Carmen Leal

Persistent Auditory Hallucinations

Background: There is still a significant proportion of psychotic patients who suffer from persistent auditory hallucinations (PAH) in spite of treatment. The objective of our study was to analyze those clinical dimensions that characterize persistent hallucinators in comparison with episodic hallucinators. Sampling and Methods: Ninety-one outpatients with AH were assessed through semistructured interviews. The interviews included the Psychotic Symptom Rating Scales for AH and the Krawiecka scale. They elicited descriptions about the persistence of AH, existence of pleasurable hallucinations and other types of hallucinations. Results: Forty-five patients fulfilled criteria for reported PAH. Persistent hallucinators showed greater scores in frequency and duration of hallucinations, Krawiecka total score and incoherence of speech. Moreover, pleasurable experiences were more frequent in this group of patients. Logistic regression analysis rendered a model with the following variables: duration of voices, degree of control and pleasurable hallucinations. Conclusion: Specific dimensions of AH can predict the possibility of treatment resistance.

A psychopathological study of a group of schizophrenic patients after attempting suicide. Are there two different clinical subtypes

Fifty-six schizophrenic patients at the moment of their suicidal attempt were compared to a control group of 60 patients. Schizophrenic suicidal attempters showed an identifiable clinical profile at the acute phase. Two main groups could be differentiated in regard to their reasons (depressive or psychotic) for attempting suicide.

Similar effect of family history of psychosis on Sylvian fissure size and auditory P200 amplitude in schizophrenic and bipolar subjects

Several cerebral studies point to the non-specificity of structural and functional changes described in schizophrenia and bipolar disorders. Furthermore, the origin of these changes is still unclear. The present study investigated the effect of a family history (FH) of psychotic disorders in first-degree relatives on computed tomographic (CT) measures (ventricular, cerebral and Sylvian fissure size) and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 30 schizophrenic patients and 24 bipolar type I patients. We found a significant correlation between FH and the size of the right Sylvian fissure, and between FH and auditory P200 amplitude. More specifically, the schizophrenic and bipolar patients with negative FH (n=36) had larger right Sylvian fissures and smaller P200 amplitude than patients with positive FH (n=18). These findings were independent of the specific diagnosis, gender, and age of subjects. Our results suggest some underlying process common to schizophrenia and bipolar I disorder, and they provide support for the continuum view of the nosologic structure of psychotic illness.

Insight among psychotic patients with auditory hallucinations

Poor insight in psychosis has been described as a seeming lack of awareness of the deficits, consequences of the disorder, and of the need for treatment. The aim of this study is to investigate whether patients with auditory hallucinations have less insight than those without hallucinations, and to determine which hallucination characteristics are related to patient insight. Using the PANSS and PSYRATS, the authors have evaluated the lack of insight data corresponding to 168 psychotic patients divided into three groups: patients with a history of nonpersistent hallucinations, patients with persistent hallucinations, and patients without hallucinations. Patients with persistent hallucinations showed significantly less insight than patients without persistent hallucinations and patients without hallucinations, the farther away the hallucination is located, the greater the lack of patient insight. Patients who hear the hallucination inside their head rather than outside show better insight, possibly because such patients can understand the voice as being created by their own mind.

Correlates of Symptom Dimensions in Schizophrenia Obtained with the Spanish Version of the Manchester Scale

In the last decade, a significant number of studies have been published which suggest a multifactorial psychopathological structure in schizophrenia. Seventy-eight acute and chronic schizophrenic patients diagnosed in accordance with DSM-III-R criteria were studied with the Manchester Scale, Premorbid Adjustment Scale, Family History-RDC Interview, Digit Span, Mini-Mental State and computerized tomography (CT). A factorial analysis of the symptoms as recorded with the Spanish version of the Manchester Scale was carried out. Three factors (‘positive’, ‘negative’ and ‘disorganization’) accounted for 79% of the total variance. Poor premorbid adjustment was associated with high scores for the ‘positive’ dimension. The ‘disorganization’ dimension was significantly associated with lower scores in the Mini-Mental and attention test than the rest. However, CT did not differentiate between these symptom dimensions. This study of a sample of mostly outpatients corroborates the hypothesis of three clinical dimensions in schizophrenia.

GENDER DIFFERENCES IN AUDITORY HALLUCINATIONS IN SCHIZOPHRENIA

Introduction: Gender differences in the clinical presentation of patients with schizophrenia have been well documented, yet few studies have investigated gender-related clinical differences of auditory hallucinations in schizophrenia. We compared a group of men and women schizophrenics with auditory hallucinations (AH) in order to evaluate the possibility of characterizing relevant dimensions in this symptom between genders. Methods: The Psychotic symptom rating scale (PSYRATS) for auditory hallucinations was administered to 123 patients (86 men, 37 women) who met DSM-IV criteria for schizophrenia with AH. Patients were also assessed about demographic variables, including age of onset and whether AH were persistent. Results: The results showed that women had greater scores in the dimension “beliefs re-origin” (p<0.034) of the PSYRATS, having a more delusional interpretation about the origin of voices, while men had more persistent AH (p<0.026) and an earlier age of onset (p<029). Conclusions: The findings of our study suggest that gender differences contribute to some dimensions of auditory verbal hallucinations despite the lack of more expected remarkable differences between men and women patients with schizophrenia. References [1] Rector NA, Seeman MV. Auditory hallucinations in women and men.