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Background Previous sleep electroencephalography studies have detected abnormalities in sleep architecture and sleep spindle deficits in schizophrenia (SCZ), but the consistency of these results was not robust, which might be due to the small sample size and the influence of clinical factors such as the various medication therapies and symptom heterogeneity. This study aimed to regard auditory verbal hallucinations (AVHs) as a pointcut to downscale the heterogeneity of SCZ and explore whether some sleep architecture and spindle parameters were more severely impaired in SCZ patients with AVHs compared with those without AVHs. Methods A total of 90 SCZ patients with AVHs, 92 SCZ patients without AVHs, and 91 healthy control subjects were recruited, and parameters of sleep architecture and spindle activities were compared between groups. The correlation between significant sleep parameters and clinical indicators was analyzed. Results Deficits of sleep spindle activities at prefrontal electrodes and intrahemispheric spindle coherence were observed in both AVH and non-AVH groups, several of which were more serious in the AVH group. In addition, deficits of spindle activities at central and occipital electrodes and interhemispheric spindle coherence mainly manifested accompanying AVH symptoms, most of which were retained in the medication-naive first-episode patients, and were associated with Auditory Hallucination Rating Scale scores. Conclusions Our results suggest that the underlying mechanism of spindle deficits might be different between SCZ patients with and without AVHs. In the future, the sleep feature of SCZ patients with different symptoms and the influence of clinical factors, such as medication therapy, should be further illustrated.

Introduction: Acute and Transient Psychotic disorder (ATPD) is defined by the ICD-10 as hallucinations, delusions, and/or senseless or nonsensical speech having an acute [1]. The distinguishing characteristic of ATPD is its abrupt onset. Second, there are characteristic symptoms present, and third, there is related acute stress [2]. Clinical Findings: Sleep disturbance, aggressiveness, muttering to self, irritability, irrelevant talks and loss of appétit, hearing of voices not heard by others, suspiciousness, increased talkativeness, increased energy and fearfulness. Mental Status Examination: Conscious, dressed appropriately, well groomed, standing, eye to eye contact initiated, non cooperative, activity normal, and the mood is exhausted, frustrated, the affect is irritable, guarded, and the flow of speech rate is rapid with moderate volume and responsive quality, Thought-flight of thoughts is evident, as are perceptual abnormalities- auditory hallucination, impaired social judgment, and full denial of sickness. Outcome: After treatment, the patient shows improvement. Irritability has reduced, sleeping pattern is improved, self muttering has stopped, irrelevant talks are less, and aggressiveness is reduced. Conclusion: Patient was admitted to Psychiatric Ward with a known case of Bipolar Affective Disorder and after Mental Status Examination he is diagnosed as Acute Transient Psychotic Disorder with complain of Sleep disturbance, aggressiveness, muttering to self, irritability, irrelevant talks. He improved after receiving adequate treatment, and the treatment was continuously ongoing until my last date of care.

Introduction: An impaired relationship with reality is a hallmark of psychosis. It is a sign of a serious mental disorder. People with psychosis may have delusions or hallucinations. The way your brain processes information can be affected by psychosis. Losing touch with reality is caused by it. It's possible to see, hear, or believe things that aren't true. Psychosis is a symptom, not a disease. It can be caused by a mental or physical illness, substance abuse, or stress. This case report aims to provide nursing care for psychosis. The objectives of this case report are to identify psychosis symptoms by the nurses and to report immediately and to take action immediately and to prevent complications. Case Presentation: A 17-years adolescent male admitted at Acharya Vinoba Bhave Rural Hospital Sawangi (M) Wardha with Auditory Hallucinations in psychosis since 7 (2014) years was admitted to a psychiatric ward with a chief complaint of muttering and smiling to self, decreased interaction sleep disturbance, aggressiveness. The perpetuating factors are poor drug compliance. Conclusion: The patient underwent psycho pharmacotherapy and the patient taking the medications regularly and minimized the symptoms. The relatives were informed about the prognosis and finally patient was discharged. The nurses play a vital role at the bedside and take care of psychiatric patients with auditory hallucinations effective nursing interventions for an adolescent male with auditory hallucinations in psychosis enhancing and improving patient’s mental illness who experience auditory hallucinations in psychosis.

Introduction Musical Ear Syndrome (MES) is an uncommon phenomenon described as the perception of auditory musical sensations not corresponding to any external stimulus. It seems to be more frequent in case of profound hearing loss. Our objective was to evaluate prevalence, characteristics and risk factors in a population of cochlear implant patients. Methods A retrospective study was conducted in cochlear implant patients, who were adult (> 18 years) in 2020 and underwent cochlear implantation between 1993 and 2019. We analyzed the presence and characteristics of MES. Results 118 of the 358 patients (33%) perceived or had perceived auditory musical sensations: 71 (19.8%) before, 100 (28%) after, and 53 (14.8%) both before and after implantation. The musical auditory sensations were usually short and well-tolerated, resembling instrumental music, and occurring several times a day. Thirteen patients (11%) considered them intolerable. Fatigue was a triggering factor in 40 patients (33.9%). Personal and medical characteristics, type of implantation, make of implant, etiology and tinnitus did not emerge as risk factors. On the other hand, MES+ patients were significatively younger (56 ± 17.4 years versus 61.9 ± 17.9 years; P = 0.0009). Despite the phenomenon, patients were satisfied with implant functioning and subjective auditory performance was not affected. Conclusion Prevalence of Musical Ear Syndrome was high in cochlear implant patients, and especially in younger subjects. It is essential to improve knowledge of this phenomenon.

Background The impact of command voices (CV) on violent behaviors in patients with schizophrenia remains unclear. The literature has produced mixed results, with no research existing on CV and violence among the Lebanese population. The study objecttives were to (1) evaluate the association between voice beliefs, psychosis severity, treatment, demographic factors and command voices, and (2) evaluate the association between command voices and violence among patients with schizophrenia in Lebanon. Methods A cross-sectional study, conducted between April and August 2019, enrolled 280 patients with schizophrenia. Results The results showed that 111 (39.6%) patients with schizophrenia had auditory hallucinations, among whom 93 (83.8%) patients had command voices; from these 93 patients, 53 (57.0%) were compliant with voices. Higher positive (ORa=1.09) and general psychopathology (ORa=1.04) PANSS subscales scores were significantly associated with higher compliance to voices. A higher resistance to beliefs about voices (ORa=0.91) was significantly associated with lower compliance to voices. Conclusions The prevalence of CV in patients with schizophrenia that report auditory hallucinations, was high in our sample. The vast majority of violent acts committed by patients was in compliance to CV, with a significantly high rate of the violence committed being directed towards property. Our findings were able to connect positive symptoms to higher probability of compliance to CV.

Background: The cognitive behavior therapy (CBT) approach to psychosis is a relatively recent development and focuses directly on the core psychotic symptoms of hallucinations and delusions. Aim: The aim of this study is to assess the efficacy of cognitive behavior therapy in managing hallucination in patients with schizophrenia and to evaluate the generalizability and durability of the therapeutic gains. Materials and Methods: In this confirmatory pre–post assessment study, based on the purposive sampling technique, a sample consisting of 40 (20 for experimental and the other 20 for control group) patients having schizophrenia with core symptoms of hallucination and delusions under treatment as usual were selected and matched on the sociodemographic and clinical variables. For the clinical variables, the Psychotic Symptom Rating Scale and Scale for the Assessment of Positive Symptoms were used. After baseline assessment, the cognitive behavioral program was tailored on the experimental group and patients of both the group were reassessed after the completion of treatment. Follow-up data to see the durability of program were taken from all the patients of experimental and control groups. Results: Cognitive behavior therapy was found to be effective for the treatment of auditory hallucination in schizophrenia. The therapeutic gains in all study variables were found to be maintained or further improving at follow-up which proves that cognitive behavior therapy is durable. Conclusion: Cognitive behavior therapy in conjunction with pharmacotherapy was found to be more effective in improving clinical symptoms of schizophrenia and global functioning compared to pharmacotherapy alone.

