Persistent Auditory Hallucinations Research Articles

Hirnstimulationsverfahren zur Behandlung schizophrener Psychosen

Despite many different available pharmacological and psychosocial treatment options, an optimal control of symptoms is only partly possible for most schizophrenia patients. Especially, persistent auditory hallucinations, negative symptoms and cognitive impairment are difficult to treat symptoms. Several non-invasive brain stimulation techniques are increasingly being considered as new therapeutic add on options for the management of schizophrenia, targeting these symptom domains. The technique which has been available for the longest time and that is best established in clinical care is electroconvulsive therapy (ECT). New stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) allow a more pathophysiological-based approach. This review article introduces various non-invasive brain stimulation techniques and discusses recent treatment studies on schizophrenia. In total, the novel brain stimulation techniques discussed here can be considered relevant add on therapeutic approaches for schizophrenia. In this context, the best evidence is available for the application of rTMS for the treatment of negative symptoms and persistent auditory hallucinations; however, negative studies have also been published for both indications. Studies using other non-invasive brain stimulation techniques showed promising results but further research is needed to establish the clinical efficacy. Based on a growing pathophysiological knowledge, non-invasive brain stimulation techniques provide new treatment perspectives for patients with schizophrenia.

Transcranial magnetic stimulation (TMS) for schizophrenia.

People with schizophrenia often experience symptoms which fail to fully respond to antipsychotic medication. Transcranial magnetic stimulation (TMS) has been proposed as a new treatment for people with schizophrenia, especially those who experience persistent auditory hallucinations.To estimate the effects of TMS alone, compared with sham TMS or with 'standard management' and any other comparison interventions in reducing psychotic symptoms associated with schizophrenia.We searched the Cochrane Schizophrenia Group Trials Register (June 2006, June 2008, April 2013). This register is compiled by methodical searches of MEDLINE, EMBASE, BIOSIS, CINAHL, Dissertation abstracts, LILACS, PSYNDEX, PsycINFO, RUSSMED, and Sociofile, and is supplemented with handsearching of relevant journals and numerous conference proceedings.We included all randomised controlled trials recruiting at least five participants and comparing TMS with sham TMS or any other treatment for people with schizophrenia.We extracted data independently. For dichotomous data we calculated relative risks (RRs) and their 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MD) and 95% CI. We used a fixed-effect model. We assessed overall quality of the evidence using the GRADE approach.We included 41 studies with 1473 participants in the review. We found significant differences in favour of temporoparietal TMS compared to sham TMS for global state measured on the CGI scale (7 RCTs, n = 224, MD -0.5, 95% CI -0.76 to -0.23, very low-quality evidence) and positive symptoms measured on the PANSS scale (5 RCTs, n = 127, MD -6.09, 95% CI -10.95 to -1.22, very low-quality evidence). Participants experienced significantly more headaches in the temporoparietal TMS group (10 RCTs, n = 392, RR 2.65, 95% CI 1.56 to 4.50, very low-quality evidence). However, no more participants left the study early from the TMS group than from the sham group (very low-quality evidence). Cognitive state was assessed using 39 different measures, and all were equivocal (very low-quality evidence).We included only two trials which compared temporoparietal TMS with standard treatment. In both trials the participants received first- and second-generation antipsychotic medication in both treatment groups, therefore TMS was used an adjunctive therapy to medication. We found no significant differences in the number of participants that showed clinical improvement in global state (1 RCT, n = 100, RR 1.19, 95% CI 0.91 to 1.57) or left the study early (2 RCTs, n = 140, RR 0.33, 95% CI 0.08 to 1.46) (both very low-quality evidence). No studies reported on global state score, mental state, cognitive state and adverse effects.For prefrontal TMS compared to sham TMS, global state was measured on three different scales, all of which presented equivocal results (very low quality evidence). We could not pool data for mental state on the PANSS scale due to high heterogeneity. Cognitive state was assessed using 19 different measures, with 15/19 being equivocal (very low-quality evidence). Prefrontal TMS caused more headaches (6 RCTs, n = 164, RR 2.77, 95% CI 1.22 to 6.26, very low-quality evidence) but there was no difference in the number of participants leaving the study early (very low-quality evidence). No studies reported data for clinical improvement.We found a significant difference in favour of prefrontal theta burst stimulation TMS compared to sham TMS for mental state on the PANNS scale (3 RCTs, n = 108, MD -5.71, 95% CI -9.32 to -2.10, very low evidence). We found no difference for clinical improvement, cognitive state, number of headaches, and leaving the study early (very low-quality evidence).None of the included studies reported satisfaction with care.Based on this review, there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia. Although some evidence suggests that TMS, and in particular temporoparietal TMS, may improve certain symptoms (such as auditory hallucinations and positive symptoms of schizophrenia) compared to sham TMS, the results were not robust enough to be unequivocal across the assessment measures used. There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication.The overall quality of evidence was graded as very low due to risk of bias, and this was accompanied by an imprecision in estimates due to the relatively small number of participants in the studies. Thus, consideration is required in improving the quality of trial processes, as well as the quality of reporting of ongoing and future TMS trials, so as to facilitate accurate future judgements in assessing risk of bias. Differences in TMS techniques in relation to stimulation intensity, stimulation length, brain areas stimulated and variations in the design of sham TMS all contributed to the heterogeneity of study findings and limited the interpretation and applicability of the results. In addition, the trials assessed their outcomes with a variety of scales, and usable data were limited. Therefore, to better evaluate the treatment effects of TMS in people with schizophrenia, we favour the use of standardised treatment protocols and outcome measures.

