Introdução: Esquizofrenia é um distúrbio psicótico complexo e heterogêneo. Alucinações auditivas verbais ocorrem em 50% a 70% dos pacientes portadores de esquizofrenia, e estão associadas a prejuízo significativo, pior qualidade de vida e funcionamento social. Estudos prévios mostraram que a estimulação magnética transcraniana repetida (EMTr) parece ser capaz de modular a severidade das alucinações auditivas em pacientes com esquizofrenia. Este estudo investigou os efeitos da rTMS de 1Hz aplicada ao córtex temporoparietal esquerdo, comparada a estimulação sham, na psicopatologia geral, severidade das alucinações auditivas, qualidade de vida e funcionalidade. Métodos: Dezessete pacientes apresentando alucinações auditivas verbais pelo menos cinco vezes ao dia forma randomicamente distribuídos para receber EMTr ativa ou sham. Um total de 384 minutos de EMTr a 90% do limiar motor foram administrados ao longo de 20 dias usando um desenho paralelo, duplo-cego e controlado por placebo. Resultados: Houve um efeito positivo nos escores da BPRS no grupo ativo comparado ao grupo sham. Não houve diferenças significativas entre os grupos no final do tratamento nos escores da QLS, AHRS, CGI e FAST. Conclusões: Comparada a estimulação sham, a EMTr do cortex temporoparietal esquerdo mostrou um efeito positivo na psicopatologia geral. Novos estudos com tamanhos de amostra maiores são necessários para investigar efeitos na qualidade de vida e funcionalidade, uma vez que o poder deste estudo foi menor que 50%. Além disso, seu efeito em alucinações auditivas refratárias não é claro, uma vez que os escores de alucinações auditivas globais e individuais não foram diferentes. / Background: Schizophrenia is a complex and heterogeneous psychiatric disorder. Auditory verbal hallucinations occur in 50% to 70% of patients with schizophrenia, and are associated to significant distress, decreased quality of life and social functioning. Data from previous studies have shown that 1-hertz left temporo-parietal repetitive transcranial magnetic stimulation (rTMS) appears to be able to modulate the severity of auditory hallucinations in patients with schizophrenia. This study aimed to investigate the effects of 1 Hz rTMS of the left temporo-parietal cortex on general psychopathology, severity of auditory hallucinations, quality of life and functionality, compared to sham stimulation. Methods: Seventeen patients experiencing auditory verbal hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 384 minutes of rTMS was administered over 20 days at 90% motor threshold using a double-masked, sham-controlled, parallel design. Results: There was a positive effect on BPRS scores on the active group compared to sham group. There was no significant difference between groups at the end of the treatment on QLS, AHRS, CGI and FAST scores. Conclusions: Compared to sham stimulation, rTMS of the left temporo-parietal cortex showed a positive effect on general psychopathology. Further studies with larger sample sizes are needed to investigate effects on quality of life and functionality, since the power of the study was lower than 50%. Also, its effect on refractory auditory hallucinations is not clear, since global and individual scores of auditory hallucinations were not different.

Introdução: Esquizofrenia é um distúrbio psicótico complexo e heterogêneo. Alucinações auditivas verbais ocorrem em 50% a 70% dos pacientes portadores de esquizofrenia, e estão associadas a prejuízo significativo, pior qualidade de vida e funcionamento social. Estudos prévios mostraram que a estimulação magnética transcraniana repetida (EMTr) parece ser capaz de modular a severidade das alucinações auditivas em pacientes com esquizofrenia. Este estudo investigou os efeitos da rTMS de 1Hz aplicada ao córtex temporoparietal esquerdo, comparada a estimulação sham, na psicopatologia geral, severidade das alucinações auditivas, qualidade de vida e funcionalidade. Métodos: Dezessete pacientes apresentando alucinações auditivas verbais pelo menos cinco vezes ao dia forma randomicamente distribuídos para receber EMTr ativa ou sham. Um total de 384 minutos de EMTr a 90% do limiar motor foram administrados ao longo de 20 dias usando um desenho paralelo, duplo-cego e controlado por placebo. Resultados: Houve um efeito positivo nos escores da BPRS no grupo ativo comparado ao grupo sham. Não houve diferenças significativas entre os grupos no final do tratamento nos escores da QLS, AHRS, CGI e FAST. Conclusões: Comparada a estimulação sham, a EMTr do cortex temporoparietal esquerdo mostrou um efeito positivo na psicopatologia geral. Novos estudos com tamanhos de amostra maiores são necessários para investigar efeitos na qualidade de vida e funcionalidade, uma vez que o poder deste estudo foi menor que 50%. Além disso, seu efeito em alucinações auditivas refratárias não é claro, uma vez que os escores de alucinações auditivas globais e individuais não foram diferentes. / Background: Schizophrenia is a complex and heterogeneous psychiatric disorder. Auditory verbal hallucinations occur in 50% to 70% of patients with schizophrenia, and are associated to significant distress, decreased quality of life and social functioning. Data from previous studies have shown that 1-hertz left temporo-parietal repetitive transcranial magnetic stimulation (rTMS) appears to be able to modulate the severity of auditory hallucinations in patients with schizophrenia. This study aimed to investigate the effects of 1 Hz rTMS of the left temporo-parietal cortex on general psychopathology, severity of auditory hallucinations, quality of life and functionality, compared to sham stimulation. Methods: Seventeen patients experiencing auditory verbal hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 384 minutes of rTMS was administered over 20 days at 90% motor threshold using a double-masked, sham-controlled, parallel design. Results: There was a positive effect on BPRS scores on the active group compared to sham group. There was no significant difference between groups at the end of the treatment on QLS, AHRS, CGI and FAST scores. Conclusions: Compared to sham stimulation, rTMS of the left temporo-parietal cortex showed a positive effect on general psychopathology. Further studies with larger sample sizes are needed to investigate effects on quality of life and functionality, since the power of the study was lower than 50%. Also, its effect on refractory auditory hallucinations is not clear, since global and individual scores of auditory hallucinations were not different.

