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В статье рассматривается основной вопрос - может ли нарушение восприятия в форме слуховых галлюцинаций как самостоятельное отклонение у лица, не отягощённое расстройствами психики стать непосредственной причиной совершения преступления? Особое внимание уделяется способам, методам, позволяющим отличить действительное состояние преступника, подверженное влиянию вербальных галлюцинаций от наговаривания на себя с целью избежать наказания, ссылаясь на свою невменяемость. Стоит отметить, что на данную тему нет каких-либо опубликованных письменных работ и статей. Работа написана преимущественно путём анализа различных работ психологов и психиатров, а также случаев различных преступлений. Так как доступа к уголовным делам, рассматриваемых преступлений нет, в том числе потому что многие материалы уголовных дел засекречены, то источником служили различные новостные порталы, документальные фильмы и откровения сотрудников и специалистов, раскрывавших такие преступления., The article raises the basic question - can cognitive impairment in the form of auditory hallucinations as an independent deviation in a person without any mental disorders become a direct cause of a crime? Special attention is paid to methods that allow to distinguish the actual state of an offender, suffering from verbal hallucinations and that of self-incrimination in order to avoid punishment due to to their insanity. It is worth noting that there are no published works and articles on this topic. The paper is mainly written by analyzing various works of psychologists and psychiatrists, as well as various crime cases. As there is no access to criminal cases, because many files are classified, various news portals, documentaries and interviews of staff and professionals who solved such cases, served as a source., Международный научно-исследовательский журнал, Выпуск 6 (120) 2022, Pages 170-172

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 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.

Objective: Transcranial direct current stimulation (tDCS) could be a treatment option for medication-resistant auditory hallucinations (AH), but so far results have been inconclusive, and large sample trials have been missing. This study used tDCS as a treatment method for these hallucinations in a double-blind, placebo-controlled study with a relatively large sample size.Methods: Fifty-four patients of several diagnostic categories with medication-resistant AH were randomized and treated during 10 sessions of 20 min each, with either 2 mA tDCS or placebo, administered on five consecutive days (i.e., two sessions per day). Anodal stimulation was targeted at the left dorsolateral prefrontal cortex, cathodal stimulation at the left temporoparietal junction. AH severity was assessed using the Auditory Hallucination Rating Scale (AHRS). Other outcome measures were assessed with the Positive and Negative Syndrome Scale (PANSS), the Stroop, and the Trail Making Test.Results: AH frequency and severity decreased significantly over time, as did the scores on the total and general subscales of the PANSS. However, there was no significant interaction effect with the treatment group on any of the main outcome measures.Conclusions: We found no evidence that tDCS is more effective for medication-resistant AH than placebo, even though AH frequency and severity decreased in both groups. An alternative strategy may be to offer tDCS at an earlier stage of illness. In the light of recent investigations into the neurophysiological mechanisms behind tDCS, we may also have to consider the possibility that tDCS is not able to induce any long-lasting brain changes.

