Assessment of Voice Content for Voice Hearers: Psychometric Evaluation of the Perth Voice Content Questionnaire.

The experience of hearing voices is common to an estimated 7% of the general population, with the presence of negative content being the best predictor of whether individuals will require clinical support. Whilst largely neglected in the literature to date, there are calls to consider the significance of voice content for reducing voice-related distress. However, no quantitative and comprehensive measure of voice content with suitability for research and clinical use exists. This pilot study aimed to demonstrate preliminary psychometric properties of a newly developed measure, the Perth Voice Content Questionnaire (PVCQ), designed to measure the intensity and themes of positively and negatively valenced voice content, primarily of the dominant voice. The PVCQ and measures of voice severity and related beliefs were completed by 47 voice-hearing participants. The measure was found to be internally consistent, loaded onto two distinct factors of positive and negative content, and these factors were associated with voice-related distress and negative beliefs about voices and positive beliefs about voices, respectively, indicating good validity. The PVCQ offers the first self-report measure of voice content, with preliminary psychometric properties indicating its suitability for clinical and research use.

Self-assessment scale of auditory verbal hallucinations (SAVH): A novel tool for patients with schizophrenia.

BACKGROUND: A scale for self-assessment of auditory verbal hallucinations (SAVH) was developed for patients, and this study aimed to validate the scale by investigating its psychometric properties. METHODS: Forty one patients with schizophrenia or schizoaffective disorders (DSM-5) self-assessed their hallucinations using nine SAVH questions. Each question was scored from 0 to 5, indicating the severity of the symptoms. Patients were also evaluated with the Brief Psychiatric Rating Scale (BPRS), Auditory Hallucination Rating Scale (AHRS), and Birchwood Insight Scale (BIS). The psychometric properties of the SAVH were assessed by the face, internal consistency, construct, convergent and discriminant validities. RESULTS: SAVH scores were used to examine the psychometric properties. Cronbach's α and Guttman's Lambda-6 were 0.67 and 0.73 respectively. Significant correlations were observed between SAVH and AHRS total scores, as well as BPRS hallucinatory behavior subscores. No significant correlations were found between total SAVH scores and (i) levels of insight or (ii) negative BPRS subscores. Factor analysis on SAVH revealed three factors accounting for 59.3 % of the variance. Most patients found the questions clear, appropriate, and of adequate length. CONCLUSIONS: SAVH demonstrated good psychometric properties, suggesting its utility in assessing auditory verbal hallucinations (AVH). This self-assessment could be valuable in evaluating AVH treatment efficacy, monitoring AVH, and empowering patients.

Neuroscience robotics for controlled induction and real-time assessment of hallucinations.

Although hallucinations are important and frequent symptoms in major psychiatric and neurological diseases, little is known about their brain mechanisms. Hallucinations are unpredictable and private experiences, making their investigation, quantification and assessment highly challenging. A major shortcoming in hallucination research is the absence of methods able to induce specific and short-lasting hallucinations, which resemble clinical hallucinations, can be elicited repeatedly and vary across experimental conditions. By integrating clinical observations and recent advances in cognitive neuroscience with robotics, we have designed a novel device and sensorimotor method able to repeatedly induce a specific, clinically relevant hallucination: presence hallucination. Presence hallucinations are induced by applying specific conflicting (spatiotemporal) sensorimotor stimulation including an upper extremity and the torso of the participant. Another, MRI-compatible, robotic device using similar sensorimotor stimulation permitted the identification of the brain mechanisms of these hallucinations. Enabling the identification of behavioral and a frontotemporal neural biomarkers of hallucinations, under fully controlled experimental conditions and in real-time, this method can be applied in healthy participants as well as patients with schizophrenia, neurodegenerative disease or other hallucinations. The execution of these protocols requires intermediate-level skills in cognitive neuroscience and MRI processing, as well as minimal coding experience to control the robotic device. These protocols take ~3 h to be completed.

Barriers to Treatment of Hallucinations and Delusions in People With Dementia Residing in Long-Term Care.

