Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands.
J Clin Psychiatry. 2011 Mar;72(3):320-5. doi: 10.4088/JCP.09m05797yel.
Whereas auditory verbal hallucinations (AVHs) are most characteristic of schizophrenia, their presence has frequently been described in a continuum, ranging from severely psychotic patients to schizotypal personality disorder patients to otherwise healthy participants. It remains unclear whether AVHs at the outer borders of this spectrum are indeed the same phenomenon. Furthermore, specific characteristics of AVHs may be important indicators of a psychotic disorder.
To investigate differences and similarities in AVHs in psychotic and nonpsychotic individuals, the phenomenology of AVHs in 118 psychotic outpatients was compared to that in 111 otherwise healthy individuals, both experiencing AVHs at least once a month. The study was performed between September 2007 and March 2010 at the University Medical Center, Utrecht, the Netherlands. Characteristics of AVHs were quantified using the Psychotic Symptoms Rating Scales Auditory Hallucinations subscale.
The perceived location of voices (inside/outside the head), the number of voices, loudness, and personification did not differentiate between psychotic and healthy individuals. The most prominent differences between AVHs in healthy and psychotic individuals were the emotional valence of the content, the frequency of AVHs, and the control subjects had over their AVHs (all P values < .001). Age at onset of AVHs was at a significantly younger age in the healthy individuals (P < .001). In our sample, the negative emotional valence of the content of AVHs could accurately predict the presence of a psychotic disorder in 88% of the participants.
We cannot ascertain whether AVHs at the outer borders of the spectrum should be considered the same phenomenon, as there are both similarities and differences. The much younger age at onset of AVHs in the healthy subjects compared to that in psychotic patients may suggest a different pathophysiology. The high predictive value of the emotional content of voices implies that inquiring after the emotional content of AVHs may be a crucial step in the diagnosis of psychotic disorders in individuals hearing voices.
虽然听觉言语幻觉（AVH）是精神分裂症最具特征性的表现，但在从严重精神病患者到分裂型人格障碍患者再到其他健康参与者的连续谱中，常可观察到 AVH 的存在。目前尚不清楚该谱系两端的 AVH 是否为同一现象。此外，AVH 的特定特征可能是精神障碍的重要指标。
为了研究精神病患者和非精神病患者的 AVH 之间的差异和相似性，我们将 118 例精神病门诊患者和 111 例无精神病但至少每月经历一次 AVH 的健康个体的 AVH 现象进行了比较。该研究于 2007 年 9 月至 2010 年 3 月在荷兰乌得勒支大学医学中心进行。使用精神病症状评定量表听觉幻觉分量表对 AVH 的特征进行量化。
声音的感知位置（头内/头外）、声音数量、音量和人格化在精神病患者和健康个体之间没有差异。健康个体和精神病个体的 AVH 之间最显著的差异是内容的情感效价、AVH 的频率以及对照者对其 AVH 的控制（均 P 值<.001）。AVH 发病年龄在健康个体中明显较早（P<.001）。在我们的样本中，AVH 内容的负性情感效价可准确预测 88%参与者存在精神障碍。
我们尚不能确定谱系两端的 AVH 是否应被视为同一现象，因为既有相似之处，也有不同之处。与精神病患者相比，健康个体的 AVH 发病年龄明显更早，这可能提示其病理生理学机制不同。声音内容的情感效价具有较高的预测价值，这意味着询问 AVH 的情感内容可能是诊断听到声音的个体发生精神障碍的关键步骤。
