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Hearing distressing voices (also known as auditory verbal hallucinations) is a common symptom associated with a number of mental health problems. Psychological therapies, specifically cognitive behaviour therapy (CBT) can be an effective intervention for this patient group. The aim of CBT for voices (CBTv) is to reduce the distress associated with the experience, by encouraging the patient to re-evaluate their beliefs about the voice's omnipotence, omniscience, and malevolence. Despite the evidence for CBTv, very few patients are offered this therapy; largely due to a lack of resources. The aim of this thesis was to develop and begin to evaluate a CBT-based intervention for voices that was resource-light; in the hope that it could be more easily be implemented into clinical services, and therefore increase access. This thesis begins with an introduction to the research area, and is followed by a review and evaluation of the methods used in this thesis. Chapter 6 is a systematic review and meta-analysis of the current literature on brief (< 16 NICE recommended sessions) CBT for psychosis (CBTp). Chapters 7 and 8 describe the process of developing a brief CBT intervention for voices, based on the CBT self-help book ‘Overcoming Distressing Voices'. Both people who hear voices, and mental health clinicians were consulted on the intervention concept and design. The outcome of these studies was guided self-help CBTv, and an accompanying therapy workbook to guide the intervention. Chapters 9 and 10 detail the design and findings of a randomised controlled trial of guided self-help CBTv delivered by Clinical Psychologists, versus a wait-list control group. Data was collected at baseline (pre-randomisation) and 12 weeks post-randomisation. The primary outcome was voice-related distress. The findings across all of the studies are then summarised and reflected upon within the Discussion chapter – including consideration of the extent to which the overall aim of this thesis (increasing access) has been achieved.

La schizophrénie est un trouble mental, chronique et invalidant caractérisé par divers symptômes tels que des hallucinations, des épisodes délirants ainsi que des déficiences dans les fonctions cognitives. Au fil des ans, l'Imagerie par Résonance Magnétique (IRM) a été de plus en plus utilisée pour mieux comprendre les anomalies structurelles et fonctionnelles inhérentes à ce trouble. Les progrès récents en apprentissage automatique et l'apparition de larges bases de données ouvrent maintenant la voie vers la découverte de biomarqueurs pour le diagnostic/ pronostic assisté par ordinateur. Compte tenu des limitations des algorithmes actuels à produire des signatures prédictives stables et interprétables, nous avons prolongé les approches classiques de régularisation avec des contraintes structurelles provenant de la structure spatiale du cerveau afin de: forcer la solution à adhérer aux hypothèses biologiques, produisant des solutions interprétables et plausibles. De telles contraintes structurelles ont été utilisées pour d'abord identifier une signature neuroanatomique de la schizophrénie et ensuite une signature fonctionnelle des hallucinations chez les patients atteints de schizophrénie. / Schizophrenia is a disabling chronic mental disorder characterized by various symptoms such as hallucinations, delusions as well as impairments in high-order cognitive functions. Over the years, Magnetic Resonance Imaging (MRI) has been increasingly used to gain insights on the structural and functional abnormalities inherent to the disorder. Recent progress in machine learning together with the availability of large datasets now pave the way to capture complex relationships to make inferences at an individual level in the perspective of computer-aided diagnosis/prognosis or biomarkers discovery. Given the limitations of state-of-the-art sparse algorithms to produce stable and interpretable predictive signatures, we have pushed forward the regularization approaches extending classical algorithms with structural constraints issued from the known biological structure (spatial structure of the brain) in order to force the solution to adhere to biological priors, producing more plausible interpretable solutions. Such structured sparsity constraints have been leveraged to identify first, a neuroanatomical signature of schizophrenia and second a neuroimaging functional signature of hallucinations in patients with schizophrenia. Additionally, we also extended the popular PCA (Principal Component Analysis) with spatial regularization to identify interpretable patterns of the neuroimaging variability in either functional or anatomical meshes of the cortical surface.

No description available.