Persistent Auditory Hallucinations in a Sample of Schizophrenic Outpatients

Introduction About a third of patients with schizophrenia have persistent auditory verbal hallucinations resulting in persistent distress, functional disability, and frequent loss of behavioral control. Objectives To estimate the prevalence of persistent auditory hallucinations in a sample of schizophrenic patients, to specify their characteristics and to identify their clinical associated factors. Methods This was a cross-sectional, descriptive and analytical study carried-on 144 out-patients (101 men and 43 women, mean age 38.24 ± 10.58 years) followed for schizophrenia in the psychiatry department of the university hospital of Monastir. The assessment was consisted by the collect of epidemiological, clinical and therapeutic data and the use of the Hoffman's auditory hallucinations rating scale (AHRS), and the positive and negative symptoms scale (PANSS). Results The prevalence of persistent auditory hallucinations (score of the AHRS ≥ 5) was 40.3%. The total mean score on the AHRS was 10.7 ± 7.8 for all patients and 19.4 ± 7.7 for patients with persistent auditory hallucinations. The items of the AHRS with higher sub scores were the number, the influence and the reality of the voices. The clinical associated factors with persistent auditory hallucinations after multivariate analysis were the family history of physical illness, the absence of tobacco consumption, the hallucinatory onset of disorders, the notion of prior hospitalization and continuous course. Conclusion Our results support the multidimensional nature of auditory hallucinations and confirm the existence of interindividual differences in these hallucinations. Persistent auditory hallucinations were associated with poor prognosis, requiring more effective therapeutic strategies.

Effect of tDCS on Persistent Auditory Hallucinations in Schizophrenia: Influence of Catechol-O-methyltransferase Val158Met Genotype

*Presenting Author: [email protected]

Plasticity induced by paired associative stimulation is boosted by concurrently targeting separate motor cortical representations with excitatory and inhibitory protocols

s / Brain Stimulation 8 (2015) 360e377 371 Discussion: This novel observation suggests that PFC stimulation via anodal tDCS may help in correcting deficits in antisaccade task performance. These preliminary findings suggest that enhancement of inhibitory function might be one of the mechanisms underlying the ameliorating effect of add-on tDCS on persistent auditory hallucinations in schizophrenia.

Structural and functional brain alterations induced by a series of prefrontal repetitive transcranial magnetic stimulation

s / Brain Stimulation 8 (2015) 360e377 371 Discussion: This novel observation suggests that PFC stimulation via anodal tDCS may help in correcting deficits in antisaccade task performance. These preliminary findings suggest that enhancement of inhibitory function might be one of the mechanisms underlying the ameliorating effect of add-on tDCS on persistent auditory hallucinations in schizophrenia.