Introdução: Esquizofrenia é um distúrbio psicótico complexo e heterogêneo. Alucinações auditivas verbais ocorrem em 50% a 70% dos pacientes portadores de esquizofrenia, e estão associadas a prejuízo significativo, pior qualidade de vida e funcionamento social. Estudos prévios mostraram que a estimulação magnética transcraniana repetida (EMTr) parece ser capaz de modular a severidade das alucinações auditivas em pacientes com esquizofrenia. Este estudo investigou os efeitos da rTMS de 1Hz aplicada ao córtex temporoparietal esquerdo, comparada a estimulação sham, na psicopatologia geral, severidade das alucinações auditivas, qualidade de vida e funcionalidade. Métodos: Dezessete pacientes apresentando alucinações auditivas verbais pelo menos cinco vezes ao dia forma randomicamente distribuídos para receber EMTr ativa ou sham. Um total de 384 minutos de EMTr a 90% do limiar motor foram administrados ao longo de 20 dias usando um desenho paralelo, duplo-cego e controlado por placebo. Resultados: Houve um efeito positivo nos escores da BPRS no grupo ativo comparado ao grupo sham. Não houve diferenças significativas entre os grupos no final do tratamento nos escores da QLS, AHRS, CGI e FAST. Conclusões: Comparada a estimulação sham, a EMTr do cortex temporoparietal esquerdo mostrou um efeito positivo na psicopatologia geral. Novos estudos com tamanhos de amostra maiores são necessários para investigar efeitos na qualidade de vida e funcionalidade, uma vez que o poder deste estudo foi menor que 50%. Além disso, seu efeito em alucinações auditivas refratárias não é claro, uma vez que os escores de alucinações auditivas globais e individuais não foram diferentes. / Background: Schizophrenia is a complex and heterogeneous psychiatric disorder. Auditory verbal hallucinations occur in 50% to 70% of patients with schizophrenia, and are associated to significant distress, decreased quality of life and social functioning. Data from previous studies have shown that 1-hertz left temporo-parietal repetitive transcranial magnetic stimulation (rTMS) appears to be able to modulate the severity of auditory hallucinations in patients with schizophrenia. This study aimed to investigate the effects of 1 Hz rTMS of the left temporo-parietal cortex on general psychopathology, severity of auditory hallucinations, quality of life and functionality, compared to sham stimulation. Methods: Seventeen patients experiencing auditory verbal hallucinations at least 5 times per day were randomly allocated to receive either rTMS or sham stimulation. A total of 384 minutes of rTMS was administered over 20 days at 90% motor threshold using a double-masked, sham-controlled, parallel design. Results: There was a positive effect on BPRS scores on the active group compared to sham group. There was no significant difference between groups at the end of the treatment on QLS, AHRS, CGI and FAST scores. Conclusions: Compared to sham stimulation, rTMS of the left temporo-parietal cortex showed a positive effect on general psychopathology. Further studies with larger sample sizes are needed to investigate effects on quality of life and functionality, since the power of the study was lower than 50%. Also, its effect on refractory auditory hallucinations is not clear, since global and individual scores of auditory hallucinations were not different.

