Severity Of Hallucinations Research Articles

Reduced functional connectivity and asymmetry of the planum temporale in patients with schizophrenia and first-degree relatives

The planum temporale (PT) is a highly lateralized brain area associated with auditory and language processing. In schizophrenia, reduced structural and functional laterality of the PT has been suggested, which is of clinical interest because of its potential role in the generation of auditory verbal hallucinations. We investigated whether resting-state functional imaging (fMRI) of the PT reveals aberrant functional connectivity and laterality in patients with schizophrenia (SZ) and unaffected relatives, and examined possible associations between altered intrinsic functional organization of auditory networks and hallucinations.We estimated functional connectivity between bilateral PT and whole-brain in 24 SZ patients, 22 unaffected first-degree relatives and 24 matched healthy controls. The results indicated reduced functional connectivity between PT and temporal, parietal, limbic and subcortical regions in SZ patients and relatives in comparison with controls. Altered functional connectivity correlated with predisposition towards hallucinations (measured with the Revised Hallucination Scale [RHS]) in both patients and relatives. We also observed reduced functional asymmetry of the superior temporal gyrus in patients and relatives, which correlated significantly with acute severity of hallucinations in the patient group.To conclude, SZ patients and relatives showed abnormal asymmetry and aberrant connectivity in the planum temporale during resting-state, which was related to psychopathology. These results are in line with results from auditory processing and symptom-mapping studies that suggest that the PT is a central node in the generation of hallucinations. Our findings support reduced intrinsic functional hemispheric asymmetry of the auditory network as a possible trait marker in schizophrenia.

Impact of Repetitive Transcranial Magnetic Stimulation (rTMS) on Brain Functional Marker of Auditory Hallucinations in Schizophrenia Patients.

Several cross-sectional functional Magnetic Resonance Imaging (fMRI) studies reported a negative correlation between auditory verbal hallucination (AVH) severity and amplitude of the activations during language tasks. The present study assessed the time course of this correlation and its possible structural underpinnings by combining structural, functional MRI and repetitive Transcranial Magnetic Stimulation (rTMS). Methods: Nine schizophrenia patients with AVH (evaluated with the Auditory Hallucination Rating scale; AHRS) and nine healthy participants underwent two sessions of an fMRI speech listening paradigm. Meanwhile, patients received high frequency (20 Hz) rTMS. Results: Before rTMS, activations were negatively correlated with AHRS in a left posterior superior temporal sulcus (pSTS) cluster, considered henceforward as a functional region of interest (fROI). After rTMS, activations in this fROI no longer correlated with AHRS. This decoupling was explained by a significant decrease of AHRS scores after rTMS that contrasted with a relative stability of cerebral activations. A voxel-based-morphometry analysis evidenced a cluster of the left pSTS where grey matter volume negatively correlated with AHRS before rTMS and positively correlated with activations in the fROI at both sessions. Conclusion: rTMS decreases the severity of AVH leading to modify the functional correlate of AVH underlain by grey matter abnormalities.

Aberrant Dependence of Default Mode/Central Executive Network Interactions on Anterior Insular Salience Network Activity in Schizophrenia

In schizophrenia, consistent structural and functional changes have been demonstrated for the insula including aberrant salience processing, which is critical for psychosis. Interactions within and across default mode and central executive network (DMN, CEN) are impaired in schizophrenia. The question arises whether these 2 types of changes are related. Recently, the anterior insula has been demonstrated to control DMN/CEN interactions. We hypothesized that aberrant insula and DMN/CEN activity in schizophrenia is associated with an impaired dependence of DMN/CEN interactions on anterior insular salience network (SN) activity. Eighteen patients with schizophrenia during psychosis and 20 healthy controls were studied by resting-state-fMRI and psychometric examination. High-model-order independent component analysis of fMRI data revealed spatiotemporal patterns of synchronized ongoing blood-oxygenation-level-dependent (BOLD) activity including SN, DMN, and CEN. Scores of functional and time-lagged connectivity across networks' time courses were calculated. Connectivity scores and spatial network maps were compared between groups and related with patients' hallucination and delusion severity. Spatial BOLD-synchronicity was altered in patients' SN, DMN, and CEN, including decreased activity in the right anterior insula (rAI). Patients' functional connectivity between DMN and CEN was increased and related with hallucinations severity. Importantly, patients' time-lagged connectivity between SN and DMN/CEN was reduced, and decreased rAI activity of the SN was associated with both hallucinations and increased functional connectivity between DMN and CEN. Data provide evidence for an aberrant dependence of DMN/CEN interactions on anterior insular SN activity, linking impaired insula, DMN, CEN activity, and psychosis in schizophrenia.

