Severe Hallucinations Research Articles

EFFECTIVENESS OF AL-QURAN THERAPY IN REDUCING THE LEVEL OF AUDITORY HALLUCINATIONS

Introduction: Auditory hallucinations, which involve hearing voices that are not present, can severely impact an individual’s mental health and quality of life if left untreated. Qur'anic therapy, which involves reciting verses from the Qur’an, is believed to help calm the mind and reduce hallucination symptoms. The purpose of this community service initiative is to teach staff and patients to incorporate Qur'anic therapy into their daily routines, supporting both spiritual and psychological healing. Methods: This community service was conducted at the Pasuruan Social Rehabilitation Home with 35 clients experiencing auditory hallucinations who were coherent, cooperative, and Muslim. The aim was to provide Al-Quran therapy for 2 weeks, with each session lasting 5 minutes. The effectiveness of the therapy was measured using self-reported frequency of hallucinations and staff observations, with data analyzed through a paired sample t-test or Wilcoxon signed-rank test, depending on the distribution, to assess any significant reduction in the auditory hallucinations. Results: Some of the results experienced by patients after receiving Al-Quran therapy are that patients are more peaceful when experiencing auditory hallucinations. The patient also said that reading the Al Quran could be a distraction when the patient had auditory hallucinations. On average, 60% of patients' hallucinations were mild, 37.1% were moderate, and 2.9% had severe hallucinations. Conclusion: These findings indicate that Al-Quran therapy can be used as an effective method to reduce the frequency of auditory hallucinations in schizophrenia patients at the Pasuruan Social Rehabilitation Home. These findings have important implications for the management and care of patients with auditory hallucinations, as well as providing a therapeutic alternative that can improve patients' quality of life.

Altered sense of agency in schizophrenia: the aberrant effect of cardiac interoceptive signals.

Schizophrenia (SZ) is characterized by abnormalities in self-representation, including a disturbed sense of agency (SoA). The continuous processing of sensory information concerning the internal state of the body (interoception) is argued to be fundamental to neural representations of the self. We, therefore, tested if aberrant interoception underpins disturbances in SoA in SZ, focusing on cardiac interoceptive signaling. Forty-two SZ and 29 non-clinical participants (healthy controls; HC) performed an intentional binding task to measure SoA during concurrent heartbeat recording. The effect of cardiac interoceptive signals on SoA was measured by the difference in intentional binding effect during systole and diastole. This measure was standardized based on the overall intentional binding effect to control for non-cardiac factors, and then compared between SZ and HC. Our study revealed a significant difference between SZ and HC groups, with opposite effects of cardiac systole on SoA. Specifically, cardiac systole disrupted SoA in SZ, contrasting with the enhanced SoA in HC. Across the SZ group, the extent to which SoA was disrupted by cardiac systole correlated significantly with a clinical proxy for symptom instability, namely the number of hospital admissions for hallucinations and delusions. Furthermore, the disruption was particularly observed in patients with severe hallucinations. This study revealed a disturbance in the impact of cardiac interoceptive signals on an implicit index of SoA in schizophrenia. This supports the notion that pathophysiological disruption of the central integration of interoceptive information increases vulnerability to disturbances in self-representation and the associated expression of schizophrenic symptoms.

Creative puppet therapy reduces hallucinations in patients diagnosed with schizophrenia: Preliminary findings

Anomalous experiences and hallucinations characterize schizophrenia. This study aimed at determining the efficacy of creative puppet therapy (CPT; creation of a puppet with malleable DAS) to reduce severe anomalous experiences and hallucinations among patients diagnosed with schizophrenia. Double-blinded, controlled trials were performed on a convenience sample of 24 patients from a mental health center. The intervention group of 12 patients (who created puppets) and the pseudo-treatment group of 12 patients (who were involved in outdoor leisure trips) were compared to the control group of 12 control participants (who created puppets). Cardiff Anomalous Perceptions Scale (CAPS) assessed hallucinations; Emotional Expression Inventory (EEXI) assessed the emotional expression of one's own puppet. Puppet facial features were measured. Results showed that CPT effectively reduced (d = –4.00) hallucination frequency in patients. Hallucination reduction occurred across all sensory modalities, but touch and bodily interoception. Exteroceptive vs. interoceptive hallucinations was the most valuable classification in patients. Compared to controls, puppets created by patients expressed more negative emotions and had larger eye diameters, shorter noses, and larger whole face width. Eye diameter was correlated with fear, sadness, anger, and disgust, and whole face width with boredom. Fragmented-self integration of schizophrenia through CPT treatment might exploit aggregative dominance of the patient's own body.

