Understanding auditory verbal hallucinations: a systematic review of current evidence

Upthegrove, Rachel; Broome, Matthew R.; Caldwell, Kimberly; Ives, Jonathan; Oyebode, Femi; Wood, Stephen J.

doi:10.1111/acps.12531

Cited by 114 publications

(95 citation statements)

References 156 publications

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“…Such research will need to characterize psychopathology more accurately and take into account more detailed phenomenology of specific symptoms such as FRS in its various manifestations (i.e. hallucinations vs. delusions) [37] . Future research may also need to look at the role of factors implicated in FRS and MAP, such as the structure and functioning of the inferior parietal lobule, brain-derived neurotrophic factor, and NMDA receptormediated excitotoxicity [34,38,39] .…”

Section: Discussionmentioning

confidence: 99%

First-Rank Symptoms in Methamphetamine Psychosis and Schizophrenia

et al. 2016

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Background: Methamphetamine psychosis (MAP) symptomatology has been described as indistinguishable from that of schizophrenia (SZ), yet research comparing these two disorders on specific psychotic symptoms such as schneiderian first-rank symptoms (FRS) is lacking. We aimed to determine and compare the occurrence and associations of FRS in patients diagnosed with MAP and with SZ. Sampling and Method: Data from SCID-I interviews performed on patients with either a diagnosis of SZ or MAP were compared. We calculated the prevalence of different FRS between MAP and SZ patients and used logistic regression to assess the association between FRS and diagnosis. Results: 102 patients were included in the study (MAP = 33, SZ = 69). Thought broadcasting occurred significantly more often in SZ (42%) than in MAP (24.2%) patients (adjusted OR = 3.02; 95% CI: 1.12-8.15; p = 0.028), while auditory hallucinations (voices conversing) were significantly higher in MAP (48.5%) than in SZ (20.3%) patients (adjusted OR = 0.27; 95% CI: 0.10-0.66; p = 0.004). However, there was no significant difference in the occurrence of one or more FRS in MAP and SZ, with most FRS showing overlap. Conclusions: We found that first-rank auditory hallucinations were more prevalent in MAP, whereas first-rank delusions of thought broadcasting were more prevalent in SZ. However, there was a substantial overlap in MAP and SZ for most FRS. This is consistent with the finding that FRS may have limited diagnostic specificity and that there is significant overlap in the symptoms of MAP and SZ. Future research into the neurobiology of delusions and hallucinations needs to take FRS into account.

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Section: Discussionmentioning

confidence: 99%

First-Rank Symptoms in Methamphetamine Psychosis and Schizophrenia

et al. 2016

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“…Instability in mood and negative affect is associated with clinical and nonclinical paranoid thinking and with the emergence and persistence of auditory hallucinations. 19 It also explain new inception of paranoid ideas and auditory hallucinations at 18 months. 20 High rates of childhood trauma are reported in both schizophrenia and depression compared to controls and are thought to be important in the genesis of both disorders.…”

Section: Depression and Mood Instability As A Dimension Of Psychosismentioning

confidence: 95%

Depression and Schizophrenia: Cause, Consequence or Trans-diagnostic Issue?