Association of schizophrenia spectrum and autism spectrum disorder (ASD) symptoms in children with ASD and clinic controls

This study examines relations between the severity of specific symptoms of schizophrenia spectrum disorder (SSD) and severity of the three defining symptom domains of autism spectrum disorder (ASD) in children with ASD (N=147) and child psychiatry outpatient referrals (Controls; N=339). Participants were subdivided into four groups depending on ASD status (±) and whether they met symptom criteria for attention-deficit/hyperactivity disorder (±ADHD). Their mothers and teachers evaluated them with a DSM-IV-referenced rating scale. Correlations between schizoid personality symptoms and ASD social skills deficits were moderate to large, and this was true for children with ASD and Controls, regardless of ADHD status, and for mother's and teachers' ratings. Conversely, severity of hallucinations, delusions, and disorganized thinking were minimally correlated with ASD severity with the exception of Controls with ADHD. The disorganized behavior and negative symptoms of schizophrenia evidenced the strongest pattern of associations with ASD symptoms, and this was particularly true for children with co-morbid ADHD (±ASD, all three ASD symptom dimensions), and for teachers' ratings of all four groups. Nevertheless, there was considerable variability in relations for specific symptoms across informants and groups. Correlations between SSD symptom severity and IQ were generally low, particularly among the ASD Only group and for all teacher-rated symptoms. Associations between ASD and SSD symptoms were often dimension-specific, and this was particularly evident in children without ADHD (±ASD; mothers' ratings). Findings were interpreted as supporting the deconstruction of complex clinical phenotypes as a means of better understanding interrelations among psychiatric syndromes.

Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms

This review explores the influence of anxiety and depression on the experience of positive psychotic symptoms, and investigates the possibility of a causal role for anxiety and depression in the emergence and persistence of psychosis. A systematic literature search was undertaken, producing a number of papers which comment on the links between anxiety and depression, and the experience of delusions and hallucinations. In addition, evidence which could contribute to our understanding of the causal role of anxiety and depression was highlighted. The findings show that both anxiety and depression are associated in meaningful ways with the severity of delusions and hallucinations, the distress they elicit and their content. However, the cross-sectional nature of the majority of studies and the focus on certain symptom subtypes tempers the validity of the findings. Data from non-clinical samples, studies which track the longitudinal course of psychosis and those which examine the impact of anxiety and depression on the prognosis for people experiencing psychosis, offer some support for the possibility of an influential role for anxiety and depression. We conclude that anxiety and depression are related to psychotic symptom severity, distress and content and are also linked with sub-clinical experiences, symptom development, prognosis and relapse. These links may imply that anxiety and depression could be targets for therapeutic intervention. The article concludes with suggestions for further research, highlighting avenues which may circumvent the limitations of the body of work as it stands.

Sleep Disorders in Patients with Dementia in Parkinson’s Disease

Dementia and psychotic diseases represent a common complication of Parkinson’s disease (PD), occurring in 40–70% of cases. These complications are commonly accompanied by sleep disorders, which constitute non-motor manifestations of PD. The aims of the present work were to assess the relationship between the severity of daytime drowsiness and REM sleep behavior disorder on the one hand and the severity of cognitive deficits and hallucinations on the other; to compare methods for assessing sleep impairments in Parkinson’s disease using questionnaires and polysomnograms; and to evaluate the effects of treatment with galantamine in sleep disorders. A number of scales (MMSE, FAB, ESS, PDSS), as well as polysomnographic investigations, were used to assess sleep and cognitive functions in 26 patients with PD with dementia before and after treatment with galantamine. The results revealed a significant negative correlation between the severity of sleep disorders (increased daytime drowsiness and REM sleep behavior disorder) with hallucinations and cognitive deficits. Treatment with galantamine produced significant improvements in the quality of nocturnal sleep (restoration of its structure, decreased fragmentation), with reductions in the severity of REM sleep behavior disorder and decreases in daytime drowsiness, along with reductions in cognitive deficits and hallucinations.

