The aim of the study was to examine the dimensions of hallucinations and delusions in affective (manic episode, bipolar affective disorder, and depressive episode) and nonaffective disorders (schizophrenia, acute and transient psychotic disorders, and unspecified psychosis). Sixty outpatients divided equally into two groups comprising affective and nonaffective disorders were taken up for evaluation after screening, as per inclusion and exclusion criteria. Scores of 3 or above on delusion and hallucinatory behavior subscales of positive and negative syndrome scale were sufficient to warrant rating on the psychotic symptom rating scales with which auditory hallucination and delusion were assessed on various dimensions. Insight was assessed using the Beck cognitive insight scale (BCIS). There were no significant differences between the two groups on age, sex, marital status, education, and economic status. There were significant differences in total score and emotional characteristic subscale, cognitive interpretation subscale, and physical characteristic subscale of auditory hallucination scales in between the two groups. Correlation between BCIS-total and total auditory hallucinations score was negative (Spearman Rho ？0.319; ). Hallucinating patients, more in nonaffective group, described a negative impact of hallucinating voices along with emotional consequences on their lives which lead to distress and disruption. 1. Introduction Hallucinations may be viewed as incomprehensible experiences that the person describes or interprets, and that perception is accompanied by feelings, such as urgency, certainty, and vividness. Delusion is a false belief based on incorrect inference about external reality and its explanations are in conflict with the evidence. Both phenomena are often a cause of distress, preoccupation, and significant interference in daily functioning. Junginger and Frame [1] have argued that the important characteristic of voices perceived as outside the head is not their location per se but rather the person’s delusional attribution that they are aliens. In this context, relations between hallucinations and delusions need to be examined more carefully. The majority of hallucinations are examples of secondary delusions since the person is always trying to interpret or make sense of the anomalous experiences and that leads to secondary delusions. Evidence of the coexistence of hallucinations and delusions suggests that these two symptoms may share common ground in terms of the psychological factors underlying their presence [2–5]. The
References
[1]
J. Junginger and C. L. Frame, “Self-report of the frequency and phenomenology of verbal hallucinations,” Journal of Nervous and Mental Disease, vol. 173, no. 3, pp. 149–155, 1985.
[2]
A. P. Morrison, “The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions,” Behavioural and Cognitive Psychotherapy, vol. 29, no. 3, pp. 257–276, 2001.
[3]
A. P. Morrison, G. Haddock, and N. Tarrier, “Intrusive thoughts and auditory hallucinations: a cognitive approach,” Behavioural and Cognitive Psychotherapy, vol. 23, no. 3, pp. 265–280, 1995.
[4]
C. D. Frith, The Cognitive Neuropsychology of Schizophrenia, Erlbaum, Hillsdale, NJ, USA, 1992.
[5]
P. A. Garety, E. Kuipers, D. Fowler, D. Freeman, and P. E. Bebbington, “A cognitive model of the positive symptoms of psychosis,” Psychological Medicine, vol. 31, no. 2, pp. 189–195, 2001.
[6]
I. Al-Issa, “The illusion of reality or the reality of illusion. Hallucinations and culture,” British Journal of Psychiatry, vol. 166, pp. 368–373, 1995.
[7]
P. Thomas, P. Mathur, I. I. Gottesman, R. Nagpal, V. L. Nimgaonkar, and S. N. Deshpande, “Correlates of hallucinations in schizophrenia: a cross-cultural evaluation,” Schizophrenia Research, vol. 92, no. 1–3, pp. 41–49, 2007.
[8]
G. Stanghellini, Disembodied Spirits and Deanimated Bodies. The Psychopathology of Common Sense, Oxford University Press, Oxford, UK, 2004.
[9]
M. Cermolacce, J. Naudin, and J. Parnas, “The “minimal self” in psychopathology: re-examining the self-disorders in the schizophrenia spectrum,” Consciousness and Cognition, vol. 16, no. 3, pp. 703–714, 2007.
