Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2024 Jun;58(6):467-497. doi: 10.1177/00048674241235849. Epub 2024 Mar 12.
Auditory hallucinations (hearing voices) have been associated with a range of altered cognitive functions, pertaining to signal detection, source-monitoring, memory, inhibition and language processes. Yet, empirical results are inconsistent. Despite this, several theoretical models of auditory hallucinations persist, alongside increasing emphasis on the utility of a multidimensional framework. Thus, clarification of current evidence across the broad scope of proposed mechanisms is warranted.
A systematic search of the Web of Science, PubMed and Scopus databases was conducted. Records were screened to confirm the use of an objective behavioural cognitive task, and valid measurement of hallucinations specific to the auditory modality.
Auditory hallucinations were primarily associated with difficulties in perceptual decision-making (i.e. reduced sensitivity/accuracy for signal-noise discrimination; liberal responding to ambiguity), source-monitoring (i.e. self-other and temporal context confusion), working memory and language function (i.e. reduced verbal fluency). Mixed or limited support was observed for perceptual feature discrimination, imagery vividness/illusion susceptibility, source-monitoring for stimulus form and spatial context, recognition and recall memory, executive functions (e.g. attention, inhibition), emotion processing and language comprehension/hemispheric organisation.
Findings were considered within predictive coding and self-monitoring frameworks. Of concern was the portion of studies which - despite offering auditory-hallucination-specific aims and inferences - employed modality-general measures, and/or diagnostic-based contrasts with psychologically healthy individuals. This review highlights disparities within the literature between theoretical conceptualisations of auditory hallucinations and the body of rigorous empirical evidence supporting such inferences. Future cognitive investigations, beyond the schizophrenia-spectrum, which explicitly define and measure the timeframe and sensory modality of hallucinations, are recommended.
幻听（听到声音）与一系列认知功能改变有关，包括信号检测、来源监测、记忆、抑制和语言过程。然而，实证结果并不一致。尽管如此，几种幻听理论模型仍然存在，同时越来越强调多维框架的实用性。因此，有必要澄清当前证据在广泛提出的机制范围内的情况。
对 Web of Science、PubMed 和 Scopus 数据库进行了系统搜索。筛选记录以确认使用客观行为认知任务，并对听觉模态特有的幻听进行有效测量。
幻听主要与知觉决策困难有关（即对信号-噪声辨别力降低/准确性降低；对歧义的自由反应）、来源监测（即自我-他人和时间上下文混淆）、工作记忆和语言功能（即言语流畅性降低）。对知觉特征辨别、表象生动性/幻觉易感性、刺激形式和空间上下文的来源监测、识别和回忆记忆、执行功能（如注意力、抑制）、情绪处理以及语言理解/半球组织，观察到混合或有限的支持。
研究结果被认为是在预测编码和自我监测框架内的。令人关注的是，尽管有一些研究具有听觉幻觉特异性的目的和推断，但它们使用了模态通用的测量方法，或者与心理健康个体进行了基于诊断的对比。本综述突出了文献中听觉幻觉的理论概念化与支持这些推断的严格实证证据之间的差异。建议未来在精神分裂症谱之外进行认知研究，明确定义和测量幻觉的时间范围和感觉模态。