Experiencing malevolent voices is associated with attentional dysfunction in psychotic patients

Inattention in people with schizophrenia is common. However, there has been little research on the association between inattention and auditory hallucinations. The aim of the study was to investigate how inattention is affected by beliefs about voices as benevolent and malevolent and perceived control of voices. A total of 31 patients who experienced auditory hallucinations and who met the criteria for schizophrenia or other psychosis completed the attention subscale of the Scale for the Assessment of Negative Symptoms (SANS) and the Connors’ Continuous Performance Test II (CCPT-II). The revised Beliefs About Voices Questionnaire (BAVQ-R) was used to assess malevolent and benevolent beliefs about voices, and severity of auditory hallucinations (the Psychotic Symptom Rating Scales; PSYRATS) was used to assess perceived control of voices and frequency of voices. Levels of depression (the Beck Depression Inventory; BDI), anxiety (the Beck Anxiety Inventory; BAI), severity of overall psychiatric symptoms (the Brief Psychiatric Rating Scale; BPRS), and severity of negative symptoms (SANS) were assessed to control for their potential confounding effects. The relations between the variables were explored with correlations and multiple hierarchical regression analyses. The results indicated that more malevolent, but not more benevolent, beliefs about voices predicted lower levels of attention, independently of general psychiatric symptoms and various other psychotic symptoms such as frequency of and perceived control of voices. These findings suggest an important relationship between malevolent beliefs about voices and levels of inattention. The possible impact of changing beliefs about voices to improve attentional functioning is discussed.

Resting State Functional Connectivity in Patients with Chronic Hallucinations

Auditory verbal hallucinations (AVH) are not only among the most common but also one of the most distressing symptoms of schizophrenia. Despite elaborate research, the underlying brain mechanisms are as yet elusive. Functional MRI studies have associated the experience of AVH with activation of bilateral language-related areas, in particular the right inferior frontal gyrus (rIFG) and the left superior temporal gyrus (lSTG). While these findings helped to understand the neural underpinnings of hearing voices, they provide little information about possible brain mechanisms that predispose a person to experience AVH, i.e. the traits to hallucinate. In this study, we compared resting state connectivity between 49 psychotic patients with chronic AVH and 49 matched controls using the rIFG and the lSTG as seed regions, to identify functional brain systems underlying the predisposition to hallucinate. The right parahippocampal gyrus showed increased connectivity with the rIFG in patients as compared to controls. Reduced connectivity with the rIFG in patients was found for the right dorsolateral prefrontal cortex. Reduced connectivity with the lSTG in patients was identified in the left frontal operculum as well as the parietal opercular area. Connectivity between the lSTG and the left hippocampus was also reduced in patients and showed a negative correlation with the severity of hallucinations. Concluding, we found aberrant connectivity between the seed regions and medial temporal lobe structures which have a prominent role in memory retrieval. Moreover, we found decreased connectivity between language-related areas, indicating aberrant integration in this system potentially including corollary discharge mechanisms.

Glutathione S-transferase alpha 1 risk polymorphism and increased bilateral thalamus mean diffusivity in schizophrenia

Oxidative damage in brain cells is one of the factors hypothesized to be involved in the pathogenesis of schizophrenia. Glutathione S-transferase (GST) A1*B polymorphism, a genotype associated with a higher risk of oxidative damage, is associated with increased frequency of schizophrenia diagnosis. Thus, here we studied Glutathione S-transferase (GST) A1 polymorphism and diffusion tensor imaging-mean diffusivity (MD) data on deep grey matter brain structures in 56 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR) schizophrenia. Clinical diagnosis and psychopathological symptom severity were assessed by using the Structured Clinical Interview for DSM-IV-TR (SCID-P) and the Scales for Assessment of Positive and Negative Symptoms (SAPS and SANS). Results confirmed that patients with schizophrenia who were carriers of the GSTA1 *B risk allele had an increased MD in bilateral thalami and increased severity of auditory and global hallucinations in comparison with non-B carriers. Thus, oxidative stress associated factors may be implicated in specific mechanisms of schizophrenia such as altered microstructure of the thalami and specific psychopathological features of auditory hallucinations.

