Auditory hallucinations are auditory perception disorders in which patients hear different types of sounds without a corresponding external stimulus. It can be rustles, noises, melodies, calls, words and phrases. There are hallucinatory voices of a neutral type, threatening, imperative. Patients perceive auditory hallucinations as part of reality: they experience fear, anxiety, and perform dangerous actions for themselves and others. The survey includes a conversation, observation, performing the Aschaffenburg test. Symptomatic therapy is based on the use of neuroleptics.
general characteristics
Auditory hallucinations are manifested by various sound phenomena - melodies, noises, voices, which are perceived by patients as true, really existing. The attitude towards hallucinatory phenomena as a pathology is formed gradually as a result of beliefs on the part of close people, doctors. In mental disorders, when hallucinatory sounds are justified by delusional concepts, patients continue to believe in the reality of what they hear, despite the assurances of others.
Auditory hallucinations are simple and complex. The simple ones are represented by acoasms - noises, hissing, roaring, grinding, buzzing. Sometimes patients cannot guess what type of source generated the sound, in other cases they clearly define its “causes” - the shuffling of the sole of the boot, the creak of the floorboards, the hum of the car. Another type of simple auditory hallucinations is phonemes. These are speech deceptions of hearing in the form of a shout, individual vowel sounds, syllables, fragments of words.
Complex auditory hallucinations are represented by musical and verbal images. With musical phenomena, people hear the playing of musical instruments, singing, melodies. Verbal hallucinations - individual words, phrases, monologue or dialogic speech. Among the verbal hallucinatory phenomena are commenting, threatening and imperative. Commenting voices express an opinion about the patient's actions, threatening voices intimidate, imperative voices order or forbid something, for example, they demand to commit suicide, refuse to eat.
Causes of auditory hallucinations
Auditory hallucinations are more often related to productive psychopathological symptoms, but can occur as a manifestation of a neurological pathology affecting certain brain structures, as well as in the absence of diseases. The underlying causes of hallucinatory symptoms are abnormal, unrelated to external stimuli, activation of the auditory cortex and loss of the ability to recognize inner speech as one's own. Factors that provoke auditory hallucinations are physiological changes, mental illness, organic damage to brain tissue.
Physiological causes
According to medical research, sometimes auditory hallucinations occur in perfectly healthy people. They are transient in nature, often provoked by unusual external influences. A critical attitude to sound phenomena remains relatively intact: at the moment of hallucination, people cannot distinguish what they hear from reality, but later they begin to think about the unreality of what happened. The most likely causes of hallucinatory experiences in a healthy person are:
- Lack of sleep. Refusal of full sleep provokes depression of nervous functions: cognitive processes worsen, orientation in time and space. Visual, auditory hallucinations appear on the fourth day of insomnia, when anxiety and fussiness increase, there is a feeling of unreality of the surroundings. Volitional functions are lost, a person becomes suggestible, manageable.
- Sensory deprivation. People are constantly surrounded by background noise. Absolute silence disorganizes the work of the brain, it begins to compensate for the missing stimuli with its own pathological activity, creating auditory hallucinations - sound images that do not have an external cause. So, astronauts in outer space are at risk of hallucinosis due to sensory deprivation.
- Sleep transition. Just before falling asleep, some people experience hypnagogic visual and auditory hallucinations. Their content is often associated with events that happened during the day or about which a person has been thinking a lot lately. Auditory phenomena are unstable, easily disintegrate when trying to recognize their source. Similar hallucinations are sometimes observed during periods of awakening, light daytime naps.
- Adolescence. Auditory hallucinations without any disease can occur in children during adolescence. The reasons are a violation of the process of internalization of the inner voice: when a child learns to conduct internal dialogues and read to himself (not aloud), inner speech is separated from its source, that is, the process of its origin ceases to be fully realized. There is a sense of a voice from outside.
mental illness
The most common causes of persistent auditory hallucinations are mental disorders. Patients can hear noises, the sound of steps, squeaks, voices, melodies. In the structure of the hallucinatory-delusional syndrome, the plot of hallucinations has something in common with delusional ideas: it strengthens them, directs them, and confirms them. The most dangerous are imperative voices ordering the patient to perform actions that harm himself or others. Possible causes of auditory modality hallucinations in psychopathology:
- Bipolar affective disorder. The disease is characterized by alternating manic and depressive periods. Severe forms of depressive phases proceed with an increase in distrust of others, the formation of ideas of attitude, and manic stages - with an experience of bliss, delusions of grandeur and physical impact, auditory hallucinations. Thoughts of patients become incoherent, behavior - excited-inhibited. Auditory perceptual deceptions reinforce delusional ideas (“someone whispers, it means he wants to attack”).