Introdução: Nos últimos anos, nosso Grupo de Pesquisa em Zumbido identificou um número crescente de pacientes que referiram percepções repetidas de músicas e vozes, além do zumbido. Tais fenômenos alucinatórios nos instigaram a estudar suas possíveis relações com o psiquismo destes pacientes. Objetivos: avaliar se os fenômenos alucinatórios dos pacientes com zumbido têm relação com a psicose e/ou a depressão, além de esclarecer seu conteúdo e função no psiquismo. Casuística e métodos: Dez sujeitos (8 mulheres, idade média de 65,7 anos) foram avaliados pelo Inventário Fatorial da Personalidade (IFP), Escala para Depressão de Hamilton (HAM-D), entrevista semi-dirigida e entrevistas psicanalíticas. Resultados: Todos apresentaram relação dos fenômenos auditivos com a neurose e sintomas depressivos. Nove pacientes evidenciaram nítida relação entre o psiquismo e o conteúdo ou função de seus fenômenos, os quais representaram ou resgataram aspectos da vida afetiva. A repetição dos fenômenos e do sofrimento ofereceu uma satisfação paradoxal, que foi marcante em todos os casos. Conclusões: Evidenciou-se uma importante relação entre zumbido, fenômenos alucinatórios auditivos e depressão sustentada na satisfação paradoxal com a repetição do sofrimento, o que está vinculado ao caráter neurótico. / In the last few years, our Tinnitus Research Group identified a growing number of patients that repeatedly reported, in addition to tinnitus, perceptions of music and voices. Such hallucinatory phenomena inspired us to study their possible relation with these patients psychism. Objective: To assess whether the delusive phenomena of tinnitus patients are psychosis and / or depression related, in addition to clarify its content and function in the psychism. Methods: Ten subjects (8 women, mean age 65.7 years) were assessed by the Factorial Inventory of Personality (FIP), the Hamilton Depression Rating Scale (HDRS), semi-structured interviews and psychoanalytic interviews. Results: All results showed a relationship between auditory phenomena and neurosis or depressive symptoms. Nine patients showed a clear relationship between the psychism and the content or function of their phenomena, which represented or rescued affective aspects of life. The repetition of the phenomena and the suffering offered a paradoxical satisfaction, which was noticeable in all cases. Conclusion: A significant relationship between tinnitus, hallucinatory phenomena and depression was evidenced by the paradoxical satisfaction with the repetition of suffering, which is linked to the neurotic trait.

OBJETIVOS: Estudar o efeito da atenção e do silêncio sustentado no aparecimento de percepções auditivas fantasma em adultos normo-ouvintes e a relação com características sócio-demográficas. MÉTODOS: Dentro de uma cabina acústica, 66 voluntários (18 a 65 anos, média etária 37,3 anos) realizaram três experimentos de cinco minutos cada, apresentados consecutivamente e em ordem aleatória. Dois desviavam a atenção do sistema auditivo (Hanói - H e Atenção Visual - AV) e outro a direcionava para ele (Atenção Auditiva - AA). Os sujeitos foram questionados sobre suas percepções auditivas e visuais. Em nenhum momento foram apresentados quaisquer sons ou mudanças na iluminação. RESULTADOS: 19,7% dos sujeitos experimentaram alguma percepção auditiva durante o experimento H, 68,2% durante o experimento AV e 68,2% durante o experimento AA, enquanto percepções visuais foram relatadas por 6,1%, 15,2% e 4,5% dos sujeitos para os mesmos três experimentos. A diferença na freqüência de percepções auditivas e visuais foi estatisticamente significativa, assim com a diferença na freqüência de percepções auditivas nos três experimentos. Não houve diferença estatisticamente significativa para o aparecimento de percepções auditivas ou visuais em relação às variáveis estudadas (idade, gênero, nível de instrução, hipertensão arterial, diabetes, história de tontura, história prévia de zumbido ou de exposição a níveis de pressão sonora elevados). Um maior número de percepções auditivas foi referido no experimento AA. Enquanto nos experimentos H e AV a maioria das percepções auditivas foi descrita como sons típicos de zumbido (apito, chiado, \"hum\", som de insetos ou de água corrente), no experimento AA 39,9% dos sujeitos (n=26) relataram a percepção de sons atípicos, mais compatíveis com vivências alucinatórias que com zumbido. CONCLUSÕES: Zumbido e alucinação auditiva podem ocorrer na população normal em ambiente silencioso, independente de idade, gênero, nível de instrução, hipertensão arterial, diabetes, história de tontura, zumbido, ou exposição prévia a níveis de pressão sonora elevados. A ativação concomitante da atenção auditiva contribuiu de maneira importante na quantidade e na qualidade das percepções auditivas fantasma. / OBJECTIVE: To study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal hearing adults and social-demographics relations. METHODS: sitting in a sound booth, 66 volunteers (age range 18-65, mean age 37.3) performed three experiments of five minutes each, consecutively and randomly presented. Two deviated attention from auditory system, called Hanoi (H) and Visual Attention (VA) experiments and one drove attention to the auditory system, called Auditory Attention (AA). After each experiment, subjects were asked about their auditory and visual perception. No sound or light change was given at any moment. RESULTS: 19.7% of the subjects experienced auditory perceptions during H, 45.5% during VA and 68.2% during AA, while visual perceptions were experienced by 6.1%, 15.2% and 4.5% of the subjects for the same three experiments. The frequency of auditory and visual perception was statistically different, as well as the frequency of auditory perception among experiments. No significant differences for auditory perceptions emergence for studied variables were found (age, gender, instructional level, hypertension, diabetes, history of dizziness, history of tinnitus, previous exposure to high sound pressure levels). A higher prevalence of auditory perceptions was found on AA experiment. While on H and VA experiments most of the auditory perceptions were described as typical tinnitus sounds (whistle, buzzing, hum, insects and running water), on AA experiment 39,9% of the subjects (n=26) experienced non-typical tinnitus sounds, closer to hallucinatory experiences than to tinnitus. CONCLUSION: Tinnitus and auditory hallucination may occur in a non-clinical population in a silent environment, with no influences from age, gender, instructional level, hypertension, diabetes, history of dizziness, history of tinnitus, previous exposure to high sound pressure levels. Concomitant auditory attention seems to play an important role on the emergence of tinnitus.

