Auditory hallucination

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
Paracusia
Classification and external resources
Specialty Psychiatry
ICD-10 R44.0
ICD-9-CM 780.1

A paracusia, or auditory hallucination,[1] is a form of hallucination that involves perceiving sounds without auditory stimulus.

A common form of auditory hallucination involves hearing one or more talking voices. This may be associated with psychotic disorders, and holds special significance in diagnosing these conditions.[2] However, individuals without any psychiatric disease whatsoever may hear voices.[3]

There are three main categories into which the hearing of talking voices often fall: a person hearing a voice speak one's thoughts, a person hearing one or more voices arguing, or a person hearing a voice narrating his/her own actions.[4] These three categories do not account for all types of auditory hallucinations.

Other types of auditory hallucination include exploding head syndrome and musical ear syndrome. In the latter, people will hear music playing in their mind, usually songs they are familiar with. This can be caused by: lesions on the brain stem (often resulting from a stroke); also, sleep disorders such as narcolepsy, tumors, encephalitis, or abscesses.[5] This should be distinguished from the commonly experienced phenomenon of getting a song stuck in one's head. Reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time.[6] Other reasons include hearing loss and epileptic activity.[7]

In the past, the cause of auditory hallucinations was attributed to cognitive suppression by way of executive function failure of the fronto-parietal sulcus. Newer research has found that they coincide with the left superior temporal gyrus, suggesting that they are better attributed to speech misrepresentations.[8] It is assumed through research that the neural pathways involved in normal speech perception and production, which are lateralized to the left temporal lobe, also underlie auditory hallucinations.[8] Auditory hallucinations correspond with spontaneous neural activity of the left temporal lobe, and the subsequent primary auditory cortex. The perception of auditory hallucinations correspond to the experience of actual external hearing, despite the absence of physical acoustic output .[9]

Famous examples[edit]

Robert Schumann, a famous music composer, spent the end of his life experiencing auditory hallucinations. Schumann’s diaries state that he suffered perpetually from imagining that he had the note A5 sounding in his ears. The musical hallucinations became increasingly complex. One night he claimed to have been visited by the ghost of Schubert and wrote down the music that he was hearing. Thereafter, he began making claims that he could hear an angelic choir singing to him. As his condition worsened, the angelic voices developed into demonic ones.[10]

Brian Wilson, songwriter and co-founder of the Beach Boys, has schizoaffective disorder that presents itself in the form of disembodied voices.[11] They formed a major component of Bill Pohlad's Love & Mercy (2014), a biographical film which depicts Wilson's hallucinations as a source of musical inspiration,[12] constructing songs that were partly designed to converse with them.[13] Wilson has said of the voices: "Mostly [they're] derogatory. Some of it's cheerful. Most of it isn't."[14] To combat them, his psychiatrist advised that he "talk humorously to them", which he says has helped "a little bit".[11]

Individual accounts[edit]

The onset of delusional thinking is most often described as being gradual and insidious. Patients have described an interest in psychic phenomena progressing to increasingly unusual preoccupations and then to bizarre beliefs "in which I believed wholeheartedly". One author wrote of their hallucinations: "they deceive, derange and force me into a world of crippling paranoia". In many cases, the delusional beliefs could be seen as fairly rational explanations for abnormal experiences: "I increasingly heard voices (which I'd always call ‘loud thoughts’)... I concluded that other people were putting these loud thoughts into my head".[15] Some cases have been described as an "auditory ransom note".

History[edit]

Ancient history[edit]

Presentation[edit]

In the ancient world, auditory hallucinations were often viewed as either a gift or curse by god, or the gods (depending on the specific culture). According to the Greek historian Plutarch, during the reign of Tiberius (A.D. 14–37), a sailor named Thamus heard a voice cry out to him from across the water, "Thamus, are you there? When you reach Palodes, take care to proclaim that the great god Pan is dead."[16][10] The oracles of ancient Greece were known to experience auditory hallucinations while breathing in certain neurologically active vapors (such as the smoke from bay leaves), while the more pervasive delusions and symptomology were often viewed as possession by demonic forces as punishment for misdeeds.[10]

Treatments[edit]

Treatment in the ancient world is ill documented, but there are some cases of therapeutics being used to attempt treatment, while the common treatment was sacrifice and prayer in an attempt to placate the gods. During the Middle Ages, those with auditory hallucinations were sometimes subjected to trepanning or trial as a witch.[10] In other cases of extreme symptomatology, individuals were seen as being reduced to animals by a curse; these individuals were either left on the streets or imprisoned in insane asylums. It was the latter response that eventually led to modern psychiatric hospitals.[17]

