For a Typology of Auditory Verbal Hallucinations Based on their Content

Understanding AVATAR therapy: who, or what, is changing?

Understanding auditory verbal hallucinations in healthy individuals and individuals with psychiatric disorders

Visual P300 as a neurophysiological correlate of symptomatic improvement by a virtual reality-based computer AT system in patients with auditory verbal hallucinations: A Pilot study

Schizophrenia is a devastating disorder with cognitive deficits in a wide variety of domains. One prominent brain-based mechanism that has been proposed to account for a wide variety of deficits seen in this group is sensory gating, which refers to the ability to suppress extraneous sensory input in the environment. Impairments in this function have also been shown to be associated with positive symptoms in schizophrenia, including auditory verbal hallucinations (AVHs), which represent a core feature of the disorder; however, the neurophysiological basis of sensory gating dysfunction and its relationship to the state and trait of experiencing AVHs remain ill-understood. Furthermore, although the finding of sensory gating impairments in schizophrenia is robust, there is a substantial amount of variability in both schizophrenia patients and healthy controls, leaving questions regarding the validity of this measure as an endophenotype for schizophrenia. Event-related potential (ERP) and evoked power (EP) indices of sensory gating were assessed in 24 patients with AVHs and 24 healthy controls stratified into high and low suppressors. In patients specifically, structural volumes for cortical regions associated with both sensory gating and auditory hallucinations were assessed, and were correlated with electrophysiological measures of sensory gating, as well as with state and trait measures of AVHs. While it was suppressor type (i.e., low vs. high suppressors) rather than group (i.e., patients vs. controls) that differentiated participants with respect to most ERP and EP measures, patients did differ in a standard ERP measure of gating ability. Analyses also showed differences in cortical volume (with an emphasis on temporal region) associations with state assessments, depending on the experimental condition in which the AVHs were experienced. Furthermore, sensory gating function (as indexed by several ERP indices) was shown to be influenced by volumes in temporal, hippocampal and anterior cingulate regions. The study revealed basic electrophysiological gating mechanisms to regulate AVH experiences. Results also point to the influence of cortical volumes in regions associated with AVHs (and the state vs. the trait of such experiences) on electrophysiological measures of sensory gating function.

A detailed examination of pitch discrimination deficits associated with auditory verbal hallucinations in schizophrenia.

BACKGROUNDThe characteristics of cerebral hemodynamic indexes of patients with different types of auditory verbal hallucinations (AVHs) was not clear.AIMTo explore the characteristics of cerebral hemodynamic indexes of patients with different types of AVHs and construct the risk nomogram prediction model of patients with different types of AVHs.METHODSPatients with different types of verbal hallucinations who visited Wenzhou Seventh People’s Hospital were retrospectively selected from March 2021 to March 2023, and these patients were classified into 117 cases of schizophrenia (SCZ) with AVHs, 108 cases of post-traumatic stress disorder (PTSD) with AVHs, and 105 cases of recurrent depressive disorder with AVHs according to type. Transcranial doppler was performed to measure the hemodynamic parameters of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), basilar artery (BA) and vertebral artery (VA). Logistic regression modelling was used to explore the factors affecting patients with different types of AVHs and odds ratio, 95% confidence interval (CI). A clinical prediction model was constructed, and the efficacy of the clinical prediction model was evaluated by using receiver operating characteristic, Hosmer-Lemeshow Goodness-of-Fit test, calibration curves and decision curve analysis.RESULTSThe differences between the three groups of patients in mean velocity (Vm)-MCA, end-diastolic velocity (Vd)-MCA, Vm-ACA, pulsatility index (PI)-ACA, Vm-PCA, peak systolic velocity (Vs)-PCA, Vd-PCA, Vm-BA, Vs-BA, Vd-BA, PI-BA, resistance index (RI)-BA, Vm-VA, Vs-VA, Vd-VA, PI-VA, and RI-VA indexes were statistically significant. Rising Vm-ACA is an independent risk factor for SCZ with AVHs, and falling Vm-VA, Vd-MCA, and Vd-VA are independent risk factors for SCZ with AVHs. Rising Vm-ACA, Vm-PCA, Vs-PCA, Vd-PCA, Vm-BA, and Vs-BA are independent risk factors for PTSD with AVHs, and Vm-MCA, Vs-MCA, Vd-MCA, PI-PCA, and RI-BA are independent protective factors for PTSD with AVHs. Elevated Vm-MCA, Vd-MCA, RI-BA, Vm-VA, and Vd-VA were independent risk factors, and elevated Vm-ACA, Vs-ACA, Vm-PCA, Vs-PCA, and Vd-PCA were independent protective factors. The areas under the curve of the three models were 0.82 (95%CI: 0.76-0.87), 0.88 (95%CI: 0.83-0.92), and 0.81 (95%CI: 0.77-0.86), respectively; the Hosmer-Lemeshow Goodness-of-Fit test of the calibration curves of the three models suggests that P > 0.05.CONCLUSIONMonitoring the cerebral hemodynamic indexes of patients with AVHs is of practical significance in determining the type of mental disorder, which helps clinicians identify the type of AVHs and adopt more efficient treatment strategies to help patients recover.

