Auditory Vocal Hallucinations Research Articles

Hearing voices among Russian patients with schizophrenia.

There has been relatively little work which systematically examines whether the content of hallucinations in individuals diagnosed with schizophrenia varies by cultural context. The work that exists finds that it does. The present project explores the way auditory hallucinations, or "voices," manifest in a Russian cultural context. A total of 28 individuals, diagnosed with schizophrenia, who reported hearing voices at the Republican Clinical Psychiatric Hospitals in Kazan, Russia, were interviewed about their experience of auditory hallucinations. The voices reported by our Russian participants did appear to have culturally specific content. Commands tended to be non-violent and focused on chores or other activities associated with daily life (byt). Many patients also reported sensory hallucinations involving other visions, sounds, and smells which sometimes reflected Russian folklore themes. For the most part, religious themes did not appear in patients' auditory vocal hallucinations, though nearly all patients expressed adherence to a religion. These findings support research that finds that the content, and perhaps the form, of auditory hallucinations may be shaped by local culture.

The development, validity, and reliability of the auditory vocal hallucination rating scale questionnaire (AVHRS-Q)

PurposeThe Auditory Vocal Hallucination Rating Scale Questionnaire (AVHRS-Q) is a short self-report measure assessing several characteristics of auditory vocal hallucinations (AVH) that was derived from a validated clinical interview (the auditory vocal hallucination rating scale; AVHRS). This study investigated the internal reliability, convergent validity, and divergent validity of the AVHRS-Q using two clinical samples.MethodsIn sample I, 32 psychiatric patients with AVH were recruited from an academic hospital service and assessed with the AVHRS and the AVHRS-Q. Data for sample II were retrospectively retrieved from a pseudonymised Routine Outcome Monitoring (ROM) database collected in the context of mental healthcare at the same academic hospital service. Data from 82 psychiatric patients with AVH were retrieved, who completed the AVHRS-Q, and measures of psychological distress (the Outcome Questionnaire; OQ-45, and the Symptom Checklist; SCL-90) and quality of life (the Manchester Short Assessment of Quality of Life; MANSA).ResultsThe AVHRS-Q showed good internal consistency in both samples. Severity scores of the AVHRS-Q were strongly correlated to the severity scores of the AVHRS (r = 0.90, p < 0.01). The AVHRS-Q and AVHRS did not differ in the identification of mild and severe voice-hearers [X2 (1, N = 32) = 15.71]. AVHRS-Q severity scores had moderate correlations with measures of psychological distress (OQ-45, r = 0.43, p < 0.01; SCL-90, r = 0.50, p < 0.05) and quality of life (MANSA, r = − 0.22, p < 0.01).ConclusionsThe AVHRS-Q demonstrated good reliability, convergent validity, and divergent validity, suggesting it can be applied in both clinical and research settings for a quick and reliable assessment of AVH.

Childhood theory of mind does not predict psychotic experiences and social functioning in a general population sample of adolescents.

AimsTheory of Mind (ToM) is often impaired in early and chronic phases of psychosis and it is often suggested that poor ToM is a trait vulnerability for psychosis. The aim of this study was to examine in an adolescent sample whether childhood ToM abilities can predict psychotic experiences over a period of six years and whether this is mediated by social functioning. To examine whether ToM is a specific predictor for psychosis, symptoms of depression and anxiety were also examined.Materials and methodsA baseline case-control sample (T0: age 7–8 years) with and without auditory vocal hallucinations (AVH) in the general population was assessed after five years (T1: age 12–13 years) on ToM ability (ToM Storybook Frank), and after eleven years (T2: age 18–19 years) on psychotic experiences (Community Assessment of Psychic Experiences; CAPE), depressive and anxiety symptoms (Depression Anxiety and Stress Scale; DASS-21), and social functioning (Groningen Questionnaire on Social Behaviour; GSVG-45). Analyses were conducted on a subsample of 157 adolescents aged 18–19 years (T2) who had data available on ToM ability at T1.ResultsToM at T1 was not predictive of psychotic experiences after six years (from age 12–13 to age 18–19) and social functioning was also not a mediator. ToM was not associated with psychopathology in general (depressive and anxiety symptoms) over six years (from age 12–13 to age 18–19).ConclusionsThe current study found no evidence for a longitudinal association between ToM ability and psychotic experiences, social functioning, and symptoms of depression and anxiety, in adolescence.

