Identifying the cognitive underpinnings of voice‐hearing by comparing never, past and current voice‐hearers

Abstract

Objective The current study aimed to compare specific cognitive profiles corresponding to auditory verbal hallucinations (AVH) status and elucidate which pattern of cognitive deficits may predict voice‐hearing status. Method Clinical participants with schizophrenia spectrum disorders were partitioned into: (i) current voice‐hearers (n = 46), (ii) past voice‐hearers (n = 37) and (iii) never voice‐hearers (n = 40), and compared with 319 non‐clinical controls. Cognitive assessment employed the MATRICS Consensus Cognitive Battery (MCCB), supplemented by the Delis–Kaplan Executive Function System (D‐KEFS) Colour–Word Interference Test (Stroop) as a robust measure of executive function. Results On the Visual Learning domain, current and past voice‐hearers had significantly poorer performance relative to never voice‐hearers, who in turn had significantly poorer performance than non‐clinical controls. Current and never voice‐hearers had significantly poorer performance on the Social Cognition domain relative to non‐clinical controls. Current voice‐hearers also had significantly poorer performance on the Inhibition domain relative to non‐clinical controls. Binary logistic regression revealed that Visual Learning was the only significant cognitive predictor of AVH presence. Conclusion Visual learning, and potentially inhibition, may be viable therapeutic targets when addressing cognitive mechanisms associated with AVHs. Future research should focus on investigating additional cognitive mechanisms, employing diverse voice‐hearing populations and embarking on related longitudinal studies.

Cognitive dysfunction and cortical structural abnormalities in first-episode drug-naïve schizophrenia patients with auditory verbal hallucination

“…Moreover, we further found that AVH patients had more severe cognitive impairment in visual learning and verbal learning compared to non-AVH patients. This is partially consistent with previous studies which suggested that compared to never voice-hearers, current and past voice-hearers are more likely to encounter difficulties in integrating new information on the visual learning domain, but not significant more impaired in verbal learning (38,39). However, other studies have exhibited that poorer performance on verbal working memory was identified as the independently predictor of the severity of AVH in firstepisode schizophrenia patients (7).…”

Examining the relationships between cognition and auditory hallucinations: A systematic review

“…Although broad summaries of executive function and AHs are yet to be provided, our observation of limited significant findings were mostly consistent with recent empirical conclusions (e.g. Toh et al, 2020 ). Given that a critical portion of literature was omitted from this review due to a lack of methodological specificity to AHs, the absence of substantial evidence noted in respect to the above cognitive sub-domains does not necessarily disconfirm the relevance of these processes, but rather highlights the need for further methodological rigour in validating such inferences.…”

“…However, a notable portion of non-significant findings have also been reported (e.g. Brébion et al, 2008;Johns et al, 2001;McKay et al, 2000;McLachlan et al, 2013;Pinheiro et al, 2016;Rocca et al, 2006;Rossell et al, 2001;Schnakenberg Martin et al, 2018;Toh et al, 2020).…”

The Role of Inner Speech in Executive Functioning Tasks: Schizophrenia With Auditory Verbal Hallucinations and Autistic Spectrum Conditions as Case Studies

“…Notably, both intrusions and false recognitions were reliably associated with AVH, and these mistakes did not seem dependent on the semantic structure of words (p. 7). Another recent study conducted by Toh et al (2020) employs a battery of tasks to assess the degree of EF disruption in three subgroups diagnosed with schizophrenia: current voice-hearers, past voice-hearers, and never voice-hearers. Notably, current voice-hearers were found to be more impaired in the inhibition and visual learning domain (i.e., visual organization tasks requiring elements of planning), both with respect to controls and clinical subjects who had not recently experienced AVH.…”