The internal structure of the phenomenology of auditory verbal hallucinations

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Abstract

Background: Auditory verbal hallucinations (AVH) do not have uniform pathological significance. They affect patients with different brain disorders, and vary along multiple phenomenological dimensions. Evidence indicates that some of the phenomenological variables have specific neural substrates. Therefore, a comprehensive characterization of the phenomenological variations of AVH and the interrelationship between these variables was undertaken. Method: Twenty phenomenological variables were identified; on each AVH had a binary value (present or absent). Information about 11 of these variables were obtained from 30 patients. Hierarchical cluster (HC) and multidimensional scaling (MDS) analyses were performed to investigate the hidden structure and dimensions of these variables. Results: HC yielded two main clusters with further sub-clusters in each. The first cluster included hallucinations with low linguistic complexity, repetitive content, attributed to self, located in outer space, and associated with different kinds of control strategies. The second cluster included hallucinations with high linguistic complexity, systematized content, multiple voices, attributed to others, and located in inner space. In MDS, three dimensions were identified: linguistic complexity, self-other attribution, and inner-outer space location. Conclusion: The patterns of clustering and dimensional configuration of AVH characteristics were in accord with intuitive expectation and validated the patients' descriptions of their experiences. These findings could reflect aspects of the neural mechanisms of AVH. For example, the presence of neural specificity for each phenomenological variable, intermediate neural commonality for groups of variables, and a final common pathway for all subtypes of AVH. Another example is a differential level of language dysfunction according to the linguistic complexity of AVH.

Section snippets

Phenomenological variables

Twenty AVH variables were identified based on the literature and clinical experience of the authors (Table 1). The selection of the variables was guided by the possibility of specific pathophysiology underlying the variables. Records of 100 patients with history of AVH in outpatient treatment in the Minneapolis VA Medical Center were reviewed for information about the patients' descriptions of their hallucinations. Patients were selected from the caseloads of three psychiatrists in the clinic.

Hierarchical cluster analysis

HC yielded a two-cluster solution (Fig. 1). The first cluster includes “all control strategies”, “self attribution”, “repetitive content”, “other hallucinations”, “clear acoustics”, “low linguistic complexity, words”, and “outer space location”. The second includes “systematized content”, “high linguistic complexity, conversation”, “inner space location”, “multiple voices”, “attribution of the voices to others”, “nosognosia”, “episodic occurrence”, “spontaneous occurrence”, and “intermediate

Discussion

Asking patients for detailed description of their hallucinations does not seem to be part of routine practice of general psychiatry. Only the records of patients participating in a research protocol contained information about the characteristics of AVH. This could be related to the fact that such detailed description would not affect significantly the diagnostic formulations and treatment plan. In this study, most patients welcomed the opportunity of talking about their experiences and this

Acknowledgements

Supported by a research grant from the Mind Institute. We also would like to thank Mrs. Martha Muska and Mrs. Barbara Larson from the Martha and William Muska fund and the Saint Paul Foundation for their support of this research.

References (32)

  • C.D. Frith et al.

    Toward a neuropsychology of schizophrenia

    Br. J. Psychiatry

    (1988)
  • G. Goldberg

    Supplementary motor area structure and function: review and hypothesis

    Behav. Brain Sci.

    (1985)
  • E.H. Hare

    A short note on pseudo-hallucinations

    Br. J. Psychiatry

    (1973)
  • R.E. Hoffman

    Verbal hallucinations and language production processes in schizophrenia

    Behav. Brain Sci.

    (1986)
  • Hunter, M.D., Griffiths, T.D., Farrow, T.F.D., Zheng, Y., Wilkinson, I.D., Hegde, N., Woods, W., Spence, S.A.,...
  • Jaspers, K., 1959. General psychopathology (Allegemeine psychopathologie, 7th ed., translated by J Hoenig and MW...
  • Cited by (0)

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