On the phenomenology of auditory verbal hallucinations in affective and non-affective psychosis.
W. L. Toh, N. Thomas, Y. Hollander, S. Rossell
Psychiatry Research June 4, 2020 Peer reviewed DOI: 10.1016/j.psychres.2020.113147 via Semantic Scholar
Summary
People with bipolar disorder, major depressive disorder, schizophrenia, or schizoaffective disorder who hear voices report more similarities than differences in their experiences. Across 34 voice characteristics, only seven differed by diagnosis: frequency, number of voices, form of address, perceived location, level of conviction, beliefs about origin, and functional interference. Distress and functional impairment were best predicted by specific voice characteristics, and these predictors differed between affective and non-affective psychosis. A qualitative analysis identified four main themes: content, form, function, and non-voice experiences.
Study at a glance
| Design | cross-sectional, mixed-methods study |
|---|---|
| Sample size | 141 |
| Population | adults diagnosed with bipolar disorder, major depressive disorder, schizophrenia, or schizoaffective disorder who currently experience auditory verbal hallucinations |
| Key finding | Auditory verbal hallucination phenomenology is largely similar across diagnoses, but predictors of voice-related distress and functional impairment differ between affective and non-affective psychosis. |
Abstract
Phenomenological comparisons of auditory verbal hallucinations (AVHs) in affective versus non-affective psychosis have not been adequately documented. The current study aimed to: a) comprehensively describe AVH phenomenology by diagnosis and mood state, b) investigate significant predictors of voice-related distress and functional impairment, and c) conduct qualitative thematic analysis of participants' experiences. Participants were diagnosed with: a) bipolar disorder (n = 31), b) major depressive disorder (n = 34), c) schizophrenia (n = 50), or d) schizoaffective disorder (n = 26). Current voice-hearers were also subdivided into prevailing mood states: a) euthymic (n = 23), b) depressed (n = 51), or c) mania-mixed (n = 12). An in-depth, semi-structured interview was conducted, accompanied by mixed-methods analyses. Of the 34 AVH characteristics, significant group differences across diagnoses were identified only for frequency, number of voices, form of address, perceived location, level of conviction, beliefs regarding origin, and functional interference. Random forests modelling (RFM) showed experienced distress and functional interference were best predicted by discrete AVH variables. Qualitative thematic analysis revealed first-order themes: a) content, b) form, c) function, and d) non-voice. There were more similarities than differences in the phenomenology of AVHs across diagnoses, yet significant predictors of voice-related distress and functional impairment differed across affective and non-affective psychosis. This has important nosological and therapeutic applications.