Шкала оценки психотических симптомов (The Psychotic Symptom Rating Scales – PSYRATS) является одним из широко используемых инструментов клинической оценки вербальных галлюцинаций и бредовых идей. Цель настоящего исследования состояла в психометрическом анализе и модификации методики PSYRATS с определением критериев оценки выраженности психотических симптомов в динамике терапии пациентов с шизофренией. В исследовании приняли участие 157 пациентов с диагнозом «шизофрения», возрастной диапазон участников составил от 18 до 59 лет. Психометрический анализ проводился на основе метрической системы Раша. Факторный анализ выявил двухфакторную структуру PSYRATS (фактор «вербальных галлюцинаций» AHS и фактор «бредовых идей» DS). Анализ субшкалы AHS продемонстрировал низкую конструктную валидность 2 диагностических пунктов. Проведена модификация AHS путем исключения невалидных пунктов. Модифицированный вариант AHSmod имеет одномерную структуру и отличается высокой надежностью и дискриминативностью. AHSmod способна дифференцировать 8 метрических уровней выраженности вербальных галлюцинаций. Анализ субшкалы DS продемонстрировал адекватную конструктную валидность всех диагностических пунктов, одномерную структуру субшкалы. DS отличается высокой надежностью и способна дифференцировать 6 метрических уровней выраженности бредовых идей. В ходе метрического анализа определены критерии оценки выраженности слуховых галлюцинаций и бредовых идей в динамике проводимой терапии. Модифицированный вариант PSYRAYS обладает адекватными психометрическими характеристиками. Диагностические критерии пригодны для использования в клинической практике и научном исследовании., The Psychotic Symptom Rating Scale is one of the widely used clinical assessment tools for psychotic symptoms. The purpose of this study was psychometric analysis and modification of the PSYRATS with determination of criteria for assessing the severity of psychotic symptoms in the dynamics of therapy in patients with schizophrenia. The study involved 157 patients with the diagnosis of schizophrenia; the age of participants ranged from 18 to 59 years. Psychometric analysis was done on the base of the Rasch measurement. Factor analysis revealed the two-factor structure of the PSYRATS (the factor of “auditory hallucinations” AHS and the factor of “delusional ideas” DS). Analysis of the AHS showed the low construct validity of 2 diagnostic items. The subscale was modified by eliminating the invalid items. The modified version of the AHSmod has a unidimensional structure and demonstrates highly reliable nature and discriminativeness. The AHSmod is able to differentiate 8 metric levels of the severity of auditory hallucinations. Analysis of the DS showed the adequate construct validity of all diagnostic items, the unidimensional structure of the subscale. The DS is highly reliable and is able to differentiate 6 metric levels of the severity of delusional ideas. In the course of the metric analysis, the criteria for assessing the severity of auditory hallucinations and delusion ideas in the dynamics of the therapy were determined. The modified version of PSYRATS has adequate psychometric characteristics. The diagnostic criteria are suitable for use in clinical practice and research., Психиатрия, психотерапия и клиническая психология, Выпуск 1 2021, Pages 12-24

BACKGROUND: Several studies in patients with schizophrenia have demonstrated an abnormal thalamic volume and thalamocortical connectivity. Specifically, hyperconnectivity with somatosensory areas has been related to the presence of auditory hallucinations (AHs). The 22q11.2 deletion syndrome is a neurogenetic disorder conferring proneness to develop schizophrenia, and deletion carriers (22qdel carriers) experience hallucinations to a greater extent than the general population. METHODS: We acquired 442 consecutive magnetic resonance imaging scans from 120 22qdel carriers and 110 control subjects every 3 years (age range: 8-35 years). The volume of thalamic nuclei was obtained with FreeSurfer and was compared between 22qdel carriers and control subjects and between 22qdel carriers with and without AHs. In a subgroup of 76 22qdel carriers, we evaluated the functional connectivity between thalamic nuclei affected in patients experiencing AHs and cortical regions. RESULTS: As compared with control subjects, 22qdel carriers had lower and higher volumes of nuclei involved in sensory processing and cognitive functions, respectively. 22qdel carriers with AHs had a smaller volume of the medial geniculate nucleus, with deviant trajectories showing a steeper volume decrease from childhood with respect to those without AHs. Moreover, we showed an aberrant development of nuclei intercalated between the prefrontal cortex and hippocampus (the anteroventral and medioventral reuniens nuclei) and hyperconnectivity of the medial geniculate nucleus and anteroventral nucleus with the auditory cortex and Wernicke's area. CONCLUSIONS: The increased connectivity of the medial geniculate nucleus and anteroventral nucleus to the auditory cortex might be interpreted as a lack of maturation of thalamocortical connectivity. Overall, our findings point toward an aberrant development of thalamic nuclei and an immature pattern of connectivity with temporal regions in relation to AHs. ispartof: BIOLOGICAL PSYCHIATRY-COGNITIVE NEUROSCIENCE AND NEUROIMAGING vol:5 issue:9 pages:875-890 ispartof: location:United States status: published

Auditory hallucinations are among the most prevalent and most distressing symptoms of schizophrenia. Despite significant progress, it is still unclear whether auditory hallucinations arise from abnormalities in primary sensory processing or whether they represent failures of higher-order functions. To address this knowledge gap, we capitalized on the increased spatial resolution afforded by ultra-high field imaging at 7 Tesla to investigate the tonotopic organization of the auditory cortex in patients with schizophrenia with a history of recurrent hallucinations. Tonotopy is a fundamental feature of the functional organization of the auditory cortex that is established very early in development and predates the onset of symptoms by decades. Compared to healthy participants, patients showed abnormally increased activation and altered tonotopic organization of the auditory cortex during a purely perceptual task, which involved passive listening to tones across a range of frequencies (88–8000 Hz). These findings suggest that the predisposition to auditory hallucinations is likely to be predicated on abnormalities in the functional organization of the auditory cortex and which may serve as a biomarker for the early identification of vulnerable individuals.