Importance: Most people with dementia will experience neuropsychiatric symptoms, including psychosis characterized by hallucinations and delusions. Across dementia subtypes, hallucinations and delusions are common, though their prevalence and presentation may vary. These symptoms have been associated with worse outcomes compared with dementia alone, including accelerated functional decline and mortality. Many people with dementia reside in long-term care facilities, and identification and management of hallucinations and delusions in this setting are critical.Observations: For residents in long-term care facilities, the following factors can hinder management of hallucinations and delusions related to dementia: (1) delayed recognition of symptoms; (2) reluctance of staff and family members to acknowledge psychiatric issues; (3) lack of approved pharmacotherapies to treat hallucinations and delusions associated with dementia-related psychosis; and (4) regulatory and institutional guidelines, including the long-term care regulatory guidelines established by the Centers for Medicare and Medicaid Services and the 5-star rating system.Conclusions and Relevance: Barriers to the treatment of hallucinations and delusions in patients with dementia in the long-term care setting are myriad and complex. Early diagnosis of dementia-related psychosis and new treatment options for managing hallucinations and delusions are needed to improve care of this patient population.

The cognitive-phenomenological assessment of delusions and hallucinations at the early intervention in psychosis service stage: The results of a quality improvement project.

AIM: Clinical assessments are vital for gaining an understanding of a patients' presenting problem. A priority for Early Intervention in Psychosis Service staff is understanding and supporting their patients' experiences of hallucinations and/or delusions. We aimed to identify what cognitive-phenomenology dimensions of hallucinations and delusions EIPS staff were assessing with their patients. METHODS: We developed a brief checklist of cognitive-phenomenological dimensions of hallucinations and delusions called the Lived Experience Symptom Survey (LESS) based on relevant literature. As part of a Quality Improvement Project, we reviewed the health records of a sub-sample of EIPS patients using the LESS identifying whether each dimension was present or absent. RESULTS: We found that all patients had been asked about the content of their hallucinations and/or delusions, and the majority had been asked about the valence of this content. Despite patients having experienced psychosis for almost 2 years on average, less than half of patients were asked about the potential or actual harm associated with these symptoms. All other cognitive-phenomenological dimensions were assessed inconsistently. CONCLUSIONS: The assessment of hallucination and delusions in our EIPS was inconsistent and incomprehensive. These findings require replication in other EIPS' but may point to a need for guidelines and training around how to conduct a thorough assessment of hallucinations and delusions for current and future EIPS staff. Improved assessment of these symptoms will aid the development of risk assessments and treatment plans.

Medicare Claims Data Underestimate Hallucinations in Older Adults With Dementia.

OBJECTIVE: Administrative claims data are used to study the incidence and outcomes of dementia-related hallucinations, but the validity of International Classification of Diseases (ICD) codes for identifying dementia-related hallucinations is unknown. METHODS: We analyzed Medicare-linked survey data from 2 nationally representative studies of U.S. older adults (the National Health and Aging Trends Study and the Health and Retirement Study) which contain validated cognitive assessments and a screening question for hallucinations. We identified older adults who had dementia or were permanent nursing home residents, and we combined this with questionnaire responses to define dementia-related hallucinations. Using Medicare claims data, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD codes for dementia-related hallucinations overall and within prespecified strata of age, neurologic comorbidity, and health care utilization. RESULTS: We included 2,337 older adults with dementia in our cohort. Among 3,789 person-years of data, 1,249 (33.0%) had hallucations, and of these 286 had a qualifying ICD code for dementia-related hallucinations or psychosis (sensitivity 22.9%). Of 2,540 person-years of dementia without hallucinations, 284 had a diagnosis code for hallucinations (specificity 88.8%). PPV was 50.2%, and NPV was 70.1%. Sensitivity was greatest (57.0%) among those seeing a psychiatrist. Otherwise, there were no significant differences in sensitivity, specificity, PPV, or NPV by age, neurologic diagnosis, or neurologist care. CONCLUSION: Dementia-related hallucinations are poorly captured in administrative claims data, and estimates of their prevalence and outcomes using these data are likely to be biased.

A Review of Multimodal Hallucinations: Categorization, Assessment, Theoretical Perspectives, and Clinical Recommendations.

Hallucinations can occur in different sensory modalities, both simultaneously and serially in time. They have typically been studied in clinical populations as phenomena occurring in a single sensory modality. Hallucinatory experiences occurring in multiple sensory systems-multimodal hallucinations (MMHs)-are more prevalent than previously thought and may have greater adverse impact than unimodal ones, but they remain relatively underresearched. Here, we review and discuss: (1) the definition and categorization of both serial and simultaneous MMHs, (2) available assessment tools and how they can be improved, and (3) the explanatory power that current hallucination theories have for MMHs. Overall, we suggest that current models need to be updated or developed to account for MMHs and to inform research into the underlying processes of such hallucinatory phenomena. We make recommendations for future research and for clinical practice, including the need for service user involvement and for better assessment tools that can reliably measure MMHs and distinguish them from other related phenomena.

Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia.

AIMS AND OBJECTIVES: To develop a Chinese version of Auditory Hallucination Risk Assessment Scale and evaluate its psychometric properties. BACKGROUND: Auditory hallucination, a common symptom in schizophrenia, has the potential to cause harm to patients and the people around them. However, there has been a paucity of suitable instrument developed in Asian region that can comprehensively and reliably assess its risk and inform interventions. DESIGN: This study involved 2 stages, the development of the Auditory Hallucination Risk Assessment Scale (AHRAS) and testing the psychometric properties of AHRAS. We followed STROBE guidelines in reporting the study. METHODS: Auditory Hallucination Risk Assessment Scale items were developed based on Symptom Management Theory, systematic literature review and findings of a qualitative study on the experience of auditory hallucinations. The items were evaluated by content validity. Auditory Hallucination Risk Assessment Scale was then tested for construct validity, concurrent validity, predictive validity, internal consistency and test-retest reliability in a convenience sample of 156 patients with a diagnosis of schizophrenia. RESULTS: The final version of AHRAS has nine items. Two factors were extracted from AHRAS, which explained 57.74% of the total variance. The score of AHRAS was strongly correlated with that of the Psychotic Symptom Rating Scales-Auditory Hallucinations. The area under the curve was 0.90 for the overall AHRAS score. Sensitivity (86.5%) and specificity (80.0%) were maximal for a mean overall AHRAS score of 13.5, suggesting that this is an appropriate threshold for differentiation. Cronbach's alpha coefficient for internal consistency was 0.82, and intra-class correlation coefficient for test-retest reliability was 0.84. CONCLUSIONS: Auditory Hallucination Risk Assessment Scale has good reliability and validity. It can be used in clinical settings in China and beyond to assess the risk of auditory hallucinations. RELEVANCE TO CLINICAL PRACTICE: Auditory Hallucination Risk Assessment Scale can serve as a tool for nurses and other healthcare professionals to identify patients with high-risk auditory hallucinations, monitor the changes of risk and inform nursing interventions.

Autonomic arousal during psychosis spectrum experiences: Results from a high resolution ambulatory assessment study over the course of symptom on- and offset.

INTRODUCTION: Ecological momentary assessment (EMA) studies show that stressors trigger the onset or increase of psychotic symptoms. These studies, however, predominantly rely on large sampling intervals and self-report assessment. This study aims to identify the autonomic stress-response to psychosis-spectrum experiences by using a one-day high-resolution EMA with continuous skin conductance and heart rate monitoring in a sample with attenuated positive symptoms. METHODS: Sixty-two participants were equipped with a smartphone and wearable sensors to monitor skin conductance level (SCL) and heart rate variability (HRV) for 24 h. Every 20 min, participants answered questions on current stress, hallucination spectrum experiences (HSE), and paranoia. Sampling intervals were categorized into no event, pre-onset, event, pre-offset, and post-offset phases. We contrasted stress, SCL, and HRV between phases using multilevel regression models of sampling intervals nested in participants. RESULTS: For paranoia, we found alterations in the autonomic and self-reported stress response prior to the onset that persisted until the episodes had ended. For HSE, we found no effects. Exploratory separate analyses of the different items aggregated into HSE yielded diverging results for intrusive thoughts, perceptual sensitivity, and hallucinations. CONCLUSION: Physiological parameters are sensitive indicators of the onset of paranoia, which holds implications for preventive mobile interventions. To further explore the autonomic stress-response associated with HSE, further studies of the different HSE are needed.

Assessment of visual misperceptions in patients with Parkinson's disease using single and bistable percepts as testing tools.

