This month in voices: October 2013

Adam West's tribute to Monroe seemed a good idea at the time.

The consensus was that the vent had been kinder to Marilyn Monroe.

As I mentioned in a previous post, Melbourne might currently be voice-hearing’s second city (after Utrecht), and sure enough, this month we’ll start with some research from this fine city.

As a quick aside, the city now known as Melbourne was originally called Batmania, self-named by one of the first white people to live there, the magnificently named John Batman, a syphilitic farmer from Sydney. Why would anyone want to change such a magnificent city name? Well, for a number of reasons, see a quick history of Batmania here. But, I have digressed, let’s get back to the research.

 

Melbourne, a town so cool even its Rhinos skateboard.

A Melbourne tram advert. The town is so cool even its Rhinos skateboard.

Melbourne, Australia. Neil Thomas and colleagues examine the relationship between what people think of themselves and other people, and what they believe about their voices.

Accessible summary: The meanings someone gives to their voices are influenced by what they think about themself and other people in their world (i.e., in psychology speak, the schemas they have). For example, research has already shown that people who feel powerless in relation to their voices tend to feel a lack of power in relationships with other people in their social world. This interesting study set out to examine the relationship between what people believed about their voices, and how they viewed themselves and other people in their social world.

After controlling for a range of variables, it was found that the more negatively voice-hearers viewed other people, the more malevolent they perceived their voices to be (i.e., the more they believed their voices wished to do evil to them). However, the more negatively voice-hearers viewed themselves, the more all-powerful they were likely to believe their voices to be.

However, the authors could not establish the direction of causation. So, for example, whilst it could be that having negative views of others makes you more likely to interpret your voices as malevolent, it is also possible that how malevolent you perceive your voices to be influences what you think about other people (or both!).

The authors note that “Beliefs in voice malevolence are not easy to directly modify into an alternative belief without either colluding with the idea that voices are sentient others, or challenging the person’s overall explanatory model”. Collusion seems a strong word here.

The authors conclude that techniques such as acceptance and mindfulness-based therapies that can defuse the impact of negative beliefs about oneself might be helpful for voice-hearers.

Link to paper: http://www.ncbi.nlm.nih.gov/pubmed/24103156

 

Coventry, England. Marwaha and colleagues examine the role of mood instability in psychosis.

Accessible summary: Mood stability was assessed in this study using the question, “Do you have a lot of sudden mood changes?”. People answering ‘yes’ were defined as having mood instability.

The study found that the higher mood instability was in members of the general population, the higher people’s levels of auditory hallucinations were. The authors then examined if the data was consistent with the hypothesis that childhood sexual abuse led to increased mood instability which in turn led to auditory hallucinations (i.e., whether mood instability mediated the relation between child sexual abuse and voice-hearing). The data was consistent with this (although the nature of the study didn’t allow causation to be established).

People’s levels of mood instability were also found to predict their levels of auditory hallucinations 18 months later. However, when people’s levels of general negative mood were controlled for, this relationship was no longer significant (i.e., it was plausible the association was just due to chance).

The authors conclude by suggesting that “direct therapeutic targeting of MI [mood instability] may reduce the propensity to recrudescence of psychotic symptoms”. After looking up what ‘recrudescence’ means, I think the authors are saying that therapy to help make peoples moods more stable might stop their voices re-occurring (of course, this makes the assumption that the voices breaking out again isn’t of any help to the person, which might not be true if we take seriously the idea that some voices are meaningful messangers).

Link to paper: http://dx.doi.org/10.1093/schbul/sbt149 (free to access).

 

Durham: Photo taken c.1400 (nothing changes!)

Durham: Not originally known as Batham.

Durham, England. Pete Moseley and colleagues examine the potential for neurostimulation to help us understand voice-hearing.

Accessible summary: This paper examines the use of neurostimulation techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), to help people with their voices (see previous posts for how these techniques work). The paper examines the evidence for whether these techniques work, and how they might have their potential effects (e.g., improving people’s abilities to recognise their own internally-generated mental creations as their own). It would take too long to summarise this paper, and in any case it is very readable and free to access.

Link to paper: http://dx.doi.org/10.1016/j.neubiorev.2013.10.001 (free to access)

 

Show me the Monet!

Show me the Monet!

Sandviken, Norway. Johnsen and colleagues examine the effectiveness of antipsychotics for hallucinations.

Accessible summary: This study randomly assigned 226 adults, who had been admitted to an emergency ward for psychosis, to be treated with one of four antispsychotics (risperidone, olanzapine, quetiapine, or ziprasidone). The study was particularly interested in whether these drugs helped people with their hallucinations when they were re-assessed 6 weeks later and then 2 years later.

At the start of the study 68% of patients had hallucinations. After 6 weeks this figure had decreased to 33%. Rates of hallucinations decreased quicker (over the two year period) in the patients who took quetiapine or ziprasidone. The authors conclude that “Hallucinations are fairly responsive to antipsychotic drug treatment”.

Is this a reasonable conclusion to reach from the authors’ findings?

No.

First, there was no unmedicated control group. Basically put, until you know what would have happened to people’s rates of hallucinations if they were admitted and supported in  a similar way, but not medicated, you have no good leg to stand on in order to argue that the antipsychotics caused the hallucinations to reduce.

Second, 52% (i.e., over half) of the patients didn’t make it to the 6 week follow up stage. It is quite possible that the people who dropped out were more likely to have hallucinations than those who didn’t drop out. This would have artificially reduced the percentage of people with of hallucination at the 6 week stage.

Third,  people were counted as having hallucinations even if they were only rated as having “One or two clearly formed but infrequent hallucinations, or else a number of vague abnormal perceptions which do not result in distortions of thinking or behavior” (equating to a score of 3 on a measure called the Positive and Negative Syndrome Scale). This is in contrast to many other studies which require a score of 4 or more on this scale (reflecting more severe hallucinatory experiences) in order for hallucinations to be defined as being present.

Antipsychotics may well reduce hallucinations, but unfortunately this study does not prove it (see Appendix A of my book for further discussion on antipsychotics and hallucinations).

Link to paper: http://www.biomedcentral.com/1471-244X/13/241 (free to access)

 

Other papers:

How does tDCS have it’s effect in helping voice-hearing? Link here.

What is the significance of “psychotic symptoms” in children. Free access to paper here.

Altered auditory steady state response to stimuli in people with  auditory hallucinations. Link here.

Is hallucination-proneness related to use of cannabis or cocaine? Link here (paper free to access).

Psychosis in Alzheimer’s Disease. Link here.

Hallucinations in dementia. Link here.

More next month, in the meantime Happy Christmas!

SMJ

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