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WHAT MAKES VOICES DISTRESSING? A COMPARISON OF PATIENTS WHO HEAR VOICES AND NON-PSYCHIATRIC VOICE HEARERS
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
tients with AVH were compared to healthy control subjects, the reference category. Both AVH groups were more likely to have experienced sexual and emotional abuse compared to these healthy controls. No difference could be observed between the two groups (psychotic and non-psychotic) experiencing AVH. No childhood trauma was able to distinguish between positive or negative emotional valence or distress. In addition, no significant relationships were found between sexual abuse and emotional abuse and other AVH characteristics. Healthy individuals with AVH and psychotic patients with AVH both have experienced more sexual abuse and emotional abuse during childhood compared to healthy controls. Therefore, these two childhood traumas seem related to the experience of AVH. However, no relationship was found between these two types of childhood trauma and characteristics of AVH, for instance emotional valence of content, frequency or controllability. Apparently, these childhood traumas render a person more vulnerable to experience AVH, but have no influence on voice content and associated distress.
WHAT MAKES VOICES DISTRESSING? A COMPARISON OF PATIENTS WHO HEAR VOICES AND NON-PSYCHIATRIC VOICE HEARERS Mike Jackson Bangor University, Bangor, Wales, United Kingdom Previous studies have established that a substantial proportion of the population hear voices, but do not have a mental illness in the sense of having a need for care. This study aimed to replicate and extend Andrew et al (2008) who found that compared to patients who hear voices (PVH), nonpsychiatric voice hearers (NPVH) have less negative voices, less threatening appraisals of their voices and a history of fewer traumatic events, specifically CSA. To replicate Andrews comparisons of NPVH and patients on voice hearing, appraisal and trauma history in a more representative sample of NPVH To compare the groups’ subjective experience of their voices, their current attachments and attachment history, and their metacognitive beliefs. To conduct an FMRI study of NPVH during hallucinations, compared with imagery. Sample: 20 NPVH were recruited through adverts in local media. 20 PVH were recruited from local mental health services. Measures: PANSS; PSYRATS- AH (Psychotic Symptom Rating Scales – Auditory Hallucinations Subscale); BAVQ-R (Beliefs About Voices Questionnaire); PDS (Post-trauma diagnostic scale); PBI (Parental Bonding Instrument); RSQ (Relationship Styles Questionnaire); MCQ (Metacognitive beliefs Questionnaire); Qualitative interview. NPVH only: FMRI study of live hallucinations, compared with auditory imagery, using voice localiser. NPVH did not have significant PANSS scores on positive symptoms other than voice hearing. PVH had significantly higher scores on PSYRATS ratings for voice content, distress and disruption, but not on physical characteristics of voices. PVH had substantially higher scores on all subscales of BAVQ-R; interpersonal trauma subscales of PDS; attachment avoidance and paternal care; and beliefs about need for control. FMRI analysis found that the human voice area in the superior temporal sulcus was activated during both hallucinations and imagery. Other brain areas supporting both hallucinations and imagery included fronto temporal language areas in the left hemisphere and their contralateral homologues, and the supplementary motor area (SMA). Non-psychiatric voice hearers cannot be distinguished from patients who hear voices by the physical characteristics of their experiences. Their voices are less negative in content, they make less threatening appraisals of these experiences, and they have less need for control. These contrasts could be explained the greater level of trauma and attachment disruption in patients’ histories. The FMRI study suggested that hallucinations in NPVH involved similar patterns of activation to those found in PVH in previous studies, and that hallucinations are critically distinguished from imagery by lack of voluntary control.
AUDITORY HALLUCINATIONS ELICIT SIMILAR BRAIN ACTIVATION IN PSYCHOTIC AND NON-PSYCHOTIC INDIVIDUALS Iris Sommer Institute of Psychiatry, King’s College London, London, United Kingdom While auditory verbal hallucinations (AVH) are most characteristic for schizophrenia, they also occur in non-psychotic individuals. At present, it is
S67
unclear if AVH in these non-psychotic individuals constitute the same phenomenon as AVH in psychotic patients. Comparing brain activation during AVH between non-psychotic and psychotic individuals could provide clues regarding the pathophysiology of AVH. Twenty-one non-psychotic subjects with AVH and 21 matched psychotic patients indicated the presence of AVH during 3T fMRI scanning. To identify common areas of activation during the experience of AVH in both groups a conjunction analysis was performed. In addition, a two-sample T-test was employed to discover possible differences in AVH-related activation between the groups. Several common areas of activation were observed for the psychotic and non-psychotic subjects during the experience of AVH, consisting ofthe bilateral inferior frontal gyri, insula, superior temporal gyri, supramarginal gyri and postcentral gyri, left precentral gyrus, inferior parietal lobule, superior temporal pole and right cerebellum. Nosignificant differences in AVH-related brain activation were present between the groups. The presence of multiple common areas of AVH-related activation in psychotic and non-psychotic individuals, in the absence of significant differences, implicates the involvement of the same cortical network in the experience of AVH in both groups. This suggests that the same pathophysiological mechanisms underlie the experience of AVH in psychotic and non-psychotic individuals.
