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Last edited on April 30, 2020

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psychdb [Auditory Hallucinations]
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 ===== Primer =====
-Psychotic symptoms, in particular, auditory hallucinations and delusions, can sometimes occur in normal, non-clinical populations.[([[https://www.ncbi.nlm.nih.gov/pubmed/11853979|Verdoux, H., & van Os, J. (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia research, 54(1), 59-65.]])]
+**Psychotic symptoms (hallucinations and delusions)** can occur in both clinical and normal, "non-clinical" populations.[([[https://www.ncbi.nlm.nih.gov/pubmed/11853979|Verdoux, H., & van Os, J. (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia research, 54(1), 59-65.]])] Thus, having a deep understanding of the phenomenology and possible diagnoses behind various subtypes of delusions and hallucinations is an important part of the diagnostic toolkit.
-===== Auditory Hallucinations =====
+===== Hallucinations =====
-Command auditory hallucinations are frequently considered a concerning feature of psychosis that requires inpatient hospitalization. However, in regards to suicide risk, the presence of command hallucinations is not an independent predictor of suicide attempts.[([[https://www.ncbi.nlm.nih.gov/pubmed/12927000|Harkavy-Friedman, J. M., Kimhy, D., Nelson, E. A., Venarde, D. F., Malaspina, D., & Mann, J. J. (2003). Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry, 64(8), 871-874.]])] Only individuals who were previously predisposed to suicide attempts have a higher risk of completed suicide.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1845151/|Pompili, M., Amador, X. F., Girardi, P., Harkavy-Friedman, J., Harrow, M., Kaplan, K., ... & Montross, L. P. (2007). Suicide risk in schizophrenia: learning from the past to change the future. Annals of general psychiatry, 6(1), 10.]])]
-Monosymptomatic auditory hallucinations, especially with recent substance use, can sometimes resolve without antipsychotic treatment.[([[https://www.ncbi.nlm.nih.gov/pubmed/20537613|Pierre, J. M. (2010). Nonantipsychotic therapy for monosymptomatic auditory hallucinations. Biological psychiatry, 68(7), e33-e34.]])]
-===== Visual Hallucinations =====
+==== Olfactory Hallucinations ====
-{{ :teaching:visual_perceptual_abnormalities_-_hallucinations_and_illusions.pdf |Visual Perceptual Abnormalities: Hallucinations and Illusions (Seminars in Neurology, 2000)}}
+  * Olfactory hallucinations (phantosmia) are hallucinations involving smells, and can occur in psychiatric disorders including [[psychosis:home|schizophrenia spectrum disorders]], [[neurology:approach-seizures|temporal lobe seizures]], brain neoplasms, and [[geri:parkinsons|Parkinson's Disease]].[([[https://pubmed.ncbi.nlm.nih.gov/23938227/|McAuley, J. H., & Gregory, S. (2012). Prevalence and clinical course of olfactory hallucinations in idiopathic Parkinson's disease. Journal of Parkinson's disease, 2(3), 199-205.]])][([[https://pubmed.ncbi.nlm.nih.gov/19364944/|Hirsch, A. R. (2009). Parkinsonism: the hyposmia and phantosmia connection. Archives of neurology, 66(4), 538-542.]])]
+==== Auditory Hallucinations ====
+  * Auditory hallucinations are the most common type of hallucination in non-organic (i.e. - primary) psychiatric conditions
+  * When assessing auditory hallucinations, ask:
+    * Does the patient hear one or several voices?
+    * Are the voices male or female?
+    * Are the voices or people they know or are they unfamiliar?
+    * Are these voices simple statements, or complex sentences?
+    * Do the voices engage in a conversation with the patient or comment on the patient’s thoughts?
+  * Command auditory hallucinations are frequently considered a concerning feature of psychosis that requires inpatient hospitalization. However, in regards to [[teaching:suicide-risk-assessment-sra|suicide risk]], the presence of command hallucinations is not an independent predictor of suicide attempts.[([[https://www.ncbi.nlm.nih.gov/pubmed/12927000|Harkavy-Friedman, J. M., Kimhy, D., Nelson, E. A., Venarde, D. F., Malaspina, D., & Mann, J. J. (2003). Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry, 64(8), 871-874.]])] Only individuals who were previously predisposed to suicide attempts have a higher risk of completed suicide.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1845151/|Pompili, M., Amador, X. F., Girardi, P., Harkavy-Friedman, J., Harrow, M., Kaplan, K., ... & Montross, L. P. (2007). Suicide risk in schizophrenia: learning from the past to change the future. Annals of general psychiatry, 6(1), 10.]])]
+  * Monosymptomatic auditory hallucinations, especially with recent substance use, can sometimes resolve without antipsychotic treatment.[([[https://www.ncbi.nlm.nih.gov/pubmed/20537613|Pierre, J. M. (2010). Nonantipsychotic therapy for monosymptomatic auditory hallucinations. Biological psychiatry, 68(7), e33-e34.]])]
