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Auditory Hallucinations

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15 views6 pages

Auditory Hallucinations

Uploaded by

Ethan Mcerzie
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Makazi Mugao Emmanuel

BMS/2018/38369

Auditory Hallucinations

Introduction

Hallucinations are defined as false sensory perceptions that occur without an external
stimulus. They are classified based on any of the five sensory modalities involved: auditory,
visual, gustatory, olfactory and tactile hallucinations.Auditory hallucinations are the most
common type of hallucinations, and more often than not, blur the lines between reality and
perception. They are defined as the perception of sound without an external stimulus or
simply hearing sounds that others do not hear. Understanding the pathophysiology is key to
psychiatric management of auditory hallucinations.

Auditory hallucinations have been documented throughout history. Ancient texts and
historical records often attributed them to supernatural divine forces or inebriation.

Epidemiology

Approximately 70-80% of patients diagnosed with schizophrenia commonly present with


auditory hallucinations . They can also occur in major depressive disorder, bipolar disorder
major depressive disorder, PTSD, borderline personality disorder, and even in the general
population under extreme stress, alcohol intoxication or in cases of sensory deprivation.

Classification of Auditory Hallucinations

They are categorized into various types:

Command Hallucinations: hearing voices that compel and order the person to carry out
specific actions, in some instance could be harmful to the person or the people around them.

Conversational Hallucinations: hearing two or more voices speaking among themselves and
most of the time about the person experiencing the hallucinations. The voices often insult or
speak in derogatory terms about the person, and can be very distressing and lead to social
dysfunction.

Critical or Derogatory Hallucinations: hearing voices that insult, criticize, threaten or


demean the person. The voices often command the person to perform harmful acts on
themselves that defile their physical and even mental self. These people are usually at risk of
suicidal ideation.

Music and Other Sounds: Hearing music, sounds, or noises that have no external source.

Patients think that the voices they hear or see in their hallucinations are actual voices
speaking to them from elsewhere. Patients' tests commonly attempt to verify that the voices
actually know what the patient is thinking, doing, or planning, even if they regularly try to
test the veracity of their voices. The patients belief is usually so deep rooted such that they
could deny irrefutable evidence. Even in cases where voices are unable to precisely forecast
what will be served for supper, for example, they will nevertheless produce a delusional
explanation that validates the existence of an outside source. These interpretations of the
hallucinations are further supported by ideas of reference and other illusions.

Etiology

The etiology of auditory hallucinations is multifactorial, involving a complex interplay of


genetic, neurobiological, psychological, and environmental factors:

Genetic Factors: Family and twin studies indicate a hereditary component, particularly for
schizophrenia. Neurodevelopmental Factors: Abnormal brain development and
neuroplasticity. Psychosocial Stressors: Traumatic experiences, especially in childhood, can
increase vulnerability. Substance Use: Certain substances, particularly hallucinogens and
stimulants, can induce hallucinations.

Pathophysiology

Neurobiological Mechanisms

Research on the neurological basis of auditory hallucinations has implicated various critical
regions, circuitry and pathways in the brain. These comprise: temporal lobe, broca’s area,
thalamus and dopamine pathways. Dysfunctions and disruptions in any of these areas usually
lead to the auditory hallucinations.

According to functional MRI and PET scans, these regions show unusual patterns of activity
while people are experiencing hallucinations.

Psychological and Cognitive Models


To explain auditory hallucinations, a number of cognitive models have been proposed,
including: The misattribution Model which implicates external sources to generation of
speech in the persons affected and the Deficit Model which posits that hallucinations are
caused by deficiencies in source memory and reality monitoring.

Clinical Features and Diagnosis

The clinical presentation of auditory hallucinations can vary widely. Key features include:

Content: can be anywhere from neutral to highly distressing. Verbal auditory hallucinations
typically have harsh, frightening, and frequently quite vulgar content in both their words and
prosody. Patients may hear threats, derogatory remarks about themselves, allegations of evil
thoughts or deeds, and expletives; masculine voices are more likely to provide this type of
negative information. It should come as no surprise that patients are frequently upset, scared,
or furious after having these experiences. As a result, they may react with complex feelings of
guilt, sadness, or hostility.

