Auditory hallucination questions

[Psych56]

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There are some questions that I've seen and read that are asked of patients who are having auditory hallucinations yet I'm not entirely sure the significance of these questions.

Asking if the voices are male or female.
Asking if the voices are coming from inside of their head or outside of their head.
Asking if the patient has names for their voices.
Asking if there are several voices talking to each other about the patient.
Asking if they are loud or soft.

Any help would be great!

 

[splik]

First you are asking about hearing voices. Not all voice hearing should be regarded as auditory hallucinations, a point that appears to be lost of many a psychiatrist. most of these questions don't have any significance except for opening up a dialogue on voice hearing with the patient and establishing rapport.

voices heard in the head are called "false hallucinations" and voices emanating from elsewhere are called "true hallucinations", the point being hallucinations are perceptions that are experienced as real and outside the self. However even patients with psychotic illness experience these false hallucinations so it's not always that helpful.

voices heard arguing about the patient is one of Schneider's first-rank symptoms. The other auditory hallucinations that are first-rank symptoms are voices giving a running commentary, and thought echo (gedankenlautwerden). These were thought by Schneider to be characteristic of schizophrenia, but of course they also occur in mood disorder, delirium, organic brain syndrome, substance-induced psychosis. Up until DSM-5 they still held special significance in that having one of these symptoms alone was enough to get a diagnosis of schizophrenia, rather than 2 symptoms typically needed, though this is no longer the case. Schneiderian symptoms do however have a poorer prognosis and don't respond as well to neuroleptics so there is that. They also can be explained very well in from a cognitive neuropsychological perspective (http://www.nature.com/nrn/journal/v10/n1/full/nrn2536.html)

 

[Psych56]

Thank you very very much for your helpful response. I know where to direct my reading now.

 

[Ceke2002]

Just out of interest what is the difference if the voices are quiet or loud? Is it a matter of functionality for the person, with louder voices being more intrusive perhaps than ones that are quieter? Also how does thought echo differ from thought broadcast. If a person is say hearing their thoughts being beamed out of the radio at them, is that thought echo or thought broadcast? What about so called Musical Ear Syndrome versus auditory hallucinations of music, what's the differential on that?

 

[slappy]

First you are asking about hearing voices. Not all voice hearing should be regarded as auditory hallucinations, a point that appears to be lost of many a psychiatrist. most of these questions don't have any significance except for opening up a dialogue on voice hearing with the patient and establishing rapport.

voices heard in the head are called "false hallucinations" and voices emanating from elsewhere are called "true hallucinations", the point being hallucinations are perceptions that are experienced as real and outside the self. However even patients with psychotic illness experience these false hallucinations so it's not always that helpful.

voices heard arguing about the patient is one of Schneider's first-rank symptoms. The other auditory hallucinations that are first-rank symptoms are voices giving a running commentary, and thought echo (gedankenlautwerden). These were thought by Schneider to be characteristic of schizophrenia, but of course they also occur in mood disorder, delirium, organic brain syndrome, substance-induced psychosis. Up until DSM-5 they still held special significance in that having one of these symptoms alone was enough to get a diagnosis of schizophrenia, rather than 2 symptoms typically needed, though this is no longer the case. Schneiderian symptoms do however have a poorer prognosis and don't respond as well to neuroleptics so there is that. They also can be explained very well in from a cognitive neuropsychological perspective (http://www.nature.com/nrn/journal/v10/n1/full/nrn2536.html)

Excellent post. However, could you provide the reference for your second paragraph? I was not aware of that distinction, and I was under the impression that the term false hallucinations only referred to phenomena that were similar to hallucinations but did not quite fulfill the necessary criteria.

If a person is say hearing their thoughts being beamed out of the radio at them, is that thought echo or thought broadcast?

Neither.

 

[splik]

Excellent post. However, could you provide the reference for your second paragraph? I was not aware of that distinction, and I was under the impression that the term false hallucinations only referred to phenomena that were similar to hallucinations but did not quite fulfill the necessary criteria.

One of the problems has been the polysemous nature and lack of standardization of descriptive psychopathological terms so they are often used in different ways.

Taine, H. (1870) De l'intelligence. Tome 2. Paris:Librairie Hachette et Cie.

 

[Ceke2002]

Neither.

Hmm, time to go hunting for some reading material then. Cheers. 🙂

 

[slappy]

One of the problems has been the polysemous nature and lack of standardization of descriptive psychopathological terms so they are often used in different ways.

Fair enough!

 

[hamstergang]

I've come to this study a few times: On the non-significance of internal versus external auditory hallucinations, Schizophrenia Research 7/2004.

It's a study of almost 200 people with mostly schizophrenia and indicates they can report the voices as being inside or outside or both. It is possible that people without real psychosis are more likely to report internal voices, but it seems clear that internal voices are not inconsistent with true psychosis.

I agree that I generally ask questions about the voices mainly to get the patient talking about them. If they're fake, that may become evident. If not, it allows for rapport building and gives me insight into my patient's life. I can understand how the voices impact their lives to better understand where they need help.

 

[Ceke2002]

I've come to this study a few times: On the non-significance of internal versus external auditory hallucinations, Schizophrenia Research 7/2004.

It's a study of almost 200 people with mostly schizophrenia and indicates they can report the voices as being inside or outside or both. It is possible that people without real psychosis are more likely to report internal voices, but it seems clear that internal voices are not inconsistent with true psychosis.

Just personally I think the subject does have a tendency to be looked at in too simplified a manner: external voices are hallucinations and internal voices are just thoughts. In my experience internal voices have their own unique quality that is separate from the experience of just going through a process of thought, even a ruminating or intrusive one.