+  * Individuals with hearing loss or impairment may experience non-specific auditory hallucinations that are non-psychiatric in etiology.
+    * Individuals may report hearing sounds including sounds of familiar or unfamiliar voices, music, bells, animals, machines.
+    * The use of hearing aids or reducing the hearing impairment may reduce the auditory hallucinations in these cases.[([[https://pubmed.ncbi.nlm.nih.gov/29554989/|Linszen, M. M. J., Van Zanten, G. A., Teunisse, R. J., Brouwer, R. M., Scheltens, P., & Sommer, I. E. (2019). Auditory hallucinations in adults with hearing impairment: a large prevalence study. Psychological Medicine, 49(1), 132-139.]])]
+    * Individuals with hearing loss may also report a history of tinnitus; when inquiring about tinnitus, red flags that may warrant an otolaryngology (ENT) referral include:
+        * Pulsatile tinnitus locked in time with the heartbeat
+        * Unilateral tinnitus or unilateral hearing loss
+        * Severe, disabling tinnitus
+==== Hypnagogic and Hypnopompic Hallucinations ====
+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">
+See main article: **[[sleep:2-benign-sleep-phenomena|]]**
+</alert>
+  * Hypnagogic and hypnopompic hallucinations are non-psychotic disorder type hallucinations that can occur in sleep disorders and within normal populations. Hypnagogic hallucinations are vivid perceptual experiences occurring at sleep onset at night, while hypnopompic hallucinations are similar experiences that occur at awakening in the morning.
+==== Visual Hallucinations ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **{{ :teaching:visual_perceptual_abnormalities_-_hallucinations_and_illusions.pdf |Visual Perceptual Abnormalities: Hallucinations and Illusions (Seminars in Neurology, 2000)}}**
+</alert>
+  * Visual hallucinations can be both psychiatric or neurological and it is important to understand what exactly is occurring. Visual hallucinations should prompt a more detailed [[neurology:neuro-exam:home|neurologic history and exam]].
+  * [[neurology:approach-headaches|Migraines]] are the most common single cause of visual hallucinations and illusions.
+  * Visual phenonemona (e.g. - [[neurology:approach-seizures|auras from seizures]]) can also be reported as visual hallucinations.
+  * Individuals with [[geri:dementia:lewy-body|Dementia with Lewy Bodies]] may experience visual hallucinations are part of their core symptoms.
+  * [[teaching:rare-unusual-syndromes|Charles Bonnet Syndrome (CBS)]] is a common non-psychiatric condition among people with serious vision loss (macular degeneration, glaucoma, and diabetic retinopathy) characterized by temporary visual hallucinations.
+  * Individuals with [[sleep:4-narcolepsy|narcolepsy]] may also experience visual hallucinations
+==== Cenesthesic Hallucinations ====
+  * Cenesthetic hallucinations are a type of somatic hallucination that involves involves visceral organs. For example, a patient with schizophrenia may report a pushing sensation in the blood vessels, feeling that their brain is on fire, or a cutting sensation in their bone marrow.[(Kaplan, H. I., Sadock, B. J., & Grebb, J. A. (1994). Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences, clinical psychiatry. Williams & Wilkins Co.)] [[geri:parkinsons|Parkinson's]] patients on dopaminergic agents may also report these types of hallucinations.[([[https://pubmed.ncbi.nlm.nih.gov/9221983/|Jimenez-Jimenez, F. J., Orti-Pareja, M., Gasalla, T., Tallon-Barranco, A., Cabrera-Valdivia, F., & Fernandez-Lliria, A. (1997). Cenesthetic hallucinations in a patient with Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 63(1), ]])]
+===== Delusions =====
+==== Geriatric ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671775/|Holt, A. E., & Albert, M. L. (2006). Cognitive neuroscience of delusions in aging. Neuropsychiatric disease and treatment, 2(2), 181.]]**
+</alert>
+  * Delusions in the elderly can be different from those of younger patients.
+  * Delusions in the elderly are reality-based, unlike the fantastic delusions of early onset schizophrenia. Furthermore, delusions in the elderly do not share other characteristic symptoms of schizophrenia.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671775/|Holt, A. E., & Albert, M. L. (2006). Cognitive neuroscience of delusions in aging. Neuropsychiatric disease and treatment, 2(2), 181.]])]