DOPAMINERGIC FUNCTION IN THE PSYCHOSIS SPECTRUM: AN [18 F]-DOPA IMAGING STUDY IN HEALTHY INDIVIDUALS WITH AUDITORY HALLUCINATIONS Peter Shotbolt Institute of Psychiatry, King’s College London, London, United Kingdom The psychosis phenotype appears to exist in the population as a continuum but it is not clear if sub-clinical psychotic symptoms and psychotic disorders share the same neurobiology. We investigated whether the dopaminergic dysfunction seen in psychotic disorders is also present in well functioning people with hallucinations. We compared dopamine synthesis capacity (using [18 F]-DOPA PET imaging) in 16 healthy individuals with frequent persistent auditory verbal hallucinations (hallucinatory group) with that in 16 matched controls. There was no significant difference in the age or gender distribution between the two groups, or in the specific activity of [18 F]-DOPA administered. By chance the hallucinator group received a small but significantly greater injected dose in the hallucinator group than in the control group. However, there was no relationship between injected dose and striatal dopamine synthesis capacity in either group (r<0.2 and p>0.5 in both groups). There was no significant difference in dopamine synthesis capacity in the striatum (Fig. 1), or its functional subdivisions, between groups. There was no effect of group on striatal dopamine synthesis capacity in the univariate analysis with injected dose as a covariate (F=0.2, df=1, 28, p=0.6). A parametric analysis showed no difference between groups even at the liberal threshold of p<0.001 uncorrected. In the hallucinator group, there was no relationship between whole striatal dopamine synthesis capacity and total scores on the Psyrat AHRS (ρ=-0.15, p=0.6), PDI (ρ=-0.14, p=0.6) or SPQ (ρ=0.13, p=0.63) ratings, or their sub-scales. Conclusions: Dopamine synthesis capacity is unaltered in healthy people with auditory verbal hallucinations and not related to the severity of sub-clinical psychotic experiences in these individuals. This suggests that although there may be a phenomenological psychosis continuum, there are distinctions at the neurobiological level. Other cortical abnormalities, rather than striatal dopaminergic alterations, are associated with hallucinations. Elevated dopamine synthesis capacity appears to be specific to psychosis in schizophrenia-spectrum disorders.
Symposium NATURE AND NURTURE IN SCHIZOPHRENIA: ARE THERE COMMON UNDERLYING MECHANISMS? Chairpersons: Oliver D. Howes and Jean Paul Selten Discussant: Shitij Kapur Wednesday, 18 April 2012 2:00 pm – 4:00 pm Overall Abstract: Whilst there is undoubtedly a large genetic contribution to schizophrenia, the odds ratios associated with environmental risk
tients with AVH were compared to healthy control subjects, the reference category. Both AVH groups were more likely to have experienced sexual and emotional abuse compared to these healthy controls. No difference could be observed between the two groups (psychotic and non-psychotic) experiencing AVH. No childhood trauma was able to distinguish between positive or negative emotional valence or distress. In addition, no significant relationships were found between sexual abuse and emotional abuse and other AVH characteristics. Healthy individuals with AVH and psychotic patients with AVH both have experienced more sexual abuse and emotional abuse during childhood compared to healthy controls. Therefore, these two childhood traumas seem related to the experience of AVH. However, no relationship was found between these two types of childhood trauma and characteristics of AVH, for instance emotional valence of content, frequency or controllability. Apparently, these childhood traumas render a person more vulnerable to experience AVH, but have no influence on voice content and associated distress.
WHAT MAKES VOICES DISTRESSING? A COMPARISON OF PATIENTS WHO HEAR VOICES AND NON-PSYCHIATRIC VOICE HEARERS Mike Jackson Bangor University, Bangor, Wales, United Kingdom Previous studies have established that a substantial proportion of the population hear voices, but do not have a mental illness in the sense of having a need for care. This study aimed to replicate and extend Andrew et al (2008) who found that compared to patients who hear voices (PVH), nonpsychiatric voice hearers (NPVH) have less negative voices, less threatening appraisals of their voices and a history of fewer traumatic events, specifically CSA. To replicate Andrews comparisons of NPVH and patients on voice hearing, appraisal and trauma history in a more representative sample of NPVH To compare the groups’ subjective experience of their voices, their current attachments and attachment history, and their metacognitive beliefs. To conduct an FMRI study of NPVH during hallucinations, compared with imagery. Sample: 20 NPVH were recruited through adverts in local media. 20 PVH were recruited from local mental health services. Measures: PANSS; PSYRATS- AH (Psychotic Symptom Rating Scales – Auditory Hallucinations Subscale); BAVQ-R (Beliefs About Voices Questionnaire); PDS (Post-trauma diagnostic scale); PBI (Parental Bonding Instrument); RSQ (Relationship Styles Questionnaire); MCQ (Metacognitive beliefs Questionnaire); Qualitative interview. NPVH only: FMRI study of live hallucinations, compared with auditory imagery, using voice localiser. NPVH did not have significant PANSS scores on positive symptoms other than voice hearing. PVH had significantly higher scores on PSYRATS ratings for voice content, distress and disruption, but not on physical characteristics of voices. PVH had substantially higher scores on all subscales of BAVQ-R; interpersonal trauma subscales of PDS; attachment avoidance and paternal care; and beliefs about need for control. FMRI analysis found that the human voice area in the superior temporal sulcus was activated during both hallucinations and imagery. Other brain areas supporting both hallucinations and imagery included fronto temporal language areas in the left hemisphere and their contralateral homologues, and the supplementary motor area (SMA). Non-psychiatric voice hearers cannot be distinguished from patients who hear voices by the physical characteristics of their experiences. Their voices are less negative in content, they make less threatening appraisals of these experiences, and they have less need for control. These contrasts could be explained the greater level of trauma and attachment disruption in patients’ histories. The FMRI study suggested that hallucinations in NPVH involved similar patterns of activation to those found in PVH in previous studies, and that hallucinations are critically distinguished from imagery by lack of voluntary control.
