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

Published online by Cambridge University Press:  30 November 2007

R. E. Hoffman*
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
M. Varanko
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
J. Gilmore
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
A. L. Mishara
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
*
*Address for correspondence: R. E. Hoffman, M.D., Yale-New Haven Psychiatric Hospital, 184 Liberty Street LV108, New Haven, CT 06519, USA. (Email: [email protected])

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.

Type
Original Articles
Copyright
Copyright © 2007 Cambridge University Press

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References

Aggernaes, A (1972). The experienced reality of hallucinations and other psychological phenomena. Acta Psychiatrica Scandinavica 48, 220238.CrossRefGoogle ScholarPubMed
Andreasen, NC, Flaum, M (1991). Schizophrenia: the characteristic symptoms. Schizophrenia Bulletin 17, 2750.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
Dennett, D (1991). Consciousness Explained. Little, Brown & Company: Boston.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
Ford, JM, Roach, BJ, Faustman, WO, Mathalon, DH (2007). Synch before you speak: auditory hallucinations in schizophrenia. American Journal of Psychiatry 164, 458466.CrossRefGoogle ScholarPubMed
Frith, CD, Done, DJ (1986). Towards a neuropsychology of schizophrenia. British Journal of Psychiatry 153, 437443.CrossRefGoogle Scholar
Garrett, M, Silva, R (2003). Auditory hallucinations, source monitoring and the belief that voices are real. Schizophrenia Bulletin 29, 445457.CrossRefGoogle ScholarPubMed
Hersch, K, Borum, R (1998). Command hallucinations, compliance, and risk assessment. Journal of the American Academy of Psychiatry and Law 26, 353359.Google Scholar
Hoffman, RE (1986). Verbal hallucinations and language production processes in schizophrenia. Behavioral and Brain Sciences 9, 503517.CrossRefGoogle Scholar
Hoffman, RE (2007). A social deafferentation hypothesis for induction of active schizophrenia. Schizophrenia Bulletin 33, 10661070.Google Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Hoffman, RE, McGlashan, T (1993). Parallel, distributed processing and the emergence of schizophrenic symptoms. Schizophrenia Bulletin 19, 119140.CrossRefGoogle ScholarPubMed
Hoffman, RE, McGlashan, TH (1997). Synaptic elimination, neurodevelopment and the mechanism of hallucinated ‘voices’ in schizophrenia. American Journal of Psychiatry 154, 16831689.CrossRefGoogle ScholarPubMed
Hoffman, RE, Oates, E, Hafner, RJ, Hustig, HH, McGlashan, TH (1994). Semantic organization of hallucinated ‘voices’ in schizophrenia. American Journal of Psychiatry 151, 12291230.Google ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Hustig, HH, Hafner, RJ (1990). Persistent auditory hallucinations and their relationship to delusions and mood. Journal of Nervous and Mental Disease 178, 264267.CrossRefGoogle ScholarPubMed
Johns, LC, McGuire, PK (1999). Verbal self-monitoring and auditory hallucinations in schizophrenia. Lancet 353, 469470.CrossRefGoogle ScholarPubMed
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.Google Scholar
Junginger, J, Frame, C (1985). Self-report of the frequency and phenomenology of verbal hallucinations. Journal of Nervous and Mental Disease 173, 149155.CrossRefGoogle ScholarPubMed
Leudar, I, Thomas, P, McNally, D, Glinski, A (1997). What voices can do with words: pragmatics of verbal hallucinations. Psychological Medicine 27, 885898.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
Moller, P, Husby, R (2000). The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin 26, 217232.CrossRefGoogle ScholarPubMed
Mueser, KT, Bellack, AS, Brady, EU (1990). Hallucinations in schizophrenia. Acta Psychiatrica Scandinavica 82, 2629.CrossRefGoogle ScholarPubMed
Nayani, TH, David, AS (1996). The auditory hallucination: a phenomenological survey. Psychological Medicine 26, 179189.Google Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
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.Google Scholar
Shergill, SS, Murray, RM, McGuire, PK (1998). Auditory hallucinations: a review of psychological treatments. Schizophrenia Research 32, 137150.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Uhlhaas, PJ, Mishara, AL (2007). Perceptual anomalies in schizophrenia: integrating phenomenology and neuropsychiatry. Schizophrenia Bulletin 33, 142156.CrossRefGoogle Scholar