Frequency and Duration: Can be intermittent or constant. Typically, they occur several times
a day and might last for weeks or even months. Their intensity or volume ranges from soft
murmurs to loud, eerie sounds. The length varies, with some episodes lasting only a few
seconds and others lasting many minutes.

Context: they occur in specific situations or settings, or be pervasive across all contexts.

Comprehensive clinical interviews and the application of standardised evaluation


instruments, such as the Positive and Negative Syndrome Scale (PANSS) or the Auditory
Hallucinations Rating Scale (AHRS), are commonly used in the diagnosis process.

Comorbidities

Auditory hallucinations often co-occur with other psychiatric symptoms and disorders, such
as:

Delusions: Fixed false beliefs, often with themes similar to the content of hallucinations.

Anxiety and Depression: High levels of distress associated with the hallucinations can lead to
or exacerbate anxiety and depressive symptoms.

Substance Use Disorders: Can be both a cause and a consequence of hallucinations.


Impact on Functioning

Auditory hallucinations can significantly impair various aspects of a person’s life, including:

Social Functioning: Strain on relationships and social withdrawal.

Occupational Functioning: Difficulty maintaining employment due to distractibility or


distress.

Overall Quality of Life: Persistent distress and disruption to daily activities.

Differential Diagnosis

It's important to distinguish auditory hallucinations from other conditions like:

Illusions: Misperception of real external stimuli, where actual sensory input is incorrectly
perceived as something different or distorted.

Pseudohallucinations: Recognized by the person as not real, unlike true hallucinations.

Hypnagogic and Hypnopompic Hallucinations: Occur at the boundary of sleep and


wakefulness and are typically benign.

Management

Pharmacological and psychological therapies are combined in the treatment of auditory


hallucinations:

Pharmacological management

Antipsychotics: The cornerstone of treatment, and aids in lowering hallucinations' frequency


and intensity.

First-generation (Typical) Antipsychotics: E.g., Haloperidol, Chlorpromazine.

Second-generation (Atypical) Antipsychotics: E.g., Risperidone, Olanzapine, Clozapine.

Adjunctive Medications: Antidepressants or mood stabilizers may be used in cases of


comorbid mood disorders.

Psychosocial Interventions
Cognitive Behavioral Therapy (CBT): Focuses on changing the person’s response to
hallucinations and reducing distress.

Acceptance and Commitment Therapy (ACT): Helps individuals accept their hallucinations
without judgment and focus on valued life goals.

Family Therapy: Involves educating family members and improving communication and
support within the family system.

Social Skills Training: Aims to improve social functioning and reduce isolation.

Emerging Treatments and Research

Emerging treatments and ongoing research are exploring novel approaches:

Transcranial Magnetic Stimulation (TMS): Non-invasive brain stimulation technique


showing promise in reducing auditory hallucinations.

Conclusion

Auditory hallucinations are a key symptom in a variety of psychiatric illnesses. A thorough


grasp of their processes, clinical characteristics, and therapy alternatives is required for
successful management. Ongoing research advances our understanding and improves
therapeutic techniques, providing hope for better outcomes for those impacted by this
difficult symptom.

References

Sadock, B. J., Sadock, V. A., & Ruiz, P. (Eds.). (2015). Kaplan & Sadock's Comprehensive
Textbook of Psychiatry (10th ed.). Wolters Kluwer.
Lin, X., Zhuo, C., Li, G., Li, J., Gao, X., Chen, C., & Jiang, D. (2020). Functional brain
alterations in auditory hallucination subtypes in individuals with auditory hallucinations
without the diagnosis of specific neurological diseases and mental disorders at the current
stage. Brain and Behavior, 10(1), e01487.

Thakur, T., & Gupta, V. (2023). Auditory Hallucinations. In StatPearls. StatPearls Publishing.

Waters, F., & Fernyhough, C. (2017). Hallucinations: A Systematic Review of Points of


Similarity and Difference Across Diagnostic Classes. Schizophrenia bulletin, 43(1), 32–43.
https://doi.org/10.1093/schbul/sbw132

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