A literature review about verbal hallucinations provides tracks to work with the patient on his hallucinatory experience. Verbal hallucina tion s are experienced by a considerable proportion of the general population. There is a significant prevalence in adolescents and childr en, among whom most are transient and occur in the context of anxiety or are associated with trauma. Their persistence and one's reaction to them are more significant than their presence itself. Psych olo gically, verbal hallucinati ons are seen as a dissociativeresponse to trauma, by which the emotional and experienti al content is dissociated. From a psycho anal ytic point of view, they are built on an « unthinkable » that is rejected outside andgrasped as a perception. Psychotherapeutic approaches focus on the appropriation process which the hallucinatory experience can be the subject of. The psychoanalytic approach aims to transform the hallucination into though,t as the intolerable experience is symbolized within the clinical relationship. CBT off er protocols such as attentional training or acceptation and commitment therapy which aim to promote psychological flexib ility . Integrative therapy helps to develop one's own coping strategies. Een overzicht van de literatuur betreffende verbale hallucinatie biedt onsrichtlijnen in het werk met de patient over zijn halluci­ nerende ervaring. Verbale hallucinatieszijnin eengroat deel van de algemene bevolking te vinden, waarond er een aanzienlijke prevalentie bij adolescenten en kinderen. Bij die laatste groep zijn de meeste verbael hallucinaties van voorbijgaande aard en komen veer in een angst cont ext of zijn geassocieerdaan trau­ mata. Vanuit psychologisch standpunt, wordt de verbael haliu­ cinatie gezien als een dissociatieve reactie op traumata, waarbij de emotionele- en de ervarings inhoud dissocieert. Vanuit ana· lytisch standpunt, komt de hallucinatie tot stand vertrekkend vanuit een naar buiten verworpen niet-denkbare, die dan wordt opgevat als waarneming. Psychotherapeutische benaderingen zijn gericht op de procesvormin g van subjectiviteit waarvande hallucin erende beleving de drager kan zijn . Het analytsi ch werk stelt als doel, de transformatie van de hallucinatie in gedachten, naarmate dat de ontoelaatbareervaring wordt gesymboliseer d in de klinische relatie. De Cog niti eve Gedrags Therapie (CGT) biedt protocollen aan zeals aandachtstr aining of 'acceptance and commitment therapy' (ACT), die gericht zijn op de ont ik· keling van psychologische flexibiliteit. Tot slot, de integ a eve therapie kan de pati ent helpen zijn eigen coping-strateg ei en te ontwikkelen.

BackgroundSimilar to visual hallucinations in visually impaired patients, auditory hallucinations are often suggested to occur in adults with hearing impairment. However, research on this association is limited. This observational, cross-sectional study tested whether auditory hallucinations are associated with hearing impairment, by assessing their prevalence in an adult population with various degrees of objectified hearing impairment.MethodsHallucination presence was determined in 1007 subjects aged 18–92, who were referred for audiometric testing to the Department of ENT-Audiology, University Medical Center Utrecht, the Netherlands. The presence and severity of hearing impairment were calculated using mean air conduction thresholds from the most recent pure tone audiometry.ResultsOut of 829 participants with hearing impairment, 16.2% (n= 134) had experienced auditory hallucinations in the past 4 weeks; significantly more than the non-impaired group [5.8%;n= 10/173;p< 0.001, odds ratio 3.2 (95% confidence interval 1.6–6.2)]. Prevalence of auditory hallucinations significantly increased with categorized severity of impairment, with rates up to 24% in the most profoundly impaired group (p< 0.001). The corrected odds of hallucination presence increased 1.02 times for each dB of impairment in the best ear. Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%).ConclusionsOur findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Although more research on potential confounding factors is necessary, clinicians should be aware of this phenomenon, by inquiring after hallucinations in hearing-impaired patients and, conversely, assessing hearing impairment in patients with auditory hallucinations, since it may be a treatable factor.

Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).