At a psychiatric refugee clinic for survivors of the Khmer Rouge genocide, a survey revealed that 42% (38/90) had auditory hallucinations (AHs) in the last month. Of those with AHs, 87% (33/38) had PTSD, whereas of those without AHs, 31% (16/52) had PTSD, giving a chi square of 27.8, p < .001, odds ratio 14.8 (4.8-45). Most AHs were of a "ghost summoning" (khmaoch hao), considered an exhortation to go with a ghost (e.g., hearing "Please come with me, younger sister"), experienced by 73% percent of patients with AHs. The voices were always exterior and usually loud and clear. AHs were heard most often during hypnagogia (i.e., upon falling asleep or awakening), experienced by 72% of patients with AHs, whereas 42% of patients with AHs experienced AHs when fully awake. AHs were almost always attributed to a ghost, giving rise to great fear: of having the "soul" called away or of being frightened to death. AH episodes almost always triggered trauma recall. AHs caused patients to undertake certain actions to address acute episodes and to prevent further ones. To illustrate these processes, cases are provided. AH appears to be a key part of the Cambodian bioculturally shaped trauma subjectivity.

Schizophrenia is a serious mental disorder characterized by chronic relapsing episodes of psychosis. The disease is multifactorial, where infections, genetic vulnerability and environmental factors are involved in the development of the illness. Toxoplasma gondii is one of the parasites that has long been known associated with schizophrenia in many studies. To date, there is growing evidence of association between T. gondii infections and schizophrenia. Herein we report a rare case of reactivated toxoplasmosis in a schizophrenia individual. This patient was incidentally diagnosed with reactivated T. gondii infection. He denied any symptoms of toxoplasmosis but experienced a mild psychiatric auditory hallucination. Serology test for T. gondii immunoglobulin antibodies measured a high positive IgG titer (135.9 IU/ml) and negative for IgM. Interestingly, nested PCR exhibited a positive result for the type I strain of T. gondii dense granular (GRA) 7 gene (GRA7). This case highlights the detection of probable reactivation of toxoplasmosis in an immunocompetent schizophrenic patient without psychiatric treatment-resistant and remains asymptomatic for toxoplasmosis. Both serology and molecular tools have been a helpful aid in establishing the diagnosis. Nonetheless, early detection as in this case may aid the patient management in the future.

We report the case of a pregnant woman who experienced auditory hallucinations only while suffering from hyperemesis gravidarum. To the best of our knowledge, the present report is the first report of a case of obvious auditory hallucinations and hyperemesis gravidarum at the same time in a pregnant woman who had not been diagnosed with any psychiatric disorder. The patient was a 24‐year‐old pregnant woman with no history of psychiatric disorder. Two years prior to this admission, she became pregnant for the first time, and she was admitted to an obstetrics clinic due to severe hyperemesis gravidarum. She developed mild auditory hallucinations at the same time. After she gave birth, the auditory hallucinations disappeared. When she was 24 years old, she became pregnant again. She suffered from severe hyperemesis gravidarum from the early stage of pregnancy. At 20 weeks of pregnancy, she visited the Department of Psychiatry of our hospital for a detailed psychiatric evaluation and treatment because her moderate auditory hallucinations had relapsed. We administered an antipsychotic agent, perospirone, to treat the auditory hallucinations, which disappeared, although the hyperemesis gravidarum persisted until childbirth. After childbirth, perospirone treatment was discontinued, and her auditory hallucinations did not relapse. The auditory hallucinations may have occurred as a result of complicated biological and psychosocial factors. Physicians should carefully evaluate psychotic symptoms, such as auditory hallucinations, not only during the postpartum period but also throughout the course of pregnancy., The present report is the first report of a case of obvious auditory hallucinations and hyperemesis gravidarum at the same time in a pregnant woman who had not been diagnosed with any psychiatric disorder. We administered an antipsychotic agent, perospirone, to treat the auditory hallucinations, which disappeared, although the hyperemesis gravidarum persisted until childbirth. After childbirth, perospirone treatment was discontinued, and her auditory hallucinations did not relapse.

Background: The present study was conducted to assess the clinical profile of unipolar and bipolar depressive patients. Subjects & Methods: 74 patients diagnosed with unipolar (40) and bipolar (34) depressive disorders were selected. Depressive cognitions, catatonic features, suicidal thoughts, anhedonia, pseudodementia, dissociative features, panic attacks, delusions, first-rank symptoms, auditory hallucinations, and affective reactivity were recorded. Results: Out of 74 patients, males were 32 and females were 42. Age of onset was 32.2 years in group I and 20.4 years in group II, total duration was 12.4 years in group I and 16.2 years in group II, the number of episodes was 3.4 and 7.1 in group II, the number of hospitalizations was 2.8 in group I and 5.2 in group II, suicidal thoughts were seen in 21 in group I and 24 in group II, anhedonia 10 in group I and 23 in group II, psuedodementia 7 in group I and 13 in group II, dissociative features were seen in 11 in group I and 27 in group II, delusions 4 in group I and 8 in group II, panic symptoms 10 in group I and 18 in group II and auditory hallucination 7 in group I and 18 in group II. The difference was significant (P< 0.05). Conclusion: Authors found that common clinical features were suicidal thoughts, dissociative features, and anhedonia.

Aims Ambulatory video-EEG monitoring has been utilized as a cost-effective alternative to inpatient video-EEG monitoring for non-surgical diagnostic evaluation of symptoms suggestive of epileptic seizures. We aimed to assess incidence of epileptiform discharges in ambulatory video-EEG recordings according to seizure symptom history obtained during clinical evaluation. Methods This was a retrospective cohort study. We queried seizure symptoms from 9,221 consecutive ambulatory video-EEG studies in 35 states over one calendar year. We assessed incidence of epileptiform discharges for each symptom, including symptoms that conformed to a category heading, even if not included in the ILAE 2017 symptom list. We report incidences, odds ratios, and corresponding p values using Fisher's exact test and univariate logistic regression. We applied multivariable logistic regression to generate odds ratios for the six symptom categories that are controlled for the presence of other symptoms. Results History that included motor symptoms (OR=1.53) or automatisms (OR=1.42) was associated with increased occurrence of epileptiform discharges, whereas history of sensory symptoms (OR=0.76) predicted lack of epileptiform discharges. Patient-reported symptoms that were associated with increased occurrence of epileptiform discharges included lip-smacking, moaning, verbal automatism, aggression, eye-blinking, deja vu, muscle pain, urinary incontinence, choking and jerking. On the other hand, auditory hallucination memory deficits, lightheadedness, syncope, giddiness, fibromyalgia and chronic pain predicted absence of epileptiform discharges. The majority of epileptiform discharges consisted only of interictal sharp waves or spikes. Conclusions Our study shows that the use of ILAE 2017 symptom categories may help guide ambulatory video-EEG studies.

Psychiatric symptoms are common after traumatic brain injury (TBI), and some patients have poor drug therapeutic efficacy. We report a successfully treated case of psychiatric symptoms after TBI using deep brain stimulation (DBS) to the anterior limb of internal capsule (ALIC)-nucleus accumbens (NAc) in a 76-year-old woman. The patient suffered from auditory hallucination, mood changes, and insomnia caused by TBI. Psychological test assessment showed the scores of Hamilton Anxiety Scale, Hamilton Depression Scale and Positive and Negative Syndrome Scale were 30, 35, and 96 respectively. Head magnetic resonance imaging scan showed right temporal lobe encephalomalacia. Head magnetic resonance spectroscopy (MRS) showed bilateral basal ganglia choline increased relatively. After DBS to the ALIC-NAc, the target parameters were adjusted. The psychiatric symptoms were completely improved and the result of head MRS was normal in the end. The current report declares that DBS is reversible, adjustable and safe in the treatment of psychiatric symptoms caused by TBI. DBS to the ALIC-NAc should be considered as a possible treatment choice once a patient showed psychiatric symptoms after TBI.