Mental Health Nursing Care for Mrs. R with the Main Issue of Risk of Violent Behavior Due to Paranoid Schizophrenia in the Brotojoyo Ward, Dr. Amino Gondohutomo Psychiatric Hospital

Background: Paranoid schizophrenia is a mental disorder characterized by severe psychopathological symptoms, including delusions and hallucinations, which often lead to a risk of violent behavior. Purpose: This case study aims to provide nursing care for patients with paranoid schizophrenia at RSJD dr. Amino Gondohutomo, Central Java. The case discussed involves Mrs. R, who experiences a risk of violent behavior as a consequence of paranoid schizophrenia. Methods: The method used in this discussion is a case study with a mental health nursing care approach, including assessment, nursing diagnosis, intervention, implementation, and evaluation. Results: The results of the nursing care show that appropriate interventions, such as physical and verbal anger control exercises, as well as spiritual approaches, can reduce the intensity of violent behavior in the patient. Family support and patient compliance in undergoing pharmacological therapy also play a significant role in the recovery process. Conclusion: In conclusion, comprehensive and collaborative nursing care can improve the patient's psychological condition and reduce the risk of violent behavior.

No effect of anodal F3/cathodal Cpz tDCS in a patient with severe treatment-refractory coenaesthetic hallucinations

This article presents a case report of a 57-year-old patient with chronic (>20 years) schizophrenia and severe treatment-refractory coenaesthetic hallucinations located within the genital area. Due to the lack of therapeutic alternatives, a course of transcranial direct current stimulation targeting the somatosensory cortex that represents the genital area was performed. The severity of symptoms was assessed using the Clinical Global Impression (CGI, Severity and Improvement), Positive and Negative Syndrome Scale (PANSS) and three visual-analogue scales, separately for the three distinctive features of “general discomfort”, “ripping out”, and “pain”. After completing the three-week transcranial direct current stimulation course, there were no changes between the baseline and final clinical scores.

Penerapan Terapi Zikir Terhadap Penurunan Tanda dan Gejala Halusinasi pada Pasien Halusinasi RSJD Dr. RM. Soedjarwadi Provinsi Jawa Tengah

Hallucinations are one of the symptoms of mental disorders in which the patient experiences changes in sensory perception, feels false sensations in the form of sound or without real stimulation. One way to reduce the impact of auditory hallucinations is by giving dhikr therapy. The objective of the research; To find out the results of the implementation of the Application of Dhikr Therapy on the Level of Signs and Symptoms of Hallucinations in Hallucinatory Patients at Rsjd Dr. Rom. Soedjarwadi, Central Java Province. Method; The research design was conducted on 2 respondents by way of pretest posttest by interviewing and providing observation sheets for signs and symptoms of the ability to control hallucinations. Results; signs and symptoms of the respondent's hallucinations before the dhikr therapy was carried out. Tn.I was at a score of 28 with severe hallucinations and Mr.E was at a score of 26 with severe hallucinations. Then the signs and symptoms of hallucinations after the respondent's dhikr therapy were carried out, Mr. I was at a score of 9 with mild hallucinations and development of signs and symptoms in respondents in controlling auditory hallucinations before and after the dhikr therapy intervention. Summary; There are differences in development before and after dhikr therapy in patients with auditory hallucinations with both respondents having mild hallucinations.

Penerapan Terapi Musik Terhadap Penurunan Tingkat Halusinasi Pendengaran pada Pasien Gangguan Jiwa di Rumah Sakit Jiwa RSJD Dr. RM Soedjarwadi Klaten Provinsi Jawa Tengah

Hallucinations are one of the symptoms of mental disorders in which the patient experiences changes in sensory perception, feels false sensations in the form of sound or without real stimulation. One way to reduce the impact of auditory hallucinations is by providing music therapy. Purpose To find out the results of the implementation of the application of music therapy to the level of auditory hallucinations at Rsjd Dr. RM. Soedjarwadi, Central Java Province. Methods The research design was conducted on 2 female respondents by way of pretest posttest with the action of Mozart music therapy for 10-15 minutes and using interviews and providing AHRS observation sheets. The results of 2 respondents before music therapy were in severe auditory hallucinations, namely Mrs.S with a score of 24 and Mrs. SR 27. Then the auditory hallucinations of 2 respondents after music therapy were in mild and moderate hallucinations with a score of Mrs.S 7 and Ny. Sr 12. There are differences in the development of respondents with auditory hallucinations before and after the music therapy intervention. Conclusion There are differences in development before and after music therapy is carried out in hallucinatory patients.