Missing referents, psychotic symptoms, and discriminating the internal from the externalized.

The communicative efficacy of the speech of schizophrenia patients is compromised by the presence of references for which there are no referents. There is evidence that this kind of error is positively associated with the genetic substrate of schizophrenia. The present study was an effort to identify a cognitive process source of these errors by looking at their association with performance on an internal source memory task assessing the ability to remember what one has said out loud versus only thought. Their relationship to psychotic symptoms also was examined. A sample of 110 schizophrenic/schizoaffective outpatients, and 23 nonpsychiatric controls provided 10-min speech samples and completed a battery of memory tests. Patients' symptoms also were rated for severity. Patients performed more poorly than controls on the memory tests, and their speech contained much more frequent references without referents. Frequency of missing referents was associated with scores on the test of internal source memory, even after scores on tests of immediate memory, working memory, and external source memory were regressed out. Missing referents were also related to severity of hallucinations and delusions, and internal source memory performance was related to hallucinations. The findings of this study support the idea that missing referents, hallucinations, and delusions have some common process underpinnings. Impairment in internal source memory appears to be one such process.

The Neurodynamic Organization of Modality-Dependent Hallucinations

The pathophysiology of hallucinations remains mysterious. This research aims to specifically explore the interaction between hallucinations and spontaneous resting-state activity. We used multimodal magnetic resonance imaging during hallucinations occurrence in 20 drug-free adolescents with a "brief psychotic disorder." They were furthermore compared with 20 matched controls at rest or during exteroceptive stimuli. Anatomical and functional symptom-mapping demonstrated reduced cortical thickness and increased blood oxygen level-dependent signal in modality-dependent association sensory cortices during auditory, visual, and multisensory hallucinations. On the contrary, primary-sensory-cortex recruitment was not systematic and was shown to be associated with increased vividness of the hallucinatory experiences. Spatiotemporal activity patterns in the default-mode network (DMN) during hallucinations and symptom-free periods in patients were compared with patterns measured in healthy individuals. A disengagement of the DMN was concomitant to hallucinations, as for exogenous stimulations in healthy participants. Specifically, spatial and temporal instabilities of the DMN correlated with the severity of hallucinations but persisted during symptom-free periods. These results suggest that hallucinatory experiences emerge from a spontaneous DMN withdrawal, providing a convincing model for hallucinations beyond the auditory modality.

The Treatment of Hallucinations in Schizophrenia Spectrum Disorders

This article reviews the treatment of hallucinations in schizophrenia. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2-4 weeks of treatment. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. Blood levels should be above 350-450 μg/ml for maximal effect. For relapse prevention, medication should be continued in the same dose. Depot medication should be considered for all patients because nonadherence is high. Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. Several meta-analyses found significantly better symptom reduction for low-frequency repetitive TMS as compared with placebo. Consequently, TMS currently has the status of a potentially useful treatment method for auditory hallucinations, but only in combination with state of the art antipsychotic treatment. Electroconvulsive therapy (ECT) is considered a last resort for treatment-resistant psychosis. Although several studies showed clinical improvement, a specific reduction in hallucination severity has never been demonstrated.

Cognitive decision modelling of emotion-based learning impairment in schizophrenia: The role of awareness

Individuals with schizophrenia often lack insight or awareness. Resulting impairment has been observed in various cognitive domains and, recently, linked to problems in emotion-based learning. The Iowa Gambling Task (IGT) has been used to assess emotion-based decision-making in patients with schizophrenia, but results have been inconclusive. The current study further investigates emotion-based decision-making in schizophrenia by elucidating the unique contribution of awareness. Twenty-five patients with schizophrenia and 24 healthy controls were assessed with a modified version of the IGT recording awareness at regular intervals. Symptom assessment, medication and medical history were recorded for the clinical group. Patients with schizophrenia underperformed on the IGT compared to controls. Subjective awareness levels were significantly lower in the schizophrenia group and were associated with hallucination severity. Cognitive decision modelling further indicated that patients with schizophrenia had impaired attention to losses, compared to controls. This parameter was positively correlated with awareness. We also found that positive symptoms altered awareness levels and suggest that this disruption may contribute to sub-optimal decision-making. Overall, a lack of awareness may be an important aspect in understanding impaired social cognitive functioning and emotion-based learning observed in schizophrenia.