AUDITORY HALLUCINATIONS ELICIT SIMILAR BRAIN ACTIVATION IN PSYCHOTIC AND NON-PSYCHOTIC INDIVIDUALS Iris Sommer Institute of Psychiatry, King’s College London, London, United Kingdom While auditory verbal hallucinations (AVH) are most characteristic for schizophrenia, they also occur in non-psychotic individuals. At present, it is
S67
unclear if AVH in these non-psychotic individuals constitute the same phenomenon as AVH in psychotic patients. Comparing brain activation during AVH between non-psychotic and psychotic individuals could provide clues regarding the pathophysiology of AVH. Twenty-one non-psychotic subjects with AVH and 21 matched psychotic patients indicated the presence of AVH during 3T fMRI scanning. To identify common areas of activation during the experience of AVH in both groups a conjunction analysis was performed. In addition, a two-sample T-test was employed to discover possible differences in AVH-related activation between the groups. Several common areas of activation were observed for the psychotic and non-psychotic subjects during the experience of AVH, consisting ofthe bilateral inferior frontal gyri, insula, superior temporal gyri, supramarginal gyri and postcentral gyri, left precentral gyrus, inferior parietal lobule, superior temporal pole and right cerebellum. Nosignificant differences in AVH-related brain activation were present between the groups. The presence of multiple common areas of AVH-related activation in psychotic and non-psychotic individuals, in the absence of significant differences, implicates the involvement of the same cortical network in the experience of AVH in both groups. This suggests that the same pathophysiological mechanisms underlie the experience of AVH in psychotic and non-psychotic individuals.
DOPAMINERGIC FUNCTION IN THE PSYCHOSIS SPECTRUM: AN [18 F]-DOPA IMAGING STUDY IN HEALTHY INDIVIDUALS WITH AUDITORY HALLUCINATIONS Peter Shotbolt Institute of Psychiatry, King’s College London, London, United Kingdom The psychosis phenotype appears to exist in the population as a continuum but it is not clear if sub-clinical psychotic symptoms and psychotic disorders share the same neurobiology. We investigated whether the dopaminergic dysfunction seen in psychotic disorders is also present in well functioning people with hallucinations. We compared dopamine synthesis capacity (using [18 F]-DOPA PET imaging) in 16 healthy individuals with frequent persistent auditory verbal hallucinations (hallucinatory group) with that in 16 matched controls. There was no significant difference in the age or gender distribution between the two groups, or in the specific activity of [18 F]-DOPA administered. By chance the hallucinator group received a small but significantly greater injected dose in the hallucinator group than in the control group. However, there was no relationship between injected dose and striatal dopamine synthesis capacity in either group (r<0.2 and p>0.5 in both groups). There was no significant difference in dopamine synthesis capacity in the striatum (Fig. 1), or its functional subdivisions, between groups. There was no effect of group on striatal dopamine synthesis capacity in the univariate analysis with injected dose as a covariate (F=0.2, df=1, 28, p=0.6). A parametric analysis showed no difference between groups even at the liberal threshold of p<0.001 uncorrected. In the hallucinator group, there was no relationship between whole striatal dopamine synthesis capacity and total scores on the Psyrat AHRS (ρ=-0.15, p=0.6), PDI (ρ=-0.14, p=0.6) or SPQ (ρ=0.13, p=0.63) ratings, or their sub-scales. Conclusions: Dopamine synthesis capacity is unaltered in healthy people with auditory verbal hallucinations and not related to the severity of sub-clinical psychotic experiences in these individuals. This suggests that although there may be a phenomenological psychosis continuum, there are distinctions at the neurobiological level. Other cortical abnormalities, rather than striatal dopaminergic alterations, are associated with hallucinations. Elevated dopamine synthesis capacity appears to be specific to psychosis in schizophrenia-spectrum disorders.
Symposium NATURE AND NURTURE IN SCHIZOPHRENIA: ARE THERE COMMON UNDERLYING MECHANISMS? Chairpersons: Oliver D. Howes and Jean Paul Selten Discussant: Shitij Kapur Wednesday, 18 April 2012 2:00 pm – 4:00 pm Overall Abstract: Whilst there is undoubtedly a large genetic contribution to schizophrenia, the odds ratios associated with environmental risk