Cerebral blood flow and its connectivity features of auditory verbal hallucinations in schizophrenia: A perfusion study

BackgroundTranscranial direct-current stimulation (tDCS), a noninvasive neurostimulation treatment, has been reported to show improvements in treatment-resistant auditory hallucinations in patients with schizophrenia. tDCS administered over a limited number of sessions effectively produced lasting attenuation of auditory hallucinations in otherwise stable outpatients. It has also been shown that tDCS may be a useful intervention for ameliorating cognitive deficits in patients with chronic schizophrenia. The purpose of this study was to test tDCS for auditory hallucinations in ultra-treatment resistant schizophrenia to assess if this form of neurostimulation can alleviate treatment-refractory auditory hallucination symptoms up to 4 weeks after the final treatment. In addition, we also wanted to examine the effects of tDCS on cognitive functions.Methods28 inpatients with DSM-V schizophrenia and long-standing treatment resistance and persistent auditory verbal hallucinations were recruited. Each individual participated in behavioral assessments at baseline, endpoint and follow-up [PANSS and Auditory Hallucinations Rating Scale (AHRS) and MCCB cognitive battery] and were randomized to receive active vs. sham tDCS treatments. For active treatment, patients had the inhibitory (cathodal) tDCS electrode placed over left auditory cortex relative to an excitatory (anodal) electrode placed over frontal cortex on the right side. tDCS treatments took place for 20 min twice daily for 5 consecutive days. Assessment batteries were repeated following the 4 weeks of treatment. The Chattanooga, dual channel CHA-1335 stimulator with two 7 × 5 cm (35 cm2) sponge electrodes soaked in a saline solution (0.9% NaCl) was used for the delivery of 2 mA current.ResultsA total of 28 subjects were enrolled (tDCS, n = 13; Control, n = 15). 20 subjects completed the trial. 3 subjects dropped out of the active tDCS treatment group, while 4 subjects did not complete the control treatment due to early discharge from the hospital. Most subjects were male (tDCS n = 10, 76.9%; Control n = 6, 40.0%). Length of present psychiatric admission ranged from 1–25 months, with a mode of 2 months (n = 12) and average of 2.9 months. Participating inpatients were on clozapine, haloperidol, paliperidone depot, fluphenazine decanoate, paliperidone, olanzapine, and risperidone as primary medications. Repeated Measures ANOVA showed a significant difference for the auditory hallucination total score, frequency and number of voices over time (p < 0.05) with greater reduction in scores observed for the tDCS group. Improvements were maintained after 4 weeks. There was no significant change over time observed for the PANSS positive symptoms or total score, or for the PANSS Hallucinatory Behavior item score. When assessing cognitive functioning, only Working Memory change was significant (p = 0.048) between the tDCS and the Control group with the tDCS group showing significant improvement in T-Score as compared to the Control group.DiscussionSubjects who received tDCS treatment showed a significant reduction in the frequency, number of voices, and total scores of their auditory hallucination. Additionally, subjects in the tDCS group showed significant improvement in the Working Memory. Our results indicate that patients who have been ultra-resistant to antipsychotic treatments and who received tDCS treatment presented with robust diminution of their auditory hallucinations. We conclude that tDCS seems to be effective not only for ambulatory, higher functioning patients, but also for much lower functioning patients with medication-refractory auditory verbal hallucinations.

