Experience Of Auditory 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.

Brain plasticity, language anomalies, genetic risk and the patient with schizophrenia: Trajectory of change over a lifetime. A commentary

Research on schizophrenia has been pursued for over a century. While the ability to view the brain and also the entire human genome advanced dramatically during this time and particularly in recent years, it is still unclear whether these advances helped to understand the nature of schizophrenia. What appears, however, to be the case is that early detection and treatment of people who are at high risk for developing schizophrenia due to various clinical signs, lead to better outcomes and recovery in many cases. Medications have also dramatically improved and have not been associated with the side-effects of earlier treatments, although they still are not without new sets of adverse effects. Over the years it was shown that structural brain abnormalities were present in the brains of people with chronic schizophrenia and that these observations were present early in the onset of illness. It was then shown these were not static and changed over the years of illness. At the same time it was shown that the brain centers for perceiving and speaking language appeared particularly abnormal in patients with schizophrenia and that these abnormalities could underlie the misperceptions and experiences of auditory hallucinations so characteristic of this illness. In a separate set of investigations that began with family, then twin and adoption studies, it was shown that schizophrenia is inherited, but in a complex manner. At present many genetic studies now find that genes, whose variants can lead to a high risk for schizophrenia, are ones specifically involving brain development and functioning. At present, although still speculative, it can be concluded that the progressive changes in brain structure, particularly related to language processing, take place in genetically vulnerable people and put them ultimately at high risk for developing schizophrenia in a trajectory for a lifelong illness. It is hoped that in the future these brain changes can be prevented by intervening early on the processes of brain growth and plasticity, thus arresting the illness before it begins.

Does the Phenomenology of Auditory Hallucinations Differ Across Patients Having Severe Mental Illness With and Without Hearing Impairment?

Abstract We compared the experience of auditory hallucinations, in persons who have normal (HN; N = 20), or impaired hearing (HI; N = 20), while experiencing psychoses. We assessed this experience across 42 domains and observed that irrespective of the hearing status, patients most often heard voices mainly in the language that they had learnt first (χ2 = 5.584; P = .018). However, a few experienced hallucinations in languages they “did not know” (3/20; 15%). The voices were most often attributed to both males and females (35/40; 87.5%). Those with hearing impairment heard voices closer to their ears, a hubbub of voices of crowds talking to them, and “as if” stuck or repetitive; often in the hearing-impaired ear. The hearing-impaired subjects also reported hearing nonverbal auditory hallucinations more frequently (χ2 = 17.625; P = .001), and the voices lacked emotional salience (χ2 = 4.055; P = .044). In contrast, the hallucinations were experienced in elaborate detail by the HN (20/20), while those with HI often heard only simple sentences (14/20, P = 0.05). The intensity of the hallucinatory voices remained the same on closing the affected ear or both of the ears in the HI group as compared to the HN group. Interestingly, the use of hearing aids attenuated the intensity of the hallucinations (6/7; 85%) in those with HI.

Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia.

To develop a Chinese version of Auditory Hallucination Risk Assessment Scale and evaluate its psychometric properties. Auditory hallucination, a common symptom in schizophrenia, has the potential to cause harm to patients and the people around them. However, there has been a paucity of suitable instrument developed in Asian region that can comprehensively and reliably assess its risk and inform interventions. This study involved 2 stages, the development of the Auditory Hallucination Risk Assessment Scale (AHRAS) and testing the psychometric properties of AHRAS. We followed STROBE guidelines in reporting the study. Auditory Hallucination Risk Assessment Scale items were developed based on Symptom Management Theory, systematic literature review and findings of a qualitative study on the experience of auditory hallucinations. The items were evaluated by content validity. Auditory Hallucination Risk Assessment Scale was then tested for construct validity, concurrent validity, predictive validity, internal consistency and test-retest reliability in a convenience sample of 156 patients with a diagnosis of schizophrenia. The final version of AHRAS has nine items. Two factors were extracted from AHRAS, which explained 57.74% of the total variance. The score of AHRAS was strongly correlated with that of the Psychotic Symptom Rating Scales-Auditory Hallucinations. The area under the curve was 0.90 for the overall AHRAS score. Sensitivity (86.5%) and specificity (80.0%) were maximal for a mean overall AHRAS score of 13.5, suggesting that this is an appropriate threshold for differentiation. Cronbach's alpha coefficient for internal consistency was 0.82, and intra-class correlation coefficient for test-retest reliability was 0.84. Auditory Hallucination Risk Assessment Scale has good reliability and validity. It can be used in clinical settings in China and beyond to assess the risk of auditory hallucinations. Auditory Hallucination Risk Assessment Scale can serve as a tool for nurses and other healthcare professionals to identify patients with high-risk auditory hallucinations, monitor the changes of risk and inform nursing interventions.