Charles Bonnet syndrome (CBS) is defined as complex persistent visual hallucinations in the absence of mental disorder. It is associated with advanced age and poor vision. It is common, with prevalence estimates of up to 63% among older people with significant visual impairment. CBS would not be diagnosed in the presence of dementia, but its relationship to milder cognitive impairment is unclear. The few studies that have examined this are underpowered and provide contradictory results. There are 16 case reports of dementia emerging in people with a diagnosis of CBS. These cases raise the possibility of an association between impaired insight at diagnosis of CBS and the subsequent development of dementia. This thesis reports the findings of a prospective cohort study which describes changes in cognitive functioning over one year in patients with CBS and age-matched controls. Participants were recruited from low vision and glaucoma assessment clinics. A clinical assessment was carried out by an old age psychiatrist, and participants had a detailed assessment of visual functioning. This thesis also describes the findings of the first study to use voxel-based morphometry (VBM) to investigate changes in volume of grey and white matter in CBS. Participants were recruited from the same clinics as the cohort study, and underwent MRI scanning on a 1.5T scanner, to a protocol designed to produce 1mm3 voxels. Twelve participants with CBS and ten controls were followed up. Two people in the CBS group developed dementia, while none did in the control group. The CBS group showed a mean change in the score on the Addenbrooke’s cognitive examination (ACE-R) of -3.7 points, compared to a change of +1.4 in the control group. This difference was not statistically significant. The CBS participants performed worse on the verbal fluency item of the ACE-R, a difference which was statistically significant. The VBM analysis was conducted on 11 CBS participants and 11 controls. The CBS group showed an increase in grey matter volume in the right cerebellar hemisphere. This difference retained significance after family-wise error correction, non-stationary correction, and ANCOVA to control for the effects of possible confounders. As far as the author is aware, these are the most methodologically robust studies to date to have investigated cognition and morphological brain changes in CBS. The findings of the cohort study were inconclusive. However, the two cases of dementia in CBS patients add weight to the suspicion that this is a clinically important outcome in the condition, and the finding of abnormalities in frontal lobe testing in participants with CBS fits with a theoretical model of visual hallucination generation. Moreover, this type of research appears to be acceptable to a frail and visually disabled population, and studies powered to investigate this issue more fully would be feasible. The VBM findings report the presence of underlying structural brain abnormalities in CBS, in a region not usually associated with visual hallucinations. Possible links with Lewy body dementia, and implications for theories of visual hallucinations, are discussed.

Hallucinations are often seen as a serious symptom of mental illness. Nonetheless, recent decades have produced a body of evidence that documented the presence of hallucinations even in non-clinical samples. Therefore, focusing on these samples is critical for improving understanding of processes underlying auditory hallucinations. The present study examines cognitive mechanisms that have been proposed to influence proneness to auditory hallucinations. A battery of experimental measures is implemented to assess some of the mechanisms implicated in the aetiology of hallucinations. Source monitoring, cognitive inhibition, bottom-up processes, working memory and traumatic experiences were measured in a laboratory study of 52 participants. Findings suggest that proneness to hallucinations is associated with impaired top-down processing and early traumatic experiences. No association between other cognitive mechanisms and hallucination proneness, contrary to previous evidence, has been found. This indicates that impaired source memory, working memory and bottom-up processing impairments might distinguish clinical and non-clinical hallucinators. An alternative implication of these findings points at issues with reproducibility in the hallucination research. Keywords: Auditory verbal hallucinations,...

No description available.

Objective: To examine the hypothesis that the “natural” combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use. Methods: In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions. Results: Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need. Conclusions: The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory–delusional syndrome.

No description available.

2D Animation is explored as a tool to visualize hallucinations in the VR (Virtual Reality) documentary film Urban Witches. The hallucinations are based on the memories of the filmmaker Nicia Fernandez who traveled to Mexico to experience a peyote ceremony - which is a collective healing ritual among several native Mexican tribes, in which the hallucinogenic plant peyote is consumed. The film involves several layers of interpretation: the camera, memories, neoshamanism etc. and touches upon subjects such as authenticity and mindfulness. An interpretive animation method is used, so as to avoid any unfounded representations, while an intuitive method is proposed as an alternative at the end. / 2D Animation utforskas som ett verktyg för att representera hallucinationer i den dokumentära VR (Virtual Reality) filmen Urban Witches. Hallucinationerna är baserade på minnen från filmskaparen Nicia Fernandez som reste till Mexiko för att ta del av en peyote ceremoni, vilket är en kollektiv ceremoni för själsligt läkande bland många urinvånare i Mexico, där den hallucinogena drogen peyote tas. Filmen har flera lager av tolkningar: kameran, minnen, neoshamanism m.m. och rör vid ämnen såsom autenticitet och "medveten närvaro” (mindfulness). En tolkande metod för animationen är använd för att försöka undvika felaktiga representationer, medan en mer intuitiv metod är föreslagen mot slutet av arbetet.

The aims of this study were to explore professionals’ and clients’ experiences of diagnosis and treatment of auditory verbal hallucinations with a view to identifying important clinical issues for counselling psychologists. Six professionals, three psychologists and three psychiatrists, who had worked with people who hear voices, alongside four clients who hear voices, volunteered and participated in a semi-structured interview. These interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA) as described by Smith, Flowers and Larkin (2009). A table of super-ordinate and sub-ordinate themes was created as a result of this analysis. A number of themes arose from both groups of participants’ experiences. The main themes that arose for the professionals was: professional ambivalence; varying theories on causes of voices; perspectives on diagnosis and formulation; perspectives on medication; thoughts on working therapeutically; and, thinking on recovery. The themes that arose from the clients’ experiences were feelings about diagnosis and experiences of treatment. This research concludes that there is professional ambivalence in working with people who hear voices that is caused by a lack of certainty about the causes of the phenomenon alongside a lack of training in working with clients who have symptoms of psychosis. This impacts clients in several ways. The clients in this study were not offered the option to have any involvement in their own care and none of them were offered therapy as a treatment option. The study also concludes that psychiatric diagnosis does not consider all pertinent information related to clients’ issues which can lead to inconsistency in the diagnosis of clients who hear voices.