theoretical conceptualization of mental imagery and AVHs. In addition, the studies confirmed as was expected that non-emotional mental imagery seemed unrelated to AVHs whereas emotional mental imagery was related to AVHs. Lastly, we proposed a model of mental imagery domains and corresponding assessment methods distinguishing between emotional and non-emotional mental imagery.

FMRI fluctuations within the language network are correlated with severity of hallucinatory symptoms in schizophrenia

Although schizophrenia (SZ) represents a complex multiform psychiatric disorder, one of its most striking symptoms are auditory verbal hallucinations (AVH). While the neurophysiological origin of this pervasive symptom has been extensively studied, there is so far no consensus conclusion on the neural correlates of the vulnerability to hallucinate. With a network-based fMRI approach, following the hypothesis of altered hemispheric dominance (Crow, 1997), we expected that LN alterations might result in self-other distinction impairments in SZ patients, and lead to the distressing subjective experiences of hearing voices. We used the independent component analysis of resting-state fMRI data, to first analyze LN connectivity in three groups of participants: SZ patients with and without hallucinations (AVH/D+ and AVH/D–, respectively), and a matched healthy control (HC) group. Then, we assessed the fMRI fluctuations using additional analyses based on fractional Amplitude of Low Frequency-Fluctuations (fALFF), both at the network- and region of interest (ROI)-level. Specific LN nodes were recruited in the right hemisphere (insula and Broca homologous area) for AVH/D+ , but not for HC and AVH/D–, consistent with a left hemisphere deficit in AVH patients. The fALFF analysis at the ROI level showed a negative correlation between fALFF Slow-4 and P1 Delusions PANSS subscale and a positive correlation between the fALFF Slow-5 and P3 Hallucination PANSS subscale for AVH/D+ only. These effects were not a consequence of structural differences between groups, as morphometric analysis did not evidence any group differences. Given the role of language as an emerging property resulting from the integration of many high-level cognitive processes and the underlying cortical areas, our results suggest that LN features from fMRI connectivity and fluctuations can be a marker of neurophysiological features characterizing SZ patients depending on their vulnerability to hallucinate.

Bridging phenomenology and neural mechanisms of inner speech: ALE meta-analysis on egocentricity and spontaneity in a dual-mechanistic framework

The neural mechanisms of inner speech remain unclear despite its importance in a variety of cognitive processes and its implication in aberrant perceptions such as auditory verbal hallucinations. Previous research has proposed a corollary discharge model in which inner speech is a truncated form of overt speech, relying on speech production-related regions (e.g. left inferior frontal gyrus). This model does not fully capture the diverse phenomenology of inner speech and recent research suggesting alternative perception-related mechanisms of generation. Therefore, we present and test a framework in which inner speech can be generated by two separate mechanisms, depending on its phenomenological qualities: a corollary discharge mechanism relying on speech production regions and a perceptual simulation mechanism within speech perceptual regions. The results of the activation likelihood estimation meta-analysis examining inner speech studies support the idea that varieties of inner speech recruit different neural mechanisms.

Robotically-induced auditory-verbal hallucinations: combining self-monitoring and strong perceptual priors.

Inducing hallucinations under controlled experimental conditions in non-hallucinating individuals represents a novel research avenue oriented toward understanding complex hallucinatory phenomena, avoiding confounds observed in patients. Auditory-verbal hallucinations (AVH) are one of the most common and distressing psychotic symptoms, whose etiology remains largely unknown. Two prominent accounts portray AVH either as a deficit in auditory-verbal self-monitoring, or as a result of overly strong perceptual priors. In order to test both theoretical models and evaluate their potential integration, we developed a robotic procedure able to induce self-monitoring perturbations (consisting of sensorimotor conflicts between poking movements and corresponding tactile feedback) and a perceptual prior associated with otherness sensations (i.e. feeling the presence of a non-existing another person). Here, in two independent studies, we show that this robotic procedure led to AVH-like phenomena in healthy individuals, quantified as an increase in false alarm rate in a voice detection task. Robotically-induced AVH-like sensations were further associated with delusional ideation and to both AVH accounts. Specifically, a condition with stronger sensorimotor conflicts induced more AVH-like sensations (self-monitoring), while, in the otherness-related experimental condition, there were more AVH-like sensations when participants were detecting other-voice stimuli, compared to detecting self-voice stimuli (strong-priors). By demonstrating an experimental procedure able to induce AVH-like sensations in non-hallucinating individuals, we shed new light on AVH phenomenology, thereby integrating self-monitoring and strong-priors accounts.

