Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, UK.
Bipolar Disord. 2017 Sep;19(6):417-433. doi: 10.1111/bdi.12520. Epub 2017 Aug 14.
The aim of the current study was to inform ongoing attempts to identify clinically meaningful subcategories of auditory verbal hallucination (AVH), and to evaluate evidence that might pertain to the suitability of current psychological interventions for people with bipolar disorder (BD) who experience psychotic symptoms.
A comprehensive synthesis of findings on the phenomenology of AVH and delusions in BD is included, alongside a critical review of clinical and cognitive correlates. Studies published in the previous 20 years, until December 2016, were retrieved from the following databases: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. Thirty-two articles were reviewed after applying a set of predetermined inclusion criteria.
Psychotic symptoms were common in both manic and depressive phases, although higher frequencies were indicated in mania. Few detailed characterizations of AVH phenomenology were identified. Delusions with persecutory, grandiose and referential themes were the most common in BD. AVHs were associated with delusions and there was evidence to suggest that delusion subtype may vary according to mood state and type of AVH. Data on clinical correlates of AVH in BD were sparse. However, the results indicated that cognitive appraisals or interpretations of voices might be different in BD from those established to be predictive of clinical outcomes in schizophrenia spectrum disorders.
Clear gaps exist in our current understanding of the first-person experience of AVH in BD and the potential relationship to co-occurring symptoms, including delusions. Further research into cognitive interpretations of AVH in BD might inform adapted psychological interventions for psychotic symptoms in this population.
本研究旨在为当前正在进行的识别听觉言语幻觉（AVH）有临床意义的亚类的尝试提供信息，并评估可能与当前针对经历精神病症状的双相障碍（BD）患者的心理干预措施的适用性相关的证据。
包括对 BD 中的 AVH 和妄想的现象学的全面综合，以及对临床和认知相关性的批判性回顾。在之前 20 年中，截至 2016 年 12 月，从以下数据库中检索到已发表的研究：Embase、CINAHL、MEDLINE、PsycINFO 和 Web of Science。在应用一套预定的纳入标准后，共审查了 32 篇文章。
精神病症状在躁狂和抑郁期都很常见，尽管在躁狂期频率更高。确定的 AVH 现象学的详细特征很少。BD 中最常见的妄想主题是迫害、夸大和参照。AVH 与妄想有关，并且有证据表明，妄想亚型可能根据情绪状态和 AVH 的类型而有所不同。BD 中 AVH 的临床相关性数据很少。然而，结果表明，在 BD 中，对声音的认知评估或解释可能与在精神分裂症谱系障碍中预测临床结果的那些不同。
我们目前对 BD 中 AVH 的第一人称体验以及与共病症状（包括妄想）的潜在关系的理解存在明显差距。进一步研究 BD 中对 AVH 的认知解释可能为该人群的精神病症状提供适应性心理干预措施。
