Non-verbal Auditory Hallucinations Research Articles

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.

Differences in functional connectivity density among subtypes of schizophrenic auditory hallucination.

This study aimed to investigate alterations in brain function among different subtypes of auditory hallucinations (AH) in drug-naïve first episode schizophrenia patients. We recruited 20 patients with drug-naïve first episode schizophrenia who had constant commanding and commenting auditory verbal hallucinations (CCCAVH), 15 drug-naïve first episode schizophrenia patients who had nonverbal auditory hallucinations (NVAH), and 20 healthy controls to participate in this study. We used global functional connectivity density (gFCD) and one-way analysis of covariance to characterize differences in brain function between the two patient groups. Statistical significance was set at P < 0.05. As compared to controls, schizophrenia patients with CCCAVH demonstrated increased gFCD in the right Broca's area, bilateral superior temporal gyri, hippocampus, bilateral insula, and anterior cingulate gyri, and decreased gFCD in the left temporoparietal junction (family-wise error [FEW] correct, P < 0.05). Schizophrenia patients with NVAH demonstrated increased gFCD in the bilateral superior temporal gyri and most of the components of the default mode network (DMN), and decreased gFCD in components of the executive control network (FWE correct, P < 0.05). We found that schizophrenia patients with CCCAVH and NVAH have distinct functional brain patterns. The features observed in patients with CCCAVH are consistent with the "inner speech" hypothesis of AH. Features of patients with NVAH suggest hyperactivity of the superior temporal gyrus and DMN, and hypoactivity of the prefrontal lobe.

Functional brain alterations in auditory hallucination subtypes in individuals with auditory hallucinations without the diagnosis of specific neurological diseases and mental disorders at the current stage.

BackgroundWe explored common and distinct pathological features of different subtypes of auditory hallucinations (AHs) to elucidate the underlying pathological mechanisms.MethodsWe recruited 39 individuals with constant commanding and commenting auditory verbal hallucinations (CCCAVHs), 49 with own thought auditory verbal hallucinations (OTAVHs), 46 with nonverbal AHs (NVAHs), 32 with replay AVHs (RAVHs), and 50 healthy controls. Functional connectivity density mapping was used to investigate global functional connectivity density (gFCD) alterations in these AH groups relative to the control group.ResultsWe observed common brain functional alterations among four subtypes of AHs, such as increased gFCD in the bilateral superior temporal gyrus and mesial frontal lobe, and decreased gFCD in the bilateral medial prefrontal cortex. Increased gFCD was detected in the bilateral insula in CCCAVH individuals, bilateral thalamus in OTAVH individuals, bilateral precuneus in NVAH individuals, and bilateral hippocampus in RAVH individuals. The common and distinct gFCD alterations among four AH subtypes were located in main components of the frontoparietal, default mode, salience, central executive, and memory networks. Different AH subtypes exhibited specific aberrant patterns.ConclusionsOur findings suggest that aberrant functional activity and metabolism in the abovementioned networks play key roles in the occurrence of AHs. Our findings provide evidence for distinct gFCD alterations in specific AH subtypes.

Recognizing psychiatric presentations of anti-NMDA receptor encephalitis in children and adolescents: A synthesis of published reports.

The aim of this study was to improve early recognition of anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDArE) in children and adolescents by identifying characteristic temporal patterns of clinical features in patients likely to be referred for psychiatric evaluation. In this form of autoimmune encephalitis, NMDAr hypofunction is caused by autoantibodies to receptor surface components. Clinical outcomes following prompt immunotherapy are usually good, but delayed treatment often results in a protracted course with significant residual disability or death. Anti-NMDArE frequently mimics psychiatric disorders, so most patients are referred initially to a psychiatrist and treated for days or weeks before being correctly diagnosed. A systematic search of PubMed and EMBASE electronic databases identified all published reports of antibody-confirmed anti-NMDArE associated with psychiatric symptoms in patients <19 years old. Redundant reports were eliminated manually. For each patient, the order in which each feature was first observed was ranked relative to others. Median temporal ranks were used to compare the sequencing of individual features and major symptom domains. One hundred and sixty seven cases (121 females) met the inclusion criteria. The most common features were dyskinesias (77.8%), seizures (72.5%), mutism or staring (40.7%), insomnia (39.5%), language dysfunction (36.5%), fever (31.1%), disorientation/confusion (28.7%), reduced arousal (28.1%), and memory disturbance (26.9%). The configuration and temporal sequencing of features were highly variable between individuals. Clinicians need to suspect this disorder: if new behavioral symptoms arise in the context of a recent viral prodrome; if they are accompanied by dyskinesias, seizures or insomnia; or if psychiatric symptoms are unusual (e.g., non-verbal auditory hallucinations).

Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms.