Course of auditory vocal hallucinations in childhood: 11-year follow-up study.

Childhood auditory vocal hallucinations (AVH) are mostly transient but may predict clinical outcomes. Little is known about their course over time and associations with risk factors, and how this may inform early intervention. Our objective was to assess the 11-year course of AVH, associated psychopathology and risk factors. A 5-year (T1) and 11-year (T2) follow-up of a baseline case-control sample (n = 694, of whom 347 with AVH). At T2, online assessment of AVH, other psychotic experiences, psychopathology, trauma and cannabis use was completed by 293 adolescents aged 18-19 years. The AVH 6-year (T1-T2) persistence rate was 18.2%, and the AVH 11-year (T0-T2) persistence rate was 6.2%. AVH at T2 were associated with higher levels of T2 other psychotic experiences, T2 psychopathology and T2 traumatic events, but not with T2 stress or T2 cannabis use. Persistence of AVH (i.e. AVH reported two or three times from T0) was associated with T2 traumatic events and higher risk for post-traumatic stress disorder. Auditory vocal hallucinations in early childhood are mostly transitory. AVH in adolescence, especially when persistent, are associated with affective symptoms and environmental risk, particularly traumatic events.

Religiosity in young adolescents with auditory vocal hallucinations

The current exploratory study examined the associations between auditory vocal hallucinations (AVH) and delusions and religiosity in young adolescents. 337 children from a population-based case-control study with and without AVH, were assessed after five years at age 12 and 13, on the presence and appraisal of AVH, delusions and religiosity. AVH status (persistent, remittent, incident or control) was examined in relationship to religiosity. Results demonstrated a non-linear association between AVH and religiosity. Moderately religious adolescents were more likely to report AVH than non-religious adolescents (O.R.=2.6). Prospectively, moderately religious adolescents were more likely to have recently developed AVH than non-religious adolescents (O.R.=3.6) and strongly religious adolescents (O.R.=7.9). Of the adolescents reporting voices in this sample (16.3%), more than half reported positive voices. Religious beliefs were often described as supportive, useful or neutral (82%), regardless of the level of religiosity, for both adolescents with and without AVH. Co-occurrence of AVH and delusions, and severity of AVH were not related to religiosity. The present findings suggest there may be a non-linear association between religiosity and hearing voices in young adolescents. A speculative explanation may be that religious practices were adopted in response to AVH as a method of coping.

Prevalence and correlates of auditory vocal hallucinations in middle childhood

Prevalence and correlates of auditory vocal hallucinations in middle childhood

Course of auditory vocal hallucinations in childhood: 5-year follow-up study

In a baseline study among 7- and 8-year-old children with auditory vocal hallucinations, only limited functional impact was observed. To assess 5-year course and predictors of auditory vocal hallucinations, as well as 5-year incidence and its risk factors. A sample of 337 children, 12 and 13 years of age, were reassessed on auditory vocal hallucinations and associated symptoms after a mean follow-up period of 5.1 years. The 5-year persistence and incidence rates were 24% and 9% respectively, with more new cases arising in urban areas.Both persistent and incident auditory vocal hallucinations were associated with problem behaviour in the clinical range of psychopathology as measured with the Child Behavior Checklist, particularly at follow-up, as well as with other psychotic symptoms, particularly at baseline. Persistence was predicted by baseline auditory vocal hallucinations severity,particularly in terms of external attribution of voices and hearing multiple voices, and was associated with worse primary school test scores and lower secondary school level. First onset of auditory vocal hallucinations in middle childhood is not uncommon and is associated with psychopathological and behavioural comorbidity. Similarly,persistence of auditory vocal hallucinations in childhood is not uncommon and is associated with psychopathological,behavioural and cognitive alterations.

