Johns Louise C, Gregg Lynsey, Allen Paul, McGuire Philip K
Section of Neuroimaging, Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London, UK.
Psychol Med. 2006 Apr;36(4):465-74. doi: 10.1017/S0033291705006628. Epub 2006 Jan 10.
Cognitive models propose that auditory verbal hallucinations arise through defective self-monitoring and external attribution of inner speech. We used a paradigm that engages verbal self-monitoring to examine how deficits in this process are related to symptoms and diagnosis in patients with psychosis.
We tested 45 patients with schizophrenia. Fifteen had current auditory hallucinations, 15 had a history of (but no current) auditory hallucinations, and 15 had delusions but neither current nor previous hallucinations. We also tested 10 patients with affective psychosis and current auditory hallucinations, and 20 healthy volunteers. Participants read single adjectives aloud while the source and the pitch of the on-line auditory verbal feedback was manipulated, then immediately identified the source of the speech they heard ('self'/'other'/'unsure').
When reading aloud with distorted feedback of their own voice, patients with schizophrenia who had auditory hallucinations were more likely than controls to misidentify its source as 'other'. Patients with delusions but no current hallucinations displayed a similar deficit, although there was a trend for this to be less marked. Patients with a history of hallucinations did not differ from controls. Patients with hallucinations in the context of an affective disorder made more unsure responses rather than misattributions.
Difficulty with source monitoring was related to the acute psychotic state rather than a predisposition to hallucinations, and was evident in patients with affective psychosis as well as schizophrenia. External misattribution of source may reflect an impairment in verbal self-monitoring and/or the appraisal of ambiguous sensory material.
认知模型提出，听幻觉是通过内部言语的自我监测缺陷和外部归因产生的。我们采用了一种涉及言语自我监测的范式，以研究这一过程中的缺陷与精神病患者症状及诊断之间的关系。
我们测试了45名精神分裂症患者。其中15名有当前听幻觉，15名有听幻觉病史（但目前没有），15名有妄想但目前及既往均无幻觉。我们还测试了10名患有情感性精神病且有当前听幻觉的患者以及20名健康志愿者。参与者大声朗读单个形容词，同时对在线听觉言语反馈的来源和音高进行操控，然后立即辨别他们所听到言语的来源（“自己”/“他人”/“不确定”）。
在朗读时听到自己声音的失真反馈时，有听幻觉的精神分裂症患者比对照组更有可能将其来源错误地识别为“他人”。有妄想但目前无幻觉的患者也表现出类似的缺陷，尽管这种趋势不太明显。有幻觉病史的患者与对照组没有差异。患有情感障碍且有幻觉的患者做出更多不确定的反应而非错误归因。
来源监测困难与急性精神病状态有关，而非幻觉倾向，并且在情感性精神病患者以及精神分裂症患者中均很明显。来源的外部错误归因可能反映了言语自我监测和/或对模糊感官材料评估的损害。