Bilateral Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations in Patients with Schizophrenia: A Randomized Controlled, Cross-over Study.

ObjectiveA randomized double-blind cross-over trial was conducted in patients with persistent auditory hallucinations (AHs) to investigate whether bilateral repetitive transcranial magnetic stimulation (rTMS) at the temporoparietal area or Broca's area is more effective at high- or low-frequencies compared to a sham condition.MethodsTwenty three patients with persistent AHs who remained stable on the same medication for 2 months were enrolled. They were randomized to one of four conditions: low-frequency (1 Hz)-rTMS to the temporoparietal area (L-TP), high-frequency (20 Hz)-rTMS to the temporoparietal area (H-TP), high-frequency (20 Hz)-rTMS to Broca's area (H-B), or sham.ResultsAll the four rTMS conditions resulted in significant decrease in the scores under the auditory hallucination rating scale and hallucination change scale over time. However, there were no significant treatment effects or interaction between time and treatment, suggesting no superior effects of the new paradigms over the sham condition.ConclusionOur findings suggest that bilateral rTMS at the temporoparietal area or Broca's area with high- or low-frequency does not produce superior effects in reducing AHs compared to sham stimulation.

Resting-state functional connectivity alterations in the default network of schizophrenia patients with persistent auditory verbal hallucinations

To understand the neural mechanism that underlies treatment resistant auditory verbal hallucinations (AVH), is still an important issue in psychiatric research. Alterations in functional connectivity during rest have been frequently reported in patients with schizophrenia. Though the default mode network (DN) appears to be abnormal in schizophrenia patients, little is known about its role in resistant AVH. We collected resting-state functional magnetic resonance imaging (R-fMRI) data with a 3T scanner from 19 schizophrenia patients with chronic AVH resistant to pharmacological treatment, 14 schizophrenia patients without AVH and 20 healthy controls. Using seed-based correlation analysis, we created spherical seed regions of interest (ROI) to examine functional connectivity of the two DN hub regions (posterior cingulate cortex and anteromedial prefrontal cortex) and the two DN subsystems: dorsomedial prefrontal cortex subsystem and medial temporal lobe subsystem (p<0.0045 corrected). Patients with hallucinations exhibited higher FC between dMPFC ROI and bilateral central opercular cortex, bilateral insular cortex and bilateral precentral gyrus compared to non hallucinating patients and healthy controls. Additionally, patients with hallucinations also exhibited lower FC between vMPFC ROI and bilateral paracingulate and dorsal anterior cingulate cortex. As the anterior cingulate cortex and the insula are two hubs of the salience network, our results suggest cross-network abnormalities between DN and salience system in patients with persistent hallucinations.

Short and long term effects of left and bilateral repetitive transcranial magnetic stimulation in schizophrenia patients with auditory verbal hallucinations: a randomized controlled trial.

BackgroundRepetitive transcranial magnetic stimulation of the left temporo-parietal junction area has been studied as a treatment option for auditory verbal hallucinations. Although the right temporo-parietal junction area has also shown involvement in the genesis of auditory verbal hallucinations, no studies have used bilateral stimulation. Moreover, little is known about durability effects. We studied the short and long term effects of 1 Hz treatment of the left temporo-parietal junction area in schizophrenia patients with persistent auditory verbal hallucinations, compared to sham stimulation, and added an extra treatment arm of bilateral TPJ area stimulation.MethodsIn this randomized controlled trial, 51 patients diagnosed with schizophrenia and persistent auditory verbal hallucinations were randomly allocated to treatment of the left or bilateral temporo-parietal junction area or sham treatment. Patients were treated for six days, twice daily for 20 minutes. Short term efficacy was measured with the Positive and Negative Syndrome Scale (PANSS), the Auditory Hallucinations Rating Scale (AHRS), and the Positive and Negative Affect Scale (PANAS). We included follow-up measures with the AHRS and PANAS at four weeks and three months.ResultsThe interaction between time and treatment for Hallucination item P3 of the PANSS showed a trend for significance, caused by a small reduction of scores in the left group. Although self-reported hallucination scores, as measured with the AHRS and PANAS, decreased significantly during the trial period, there were no differences between the three treatment groups.ConclusionWe did not find convincing evidence for the efficacy of left-sided rTMS, compared to sham rTMS. Moreover, bilateral rTMS was not superior over left rTMS or sham in improving AVH. Optimizing treatment parameters may result in stronger evidence for the efficacy of rTMS treatment of AVH. Moreover, future research should consider investigating factors predicting individual response.Trial RegistrationDutch Trial Register NTR1813

Transcranial direct-current stimulation as an adjunct to electroconvulsive therapy and clozapine for refractory psychosis.

