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Experiential features used by patients with schizophrenia to differentiate ‘voices’ from ordinary verbal thought

  • R. E. Hoffman (a1), M. Varanko (a1), J. Gilmore (a1) and A. L. Mishara (a1)
Abstract
Background

Determining how patients distinguish auditory verbal hallucinations (AVHs) from their everyday thoughts may shed light on neurocognitive processes leading to these symptoms.

Method

Fifty patients reporting active AVHs (‘voices’) with a diagnosis of schizophrenia or schizo-affective disorder were surveyed using a structured questionnaire. Data were collected to determine: (a) the degree to which patients distinguished voices from their own thoughts; (b) the degree to which their thoughts had verbal form; and (c) the experiential basis for identifying experiences as voices versus their own verbal thoughts. Six characteristics of acoustic/verbal images were considered: (1) non-self speaking voice, (2) loudness, (3) clarity, (4) verbal content, (5) repetition of verbal content, and (6) sense of control.

Results

Four subjects were eliminated from the analysis because they reported absent verbal thought or a total inability to differentiate their own verbal thoughts from voices. For the remaining 46 patients, verbal content and sense of control were rated as most salient in distinguishing voices from everyday thoughts. With regard to sensory/perceptual features, identification of speaking voice as non-self was more important in differentiating voices from thought than either loudness or clarity of sound images.

Conclusions

Most patients with schizophrenia and persistent AVHs clearly distinguish these experiences from their everyday thoughts. An adequate mechanistic model of AVHs should account for distinctive content, recognizable non-self speaking voices, and diminished sense of control relative to ordinary thought. Loudness and clarity of sound images appear to be of secondary importance in demarcating these hallucination experiences.