Penerapan Terapi Generalis Halusinasi Untuk Menurunkan Tingkat Halusinasi Pada Pasien Skizofrenia Di RSJD Dr.RM. Soedjarwadi Klaten

Background: Hallucinations are false perceptual distortions that occur in maladaptive neurobiological responses, sufferers actually experience sensory distortions as real things and respond to them (Pardede, 2020). Generalist therapy is the application of standard scheduled nursing care that is applied to patients with the aim of reducing the mental nursing problems being handled. (Livana et al., 2020).Objective: To find out the results of implementing Generalist Therapy to Reduce the Level of Hallucinations in Schizophrenic Patients at RSJD Dr.RM Soedjarwadi Klaten.Method: The method used was a case study research design, the sample used was 2 respondents, the research instrument used was the AHRS observation sheet which was carried out before and after Hallucination Generalist Therapy was carried out. Findings: Before Generalist Hallucination Therapy Mr. A was in the category of severe hallucinations while Mr. P was in the category of moderate hallucinations. After Generalist Hallucination Therapy Mr. A was in the category of seeding hallucinations while Mr. P was in the mild category. Implication: There was a decrease in the level of hallucinations after the Hallucination Generalist Therapy was carried out on Mr. A and Mr.P which was carried out for 3 meetings.

Influence of Dhikr Therapy on Reducing Signs and Symptoms of Halucinations in Hallucination Patients in Regional Psychiatric Hospital Dr. Arif Zainudin Surakarta

The increasing prevalence of schizophrenic patients is as much as 7% of the Indonesian population and around 70% of schizophrenic patients experience hallucinations. hallucinations are false perceptions, clients with hallucinations often feel a state that can only be felt by them but cannot be felt by other people. in minimizing the impact caused by hallucinations, proper treatment is needed, one of which is dhikr therapy, where dhikr therapy can relieve anxiety, anxiety and calm the heart. This research aim to dhikr therapy for reducing signs and symptoms in halucinations patient. The research design used in this research is a descriptive research design in the form of a case study by providing AHRS observation sheets. The level of hallucinations before the dhikr therapy was carried out, the patient was in the category of signs and symptoms of severe hallucinations. after dhikr therapy the patient experienced mild hallucinations. there are differences in the development of signs and symptoms of hallucinations before and after the application of dhikr therapy. There is a comparison of development between patients who experience signs and symptoms of hallucinations before and after being given dhikr therapy.

TERAPI OKUPASI MENGGAMBAR TERHADAP PERUBAHAN TANDA DAN GEJALA HALUSINASI PADA PASIEN DENGAN GANGGUAN PRESEPSI SENSORI HALUSINASI DI RSUD TOMBULILATO

Hallucinations are a symptom of mental disorders in individuals characterized by changes in sensory perception: feeling false sensations in the form of sound, sight, touch, taste and smell. Patients with hallucinations get a response about their environment without any real object of stimulation. The purpose of this study was to determine Occupational Drawing Therapy for Changes in Signs and Symptoms of Hallucinations in Patients with Hallucination Sensory Perception Disorders at Tombulilato Hospital. Pre-experimental research design with one group pretest and posttest research design. Sampling using Total Sampling with 15 respondents. Data collection used an observation sheet with the results of the study that there were 15 (100%) respondents with severe hallucinations before being given occupational drawing therapy and after being given occupational drawing therapy there were 14 (93.0%) respondents with mild hallucinations and there was 1 (7.0%) ) respondents with severe hallucinations. The results of statistical tests using the Paired T-Test showed a p value = 0.000 with ? <0.05, there was a significant effect between occupational drawing therapy on changes in signs and symptoms in patients with hallucinatory sensory perception disorders. It is hoped that changes in signs and symptoms can reduce hallucinations from patients.

A Case of Severe Somatic Hallucination and Apathy with Parkinsonism Successfully Treated with Yokukansankachimpihange

A Case of Severe Somatic Hallucination and Apathy with Parkinsonism Successfully Treated with Yokukansankachimpihange

The role of religiosity types in the phenomenology of hallucinations: A large cross-sectional community-based study in a predominantly Muslim society

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education.

