History Of Auditory Hallucinations Research Articles

C-69 Neuropsychological Functioning in a Patient with an Unspecified Pediatric Movement Disorder Without Abnormal Brain MRI

Abstract Objective Neuropsychological profiles of patients with pediatric movement disorders are not fully understood, though research suggests greater impairments in cognitive processes reliant on white matter functional integrity. Interpretation of neuropsychological data in these patients is often informed by imaging data that suggests specific areas of brain abnormality. The purpose of this presentation is to discuss the neurocognitive profile of a patient with an unspecified, progressive movement disorder with onset in middle childhood with no observable brain abnormality. Method The patient is an 11-year-old, right-handed male with a history of spastic diplegia and ataxia, onset at seven years of age, in the context of a normal brain MRI and genetic anomaly of unclear clinical significance. Patient has since experienced progressive weakness and spasticity of his bilateral lower limbs, and increasing inflammation in the upper thoracic region. He also has a history of auditory hallucinations. Results His neuropsychological profile was indicative of white matter and right hemispheric dysfunction in the brain with well-preserved left hemisphere functions. He demonstrated stronger verbal reasoning and verbally-based executive functioning abilities compared to visual-spatial reasoning and visual perception. Deficits in sustained attention, vigilance, working memory, and processing speed were also noted. Psychomotor coordination and planning was impaired bilaterally, with more pronounced left-hand deficits. He also demonstrated significant speech dysarthria and dyspraxia. He denied experiencing auditory hallucinations in the past six months. Conclusions This patient’s neurocognitive profile is largely consistent with literature on neuropsychological functioning in pediatric movement disorders despite the absence of an identifiable region of brain abnormality.

O2.7. CAN THEY HEAR IT? DO PATIENTS WITH AUDITORY VERBAL HALLUCINATIONS HAVE AUDITORY PROCESSING DEFICITS?

BackgroundIt has been well established for over half a century that patients with a diagnosis of schizophrenia have auditory processing deficits. More recently, there has been a small body of work that has suggested patients with a history of auditory hallucinations have particularly pertinent auditory processing deficits, with the importance of pitch perception being noted in a single study. This current body of work has systematically investigated whether auditory perception, using a tone detection task, are related to auditory verbal hallucinations (AVH).MethodsFour studies will be presented each of which used a tone detection task that manipulated pitch, with the study 1 also have a tone duration manipulation.ResultsStudy 1 compared 15 AVH with 15 non-AVH patients with schizophrenia with 34 healthy controls, AVH patients demonstrated the greatest impairments on pitch and tone duration deficits compared to the other two groups. Study 2 compared 99 patients with schizophrenia (65 with a history of AVH and 34 without) with 95 healthy controls and confirmed pitch deficits in schizophrenia, specifically those with AVH. Study 3 established in 100 healthy controls that unusual experiences or auditory hallucination proneness were significantly correlated to pitch perception performance. Lastly, study 4 demonstrated that relatives of patients with schizophrenia also showed a significant correlation between usual experiences and pitch perception.DiscussionThis research indicates auditory processing deficits are a core feature of AVH in schizophrenia, and potentially represent an endophenotype for AVH. The authors will discuss a potential cognitive model which explains the relationship between AVH and pitch perception. There are clear translational elements to this research, and we suggest there might be some utility in using auditory training as an intervention to reduce the impact of AVH.

Resting State Effective Connectivity Allows Auditory Hallucination Discrimination

Hallucinations are elusive phenomena that have been associated with psychotic behavior, but that have a high prevalence in healthy population. Some generative mechanisms of Auditory Hallucinations (AH) have been proposed in the literature, but so far empirical evidence is scarce. The most widely accepted generative mechanism hypothesis nowadays consists in the faulty workings of a network of brain areas including the emotional control, the audio and language processing, and the inhibition and self-attribution of the signals in the auditive cortex. In this paper, we consider two methods to analyze resting state fMRI (rs-fMRI) data, in order to measure effective connections between the brain regions involved in the AH generation process. These measures are the Dynamic Causal Modeling (DCM) cross-covariance function (CCF) coefficients, and the partially directed coherence (PDC) coefficients derived from Granger Causality (GC) analysis. Effective connectivity measures are treated as input classifier features to assess their significance by means of cross-validation classification accuracy results in a wrapper feature selection approach. Experimental results using Support Vector Machine (SVM) classifiers on an rs-fMRI dataset of schizophrenia patients with and without a history of AH confirm that the main regions identified in the AH generative mechanism hypothesis have significant effective connection values, under both DCM and PDC evaluation.

Discrimination of schizophrenia auditory hallucinators by machine learning of resting-state functional MRI.