OBJECTIVES Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). DESIGN Case series. METHODS A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6-month intervention window. Participants were assessed four times over a 12-month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental-health and recovery measures. RESULTS Sixteen participants engaged in the intervention and were included in last-observation-carried-forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post-traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. CONCLUSIONS The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. PRACTITIONER POINTS Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma. Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices. Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.

Background Functional connectivity abnormalities between Broca’s and Wernicke’s areas and the putamen revealed by functional magnetic resonance imaging (fMRI) are related to auditory hallucinations (AH). In long-term schizophrenia, reduced white matter structural integrity revealed by diffusion imaging in left arcuate fasciculus (connecting Broca’s and Wernicke’s areas) is likely related to AH. The structural integrity of connections with putamen and their relation to AH are unknown. Little is known about this relationship in first-episode psychosis (FEP), although auditory transcallosal connections were reported to play a role. White matter in the Broca’s-Wernicke’s-putamen language-related circuit and auditory transcallosal fibers was examined to investigate associations with AH in FEP. Methods White matter connectivity was measured in 40 FEP and 32 matched HC using generalized fractional anisotropy (gFA) derived from diffusion spectrum imaging (DSI). Results FEP and HC did not differ in gFA in any fiber bundle. In FEP, AH severity was significantly inversely related to gFA in auditory transcallosal fibers and left arcuate fasciculus. Although the right hemisphere arcuate fasciculus-AH association did not attain significance, the left and right arcuate fasciculus associations were not significantly different. Conclusions Despite overall normal gFA in FEP, AH severity was significantly related to gFA in transcallosal auditory fibers and the left hemisphere connection between Broca’s and Wernicke’s areas. Other bilateral tracts’ gFA were weakly associated with AH. At the first psychotic episode, AH are more robustly associated with left hemisphere arcuate fasciculus and interhemispheric auditory fibers microstructural deficits, likely reflecting mistiming of information flow between language-related cortical centers.

Crohn’s disease is a chronic inflammatory disease that involves the upper and lower gastrointestinal tracts, including the oral cavity. For the conventional treatment of inflammatory bowel diseases, steroids are usually used as induction therapy, and azathioprine is used as maintenance therapy. Steroids are associated with various side effects. Under rare circumstances, they can even cause psychotic symptoms, and reports on steroid-induced psychosis in the pediatric population are few. Here, we report the first case of steroid-induced psychosis in a 16-year-old female with Crohn’s disease administered with steroids as induction therapy in South Korea. She showed psychotic symptoms, including auditory hallucination, loosening of association, and idea of reference, after 2 weeks of administering prednisolone 60 mg/day. One week after steroid discontinuation, the patient gradually recovered and was treated with quetiapine. Therefore, pediatricians should be aware of serious psychiatric adverse effects when administering corticosteroids for various indications.

Atypical spontaneous activities in resting‐state networks may play a role in auditory hallucinations (AHs), but networks relevant to AHs are not apparent. Given the debating role of the default mode network (DMN) in AHs, a parietal memory network (PMN) may better echo cognitive theories of AHs in schizophrenia, because PMN is spatially adjacent to the DMN and more relevant to memory processing or information integration. To examine whether PMN is more relevant to AHs than DMN, we characterized these intrinsic networks in AHs with 59 first‐episode, drug‐naïve schizophrenics (26 AH+ and 33 AH−) and 60 healthy participants in resting‐state fMRI. We separated the PMN, DMN, and auditory network (AN) using independent component analysis, and compared their functional connectivity across the three groups. We found that only AH+ patients displayed dysconnectivity in PMN, both AH+ and AH− patients exhibited dysfunctions of AN, but neither patient group showed abnormal connectivity within DMN. The connectivity of PMN significantly correlated with memory performance of the patients. Further region‐of‐interest analyses confirmed that the connectivity between the core regions of PMN, the left posterior cingulate gyrus and the left precuneus, was significantly lower only in the AH+ group. In exploratory correlation analysis, this functional connectivity metric significantly correlated with the severity of AH symptoms. The results implicate that compared to the DMN, the PMN is more relevant to the AH symptoms in schizophrenia, and further provides a more precise potential brain modulation target for the intervention of AH symptoms.

This study aimed to investigate alterations in brain function among different subtypes of auditory hallucinations (AH) in drug-naive first episode schizophrenia patients. We recruited 20 patients with drug-naive first episode schizophrenia who had constant commanding and commenting auditory verbal hallucinations (CCCAVH), 15 drug-naive first episode schizophrenia patients who had nonverbal auditory hallucinations (NVAH), and 20 healthy controls to participate in this study. We used global functional connectivity density (gFCD) and one-way analysis of covariance to characterize differences in brain function between the two patient groups. Statistical significance was set at P

rTMS treatment is clearly most well established for depressive disorders. However, a considerable body of research has investigated its use in other clinical areas. In schizophrenia, evidence does not consistently show an effect on general positive symptoms. However, there is a suggestion that prefrontal rTMS may modulate negative symptoms and cognition and substantive evidence that left temporoparietal stimulation can reduce the intensity and frequency of auditory hallucinations. There is inconsistent evidence, with many studies not replicated, supporting the use of rTMS in mania or anxiety disorders. There is emerging evidence to suggest that rTMS may modulate the experience of pain although studies are required to better establish its therapeutic use from a longer-term perspective in patients with chronic pain syndromes.

Objectives:This study aimed to investigate the effect of childhood trauma, especially its specific dimensions, and clinical risk factors for suicidal ideation in patients with schizophrenia.Methods:A total of 83 inpatients with schizophrenia were enrolled and divided into two groups: with suicidal ideation (n= 33) and without suicidal ideation (n= 50). All participants were administered the Childhood Trauma Questionnaire-Short Form, the Insomnia Severity Index, the Beck Scale for Suicide Ideation, the Modified Overt Aggression Scales, the auditory hallucination rating scale, the Hamilton Rating Scale of Depression and the Positive and Negative Syndrome Scale.Results:In our sample, 39.8% of the subjects had suicidal ideation, and 60.6% of them had suffered from childhood trauma. Patients with suicidal ideation had a higher Insomnia Severity Index score, Physical neglect score, the Childhood Trauma Questionnaire-Short Form total score (allP< 0.05) compared to those without. The logistic regression analysis revealed that physical neglect in Childhood Trauma Questionnaire was significantly associated with suicidal ideation (OR = 5.46,P< 0.05, 95% CI = 0.007–0.483). Further stepwise multiple linear regression identified that insomnia (β = 0.272,P= 0.011) and physical neglect (β = 0.257,P= 0.017) were strong risk factors for the severity of suicidal ideation in patients with schizophrenia. Mediation analysis showed that insomnia played a complete mediating role between physical neglect and suicidal ideation.Conclusion:Our results indicate that childhood maltreatment of physical neglect is a strong independent risk factor for suicidal ideation in schizophrenia. The risk is probably aggravated by the poor quality of sleep. Early screening and psychosocial treatment are recommended for psychotic individuals with a trauma history.

Approximately 30% of individuals with severe SARS-CoV-2 infections also develop neurological and psychiatric complaints. In rare cases, the occurrence of autoimmune encephalitis has been reported after SARS-CoV-2 infection. In this systematic review, we have identified eight SARS-CoV-2-associated cases of anti-NMDA receptor encephalitis. All had cerebrospinal fluid antibodies against the NMDA receptor and a recent onset of working memory deficits, altered mental status, or psychiatric symptoms, such as confusion, agitation, auditory hallucination, catatonia and speech dysfunction. All patients received high-dose steroid and immunoglobulin therapeutics and conditions improved in each case. These findings suggest that clinical attention should be paid to warning signs of autoimmune encephalitis in severe COVID-19 cases. If characteristic features of autoimmune encephalitis are present, autoantibody diagnostics should be performed and confirmed cases should be treated with immunotherapy to minimize neurological impairments. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02293-x.