PSAT220 Severe Vitamin D Deficiency and Hypocalcemia during Pregnancy Masquerading as Thyroid Storm

Abstract Background Hypocalcemic tetany in young female patients is a clinical entity that is well-described in literature. Here we present a potentially life-threatening case of hypocalcemia secondary to severe Vitamin D deficiency and hyperemesis gravidarum mimicking thyroid storm. Case Presentation A 22-year-old Caucasian woman at 21 weeks gestation was transferred to our hospital for suspected thyroid storm with TSH <0.01 mIU/L (0.05-5.7). She had no history of nor risk factors for thyroid disease and presented with severe agitation, hallucinations, and muscle spasms after weeks of vomiting and poor oral intake. In the ambulance her temperature was 106.6F (rectal) and she was tachycardic (216/minute). EKG revealed ventricular arrhythmia with QTc 532 ms. EMS interventions included unsuccessful cardioversion with 100J and 300mg IV amiodarone bolus. In the ED, serum calcium level was 5.9 mmol/L (8.4-10.2), albumin 2.8 g/dL (3.3-4.5), magnesium 1.0 mmol/L (1.7-2.3), potassium 3.1 mmol/L (3.5-4.8), lactic acid 9.5 mmol/L (0.5-2.2), Free T4 1.36 ng/dL (0.58-1.65), troponin 2.21 ng/ml (0.00-0.03), β-hcg 48,775 mIU/ml, CK 9960 U/L (0-188), AST 171 U/L (8-34), ALT 45 (0-24). She received IV calcium gluconate, aggressive IV hydration and electrolyte repletion. Free T3 was drawn prior to initiating empiric thyroid storm treatment (hydrocortisone, propylthiouracil) returned at 3.8 pmol/L (2.5-3.9). Thyroid storm was further ruled out with negative antibodies for TPO and TSI and ultrasound revealing normal-sized gland without nodules and with normal vascularity. Hydrocortisone and Thionamide therapy were discontinued. The patient had rapid improvement in mentation and vitals with continued hydration and electrolyte repletion. 25-hydroxy-Vitamin D level was undetectable and PTH 118 pg/mL (12-88), consistent with secondary hyperparathyroidism. Celiac disease was ruled out with negative tissue transglutaminase IgA and IgG. At her follow-up clinic visit, symptoms had resolved with calcium and Vitamin D supplementation. Discussion Though a common phenomenon in pregnant women, metabolic derangements due to hyperemesis gravidarum can be quite severe and/or life-threatening, as in our case. Literature search revealed an isolated case of hyperemesis gravidarum presenting with severe electrolyte derangement and subsequent paraparesis which resolved after vitamin D and calcium supplementation. Hyperthyroidism is typically associated with hypercalcemia in the Western population. This patient's presenting features of hyperpyrexia, malignant cardiac arrhythmia, hepatitis, and altered mentation were reminiscent of thyroid storm and could easily be attributed to such in a pregnant patient with suppressed TSH. This could lead to continued use of thionamide and further hepatic damage. Thus, it is prudent to consider hypocalcemia in the differential diagnosis of thyrotoxicosis-like presentation, particularly in pregnant patients. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Co-occurring first-episode psychosis and borderline personality pathology in an early intervention for psychosis cohort.

Borderline personality disorder (BPD) is common among people diagnosed with first episode of psychosis (FEP), but is often under-recognized and under-researched. This study aimed to determine: (i) the prevalence of borderline personality pathology (subthreshold features and categorical disorder) in a FEP cohort (termed FEP + BPP); (ii) demographic and clinical factors associated with FEP + BPP; (iii) the symptomatic and functional outcomes. This study was conducted within the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen over the 30-month period between 2014 and 2016. BPP was evaluated by using the Structured Clinical Interview for DSM-IV Axis II Personality Questionnaire BPD criteria. In a cohort of 457 young people with a FEP (mean age 19.5 years, 56% male), 18.4% had borderline personality pathology (BPP). Compared with FEP alone, young people with FEP + BPP were more likely to be female, younger, Australian-born. In addition, young people with FEP + BPP were more likely to be diagnosed with Psychosis NOS, present with more severe hallucinations, and have alcohol abuse. Young people with FEP + BPP had more relationship difficulties at presentation and they were more likely to suffer of depression and to engage in self-harm throughout the follow-up. In relation to outcome, FEP + BPP was not associated with different rates of remission or relapse, however they were less likely to be admitted to hospital at presentation or involuntarily during their episode of care. BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self-harm. Specific interventions need to be developed.

