Hallucinations: A Systematic Review of Points of Similarity and Difference Across Diagnostic Classes

Abstract

Hallucinations constitute one of the 5 symptom domains of psychotic disorders in DSM-5, suggesting diagnostic significance for that group of disorders. Although specific featural properties of hallucinations (negative voices, talking in the third person, and location in external space) are no longer highlighted in DSM, there is likely a residual assumption that hallucinations in schizophrenia can be identified based on these candidate features. We investigated whether certain featural properties of hallucinations are specifically indicative of schizophrenia by conducting a systematic review of studies showing direct comparisons of the featural and clinical characteristics of (auditory and visual) hallucinations among 2 or more population groups (one of which included schizophrenia). A total of 43 articles were reviewed, which included hallucinations in 4 major groups (nonclinical groups, drug- and alcohol-related conditions, medical and neurological conditions, and psychiatric disorders). The results showed that no single hallucination feature or characteristic uniquely indicated a diagnosis of schizophrenia, with the sole exception of an age of onset in late adolescence. Among the 21 features of hallucinations in schizophrenia considered here, 95% were shared with other psychiatric disorders, 85% with medical/neurological conditions, 66% with drugs and alcohol conditions, and 52% with the nonclinical groups. Additional differences rendered the nonclinical groups somewhat distinctive from clinical disorders. Overall, when considering hallucinations, it is inadvisable to give weight to the presence of any featural properties alone in making a schizophrenia diagnosis. It is more important to focus instead on the co-occurrence of other symptoms and the value of hallucinations as an indicator of vulnerability.

Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

“…AVHs, on the other hand, were attributed to the sensory functions of the language system, since they consist in an abnormal perception of speech [9, 49-51]. …”

Paracingulate sulcus morphology and hallucinations in clinical and non-clinical groups

“…However, there are differences in frequency, duration and age of onset of hallucinatory experiences 14 , and in the preponderance of male voices 16 and more negative content of clinical AVHs 14,17 . Indeed, a recent systematic review found that only 52% of the 21 features of hallucinations studied were experienced by individuals in both groups 18 , suggesting that the continuum model might not be an accurate representation of the variation in hallucinations experienced by individuals with and without a clinical diagnosis.…”

From Perception to Thought: A Phenomenological Approach to Hallucinatory Experience

“…This is particularly evident in the case of the definition of hallucinatory experiences, allegedly a prototype of psychotic mental states. In the current issue, Waters and Fernyhoug's systematic review 7 raises nontrivial reservations on the value of hallucination features in terms of differential diagnosis. While possibly a byproduct of descriptive blindspots in available assessment tools, their findings question the pathognomonic value of hallucinations, that overall appear as relatively nonspecific symptoms (and-to some extent-not even indicative of a psychotic state).…”