Auditory Hallucinations (AH) cause substantial suffering and dysfunction, yet remain poorly understood and modeled. Previous reports have linked AH to increases in negative emotions, suggesting a role for the autonomic nervous system (ANS) in underlying this link. Employing an Experience Sampling Method (ESM) approach, 40 individuals with schizophrenia completed a 36-hour ambulatory assessment of AH and cardiac autonomic regulation. Participants carried mobile electronic devices that prompted them to report 10 times/d the severity of their momentary AH, along with a Holter monitor that continuously recorded their cardiac autonomic regulation. The clocks of the devices and monitors were synchronized, allowing for high time-resolution temporal linking of the AH and concurrent autonomic data. Power spectral analysis was used to determine the relative vagal (parasympathetic) contribution to autonomic regulation during 5 minutes prior to each experience sample. The participants also completed interview-based measures of AH (SAPS; PSYRATS). The ESM-measured severity of AH was significantly correlated with the overall SAPS-indexed AH severity, along with the PSYRATS-indexed AH frequency, duration, loudness, degree of negative content, and associated distress. A mixed-effect regression model indicated that momentary increases in autonomic arousal, characterized by decreases in vagal input, significantly predicted increases in ESM-measured AH severity. Vagal input averaged over the 36-hour assessment displayed a small but significant inverse correlation with the SAPS-indexed AH. The results provide preliminary support for a link between ANS regulation and AH. The findings also underscore the highly dynamic nature of AH and the need to utilize high time-resolution methodologies to investigate AH.

Auditory-verbal hallucinations (AVHs) are frequently associated with activation of the left superior temporal gyrus (including Wernicke’s area), left inferior frontal gyrus (including Broca’s area), and the right hemisphere homologs of both areas. It has been hypothesized that disconnectivity of both interhemispheric transfer and frontal and temporal areas may underlie hallucinations in schizophrenia. We investigated reduced information flow in this circuit for the first time using dynamic causal modeling, which allows for directional inference. A group of healthy subjects and 2 groups of schizophrenia patients—with and without AVH—performed a task requiring inner speech processing during functional brain scanning. We employed connectivity models between left hemispheric speech-processing areas and their right hemispheric homologs. Bayesian model averaging was used to estimate the connectivity strengths and evaluate group differences. Patients with AVH showed significantly reduced connectivity from Wernicke’s to Broca’s area (97% certainty) and a trend toward a reduction in connectivity from homologs of Broca’s and Wernicke’s areas to Broca’s area (93% and 94% certainty). The connectivity magnitude in patients without hallucinations was found to be intermediate. Our results point toward a reduced input from temporal to frontal language areas in schizophrenia patients with AVH, suggesting that Broca’s activity may be less constrained by perceptual information received from the temporal cortex. In addition, a lack of synchronization between Broca and its homolog may lead to the erroneous interpretation of emotional speech activity from the right hemisphere as coming from an external source.

The potential of noninvasive neurostimulation by repetitive transcranial magnetic stimulation (rTMS) for improving psychiatric disorders has been studied increasingly over the past two decades. This is especially the case for major depression and for auditory verbal hallucinations in schizophrenia. The present review briefly describes the background of this novel treatment modality and summarizes evidence from clinical trials into the efficacy of rTMS for depression and hallucinations, Evidence for efficacy in depression is stronger than for hallucinations, although a number of studies have reported clinically relevant improvements for hallucinations too, Different stimulation parameters (frequency, duration, location of stimulation) are discussed. There is a paucity of research into other psychiatric disorders, but initial evidence suggests that rTMS may also hold promise for the treatment of negative symptoms in schizophrenia, obsessive compulsive disorder and post traumatic stress disorder. It can be concluded that rTMS induces alterations in neural networks relevant for psychiatric disorders and that more research is needed to elucidate efficacy and underlying mechanisms of action.

The potential of noninvasive neurostimulation by repetitive transcranial magnetic stimulation (rTMS) for improving psychiatric disorders has been studied increasingly over the past two decades. This is especially the case for major depression and for auditory-verbal hallucinations in schizophrenia. The present review briefly describes the background of this novel treatment modality and summarizes evidence from clinical trials into the efficacy of rTMS for depression and hallucinations. Evidence for efficacy in depression is stronger than for hallucinations, although a number of studies have reported clinically relevant improvements for hallucinations too. Different stimulation parameters (frequency, duration, location of stimulation) are discussed. There is a paucity of research into other psychiatric disorders, but initial evidence suggests that rTMS may also hold promise for the treatment of negative symptoms in schizophrenia, obsessive compulsive disorder and post-traumatic stress disorder. It can be concluded that rTMS induces alterations in neural networks relevant for psychiatric disorders and that more research is needed to elucidate efficacy and underlying mechanisms of action.