Background : although the exact pathogenesis of auditory hallucinations is not yet known, some suggested the impairment of perception and processing of auditory information as a possible explanation. So, the aim of this study is to evaluate auditory pathways of schizophrenic patients using auditory brainstem responses (ABR). Methods : schizophrenic patients with auditory hallucinations and age and sex matched healthy non-relative controls were recruited in this case-control study. Scale for assessment of positive symptoms (SAPS) was used for rating the severity of hallucinations. Then, ABR recorded from all participants and the latencies of waves I, II, III, IV, V and inter-peak latencies (IPL) of waves I-III, III-V were analyzed on both sides. Chi squire and independent t tests were applied for statistical analysis. P-value≤0.05 was considered significant. Results : 39 patients and 35 controls were included. Latencies of waves III and V and IPL of III-V were significantly prolonged on the left side. Disease duration had no influence on the results. Conclusion : there is a link between abnormal ABRs and auditory hallucinations in schizophrenic patients that indicates dysfunction and abnormal asymmetry of auditory pathways in these patients.

The main symptoms of Meige's syndrome are involuntary eye blinking with muddled speech and uncontrollable contraction of the platysma muscle characterized by segmental, primarily oromandibular, dystonia (hyperkinesia). It can also develop after long‐term medication of first‐ and second‐generation antipsychotics. Here, we report the case of a Japanese female schizophrenic patient comorbid with Meige's syndrome and hyperthyroidism. We discuss the relationship between the three diseases, that is, schizophrenia, Meige's syndrome, and hyperthyroidism. Our intention is to consider the important role of the cerebral basal ganglia, where little attention has been given in regard to schizophrenia and Meige's syndrome. A part of this article was presented in a poster section at the joint congress of the 28th Annual Meeting of the Japanese Society of Clinical Neuropsychopharmacology and the 48th Annual Meeting of the Japanese Society of Neuropsychopharmacology held in 2018., We report the case of a Japanese female schizophrenic patient comorbid with Meige's syndrome and hyperthyroidism. We discuss the relationship between the three diseases considering the importance of the basal ganglia, where little attention has been given in regard to schizophrenia and Meige's syndrome.

Past studies have presented evidence that depressive symptoms are affected in different ways by social interaction skills and auditory hallucinatory symptoms in people with schizophrenia. However, few studies have focused on examining the relationship among auditory hallucinatory severity, social interaction skills, and depressive symptoms. This study aimed to explore the mediating effect of auditory hallucinatory severity on social interaction skills and depressive symptoms in people with long-term schizophrenia. We propose that auditory hallucination severity functions as a mechanism through which impaired social interaction skills increase depressive symptoms. In this study, a convenience sample of 186 people with schizophrenia was obtained from hospital-based rehabilitation wards. Four instruments were used: A demographic data questionnaire, the Assessment of Communication and Interaction Skills-Chinese version, the Characteristics of Auditory Hallucinations Questionnaire, and the Beck Depression Inventory II. To investigate the mediating effect of auditory hallucinatory severity after controlling for six covariates, we tested an indirect effect in a simple mediation model using the SPSS macro PROCESS, which is a regression-based approach. The indirect effect and the results of Sobel's test were significant (Z = -2.824, P = 0.005), which confirms that auditory hallucination severity mediates social interaction skills and depressive symptoms. This finding suggests that psychiatric nurses must teach people with schizophrenia to use auditory hallucination management strategies to prevent them from becoming immersed in auditory hallucinations and reducing their social interaction with the real world, so that depressive symptoms can be improved.

Supplemental Digital Content is available in the text, Background: Recent genome-wide association studies have identified an important role of T-cell receptor α (TRA) gene in the development of narcolepsy type 1. However, the role of TRA haplotype polymorphisms in the symptomatic diversity of narcolepsy remains unclear. This study aimed to investigate whether TRA polymorphisms can influence the symptomatic diversity of narcolepsy. Methods: Totally, 903 patients with narcolepsy type 1 were included in the study. Patients were divided into different groups according to their symptoms. First, 13 genotyped single nucleotide polymorphisms in the TRA were assessed for their association with symptoms of narcolepsy. We used the Chi-square test to determine differences in genotype frequencies in patients with narcolepsy. Further, we identified the haplotypes and variations of the TRA and tested their association with the symptoms of narcolepsy using a logistic regression model. Results: According to the results of the logistic regression, TRA haplotypes TG and CT were significantly associated with auditory hallucination, with odds ratios of 1.235 (95% confidence interval [CI], 1.012–1.507) and 1.236 (95% CI, 1.012–1.511), respectively (P

Musical hallucinations are poorly understood phenomena. Their relation with epilepsy was first described over a century ago, but never systematically explored. We, therefore, reviewed the literature, and assessed all descriptions of musical hallucinations attributed to epileptic activity. Our search yielded 191 articles, which together describe 983 unique patients, with 24 detailed descriptions of musical hallucinations related to epilepsy. We also describe six of our own patients. Based on the phenomenological descriptions and neurophysiological data, we distinguish four subgroups of epilepsy-related musical hallucination, comprising auras/ictal, inter-ictal and post-ictal phenomena, and phenomena related to brain stimulation. The case descriptions suggest that musical hallucinations in epilepsy can be conceptualised as lying on a continuum with other auditory hallucinations, including verbal auditory hallucinations, and—notably—tinnitus. To account for the underlying mechanism we propose a Bayesian model involving top-down and bottom-up prediction errors within the auditory network that incorporates findings from EEG and MEG studies. An analysis of phenomenological characteristics, pharmacological triggers, and treatment effects suggests wider ramifications for understanding musical hallucinations. We, therefore, conclude that musical hallucinations in epilepsy open a window to understanding these phenomena in a variety of conditions.

Epidemiological studies have suggested that maternal diabetes in pregnancy increases the risk of schizophrenia in offspring. A recent cohort study observed that maternal diabetes in early pregnancy is also associated with psychotic experiences in the general adolescent population. However, it remains unclear whether maternal diabetes in early pregnancy is specifically associated with psychotic experiences, or is generally associated with broader mental health problems, including depressive symptoms in adolescence. The present study investigated the longitudinal associations between maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring. Our data were derived from the Tokyo Early Adolescence Survey, a population-based survey of early adolescents (N = 4478) and their primary caregivers. Diabetes in early pregnancy was determined by records in the mother's Maternal and Child Health Handbook, documented during the pregnancy. Psychotic experiences and depressive symptoms were established through self-report by the offspring at 10 years of age. Diabetes in early pregnancy was associated with an increased risk of hallucination in the offspring (auditory hallucination [odds ratio {OR} 4.33, 95% confidence interval {CI} 1.12–16.75]; visual hallucination [OR 6.58, 95% CI 1.69–25.66]), even after adjusting for depressive symptoms and other covariates. However, the association between maternal diabetes and delusional thoughts was not significant and diabetes in early pregnancy was not associated with adolescent depressive symptoms. Our investigation suggests that maternal diabetes in early pregnancy may specifically affect the risk of hallucinatory experiences in adolescent offspring.