Pre-modern[edit]

Presentation[edit]

Auditory hallucinations were rethought during the enlightenment. As a result, the predominant theory in the western world beginning in the late 18th century was that auditory hallucinations were the result of a disease in the brain (e.g. mania), and treated as such.[17]

Treatments[edit]

There were no effective treatments for hallucinations at this time. Conventional thought was that clean food, water, and air would allow the body to heal itself (Sanatorium). Beginning in the 16th century Insane Asylums were first introduced in order to remove “the mad dogs” from the streets and left them chained to walls and living in their own filth.[17] These asylums acted as prisons until the late 18th century. This is when doctors began the attempt to treat patients. Often attending doctors would douse patients in cold water, starve them, or spin patients on a wheel. Soon, this gave way to brain specific treatments with the most famous examples including Lobotomies, shock therapy and branding the skull with hot iron.[17]

Potential causes[edit]

In 2015 a small survey[18] reported voice hearing in persons with a wide variety of DSM-5 diagnoses, including:

However, numerous persons surveyed reported no diagnosis. In his popular 2012 book Hallucinations, neurologist Oliver Sacks describes voice hearing in patients with a wide variety of medical conditions, as well as his own personal experience of hearing voices.

Schizophrenia[edit]

In the case of psychotic patients the premier cause of auditory hallucinations is schizophrenia. In schizophrenia, patients show a consistent increase in activity of the thalamic and strietal subcortical nuclei, hypothalamus, and paralimbic regions; confirmed via PET scan and fMRI.[19][20] Other research shows an enlargement of temporal white matter, frontal gray matter, and temporal gray matter volumes (those areas crucial to both inner and outer speech) when compared to control patients.[21][22] This implies both functional and structural abnormalities in the brain, both of which may have a genetic component, can induce auditory hallucinations.[23]

Auditory hallucinations attributed to an external source, rather than internal, are considered the defining factor for the diagnoses of schizophrenia. The voices heard are generally destructive and emotive, adding to the state of artificial reality and disorientation seen in psychotic patients.[8] The causal basis of hallucinations has been explored on the cellular receptor level. The glutamate hypothesis, proposed as possible cause for schizophrenia, may also have implications in auditory hallucinations, which are suspected to be triggered by altered glutamatergic transmission.[24]

Studies using dichotic listening methods suggest that Schizophrenic patients have major deficits in the functioning of the left temporal lobe by showing that patients do not generally exhibit what is a functionally normal right ear advantage.[25] Inhibitory control of hallucinations in patients have been shown to involve failure of top-down regulation of resting-state networks and up-regulation of effort networks, further impeding normal cognitive functioning.[26]

Mood disorders and dementias[edit]

Mood disorders have also been known to correlate with auditory hallucinations, but tend to be milder than their psychosis induced counterpart. Auditory hallucinations are a relatively common sequelae of Major Neurocognitive Disorders (formerly dementia) such as Alzheimer's disease.[27]

Transient causes[edit]

Auditory hallucinations have been known to manifest as a result of intense stress, sleep deprivation, drug use, and errors in development of proper psychological processes.[clarification needed][28] Genetic correlation has been identified with auditory hallucinations,[29] but most work with non-psychotic causes of auditory hallucinations is still ongoing.[28][30]

High caffeine consumption has been linked to an increase in the likelihood of experiencing auditory hallucinations. A study conducted by the La Trobe University School of Psychological Sciences revealed that as few as five cups of coffee a day could trigger the phenomenon.[31]

Diagnosis and treatments[edit]

Pharmaceuticals[edit]

The primary means of treating auditory hallucinations is antipsychotic medications which affect dopamine metabolism. If the primary diagnosis is a mood disorder (with psychotic features), adjunctive medications are often used (e.g., antidepressants or mood stabilizers). These medical approaches may allow the person to function normally but are not a cure as they do not eradicate the underlying thought disorder.[32]

Psychological therapies[edit]

Cognitive behavioral therapy has been shown to help decrease the frequency and distressfulness of auditory hallucinations, particularly when other psychotic symptoms were presenting.[33] Enhanced Supportive Therapy has been shown to reduce the frequency of auditory hallucinations, the violent resistance the patient displayed towards said hallucinations, and an overall decrease in the perceived malignancy of the hallucinations.[33] Other cognitive and behavioral therapies have been used with mixed success.[34][35]

Non-conventional therapies[edit]

Electroconvulsive therapy or ECT has been shown to reduce psychotic symptoms associated with schizophrenia[citation needed], mania, and depression, and is often used in psychiatric hospitals.