BACKGROUND: Visual misperceptions (VMs) and hallucinations (VHs) often go unreported in patients with Parkinson's disease (PD). We assessed the utility of single and bistable visual percepts as testing tools for visual perceptual abnormalities in PD. AIM: To assess VM in patients with PD using single and bistable percepts as testing tools. SETTINGS AND DESIGN: This was a case-control study conducted at a movement disorders clinic. MATERIALS AND METHODS: Thirty patients with PD and 30 age and sex-matched controls were assessed for motor severity and stage using Unified Parkinson's Disease Rating Scale-III (UPDRS-III) and modified Hoehn and Yahr scale. Higher mental functions were assessed by Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Trail making tests (TMT-A and B) scores. The participants were presented with monochromatic images representing either "single" or "bistable percepts" and the misperceptions were recorded. VM scores of patients and controls were compared. The correlation between disease duration, treatment period, motor severity, frontal executive functions, and VMs were determined. RESULTS: Twenty-six patients had mild-to-moderate PD. Patients with PD had higher mean VM scores (P < 0.0005). None of the patients reported VHs. TMT-A, TMT-B, TMT-B - A scores were significantly lower in the control group (P < 0.0005). Cases showed significant positive correlation of VM with disease duration, treatment duration, UPDRS-III score, H and Y stage, and TMT A and B and an inverse correlation with MMSE and FAB scores. The patients with VM score greater than the upper limit of normal (Mean + 1.5 standard deviation [SD]), calculated from the control group, showed similar correlation of VM with motor and cognitive parameters. CONCLUSIONS: VMs are frequent in patients with PD when assessed using single and bistable visual percepts. VM correlates with frontal executive dysfunction, disease duration, and severity.

Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations.

The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.

Smartphone-based ecological momentary assessment and intervention in a coping-focused intervention for hearing voices (SAVVy): study protocol for a pilot randomised controlled trial.

BACKGROUND: Smartphone-based ecological momentary assessment and intervention (EMA/I) show promise for enhancing psychological treatments for psychosis. EMA has the potential to improve assessment and formulation of experiences which fluctuate day-to-day, and EMI may be used to prompt use of therapeutic strategies in daily life. The current study is an examination of these capabilities in the context of a brief, coping-focused intervention for distressing voice hearing experiences. METHODS/DESIGN: This is a rater-blinded, pilot randomised controlled trial comparing a four-session intervention in conjunction with use of smartphone EMA/I between sessions, versus treatment-as-usual. The recruitment target is 34 participants with persisting and distressing voice hearing experiences, recruited through a Voices Clinic based in Melbourne, Australia, and via wider advertising. Allocation will be made using minimisation procedure, balancing of the frequency of voices between groups. Assessments are completed at baseline and 8 weeks post-baseline. The primary outcomes of this trial will focus on feasibility and acceptability of the intervention and trial methodology, with secondary outcomes examining preliminary clinical effects related to overall voice severity, the emotional and functional impact of the voices, and emotional distress. DISCUSSION: This study offers a highly novel examination of specific smartphone capabilities and their integration with traditional psychological treatment for distressing voices. Such technology has potential to enhance psychological interventions and promote adaptation to distressing experiences. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry, ACTRN12617000348358 . Registered on 7 March 2017.

Screening for sub-threshold psychotic experiences and perceived need for psychological services.

AIM: Sub-threshold psychotic experiences (PEs) are common in the general population and may increase risk for psychological distress and psychosis onset, generating a need for effective community screening instruments. This study aimed to explore the utility of a brief, self-report, psychosis risk screening tool in predicting perceived need for psychological treatment among a non-clinical sample, above and beyond that accounted for by accompanying forms of psychopathology or trait neuroticism. METHODS: Construct validity, predictive validity and test-retest reliability of the brief, self-report questionnaire for screening putative prepsychotic states were determined among college students (N = 679). Multiple linear regression analyses were conducted to explore the relationship between PEs and perceived need for psychological services. RESULTS: With the exception of auditory perceptual disturbances, PEs were not significantly associated with one's need for services, or the belief from others that services are needed, after controlling for neuroticism, anxiety and depressive symptoms. Auditory perceptual disturbances were significantly associated with the perceived need for psychological services, even after accounting for these additional symptoms. CONCLUSIONS: These results confirm the usefulness of the psychosis risk screening tool in evaluating the presence of sub-threshold PEs, particularly auditory perceptual disturbances. The relationship between other PEs and a perceived need for psychological services, however, was largely explained by the existence of neurotic traits and anxiety and depressive symptoms. Screening for auditory perceptual disturbances may be useful in identifying unmet clinical need among young adults.

Development of assessment toolkits for improving the diagnosis of the Lewy body dementias: feasibility study within the DIAMOND Lewy study.