Auditory hallucinations (AH) are a symptom that is most often associated with schizophrenia, but patients with other neuropsychiatric conditions, and even a small percentage of healthy individuals, may also experience AH. Elucidating the neural mechanisms underlying AH in schizophrenia may offer insight into the pathophysiology associated with AH more broadly across multiple neuropsychiatric disease conditions. In this paper, we address the problem of classifying schizophrenia patients with and without a history of AH, and healthy control (HC) subjects. To this end, we performed feature extraction from resting state functional magnetic resonance imaging (rsfMRI) data and applied machine learning classifiers, testing two kinds of neuroimaging features: (a) functional connectivity (FC) measures computed by lattice auto-associative memories (LAAM), and (b) local activity (LA) measures, including regional homogeneity (ReHo) and fractional amplitude of low frequency fluctuations (fALFF). We show that it is possible to perform classification within each pair of subject groups with high accuracy. Discrimination between patients with and without lifetime AH was highest, while discrimination between schizophrenia patients and HC participants was worst, suggesting that classification according to the symptom dimension of AH may be more valid than discrimination on the basis of traditional diagnostic categories. FC measures seeded in right Heschl's gyrus (RHG) consistently showed stronger discriminative power than those seeded in left Heschl's gyrus (LHG), a finding that appears to support AH models focusing on right hemisphere abnormalities. The cortical brain localizations derived from the features with strong classification performance are consistent with proposed AH models, and include left inferior frontal gyrus (IFG), parahippocampal gyri, the cingulate cortex, as well as several temporal and prefrontal cortical brain regions. Overall, the observed findings suggest that computational intelligence approaches can provide robust tools for uncovering subtleties in complex neuroimaging data, and have the potential to advance the search for more neuroscience-based criteria for classifying mental illness in psychiatry research.

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.

996 – Capgras syndrome in a three-decades non-treated schizophrenia: a case report

Introduction Capgras syndrome is a misidentification syndrome typically characterized by the delusional belief that a close relative has been replaced by an impostor. This monothematic delusion can be found in numerous disorders such as paranoid schizophrenia, schizoaffective disorder, affective disorders, Alzheimer's disease, Lewy body dementia, head trauma, epilepsy, cerebrovascular disease and dementia, pituitary tumor, multiple myeloma, multiple sclerosis, viral encephalitis, frontal lobe pathology and AIDS. We present a case of a patient that presents Capgras Syndrome at the first psychiatric evaluation in the context of three-decades untreated paranoid schizophrenia. Case report A 56-year-old woman was brought to the psychiatric department for evaluation for aggressive behavior directed to relatives. She has a history of auditory hallucinations, experiences of self-reference and paranoid delusions with more than 30 years of evolution. More recently, she started becoming aggressive with relatives, saying her real family members had been taken by strangers to an unknown hospital. She also said that her ID photo had been replaced by another person's photo. After detailed psychiatric evaluation, blood analysis and imaging study, the diagnosis of Paranoid Schizophrenia was established. She was treated with olanzapine 20mg/day with behavioral improvement. Conclusions Although Capgras Syndrome is not a psychiatric diagnosis but a feature of several different conditions, psychiatrists should be aware of this syndrome as it can signalize underlying psychiatric disorders and is usually associated with violent behaviors that should be managed.

Interhemispheric transfer time in patients with auditory hallucinations: An auditory event-related potential study

Central auditory processing in schizophrenia patients with a history of auditory hallucinations has been reported to be impaired, and abnormalities of interhemispheric transfer have been implicated in these patients. This study examined interhemispheric functional connectivity between auditory cortical regions, using temporal information obtained from latency measures of the auditory N1 evoked potential. Interhemispheric Transfer Times (IHTTs) were compared across 3 subject groups: schizophrenia patients who had experienced auditory hallucinations, schizophrenia patients without a history of auditory hallucinations, and normal controls. Pure tones and single-syllable words were presented monaurally to each ear, while EEG was recorded continuously. IHTT was calculated for each stimulus type by comparing the latencies of the auditory N1 evoked potential recorded contralaterally and ipsilaterally to the ear of stimulation. The IHTTs for pure tones did not differ between groups. For word stimuli, the IHTT was significantly different across the 3 groups: the IHTT was close to zero in normal controls, was highest in the AH group, and was negative (shorter latencies ipsilaterally) in the nonAH group. Differences in IHTTs may be attributed to transcallosal dysfunction in the AH group, but altered or reversed cerebral lateralization in nonAH participants is also possible.