In recent years, repetitive transcranial magnetic stimulation (rTMS) has been studied as a biological method of treatment for auditory hallucinations. rTMS plays a role in altering neural activity over language cortical regions. Studies have shown that when rTMS is used as an adjunct to antipsychotic medication in treatment-resistant cases, the frequency and severity of auditory hallucinations can be reduced.[36]

Ongoing research[edit]

Non-psychotic symptomology[edit]

There is on-going research that supports the prevalence of auditory hallucinations, with a lack of other conventional psychotic symptoms (such as delusions, or paranoia), particularly in pre-pubertal children.[37] These studies indicate a remarkably high percentage of children (up to 14% of the population sampled[38]) experienced sounds or voices without any external cause, although "sounds" are not considered by psychiatrists to be examples of auditory hallucinations. Differentating actual auditory hallucinations from "sounds" or a normal internal dialogue is important since the latter phenomena are not indicative of mental illness.

Methods[edit]

To explore the auditory hallucinations in schizophrenia, experimental neurocognitive use approaches such as dichotic listening, structural fMRI, and functional fMRI. Together, they allow insight into how the brain reacts to auditory stimulus, be it external or internal. Such methods allowed researchers to find a correlation between decreased gray matter of the left temporal lobe and difficulties in processing external sound stimulus in hallucinating patients.[8]

Functional neuroimaging has shown increased blood and oxygen flow to speech related areas of the left temporal lobe, including Broca’s area and the thalamus.[8]

Causes[edit]

The causes of auditory hallucinations are unclear.

It is suspected that deficits in the left temporal lobe attribute that lead to spontaneous neural activity cause speech misrepresentations that account for auditory hallucinations.[8]

Charles Fernyhough, of the University of Durham poses one theory among many but stands as a reasonable example of the literature. Given standing evidence towards involvement of the inner voice in auditory hallucinations,[39] he proposes two alternative hypotheses on the origins of auditory hallucinations in the non-psychotic. They both rely on an understanding of the internalization process of the inner voice.[28][38][40]

Internalization of the inner voice[edit]

The internalization process of the inner voice is the process of creating an inner voice during early childhood, and can be separated into four distinct levels.[28][38][40]

Level one (external dialogue) involves the capacity to maintain an external dialogue with another person, i.e. a toddler talking with their parent(s).

Level two (private speech) involves the capacity to maintain a private external dialogue, as seen in children voicing the actions of play using dolls or other toys, or someone talking to themselves while repeating something they had written down.

Level three (expanded inner speech) is the first internal level in speech. This involves the capacity to carry out internal monologues, as seen in reading to oneself, or going over a list silently.

Level four (condensed inner speech) is the final level in the internalization process. It involves the capacity to think in terms of pure meaning without the need to put thoughts into words in order to grasp the meaning of the thought.

Disruption to internalization[edit]

A disruption could occur during the normal process of internalizing one's inner voice, where the individual would not interpret their own voice as belonging to them; a problem that would be interpreted as level one to level four error.[28][38][40]

Re-expansion[edit]

Alternatively, the disruption could occur during the process of re-externalizing one's inner voice, resulting in an apparent second voice that seems alien to the individual; a problem that would be interpreted as a level four to level one error.[28][38][40]

Treatments[edit]

Psychopharmacological treatments include anti-psychotic medications. Psychology research shows that first step in treatment is for the patient to realize that the voices they hear are creation of their own mind. This realization is argued to allow patients to reclaim a measure of control over their lives. Some additional psychological interventions might allow for the process of controlling these phenomena of auditory hallucinations but more research is needed.[28]

Affected Brain Regions[edit]

  • Left Temporal Lobe: processes semantics in speech and vision, includes primary auditory cortex [8]
  • Broca's Area: speech and language comprehension [8]
  • Superior Temporal Gyrus: contains primary auditory cortex [8]
  • Primary Auditory Cortex: processes hearing and speech perception [8]
  • Globus Pallidus: Regulation of voluntary movement [9]

See also[edit]

References[edit]

