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      Auditory verbal hallucinations in first-episode psychosis: a phenomenological investigation

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          Abstract

          Background

          In dimensional understanding of psychosis, auditory verbal hallucinations (AVH) are unitary phenomena present on a continuum from non-clinical voice hearing to severe mental illness. There is mixed evidence for this approach and a relative absence of research into subjective experience of AVH in early psychosis.

          Aims

          To conduct primary research into the nature of subjective experience of AVH in first-episode psychosis.

          Method

          A phenomenological study using diary and photo-elicitation qualitative techniques investigating the subjective experience of AVH in 25 young people with first-episode psychosis.

          Results

          AVH are characterised by: (a) entity, as though from a living being with complex social interchange; and (b) control, exerting authority with ability to influence. AVH are also received with passivity, often accompanied by sensation in other modalities.

          Conclusions

          A modern detailed phenomenological investigation, without presupposition, gives results that echo known descriptive psychopathology. However, novel findings also emerge that may be features of AVH in psychosis not currently captured with standardised measures.

          Declaration of interest

          None.

          Copyright and usage

          © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

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          Most cited references26

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          The positive and negative syndrome scale (PANSS) for schizophrenia.

          L Opler, Jennifer Kay, Paul Opler … (1986)
          The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
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            The same or different? A phenomenological comparison of auditory verbal hallucinations in healthy and psychotic individuals.

            I. E. C. Sommer, Susan R. Kahn, M P M Boks … (2011)
            Whereas auditory verbal hallucinations (AVHs) are most characteristic of schizophrenia, their presence has frequently been described in a continuum, ranging from severely psychotic patients to schizotypal personality disorder patients to otherwise healthy participants. It remains unclear whether AVHs at the outer borders of this spectrum are indeed the same phenomenon. Furthermore, specific characteristics of AVHs may be important indicators of a psychotic disorder. To investigate differences and similarities in AVHs in psychotic and nonpsychotic individuals, the phenomenology of AVHs in 118 psychotic outpatients was compared to that in 111 otherwise healthy individuals, both experiencing AVHs at least once a month. The study was performed between September 2007 and March 2010 at the University Medical Center, Utrecht, the Netherlands. Characteristics of AVHs were quantified using the Psychotic Symptoms Rating Scales Auditory Hallucinations subscale. The perceived location of voices (inside/outside the head), the number of voices, loudness, and personification did not differentiate between psychotic and healthy individuals. The most prominent differences between AVHs in healthy and psychotic individuals were the emotional valence of the content, the frequency of AVHs, and the control subjects had over their AVHs (all P values < .001). Age at onset of AVHs was at a significantly younger age in the healthy individuals (P < .001). In our sample, the negative emotional valence of the content of AVHs could accurately predict the presence of a psychotic disorder in 88% of the participants. We cannot ascertain whether AVHs at the outer borders of the spectrum should be considered the same phenomenon, as there are both similarities and differences. The much younger age at onset of AVHs in the healthy subjects compared to that in psychotic patients may suggest a different pathophysiology. The high predictive value of the emotional content of voices implies that inquiring after the emotional content of AVHs may be a crucial step in the diagnosis of psychotic disorders in individuals hearing voices. © Copyright 2011 Physicians Postgraduate Press, Inc.
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              The characteristic features of auditory verbal hallucinations in clinical and nonclinical groups: state-of-the-art overview and future directions.

              Antonio Preti, C Slotema, Louise C. Johns … (2012)
              Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and clinical levels. We look at some of the most prominent descriptive features of AVHs in schizophrenia (SZ). These are then examined in clinical conditions including substance abuse, Parkinson's disease, epilepsy, dementia, late-onset SZ, mood disorders, borderline personality disorder, hearing impairment, and dissociative disorders. The phenomenological changes linked to AVHs in prepsychotic stages are also outlined, together with a review of AVHs in healthy persons. A discussion of key issues and future research directions concludes the review.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BJPsych Open
                Journal ID (iso-abbrev): BJPsych Open
                Journal ID (publisher-id): bjporcpsych
                Journal ID (hwp): bjporcpsych
                Title: BJPsych open
                Publisher: The Royal College of Psychiatrists
                ISSN (Electronic): 2056-4724
                Publication date (Electronic): 15 February 2016
                Publication date Collection: January 2016
                Volume: 2
                Issue: 1
                Pages: 88-95
                Affiliations
                [1] Rachel Upthegrove, MBBS, MRCPsych, PhD, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
                [2] Jonathan Ives, PhD, Medicine, Ethics, Society and History, University of Birmingham, Birmingham, UK
                [3] Matthew R. Broome, MBChB, MRCPsych, PhD, Department of Psychiatry, University of Oxford, Oxford, UK; Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
                [4] Kimberly Caldwell, MSc, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
                [5] Stephen J. Wood, MA (Cantab), PhD, School of Psychology, University of Birmingham, Birmingham, UK; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Carlton, Victoria, Australia
                [6] Femi Oyebode, MBBS, MD, PhD, FRCPsych, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
                Author notes
                Correspondence: Rachel Upthegrove, MBBS MRCPsych PhD, Clinical Senior Lecturer, School of Clinical and Experimental Medicine, University of Birmingham, 25 Vincent Drive, Birmingham B15 2F, UK. Email: r.upthegrove@ 123456bham.ac.uk
                Article
                Publisher ID: bjporcpsych002303
                DOI: 10.1192/bjpo.bp.115.002303
                PMC ID: 4998935
                SO-VID: 20510a0c-1aff-47d6-8d69-d07d192a22e4
                Copyright © © 2016 The Royal College of Psychiatrists
                License:

                This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 15 October 2015
                Date revision received : 4 January 2016
                Date accepted : 5 January 2016
                Categories
                Subject: Paper

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