Transcranial direct current stimulation (tDCS) has generated interest in recent years as a potential adjunctive treatment for patients with schizophrenia. The primary objective of this meta-analysis was to evaluate the efficacy of tDCS on positive symptoms, particularly auditory hallucinations, and negative symptoms. A literature search of randomized sham-controlled trials was conducted using the OVID database on October 9, 2018. The standardized mean differences (SMDs) were calculated to examine changes in symptom severity between active and sham groups for the following symptom domains: auditory hallucinations, positive symptoms (including auditory hallucinations), and negative symptoms. Moderator analyses were performed to examine the effects of study design and participant demographics. We identified 10 eligible studies. Main-analyses showed no effects of tDCS on auditory hallucinations (7 studies, n = 242), positive symptoms (9 studies, n = 313), or negative symptoms (9 studies, n = 313). Subgroup analyses of studies that applied twice-daily stimulation showed a significant reduction in the severity of auditory hallucinations (4 studies, n = 138, SMD = 1.04, p = 0.02). Studies that applied ≥10 stimulation sessions showed a reduction in both auditory hallucination (5 studies, n = 186, SMD = 0.86, p = 0.009) and negative symptom severity (7 studies, n = 257, SMD = 0.41, p = 0.04). Meta-regression analyses revealed a negative association between mean age and the SMDs for auditory hallucinations and negative symptoms, and a positive association between baseline negative symptom severity and the SMDs for negative symptoms. Our findings highlight the need to optimize tDCS parameters and suggest twice-daily or 10 or more stimulation sessions may be needed to improve clinical outcomes in patients with schizophrenia.

Hallucinations are an elusive phenomena that has been associated with psychotic behavior, but which has a high prevalence in healthy population. Some models of Auditory Hallucinations (AH) have been proposed in the literature, but so far empirical evidence is scarce. The current study aims to obtain measurement of effective connectivity on rs-fMRI showing discrimination of subjects with a history of AH to give empirical validation of AH models. In this paper, we consider the Dynamic Causal Modeling (DCM) for the estimation of the effective connection between brain regions on resting state functional magnetic resonance imaging (rs-fMRI). Applying DCM to rs-fMRI data is a very recent approach, that allows studies of effective connectivity on rs-fMRI data. Brain regions are selected on the basis of previous results on functional connectivity in agreement with the models proposed in the literature. The selection of the most significant connection structure is carried as a wrapper feature selection process using Support Vector Machine (SVM) classifiers. Results on a dataset of Schizophrenia patients with and without a history of AH are provided which are in good agreement with the models in the literature.

There has been burgeoning interest in studying hallucinations in psychosis occurring across multiple sensory modalities. The current study aimed to characterize the auditory hallucination and delusion profiles in patients with auditory hallucinations only versus those with multisensory hallucinations. Participants with psychosis were partitioned into groups with voices only (AVH; n = 50) versus voices plus hallucinations in at least one other sensory modality (AVH+; n = 50), based on their responses on the Scale for the Assessment of Positive Symptoms (SAPS). Basic demographic and clinical information was collected, and the Questionnaire for Psychotic Experiences (QPE) was used to assess psychosis phenomenology. Relative to the AVH group, greater compliance to perceived commands, auditory illusions, and sensed presences was significantly elevated in the AVH+ group. The latter group also had greater levels of delusion-related distress and functional impairment and was more likely to endorse delusions of reference and misidentification. This preliminary study uncovered important phenomenological differences in those with multisensory hallucinations. Future hallucination research extending beyond the auditory modality is needed.

Objective Violent behaviour is an alarming problem among schizophrenia patients. The effects of historical, clinical, and pathological risk factors for violence have been investigated by multiple studies, but consensus has not been achieved. As psychotic symptoms are more direct and intuitive indicators for violence, identifying robustly associated symptoms is a crucial part of the future prediction and precise management of violent patients in clinics. This study aims to identify the psychotic symptoms correlated with violence among schizophrenia patients in a Chinese population. Methods In this cross-sectional study, the medical records of 7711 schizophrenia patients (4711 in the discovery set and 3000 in the validation set) were collected from 1998 to 2010. Their psychotic symptoms were extracted, and the patients were divided into violent and non-violent groups. Multivariate logistic analysis was applied to identify symptoms associated with violence in the discovery set. Results Eight psychotic symptoms were found to be significantly correlated with violence in schizophrenia. “Destruction of property”, “verbal aggression” and “insomnia” increased the risk of violence, while “flat affect”, “delusion of persecution”, “auditory hallucination”, “vagueness of thought” and “poverty of thought” decreased the risk of violence. The regression model was evaluated by receiver operating characteristic (ROC) analysis for its discriminatory performance, achieving area under curve (AUC) values of 0.887 in the discovery sample set and 0.824 in the validation sample set. Conclusions The correlated symptoms identified by this study can serve as future candidate predictors for violence in schizophrenia, paving the way for precise management of schizophrenia patients in clinics.

Fahr’s disease or Fahr’s syndrome is a condition characterized by intracranial calcifications especially in basal ganglia and dentate nuclei. They are a rare condition with a broad range of manifestations from asymptomatic condition to severe neurological and psychiatry signs and symptoms. The aim of this report to present Fahr’s syndrome as an alternative diagnosis of neuropsychiatry symptoms in systemic lupus erythematosus (SLE) patients. We present a 17-year-old teenage girl who have had a preexisting diagnosis of SLE and have been on remission. The patient recently had experienced headache, auditory hallucination and memory loss despite having a low activity score of SLE and no laboratory relapse. Head CT scan showed bilateral basal ganglia calcifications suggesting a Fahr’s disease. Clinical outcome in this condition might vary but might worsen neurocognitive functions.

Introduction. The case after exposure to intense traumatic events manifests signs and symptoms of dissociative amnesia with a dissociative fugue and schizophrenia. The psychotic symptoms we found, in this case, were very complicated and mimicking primary psychotic disorders. Therefore, this might be a good forum for the scientific world to learn from this case report, how psychotic disorders coexist with dissociative disorders, since the literatures in this area are too rare. Main Symptoms and/or Important Clinical Findings. This case report focuses on the case of dissociative amnesia with dissociative fugue and psychosis in a 25-year-old Ethiopian female who lost her husband and three children at the same time during the nearby ethnic conflict. Associated with amnesia, she lost entire autobiographical information, and she also had psychotic symptoms like delusions and auditory hallucination which is related to the traumatic event she faced. The Main Diagnoses, Therapeutic Interventions, and Outcomes. The diagnosis of dissociative amnesia with a dissociative fugue comorbid with schizophrenia was made, and both pharmacological and psychological interventions were given to the patient. After the intervention, the patient had a slight improvement regarding psychotic symptoms but her memory problem was not restored. Conclusions. The observation in this case report brings to the fore that individuals with dissociative amnesia with dissociative fugue can have psychotic symptoms, and it takes a longer time to recover from memory disturbances.

Experiencing persistent auditory hallucinations may contribute to unproductive struggle and interference with valued living among patients with schizophrenia. Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies that proposes active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. Utilization of acceptance commitment therapy may assist in reducing auditory hallucinations and may increase patient's feeling of control. Aim: Determine the effect of applying acceptance and commitment therapy on auditory hallucinations among patients with schizophrenia. Setting: The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Subjects: A random sample of 70 male inpatients with schizophrenia was selected and divided equally into a study and a control groups (35 patients in each group). Both groups were matched as much as possible in relation to socio- demographic and clinical data. Tools: Psychotic Symptom Rating Scales (PSYRATS-AHs) and Voices Acceptance and Action Scale (VAAS). A quasi-experimental research design was utilized in this study. Results: Significant differences were found between the study and control groups immediately post and after 3 months of ACT on baseline PSYRATS& VAAS scores. Conclusion: ACT offers a promising new treatment for auditory hallucination among patients with schizophrenia. A significant improvement in auditory hallucination was found in the study group immediately after implementing ACT and after 3 months. As well as a decrement in re hospitalization rate and improvement in drug compliance for the study group compares to control one. Recommendations: ACT should be integrated in psychiatric treatment and nursing interventions of inpatients with schizophrenia who experiencing auditory hallucination.