The Power of Speech in the Wild

Mobile phone sensing is increasingly being used in clinical research studies to assess a variety of mental health conditions (e.g., depression, psychosis). However, in-the-wild speech analysis -- beyond conversation detecting -- is a missing component of these mobile sensing platforms and studies. We augment an existing mobile sensing platform with a daily voice diary to assess and predict the severity of auditory verbal hallucinations (i.e., hearing sounds or voices in the absence of any speaker), a condition that affects people with and without psychiatric or neurological diagnoses. We collect 4809 audio diaries from N=384 subjects over a one-month-long study period. We investigate the performance of various deep-learning architectures using different combinations of sensor behavioral streams (e.g., voice, sleep, mobility, phone usage, etc.) and show the discriminative power of solely using audio recordings of speech as well as automatically generated transcripts of the recordings; specifically, our deep learning model achieves a weighted f-1 score of 0.78 solely from daily voice diaries. Our results surprisingly indicate that a simple periodic voice diary combined with deep learning is sufficient enough of a signal to assess complex psychiatric symptoms (e.g., auditory verbal hallucinations) collected from people in the wild as they go about their daily lives.

Intersections of phenomenology, voice beliefs and distress in bipolar disorder: a comparison with schizophrenia.

Auditory verbal hallucinations (AVH), or voice-hearing, can be a prominent symptom during fluctuating mood states in bipolar disorder (BD). The current study aimed to: (i) compare AVH-related distress in BD relative to schizophrenia (SCZ), (ii) examine correlations between phenomenology and voice beliefs across each group, and (iii) explore how voice beliefs may uniquely contribute to distress in BD and SCZ. Participants were recruited from two international sites in Australia (BD=31; SCZ=50) and the UK (BD=17). Basic demographic-clinical information was collected, and mood symptoms were assessed. To document AVH characteristics, a 4-factor model of the Psychotic Symptoms Rating Scale and the Beliefs about Voices Questionnaire-Revised were used. Statistical analyses consisted of group-wise comparisons, Pearson's correlations and multiple hierarchical regressions. It was found that AVH-related distress was not significantly higher in BD than SCZ, but those with BD made significantly more internal attributions for their voices. In the BD group, AVH-related distress was significantly positively correlated with malevolence, omnipotence and resistance, However, only resistance, alongside mania and depressive symptoms, significantly contributed to AVH-related distress in BD. Our findings have several clinical implications, including identification of voice resistance as a potential therapeutic target to prioritise in BD. Factoring in the influence of mood symptoms on AVH-related distress as well as adopting more acceptance-oriented therapies may also be of benefit.

Validation and clinical usefulness of the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) among French-speaking voice-hearers

Auditory verbal hallucinations (AVH), also called voices, are often distressing to individuals experiencing them. Valid and reliable instruments are necessary to document the hearing voices experience across cultures. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is becoming a widely used self-administered instrument for assessing characteristics, content and subjective effect of AVH. This study investigates the psychometric characteristics of the HPSVQ French version (HPSVQ FV) in a clinical sample of voice-hearers. The results showed that the HPSVQ yields a global score (HPSVQ-Global) as well as a distress (HPSVQ-Distress) and a severity (HPSVQ-Severity) sub-score having good, acceptable and questionable internal consistency respectively. Significant correlations were found between hallucination severity (BPRS 4.0), distress (PSYRATS-AH), voices acceptance (VAAS-9), anxiety and depression (HADS). However, no significant associations were observed between Suspicion and Unusual Thoughts (BPRS 4.0). At a one-week interval, the temporal stability of the three indices was excellent. Moreover, after a brief cognitive intervention, a significant reduction was observed in all indices. Taken together, the HPSVQ FV demonstrated good construct validity, reliability and sensitivity to change. These findings support the use of the HPSVQ in francophone clinical and research settings. However, the bi-factorial solution of the HPSVQ FV should be further examined in larger samples.

