Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else?

This study presents phenomenological features of auditory verbal hallucinations (AVH) in schizophrenia and associated anomalies of experience. The purpose is to compare the lived experience of AVH to the official definition of hallucinations as a perception without object. Furthermore, we wish to explore the clinical and research implication of the phenomenological approach to AVH. Our exposition is based on classic texts on AVH, recent phenomenological studies and our clinical experience. AVH differ on several dimensions from ordinary perception. Only a minority of schizophrenia patients experiences AVH localized externally. Thus, the official definition of hallucinations does not fit the AVH in schizophrenia. AVH are associated with several anomalies of subjective experiences (self-disorders) and the AVH must be considered as a product of self-fragmentation. We discuss the implications with respect to the definition of hallucination, clinical interview, conceptualization of a psychotic state and potential target of pathogenetic research.

Late-onset schizophrenia.

Patients with late-onset schizophrenia form a subgroup of schizophrenia that to some extent differs from the typical Gestalt of schizophrenia. Therefore, some of these patients may be overlooked in the clinic. This review describes the characteristics of the late-onset subgroup: Overweight of women, higher education, has been or is still married, and with more children than patients with early onset schizophrenia. The symptomatology of the subgroup is characterised by persecutory delusions and auditory hallucination. Knowledge of this subgroup of patients may lead to attention in the clinic and hopefully have therapeutic value in the recovery process for the patients.

Auditory Verbal Hallucinations in Schizophrenia, Part II: Phenomenological Qualities and Evolution.

ABSTRACT: Hallucination is defined in the diagnostic systems as an experience resembling true perception without causal stimulus. In this second report from an in-depth phenomenological study of schizophrenia patients experiencing auditory verbal hallucinations (AVHs), we focused on the phenomenological qualities of AVHs. We found that a substantial proportion of patients could not clearly distinguish between thinking and hallucinating. The emotional tone of the voices increased in negativity. AVHs became more complex. Spatial localization was ambiguous and only 10% experienced only external hallucinations. There was an overlap with passivity phenomena in one third of the cases. The patients occasionally acted upon the content of AVHs. In the discussion section, we criticize the perceptual model of AVHs. We conclude that the definition of AVH in schizophrenia is misleading and exerts negative consequences on the clinical work and empirical research.

Auditory Verbal Hallucinations in Schizophrenia: Mode of Onset and Disclosure.

Recent reviews on auditory verbal hallucinations (AVHs) advocate a qualitative and interdisciplinary research that not only is limited to single descriptive features, but also involves contextual issues and co-occurring psychopathology. In this study of mainly readmitted patients with the International Classification of Diseases, Tenth Revision, diagnosis of paranoid schizophrenia and experiencing AVH, we performed a qualitative, phenomenologically oriented interview study. The focus was on the beginning of hallucinatory experiences, time to disclosure of the symptom, and the context surrounding the disclosure. We found that on average the patients experiencing AVH for 6.5 years before disclosing the symptom to a psychiatrist. Moreover, the term "voices" was typically appropriated by the patient during his contact with a psychiatric treatment facility. None of the patients considered themselves as being psychotic or severely mentally ill. The AVH in the majority of the patients was associated with other pathological subjective experiences. The significance of these findings is briefly discussed in relation to the concept of insight, diagnosis of psychosis, and early detection.

[The effect of antidepressants on brain volume].

In this review, we summarise all studies of patients with depression, who have been examined by MRI before and after treatment with antidepressants. None of the studies showed any signs of damage to the brain tissue after treatment. On the contrary, most studies showed increases in hippocampal volume and prefrontal cortices in parallel with response or remission after treatment. As depression in several meta-analyses has been shown to double the risk for dementia, this could have important implications for preventive measures, because, for instance, hippocampal atrophy is seen in both diseases.

[Overtreatment and undertreatment of depression].

The aim of this study was to examine what we know about the general practitioners' ability to diagnose and treat depression. Some studies suggest that clinicians might have considerable difficulty identifying depressions correctly, but that diagnostics become more accurate with increased severity of the disease. Several studies suggest that patients diagnosed with depression are undertreated, and some studies suggest that patients might receive antidepressants, even though they do not fulfil the International Classification of Diseases 10 criterion for depression.

Reproductive patterns among Danish women with oral clefts.

OBJECTIVE: The aim of this study was to compare reproduction patterns among Danish women born with isolated oral clefts versus the Danish background population. DESIGN AND SETTING: A nationwide population-based historic cohort study based on three registers: The Danish Facial Cleft Register, The Danish Civil Registration System, and the Fertility of Women and Couples Dataset. PARTICIPANTS: Through linkages of the registers, the number of children and the exact age at childbirth of all Danish women born with an oral cleft from 1950 through 1988 (N = 1931) were obtained. These data were compared with similar data for the entire Danish female background population (N = 1,184,390). RESULTS AND CONCLUSIONS: This study suggests that childlessness is higher among women born with an oral cleft (55%) than among women in the Danish background population (44%). Excluding women without children, women born with oral cleft had an average of 1.98 children per woman. This did not differ significantly from the background population (2.02 children/woman). Furthermore, the present study found that Danish women born with oral clefts on average were older (27.3 years of age) than the background population (24.7 years of age) when they had their first child (difference = 2.6 years, confidence interval = 2.41 to 2.80). CONCLUSION: Danish women born with an oral cleft more often are childless or have their first child later, but if they have children, they tend to have as many children as other Danish women. Social, psychological, and biological reasons might be responsible for the reduced fertility.