Objective:To explore the phenomenology of auditory verbal hallucinations (AVHs) in a clinical sample of young people who have a ‘non-psychotic’ diagnosis.Methods:Ten participants aged 17–31 years with presentation of emotionally unstable personality disorder or post-traumatic stress disorder and frequent AVHs were recruited and participated in a qualitative study exploring their subjective experience of hearing voices. Photo-elicitation and ethnographic diaries were used to stimulate discussion in an otherwise unstructured walking interview.Results:‘Non-psychotic’ voices comprised auditory qualities such as volume and clarity. Participants commonly personified their voices, viewing them as distinct characters with which they could interact and form relationships. There appeared to be an intimate and unstable relationship between participant and voice, whereby voices changed according to the participants’ mood, insecurities, distress and circumstance. Equally, participants reacted to provocation by the voice, leading to changes in mood and circumstance through emotional and physical disturbances. In contrast to our previous qualitative work in psychosis, voice hearing was not experienced with a sense of imposition or control.Conclusions:This phenomenological research yielded in-depth and novel accounts of ‘non-psychotic’ voices which were intimately linked to emotional experience. In contrast to standard reports of voices in disorders such as schizophrenia, participants described a complex and bi-directional relationship with their voices. Many other features were in common with voice hearing in psychosis. Knowledge of the phenomenology of hallucinations in non-psychotic disorders has the potential to inform future more successful management strategies. This report gives preliminary evidence for future research.

Psychological interventions have proven efficacy in treating psychotic symptoms such as delusions and hallucinations. However, the efficacy of these interventions has primarily been evaluated in the context of their use as an adjunct to antipsychotics or on patients who do not respond to adequate trials of antipsychotics. There is paucity of research about the effectiveness of psychological interventions in patients who do not take antipsychotics either because they are not willing to take medications or are not able to tolerate antipsychotics due to the side effects. We report here the case of a patient who had distressing auditory hallucinations and was not able to take antipsychotic medications because of severe reactions. She responded to metacognition and mindfulness integrated therapy for auditory hallucination. A total of eight sessions of therapy with the major focus on enhancement of metacognitive insight into the mechanisms of genesis and maintenance of hallucinations followed by encouraging the patient to use mindfulness-based strategies and regular self-monitoring of hallucinatory experiences were conducted. The patient was assessed pre–post intervention on the auditory hallucination subscale of the Psychotic Symptom Rating Scale (PSYRATS). There was significant improvement as reflected by more than 50% reduction in the PSYRATS score. This case highlights that metacognition and mindfulness integrated therapy has the potential to help patients with hallucination who do not take antipsychotic medications. The insight building helps in developing a detached approach towards hallucinatory experiences which, in turn, reduces distress caused by the hallucinations.

Introduction : Transcranial Direct Current Stimulation (tDCS) has been beneficial for treating auditory verbal hallucinations (AVH) in schizophrenia (SZ). Aberrant auditory signal detection (ASD) is one of the pathogenetic mechanisms for AVH. We investigated the correlates of ASD with AVH and the impact of single-session tDCS on ASD in SZ patients. Methods : The ASD performance in SZ patients was compared with matched healthy controls (HC) (N = 24). Subsequently, the effect of single-session tDCS on ASD in SZ patients (N = 24) with AVH was examined in a randomized, double-blind, sham-controlled, cross-over design. The true and sham tDCS were administered (anode at the left dorsolateral prefrontal cortex and cathode at the left temporoparietal junction) on two different days. ASD task was performed before and after each session of tDCS. Results : Auditory hallucination rating scores correlated significantly with false alarm rate, discriminability index, and response bias. SZ patients had a significantly lesser discriminability index in ASD than HC. Single-session tDCS (true versus sham) did not have any significant effect on ASD in SZ patients. Conclusion : The study findings support the pathogenetic role of ASD in AVH in SZ. Lack of effect on ASD following single-session tDCS suggests the need for multi-session studies in the future.

Infectious diseases of immigrant populations have recently become important issues for the health of both Korean nationals and foreigners living in Korea. This case report of general paresis is intended to raise awareness about re-emerging neurosyphilis in Korea as a possible etiology of psychotic disorders. A 68-year-old male Chinese resident came to Korea in 2019 with disorientation, auditory hallucination, persecutory delusion, and aggressive behavior, and was admitted to a psychiatric ward for further evaluation and treatment via the emergency department. He was confirmed to have neurosyphilis by serum test, analysis of cerebrospinal fluid, and brain magnetic resonance imaging. After treatment with antibiotics, including intravenous penicillin, in combination with atypical antipsychotics for 6 weeks, his disorientation, auditory hallucination, delusion, and aggressive behavior had attenuated. Neurosyphilis should still be included as a possible etiology of psychotic disorders in Korea. At the initial evaluation, syphilis screening serum tests are recommended for psychotic patients, especially those with pleomorphic symptoms and cognitive dysfunction., Graphical Abstract

Highlights • Transdiagnostic evidence for neural disruption in psychotic hallucinations. • Hallucinations associated increased connectivity in auditory association cortex. • Brain regions for auditory-verbal language comprehension linked to hallucinations. • Interhemispheric connectivity alterations related to subgroup-specific findings. • Hallucinations link to auditory rs-connectivity tested in 243 psychosis patients., Background Auditory hallucinations are prevalent across the major psychotic disorders, but their underlying mechanism is poorly understood. Limited prior work supports a hypothesis of altered auditory/language brain systems. To more definitively assess this, we examined whether alterations in resting state connectivity of auditory and language cortices are associated with hallucination severity in a large sample of individuals in the schizo-bipolar spectrum. Methods Whole brain resting state connectivity of auditory and language cortex (primary auditory cortex, unimodal auditory association cortex, Wernicke’s area [speech and heteromodal association cortex] and Broca’s area [speech production motor]) was evaluated for 243 subjects with schizophrenia, schizoaffective, or bipolar disorder with psychosis and 186 healthy controls from the Bipolar Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Regression analyses were conducted to evaluate whether resting state connectivity of auditory and language cortex was a significant predictor of current overall hallucination severity (information about specific modality of hallucinations experienced was not available). Results Increased connectivity between lower and higher order regions of left temporal-parietal auditory/language processing cortex was associated with worse hallucination severity for all psychosis patients. Additionally, within bipolar subjects, increased interhemispheric connectivity between higher order temporal-parietal auditory/language regions was related to greater hallucination severity. When patients were categorized by B-SNIP biomarker-based Biotype groups, interhemispheric connectivity between left auditory association cortex and right core auditory cortex was related to greater hallucination severity for Biotype 1 patients. Exploratory analyses resulted in different patterns of connectivity of auditory/language cortex in patients and controls, unrelated to current hallucination severity. Conclusions Although the findings cannot be precisely attributed to auditory hallucination severity or possible differences in such experiences between groups, increased connectivity among the left hemisphere auditory and receptive language cortex may represent a significant factor contributing to hallucination severity across psychotic disorders, and additional subgroup specific connectivity alterations may also be present.

Introduction Presently the COVID-19 pandemic is raging through the United States and worldwide. This enigmatic virus characteristically affects the respiratory system. Atypical presentations, such as gastrointestinal symptoms, and cases of encephalopathy have also been reported. However, psychiatric symptoms as the initial presenting feature is novel. We describe one such case. Case Presentation 53-year-old man with no prior psychiatric or significant medical history was brought to the emergency department after ingesting bleach in an apparent suicide attempt. On initial presentation, the patient was uncooperative and withdrawn, though alert and oriented. He subsequently developed fever, tachycardia, elevated blood urea nitrogen and transaminases. SARS CoV-2 was confirmed on RT-PCR. Neurological examination was non-contributory. As his clinical condition improved, the patient reported that his initial symptom was an auditory hallucination telling him to jump from a bridge or ingest bleach. He reported that the increasing intensity of his auditory hallucinations led him to act upon it. He denied mood symptoms or suicidal ideation. The hallucinations did not recur during the hospital course, but he required 3 doses of antipsychotic medication for agitation. After improvement of his SARS CoV-2 infection, he was free of psychiatric symptoms and was discharged to a subacute rehabilitation center. Conclusion This case indicates that what appears as a sudden onset of a psychiatric illness in the current context may be an initial manifestation of a developing COVID illness.

