Zisook S, Byrd D, Kuck J, Jeste D V
Department of Psychiatry, University of California, San Diego, USA.
J Clin Psychiatry. 1995 Oct;56(10):462-5.
The presence of command hallucinations in individuals with schizophrenia may result in an increase in clinical monitoring to reduce the perceived risk of violent behavior. However, the issue of whether command hallucinations hold any clinical relevance in relatively stable outpatient samples has not been established.
The clinical and research records of individuals with schizophrenia who participated in outpatient research protocols at the University of California, San Diego were reviewed for the presence of command hallucinations. Information on clinical characteristics was collected in a detailed chart review from 106 patient records.
Command hallucinations were reported by one half of all patients with auditory hallucinations, and these hallucinations often were violent in content. Yet, in over a third of the patients, these hallucinations had not been documented in their clinical charts, but instead were uncovered during a secondary source review. Patients with command hallucinations generally did not differ on prognostic or clinical course variables. However, the 2 patients who committed suicide during the study were patients with command hallucinations.
Although command hallucinations may be more frequent than clinicians generally note, in most cases they have minimal influence on the outcome of schizophrenia. However, in outpatients with schizophrenia who have a history of suicide attempts, suicidal command hallucinations should be taken seriously.
精神分裂症患者出现命令性幻听可能会导致临床监测增加，以降低感知到的暴力行为风险。然而，在相对稳定的门诊样本中，命令性幻听是否具有任何临床相关性这一问题尚未明确。
回顾了在加利福尼亚大学圣地亚哥分校参与门诊研究方案的精神分裂症患者的临床和研究记录，以确定是否存在命令性幻听。通过对106份患者记录进行详细的病历审查，收集了临床特征信息。
所有有幻听的患者中有一半报告有命令性幻听，且这些幻听的内容往往具有暴力性。然而，超过三分之一的患者，这些幻听在其临床病历中未被记录，而是在二次资料审查中被发现。有命令性幻听的患者在预后或临床病程变量方面通常没有差异。然而，在研究期间自杀的2名患者是有命令性幻听的患者。
虽然命令性幻听可能比临床医生通常注意到的更为频繁，但在大多数情况下，它们对精神分裂症的预后影响极小。然而，对于有自杀未遂史的精神分裂症门诊患者，应认真对待自杀性命令性幻听。
