AUDITORY HALLUCINATIONS: CAUSES, TYPES, TREATMENTS - ECONOMÍA - 2024

The auditory hallucinations are impaired perception in which unrealistic sounds are perceived by the auditory sense. This type of hallucinations constitute one of the main perceptual alterations that can be witnessed in human beings.

Normally, this type of symptomatology is associated with schizophrenia, however, hallucinations can appear in other mental disorders and as a direct effect of other causes.

At present, hallucinations are considered to constitute an alteration of both thought and perception, so both factors are involved in the appearance of symptoms.

Causes

Auditory hallucinations are often associated with the presence of schizophrenia, however, this disease is not the only cause that can lead to its appearance. The main causes that can motivate the manifestation of auditory hallucinations are:

• Temporal lobe epilepsy: seizures in this region of the brain can cause hallucinations to occur relatively frequently.
• Use of hallucinogens: substances such as cannabis, LSD, methamphetamine and many others can cause hallucinations.
• Dementia: in the more advanced stages of the disease, hallucinations can be seen in response to brain deterioration.
• Alcohol withdrawal: the alcoholic who stops consuming his desired substance may manifest a series of symptoms, one of them auditory hallucinations.
• Psychosis: any type of psychotic disorder can manifest itself with auditory hallucinations.
• Depression: severe and psychotic depressions can lead to hallucinations.
• Narcolepsy: it is a disease that causes excess drowsiness and that can cause fleeting visions in the wake-sleep transition.
• Other causes: although less frequently, physical illnesses such as cancer, encephalitis, hemiplegic migraine and cardiovascular accidents can also cause the appearance of auditory hallucinations.

Types of auditory hallucinations

Auditory hallucinations are the ones that occur most frequently, especially in psychotic subjects, so they are also the ones that have received the most scientific attention in recent years.

They can acquire two forms of presentation: verbal and non-verbal. In addition, an individual can suffer from both types of hallucinations simultaneously.

Both verbal and non-verbal can be heard inside or outside the head, heard clearly or vaguely, be poor in detail, or become authentic speech.

In general, it is maintained that those that are heard outside the head, are heard vaguely, are poor in details and adopt the non-verbal form, are those that revert less seriousness on the patient.

Verbal auditory hallucinations

Wernicke called these types of hallucinations as phonemes, and pointed out that they tend to present with a more threatening and imperative tone, especially in people with schizophrenia.

The patient can perceive the voices of known or unknown people who comment on their own actions or dialogue with them directly.

Severe affective psychoses of the depressive type can also cause auditory verbal hallucinations. In these cases, the voices that the patient perceives usually have an imperative tone and emphasize their feelings of guilt.

In contrast, those seen in the manic episodes of bipolar disorder can have pleasant or grandiose content, and correlate with the expansive mood of the person.

It should be borne in mind that the content of hallucinations can seriously influence the behavior of the person suffering from them and significantly affect their life. The life of the patient can revolve around the voices that he hears frequently and these can cause him great discomfort.

In some exceptional cases, hallucinations can be reassuring and not bother the patient.

Non-verbal auditory hallucinations

These types of hallucinations have a wide spectrum of presentation and patients complain of hearing noises, unstructured sounds, whispers, bells, motors, etc.

They tend to be less severe in character than verbal hallucinations and generally produce less structured, vague perceptual distortions with less impact on the behavior and well-being of the person.

However, these hallucinations can also be highly unpleasant for the person suffering from it and may require treatment.

Musical hallucination

It is a special type of very rare auditory hallucination, of which a good part of its diagnostic function and its etiological factors are unknown. Berrios pointed out in 1990 that its most frequent causes are deafness and brain injuries.

The hallucinatory experience of these symptoms may vary in some aspects such as the beginning form, the familiarity of what is heard, the musical genre and the location of what is perceived.

However, all the forms of presentation are characterized by hearing "musiquillas" or well-defined songs without the presence of the auditory stimulus.

Treatment

Hallucinations are a serious alteration that can endanger both the well-being and the integrity of the person who suffers.

Suffering hallucinations is not only an annoying symptom for the person who suffers from it, but when they affect their behavior, it can pose a significant danger to the individual.

The characteristics of these alterations highlight the high importance of applying an appropriate treatment when hallucinations are suffered.

The intervention to be performed must address the underlying mental illness that motivates the auditory hallucinations. However, before this type of psychotic symptomatology, pharmacological treatment based on antipsychotic medications is usually required.

In addition, psychological treatments such as cognitive behavioral therapy may be appropriate in some cases to increase the patient's coping skills and strategies.

Clinical dimensions

Hallucinations should be interpreted as multidimensional phenomena and not as a one-dimensional alteration. In other words, not only the presence or absence of hallucination must be addressed, but also the functional continuum that characterizes it.