A direct relationship between auditory verbal hallucinations (AVHs) and decreased left-hemispheric lateralization in speech perception has been often described, although it has not been conclusively proven. The specific lateralization of AVHs has been poorly explored. However, patients with verbal hallucinations show a weak Right Ear Advantage (REA) in verbal perception compared to non AVHs listeners suggesting that left-hemispheric language area are involved in AVHs. In the present study, 29 schizophrenia patients with AVHs, 31 patients with psychotic bipolar disorder who experienced frequent AVHs, 27 patients with schizophrenia who had never experienced AVHs and 57 healthy controls were required to imagine hearing a voice in one ear alone. In line with previous evidence healthy controls confirmed the expected REA for auditory imagery, and the same REA was also found in non-hallucinator patients. However, in line with our hypothesis, patients with schizophrenia and psychotic bipolar disorder with AVHs showed no lateral bias. Results extend the relationship between abnormal asymmetry for verbal stimuli and AVHs to verbal imagery, suggesting that atypical verbal imagery may reflect a disruption of inter-hemispheric connectivity between areas implicated in the generation and monitoring of verbal imagery and may be predictive of a predisposition for AVHs. Results also indicate that the relationship between AVHs and hemispheric lateralization for auditory verbal imagery is not specific to schizophrenia but may extend to other disorders as well.

Auditory hallucinations (AHs) are among the cardinal symptoms of schizophrenia (SZ). During the presence of AHs aberrant activity of auditory cortices have been observed, including hyperactivation during AHs alone and hypoactivation when AHs are accompanied by a concurrent external auditory competitor. Mismatch negativity (MMN) and P3a are common ERPs of interest within the study of SZ as they are robustly reduced in the chronic phase of the illness. The present study aimed to explore whether background noise altered the auditory MMN and P3a in those with SZ and treatment-resistant AHs. Methods MMN and P3a were assessed in 12 hallucinating patients (HPs), 11 non-hallucinating patients (NPs) and 9 healthy controls (HCs) within an auditory oddball paradigm. Standard (P = 0.85) and deviant (P = 0.15) stimuli were presented during three noise conditions: silence (SL), traffic noise (TN), and wide-band white noise (WN). Results HPs showed significantly greater deficits in MMN amplitude relative to NPs in all background noise conditions, though predominantly at central electrodes. Conversely, both NPs and HPs exhibited significant deficits in P3a amplitude relative to HCs under the SL condition only. Significance These findings suggest that the presence of AHs may specifically impair the MMN, while the P3a appears to be more generally impaired in SZ. That MMN amplitudes are specifically reduced for HPs during background noise conditions suggests HPs may have a harder time detecting changes in phonemic sounds during situations with external traffic or "real-world" noise compared to NPs.

Voice hearing (VH) can occur in trauma spectrum disorders (TSD) such as posttraumatic stress disorder (PTSD) and dissociative disorders. However, previous estimates of VH among individuals with TSD vary widely. In this study, we sought to better characterize the rate and phenomenology of VH in a sample of 70 women with TSD related to childhood abuse who were receiving care in a specialized trauma program. We compared the rate of VH within our sample using two different measures: 1) the auditory hallucination (AH) item in the Structured Clinical Interview for DSM-IV-TR (SCID), and 2) the thirteen questions involving VH in the Multidimensional Inventory of Dissociation (MID), a self-report questionnaire that comprehensively assesses pathological dissociation. We found that 45.7% of our sample met threshold for SCID AH, while 91.4% met criteria for MID VH. Receiver operating characteristics (ROC) analyses showed that while SCID AH and MID VH items have greater than chance agreement, the strength of agreement is only moderate, suggesting that SCID and MID VH items measure related but not identical constructs. Thirty-two patients met criteria for both SCID AH and at least one MID VH item ("unequivocal VH"), 32 for at least one MID VH item but not SCID AH ("ambiguous VH"), and 6 met criteria for neither ("unequivocal non-VH"). Relative to the ambiguous VH group, the unequivocal VH group had higher dissociation scores for child voices, and higher mean frequencies for child voices and Schneiderian voices. Our findings suggest that VH in women with TSD related to childhood abuse is common, but that the rate of VH depends on how the question is asked. We review prior studies examining AH and/or VH in TSD, focusing on the measures used to ascertain these experiences, and conclude that our two estimates are consistent with previous studies that used comparable instruments and patient samples. Our results add to growing evidence that VH-an experience typically considered psychotic or psychotic-like-is not equivalent to having a psychotic disorder. Instruments that assess VH apart from psychotic disorders and that capture their multidimensional nature may improve identification of VH, especially among patients with non-psychotic disorders.

Objective: Transcranial direct current stimulation (tDCS) could be a treatment option for medication-resistant auditory hallucinations (AH), but so far results have been inconclusive, and large sample trials have been missing. This study used tDCS as a treatment method for these hallucinations in a double-blind, placebo-controlled study with a relatively large sample size.Methods: Fifty-four patients of several diagnostic categories with medication-resistant AH were randomized and treated during 10 sessions of 20 min each, with either 2 mA tDCS or placebo, administered on five consecutive days (i.e., two sessions per day). Anodal stimulation was targeted at the left dorsolateral prefrontal cortex, cathodal stimulation at the left temporoparietal junction. AH severity was assessed using the Auditory Hallucination Rating Scale (AHRS). Other outcome measures were assessed with the Positive and Negative Syndrome Scale (PANSS), the Stroop, and the Trail Making Test.Results: AH frequency and severity decreased significantly over time, as did the scores on the total and general subscales of the PANSS. However, there was no significant interaction effect with the treatment group on any of the main outcome measures.Conclusions: We found no evidence that tDCS is more effective for medication-resistant AH than placebo, even though AH frequency and severity decreased in both groups. An alternative strategy may be to offer tDCS at an earlier stage of illness. In the light of recent investigations into the neurophysiological mechanisms behind tDCS, we may also have to consider the possibility that tDCS is not able to induce any long-lasting brain changes.

A 94 year old woman with a late-onset paraphrenia was referred to our clinic from a community care center. The patient showed symptoms of paranoia and auditory hallucination. The patient was in conflict with her neighbors regarding noise-related problems and was experiencing loss of appetite. Because the patient had a strong aversion to outpatient treatment due to difficulty in commuting, home visits were commenced. Improvements were observed after administration of 2.5 mg per day of olanzapine.In home medical care, precise definitive diagnosis and determination of treatment approach is necessary under limited time and resources. The fact that elderly people often exhibit psychological symptoms such as hallucinations is well known among clinical professions. However, this is not well known among home care patients, families and other professionals, and, therefore, is often overlooked. As the population ages further, it can be predicted that cases of elderly patients requiring treatment for psychological symptoms will increase in home medical care situations. In Japan, with a super-aging society, understanding and continuously supporting late-onset paraphrenia among elderly people is a pressing issue for all communities in advancing home medical care and nursing.

Background Patients with psychiatric disorders in critical condition are difficult to treat. In this study, we report on a patient with underlying schizoaffective disorder who developed catatonia, cardiac arrest, and pulmonary embolism, as well as a successful treatment strategy. Case presentation The inpatient is a 41-year-old morbidly obese male with schizoaffective disorder whose clozapine dosage was titrated from 100 mg to 175 mg due to auditory hallucination and agitation. The patient abruptly developed acute cardiopulmonary symptoms associated with an elevated troponin-I level. He was transferred to a cardiac intensive care unit, where he remained for 3 days. He was also found to have excited catatonic symptoms, and the lorazepam-diazepam protocol was initiated to quickly relieve the catatonia. Once the coronary angiogram was read as normal, the patient was transferred back to the psychiatric ward. However, the patient then suffered from in-hospital cardiac arrest. He was resuscitated and again transferred to the medical intensive care unit. Computed tomography confirmed the diagnosis of a pulmonary embolism. The patient was treated with Rivaroxaban 30 mg/d for the first 21 days, followed by 20 mg daily for 3 months. To control his severe and refractory psychotic symptoms, the patient was re-prescribed clozapine. During the 15-month follow-up period, the patient demonstrated a fair response and tolerability to clozapine 150 mg without symptoms relapse and no thromboembolic event. Conclusion This report can serve to remind psychiatrists and physicians to be aware of fatal conditions in patients with psychiatric diseases and physical illnesses.