Auditory hallucinations in childhood: associations with adversity and delusional ideation

Previous work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful events (SE)] and (ii) delusional ideation were examined. A baseline case-control sample of children with and without AVH were re-assessed on AVH after 5 years and interviewed about the experience of social adversity and delusions. A total of 337 children (mean age 13.1 years, S.D.=0.5) were assessed: 40 children continued to hear voices that were present at baseline (24%, persistent group), 15 heard voices only at follow-up (9%, incident group), 130 children no longer reported AVH that were present at baseline (remitted group) and 152 never heard voices (referent group). Both TE and SE were associated with both incident and persistent AVH, as well as with greater AVH severity and delusional ideation at follow-up. In addition, the combination of AVH and delusions displayed a stronger association with TE and SE compared with either AVH or delusions alone. Early childhood AVH are mostly benign and transitory. However, experience of social adversity is associated with persistence, severity and onset of new AVH closer to puberty, and with delusional ideation.

Voices behind the left shoulder: Two patients with right-sided temporal lobe epilepsy

Auditory vocal hallucinations are sometimes observed in temporal-lobe epilepsy, but are a frequent sign of psychosis and may rarely be mistaken for the latter. Here we report two patients who suffered from auditory vocal hallucinations, described as unintelligible human voices perceived at their left side during epileptic seizures. MEG revealed interictal epileptic discharges within the anterior partition of the right superior temporal gyrus; signal-to-noise ratio of these discharges was overall poor in EEG. The findings suggest that auditory vocal hallucinations without verbal content can evolve in the right hemisphere and are probably independent of language lateralization. This is in accordance with evidence from functional imaging, whereas most previous reports of seizures with auditory vocal hallucinations were confined to the left hemisphere.

FC06-03 - Course of auditory vocal hallucinations in childhood: A 5-year follow-up study

BackgroundIn a baseline study among 7–8 year old children with auditory vocal hallucinations (AVH), only limited functional impact of AVH was observed.AimsTo assess AVH 5-year course and its predictors, as well as AVH 5-year incidence and its risk factors.MethodA sample of 337 12- and 13-year-old children were reassessed on AVH after a mean follow-up period of 5.1 years. Parents completed the Child Behaviour Checklist (CBCL). School performance was assessed.ResultsThe AVH 5-year persistence and incidence rates were 24% and 9% respectively, more new cases arising in urban areas. Both persistent and incident AVH were associated with problem behaviour in the (CBCL) clinical range, particularly at follow-up, as well as with other psychosis-like symptoms, particularly at baseline. AVH persistence was predicted by baseline AVH severity, notably in terms of external attribution of voices and hearing multiple voices, and was associated with worse primary school test scores and lower level secondary school.ConclusionsFirst-onset AVH in middle childhood is neither rare nor neutral in terms of psychopathological and behavioural comorbidity. Persistence of AVH in early childhood similarly is not rare and associated with psychopathological, behavioural and cognitive alterations.

P03-174 - Risk factors of auditory hallucinations in childhood: adversity and the formation of psychotic-like ideation

Auditory vocal hallucinations (AVH) in general had limited functional impact in 7–8 year old children. However, transitory developmental expression of psychotic symptoms may become more persistent (and clinically relevant), depending on the degree of exposure to environmental risk factors. Therefore, in a five-year follow-up study of a case-control sample associations of (severity of) AVH with social adversity (traumatic experiences and stressful events) and the formation of delusional ideation were examined. In total 337 children (mean age 13.1 years; SD = 0.5) were reassessed. Forty children had continued to hear voices (24%, persistent group), 15 had heard voices for the first time (9%, incident group), 130 children no longer reported AVH (remitted group) and 152 never heard voices (referent group). Early social adversity was strongly associated with both incident and persistent AVH, and predicted greater AVH severity at follow-up. Children with both AVH and delusions were more likely to have experienced traumatic or stressful events than children with either symptom alone. AVH severity was shown to be a mediator in the association between TE (but not SE) and delusion formation. These results suggest that, although hearing voices in 7–8 year olds is in most cases benign, experience of social adversity can predict persistence and onset of new AVH closer to puberty. Given evidence for the association with delusion formation, they do pose a significant clinical risk.