To the Editor: Twenty-five to 30% of patients with schizophrenia report persistent auditory hallucinations despite an adequate treatment regimen.1 Transcranial direct-current stimulation (tDCS) is a noninvasive method that modulates cortical excitability through electrodes placed directly on the scalp. Anode stimulation subthreshold depolarizes neuronal membranes, while cathode stimulation subthreshold hyperpolarizes neurons.2 The tDCS method has been used to treat major depressive disorder. In patients with major depressive disorder, functional magnetic resonance imaging has shown prefrontal asymmetry with hypoactivity of the left dorsolateral prefrontal cortex (DLPFC) and hyperactivity of the right DLPFC.3 Placement of the anode (excitatory) over the left DLPFC and the cathode (inhibitory) over the right DLPFC is theorized to correct the abnormal frontal activity. Using this model of neuromodulation, it can be hypothesized that similar strategies could be used to target imbalances of neuronal activity in patients experiencing auditory hallucinations. Studies with functional magnetic resonance imaging have shown that hypoactivity in the left prefrontal cortex and left anterior cingulate is associated with auditory hallucinations in patients with schizophrenia.4 Brunelin et al1 showed that tDCS significantly reduced persistent auditory hallucinations in refractory psychosis. Additionally, the effects of tDCS appear to be multifactorial, as it stimulates both local and remote plastic changes mediated by regulation of neurotransmitters including dopamine, acetylcholine, and serotonin.5 We describe a patient who was not responding to treatment with clozapine and ECT and ultimately derived benefit from the addition of tDCS. Case report. Mr A is a 53-year-old man with a 30-year history of schizoaffective disorder, depressed type (per DSM-IV criteria), who suffers from persistent auditory hallucinations. He received an acute course of electroconvulsive therapy (ECT) with maintenance weekly ECT treatments for several months and clozapine 700 mg daily, yet continued to psychiatrically decompensate. Time between weekly ECT treatments could not be lengthened due to worsening auditory hallucinations, leading him to become suicidal and subsequently hospitalized. Mr A was given tDCS adjunctively, and his progress was monitored using the Positive and Negative Syndrome Scale (PANSS), with baseline assessment recorded before treatment initiation and reassessment recorded 1 day posttreatment before subsequent initiation of ECT. Weekly ECT treatments were held during tDCS administration and restarted the following week. Mr A was given the standard regimen of 20-minute tDCS treatments twice daily for 5 consecutive days. The stimulator was set to deliver 2 milliamps with anodal (excitatory) stimulation placed over the left DLPFC and cathodal (inhibitory) stimulation placed over the left temporoparietal cortex. Mr A’s pretreatment PANSS score for positive symptoms was 13 and remained the same posttreatment, but showed a 67% improvement in delusions and a 20% improvement in auditory hallucinations. The negative symptom pretreatment PANSS score of 22 remained static posttreatment; however, blunted affect decreased by 20% and emotional withdrawal decreased by 40%. The general psychopathology pretreatment PANSS score demonstrated overall improvement of 22%, with a 33% decrease in anxiety, 20% decrease in depression, 67% decrease in lack of judgment/insight, and 50% decrease in guilt, tension, and uncooperativeness. Overall, Mr A reported improved mood, feelings of hope, and fewer auditory hallucinations. Discussion. The addition of tDCS, as an adjunctive treatment to ECT and clozapine, provided a beneficial response in Mr A. This case shows a patient who experienced near immediate improvement in positive symptoms of auditory hallucinations, which is consistent with the findings published by Brunelin et al,1 who found tDCS reduces auditory hallucinations refractory to antipsychotic drugs in patients with schizophrenia. This case suggests that tDCS may help reduce severe auditory hallucinations as well as negative symptoms when used in combination with ECT and antipsychotic treatment. The patient presented here demonstrates an overall positive response with the addition of tDCS to his treatment regimen. Further study is warranted to ascertain whether tDCS may be an effective adjunct to ECT and pharmacotherapy in treatment-resistant hallucinations.