O4.4. REAL TIME FMRI NEUROFEEDBACK TARGETING STG AND DMN REDUCES AUDITORY HALLUCINATIONS

BackgroundAuditory hallucinations (AH) are one of the core symptoms of schizophrenia (SZ) and constitute a significant source of suffering and disability. One third of SZ patients experience pharmacology-resistant AH, so an alternative/complementary treatment strategy is needed to alleviate this debilitating condition. In this study, real-time functional Magnetic Resonance Imaging neurofeedback (rt-fMRI NFB), a non-invasive technique, was used to help 10 SZ patients modulate their brain activity in key brain regions belonging to the network involved in the experience of auditory hallucinations. In two experiments we selected two different brain targets. 1. the superior temporal gyrus (STG) and 2. default mode network (DMN)-central executive network (CEN) connectivity. STG is a key area in the neurophysiology of AH. Hyperactivation of the default mode network (DMN) and of the superior temporal gyrus (STG) in SZ has been shown in imaging studies. Furthermore, several studies point to reduced anticorrelation between the DMN and the central executive network (CEN). Finally, DMN hyperconnectivity has been associated with positive symptoms such as AHs while reduced DMN anticorrelations have been associated with cognitive impairment.MethodsIn the STG-focused NFB experiment, subjects were trained to upregulate the STG activity while listening to their own voice recording and downregulate it while ignoring a stranger’s voice recording in the course of 21 min NFB session. Visual feedback was provided to subjects at the end of each run from their own STG activity in the form of a thermometer. AH were assessed with auditory hallucination scale pre-NFB and within a week after the NFB session.The DMN-CEN focused NFB experiment was conducted about 1 month later to minimize the carry over effects from the STG-focused NFB and was designed to help SZ patients modulate their DMN and CEN networks. DMN and CEN networks were defined individually for each subject. The goal of the task was to increase CEN-DMN anti-correlations. To achieve that patients were provided with meditation strategies to guide their performance. Feedback was provided in the form of a ball that traveled up if the modulation of DMN-CEN connectivity was successful and traveled down if it was not successful. AH measures were taken before the NFB session and within a week after the session.ResultsIn the STG-focused NFB task, significant STG activation reduction was found in the comparison of pre- relative to post-NFB in the condition of ignoring another person’s voice (p<0.05), FWE-TFCE corrected. AH were also significantly reduced (p<0.01). Importantly, significant correlation was found between reductions in the STG activation and AH reductions (r=.83).In the DMN-CEN focused NFB task, significant increase in the anti-correlations between medial prefrontal cortex (mPFC) and dorsolateral prefrontal cortex (DLPFC) (p<0.05) was observed as well as significant reduction in the mPFC-PCC connectivity (p <0.05), in the pre-post NFB comparisons. AH were significantly reduced in post- relative to pre-NFB comparison (p<0.02). Finally, there was a significant correlation between individual scores in mPFC-STG connectivity and AH reductions.DiscussionThese the two experiments suggest that targeting both the STG BOLD activation and DMN-CEN connectivity in NFB tasks aimed at AH reduction result both in brain changes and in AH reductions. Together, these results provide strong preliminary support for the NFB use as a means to impact brain function leading to reductions in AH in SZ. Importantly, these results suggest that AH result from brain abnormalities in a network of brain regions and that targeting a brain region belonging to this network will lead to AH symptom reduction.

Understanding AVATAR therapy: who, or what, is changing?

Understanding AVATAR therapy: who, or what, is changing?

Altered States of Consciousness: Evaluation of a voice-hearing simulation during an immersive art exhibition.