Correlates of late-onset antipsychotic treatment resistance

IntroductionThere is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS.ObjectivesThis study aims to investigate socio-demographic and clinical correlates of late-onset of TRS.MethodsUsing data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics.ResultsWe observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS.ConclusionsOur findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance.DisclosureDFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp

Religiosity and Psychotic Experiences: A Large Community-Based Study From Qatar

AimsWe wished to explore associations between intrinsic religiosity, extrinsic (non-organizational (ENORG) and organizational (EORG)) religiosity and hallucinations phenomenology in a non-clinical Muslim population.MethodsWe selected full-time students at Qatar University using systematic random sampling and administered the Questionnaire of Psychotic Experiences online. We modelled the effects of sociodemographic variables, anxiety, depressive symptoms, and religiosity measures, delusions on hallucinations severity and distress/impact in the past week, using structural equation modelling.ResultsDirect-effects models supported ENORG religiosity's protective role against experiencing distress or negative impact on daily function from hallucinations. Intrinsic religiosity had positive indirect-effects on hallucinations distress/impact through depression, anxiety, and through EORG but negative (suppression) indirect-effects on hallucinations distress/impact through ENORG. Younger and married from lower socio-economic class participants had comparatively more severe hallucinations and more distress from them.ConclusionWe present evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and past week distress/impact of hallucinations.Our data support the importance of alignment between religious education and mental health and well-being education.

0816 Chronic insomnia secondary to severe nocturnal visual hallucinations in Charles Bonnet syndrome; a challenging case to manage

Abstract Introduction Over 1 million Americans are blind. Charles Bonnet syndrome (CBS), a parallel to phantom limb syndrome and also known as release hallucinations, describes visual hallucinations in patients with severe visual loss and blindness. The prevalence of release hallucinations, though likely underreported, is believed to be 12 to 20% of visually impaired persons. Report of Cases: A 45-year-old male with past medical history of migraines presented to the hospital with what was determined to be a ruptured pituitary macroadenoma and as a result, lost complete visual function including pupillary reflexes. The patient subsequently experienced both simple and complex release hallucinations and was eventually diagnosed with Charles Bonnet syndrome. Most disturbing to the patient was the simple release hallucinations which was described as a bright white light in a honeycomb lattice predominately in his right visual field which lasted for hours. This phantom light was not consistently associated with any other symptoms and could occur at any time throughout the 24-hour day. Nocturnal symptoms occurred approximately 50% of nights and caused severe onset/maintenance insomnia and insufficient sleep duration. The patient tried therapy in addition to proper sleep hygiene without relief. He was trialed on several medications and the only one able to alleviate all but the worst of the phantom light was diazepam. The GABA-A receptor agonist finally allowed the patient an opportunity to sleep. His insomnia was then treated with once nightly temazepam, in addition to as needed diazepam. Approximately nine years after losing his vision, he was transitioned from temazepam to the tricyclic antidepressant amitriptyline, which offered improved relief from the phantom lights causing his insomnia. The patient continues to utilize once nightly amitriptyline with diazepam for breakthrough symptoms, though he still suffers significant impairment due to the phantom lights of his Charles Bonnet syndrome. Conclusion Treatment of Charles Bonnet syndrome is multifactorial and includes maintaining optimal eye care, stimulating senses, psychosocial therapy, and pharmacotherapy. Insomnia from release hallucinations remains difficult to manage, though GABA-A receptor agonists have shown some relief. Case reports of atypical antipsychotics and antidepressants, including melperone and agomelatine respectively, have demonstrated ability to improve release hallucinations. Support (If Any) Charles Bonnet Syndrome FAQs. Charles Bonnet Syndrome Foundation (Australia). https://www.charlesbonnetsyndrome.org/index.php/cbs/faq. Accessed December 15, 2021.Hsu HC, Huang YS, Fan WX, Chen TC. Charles Bonnet Syndrome (CBS): Successful Treatment of Visual Hallucinations Due to Vision Loss with Agomelatine in Three Cases. European Psychiatry. 2017;41(S1):S172-S172. doi:10.1016/j.eurpsy.2017.01.2065Pelak VS. Visual release hallucinations (Charles Bonnet syndrome). UpToDate. Waltham, MA: UpToDate; June 7, 2016; https://www.uptodate.com/contents/visual-release-hallucinations-charles-bonnet-syndrome.