While the majority of cognitive studies on auditory hallucinations (AHs) have been conducted in schizophrenia (SZ), an increasing number of researchers are turning their attention to different clinical and nonclinical populations, often using SZ findings as a model for research. Recent advances derived from SZ studies can therefore be utilized to make substantial progress on AH research in other groups. The objectives of this article were to (1) present an up-to-date review regarding the cognitive mechanisms of AHs in SZ, (2) review findings from cognitive research conducted in other clinical and nonclinical groups, and (3) integrate these recent findings into a cohesive framework. First, SZ studies show that the cognitive underpinnings of AHs include self-source-monitoring deficits and executive and inhibitory control dysfunctions as well as distortions in top-down mechanisms, perceptual and linguistic processes, and emotional factors. Second, consistent with SZ studies, findings in other population groups point to the role of top-down processing, abnormalities in executive inhibition, and negative emotions. Finally, we put forward an integrated model of AHs that incorporates the above findings. We suggest that AHs arise from an interaction between abnormal neural activation patterns that produce salient auditory signals and top-down mechanisms that include signal detection errors, executive and inhibition deficits, a tapestry of expectations and memories, and state characteristics that influence how these experiences are interpreted. Emotional factors play a particular prominent role at all levels of this hierarchy. Our model is distinctively powerful in explaining a range of phenomenological characteristics of AH across a spectrum of disorders.

Auditory hallucinations can be experienced in the context of many different disorders and syndromes. The differential diagnosis basically rests on the presence or absence of accompanying symptoms. In terms of clinical relevance, the most important distinction to be made is between auditory hallucinations occurring in the context of psychotic disorders and those that are due to a somatic disorder. Auditory hallucinations are also quite common in otherwise healthy individuals and are therefore not necessarily disease-related. As auditory hallucinations are often accompanied by hallucinations in other modalities, pinpointing the modality in which hallucinations are experienced most frequently may provide a first – albeit coarse – indication of whether the auditory hallucinations are part of a neurological disorder (mainly visual), a psychiatric disorder (mainly auditory), an ear disorder (mainly auditory) or whether they occur in the absence of any disorder (mainly auditory). Epilepsy is the most important exception to this coarse differentiation. Another traditional distinction between hallucinations occurring in the context of neurological and psychiatric disorders is that the former are assumed to start at an advanced age, whereas hallucinations in the context of psychiatric disorders typically begin in late adolescence or early adulthood. Although there are many exceptions to this rule of thumb – as in psychotic depression, late-onset schizophrenia and epilepsy – age of onset can still be a valuable clinical indicator. The content of auditory hallucinations is notoriously unreliable for differential diagnosis and the safest way to an accurate diagnosis rests with the detection of psychiatric and somatic comorbid symptoms.

Auditory hallucinations can be experienced in the context of many different disorders and syndromes. The differential diagnosis basically rests on the presence or absence of accompanying symptoms. In terms of clinical relevance, the most important distinction to be made is between auditory hallucinations occurring in the context of psychotic disorders and those that are due to a somatic disorder. Auditory hallucinations are also quite common in otherwise healthy individuals and are therefore not necessarily disease-related. As auditory hallucinations are often accompanied by hallucinations in other modalities, pinpointing the modality in which hallucinations are experienced most frequently may provide a first - albeit coarse - indication of whether the auditory hallucinations are part of a neurological disorder (mainly visual), a psychiatric disorder (mainly auditory), an ear disorder (mainly auditory) or whether they occur in the absence of any disorder (mainly auditory). Epilepsy is the most important exception to this coarse differentiation. Another traditional distinction between hallucinations occurring in the context of neurological and psychiatric disorders is that the former are assumed to start at an advanced age, whereas hallucinations in the context of psychiatric disorders typically begin in late adolescence or early adulthood. Although there are many exceptions to this rule of thumb - as in psychotic depression, late-onset schizophrenia and epilepsy - age of onset can still be a valuable clinical indicator. The content of auditory hallucinations is notoriously unreliable for differential diagnosis and the safest way to an accurate diagnosis rests with the detection of psychiatric and somatic comorbid symptoms.