Alterations in brain connectivity patterns in schizophrenia patients with auditory verbal hallucinations during low frequency repetitive transcranial magnetic stimulation

ObjectiveAuditory verbal hallucinations (AVH) are a characteristic symptom of schizophrenia. Although low-frequency repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to alleviate the severity of AVH, its exact neurophysiological mechanisms remain unclear. This study aimed to elucidate the alterations in brain connectivity patterns in schizophrenia patients with AVH after low frequency rTMS. Furthermore, the relationship between these alterations and clinical outcomes was examined, thereby identifying potential biomarkers for rTMS treatment efficacy. MethodsA total of 30 schizophrenia patients with AVH and 33 healthy controls were recruited. The patients received 1 Hz rTMS applied to the left temporoparietal junction region over 15 days. Resting-state functional magnetic resonance imaging scans were conducted for all participants. Subsequently, degree centrality (DC) and seed-based functional connectivity (FC) analyses were employed to identify specific alterations in brain connectivity patterns after rTMS treatment. ResultsAt baseline, patients exhibited divergent DC patterns in the frontal, occipital, and limbic lobes compared to healthy controls. In addition, prior to treatment, patients demonstrated altered FC from the superior frontal gyrus seeds that linked to the frontal, temporal, and somatosensory regions. Following rTMS treatment, these abnormalities were notably reversed, correlating with improved clinical outcomes. ConclusionsThese findings demonstrate that schizophrenia patients with AVH exhibited atypical interactions within the frontal and temporal lobes. These alterations might be crucial biomarkers for predicting the efficacy of low frequency rTMS.

Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation.

A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.

Hypoconnectivity networks in schizophrenia patients: A voxel-wise meta-analysis of Rs-fMRI

BackgroundIn recent years several meta-analyses regarding resting-state functional connectivity in patients with schizophrenia have been published. The authors have used different data analysis techniques: regional homogeneity, seed-based data analysis, independent component analysis, and amplitude of low frequencies. Hence, we aim to perform a meta-analysis to identify connectivity networks with different activation patterns between people diagnosed with schizophrenia and healthy controls using voxel-wise analysis. Method: We collected primary studies exploring whole brain connectivity by functional magnetic resonance imaging at rest in patients with schizophrenia compared with healthy controls. We identified 25 studies included high-quality studies that included 1285 patients with schizophrenia and 1279 healthy controls. Results: The results indicate hypoactivation in the right precentral gyrus and the left superior temporal gyrus of patients with schizophrenia compared with healthy controls. Conclusions: These regions have been linked with some clinical symptoms usually present in Plea with schizophrenia, such as auditory verbal hallucinations, formal thought disorder, and the comprehension and production of gestures.

Functional Connectivity Between Auditory and Medial Temporal Lobe Networks in Antipsychotic-Naïve Patients With First-Episode Schizophrenia Predicts the Effects of Dopamine Antagonism on Auditory Verbal Hallucinations