OBJECTIVE: The Lewy body dementias (LBD, dementia with Lewy bodies and Parkinson's disease dementia) are the second most common cause of neurodegenerative dementia but remain under-recognised, with long delays from initial assessment to diagnosis. Whilst validated instruments have been developed for key symptoms, there is no brief instrument for overall diagnostic assessment suitable for routine practice. We here report the development of such assessment toolkits. METHODS: We developed the LBD assessment toolkits in three stages. First, we conducted a systematic search for brief validated assessments for key symptoms and combined these into draft instruments. Second, we obtained feedback on acceptability and feasibility through two rounds of interviews with our patient and public involvement group. This led to modification of the toolkits. Finally, we piloted the toolkits in a feasibility study in routine dementia and Parkinson's disease services to produce final instruments suitable for routine clinical practice. RESULTS: Eleven clinicians, working in both dementia/memory assessment and Parkinson's disease/movement disorder services, consented to pilot the assessment toolkits and provide feedback on their feasibility. Clinicians worked in routine health service (not academic) settings and piloted the draft toolkits by integrating them into their regular clinical assessments. Feedback obtained informally, by written comments and through qualitative interviews led to modifications and production of final acceptable versions. CONCLUSIONS: We were able to address an important need, the under-diagnosis of LBD, by developing toolkits for improving the recognition and diagnosis of the LBD, which were acceptable to clinicians working in routine dementia and Parkinson's disease services. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.

[The Assessment of the Auditory Hallucinations and Delusions: The Reliability and the Validity of Turkish Version of the Psychotic Symptom Rating Scales (PSYRATS)]. / Isitsel Varsani ve Sanrilarin Degerlendirilmesi: Psikotik Belirti Degerlendirme Ölçeklerinin (PSYRATS) Türkçe Formunun Güvenilirligi ve Geçerligi.

OBJECTIVE: The aim of this study is to examine the reliability and validity of Turkish version of PSYRATS Auditory Hallucinations Scales (AHS) and Delusion Scales (DS). METHOD: 85 schizophrenic outpatients or inpatients aged between 18 and 65 years were the subjects of this study. The patients diagnosed by using the DSM-IV-TR and who have psychosis with alcohol or drug dependence, organic, mental and physical deficit were not included to the study. PSYRATS scales were translated and corrected by the authors. PSYRATS were applied for two times per week to 57 patients to determine test-retest reliability. 85 patients were applied PANSS and 71 of them were applied SAPS to determine the concurrent validity. RESULTS: Cronbach Alpha coefficient was calculated as .79 for AHS and .80 for DS. For the AHS each item correlated between .59 and .98; for the DS each correlated between .66 and .93. For the test-retest reliability, item correlation coefficient of AHS is determined between .68 and .89, DS is .61 and .76 (p<0.01). Supporting the concurrent validity, a significant correlation was found between PANSS and SAPS (p<0.01). Three factor groups for AHS and also DH were revealed and examined more than 90 % of the variance. The results were supported by the original study findings. CONCLUSION: PSYRATS Auditory Hallucination and Delusion Scales were found to be reliable and valid measures to assess the dimensions of psychotic symptoms in Turkish schizophrenia patients.

Psychometric Properties of "Community Assessment of Psychic Experiences": Review and Meta-analyses.

The Community Assessment of Psychic Experiences (CAPE) has been used extensively as a measurement for psychosis proneness in clinical and research settings. However, no prior review and meta-analysis have comprehensively examined psychometric properties (reliability and validity) of CAPE scores across different studies. To study CAPE's internal reliability--ie, how well scale items correlate with one another--111 studies were reviewed. Of these, 18 reported unique internal reliability coefficients using data at hand, which were aggregated in a meta-analysis. Furthermore, to confirm the number and nature of factors tapped by CAPE, 17 factor analytic studies were reviewed and subjected to meta-analysis in cases of discrepancy. Results suggested that CAPE scores were psychometrically reliable--ie, scores obtained could be attributed to true score variance. Our review of factor analytic studies supported a 3-factor model for CAPE consisting of "Positive", "Negative", and "Depressive" subscales; and a tripartite structure for the Negative dimension consisting of "Social withdrawal", "Affective flattening", and "Avolition" subdimensions. Meta-analysis of factor analytic studies of the Positive dimension revealed a tridimensional structure consisting of "Bizarre experiences", "Delusional ideations", and "Perceptual anomalies". Information on reliability and validity of CAPE scores is important for ensuring accurate measurement of the psychosis proneness phenotype, which in turn facilitates early detection and intervention for psychotic disorders. Apart from enhancing the understanding of psychometric properties of CAPE scores, our review revealed questionable reporting practices possibly reflecting insufficient understanding regarding the significance of psychometric properties. We recommend increased focus on psychometrics in psychology programmes and clinical journals.