Anti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death. This study focuses on the frequency and chronology of salient clinical features in adults with anti-NMDAr encephalitis who are likely to be first evaluated by a psychiatrist because their presentation suggests a primary psychiatric disorder. A systematic search of PubMed and EMBASE databases identified published reports of anti-NMDAr encephalitis associated with prominent behavioral or psychiatric symptoms. After eliminating redundancies, the frequencies and relative timing of clinical features were tabulated. Signs and symptoms were assigned temporal ranks based on the timing of their first appearance relative to the first appearance of other signs and symptoms in each patient; median ranks were used to compare temporal sequencing of both individual features and major symptom domains. Two hundred thirty unique cases (185 female) met study inclusion criteria. The most common features were seizures (60.4%), disorientation/confusion (42.6%), orofacial dyskinesias (39.1%), and mutism/staring (37.4%). Seizures, fever, and cognitive dysfunction were often the earliest features to emerge, but psychiatric features predominated and sequencing varied greatly between individuals. Clinicians should consider anti-NMDAr encephalitis when new psychiatric symptoms are accompanied by a recent viral prodrome, seizures or unexplained fever, or when the quality of the psychiatric symptoms is unusual (e.g. non-verbal auditory hallucinations).

Auditory and visual hallucination prevalence in Parkinson's disease and dementia with Lewy bodies: a systematic review and meta-analysis.

Non-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood. Systematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods. Searches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3-14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates. AH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.

Preliminary evidence of an interaction between the FOXP2 gene and childhood emotional abuse predicting likelihood of auditory verbal hallucinations in schizophrenia

ObjectiveThe FOXP2 gene is involved in the development of speech and language. As some single nucleotide polymorphisms (SNPs) of FOXP2 have been found to be associated with auditory verbal hallucinations (AVHs) at trend levels, this study set out to undertake the first examination into whether interactions between candidate FOXP2 SNPs and environmental factors (specifically, child abuse) predict the likelihood of AVHs. MethodData on parental child abuse and FOXP2 SNPs previously linked to AVHs (rs1456031, rs2396753, rs2253478) were obtained from the Australian Schizophrenia Research Bank for people with schizophrenia-spectrum disorders, both with (n = 211) and without (n = 122) a lifetime history of AVHs. ResultsGenotypic frequencies did not differ between the two groups; however, logistic regression found that childhood parental emotional abuse (CPEA) interacted with rs1456031 to predict lifetime experience of AVH. CPEA was only associated with significantly higher levels of AVHs in people with CC genotypes (odds ratio = 4.25), yet in the absence of CPEA, people with TT genotypes had significantly higher levels of AVHs than people with CC genotypes (odds ratio = 4.90). This interaction was specific to auditory verbal hallucinations, and did not predict the likelihood of non-verbal auditory hallucinations. ConclusionsOur findings offer tentative evidence that FOXP2 may be a susceptibility gene for AVHs, influencing the probability people experience AVHs in the presence and absence of CPEA. However, these findings are in need of replication in a larger study that addresses the methodological limitations of the present investigation.

Hypoperfusion of the auditory and prefrontal cortices in Parkinsonian patients with verbal hallucinations

We examined patients with and without auditory hallucinations, using n-isopropyl-p-[123I]iodoamphetamine single photon emission computed tomographic imaging. We assessed verbal hallucinations in the present study: patients with nonverbal auditory hallucinations were excluded. A total of 11 patients with verbal and visual hallucinations and 17 patients with visual hallucinations only were enrolled. Patients with both verbal and visual hallucinations revealed significant hypoperfusion in the bilateral prefrontal cortex and right superior temporal gyrus compared to patients with visual hallucinations only. There were no significant hyperperfusion in patients with verbal plus visual hallucinations. These results may support the release hallucination theory in verbal hallucinations of Parkinson's disease, although another explanations may be more appropriate and further studies are required.

Cannabis and psychotic illness.

In-patients with psychotic symptoms and cannabis-positive urine analysis were assessed by PSE within one week of admission and again at one and six months. Concurrently admitted psychotic patients with drug-free urine analysis were controls. At one week the two groups differed significantly on only five PSE items: changed perception, thought insertion, non-verbal auditory hallucinations, delusions of control, and delusions of grandiose ability. One item (delayed sleep) differed at one month, and none at six months. The symptom cluster at one week is consistent with acute cannabis intoxication. Subjects and controls were mostly single, poorly educated, unemployed people with histories of psychotic disorders, and given major tranquillisers on admission. Compared with controls, subjects were younger, less likely to have psychiatric histories, more often male, Afro-Caribbeans with a history of convictions and compulsory admissions. The commonest diagnosis was schizophrenia. Use of the label 'cannabis-induced psychosis' may obscure a diagnosis of paranoid schizophrenia. A short-lived psychotic episode does occur in clear consciousness after cannabis intoxication, but chronic cannabis-induced psychosis was not found.