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Purpose: The Auditory Vocal Hallucination Rating Scale Questionnaire (AVHRS-Q) is a short self-report measure assessing several characteristics of auditory vocal hallucinations (AVH) that was derived from a validated clinical interview (the auditory vocal hallucination rating scale; AVHRS). This study investigated the internal reliability, convergent validity, and divergent validity of the AVHRS-Q using two clinical samples., Methods: In sample I, 32 psychiatric patients with AVH were recruited from an academic hospital service and assessed with the AVHRS and the AVHRS-Q. Data for sample II were retrospectively retrieved from a pseudonymised Routine Outcome Monitoring (ROM) database collected in the context of mental healthcare at the same academic hospital service. Data from 82 psychiatric patients with AVH were retrieved, who completed the AVHRS-Q, and measures of psychological distress (the Outcome Questionnaire; OQ-45, and the Symptom Checklist; SCL-90) and quality of life (the Manchester Short Assessment of Quality of Life; MANSA)., Results: The AVHRS-Q showed good internal consistency in both samples. Severity scores of the AVHRS-Q were strongly correlated to the severity scores of the AVHRS (r = 0.90, p < 0.01). The AVHRS-Q and AVHRS did not differ in the identification of mild and severe voice-hearers [X 2 (1, N = 32) = 15.71]. AVHRS-Q severity scores had moderate correlations with measures of psychological distress (OQ-45, r = 0.43, p < 0.01; SCL-90, r = 0.50, p < 0.05) and quality of life (MANSA, r = - 0.22, p < 0.01)., Conclusions: The AVHRS-Q demonstrated good reliability, convergent validity, and divergent validity, suggesting it can be applied in both clinical and research settings for a quick and reliable assessment of AVH.

Background: Previous work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful events (SE)] and (ii) delusional ideation were examined., Method: A baseline case-control sample of children with and without AVH were re-assessed on AVH after 5 years and interviewed about the experience of social adversity and delusions., Results: A total of 337 children (mean age 13.1 years, S.D.=0.5) were assessed: 40 children continued to hear voices that were present at baseline (24%, persistent group), 15 heard voices only at follow-up (9%, incident group), 130 children no longer reported AVH that were present at baseline (remitted group) and 152 never heard voices (referent group). Both TE and SE were associated with both incident and persistent AVH, as well as with greater AVH severity and delusional ideation at follow-up. In addition, the combination of AVH and delusions displayed a stronger association with TE and SE compared with either AVH or delusions alone., Conclusions: Early childhood AVH are mostly benign and transitory. However, experience of social adversity is associated with persistence, severity and onset of new AVH closer to puberty, and with delusional ideation.

Background: In a baseline study among 7- and 8-year-old children with auditory vocal hallucinations, only limited functional impact was observed., Aims: To assess 5-year course and predictors of auditory vocal hallucinations, as well as 5-year incidence and its risk factors., Method: A sample of 337 children, 12 and 13 years of age, were reassessed on auditory vocal hallucinations and associated symptoms after a mean follow-up period of 5.1 years., Results: The 5-year persistence and incidence rates were 24% and 9% respectively, with more new cases arising in urban areas.Both persistent and incident auditory vocal hallucinations were associated with problem behaviour in the clinical range of psychopathology as measured with the Child Behavior Checklist, particularly at follow-up, as well as with other psychotic symptoms, particularly at baseline. Persistence was predicted by baseline auditory vocal hallucinations severity,particularly in terms of external attribution of voices and hearing multiple voices, and was associated with worse primary school test scores and lower secondary school level., Conclusions: First onset of auditory vocal hallucinations in middle childhood is not uncommon and is associated with psychopathological and behavioural comorbidity. Similarly,persistence of auditory vocal hallucinations in childhood is not uncommon and is associated with psychopathological,behavioural and cognitive alterations.

Background: Hearing voices occurs in middle childhood, but little is known about prevalence, aetiology and immediate consequences., Aims: To investigate prevalence, developmental risk factors and behavioural correlates of auditory vocal hallucinations in 7- and 8-year-olds., Method: Auditory vocal hallucinations were assessed with the Auditory Vocal Hallucination Rating Scale in 3870 children. Prospectively recorded data on pre- and perinatal complications, early development and current problem behaviour were analysed in children with auditory vocal hallucinations and matched controls., Results: The 1-year prevalence of auditory vocal hallucinations was 9%, with substantial suffering and problem behaviour reported in 15% of those affected. Prevalence was higher in rural areas but auditory vocal hallucinations were more severe and had greater functional impact in the urban environment. There was little evidence for associations with developmental variables., Conclusions: Auditory vocal hallucinations in 7- and 8-year-olds are prevalent but mostly of limited functional impact. Nevertheless, there may be continuity with more severe psychotic outcomes given the serious suffering in a subgroup of children and there is evidence for a poorer prognosis in an urban environment.

Objective: This study aimed to investigate the outcome of an 18-month randomized controlled trial (RCT) on subjective burden and psychopathology of patients suffering from schizophrenia., Method: An RCT was used to compare hallucination-focused integrative treatment (HIT) and routine treatment (RT) in schizophrenia patients who persistently hear voices. We performed an intent-to-treat analysis on each of the 63 patients who were assessed at baseline, 9, and 18 months. On each of the 3 occasions, the differential effects of the treatment conditions were tested repeatedly. Sex, age, education, and illness (hallucination) duration were used as covariates., Results: Patients in the experimental group retained improvements over time. Improvements in hallucinations, distress, and negative content of voices remained significant at the 5% level., Conclusion: HIT seems to be an effective treatment strategy with long-lasting effects for treatment-refractory voice-hearing patients.