To improve public understanding of the subjective experience of auditory hallucinations and increase empathy towards individuals who hear voices and have other unusual sensory experiences. This pilot study developed a new immersive art exhibition, Altered States of Consciousness, which gave members of the public an individualized voice-hearing simulation experience in 2 real-world settings-an art gallery and the London Underground. A total of 150 visitors completed visual analogue scales immediately before and after their experience of the exhibition. Post-exhibition, there were significant increases in understanding what it feels like to hear voices, compassion towards voice hearers, and comfort in talking about these experiences. Participants enjoyed the simulation, felt they learned from their involvement, and did not find it stressful. The exhibition and voice-hearing simulation has further potential for public engagement and stigma reduction.

Auditory feature perception and auditory hallucinatory experiences in schizophrenia spectrum disorder.

Schizophrenia spectrum disorder (SZ) is associated with deficits in auditory perception as well as auditory verbal hallucinations (AVH). However, the relationship between auditory feature perception and auditory verbal hallucinations (AVH), one of the most commonly occurring symptoms in psychosis, has not been well characterized. This study evaluated perception of a broad range of auditory features in SZ and determined whether current AVHs relate to auditory feature perception. Auditory perception, including frequency, intensity, duration, pulse-train and temporal order discrimination, as well as an embedded tone task, was assessed in both AVH (n=20) and non-AVH (n=24) SZ individuals and in healthy controls (n=29) with the Test of Basic Auditory Capabilities (TBAC). The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) was used to assess the experience of auditory hallucinations in patients with SZ. Findings suggest that compared to controls, the SZ group had greater deficits on an array of auditory features, with non-AVH SZ individuals showing the most severe degree of abnormality. IQ and measures of cognitive processing were positively associated with performance on the TBAC for all SZ individuals, but not with the HPSVQ scores. These findings indicate that persons with SZ demonstrate impaired auditory perception for a broad range of features. It does not appear that impaired auditory perception is associated with recent auditory verbal hallucinations, but instead associated with the degree of intellectual impairment in SZ.

The Lived Experience of Auditory Hallucinations among Egyptian Mentally Ill Patients: A Phenomenological Study

The Lived Experience of Auditory Hallucinations among Egyptian Mentally Ill Patients: A Phenomenological Study

EVENT-RELATED POTENTIALS AND CLINICAL SYMPTOMS IN SCHIZOPHRENIA

The investigation of schizophrenia's aetiology and pathomechanism is of high importance in neurosciences. In the recent decades, analyzing event-related potentials have proven to be useful to reveal the neuropsychological dysfunctions in schizophrenia. Even the very early stages of auditory stimulus processing are impaired in this disorder; this might contribute to the experience of auditory hallucinations. The present review summarizes the recent literature on the relationship between auditory hallucinations and event-related potentials. Due to the dysfunction of early auditory sensory processing, patients with schizophrenia are not able to locate the source of stimuli and to allocate their attention appropriately. These deficits might lead to auditory hallucinations and problems with daily functioning. Studies involving high risk groups may provide tools for screening and early interventions; thus improving the prognosis of schizophrenia.

Is schizophrenia a spatiotemporal disorder of the brain's resting state?

Is schizophrenia a spatiotemporal disorder of the brain's resting state?

Auditory processing and hallucinations in schizophrenia

The aim of this study was to investigate whether deficits in auditory processing are associated with auditory hallucinations in patients with schizophrenia. It was hypothesised that individuals with a diagnosis of schizophrenia would demonstrate deficits in processing the spectral and temporal aspects of sound and that such deficits would be more pronounced in patients with a history of auditory hallucinations (hallucinators) than those without such a history (non-hallucinators). A community sample meeting clinical criteria for schizophrenia or schizoaffective disorder (19 hallucinators, 15 non-hallucinators) and a matched healthy control group (n=17) completed a broad range of auditory processing tasks involving pitch discrimination of modulated (temporal) and unmodulated (spectral) pure tones, auditory streaming and affective prosodic identification, as well as measures assessing current psychiatric symptoms. In all experimental tasks patients were impaired compared to controls. Specifically hallucinators performed worse than non-hallucinators and controls for pitch discrimination of unmodulated tones and auditory streaming, and both hallucinators and non-hallucinators performed significantly worse than controls for discrimination of modulated tones and affective prosody. These findings suggest that impaired temporal processing may contribute to general difficulties identifying affective speech prosody in patients with schizophrenia, while spectral processing deficits may specifically compromise melodic streaming in hallucinators, which combined with deficits in temporal processing, contribute to the experience of auditory hallucinations.

