Healthy Individuals With Auditory Verbal Hallucinations; Who Are They? Psychiatric Assessments of a Selected Sample of 103 Subjects

Abstract

Epidemiological studies suggest that auditory verbal hallucinations (AVH) occur in approximately 10%-15% of the general population, of whom only a small proportion has a clinically relevant psychotic disorder. It is unclear whether these hallucinations occur as an isolated phenomenon or if AVH in nonclinical individuals are part of a more general susceptibility to schizophrenia. For this study, 103 healthy individuals with frequent AVH were compared with 60 controls matched for sex, age, and education. All participants were examined by a psychiatrist using standardized diagnostic interviews and questionnaires. The individuals with AVH did not have clinically defined delusions, disorganization, or negative or catatonic symptoms, nor did they meet criteria for cluster A personality disorder. However, their global level of functioning was lower than in the controls and there was a pronounced increase on all subclusters of the Schizotypal Personality Questionnaire (SPQ) and the Peters Delusion Inventory, indicating a general increased schizotypal and delusional tendency in the hallucinating subjects. History of childhood trauma and family history of axis I disorders were also more prevalent in these individuals. We showed that higher SPQ scores, lower education, and higher family loading for psychiatric disorders, but not presence of AVH, were associated with lower global functioning. Our data suggest that AVH in otherwise healthy individuals are not an isolated phenomenon but part of a general vulnerability for schizophrenia.

Varieties of Voice-Hearing: Psychics and the Psychosis Continuum

“…First, the sample is very small compared to studies that used population-based approaches to nonclinical voice-hearing, 58,59 although we replicated many of the findings typical of voice-hearing in those studies. Nevertheless, other differences may arise in a larger sample and interesting subgroups may be identified.…”

Dopaminergic Function in the Psychosis Spectrum: An [18F]-DOPA Imaging Study in Healthy Individuals With Auditory Hallucinations

“…Within this putative continuum, there is a group of people who are not functionally impaired, yet report persistent auditory verbal hallucinations. 2,3 The hallucinations they report are of psychotic intensity and are quite similar at the phenomenological level to those in patients with schizophrenia and related psychotic disorders. 4 However, subjects with these symptoms do not meet diagnostic criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychotic disorder because the hallucinations are not associated with distress and subjects do not show functional impairment.…”

“…The subjects did not meet DSM-IV criteria for psychosis not otherwise specified despite having persistent auditory verbal hallucinations because the symptoms were not associated with occupational, social, or psychological dysfunction. They completed the following assessments administered by experienced psychiatrists trained in their use: Peter's Delusion Inventory (PDI), Schizotypal Personality Questionnaire (SPQ), and Psyrats Auditory Hallucinations Rating Scale (AHRS) modified as previously described 3 and the Global Assessment of Function scale. 3,[17][18][19] Sixteen subjects with persistent auditory hallucinations participated in the study ( …”

“…4 However, subjects with these symptoms do not meet diagnostic criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychotic disorder because the hallucinations are not associated with distress and subjects do not show functional impairment. 3 It is thought that dopaminergic dysfunction underlies the development of psychosis. 5,6 Supporting this, 15 molecular imaging studies suggest increased dopamine release and elevated dopamine synthesis capacity in patients with schizophrenia, including those in their first psychotic episode (see Abi-Dargham, 7 Howes et al, 8 and Meisenzahl et al 9 for reviews).…”

The emerging biology of delusions

“…Not everyone who experiences hallucinations develops a psychotic illness or a delusional interpretation of their hallucination (Sommer et al 2008). Studies of reasoning in schizophrenia and other psychoses have demonstrated intact logical reasoning but impaired probabilistic reasoning.…”