Introdução: Nos últimos anos, nosso Grupo de Pesquisa em Zumbido identificou um número crescente de pacientes que referiram percepções repetidas de músicas e vozes, além do zumbido. Tais fenômenos alucinatórios nos instigaram a estudar suas possíveis relações com o psiquismo destes pacientes. Objetivos: avaliar se os fenômenos alucinatórios dos pacientes com zumbido têm relação com a psicose e/ou a depressão, além de esclarecer seu conteúdo e função no psiquismo. Casuística e métodos: Dez sujeitos (8 mulheres, idade média de 65,7 anos) foram avaliados pelo Inventário Fatorial da Personalidade (IFP), Escala para Depressão de Hamilton (HAM-D), entrevista semi-dirigida e entrevistas psicanalíticas. Resultados: Todos apresentaram relação dos fenômenos auditivos com a neurose e sintomas depressivos. Nove pacientes evidenciaram nítida relação entre o psiquismo e o conteúdo ou função de seus fenômenos, os quais representaram ou resgataram aspectos da vida afetiva. A repetição dos fenômenos e do sofrimento ofereceu uma satisfação paradoxal, que foi marcante em todos os casos. Conclusões: Evidenciou-se uma importante relação entre zumbido, fenômenos alucinatórios auditivos e depressão sustentada na satisfação paradoxal com a repetição do sofrimento, o que está vinculado ao caráter neurótico. / In the last few years, our Tinnitus Research Group identified a growing number of patients that repeatedly reported, in addition to tinnitus, perceptions of music and voices. Such hallucinatory phenomena inspired us to study their possible relation with these patients psychism. Objective: To assess whether the delusive phenomena of tinnitus patients are psychosis and / or depression related, in addition to clarify its content and function in the psychism. Methods: Ten subjects (8 women, mean age 65.7 years) were assessed by the Factorial Inventory of Personality (FIP), the Hamilton Depression Rating Scale (HDRS), semi-structured interviews and psychoanalytic interviews. Results: All results showed a relationship between auditory phenomena and neurosis or depressive symptoms. Nine patients showed a clear relationship between the psychism and the content or function of their phenomena, which represented or rescued affective aspects of life. The repetition of the phenomena and the suffering offered a paradoxical satisfaction, which was noticeable in all cases. Conclusion: A significant relationship between tinnitus, hallucinatory phenomena and depression was evidenced by the paradoxical satisfaction with the repetition of suffering, which is linked to the neurotic trait.