BackgroundUnderstanding how antipsychotic medication ameliorates auditory verbal hallucinations (AVHs) through modulation of brain circuitry is pivotal for understanding the pathophysiology of psychosis and for predicting treatment response. MethodsThis case-control study included examinations at baseline and at follow-up after 6 weeks. Initially, antipsychotic-naïve patients with first-episode schizophrenia who were experiencing AVHs were recruited together with healthy control participants. Antipsychotic treatment with the relatively selective D2 receptor antagonist amisulpride was administered as monotherapy. Functional connectivity measured by resting-state functional magnetic resonance imaging between networks of interest was used to study the effects of D2 blockade on brain circuitry and predict clinical treatment response. Hallucinations were rated with the Positive and Negative Syndrome Scale. ResultsThirty-two patients experiencing AVHs and 34 healthy control participants were scanned at baseline. Twenty-two patients and 34 healthy control participants were rescanned at follow-up. Connectivity between the auditory network and the medial temporal lobe network was increased in patients at baseline (p = .002) and normalized within 6 weeks of D2 blockade (p = .018). At baseline, the connectivity between these networks was positively correlated with ratings of hallucinations (t = 2.67, p = .013). Moreover, baseline connectivity between the auditory network and the medial temporal lobe network predicted reduction in hallucinations (t = 2.34, p = .032). ConclusionsFunctional connectivity between the auditory network and the medial temporal lobe predicted response to initial antipsychotic treatment. These findings demonstrate that connectivity between networks involved in auditory processing, internal monitoring, and memory is associated with the clinical effect of dopamine antagonism.

A detailed examination of pitch discrimination deficits associated with auditory verbal hallucinations in schizophrenia.

Individuals with schizophrenia spectrum disorders (SSD) and a history of experiencing auditory verbal hallucinations (AVH) exhibit poor pitch discrimination relative to those with an SSD but no AVH history. The present study extended this research, asking if a lifetime history, and the current presence, of AVH exacerbated the pitch discrimination challenges that are seen in SSD. Participants completed a pitch discrimination task, where the tones presented differed in pitch by either 2%, 5%, 10%, 25% or 50%. Pitch discrimination accuracy, sensitivity, reaction time (RT) and intra-individual RT variability (IIV) were examined in individuals with SSD and AVHs (AVH+; n=46), or without AVHs (AVH-; n=31), and healthy controls (HC; n=131). Secondary analyses split the AVH+ group into state (i.e., actively experiencing AVH; n=32) and trait hallucinators (i.e., a history of, but not actively experiencing, AVH; n=16). Relative to HC, significantly poorer accuracy and sensitivity was detected in individuals with SSD at 2% and 5% pitch deviants, and in hallucinators at 10%; however, no significant differences in accuracy, sensitivity, RT nor IIV were found between AVH+ and AVH- groups. No differences between state and trait hallucinators were observed. A general SSD deficit drove the current findings. The findings may inform future research into the auditory processing capabilities of AVH+ individuals.

Phenomenological and Cognitive Features Associated With Auditory Hallucinations in Clinical and Nonclinical Voice Hearers.

Auditory verbal hallucinations (AVH) are central features of schizophrenia (SZ). However, AVH also occur in a small percentage of the general population who do not have a need for care, termed nonclinical voice hearers (NCVH). We sought to determine the degree to which the experience of AVH was similar in NCVH and in people with schizophrenia (PSZ) and evaluate the degree to which NCVH shared other features of SZ such as delusional beliefs, cognitive impairment, and negative symptoms. We recruited 76 people with a DSM-V diagnosis of SZ/schizoaffective disorder (PSZ; 49 with current AVH, 27 without), 48 NCVH, and 51 healthy controls. Participants received a broad battery of clinician-administered and self-report symptom assessments and a focused cognitive assessment. The AVH of NCVH and PSZ shared very similar sensory features. NCVH experienced less distress, had greater control over their AVH, and, unlike PSZ, rarely heard 2 voices speaking to each other. NCVH demonstrated a wide range of deeply held unusual beliefs, but reported less paranoia, and fewer first-rank symptoms such as passivity and alterations in self-experience. NCVH showed no evidence of cognitive deficits or negative symptoms. The AVH in NCVH and PSZ demonstrate important similarities as well as clear differences. Specific features, rather than the presence, of AVH appear to determine the need for care. NCVH do not share the cognitive and motivational deficits seen in PSZ. These results suggest that AVH and unusual beliefs can be separated from the broader phenotype of SZ.