+    * Thought withdrawal, thought insertion, and thought broadcasting are not typically seen in patients with late-onset schizophrenia
+<panel type="info" title="Common Delusions in the Elderly" subtitle="Holt, A. E., Albert, M. L. (2006). Cognitive neuroscience of delusions in aging. Neuropsychiatric disease and treatment, 2(2), 181." no-body="true" footer="">
+<mobiletable 1>
+^ Delusion                               ^ Type               ^ Description                                     ^ Percentage of Delusions  ^
+^ Delusions of theft                     | Persecutory        | Patient is being robbed of possessions          | 20–75                    |
+^ Delusions of suspicion–physical anger  | Persecutory        | Harm to patient or patient’s loved ones         | 11–30                    |
+^ Delusions of jealousy                  | Persecutory        | Spouse is unfaithful                            | 3–16                     |
+^ Misidentification of familiar persons  | Misidentification  | Familiar person is misidentified                | 16                       |
+^ Misidentification of objects           | Misidentification  | Familiar object is misidentified                | 10–20                    |
+^ Capgras delusion                       | Misidentification  | Familiar person replaced by identical imposter  | 6–36                     |
+^ Phantom boarder syndrome               | Misidentification  | Phantom residents inhabit patient home          | 20–30                    |
+^ Mirror sign                            | Misidentification  | Misidentifies mirror image                      | 3                        |
+^ TV sign                                | Misidentification  | Misidentifies television image as real          | 7–8                      |
+^ Nurturing syndrome                     | Misidentification  | Deceased family members still living            | No range reported        |
+</mobiletable>
+</panel>
+==== Reference ====
+  * **Delusions of reference** are delusions characterized by beliefs that random events are ascribed to particular importance for the self.
+==== Grandiosity ====
+  * **Grandiose delusions** are characterized by overestimation of one's abilities, most commonly seen in mania in [[bipolar:bipolar-i|bipolar disorder]].
+==== Erotomanic ====
+  * **Erotomanic delusions** are characterized by the belief is another person is in love with the individual.
+==== Nihilistic ====
+  * **Nihilistic delusions** are characterized by a conviction that all is lost, and everything is hopeless. It can commonly be seen in [[mood:1-depression:psychotic|psychotic depression]] in the elderly.
+==== Guilt ====
+  * **Delusions of guilt** are characterized by ungrounded feeling of remorse or extreme guilt of delusional intensity.
+==== Sin ====
+  * **Delusions of sin** are characterized by fixed false beliefs that failed or defiled certain religious commandments.
+==== Somatic ====
+  * **Somatic delusions** are characterized by fixed false beliefs that one's bodily function or appearance is grossly abnormal (e.g. - "my organs are rotting inside").
+==== Poverty/Impoverishment ====
+  * **Delusions of poverty/impoverishment** are characterized by fixed false beliefs that one's financial savings are lost (despite evidence to the contrary).
+==== Theft ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://pubmed.ncbi.nlm.nih.gov/29956101/|Seeman, M. V. (2018). Understanding the delusion of theft. Psychiatric Quarterly, 89(4), 881-889.]]**
+</alert>
+  * **Delusions of theft** are characterized by the beliefs that one's belongings have been stolen someone. This can be a prodrome for neurodegenerative disorders such as Alzheimer's dementia, when individuals have in fact misplaced their belongings.
+==== Hypochondriasis ====
+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">
+See also section: **[[somatic:dsm-5:home|]]**
+</alert>
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://pubmed.ncbi.nlm.nih.gov/1441688/|Fuchs, T. (1992). The hypochondriacal delusion. Zeitschrift fur klinische Psychologie, Psychopathologie und Psychotherapie, 40(4), 396-410.]]**
+</alert>
+  * **Hypochondriacal delusions** are characterized by the delusional belief that one is afflicted with a medical disorder of defect.
+==== Persecution/Persecutory ====
+<alert type="info" icon="fa fa-book fa-lg fa-fw">
+See also: **[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108844/|Freeman, D., & Garety, P. (2014). Advances in understanding and treating persecutory delusions: a review. Social psychiatry and psychiatric epidemiology, 49(8), 1179-1189.]]**
+</alert>
+  * **Delusions of persecution** is characterized by the delusional belief that one is being targeted by an individual, group, or entity (conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed). It is most commonly seen in primary psychotic disorders such as [[psychosis:schizophrenia-scz|schizophrenia]].
+===== Congruency =====
+==== Mood-Congruent ====
+  * Mood-congruent psychotic symptoms means that the //content// of the hallucinations and delusions is consistent with typical depressive themes.
+==== Mood-Incongruent ====
+  * Mood-//incongruent// psychotic features means that the content of the hallucinations and delusions do not involve typical depressive themes.
 ===== Resources =====
 <WRAP group>
-<WRAP half column>
+<WRAP third column>
 ==== Controversies ====
   * [[https://www.psychologytoday.com/blog/saving-normal/201412/procon-british-psychological-society-report-psychosis|Pro/Con: PsychologyToday: British Psychological Society Report On 'Psychosis']]
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   * [[https://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann-redefining-mental-illness.html|NYT: Redefining Mental Illness]]
 </WRAP>
-<WRAP half column>
+<WRAP third column>
 == Research ==
   * [[https://hallucinationconsortium.org/|International Consortium on Hallucination Research (ICHR)]]
   * [[https://academic.oup.com/schizophreniabulletin/issue/40/Suppl_4|Schizophrenia Bulletin - Hallucinations Special Supplement 2013]]
+</WRAP>
+<WRAP third column>
 == Articles ==
   * [[https://www.nytimes.com/2016/10/02/opinion/sunday/medicating-a-prophet.html|NYT: Medicating a Prophet]]