Does hallucination perceptual modality impact psychosis risk?

Abstract

Woods SW, Powers AR III. Does hallucination perceptual modality impact psychosis risk?.Objective: Subthreshold perceptual abnormalities are commonly used to identify individuals at clinical high risk (CHR) for developing a psychotic disorder. Predictive validity for modality-specific perceptual abnormality severity on psychosis risk is unknown. Methods: We examined prospectively collected data from 164 individuals age 12-35 meeting criteria for CHR followed for 6-24 months or until conversion to psychosis. Using intake interview notes, baseline perceptual abnormality scores were split into auditory, visual, somatic/tactile, and olfactory/gustatory components, and auditory scores were further split into those for verbal vs non-verbal content. Relationships between perceptual abnormality characteristics and conversion were assessed with Cox proportional hazards regression and logistic regression. Results: Unusual thought content and paranoia were predictive of conversion, but no modality-specific perceptual abnormality score predicted conversion status or days to conversion. However, when auditory perceptual abnormalities were further categorized as verbal vs non-verbal, the severity of verbal experiences was predictive of conversion to psychosis (P = 0.007). Conclusions: Perceptual abnormality scores failed to meaningfully predict conversion to psychosis in either direction in this CHR sample. However, verbal auditory experiences may identify a group of CHR individuals at elevated risk of conversion. Further exploration of the relationship between phenomenological aspects of perceptual abnormalities and conversion risk is warranted. Significant outcomes• Subclinical hallucinations and perceptual abnormalities do not predict risk of conversion among CHR populations.• Verbal auditory experiences may be uniquely associated with greater risk of conversion to psychotic disorders. Limitations• As a retrospective study, severity scores for individual perceptual modalities were not recorded prospectively, but were generated per protocol from original study interview notes as a secondary analysis. Rater knowledge of conversion status was minimized prior to rescoring, but the possibility remains for slight bias owing to this methodology.• Research within the CHR population is often limited by poor retention rates, and this study was no exception. 26.5% of the 223 participants meeting criteria at baseline were lost to follow-up within 6 months.

Measuring Voluntary Control Over Hallucinations: The Yale Control Over Perceptual Experiences (COPE) Scales

“…Applied prospectively, the scales may aid in the prediction of conversion to psychosis in those at clinical high risk for psychosis. Individuals in this group often present with perceptual abnormalities that, while at times distressing, do not themselves predict conversion 54 . Precise measurement of control abilities also allows for identification of predictors of control over voice-hearing experiences.…”

Modeling perception and behavior in individuals at clinical high risk for psychosis: Support for the predictive processing framework

“…However, a second possibility may hold more promise for explaining pathological states leading to hallucinations. In this account, a lack of correlation with symptoms may be related to the phenomenologically semi-developed nature of the voice-hearing experience in CHR: most individuals with non-zero P4 scores experience relatively mild hallucinations, and most are non-verbal ( Niles et al, 2019 ). This relative developmental nascency may mean that those who exhibit altered performance on these tasks and hyper-precise priors may not be individuals with high hallucination propensity at the moment, but may be more likely to develop frank hallucinations in the future.…”

Tailoring cognitive behavioural therapy to subtypes of voice-hearing using a novel tabletised manual: a feasibility study

“…Hallucinations can be very common in first-episode psychosis (with prevalence rates of up to 75% reported; Mbewe et al, 2006;Rajapakse et al, 2011) and evidence suggests that hallucination severity is associated with likelihood of disengaging from EIP services (Solmi et al, 2018). Auditory verbal hallucinations are particularly associated with risk of developing psychotic disorders in clinically high risk groups (Niles et al, 2019) and the intensity, frequency and duration of hallucinations are key factors in the screening tools for ARMS (Yung et al, 2005) and EIP services (Kay et al, 1987). Therefore, an intervention like MUSE, being targeted at voices at an early stage (i.e.…”