Structural correlates of auditory hallucinations in schizophrenia: A meta-analysis

BackgroundDespite being one of the most common symptoms of schizophrenia, determining the neural correlates of auditory hallucinations still remains elusive with various studies providing inconsistent results. MethodsWe conducted a voxel-based meta-analysis of studies investigating the structural correlates of auditory hallucinations in schizophrenia. Results7 datasets including 350 patients were identified. There was a significant negative correlation between the severity of hallucinations and gray matter volume in the left insula and right superior temporal gyrus. ConclusionWith its key role in stimulus evaluation and optimizing prediction (proximal salience), the insula is likely to be a cardinal region along with superior temporal gyrus in the mechanism of auditory hallucinations in schizophrenia.

Effect of 1 Hz Repetitive Transcranial Magnetic Stimulation Over the Auditory Cortex on Audiometry and Otoacustic Emissions

Repetitive transcranial magnetic stimulation (rTMS) at low frequencies (≤1 Hz) delivered to the primary motor cortex for 15 min or longer has been shown to reduce motor cortex excitability. Over the visual cortex, 1 Hz rTMS led to increased phosphene thresholds and over the auditory cortex rTMS reduced auditory evoked potentials. rTMS above the auditory or temporo-parietal cortex has also been reported to reduce the severity of auditory hallucinations and the perception of tinnitus. However, possible unwanted effects on hearing function have not yet been investigated systematically. 12 right-handed normal hearing subjects (5 male, mean age 28.2 ± 4.3) received a single session of 18 min 1 Hz rTMS at 90% resting motor threshold intensity using an established coil positioning method targeting the Heschl's area of the left superior temporal gyrus. Standard pure tone audiometry and distortion-products otoacustic emissions (DPOAE) were performed before and immediately after stimulation. The main finding was that one session of 1 Hz rTMS over the temporal cortex modified neither the auditory threshold meaningfully nor the presence of DPOAE in healthy subjects. In conclusion, we found in this pilot approach no obvious indication for auditory dysfunctions due to direct electromagnetic stimulation of the superior temporal gyrus after one session of rTMS in healthy controls that may be interpreted as unwanted side effects. Nevertheless monitoring of auditory functions is strongly recommended in future clinical trials stimulating the auditory cortex, as this has not been done systematically in the past.

Multimodal morphometry and functional magnetic resonance imaging in schizophrenia and auditory hallucinations

To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations. Twenty-two patients meeting Diagnostic and Statistical Manual of Mental Disorders (fourth edition, DSM-IV) criteria for schizophrenia and experiencing persistent hallucinations together with 28 healthy controls were evaluated with structural and functional MR imaging with an auditory paradigm designed to replicate those emotions related to the patients' hallucinatory experiences. Coincidence maps were obtained by combining structural maps of gray matter reduction with emotional functional increased activation. Abnormal areas were correlated with the brief psychiatric rating scale (BPRS) and the psychotic symptom rating scale (PSYRATS) scales. The coincidence analysis showed areas with coexistence gray matter reductions and emotional activation in bilateral middle temporal and superior temporal gyri. Significant negative correlations between BPRS and PSYRATS scales were observed. BPRS scores were negatively correlated in the middle temporal gyrus (right) (t = 6.86, P = 0.001), while negative PSYRATS correlation affected regions in both the superior temporal gyrus (left) (t = 7.85, P = 0.001) and middle temporal gyrus (left) (t = 4.97, P = 0.002). Our data identify left superior and middle temporal gyri as relevant areas for the understanding of auditory hallucinations in schizophrenia. The use of multimodal approaches, sharing structural and functional information, may demonstrate areas specifically linked to the severity of auditory hallucinations.