Soundless voices, silenced selves: are auditory verbal hallucinations in schizophrenia truly perceptual?

This report is the result of the Bachelor Final Assignment of Jeroen Terpstra, student of Industrial Design Engineering at the University of Twente. This report describes the development of a new modular gymnastics apparatus for the company Penta Management & Adviesbureau. The essence of existing gymnastics equipment has hardly changed over the years. They are therefore often heavy and poorly manageable devices. This resulted in a demand for new gymnastics apparatus that distinguish themselves from traditional equipment regarding aspects such as multifunctionality, adaptability, and stimulating excercize. The goal of the assignment is therefore to design concept that meets this demand. To achieve this goal, the assignment is divided into four main parts. The first part of the assignment maps the aspects of the tradional equipment that can be innovated . This is achieved by analyzing gymnastic apparatus in several ways. The first way is by comparing the needs of the stakeholdes to the properties and functions of the existing movable gymnastic equipment. After this, the way gymnastics equipment have developed is examined. Finally the difficulties that the students and teachers face with traditional gymnastics apparatus are examined using a user survey. The results of these studies are described in section 2.7. The second main part of the report is the analysis which will lead to the list of requirements. In this section an overview has been made of similar competitive products. After this, a number of requirements have been defined by considering the restrictions the environment will put on the concept and by considering the influence of the government. Then all stakeholders of the concept have been mapped in the product function analysis. This analysis results in a list of requirements. In the third main section the list of requirements has been used as a guide for making a design proposal. First, the solutionpath is described in which the project experts thought that a solution had to be found. Next comes the idea stage where three concept directions have been generated following the advice of the experts. Besides this other broadening ideas have been suggested. After this the experts made a choice of directions resulted into two concepts in the concept phase. The client choose the concept with the most potential for further development. The final concept is then evaluated after which through new insights another concept has been developed. As a final result an animation has been made with the program Maya the plans for a prototype have been made. The last part concludes a section with further specification of the list of requirements and conclusions and recommendations are given.

Neurocognitive models and previous neuroimaging work posit that auditory verbal hallucinations (AVH) arise due to increased activity in speech-sensitive regions of the left posterior superior temporal gyrus (STG). Here, we examined if patients with schizophrenia (SCZ) and AVH could be trained to down-regulate STG activity using real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF). We also examined the effects of rtfMRI-NF training on functional connectivity between the STG and other speech and language regions. Twelve patients with SCZ and treatment-refractory AVH were recruited to participate in the study and were trained to down-regulate STG activity using rtfMRI-NF, over four MRI scanner visits during a 2-week training period. STG activity and functional connectivity were compared pre- and post-training. Patients successfully learnt to down-regulate activity in their left STG over the rtfMRI-NF training. Post- training, patients showed increased functional connectivity between the left STG, the left inferior prefrontal gyrus (IFG) and the inferior parietal gyrus. The post-training increase in functional connectivity between the left STG and IFG was associated with a reduction in AVH symptoms over the training period. The speech-sensitive region of the left STG is a suitable target region for rtfMRI-NF in patients with SCZ and treatment-refractory AVH. Successful down-regulation of left STG activity can increase functional connectivity between speech motor and perception regions. These findings suggest that patients with AVH have the ability to alter activity and connectivity in speech and language regions, and raise the possibility that rtfMRI-NF training could present a novel therapeutic intervention in SCZ.