Reduced connectivity of the auditory cortex in patients with auditory hallucinations: a resting state functional magnetic resonance imaging study

Previous research has reported auditory processing deficits that are specific to schizophrenia patients with a history of auditory hallucinations (AH). One explanation for these findings is that there are abnormalities in the interhemispheric connectivity of auditory cortex pathways in AH patients; as yet this explanation has not been experimentally investigated. We assessed the interhemispheric connectivity of both primary (A1) and secondary (A2) auditory cortices in n=13 AH patients, n=13 schizophrenia patients without auditory hallucinations (non-AH) and n=16 healthy controls using functional connectivity measures from functional magnetic resonance imaging (fMRI) data. Functional connectivity was estimated from resting state fMRI data using regions of interest defined for each participant based on functional activation maps in response to passive listening to words. Additionally, stimulus-induced responses were regressed out of the stimulus data and the functional connectivity was estimated for the same regions to investigate the reliability of the estimates. AH patients had significantly reduced interhemispheric connectivity in both A1 and A2 when compared with non-AH patients and healthy controls. The latter two groups did not show any differences in functional connectivity. Further, this pattern of findings was similar across the two datasets, indicating the reliability of our estimates. These data have identified a trait deficit specific to AH patients. Since this deficit was characterized within both A1 and A2 it is expected to result in the disruption of multiple auditory functions, for example, the integration of basic auditory information between hemispheres (via A1) and higher-order language processing abilities (via A2).

Anatomical brain connectivity and positive symptoms of schizophrenia: A diffusion tensor imaging study

Structural brain changes in schizophrenia are well documented in the neuroimaging literature. The classical morphometric analyses of magnetic resonance imaging (MRI) data have recently been supplemented by diffusion tensor imaging (DTI), which mainly assesses changes in white matter (WM). DTI increasingly provides evidence for abnormal anatomical connectivity in schizophrenia, most often using fractional anisotropy (FA) as an indicator of the integrity of WM tracts. To better understand the clinical significance of such anatomical changes, we studied FA values in a whole-brain analysis comparing paranoid schizophrenic patients with a history of auditory hallucinations and matched healthy controls. The relationship of WM changes to psychopathology was assessed by correlating FA values with PANSS scores (positive symptoms and severity of auditory hallucinations) and with illness duration. Schizophrenic patients showed FA reductions indicating WM integrity disturbance in the prefrontal regions, external capsule, pyramidal tract, occipitofrontal fasciculus, superior and inferior longitudinal fasciculi, and corpus callosum. The arcuate fasciculus was the only tract which showed increased FA values in patients. Increased FA values in this region correlated with increased severity of auditory hallucinations and length of illness. Our results suggest that local changes in anatomical integrity of WM tracts in schizophrenia may be related to patients' clinical presentation.

Revision of the factor structure of the Launay–Slade Hallucination Scale (LSHS-R)

The Launay–Slade Hallucination Scale (LSHS-R) (Launay & Slade, 1981; Bentall & Slade, 1985a) is a frequently used measure of predisposition to hallucinations in normal individuals. The current study administered the LSHS-R to a large sample of English-speaking undergraduate students (N=562). Principal component analyses identified three factors characterised as (1) vivid mental events, (2) hallucinations with a religious theme, and (3) auditory and visual hallucinatory experiences. The first factor refers to mental events where the experience is recognised as one's own whereas the other two factors have in common that the experience is attributed to another source. The current factor structure is similar to the factors obtained by Levitan, Ward, Catts and Hemsley (1996) for participants with a psychiatric disorder and a history of auditory hallucinations, supporting the view that hallucinations exist on a continuum with normal experiences.

Acute psychotic symptoms induced by topiramate

The incidence of psychosis during clinical trials of topiramate was 0.8%, not significantly different from the rate for placebo or reported rates of psychosis in patients with refractory epilepsy. We observed psychotic symptoms in five patients soon after initiation of topiramate therapy. We performed a retrospective chart review of the first 80 patients who began on topiramate after approval for clinical use, between January and April 1997. Symptoms suggestive of psychosis, including hallucinations and delusions, were sought for analysis. Cognitive effects such as psychomotor slowing, confusion, and somnolence were not included. Five patients developed definite psychotic symptoms 2 to 46 days after beginning topiramate. Dosages at symptom onset were 50–400 mg/day. Symptoms included paranoid delusions in four patients and auditory hallucinations in three. Symptoms of psychosis and other psychiatric symptoms resolved quickly with discontinuation of topiramate in three patients, dose reduction from 300 to 200 mg/day in one and with inpatient treatment and neuroleptics in another. One patient had a history of auditory hallucinations, one of aggressive and suicidal thoughts, but three had no significant psychiatric history. Physicians should be aware of the possibility of psychotic symptoms, even in patients without a previous psychiatric history, when prescribing topiramate. Symptoms resolve quickly with discontinuation.