Upthegrove

Marwaha

Birchwood

2016

SCHBUL

264

278

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The presence of depression in schizophrenia has been a challenge to the Kraepelinian dichotomy, with various attempts to save the fundamental distinction including evoking and refining diagnoses such as schizoaffective disorder. But the tectonic plates are shifting. Here we put forward a summary of recent evidence regarding the prevalence, importance, possible aetiological pathways and treatment challenges that recognizing depression in schizophrenia bring. Taken together we propose that depression is more than comorbidity and that increased effective therapeutic attention to mood symptoms will be needed to improve outcomes and to support prevention.Key words: schizophrenia/depression/aetiology/ transdiagnostic/psychosis Prevalence of Depression in the Life Course of SchizophreniaThe prevalence of depressive disorder in schizophrenia has been reported to be around 40%, however the stage of illness (early vs chronic) and state (acute or post-psychotic) factors influences figures, which can thus vary considerably.1 In acute episodes rates are up to 60%, whilst in post-psychotic schizophrenia rates of moderate to severe depression vary between 20% in chronic schizophrenia and 50% following treatment of first episode.2 When examining very early phases of illness, in groups identified as ultra high risk (UHR) for psychosis, high rates of "comorbid" axis one diagnoses are reported, with over 40% reaching criteria for a depressive disorder, outweighing anxiety or other mood symptoms.3 When depression is investigated longitudinally in schizophrenia, the vast majority, up to 80%, of patients experience a clinically significant depressive episode at 1 or more time point during the early phase. This underlines how cross-sectional rates markedly underestimate the true prevalence and suggests that in the early phase of illness at least, mood symptoms may be more than "comorbid" experiences. The diversity in reported figures for depression is also partly attributed to the challenge in distinguishing mood symptoms from negative symptoms, suggesting a complex and as yet poorly understood overlap with other symptom dimensions at a phenomenological level. 4 Depression in schizophrenia has long been a taxonomic challenge leading to assertions that true schizophrenia is "non-affective"; or invention of new diagnoses and broadening definitions, such as schizoaffective disorder. In DSM-V schizoaffective disorder, the occurrence of the delusions or hallucinations must be present in the absence of any serious mood symptoms for at least 2 weeks whilst the mood disorder must be present for the majority of the total duration of illness.5 Our increasing knowledge as to the prevalence and course of depression in schizophrenia particularly, in the early years makes, the distinction between schizophrenia and new definitions of schizoaffective disorder even more challenging.

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“…Thus, there is increasing evidence from our and other groups that hallucinations in schizophrenia involve a disturbance of brain areas of the language system, among other brain regions [90]. …”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence Formentioning

confidence: 99%

Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

et al. 2017

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Schizophrenia research has been in a deadlock for many decades. Despite important advances in clinical treatment, there are still major concerns regarding long-term psychosocial reintegration and disease management, biological heterogeneity, unsatisfactory predictors of individual course and treatment strategies, and a confusing variety of controversial theories about its etiology and pathophysiological mechanisms. In the present perspective on schizophrenia research, we first discuss a methodological pitfall in contemporary schizophrenia research inherent in the attempt to link mental phenomena with the brain: we claim that the time-honored phenomenological method of defining mental symptoms should not be contaminated with the naturalistic approach of modern neuroscience. We then describe our Systems Neuroscience of Psychosis (SyNoPsis) project, which aims to overcome this intrinsic problem of psychiatric research. Considering schizophrenia primarily as a disorder of interindividual communication, we developed a neurobiologically informed semiotics of psychotic disorders, as well as an operational clinical rating scale. The novel psychopathology allows disentangling the clinical manifestations of schizophrenia into behavioral domains matching the functions of three well-described higher-order corticobasal brain systems involved in interindividual human communication, namely, the limbic, associative, and motor loops, including their corticocortical sensorimotor connections. The results of several empirical studies support the hypothesis that the proposed three-dimensional symptom structure, segregated into the affective, the language, and the motor domain, can be specifically mapped onto structural and functional abnormalities of the respective brain systems. New pathophysiological hypotheses derived from this brain system-oriented approach have helped to develop and improve novel treatment strategies with noninvasive brain stimulation and practicable clinical parameters. In clinical practice, the novel psychopathology allows confining the communication deficits of the individual patient, shifting attention from the symptoms to the intact resources. We have studied this approach and observed important advantages for therapeutic alliances, personalized treatment, and de-escalation strategies. Future studies will further conjoin clinical definitions of psychotic symptoms with brain structures and functions, and disentangle structural and functional deficit patterns within these systems to identify neurobiologically distinct subsyndromes. Neurobiologically homogeneous patient groups may provide new momentum for treatment research. Finally, lessons learned from schizophrenia research may contribute to developing a comprehensive perspective on human experience and behavior that integrates methodologically distinct, but internally consistent, insights from humanities and neuroscience.

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Understanding auditory verbal hallucinations: a systematic review of current evidence

Cited by 114 publications

References 156 publications

First-Rank Symptoms in Methamphetamine Psychosis and Schizophrenia

First-Rank Symptoms in Methamphetamine Psychosis and Schizophrenia

Depression and Schizophrenia: Cause, Consequence or Trans-diagnostic Issue?

Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

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