  1. ^ "Paracusia". Medical dictionary. 
  2. ^ Yuhas D. "Throughout History, Defining Schizophrenia Has Remained A challenge". Scientific American Mind (March 2013). Retrieved 2 March 2013. 
  3. ^ Thompson A (September 15, 2006). "Hearing Voices: Some People Like It". LiveScience.com. Archived from the original on 2 November 2006. Retrieved 2014-02-01. 
  4. ^ Semple, David. "Oxford hand book of psychiatry" Oxford press, 2005
  5. ^ "Rare Hallucinations Make Music In The Mind". ScienceDaily.com. August 9, 2000. Archived from the original on 5 December 2006. Retrieved 2006-12-31. 
  6. ^ Young K (July 27, 2005). "IPod hallucinations face acid test". Vnunet.com. Archived from the original on 2007-12-20. Retrieved 2008-04-10. 
  7. ^ Engmann B, Reuter M (April 2009). "Spontaneous perception of melodies – hallucination or epilepsy?". Nervenheilkunde. 28: 217–221. ISSN 0722-1541. 
  8. ^ a b c d e f g h i j Hugdahl K, Løberg EM, Nygård M (May 2009). "Left temporal lobe structural and functional abnormality underlying auditory hallucinations in schizophrenia". Frontiers in Neuroscience. 3 (1): 34–45. doi:10.3389/neuro.01.001.2009. PMC 2695389Freely accessible. PMID 19753095. 
  9. ^ a b Ikuta T, DeRosse P, Argyelan M, Karlsgodt KH, Kingsley PB, Szeszko PR, Malhotra AK (December 2015). "Subcortical modulation in auditory processing and auditory hallucinations". Behavioural Brain Research. 295: 78–81. doi:10.1016/j.bbr.2015.08.009. PMC 4641005Freely accessible. PMID 26275927. 
  10. ^ a b c d Laqueur T (2007-09-03). "Spirited Away". pp. 36–42. 
  11. ^ a b "Brian Wilson – A Powerful Interview". Ability Magazine. Ability Magazine. 
  12. ^ Tapley K (May 21, 2015). "Bill Pohlad wants 'Love & Mercy' to take you inside the genius of Beach Boy Brian Wilson". HitFix. 
  13. ^ Powers A (July 7, 2015). "Why Films About Musicians Leave So Much Music Off Screen". NPR. 
  14. ^ Gilstrap P (June 3, 2015). "Inside Brian Wilson's room: The famed Beach Boy opens up about mental illness, medication, manipulation and the movie about his life". Salon. 
  15. ^ Stanton B (2000). "First-person accounts of delusions". Psychiatric Bulletin. 20 (9): 333–336. doi:10.1192/pb.24.9.333. 
  16. ^ Plutarch, Moralia Book 5:17, De defectu oraculorum ("The Obsolescence of Oracles").
  17. ^ a b c d Boyer, Paul S. (2001). "Mental Health Institutions (Insane Asylums)". The Oxford companion to United States history. Oxford: Oxford Univ. Press. p. 488. ISBN 978-0-19-508209-8. 
  18. ^ Woods A, Jones N, Alderson-Day B, Callard F, Fernyhough C (April 2015). "Experiences of hearing voices: analysis of a novel phenomenological survey". The Lancet. Psychiatry. 2 (4): 323–31. doi:10.1016/S2215-0366(15)00006-1. PMC 4580735Freely accessible. PMID 26360085. 
  19. ^ Silbersweig DA, Stern E, Frith C, Cahill C, Holmes A, Grootoonk S, Seaward J, McKenna P, Chua SE, Schnorr L (November 1995). "A functional neuroanatomy of hallucinations in schizophrenia". Nature. 378 (6553): 176–9. doi:10.1038/378176a0. PMID 7477318. 
  20. ^ Gaser C, Nenadic I, Volz HP, Büchel C, Sauer H (January 2004). "Neuroanatomy of "hearing voices": a frontotemporal brain structural abnormality associated with auditory hallucinations in schizophrenia". Cerebral Cortex. 14 (1): 91–6. doi:10.1093/cercor/bhg107. PMID 14654460. 
  21. ^ Shin SE, Lee JS, Kang MH, Kim CE, Bae JN, Jung G (January 2005). "Segmented volumes of cerebrum and cerebellum in first episode schizophrenia with auditory hallucinations". Psychiatry Research. 138 (1): 33–42. doi:10.1016/j.pscychresns.2004.11.005. PMID 15708299. 
  22. ^ Shergill SS, Brammer MJ, Fukuda R, Williams SC, Murray RM, McGuire PK (June 2003). "Engagement of brain areas implicated in processing inner speech in people with auditory hallucinations". The British Journal of Psychiatry. 182 (6): 525–31. doi:10.1192/bjp.182.6.525. PMID 12777344. 
  23. ^ Boksa P (July 2009). "On the neurobiology of hallucinations". Journal of Psychiatry & Neuroscience. 34 (4): 260–2. PMC 2702442Freely accessible. PMID 19568476. 