Attenuation of mismatch negativity (MMN) and novelty P300 in schizophrenia patients with auditory hallucinations experiencing acute exacerbation of illness

This study examined measures of early auditory feature analysis, including the mismatch negativity (MMN) and novelty P300 (NP3) in schizophrenia patients (SZ) with persistent auditory hallucinations (AH) during an acute psychotic episode requiring hospitalisation. Neuroelectric activity was recorded in 10 SZ patients and 13 healthy controls (HC) during a passive auditory oddball task including novel environmental sounds. MMN/NP3 amplitudes and latencies were compared between groups and were correlated with trait (PSYRATS) and state measures of AH severity as well as clinical symptom ratings in SZs.SZ patients (vs. HCs) exhibited reduced MMN amplitudes to both rare deviant and novel stimuli, as well as reduced NP3 amplitudes. Additionally, while novelty MMN amplitudes were correlated with measures of hallucinatory trait, NP3 amplitudes were correlated with measures of hallucinatory state. Therefore, in acutely ill SZ patients, individual components of the auditory novelty detection mechanism may be differentially sensitive to varying aspects of AHs.

A study of psychotic symptoms in borderline personality disorder.

Patients with borderline personality disorder (BPD) report psychotic symptoms, but it has been questioned whether they are intrinsic to BPD. Thirty patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for BPD were drawn from a specialist personality disorder service. Exclusion criteria included a preexisting clinical diagnosis of nonaffective psychotic disorder. Participants underwent structured psychiatric interview using the Present State Examination (PSE), lifetime version. Approximately 60% of the patients reported psychotic symptoms unrelated to drugs or affective disorder. Auditory hallucinations were the most common symptom (50%), which were persistent in the majority of cases. A fifth of the patients reported delusions, half of whom (three patients) also met DSM-IV criteria for schizophrenia, who were previously undiagnosed. The form of auditory hallucinations was similar to that in schizophrenia; the content was predominantly negative and critical. Persistent auditory hallucinations are intrinsic symptoms of BPD. This may inform current diagnostic criteria and have implications for approaches to treatment, both pharmacological and psychological. The presence of delusions may indicate a comorbid axis I disorder.

Insight facilitation with add-on tDCS in schizophrenia

Impaired insight in schizophrenia patients has been linked with prefrontal deficits. In this open-label study, we examined for potential insight facilitation effects of add-on tDCS (with anodal stimulation of left DLPFC and cathodal stimulation over left temporo-parietal junction) in schizophrenia patients (N=21) with persistent auditory hallucinations despite adequate antipsychotic treatment. Following tDCS, there was a significant improvement in insight with concurrent significant reduction in auditory hallucination severity. Improvement in insight correlated significantly with improvement in severity of auditory hallucinations. These findings suggest improvement of insight with add-on tDCS in schizophrenia with persistent auditory hallucinations.

Persistent auditory hallucinations and treatment challenges.

Despite improved neurotransmitter identification and emergence of novel antipsychotics, treatment of auditory hallucinatory experiences is frustrating. Interest has developed in non-pharmacological approaches to this problem – these do not eliminate the voices but reduce the distress associated with the experience.

Current and emergent treatments for symptoms and neurocognitive impairment in schizophrenia.