Prevalence and correlates of auditory vocal hallucinations in middle childhood

Hearing voices occurs in middle childhood, but little is known about prevalence, aetiology and immediate consequences. To investigate prevalence, developmental risk factors and behavioural correlates of auditory vocal hallucinations in 7- and 8-year-olds. Auditory vocal hallucinations were assessed with the Auditory Vocal Hallucination Rating Scale in 3870 children. Prospectively recorded data on pre- and perinatal complications, early development and current problem behaviour were analysed in children with auditory vocal hallucinations and matched controls. The 1-year prevalence of auditory vocal hallucinations was 9%, with substantial suffering and problem behaviour reported in 15% of those affected. Prevalence was higher in rural areas but auditory vocal hallucinations were more severe and had greater functional impact in the urban environment. There was little evidence for associations with developmental variables. Auditory vocal hallucinations in 7- and 8-year-olds are prevalent but mostly of limited functional impact. Nevertheless, there may be continuity with more severe psychotic outcomes given the serious suffering in a subgroup of children and there is evidence for a poorer prognosis in an urban environment.

P03-191 Positive and useful auditory vocal hallucinations: Prevalence, characteristics, attributions and implications for treatment

Objective:Patients who seek treatment often suffer from negative auditory vocal hallucinations (‘voices’). However, some of these patients also report positive or useful voices, that they wish to preserve. When this wish is neglected by their therapist, this may lead to rejection of therapy or low compliance. This study describes prevalence, characteristics, course of and attributions to these voices in psychotic and non-psychotic patients.Method:One hundred and thirty one patients of a Voices Clinic and 65 members of the Dutch Resonance Foundation were assessed with the Positive and Useful Voices Inquiry. Data were analyzed using Pearson's chi-square, one-way ANOVA, Student's T-test and Crohnbach's alpha statistics.Results:First voices are most often reported as negative. the lifetime prevalence of positive voices ranged from 50 to 75%, useful voices were reported by 40 to 60% of respondents, with higher prevalences among the members of the Resonance Foundation. Positive voices occur more among non-psychotic patients. No significant association was found between voice characteristics and diagnosis. Attributions of protective power to positive voices has the strongest association with positive experience. Useful voices that are advising are experienced as most useful. Over 30% of respondents want to keep their positive and/or useful hallucinations. This wish is significantly associated with perceived control over the voices.Conclusions:The prevalence of positive and useful voices is considerable and therefore clinically relevant. A substantial part of patients want to preserve these voices.

Positive and useful auditory vocal hallucinations: prevalence, characteristics, attributions, and implications for treatment

Auditory hallucinations that are viewed by patients as positive and useful may be barriers to treatment-seeking. The aim was to assess prevalence, impact, and course of, and attributions to, these voices in psychotic and non-psychotic patients. One hundred thirty-one patients of a Voices Clinic and 65 members of the Dutch Resonance Foundation were assessed with the Positive and Useful Voices Inquiry. Data were analyzed using Pearson's chi-square, one-way anova, and Crohnbach's alpha statistics. First voices are most often reported as negative. Positive voices occur more among non-psychotic subjects, but the specific characteristics and diagnosis are not significantly associated. Lifetime prevalence of positive and useful voices ranged between 40% and 60%, with varied prevalence rates over time. Positive voices are experienced by subjects as direct addresses in the third person. Perceived control of voices is significantly associated with the wish to preserve them. Attribution of protective power to positive voices has the strongest association with positive experience. Many patients express a desire to preserve these voices. Voice characteristics do not allow for validly discriminating psychotic from non-psychotic disorders.