This study was to investigate the association of auditory hallucinations and anxiety symptoms with depressive symptoms in patients with schizophrenia for three months. The participants (N = 189) were evaluated using Characteristics of Auditory Hallucination Questionnaire (CAHQ), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II. Forty-two participants suffered from depressive symptoms at both baseline and 3-month follow-up. Higher CAHQ and BAI at both periods predicted depressive symptoms at three-month end. Being male, increased severity of CAHQ and BAI were risk factors of depressive symptoms. Psychiatric professionals must educate patients to manage auditory hallucinations and anxiety symptoms to decrease depressive symptoms.

Objective: Evidence suggests that individuals with Alzheimer’s disease (AD) are often diagnosed in the later stages of their disease with a poor prognosis. This study is aimed to identify patterns in signs and symptoms preceding the clinical diagnosis of AD to suggest a predictive model for earlier diagnosis of the disease in the primary care. Design: A retrospective medical record review; nested case control design. Participants: Participants included one hundred and nine patients from three general practice (GP) surgeries in Milton Keynes and Luton Clinical Commissioning Groups (CCG) (37 cases with AD and 72 controls without AD). Main outcome measure: A retrospective analysis using the logistic regression of the presence of signs and symptoms before the diagnosis of AD was attained. Identification of the timing and sequence of appearance of these presentations as first reported before the clinical diagnosis was measured. Result: Episodic memory with an odds ratio of 1.85 was the most frequent presentation, documented in 1.38% of the controls and 75.6% in cases. Auditory disturbance with an odds ratio of 3.03, which has not previously been noted except in the form of auditory hallucination, could have a diagnostic value. Conclusion: Auditory disturbance, which occurred mostly in the Caucasian females, could discriminate individuals with AD from those without the disease. The symptom, which presented up to 14.5 (mean time) years prior to clinical diagnosis, was identified in Caucasians and mixed race individuals only. Strengths: The study demonstrates that auditory disturbance could allow an earlier diagnosis of AD in Caucasian females. Episodic memory was confirmed as being frequently noted in AD patients prior to a clinical diagnosis as per previous publications. This study supports the development of a scoring system for the earlier diagnosis of AD. The data used was free from the confounding effects of misinformation, as this was written at the point of collection, thereby benefitting from the use of GP data that is diversified, reliable and valid. Limitations: Limited sample size that will not allow for generalization of less frequent observations due to their low prevalence in case notes. Randomisation was not achieved; however, the best available nonrandomisation which is consecutive sampling was used. Patterns identified were in LOAD, the baseline could vary with other geographical areas.

Schizophrenia is a severe global health problem, with over half of such patients experiencing auditory verbal hallucinations (AVHs). A better understanding of the neural correlates differentiating patients experiencing AVHs from patients not experiencing AVHs and healthy controls may identify targets that lead to better treatment strategies for AVHs. Employing 2 data-driven, voxel-based measure of functional connectivity, we studied 46 patients with schizophrenia or schizoaffective disorder (28 experiencing AVHs and 18 not experiencing AVHs). Twenty healthy controls matched for age, gender, ethnicity, education level, handedness, and estimated verbal intelligence were included for comparison. The intrinsic connectivity distribution (ICD) was used to model each voxel’s connectivity to the rest of the brain using a Weibull distribution. To investigate lateralization of connectivity, we used cross-hemisphere ICD, a method that separates the contribution of each hemisphere to interrogate connectivity laterality. Patients with AVHs compared with patients without AVHs exhibited significantly decreased whole-brain connectivity in the medial prefrontal cortex and posterior cingulate cortex, less lateralized connectivity in left putamen, and more lateralized connectivity in left interior frontal gyrus. Correlations with Auditory Hallucination Rating Scale (AHRS) and post hoc seed connectivity analyses revealed significantly altered network connectivity. Using the results from all analyses comparing the patient groups and correlations with AHRS, we identified a potential AVH network, consisting of 25 nodes, showing substantial overlap with the default mode network and language processing networks. This network as a whole, instead of individual nodes, may represent actionable targets for interventions.

Wilson's disease (WD) is a neurodegenerative disorder due to copper metabolism. Schizophrenia-like psychosis and delusional disorder are rare forms of psychiatric manifestations of WD. The lack of recognition of these signs and symptoms as being attributable to WD often leads to delays in diagnosis and management. Knowledge about relationship of the psychiatric manifestations to WD can help with the administration of adequate management aimed at both the psychiatric issues and underlying WD. The objectives of this article are to review case reports whose subject is the incorrect diagnosis of schizophrenia or schizophrenia-like syndrome in patients with WD and to detail one case of this mismanagement of the disease. A 35-year-old unmarried Iranian woman presented to the consulting psychiatrist in the emergency room after a suicide attempt due to commanding auditory hallucination. She had previous eleven admissions in psychiatric hospital with major depressive episode with psychotic features, schizoaffective disorders, and then schizophrenia diagnosis. Nineteen years after her first symptoms, it was discovered that the patient was suffering from WD. We searched Google Scholar, Ovid, PsycINFO, CINHAL, and PubMed databases from 1985 to 2015. Finally, 14 researches were entered into the study. Psychiatric manifestations may precede the diagnosis of WD and other symptoms related to neurological or hepatic impairment. Early detection of WD is important to prevent catastrophic outcome. Young patients presenting with psychiatric presentations along with abnormal movement disorder, seizure, or conversion-like symptoms should be evaluate for WD even if signs and symptoms are typically suggestive of schizophrenia or manic episode. An interdisciplinary approach with good collaboration of psychiatrists and neurologists is crucial for WD because early diagnosis and management without delay is an important for good prognosis.

Schizotypy is regarded as a trait vulnerability for psychotic disorders, yet alone is insufficient for development of a diagnosable disorder. Additional symptoms and psychological distress are necessary for help seeking and transition from an at risk mental state to a clinical diagnosis. The present study investigated the interaction between trait schizotypy, state auditory verbal hallucination (AVH) predisposition, distress and handedness for the expression of neurological soft signs (NSS), a neurodevelopmental vulnerability factor for psychosis. Cluster analysis formed schizotypy groups statistically across the dimensions captured by the SPQ. It was hypothesized that schizotypy and AVH predisposition would interact, resulting in significantly greater NSS. Psychological distress and handedness were hypothesized to be significant covariates, accounting for some variance in the expression of NSS between the groups. A sample of University students (n = 327) completed the Schizotypal Personality Questionnaire, Launay-Slade Hallucination Scale, General Health Questionnaire and the Neurological Evaluation Scale (NES). Cluster Analysis revealed four schizotypy groups. Distress was not a significant covariate in any analysis. As expected, those with high overall schizotypy and high AVH predisposition expressed significantly greater Motor-Coordination NSS compared to those with high schizotypy and low AVH predisposition. Within the Mixed Interpersonal and Cognitive-Perceptual Schizotypy cluster, those with low AVH predisposition expressed significantly more Motor-Coordination NSS than those with high AVH predisposition. These findings suggest motor coordination NSS are detectable in schizotypy, and AVH predisposition appears to interact with these traits. This study highlights the importance of considering both trait and subclinical state risk factors when investigating risk for psychosis.