retrospective ative in content (e.g., derogatory, critical, and intru-study of more than 3,000 patients with complex partial sive), and more often of known identity and of the male seizures, Mauguiere and colleagues [164] reported a gender. Voices are heard inside the head, outside the frequency of auditory ictal phenomena in 2.4% This head, or both inside and outside in roughly equal pro-included hyperacusis (19%), elementary noises (14% ) portions (34%, 28%, and 38%) [152]. There is mixed speech (18%), and music (23%).
evidence as to whether externally heard hallucinated Auditory hallucinations can comprise some of voices are more likely to be judged to be real, [151,
the symptoms of a schizophrenia-like psychosis in 152, 153] but they both appear to evoke similar lev-epilepsy. Most ( ∼ 70%) of these seizure disorders have els of negative feelings [152]. Most hallucinated voices a temporal focus [165] and have the clinical pat-are heard clearly and are either loud or very loud, and tern of complex partial seizures. The psychoses of address the hearer in the second or third person [154].
epilepsy are currently defined as ictal (concurrent with Approximately 50% of adult psychiatric patients with seizure), postictal (within 1–2 days of seizure) and auditory hallucinations experience command hallu-brief (days to weeks post seizure) or chronic interic-cinations, with approximately 50% being associated tal [166]. Although ictal psychoses most closely resem-with dangerous behavior [155]. The majority (66%) of ble a delirium as described above, often with pre-patients with auditory hallucinations report using cop-served, if delayed insight, the other presentations may ing strategies to deal with them; such strategies include include auditory hallucinations, particularly of the distraction, auditory competition, or trying to relax or spoken voice, which mimic those of schizophrenia.
sleep, which are often at least partially successful [4].
A large body of research has explored the neurobiological basis for the high rate of auditory halluci-Traumatic brain injury nations in schizophrenia. Consensus is emerging that Auditory hallucinations are also reported in trau-aberrant speech mechanisms underlie these symptoms matic brain injury. Although psychotic symptoms in most psychotic patients [156], resulting in inner are described in up to 8% with some form of trau-
30
speech identified as external due to defective self-matic brain injury, delusions are more common than Chapter 3 – Secondary hallucinations
hallucinations, of which auditory hallucinations are back between the perception and recognition modules the most common, particularly if the psychotic symp-resulting in a percept without a stimulus. This, in turn, toms are of delayed onset [167] . Frontal and temporal would allow inputs to be misinterpreted or act as trig-lobe abnormalities on neuroimaging are more com-gers for musical hallucinosis.
mon in patients with traumatic brain injury and psy-Some anatomical substrates for this model have chosis, but there was no association with left or right been suggested by functional neuroimaging. Although lesions or the severity of hallucinations. Unfortunately, perception of simple sounds may involve primary the precise nature of auditory hallucinations is poorly auditory cortex (Heschl’s gyrus) [175] , perception of characterized in the literature, although derogatory complex sounds seems to be more widely distributed.
spoken words are described [168]. Auditory hallu-The right planum temporale and bilateral frontal areas cinations and schizophrenia-like psychosis are also seem to be involved in determination of melody [176],
described in patients who have undergone temporal whereas the cerebellum and basal ganglia seem to have lobectomy, with the hallucinations most often taking a role in the processing of rhythmic sound [177].
the form of second person spoken voices [169]. In this Lesions in the brainstem [178,
evidence as to whether externally heard hallucinated Auditory hallucinations can comprise some of voices are more likely to be judged to be real, [151,
the symptoms of a schizophrenia-like psychosis in 152, 153] but they both appear to evoke similar lev-epilepsy. Most ( ∼ 70%) of these seizure disorders have els of negative feelings [152]. Most hallucinated voices a temporal focus [165] and have the clinical pat-are heard clearly and are either loud or very loud, and tern of complex partial seizures. The psychoses of address the hearer in the second or third person [154].
epilepsy are currently defined as ictal (concurrent with Approximately 50% of adult psychiatric patients with seizure), postictal (within 1–2 days of seizure) and auditory hallucinations experience command hallu-brief (days to weeks post seizure) or chronic interic-cinations, with approximately 50% being associated tal [166]. Although ictal psychoses most closely resem-with dangerous behavior [155]. The majority (66%) of ble a delirium as described above, often with pre-patients with auditory hallucinations report using cop-served, if delayed insight, the other presentations may ing strategies to deal with them; such strategies include include auditory hallucinations, particularly of the distraction, auditory competition, or trying to relax or spoken voice, which mimic those of schizophrenia.
sleep, which are often at least partially successful [4].
A large body of research has explored the neurobiological basis for the high rate of auditory halluci-Traumatic brain injury nations in schizophrenia. Consensus is emerging that Auditory hallucinations are also reported in trau-aberrant speech mechanisms underlie these symptoms matic brain injury. Although psychotic symptoms in most psychotic patients [156], resulting in inner are described in up to 8% with some form of trau-
30
speech identified as external due to defective self-matic brain injury, delusions are more common than Chapter 3 – Secondary hallucinations
hallucinations, of which auditory hallucinations are back between the perception and recognition modules the most common, particularly if the psychotic symp-resulting in a percept without a stimulus. This, in turn, toms are of delayed onset [167] . Frontal and temporal would allow inputs to be misinterpreted or act as trig-lobe abnormalities on neuroimaging are more com-gers for musical hallucinosis.
mon in patients with traumatic brain injury and psy-Some anatomical substrates for this model have chosis, but there was no association with left or right been suggested by functional neuroimaging. Although lesions or the severity of hallucinations. Unfortunately, perception of simple sounds may involve primary the precise nature of auditory hallucinations is poorly auditory cortex (Heschl’s gyrus) [175] , perception of characterized in the literature, although derogatory complex sounds seems to be more widely distributed.
spoken words are described [168]. Auditory hallu-The right planum temporale and bilateral frontal areas cinations and schizophrenia-like psychosis are also seem to be involved in determination of melody [176],
described in patients who have undergone temporal whereas the cerebellum and basal ganglia seem to have lobectomy, with the hallucinations most often taking a role in the processing of rhythmic sound [177].
the form of second person spoken voices [169]. In this Lesions in the brainstem [178,
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