Objective: To test feasibility and effectiveness of multi-family treatment (MFT) for patients with persistent auditory hallucinations., Method: A naturalistic pilot study with 6-month follow-up of 12 patients and 10 relatives. Pre- and post-treatment assessment concerned compliance, satisfaction, subjective burden, and control of voices, psychopathology, quality of life, social functioning and burden on the family., Results: Significant improvements were found in all domains. Compliance and satisfaction with treatment were satisfactory. Self-help contacts outside treatment sessions increased over time., Conclusion: MFT may be considered a potentially effective form of additional treatment for refractory voice hearers.

Objective: Psychosocial treatment seems to be effective in the management of schizophrenia, although less in the area of quality of life and social functioning. To study the effectiveness of a hallucination focused integrated treatment with cognitive-behaviour therapy and coping training among schizophrenia patients suffering from 'hearing voices'., Method: In a randomized controlled trial (RCT) with 31 patients in the integrated treatment condition and 32 patients in the routine care condition, quality of life was assessed with the self-report questionnaire of the WHO (Bref), and social role functioning with an interviewer based schedule, at entry and 9 (post-treatment) and 18 months later., Results: Follow-up data suggest a significant improvement of quality of life and in particular in social role functioning (effect size 0.64) in favour of the integrated treatment., Conclusion: The integrated treatment seems to be effective in reducing overall disability levels and number of patients with serious disabilities.

Improvements in psychopathology, subjective burden, and coping with voices after hallucination focused integrative treatment (HIT) were studied in chronic schizophrenic patients with persistent (> 10 years), drug-refractory auditory hallucinations. In a randomized controlled trial, routine care was compared with HIT pre- and posttreatment at a 9-month interval. Independent raters used semistructured interviews to assess burden, symptoms, and coping. Within-group improvements in both burden and psychopathology were most significant in the experimental group (p < 0.05) after treatment. HIT patients showed change in applied coping strategies, but it did not reach statistical significance. Type and (change in) number of coping strategies did not seem related to outcome. The results suggest that HIT is a cost-effective practice that positively affects mental state in general, subjective burden, quality of life, and social functioning.

Objective: To examine the cost-effectiveness of Hallucination focused Integrative Treatment (HIT) in patients with schizophrenia and a history of persistent auditory hallucinations., Method: Costs, in and outside the health care sector, and outcomes were registered prospectively during a period of 18 months for patients who received the HIT programme and for patients in the care as usual (CAU) condition. The Positive and Negative Syndrome Scale (PANSS) was used as main outcome measure in the cost-effectiveness analysis. Bootstrap analyses provided additional information on the skewly distributed costs., Results: Mean costs per patient in the HIT group (18,237 dollars) were lower than the mean costs per patient in the CAU group (21,436 dollars). Results of the PANSS were slightly in favour of the HIT group., Conclusion: There appears to be no significant cost-effectiveness advantage of the HIT programme over CAU. Additional analyses indicated that future application of the HIT programme will, in most cases, lead to a reduction of (non) medical costs.

Objective: To investigate the durability of positive effects of cognitive behaviour therapy (CBT) with coping training on psychotic symptoms and social functioning., Method: Forty patients with schizophrenia or related psychotic disorders and refractory auditory hallucinations were given CBT and coping training in an integrated single family treatment programme. In a naturalistic study patients were followed after 2 and 4 years since the start of treatment., Results: The treatment improved overall burden of 'hearing voices', with a generalization into daily functioning. Improvement with regard to fear, loss of control, disturbance of thought and interference with thinking was sustained by 60% of the patients while one-third improved further. Complete disappearance of hallucinations occurred in 18% of the patients., Conclusion: CBT with coping training can improve both overall symptomatology and quality of life, even over longer periods of time, but a status of persistent disablement indicates a continuing need for mental health care.

Objective: Early intervention in psychosis is considered important in relapse prevention. Limited results of monotherapies prompt to development of multimodular programmes. The present study tests feasibility and effectiveness of HIT, an integrative early intervention treatment for auditory hallucinations, in community psychiatry., Method: Adolescents with auditory hallucinations consecutively referred to Groningen Voices Outpatient Department. Independent research staff collected diagnosis, sociodemographics, psychiatric history, former treatment and current treatment status from medical files. The auditory Hallucinations Rating Scale, Groningen Social Disabilities Scale and five-point rating scales on characteristics and subjective burden of voices, and satisfaction with therapy were scored with semi-structured interview., Results: Good compliance and high satisfaction with HIT treatment in most cases; 65% free of voices; majority demonstrates substantial improvement on mastery, anxiety, interference with thinking and social functioning; none worsened., Conclusion: Integrative treatment as composed in the HIT-programme is feasible in community psychiatry and appears to be an effective early intervention in adolescents with schizophrenia both in reducing psychotic symptoms as improving quality of life.

Recent studies have suggested positive effects of cognitive therapy on psychotic symptoms. However, the effects of coping training are less clear, and generalization to daily functioning has not been attempted for either intervention. A total of 40 patients with therapy-refractory auditory hallucinations received standard care plus cognitive therapy with coping training. In a retrospective, descriptive study, multiple assessments of outcome were measured. The experimental therapy seems to improve both overall symptomatology and quality of life, and is acceptable to both patients and relatives. Generalization to daily functioning and continuation over time was observed. Improvements with regard to the occurrence of hallucinations, fear, disturbance of thought, social interactions and daily activities were significant. Complete disappearance of hallucinations occurred in 20% of participants, and in 40% of those who were regularly discharged from treatment. The level of satisfaction with therapy was high (78%), and the drop-out rate was low (9%). Improvement was not significantly correlated with psychiatric diagnosis (schizophrenia vs. other diagnoses), and was sustained at follow-up after 1 year.