Novel strategies are needed in the treatment of hallucinations as a subgroup of patients with pathological hallucinations (>30%) do not respond to antipsychotics or are not compliant with medication. We review recently developed biological and cognitive treatments. Repetitive transcranial magnetic stimulation concerns neuromodulation targeted at aberrant activity in regions shown to be hyperactive in neuroimaging studies. Repetitive transcranial magnetic stimulation has been shown to reduce auditory hallucinations in several studies. However, not all studies have confirmed such effects, and a number of questions remain. With regard to cognitive therapeutic approaches, new proposals include attention training, acceptance and commitment therapy, and competitive memory training. After a brief discussion of these approaches, we take stock of recent advances and discuss avenues for future research.

Novel strategies are needed in the treatment of hallucinations as a subgroup of patients with pathological hallucinations (>30%) do not respond to antipsychotics or are not compliant with medication. We review recently developed biological and cognitive treatments. Repetitive transcranial magnetic stimulation concerns neuromodulation targeted at aberrant activity in regions shown to be hyperactive in neuroimaging studies. Repetitive transcranial magnetic stimulation has been shown to reduce auditory hallucinations in several studies. However, not all studies have confirmed such effects, and a number of questions remain. With regard to cognitive therapeutic approaches, new proposals include attention training, acceptance and commitment therapy, and competitive memory training. After a brief discussion of these approaches, we take stock of recent advances and discuss avenues for future research.

Theories about auditory hallucinations in schizophrenia suggest that these experiences occur because patients fail to recognize thoughts and mental events as self-generated. Different theoretical models have been proposed about the cognitive mechanisms underlying auditory hallucinations. Regardless of the cognitive model being tested, however, experimental designs are almost identical in that they require a judgment regarding whether an action was self-originated or not. The aim of the current study was to integrate all available literature for a meta-analysis on this topic and reach conclusions about self-recognition performance in (1) patients with schizophrenia compared with healthy controls and (2) patients with auditory hallucinations compared with patients without these symptoms. A comprehensive literature review identified 23 studies that contrasted the performance of schizophrenia patients with healthy controls (1370 participants) and 9 studies that directly compared patients with and without auditory hallucinations (315 participants). We found significantly reduced self-recognition performance in schizophrenia patients, which was more pronounced in patients with auditory hallucinations compared with patients without. In patients with hallucinations, this pattern of performance was specific to self-recognition processes and not to the recognition of new external information. A striking finding was the homogeneity in results across studies regardless of the action modality, timing delay, and design used to measure self-recognition. In summary, this review of studies from the last 30 years substantiates the view that self-recognition is impaired in patients with schizophrenia and particularly those with auditory hallucinations. This suggests an association, perhaps a causal one, between such deficit and hallucinatory experiences in schizophrenia.

Objective: Activation in a network of language-related regions has been reported during auditory verbal hallucinations. It remains unclear, however, how this activation is triggered. Identifying brain regions that show significant signal changes preceding auditory hallucinations might reveal the origin of these hallucinations.Method: Twenty-four patients with a psychotic disorder indicated the presence of auditory verbal hallucinations during 3-Tesla functional magnetic resonance imaging by squeezing a handheld balloon. A one-sample t test was performed to reveal groupwise activation during hallucinations. To enable analysis of brain activation 6 to 0 seconds preceding hallucinations, a tailored "selective averaging" method, without any a priori assumptions concerning the hemodynamic response profile, was performed. To control for motor-related activation, 15 healthy comparison subjects squeezed a balloon at matched time intervals.Results: Groupwise analysis during auditory verbal hallucinations revealed brain activation in bilateral (right more than left) language-related regions and bilateral motor regions. Prominent deactivation preceding these hallucinations was observed in the left parahippocampal gyrus. In addition, significant deactivation preceding hallucinations was found in the left superior temporal, right inferior frontal, and left middle frontal gyri as well as in the right insula and left cerebellum. No significant signal changes were revealed prior to the matched balloon squeezing among the comparison subjects.Conclusions: Auditory verbal hallucinations in patients with a psychotic disorder are consistently preceded by deactivation of the parahippocampal gyrus. The para-hippocampus has been hypothesized to play a central role in memory recollection, sending information from the hippocampus to the association areas. Dysfunction of this region could trigger inadequate activation of right language areas during auditory hallucinations.