Current treatments for schizophrenia function by blocking neurotransmission at dopamine D2 receptors. These compounds have proven highly effective for treatment of schizophrenia and especially for management of positive symptoms. A range of compounds and formulations are presently available, which permits tailoring of side effects to optimize treatment for individual subjects. Nevertheless, many patients suffer from persistent negative symptoms and neurocognitive deficits that contribute to persistent psychosocial impairments and long-term disability. At present, there are no approved pharmacological treatments for either negative symptoms or neurocognitive dysfunction. Instead, various behavioral approaches such as diet, exercise and cognitive remediation may be needed to help optimize cognitive function and mitigate symptoms. Furthermore, neuromodulation approaches, such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) are beginning to be employed both to minimize symptoms and to augment cognitive retraining approaches. At present, encouraging effects of tDCS on persistent auditory hallucinations have been reported, and if confirmed, may open the way for more widespread use of non-pharmacological treatments. At present, phase III studies remain ongoing for α7 nicotinic agonists in treatment of cognitive impairments and glycine reuptake inhibitors for suboptimal treatment response. Furthermore, preclinical studies suggest that glutamate-based treatment approaches may be effective if applied early in the illness. Future studies are needed to determine whether this will lead to effective approaches to halt illness progression for individuals at high clinical risk for schizophrenia.

Brain functional connectivity during the experience of thought blocks in schizophrenic patients with persistent auditory verbal hallucinations: An EEG study

Thought blocks (TBs) are characterized by regular interruptions in the stream of thought. Outward signs are abrupt and repeated interruptions in the flow of conversation or actions while subjective experience is that of a total and uncontrollable emptying of the mind. In the very limited bibliography regarding TB, the phenomenon is thought to be conceptualized as a disturbance of consciousness that can be attributed to stoppages of continuous information processing due to an increase in the volume of information to be processed. In an attempt to investigate potential expression of the phenomenon on the functional properties of electroencephalographic (EEG) activity, an EEG study was contacted in schizophrenic patients with persisting auditory verbal hallucinations (AVHs) who additionally exhibited TBs. In this case, we hypothesized that the persistent and dense AVHs could serve the role of an increased information flow that the brain is unable to process, a condition that is perceived by the person as TB. Phase synchronization analyses performed on EEG segments during the experience of TBs showed that synchrony values exhibited a long-range common mode of coupling (grouped behavior) among the left temporal area and the remaining central and frontal brain areas. These common synchrony-fluctuation schemes were observed for 0.5 to 2s and were detected in a 4-s window following the estimated initiation of the phenomenon. The observation was frequency specific and detected in the broad alpha band region (6–12Hz). The introduction of synchrony entropy (SE) analysis applied on the cumulative synchrony distribution showed that TB states were characterized by an explicit preference of the system to be functioned at low values of synchrony, while the synchrony values are broadly distributed during the recovery state. Our results indicate that during TB states, the phase locking of several brain areas were converged uniformly in a narrow band of low synchrony values and in a distinct time window, impeding thus the ability of the system to recruit and to process information during this time window.

Abnormal synchrony and effective connectivity in patients with schizophrenia and auditory hallucinations.

Auditory hallucinations (AH) are the most frequent positive symptoms in patients with schizophrenia. Hallucinations have been related to emotional processing disturbances, altered functional connectivity and effective connectivity deficits. Previously, we observed that, compared to healthy controls, the limbic network responses of patients with auditory hallucinations differed when the subjects were listening to emotionally charged words. We aimed to compare the synchrony patterns and effective connectivity of task-related networks between schizophrenia patients with and without AH and healthy controls.Schizophrenia patients with AH (n = 27) and without AH (n = 14) were compared with healthy participants (n = 31). We examined functional connectivity by analyzing correlations and cross-correlations among previously detected independent component analysis time courses. Granger causality was used to infer the information flow direction in the brain regions.The results demonstrate that the patterns of cortico-cortical functional synchrony differentiated the patients with AH from the patients without AH and from the healthy participants. Additionally, Granger-causal relationships between the networks clearly differentiated the groups. In the patients with AH, the principal causal source was an occipital–cerebellar component, versus a temporal component in the patients without AH and the healthy controls.These data indicate that an anomalous process of neural connectivity exists when patients with AH process emotional auditory stimuli. Additionally, a central role is suggested for the cerebellum in processing emotional stimuli in patients with persistent AH.