Copyright
Corresponding author
*Address for correspondence: R. E. Hoffman, M.D., Yale-New Haven Psychiatric Hospital, 184 Liberty Street LV108, New Haven, CT 06519, USA. (Email: Ralph.hoffman@yale.edu)
References
Hide All
Aggernaes A (1972). The experienced reality of hallucinations and other psychological phenomena. Acta Psychiatrica Scandinavica 48, 220238.
Andreasen NC, Flaum M (1991). Schizophrenia: the characteristic symptoms. Schizophrenia Bulletin 17, 2750.
Birchwood M, Gilbert P, Gilbert J, Trower P, Meaden A, Hay J, Murray E, Miles JN (2004). Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models. Psychological Medicine 34, 15711580.
Copolov DL, Seal ML, Maruff P, Ulusoy R, Wong MT, Tochon-Danguy HJ, Egan GF (2003). Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia: a PET correlation study. Psychiatry Research 122, 139152.
David AS (1994). The neuropsychological origin of auditory hallucinations. In The Neuropsychology of Schizophrenia (ed. David A. S. and Cutting J. C.), pp. 269313. Erlbaum: Mahwah, NJ.
Dennett D (1991). Consciousness Explained. Little, Brown & Company: Boston.
Dierks T, Linden DEJ, Jandl M, Formisano E, Goebel R, Lanfermann H, Singer W (1999). Activation of Heschl's gyrus during auditory hallucinations. Neuron 22, 615621.
Feinberg I, Guazzelli M (1999). Schizophrenia – a disorder of the corollary discharge systems that integrate the motor systems of thought with the sensory systems of consciousness. British Journal of Psychiatry 174, 196204.
First MB, Spitzer RL, Gibbon M, Williams JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P), Version 2.0. Biometrics Research Department, New York Psychiatric Institute: NY.
Ford JM, Roach BJ, Faustman WO, Mathalon DH (2007). Synch before you speak: auditory hallucinations in schizophrenia. American Journal of Psychiatry 164, 458466.
Frith CD, Done DJ (1986). Towards a neuropsychology of schizophrenia. British Journal of Psychiatry 153, 437443.
Garrett M, Silva R (2003). Auditory hallucinations, source monitoring and the belief that voices are real. Schizophrenia Bulletin 29, 445457.
Hersch K, Borum R (1998). Command hallucinations, compliance, and risk assessment. Journal of the American Academy of Psychiatry and Law 26, 353359.
Hoffman RE (1986). Verbal hallucinations and language production processes in schizophrenia. Behavioral and Brain Sciences 9, 503517.
Hoffman RE (2007). A social deafferentation hypothesis for induction of active schizophrenia. Schizophrenia Bulletin 33, 10661070.
Hoffman RE, Gueorguieva R, Hawkins KA, Varanko M, Boutros NN, Wu Y-T, Carroll K, Krystal JH (2005). Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and predictors in a fifty patient sample. Biological Psychiatry 58, 97104.
Hoffman RE, Hampson M, Wu K, Anderson A, Gore J, Buchanan RJ, Constable T, Hawkins K, Sahay N, Krystal JH (2007). Probing the pathophysiology of auditory hallucinations by combining functional magnetic resonance imaging and transcranial magnetic stimulation. Cerebral Cortex 17, 27332743.
Hoffman RE, McGlashan T (1993). Parallel, distributed processing and the emergence of schizophrenic symptoms. Schizophrenia Bulletin 19, 119140.
Hoffman RE, McGlashan TH (1997). Synaptic elimination, neurodevelopment and the mechanism of hallucinated ‘voices’ in schizophrenia. American Journal of Psychiatry 154, 16831689.
Hoffman RE, Oates E, Hafner RJ, Hustig HH, McGlashan TH (1994). Semantic organization of hallucinated ‘voices’ in schizophrenia. American Journal of Psychiatry 151, 12291230.
Hubl DA, Koenig T, Strik WK, Garcia LM, Dierks T (2007). Competition for neural resources: how hallucinations make themselves heard. British Journal of Psychiatry 190, 5763.
Hunter MD, Griffiths TD, Farrow TFD, Zheng Y, Wilkinson ID, Hegde N, Woods W, Spence SA, Woodruf PWR (2003). A neural basis for the perception of voices in external auditory space. Brain 126, 161169.
Hustig HH, Hafner RJ (1990). Persistent auditory hallucinations and their relationship to delusions and mood. Journal of Nervous and Mental Disease 178, 264267.
Johns LC, McGuire PK (1999). Verbal self-monitoring and auditory hallucinations in schizophrenia. Lancet 353, 469470.
Johns LC, Rossell S, Frith C, Ahmad F, Hemsley D, Kuipers E, McGuire PK (2001). Verbal self-monitoring and auditory hallucinations in patients with schizophrenia. Psychological Medicine 31, 705715.
Junginger J, Frame C (1985). Self-report of the frequency and phenomenology of verbal hallucinations. Journal of Nervous and Mental Disease 173, 149155.
Leudar I, Thomas P, McNally D, Glinski A (1997). What voices can do with words: pragmatics of verbal hallucinations. Psychological Medicine 27, 885898.
McGuire PK, Silbersweig DA, Wright I, Murray RM, Frackowiak RS, Frith CD (1996). The neural correlates of inner speech and auditory verbal imagery in schizophrenia: relationship to auditory verbal hallucinations. British Journal of Psychiatry 169, 148159.
Moller P, Husby R (2000). The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin 26, 217232.
Mueser KT, Bellack AS, Brady EU (1990). Hallucinations in schizophrenia. Acta Psychiatrica Scandinavica 82, 2629.
Nayani TH, David AS (1996). The auditory hallucination: a phenomenological survey. Psychological Medicine 26, 179189.
Olfson M, Lewis-Fernandez R, Weissman MM, Feder A, Gameroff MJ, Pilowsky D, Fuentes M (2002). Psychotic symptoms in an urban general medicine practice. American Journal of Psychiatry 159, 14121419.
Shergill SS, Brammer MJ, Fukuda R, Williams SC, Murray RM, McGuire PK (2003). Engagement of brain areas implicated in processing inner speech in people with auditory hallucinations. British Journal of Psychiatry 182, 525531.
Shergill SS, Bullmore E, Simmons A, Murray R, McGuire P (2000). Functional anatomy of auditory verbal imagery in schizophrenic patients with auditory hallucinations. American Journal of Psychiatry 157, 16911693.
Shergill SS, Murray RM, McGuire PK (1998). Auditory hallucinations: a review of psychological treatments. Schizophrenia Research 32, 137150.
Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA, Stroup TS, McEvoy JP, Lieberman JA (2006). A national survey of violent behavior in persons with schizophrenia. Archives of General Psychiatry 63, 490499.
Tan HY, Ang YG (2001). First-episode psychosis in the military: a comparative study of prodromal symptoms. Australian and New Zealand Journal of Psychiatry 35, 512519.
Trower P, Birchwood M, Meaden A, Byrne S, Nelson A, Ross K (2004). Cognitive therapy for command hallucinations: randomised controlled trial. British Journal of Psychiatry 184, 312320.
Uhlhaas PJ, Mishara AL (2007). Perceptual anomalies in schizophrenia: integrating phenomenology and neuropsychiatry. Schizophrenia Bulletin 33, 142156.
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Psychological Medicine
  • ISSN: 0033-2917
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