The analysis of hallucinations should be carried out from one extreme (normal behavior and absence of hallucinations) to the other extreme (clearly psychotic behavior and the presence of highly structured hallucinations).

The main dimensions to take into account are:

Degree of control over auditory hallucination

To speak of auditory hallucination, it has to be totally uncontrollable for the patient.

In this way, to clarify the characteristics of the symptoms suffered, it is necessary to evaluate what is the degree of control that the individual has over the elements that he hears and the perceptual distortions that he presents.

Emotional response

Normally auditory hallucinations cause discomfort and anxiety to the person suffering from it. However, this is not always the case, since in some cases they can even be pleasant and in other cases they can lead to highly disturbing emotional conditioning.

This fact is essential when specifying the characteristics of the symptom, its severity and the impact it generates on the individual's life.

Location of hallucination

Auditory hallucinations can be located inside or outside of the person's head. A patient can interpret the stimuli that she hears are produced within her brain or perceive them from the outside world.

Both types of locations can imply severity and can affect the behavior of the person, however, those that are located inside tend to cause greater discomfort in the individual.

Coping strategies

It is important to take into account what are the coping strategies that the person presents with respect to hallucinations.

These can range from none in cases in which the patient is not aware of having any hallucination, to highly elaborate strategies in individuals who try to mitigate the appearance of these annoying symptoms.

Frequency and duration

In some cases, hallucinations occur sporadically and in very short intervals of time, while in other cases they can occur continuously and for a long time.

Hallucination content

The content of the hallucination is the main factor that will determine the discomfort caused and the effect it will have on the individual's behavior.

Whenever one of these symptoms is detected or diagnosed, it is of special relevance to clarify what the content of the perceptual distortion is.

When do auditory hallucinations occur?

It must be borne in mind that not all perceptual alterations involve a hallucination. In fact, hallucinations constitute a type of perceptual alteration, however they can also adopt other forms of presentation and manifest different characteristics.

In order to properly distinguish hallucinations from other symptoms, Slade and Bentall, two cognitive authors, proposed three main criteria.

1- Any experience similar to perception that occurs in the absence of an appropriate stimulus

This first criterion allows us to differentiate between illusion and hallucination, two concepts that can be easily confused.

Both internal and external influences are involved in the illusion, a fact that produces a misinterpretation of a real stimulus. However, in hallucination there are only internal causes, so there is no real stimulus that motivates the appearance of what is perceived.

For example, in an illusion you can mistake the noise of a fan for a person's voice and think that someone is whispering something. However, in a hallucination, the person's voice does not appear after the misinterpretation of a real stimulus, but rather the element heard is produced solely by brain activity.

2- Has all the force and impact of the corresponding real perception

This second criterion enables hallucination to be differentiated from another very similar phenomenon, pseudo-hallucination. To affirm the presence of a hallucination, the person who suffers it must have the conviction that what is experienced has its origin outside the person and has a real character.

Pseudo-hallucination is a phenomenon similar to hallucination that appears motivated by dissociation but in which the person is more or less able to separate his pseudo-hallucination from reality.

3- It is not capable of being directed or controlled by the person who suffers it

The lack of control allows distinguishing the hallucination from other images or sounds experienced, and refers to the impossibility of altering or diminishing the experience by the simple desire or will of the person.

The hallucination creates a psychotic alteration. The person who suffers from it absolutely believes in it and is not able to control or alter its appearance.

References

1. Berenguer V, Echanove MJ, González JC, Cañete C, Alvarez I, Leal C, Sanjuan J.
2. Pharmacogenetic evaluation of the response to antipsychotics in patients with auditory hallucinations. Actas Esp Psiquiatr 2002.
3. González JC, Sanjuan J, Aguilar EJ, Berenguer V, Leal C. Clinical dimensions of auditory hallucinations. Archives of Psychiatry 2003; 6 (3): 231-46
4. Lawrie SM, Buechel C, Whalley HC, Frith CD, Friston KJ, Johnstone EC. Reduced frontotemporal functional connectivity in schizophrenia associated with auditory hallucinations. Biol Psychiatry 2002; 51 (12): 1008-11.
5. Junginger J, Frame CL. Self-report of the frequency and phenomenology of verbal hallucinations. J Nerv Ment Dis 1985; 173: 149-55.
6. Johns LC Hemsley D, Kuipers E. A comparison of auditory hallucinations in a psychiatric and non-psychiatric group. Br J Clin Psicol 2002; 41: 81-6.
7. Holmes C, Smith H, Ganderton R, Arranz M, Collier D, Powell J, Lovestone S. Psychosis and aggression in Alzheimer's disease: the effect of dopamine receptor gene variation. Neurol Neurosurg Psychiatry 2001; 71 (6): 777-9.
8. Slade P, Bentall R. Sensory deception: A scientific analysis of hallucination. London and Sydney: Croom Helm. 1988.