The Phenomena of Auditory Hallucination as Described by Indonesian People Living With Schizophrenia

This study was a phenomenological inquiry of the experience of auditory hallucinations as described by 13 Indonesian people diagnosed with schizophrenia. The interviewees included 6 men and 7 women and they were aged between 19 and 56years. Four themes emerged from this study: feeling more like a robot than a human being; voices of contradiction - a point of confusion; tattered relationships and family disarray; and normalizing the presence of voices as part of everyday life. The findings of this study have the potential to contribute to new understandings of how people live with and manage auditory hallucinations and so enhance client-centered nursing care.

Should repetitive Transcranial Magnetic Stimulation (rTMS) be considered an effective adjunctive treatment for auditory hallucinations in patients with schizophrenia?

The experience of auditory hallucinations, especially verbal hallucinations, is a common psychotic symptom in persons with schizophrenia, but in about 30% of these individuals traditional treatment with antipsychotic medication is not effective in reducing the hallucinations. For this subgroup of patients, alternative forms of treatment need to be assessed. The occurrence of auditory hallucinations has been linked to abnormal activation or inhibition of the neural circuits related to language processing, especially those in the left temporoparietal lobe. [1] Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive method that adjusts the excitability of the cortex, so rTMS is one type of adjunctive treatment for medication-resistant auditory hallucinations in schizophrenia that researchers have been interested in. Hoffman and colleagues [2] first reported the possibility of using rTMS to treat auditory hallucinations in 1999. There have been at least 18 sham-controlled studies that reported the effectiveness and safety of rTMS in the treatment of auditory hallucination; the majority were randomized sham-controlled trials and a minority used a cross-over design. Most participants in these studies had intractable auditory hallucinations. Low stimulation frequencies (e.g., 1Hz) were used with a strength ranging from 80 to 115% of the participant’s motor threshold. The most common site of stimulation was the left temporoparietal junction (T3P3); other sites include the right temporoparietal junction (T4P4), the left or right Wernicke areas, and individualized sites determined by fMRI. The total number of pulses ranged from 240 to 4200 for a single treatment session. The duration of rTMS treatment was usually between one and four weeks. [3] All of these studies were small-scale; only three had 20 or more participants (in each arm of the study) and none of them had more than 30 participants. Three studies published in Biological Psychiatry in 2005, 2011, and 2013, reflect the evolution of scientific thinking about rTMS as an adjunctive treatment for auditory hallucinations in schizophrenia. Hoffman and

Auditory Hallucinations and Reduced Language Lateralization in Schizophrenia: A Meta-analysis of Dichotic Listening Studies

Reduced left-hemispheric language lateralization has been proposed to be a trait marker for schizophrenia, but the empirical evidence is ambiguous. Recent studies suggest that auditory hallucinations are critical for whether a patient shows reduced language lateralization. Therefore, the aim of the study was to statistically integrate studies investigating language lateralization in schizophrenia patients using dichotic listening. To this end, two meta-analyses were conducted, one comparing schizophrenia patients with healthy controls (n = 1407), the other comparing schizophrenia patients experiencing auditory hallucinations with non-hallucinating controls (n = 407). Schizophrenia patients showed weaker language lateralization than healthy controls but the effect size was small (g = -0.26). When patients with auditory hallucinations were compared to non-hallucinating controls, the effect size was substantially larger (g = -0.45). These effect sizes suggest that reduced language lateralization is a weak trait marker for schizophrenia as such and a strong trait marker for the experience of auditory hallucinations within the schizophrenia population.