- Schizophrenia. About 70% of patients hear voices that threaten for no reason, give information about the desire of others to cause harm, comment on the actions of the patient, make comments, order to commit suicide, injure another person. Another option is antagonistic auditory hallucinations, when a person hears a dispute between "good" and "bad" voices. Concomitant symptoms - delirium, fragmentation of thinking, inadequacy of emotions, behavior.
- epileptic psychoses. Acute psychoses occur with catatonia, delirium, hallucinosis, religious-ecstatic states. Symptoms may appear against a background of clear or clouded consciousness. In chronic epileptic psychosis, an imperative hallucinosis unfolds - voices force the patient to commit neutral or illegal acts. Auditory hallucinations are religious in nature (for example, the voice of God demanding punishment for sins).
- Alcoholic psychoses. In persons who abuse alcohol, the causes of hallucinations are acute intoxication and meta-alcoholic psychosis. With alcohol intoxication, auditory hallucinations unfold at the height of intoxication, especially after taking surrogates. Voices, as a rule, report neutral information: they comment, discuss the actions of a person. During the withdrawal of alcohol after a long use, delirium develops (stupefaction) and alcoholic paranoid, which is accompanied by hallucinations of a threatening nature.
Neurological diseases
Hallucinatory phenomena of various modalities can occur as a result of an organic lesion of the central nervous system: in neurodegenerative pathologies, vascular diseases, ischemic, traumatic and tumor processes in the brain. The origin of auditory perceptual delusions is associated with increased excitability of the temporal lobes of the cortex. The following pathologies are considered as the causes of hallucinations:
- Neurodegenerative diseases. In degenerative diseases, progressive death of brain cells occurs. Dementia develops, which is manifested by a steady decrease in memory, attention, thinking. Auditory hallucinations are often combined with visual, olfactory. Voices are characteristic: words, hails, whole phrases indicating to the patient what to do.
- Local lesions of the brain. Heart attacks, strokes, aneurysms of the cerebral arteries, tumors, craniocerebral injuries are the causes of auditory hallucinations when the pathological focus is localized in the temporal lobe. Patients hear unformed noises, speech, melodies, singing. With temporal lobe epilepsy, the sound of one or more musical instruments often occurs.
- Acquired deafness. The weakening of hearing or the development of absolute deafness leads to the appearance of sound hallucinatory phenomena. The mechanism of their formation is similar to that in a situation of sensitive deprivation: the lack of impulses from outside is compensated by the brain. Patients often hear ringing, singing, music. This symptom persists after the fitting of a hearing aid or after the installation of a cochlear implant.
Diagnostics
Auditory hallucinations are often a symptom of a mental illness or an organic pathology of the brain. If there is a suspicion of psychopathology, a clinical conversation, pathopsychological testing is carried out, which allows assessing changes in the cognitive and emotional-personal spheres. To confirm or refute the presence of an organic cause, laboratory tests of blood, urine and cerebrospinal fluid, EEG CT and MRI of the brain are performed. To detect the hallucinations themselves, the psychiatrist uses the following methods:
- Collection of anamnesis. Obtaining information about symptoms can be difficult, as patients often have a critical understanding of the nature of hallucinations. A survey of family members allows the doctor to establish the approximate duration of the disorder, concomitant changes in behavior, emotional reactions, and intellectual abilities. General information about the patient is also taken into account: age, the presence of vascular and neurological diseases, alcohol or drug addiction.
- observation. The presence of auditory hallucinations can be detected by observing the behavior of the patient: he listens to something, holds his head to the side, pauses for no apparent reason before answering the doctor's question. With intrusive voices, the patient enters into a dialogue with them: he asks to be silent, not to indicate.
- Aschaffenburg test . The perceptual disturbance hidden by the patient can be detected using a provocative test. The patient is invited to talk on the disconnected phone, to share his impressions of the conversation. The presence of auditory hallucinations is confirmed when conducting a dialogue, discussing its topic with a doctor. A positive result is most characteristic of alcoholic delirium.
Treatment
The basis of symptomatic care for patients with hallucinations is the selection of antipsychotic drugs that alter dopamine metabolism. They reduce psychomotor agitation and thought disorders, stop hallucinatory-delusional phenomena. With severe emotional disorders, antidepressants and normotimics are additionally prescribed. In some cases, cognitive psychotherapy is effective, focused on persuading the patient of the unreality and pathological nature of audible phenomena.