Introduction: The literature on the possible neurobiologic correlates of auditory hallucinations is expanding rapidly. For an adequate understanding and linking of this emerging knowledge, a clear and uniform nomenclature is a prerequisite. The primary purpose of the present article is to provide an overview of the nomenclature and classification of auditory hallucinations.Materials and Methods: Relevant data were obtained from books, PubMed, Embase, and the Cochrane Library.Results: The results are presented in the form of several classificatory arrangements of auditory hallucinations, governed by the principles of content, perceived source, perceived vivacity, relation to the sleep-wake cycle, and association with suspected neurobiologic correlates.Conclusions: This overview underscores the necessity to reappraise the concepts of auditory hallucinations developed during the era of classic psychiatry, to incorporate them into our current nomenclature and classification of auditory hallucinations, and to test them empirically with the aid of the structural and functional imaging techniques currently available.

Background: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare.Objective: To review the effects of published treatment methods for musical hallucinations.Methods: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology.Results: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication.Conclusion: Treatments for musical hallucinations tend to yield favorable results when they target the main etiological factor of these phenomena. There is a need to establish the natural course of musical hallucinations, their response to non-pharmacological treatments, and their effects on the patient's quality of life. There is also a need to standardize the assessment of treatment responses, and document long-term follow up.

BACKGROUND: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. OBJECTIVE: To review the effects of published treatment methods for musical hallucinations. METHODS: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. RESULTS: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication. CONCLUSION: Treatments for musical hallucinations tend to yield favorable results when they target the main etiological factor of these phenomena. There is a need to establish the natural course of musical hallucinations, their response to non-pharmacological treatments, and their effects on the patient's quality of life. There is also a need to standardize the assessment of treatment responses, and document long-term follow up.

While auditory verbal hallucinations (AVH) are most characteristic for schizophrenia, they also occur in nonpsychotic individuals in the absence of a psychiatric or neurological disorder and in the absence of substance abuse. At present, it is unclear if AVH in these nonpsychotic individuals constitute the same phenomenon as AVH in psychotic patients. Comparing brain activation during AVH between nonpsychotic and psychotic individuals could provide important clues regarding this question. 21 nonpsychotic subjects with AVH and 21 matched psychotic patients indicated the presence of AVH during 3T functional magnetic resonance imaging (fMRI) scanning. To identify common areas of activation during the experience of AVH in both groups, a conjunction analysis was performed. In addition, a 2-sample t-test was employed to discover possible differences in AVH-related activation between the groups. Several common areas of activation were observed for the psychotic and nonpsychotic subjects during the experience of AVH, consisting of the bilateral inferior frontal gyri, insula, superior temporal gyri, supramarginal gyri and postcentral gyri, left precentral gyrus, inferior parietal lobule, superior temporal pole, and right cerebellum. No significant differences in AVH-related brain activation were present between the groups. The presence of multiple common areas of AVH-related activation in psychotic and nonpsychotic individuals, in the absence of significant differences, implicates the involvement of the same cortical network in the experience of AVH in both groups.

Introduction: Verbal auditory hallucinations (VAHs) are experienced as spoken voices which seem to originate in the extracorporeal environment or inside the head. Animal and human research has identified a 'where' pathway for sound processing comprising the planum temporale, the middle frontal gyrus and the inferior parietal lobule. We hypothesize that increased activity of that 'where' pathway mediates the exteriorization of VAHs.Methods: The fMRI scans of 52 right-handed psychotic patients experiencing frequent VAHs were compared with the reported location of hallucinations, as rated with the aid of the PSYRATS-AHRS. For each subject, a unique VAH activation model was created based on the VAH timings, and subsequently convolved with a gamma function to model the hemodynamic response. In order to examine the neurofunctional equivalents of perceived VAH location, second-level group effects of subjects experiencing either internal (n = 24) or external (n = 28) VAHs were contrasted within planum temporale, middle frontal gyrus, and inferior parietal lobule regions of interest (ROIs).Results: Three ROIs were tested for increased activity in relation with the exteriorization of VAHs. The analysis revealed a left-sided medial planum temporale and a right-sided middle frontal gyrus cluster of increased activity. No significant activity was found in the inferior parietal lobule.Conclusions: Our study indicates that internal and external VAHs are mediated by a fronto-temporal pattern of neuronal activity while the exteriorization of VAHs stems from additional brain activity in the auditory 'where' pathway, comprising the planum temporale and prefrontal regions. (C) 2013 Elsevier B.V. All rights reserved.