Decoding Activity in Broca's Area Predicts the Occurrence of Auditory Hallucinations Across Subjects

BackgroundFunctional magnetic resonance imaging (fMRI) capture aims at detecting auditory-verbal hallucinations (AVHs) from continuously recorded brain activity. Establishing efficient capture methods with low computational cost that easily generalize between patients remains a key objective in precision psychiatry. To address this issue, we developed a novel automatized fMRI-capture procedure for AVHs in patients with schizophrenia (SCZ). MethodsWe used a previously validated but labor-intensive personalized fMRI-capture method to train a linear classifier using machine learning techniques. We benchmarked the performances of this classifier on 2320 AVH periods versus resting-state periods obtained from SCZ patients with frequent symptoms (n = 23). We characterized patterns of blood oxygen level–dependent activity that were predictive of AVH both within and between subjects. Generalizability was assessed with a second independent sample gathering 2000 AVH labels (n = 34 patients with SCZ), while specificity was tested with a nonclinical control sample performing an auditory imagery task (840 labels, n = 20). ResultsOur between-subject classifier achieved high decoding accuracy (area under the curve = 0.85) and discriminated AVH from rest and verbal imagery. Optimizing the parameters on the first schizophrenia dataset and testing its performance on the second dataset led to an out-of-sample area under the curve of 0.85 (0.88 for the converse test). We showed that AVH detection critically depends on local blood oxygen level–dependent activity patterns within Broca's area. ConclusionsOur results demonstrate that it is possible to reliably detect AVH states from fMRI blood oxygen level–dependent signals in patients with SCZ using a multivariate decoder without performing complex preprocessing steps. These findings constitute a crucial step toward brain-based treatments for severe drug-resistant hallucinations.

Cognition, hallucination severity and hallucination-specific insight in neurodegenerative disorders and eye disease

ABSTRACT Introduction: Hallucinations occur across neurodegenerative disorders, with increasing severity, poorer cognition and impaired hallucination-specific insight associated with worse outcomes and faster disease progression. It remains unclear how changes in cognition, temporal aspects of hallucinations, hallucination-specific insight and distress relate to each other. Methods: Extant samples of patients experiencing visual hallucinations were included in the analyses: Parkinson’s Disease (n = 103), Parkinson’s Disease Dementia (n = 41), Dementia with Lewy Bodies (n = 27) and Eye Disease (n = 113). We explored the relationship between factors of interest with Spearman’s correlations and random-effect linear models. Results: Spearman’s correlation analyses at the whole-group level showed that higher hallucination-specific insight was related to higher MMSE score (r s = 0.39, p < 0.001) and less severe hallucinations (r s = −0.28, p < .01). Linear mixed-models controlling for diagnostic group showed that insight was related to higher MMSE (p < .001), to hallucination severity (p = 0.003), and to VH duration (p = 0.04). Interestingly, insight was linked to the distress component but not the frequency component of severity. No significant relationship was found between MMSE and hallucination severity in these analyses. Conclusion: Our findings highlight the importance of hallucination-specific insight, distress and duration across groups. A better understanding of the role these factors play in VH may help with the development of future therapeutic interventions trans-diagnostically.

The 10-year trajectories of auditory hallucinations among 496 patients with a first schizophrenia-spectrum disorder: Findings from the OPUS cohort

BackgroundAuditory hallucinations represent a key diagnostic feature of schizophrenia and one of the most frequent and debilitating psychotic symptoms. However, little is known regarding their long-term trajectories. MethodsWe included 496 patients with a first schizophrenia-spectrum disorder. Patients were at baseline and after one, two, five, and ten years asked for auditory hallucinations, scoring from 0 (“None”) to 5 (“Severe: Voices occur often every day”). We performed latent class growth analyses to identify trajectories of auditory hallucinations and multinomial logistic regression analyses to estimate predictors of trajectory membership. ResultsWe identified three trajectories of auditory hallucinations. The Low-Decreasing class (77%) had the lowest mean score at baseline (mean score = 2.1). The score improved within the first year (mean score = 0.5) and stayed low (mean score = 0 after ten years). The High-Fluctuating class (10%) improved during the first two years from a mean score of 3.0 to 1.0, but increased after five and ten years (mean score = 2.4). The High-Increasing class (13%) started at a high level (mean score = 3.5), improved a little after one year (mean score = 3.0), but increased to a mean score of 4.8 after ten years. Alcohol misuse and longer duration of untreated psychosis were associated with increased odds of being in the High-Increasing compared to the Low-Decreasing class. ConclusionsThe majority of patients with schizophrenia-spectrum disorder improved on auditory hallucinations during the first ten years, but almost one out of four had a fluctuating course with 13% experiencing an increase to severe and daily auditory hallucinations after ten years.