  24. ^ Bartha R, al-Semaan YM, Williamson PC, Drost DJ, Malla AK, Carr TJ, Densmore M, Canaran G, Neufeld RW (June 1999). "A short echo proton magnetic resonance spectroscopy study of the left mesial-temporal lobe in first-onset schizophrenic patients". Biological Psychiatry. 45 (11): 1403–11. doi:10.1016/S0006-3223(99)00007-4. PMID 10356621. 
  25. ^ Green MF, Hugdahl K, Mitchell S (March 1994). "Dichotic listening during auditory hallucinations in patients with schizophrenia". The American Journal of Psychiatry. 151 (3): 357–62. doi:10.1176/ajp.151.3.357. PMID 8109643. 
  26. ^ Fox MD, Raichle ME (September 2007). "Spontaneous fluctuations in brain activity observed with functional magnetic resonance imaging". Nature Reviews. Neuroscience. 8 (9): 700–11. doi:10.1038/nrn2201. PMID 17704812. 
  27. ^ Wilson RS, Gilley DW, Bennett DA, Beckett LA, Evans DA (August 2000). "Hallucinations, delusions, and cognitive decline in Alzheimer's disease". Journal of Neurology, Neurosurgery, and Psychiatry. 69 (2): 172–7. doi:10.1136/jnnp.69.2.172. PMC 1737043Freely accessible. PMID 10896689. 
  28. ^ a b c d e f g Fernyhough C, Jones SR (August 2013). "Thinking aloud about mental voices" (PDF). In Macpherson F, Platchias D. Hallucination. Cambridge, MA: MIT Press. ISBN 978-0-262-01920-0. 
  29. ^ Hugdahl K, Løberg EM, Specht K, Steen VM, van Wageningen H, Jørgensen HA (2008). "Auditory hallucinations in schizophrenia: the role of cognitive, brain structural and genetic disturbances in the left temporal lobe". Frontiers in Human Neuroscience. 1: 6. doi:10.3389/neuro.09.006.2007. PMID 18958220. 
  30. ^ Stip E, Letourneau G (March 2009). "Psychotic symptoms as a continuum between normality and pathology". Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 54 (3): 140–51. doi:10.1177/070674370905400302. PMID 19321018. 
  31. ^ "Too Much Coffee Can Make You Hear Things That Are Not There". Retrieved 2 July 2016. 
  32. ^ Barker P (2009). Psychiatric and Mental Health Nursing - The craft of caring (2nd ed.). England: Hodder Arnold. ISBN 978-1-4987-5958-8. 
  33. ^ a b Penn DL, Meyer PS, Evans E, Wirth RJ, Cai K, Burchinal M (April 2009). "A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations". Schizophrenia Research. 109 (1-3): 52–9. doi:10.1016/j.schres.2008.12.009. PMID 19176275. 
  34. ^ Hayashi N, Igarashi Y, Suda K, Nakagawa S (December 2007). "Auditory hallucination coping techniques and their relationship to psychotic symptomatology". Psychiatry and Clinical Neurosciences. 61 (6): 640–5. doi:10.1111/j.1440-1819.2007.01741.x. PMID 18081625. 
  35. ^ Shergill SS, Murray RM, McGuire PK (August 1998). "Auditory hallucinations: a review of psychological treatments". Schizophrenia Research. 32 (3): 137–50. doi:10.1016/S0920-9964(98)00052-8. PMID 9720119. 
  36. ^ Waters F (2010). "Auditory hallucinations in psychiatric illness". Psychiatric Times. 27 (3): 54–58. 
  37. ^ Askenazy FL, Lestideau K, Meynadier A, Dor E, Myquel M, Lecrubier Y (September 2007). "Auditory hallucinations in pre-pubertal children. A one-year follow-up, preliminary findings". European Child & Adolescent Psychiatry. 16 (6): 411–5. doi:10.1007/s00787-006-0577-9. PMID 17468968. 
  38. ^ a b c d e Jones SR, Fernyhough C (March 2007). "Neural correlates of inner speech and auditory verbal hallucinations: a critical review and theoretical integration". Clinical Psychology Review. 27 (2): 140–54. doi:10.1016/j.cpr.2006.10.001. PMID 17123676. 
  39. ^ Allen P, Aleman A, McGuire PK (August 2007). "Inner speech models of auditory verbal hallucinations: evidence from behavioural and neuroimaging studies". International Review of Psychiatry. 19 (4): 407–15. doi:10.1080/09540260701486498. PMID 17671873. 
  40. ^ a b c d Fernyhough C (2004). "Alien voices and inner dialogue: towards a developmental account of auditory verbal hallucinations". New Ideas in Psychology. 22: 49–68. doi:10.1016/j.newideapsych.2004.09.001. 

Further reading[edit]

External links[edit]