Auditory verbal hallucinations (AVH) have been proposed to result from altered connectivity between frontal speech production regions and temporal speech perception regions. Whilst the dorsal language pathway, serviced by the arcuate fasciculus, has been extensively studied in relation to AVH, the ventral language pathway, serviced by the inferior occipito-frontal fasciculus (IOFF) has been rarely studied in relation to AVH. This study examined whether structural changes in anatomically defined subregions of the IOFF were associated with AVH in patients with schizophrenia. Diffusion tensor imaging scans and clinical data were obtained from the Australian Schizophrenia Research Bank for 113 schizophrenia patients, of whom 39 had lifetime experience of AVH (18 had current AVH, 21 had remitted AVH), 74 had no lifetime experience of AVH, and 40 healthy controls. Schizophrenia patients with a lifetime experience of AVH exhibited reduced fractional anisotropy (FA) in the fronto-temporal fibers of the left IOFF compared to both healthy controls and schizophrenia patients without AVH. In contrast, structural abnormalities in the temporal and occipital regions of the IOFF were observed bilaterally in both patient groups, relative to the healthy controls. These results suggest that while changes in the structural integrity of the bilateral IOFF are associated with schizophrenia per se, integrity reductions in the fronto-temporal fibers of the left IOFF may be specifically associated with AVH.

EPA-1018 - Source-based morphometry of gray matter volume in patients with schizophrenia who have persistent auditory verbal hallucinations

Background and objectiveAs a key feature of schizophrenia, auditory verbal hallucination (AVH) is causing concern. Altered dynamic functional connectivity (dFC) patterns involving in auditory related regions were rarely reported in schizophrenia patients with AVH. The goal of this research was to find out the dFC abnormalities of auditory related regions in first-episode, drug-naïve schizophrenia patients with and without AVH using resting state functional magnetic resonance imaging (rs-fMRI).MethodsA total of 107 schizophrenia patients with AVH, 85 schizophrenia patients without AVH (NAVH) underwent rs-fMRI examinations, and 104 healthy controls (HC) were matched. Seed-based dFC of the primary auditory cortex (Heschl's gyrus, HES), auditory association cortex (AAC, including Brodmann's areas 22 and 42), and medial geniculate nucleus (MGN) was conducted to build a whole-brain dFC diagram, then inter group comparison and correlation analysis were performed.ResultsIn comparison to the NAVH and HC groups, the AVH group showed increased dFC from left ACC to the right middle temporal gyrus and right middle occipital gyrus, decreased dFC from left HES to the left superior occipital gyrus, left cuneus gyrus, left precuneus gyrus, decreased dFC from right HES to the posterior cingulate gyrus, and decreased dFC from left MGN to the bilateral calcarine gyrus, bilateral cuneus gyrus, bilateral lingual gyrus. The Auditory Hallucination Rating Scale (AHRS) was significantly positively correlated with the dFC values of cluster 1 (bilateral calcarine gyrus, cuneus gyrus, lingual gyrus, superior occipital gyrus, precuneus gyrus, and posterior cingulate gyrus) using left AAC seed, cluster 2 (right middle temporal gyrus and right middle occipital gyrus) using left AAC seed, cluster 1 (bilateral calcarine gyrus, cuneus gyrus, lingual gyrus, superior occipital gyrus, precuneus gyrus and posterior cingulate gyrus) using right AAC seed and cluster 2 (posterior cingulate gyrus) using right HES seed in the AVH group. In both AVH and NAVH groups, a significantly negative correlation is also found between the dFC values of cluster 2 (posterior cingulate gyrus) using the right HES seed and the PANSS negative sub-scores.ConclusionsThe present findings demonstrate that schizophrenia patients with AVH showed multiple abnormal dFC regions using auditory related cortex and nucleus as seeds, particularly involving the occipital lobe, default mode network (DMN), and middle temporal lobe, implying that the different dFC patterns of auditory related areas could provide a neurological mechanism of AVH in schizophrenia.

Abnormalities in brain connectivity are associated with hallucinations. Several networks including sensory and resting-state networks have been pointed out as crucial in various hallucination modalities. Here we review the literature on brain connectivity relevant to auditory verbal and visual hallucinations with an emphasis on the most recent studies. Most recent literature investigates this issue in first-episode patients who are mainly medication naive. This enables the investigation of “true” abnormalities in brain connections, how they change with medication, and how they develop with illness progression. The literature that includes neural correlates of hallucinations in mood disorder is deficient. Both visual and auditory verbal hallucinations are associated with abnormal connections of perception areas, specific to that particular hallucination modality.