Current perspectives on the mechanisms of auditory hallucinations: introduction to the special research topic

Current perspectives on the mechanisms of auditory hallucinations: introduction to the special research topic

Cognition and Neuroimaging in Schizophrenia

Cognition and Neuroimaging in Schizophrenia

The Role of Social Schema in the Experience of Auditory Hallucinations: A Systematic Review and a Proposal for the Inclusion of Social Schema in a Cognitive Behavioural Model of Voice Hearing

The interpersonal nature of the voice-hearing experience has been highlighted in recent studies investigating whether social processes (or 'schemas') that guide interpersonal interactions also govern the relationship between voice hearer and voice. A systematic literature review of relevant studies was undertaken, including those that investigated how social processes interact with appraisals of voices, as well as affective and behavioural responding to voices. The review included 13 studies published between 2000 and 2010. Two well-replicated findings emerged from the review. First, voice hearers who perceive themselves to be of low social rank (inferior) relative to others also feel inferior in relation to their voice and behave accordingly. Second, responding to voices from a position of closeness/dependency is associated with least distress. The review advocates for an extension of the Chadwick and Birchwood cognitive behavioural model of voices to include the mediating role of social schemata in explaining the affective and behavioural responses to voices. Only two interventions have yet targeted social schema variables utilizing different therapeutic approaches, both with some success. These clinical studies, as well as clinical implications drawn from the reviewed literature, will be discussed. Social processes governing relationships in the real world are also at play in the relationship between voice hearer and voice. Social schemas also shape beliefs about-and responses to-voices and thus are important to target in therapy. Voice hearers may be able to develop a more equal, and thus less distressing, relationship with their voice by improving their perceived social rank relative to others. This may be achieved through assertiveness training, social skills training and/or self-esteem work. Cognitive behavioural therapy techniques can be instrumental in helping an individual to consider the beliefs they hold about their voices and the way in which they respond and relate to them. Addressing how past traumatic experiences have influenced the voice hearer's relationships with others and their voices in therapy is recommended.

Enhanced cortical effects of auditory stimulation and auditory attention in healthy individuals prone to auditory hallucinations during partial wakefulness

Investigating auditory hallucinations that occur in health may help elucidate brain mechanisms which lead to the pathological experience of auditory hallucinations in neuropsychiatric disorders such as schizophrenia. In this study, we investigated healthy individuals who reported auditory hallucinations whilst falling asleep (hypnagogic hallucinations; HG) and waking up (hypnopompic hallucinations; HP). In an initial behavioural study, we found that subjects with a history of auditory HG/HP hallucinations (n = 26) reported significantly greater subjective sensitivity to environmental sounds than non-hallucinator controls (n = 74). Then, two fMRI experiments were performed. The first examined speech-evoked brain activation in 12 subjects with a history of auditory HG/HP hallucinations and 12 non-hallucinator controls matched for age, gender and IQ. The second fMRI experiment, in the same subjects, probed how brain activation was modulated by auditory attention using a bimodal selective attention paradigm. In the first experiment, the hallucinator group demonstrated significantly greater speech-evoked activation in the left supramarginal gyrus than the control group. In the second experiment, directing attention towards the auditory (vs. visual) modality induced significantly greater activation of the anterior cingulate gyrus in the hallucinator group than in the control group. These results suggest that hallucination proneness is associated with increased sensitivity of auditory and polysensory association cortex to auditory stimulation, an effect which might arise due to enhanced attentional bias from the anterior cingulate gyrus. Our data support the overarching hypothesis that top-down modulation of auditory cortical response characteristics may be a key mechanistic step in the generation of auditory hallucinations.

A psychometric approach to the relationship between hand–foot preference and auditory hallucinations in the general population: Atypical cerebral lateralization may cause an abnormal sense of agency

The present study examined the relationship between the atypical cerebral lateralization pattern represented in hand and foot preferences and schizotypal personality traits, especially proneness to auditory hallucinations as related to a sense of agency. A sense of agency, measured with questionnaires in the present study, is the sense that “I am the one who causes the actions.” Although atypical lateralization and an abnormal sense of agency may be related to schizophrenia or schizotypal personality, the connection between them has remained unclear. The present study used cluster analysis to categorize the handedness–footedness combinations. The results indicated that people with right-handedness and left-footedness may have more schizotypal traits and that their abnormal sense of agency may cause schizotypal personality traits. Although the reasons for crossed lateral preference remain unclear, we discuss this in terms of early switching in handedness, which may underlie atypical lateralization and lead to the experience of auditory hallucinations deriving from an abnormal sense of agency.