Brain circuits involved in language processing have been suggested to be compromised in patients with schizophrenia. This does not only include regions subserving language production and perception, but also auditory processing and attention. We investigated resting state network connectivity of auditory, language and attention networks of patients with schizophrenia and hypothesized that patients would show reduced connectivity.Patients with schizophrenia (n=45) and healthy controls (n=30) underwent a resting state fMRI scan. Independent components analysis was used to identify networks of the auditory cortex, left inferior frontal language regions and the anterior cingulate region, associated with attention. The time courses of the components where correlated with each other, the correlations were transformed by a Fisher's Z transformation, and compared between groups. In patients with schizophrenia, we observed decreased connectivity between the auditory and language networks. Conversely, patients showed increased connectivity between the attention and language network compared to controls. There was no relationship with severity of symptoms such as auditory hallucinations.The decreased connectivity between auditory and language processing areas observed in schizophrenia patients is consistent with earlier research and may underlie language processing difficulties. Altered anterior cingulate connectivity in patients may be a correlate of habitual suppression of unintended speech, or of excessive attention to internally generated speech. This altered connectivity pattern appears to be present independent of symptom severity, and may be suggestive of a trait, rather than a state characteristic. (C) 2011 Elsevier B.V. All rights reserved.

Introduction: The literature on the possible neurobiologic correlates of auditory hallucinations is expanding rapidly. For an adequate understanding and linking of this emerging knowledge, a clear and uniform nomenclature is a prerequisite. The primary purpose of the present article is to provide an overview of the nomenclature and classification of auditory hallucinations. Materials and Methods: Relevant data were obtained from books, PubMed, Embase, and the Cochrane Library. Results: The results are presented in the form of several classificatory arrangements of auditory hallucinations, governed by the principles of content, perceived source, perceived vivacity, relation to the sleep-wake cycle, and association with suspected neurobiologic correlates. Conclusions: This overview underscores the necessity to reappraise the concepts of auditory hallucinations developed during the era of classic psychiatry, to incorporate them into our current nomenclature and classification of auditory hallucinations, and to test them empirically with the aid of the structural and functional imaging techniques currently available.

Background: Schizophrenia has been conceptualized as a disorder of integration of neural activity across distributed networks. However, the relationship between specific symptom dimensions and patterns of functional connectivity remains unclear. The current study aimed to investigate the relationship between auditory-verbal hallucinations (AVH), a particularly prevalent and clinically relevant symptom in schizophrenia, and functional connectivity of the temporo-parietal junction (TPJ).Methods: Resting state functional magnetic resonance imaging scans were obtained from 27 schizophrenia patients with AVH and 27 matched control subjects. We calculated correlations reflecting functional connectivity between a priori defined regions-of-interest and the bilateral TPJ seed regions, comprising the neural network involved in inner speech processes and AVH.Results: Compared with healthy control subjects, schizophrenia patients showed reduced functional connectivity between left TPJ and the right homotope of Broca. Within the patient group, more severe AVH were associated with reduced neural coupling between left TPJ and bilateral anterior cingulate as well as the bilateral amygdala.Conclusions: In schizophrenia patients with chronic hallucinations, the left TPJ a critical node in the speech perception/AVH network- shows reduced functional connectivity with brain areas involved in the attribution of agency, self-referent processing, and attentional control.

Recently, it has been proposed that exaggerated top-down processing may generate spontaneous perceptual output, and that this may constitute a cognitive predisposition toward hallucinations. In this experiment, we investigated whether hallucination proneness would be associated with increased auditory-verbal perceptual expectations, and at which processing level this occurs. From 351 undergraduate students screened for hallucination proneness, using the Launay-Slade Hallucination Scale (LSHS), 42 subjects were recruited for participation. Two word recognition tasks were administered, in which top-down influences on perception were manipulated through sentence context (semantic task) or auditory imagery (phonological task). Results revealed that LSHS scores were correlated with the number of semantically primed errors. Subjects with higher levels of hallucination proneness were more likely to report hearing a word that fits the sentence context, when it was not actually presented. This effect remained significant after controlling for general performance on the task. In contrast, hallucination proneness was not associated with phonologically primed errors. We conclude that aberrant top-down processing, particularly in the form of strong semantic expectations, may contribute to the experience of auditory-verbal hallucinations.