Superior temporal gyral volumes and laterality correlates of auditory hallucinations in schizophrenia

Abstract Background: Previous studies have reported significant correlations, indicating an emerging relationship, between severity of auditory hallucinations and reduced size of temporal lobe cortical regions implicated in language processing. The present study used high-resolution magnetic resonance imaging (MRI) scanning, along with assessment of functional lateralization via a dichotic listening task (DLT), to extend these findings. Methods: Thirty patients with schizophrenia and a history of auditory hallucinations participated in the study. All were completely right-handed. Eleven subjects were currently hallucinating at the time of the study. Volumetric T1-weighted MRI scans were obtained and regions of interest were manually traced using the BRAINS package (Andreasen et al 1993) . Whole brain, bilateral temporal lobe, and anterior superior temporal gyrus volumes were calculated. Subjects completed a binaural consonant–vowel DLT. Results: Increased severity of hallucinatory experience was significantly associated with smaller left anterior superior temporal gyrus volumes. Current hallucinators demonstrated a reduction in right ear advantage on the DLT. Conclusions: The results suggest that auditory hallucinations are subserved by a trait-like dysfunction in language-related neural networks, of which the superior temporal cortex forms one component. The findings are also consistent with theories proposing abnormal lateralization in the etiology of auditory hallucinations.

Auditory hallucinations and the temporal cortical response to speech in schizophrenia: a functional magnetic resonance imaging study.

The authors explored whether abnormal functional lateralization of temporal cortical language areas in schizophrenia was associated with a predisposition to auditory hallucinations and whether the auditory hallucinatory state would reduce the temporal cortical response to external speech. Functional magnetic resonance imaging was used to measure the blood-oxygenation-level-dependent signal induced by auditory perception of speech in three groups of male subjects: eight schizophrenic patients with a history of auditory hallucinations (trait-positive), none of whom was currently hallucinating; seven schizophrenic patients without such a history (trait-negative); and eight healthy volunteers. Seven schizophrenic patients were also examined while they were actually experiencing severe auditory verbal hallucinations and again after their hallucinations had diminished. Voxel-by-voxel comparison of the median power of subjects' responses to periodic external speech revealed that this measure was reduced in the left superior temporal gyrus but increased in the right middle temporal gyrus in the combined schizophrenic groups relative to the healthy comparison group. Comparison of the trait-positive and trait-negative patients revealed no clear difference in the power of temporal cortical activation. Comparison of patients when experiencing severe hallucinations and when hallucinations were mild revealed reduced responsivity of the temporal cortex, especially the right middle temporal gyrus, to external speech during the former state. These results suggest that schizophrenia is associated with a reduced left and increased right temporal cortical response to auditory perception of speech, with little distinction between patients who differ in their vulnerability to hallucinations. The auditory hallucinatory state is associated with reduced activity in temporal cortical regions that overlap with those that normally process external speech, possibly because of competition for common neurophysiological resources.

Childhood Schizophrenia: Theoretical and Treatment Issues

Michael is an 8.5-year-old Caucasian male inpatient who presented at admission with severe agitation, suicidal impulses, and aggression toward his 18-month-old sister. He had been treated with stimulant medications before admission. Past history revealed bilateral genetic loading with two primary family members having a history of hallucinations and hospitalization, and two paternal aunts who were hospitalized since early childhood. Michael was raised in a chaotic, violent family environment where there was emotional, physical, and perhaps sexual abuse. Medical history included frequent staring spells. During residential treatment, more extensive interviews revealed a year's history of auditory hallucinations, inappropriate and labile affect, and a fixed delusional system. The patient was switched to neuroleptics and showed a slow response despite high doses.

Strategies of disattention and auditory hallucinations in schizophrenics.

Disattentional strategies used by schizophrenics to attenuate auditory stimulation from the environment were proposed as extraordinary conditions of attention which facilitate the misperception of lexical thought as a voice and create an auditory hallucination. Two strategies were studied. The switching strategy involved concentration upon an external visual display to prevent a clearly audible list of words from registering. The holding strategy required mentally repeating a word in the list so as to ignore the words that followed. Process (N = 32) and reactive (N = 32) schizophrenics, 46 of whom had a history of auditory hallucinations, served as subjects. Effectiveness of the two disattentional strategies was tested by subsequent inability of the schizophrenic to recognize words from the taped list. Process schizophrenics with auditory hallucinations were able to use switching effectively but not holding. In contrast, reactive schizophrenics suffering auditory hallucinations successfully used holding but not switching. Both effects were confirmed relative to hallucinating controls given standard memory instructions. Strategy effects were not apparent in nonhallucinating schizophrenics. These results suggest that different disattentional strategies may have been practiced by hallucinating schizophrenics in keeping with their premorbid status and style of attention deployment. A proposal functionally relating disattention to the genesis of auditory hallucinations was suggested.