P-1433 - Suicidal behaviour in schizophrenia - the effect of emotional reactivity and negative symptons

Introduction Schizophrenia is a serious and common disease, one of the most disabling mental disorders in developed countries (Azevedo et al., 2010) and it is associated with high suicide attempt rates. A significant percentage of premature deaths is due to suicide and up to 50% of the patients attempt suicide during their lifetime, specially during the earlier course of the disease (Meltzer, 2003). Objectives In this study, the authors aimed to identify clinical factors (focusing on emotional reactivity and negative symptoms) and social-demographic variables associated to suicidal behaviour in Schizophrenia, in a large sample of Portuguese patients. Methods 508 patients with a diagnosis of Schizophrenia were selected according ICD-10 diagnostic criteria definitions, using the OPCRIT polydiagnostic system (McGuffin et al., 1991). Clinical and social-demographic variables were extracted from DIGS (Azevedo et al., 1993; Nurnberger et al., 1994). Suicidal Behaviour was assessed with the “Suicidal Behaviour Section” from DIGS. Results Suicidal behaviour occurred in 21.8% of the patients, with voluntary drug overdosing being the most used method. Although men showed to use more violent methods, the behaviour was more frequent in female patients. There was no association with the severity of delusions or hallucinations. The absence of formal thought changes, emotional withdrawal and affective blunting (meaning greater emotional reactivity) showed to be risk factors for the occurrence of suicidal behaviour. Conclusion This work may have relevant clinical implications due to its potential to guide the clinician in identifying a suicidal profile among his/her patients with Schizophrenia and delineating early intervention strategies.

The Application of the Cognitive Behavioral Therapy in Schizophrenia

ObjectivesZZCognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services. MethodsZZThe important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy. ResultsZZCognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive. ConclusionZZAlongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system. J Korean Neuropsychiatr Assoc 2012;51:359-366 KEY WORDSZZ Schizophr enia · Cognitive behavioral therapy · Drug resistant patient ·

Auditory hallucinations in a cross-diagnostic sample of psychotic disorder patients: a descriptive, cross-sectional study

BackgroundAuditory hallucinations (AH) are a cardinal feature of schizophrenia spectrum disorders. They are not disease specific, however, and can occur in other conditions, including affective psychoses. MethodsIn this descriptive, cross-sectional study, we examined AH in relation to other psychotic symptoms, mood symptoms, illness severity, and functional status in 569 patients with psychosis (n = 172 schizophrenia, n = 153 schizoaffective disorder, n = 244 bipolar disorder with psychotic features). ResultsA total of 323 (56.7%) patients reported a lifetime history of AH (75.6% of patients with schizophrenia, 71.9% schizoaffective disorder, and 34.0% bipolar disorder). The mean score for the hallucinations item (P3) of the Positive and Negative Syndrome Scale in the AH group was 3.66 ± 1.79, indicating mild to moderate state hallucinations severity. Auditory hallucinations were strongly associated with hallucinations in other sensory modalities and with the first-rank symptoms of delusions of control, thought insertion, and thought broadcasting. Multivariate analysis showed that AH were associated with lower education even after controlling for diagnosis, age, and sex. There was no association between AH and functional status as measured by the Multnomah Community Ability Scale. ConclusionsAuditory hallucinations are associated with specific clinical features across the continuum of both schizophrenic and affective psychoses independent of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis.

Visual hallucinations in dementia with Lewy bodies: transcranial magnetic stimulation study.

BackgroundThe aetiology of visual hallucinations is poorly understood in dementia with Lewy bodies. Pathological alterations in visual cortical excitability may be one contributory mechanism.AimsTo determine visual cortical excitability in people with dementia with Lewy bodies compared with aged-matched controls and also the relationship between visual cortical excitability and visual hallucinations in dementia with Lewy bodies.MethodVisual cortical excitability was determined by using transcranial magnetic stimulation (TMS) applied to the occiput to elicit phosphenes (transient subjective visual responses) in 21 patients with dementia with Lewy bodies and 19 age-matched controls.ResultsPhosphene parameters were similar between both groups. However, in the patients with dementia with Lewy bodies, TMS measures of visual cortical excitability correlated strongly with the severity of visual hallucinations (P = 0.005). Six patients with dementia with Lewy bodies experienced visual hallucination-like phosphenes (for example, seeing people or figures on stimulation) compared with none of the controls (P = 0.02).ConclusionsIncreased visual cortical excitability in dementia with Lewy bodies does not appear to explain visual hallucinations but it may be a marker for their severity.