EPA-1018 - Source-based morphometry of gray matter volume in patients with schizophrenia who have persistent auditory verbal hallucinations

Abnormal brain structure of frontal and temporal brain regions has been suggested to occur in patients with schizophrenia who have frequent auditory verbal hallucinations (AVH). However, it is unknown whether this is specific to this patient subgroup. In this study tested the hypothesis that frontotemporal gray matter volume changes would characterize patients with persistent AVH (pAVH) in contrast to healthy controls and patients without AVH. Using structural magnetic resonance imaging at 3T, we studied 20 patients with schizophrenia and 14 matched healthy controls. Ten patients were classified as having chronic and treatment resistant AVH, whereas the remaining 10 patients either never had AVH in the past or were in full remission with regard to AVH (nAVH). Using a multivariate statistical technique for structural data, i.e. 'source-based morphometry' (SBM), we investigated naturally grouping patterns of gray matter volume variation among individuals, the magnitude of their expression between-groups and the relationship between gray matter volume and AVH-specific measures. SBM identified a lower expression of medial and inferior frontal as well as bilateral temporal gray matter volume between pAVH and nAVH. This pattern did not differ between nAVH patients and controls and was associated with 'physical' AVH characteristics (such as symptom duration, location, frequency and intensity) in the pAVH patient group. These results suggest that a pattern of lower gray matter volume in medial frontal and bilateral temporal cortical regions differentiates between patients with persistent AVH and non-hallucinating patients. Moreover, the data support a specific role of this neural pattern in AVH symptom expression.

Patterns of Auditory Verbal Hallucination among Patients Diagnosed with Chronic Schizophrenia

Background : Presence of auditory hallucination is considered to be the frontline diagnostic criteria for schizophrenia. The present study aimed to evaluate the pattern of auditory verbal hallucinations (AVH) among patients diagnosed with chronic schizophrenia. Materials and method : Consented patients (N=52) were asked individually to detail about their experience of persistent auditory hallucinations using a semi-structured interview schedule. Data was pooled and analyzed using Microsoft Excel-2007. Results : Mean age at first hearing voices was 26 years, and 50% of them reported to hear voices for about a few minutes a day. 11.5% of them reported that their voices were hostile and many (69.2%) of them heard voices of more than one person talking at a time. Commenting type of AVH was more (84.6%), voices more (61.5%) frequently heard during evening time. Majority (57.7%) of them reported to hear voices which are of both male and female and 50% of them it was not from anyone they known before. 88% reported that the intensity of AVH was more when they are alone and 65.4% of them reported to be relieved when they started doing something interesting. 50% them reported that the medications have no effect over AVH. Discussion : The result of the study may be used to increase understanding of the pattern of AVH among chronic schizophrenia and to be more empathetic in formulating nursing care plans to help those troubled voice hearers by incorporating more adaptive self help strategies to deal with it.

Source-based morphometry of gray matter volume in patients with schizophrenia who have persistent auditory verbal hallucinations

Abnormal structure of frontal and temporal brain regions has been suggested to occur in patients with schizophrenia who have frequent auditory verbal hallucinations (AVH). However, it is unknown whether this is specific to this patient subgroup. This study tested the hypothesis that frontotemporal gray matter volume changes would characterize patients with persistent AVH (pAVH) in contrast to healthy controls and patients without AVH. Using structural magnetic resonance imaging at 3T, we studied 20 patients with schizophrenia and 14 matched healthy controls. Ten patients were classified as having chronic and treatment resistant AVH, whereas the remaining 10 patients either never had AVH in the past or were in full remission with regard to AVH (nAVH). Using a multivariate statistical technique for structural data, i.e. "source-based morphometry" (SBM), we investigated naturally grouping patterns of gray matter volume variation among individuals, the magnitude of their expression between-groups and the relationship between gray matter volume and AVH-specific measures. SBM identified a reduction of medial and inferior frontal, insular and bilateral temporal gray matter volume between pAVH and nAVH. This pattern did not differ between nAVH patients and controls and was associated with "physical" AVH characteristics (such as symptom duration, location, frequency and intensity) in the pAVH patient group. These results suggest that a pattern of lower gray matter volume in medial frontal, insular and bilateral temporal cortical regions differentiates between patients with persistent AVH and non-hallucinating patients. Moreover, the data support a specific role of this neural pattern in AVH symptom expression.