The effects of an Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations (AVATAR therapy): study protocol for a randomised controlled trial.

BACKGROUND: Psychological interventions which adopt an explicitly interpersonal approach are a recent development in the treatment of distressing voices. AVATAR therapy is one such approach which creates a direct dialogue between a voice-hearer and a computerised representation of their persecutory voice (the avatar) through which the person may be supported to gain a sense of greater power and control. The main objective of the trial is to test the clinical efficacy of this therapy to reduce the frequency and severity of auditory verbal hallucinations (AVH). Secondary objectives of the study are to explore explanatory mechanisms of action and potential moderators, to carry out a qualitative evaluation of participants' experience and to conduct an economic evaluation. METHODS/DESIGN: The AVATAR randomised clinical trial will independently randomise 142 participants to receive either 7 sessions of AVATAR therapy or supportive counselling (SC). The study population will be individuals with schizophrenia spectrum and other psychotic disorders who report hearing persistent distressing voices, for more than 12 months, which are unresponsive or only partially responsive to antipsychotic medication. The main hypotheses are that, compared to SC, AVATAR therapy will reduce the frequency and severity of AVH and will also reduce the reported omnipotence and malevolence of these voices. Assessments will occur at 0 weeks (baseline), 12 weeks (post-intervention) and 24 weeks (follow-up), and will be carried out by blinded assessors. Both interventions will be delivered in a community-based mental health centre. Therapy competence and adherence will be monitored in both groups. Statistical analysis will follow the intention-to-treat principle and data will be analysed using a mixed (random) effects model at each post treatment time point separately. A formal mediation and moderator analysis using contemporary causal inference methods will be conducted as a secondary analysis. The trial is funded by the Welcome Trust (WT). DISCUSSION: AVATAR therapy showed promising effects in a pilot study, but the efficacy of the approach needs to be examined in a larger randomised clinical trial before wider dissemination and implementation in mental health services. TRIAL REGISTRATION: Current Controlled Trials ISRCTN: 65314790 , registration date: 27 March 2013.

A comparison of montreal cognitive assessment between patients with visual hallucinations and without visual hallucinations in Parkinson's disease.

BACKGROUND: Visual hallucination (VH) is closely associated with cognitive impairment in Parkinson's disease (PD). The aim of this study is to analyze the domain of cognitive impairment related to the VH by analyzing cognition in PD. METHOD: Twenty-six of 58 patients had VH (PD-VH), whereas 32 patients had no hallucinations (PD-NH); patients assigned to the PD-VH on the basis of having at least one VH per week for one month before participation in the study. All of the patients were administered the Montreal Cognitive Assessment-Korean test (MoCA-K). We analyzed the differences in cognition between PD-VH and PD-NH. RESULTS: The Hoehn-Yahr (HY) stage and the Beck Depression Inventory version I (BDI) scores in PD-VH were significantly different from those in PD-NH. After adjusting for the HY stage and BDI, the language domain of the MoCA-K cognitive domains presents a significant difference between PD-VH and PD-NH. CONCLUSION: Sentence processing and naming as the composition of the language domain in the MoCA-K have been associated in common with posterior cortical dysfunction. Although our result shows that the language domain of MoCA-K is sensitive to cognitive deficit in PD-VH patients, it needs further neuroimaging analysis for certifying the relationship between language impairment and posterior cortical deficit as the pathophysiology of PD-VH.

Auditory hallucinations interview guide: promoting recovery with an interactive assessment tool.

The Auditory Hallucinations Interview Guide (AHIG) is a 32-item tool that helps psychiatric-mental health (PMH) nurses assess past and current experiences of voice hearers so they can provide more individualized care. The AHIG was developed as a research tool but has also been found to be clinically useful in both inpatient and outpatient settings to help voice hearers and nurses develop a shared terminology of auditory hallucinations (AH). Using the AHIG, voice hearers are able to tell their stories in a structured and safe environment, thus encouraging recovery. Through respect and active listening, PMH nurses can communicate unconditional acceptance, caring, and hope for recovery, which helps develop rapport and promote trust in the nurse-patient relationship. Once trust is developed, voice hearers and PMH nurses can work together to find effective strategies for managing AH, including commands to harm self and others.