Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia.
Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia.
Psychiatry Res. 2020 Aug;290:113147. doi: 10.1016/j.psychres.2020.113147. Epub 2020 Jun 4.
Phenomenological comparisons of auditory verbal hallucinations (AVHs) in affective versus non-affective psychosis have not been adequately documented. The current study aimed to: a) comprehensively describe AVH phenomenology by diagnosis and mood state, b) investigate significant predictors of voice-related distress and functional impairment, and c) conduct qualitative thematic analysis of participants' experiences. Participants were diagnosed with: a) bipolar disorder (n = 31), b) major depressive disorder (n = 34), c) schizophrenia (n = 50), or d) schizoaffective disorder (n = 26). Current voice-hearers were also subdivided into prevailing mood states: a) euthymic (n = 23), b) depressed (n = 51), or c) mania-mixed (n = 12). An in-depth, semi-structured interview was conducted, accompanied by mixed-methods analyses. Of the 34 AVH characteristics, significant group differences across diagnoses were identified only for frequency, number of voices, form of address, perceived location, level of conviction, beliefs regarding origin, and functional interference. Random forests modelling (RFM) showed experienced distress and functional interference were best predicted by discrete AVH variables. Qualitative thematic analysis revealed first-order themes: a) content, b) form, c) function, and d) non-voice. There were more similarities than differences in the phenomenology of AVHs across diagnoses, yet significant predictors of voice-related distress and functional impairment differed across affective and non-affective psychosis. This has important nosological and therapeutic applications.
情感性与非情感性精神病中听觉言语幻觉（AVH）的现象学比较尚未得到充分记录。本研究旨在：a）通过诊断和情绪状态全面描述 AVH 现象学，b）调查与声音相关的痛苦和功能障碍的显著预测因素，c）对参与者的体验进行定性主题分析。参与者被诊断为：a）双相情感障碍（n=31），b）重性抑郁障碍（n=34），c）精神分裂症（n=50）或 d）分裂情感性障碍（n=26）。目前有幻听者也分为主要情绪状态：a）心境稳定（n=23），b）抑郁（n=51）或 c）躁狂混合（n=12）。进行了深入的半结构化访谈，并进行了混合方法分析。在 34 种 AVH 特征中，仅在诊断之间发现了频率、声音数量、称呼形式、感知位置、置信度水平、对起源的信念以及功能干扰方面的显著组间差异。随机森林模型（RFM）显示，体验到的痛苦和功能干扰最能通过离散的 AVH 变量来预测。定性主题分析揭示了第一级主题：a）内容，b）形式，c）功能和 d）非声音。在诊断之间，AVH 的现象学有更多的相似之处，而不是差异，但是与声音相关的痛苦和功能障碍的显著预测因素在情感性和非情感性精神病中有所不同。这具有重要的分类学和治疗应用价值。