OBJETIVOS: Estudar o efeito da atenção e do silêncio sustentado no aparecimento de percepções auditivas fantasma em adultos normo-ouvintes e a relação com características sócio-demográficas. MÉTODOS: Dentro de uma cabina acústica, 66 voluntários (18 a 65 anos, média etária 37,3 anos) realizaram três experimentos de cinco minutos cada, apresentados consecutivamente e em ordem aleatória. Dois desviavam a atenção do sistema auditivo (Hanói - H e Atenção Visual - AV) e outro a direcionava para ele (Atenção Auditiva - AA). Os sujeitos foram questionados sobre suas percepções auditivas e visuais. Em nenhum momento foram apresentados quaisquer sons ou mudanças na iluminação. RESULTADOS: 19,7% dos sujeitos experimentaram alguma percepção auditiva durante o experimento H, 68,2% durante o experimento AV e 68,2% durante o experimento AA, enquanto percepções visuais foram relatadas por 6,1%, 15,2% e 4,5% dos sujeitos para os mesmos três experimentos. A diferença na freqüência de percepções auditivas e visuais foi estatisticamente significativa, assim com a diferença na freqüência de percepções auditivas nos três experimentos. Não houve diferença estatisticamente significativa para o aparecimento de percepções auditivas ou visuais em relação às variáveis estudadas (idade, gênero, nível de instrução, hipertensão arterial, diabetes, história de tontura, história prévia de zumbido ou de exposição a níveis de pressão sonora elevados). Um maior número de percepções auditivas foi referido no experimento AA. Enquanto nos experimentos H e AV a maioria das percepções auditivas foi descrita como sons típicos de zumbido (apito, chiado, \"hum\", som de insetos ou de água corrente), no experimento AA 39,9% dos sujeitos (n=26) relataram a percepção de sons atípicos, mais compatíveis com vivências alucinatórias que com zumbido. CONCLUSÕES: Zumbido e alucinação auditiva podem ocorrer na população normal em ambiente silencioso, independente de idade, gênero, nível de instrução, hipertensão arterial, diabetes, história de tontura, zumbido, ou exposição prévia a níveis de pressão sonora elevados. A ativação concomitante da atenção auditiva contribuiu de maneira importante na quantidade e na qualidade das percepções auditivas fantasma. / OBJECTIVE: To study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal hearing adults and social-demographics relations. METHODS: sitting in a sound booth, 66 volunteers (age range 18-65, mean age 37.3) performed three experiments of five minutes each, consecutively and randomly presented. Two deviated attention from auditory system, called Hanoi (H) and Visual Attention (VA) experiments and one drove attention to the auditory system, called Auditory Attention (AA). After each experiment, subjects were asked about their auditory and visual perception. No sound or light change was given at any moment. RESULTS: 19.7% of the subjects experienced auditory perceptions during H, 45.5% during VA and 68.2% during AA, while visual perceptions were experienced by 6.1%, 15.2% and 4.5% of the subjects for the same three experiments. The frequency of auditory and visual perception was statistically different, as well as the frequency of auditory perception among experiments. No significant differences for auditory perceptions emergence for studied variables were found (age, gender, instructional level, hypertension, diabetes, history of dizziness, history of tinnitus, previous exposure to high sound pressure levels). A higher prevalence of auditory perceptions was found on AA experiment. While on H and VA experiments most of the auditory perceptions were described as typical tinnitus sounds (whistle, buzzing, hum, insects and running water), on AA experiment 39,9% of the subjects (n=26) experienced non-typical tinnitus sounds, closer to hallucinatory experiences than to tinnitus. CONCLUSION: Tinnitus and auditory hallucination may occur in a non-clinical population in a silent environment, with no influences from age, gender, instructional level, hypertension, diabetes, history of dizziness, history of tinnitus, previous exposure to high sound pressure levels. Concomitant auditory attention seems to play an important role on the emergence of tinnitus.

In this case study, we present a patient with preexistent posttraumatic stress disorder and psychosis who has been recently diagnosed with Dementia with Lewy Bodies. He is experiencing vivid hallucinations. What went wrong between him and his wife as a result of these hallucinations is presented. Alternative actions that could have been used are suggested.

Auditory Verbal Hallucinations (AVH) are a generally distressing phenomena that can have a negative impact on the quality of life of the experiencer. Furthermore, individuals diagnosed with psychotic disorders often display deficits in social/cognitive domains. Despite this, little is known about how AVHs directly affect social functioning and mental status. Because of this dearth of information, exploratory research is needed to generate potential avenues for future experimental research. Qualitative themes about how AVHs influence behavior were derived from interviews with mental health social workers. Eight primary domains were identified: Behavior, social ability, observable traits, voice plasticity, life difficulty, beneficial auditory hallucinations, coping strategies, and stigmas. Implications of this research could guide future direction for experimental research as well as contribute to assessment and treatment procedures of psychotic individuals.