[10]
P. Chadwick, M. Birchwood, and P. Trower, Cognitive Therapy for Delusions, Voices and Paranoia, John Wiley & Sons, Chichester, UK, 1996.
[11]
M. Stephane, P. Thuras, H. Nasrallah, and A. P. Georgopoulos, “The internal structure of the phenomenology of auditory verbal hallucinations,” Schizophrenia Research, vol. 61, no. 2-3, pp. 185–193, 2003.
[12]
M. A. J. Romme, A. Honig, E. O. Noorthoorn, and A. D. M. A. C. Escher, “Coping with hearing voices: an emancipatory approach,” British Journal of Psychiatry, vol. 161, pp. 99–103, 1992.
[13]
L. J. Miller, E. O'Connor, and T. DiPasquale, “Patients' attitudes toward hallucinations,” American Journal of Psychiatry, vol. 150, no. 4, pp. 584–588, 1993.
[14]
L. Smith Benjamin, “Is chronicity a function of the relationship between the person and the auditory hallucination?” Schizophrenia Bulletin, vol. 15, no. 2, pp. 291–310, 1989.
[15]
M. A. J. Romme and A. D. M. A. C. Escher, “Hearing voices,” Schizophrenia Bulletin, vol. 15, no. 2, pp. 209–216, 1989.
[16]
R. P. Bentall, Madness Explained: Psychosis and Human Nature, Penguin, London, UK, 2003.
[17]
J. S. Strauss, “Hallucinations and delusions as points on continua function. Rating scale evidence,” Archives of General Psychiatry, vol. 21, no. 5, pp. 581–586, 1969.
[18]
J. Junginger, S. Barker, and D. Coe, “Mood theme and bizarreness of delusions in schizophrenia and mood psychosis,” Journal of Abnormal Psychology, vol. 101, no. 2, pp. 287–292, 1992.
[19]
K. S. Kendler, W. M. Glazer, and H. Morgenstern, “Dimensions of delusional experience,” American Journal of Psychiatry, vol. 140, no. 4, pp. 466–469, 1983.
[20]
P. A. Garety and D. R. Hemsley, Delusions: Investigations into the Psychology of Delusional Reasoning, Oxford University Press, Oxford, UK, 1994.
[21]
T. F. Oltmanns, “Approaches to the definition and study of delusions,” in Delusional Beliefs, T. F. Oltmanns and B. A. Maher, Eds., pp. 3–11, John Wiley & Sons, New York, NY, USA, 1988.
[22]
M. Harrow, F. Rattenbury, and F. Stoll, “Schizophrenic delusions: an analysis of their persistence, of related premorbid ideas, and of three major dimensions,” in Delusional Beliefs, T. E. Oltmanns and B. A. Maher, Eds., pp. 184–211, John Wiley & Sons, New York, NY, USA, 1988.
[23]
P. Jorgensen and J. Jensen, “A dimensional approach to severe delusional psychoses,” Psychopathology, vol. 23, no. 1, pp. 9–14, 1990.
[24]
F. K. Taylor, “Descriptive and developmental phenomena,” in Handbook of Psychiatry: Vol. 1. General Psychopathology, M. Shepherd and F. R. S. Zangwill, Eds., pp. 59–94, CambridgeUniversity Press, Cambridge, UK, 1983.
[25]
P. A. Garety and D. R. Hemsley, “Characteristics of delusional experience,” European Archives of Psychiatry and Neurological Sciences, vol. 236, no. 5, pp. 294–298, 1987.
[26]
D. Freeman, P. A. Garety, and E. Kuipers, “Persecutory delusions: developing the understanding of belief maintenance and emotional distress,” Psychological Medicine, vol. 31, no. 7, pp. 1293–1306, 2001.
[27]
S. Wessely, A. Buchanan, A. Reed et al., “Acting on delusions. I: prevalence,” British Journal of Psychiatry, vol. 163, pp. 69–76, 1993.
[28]
J. L. Eisen, K. A. Phillips, L. Baer, D. A. Beer, K. D. Atala, and S. A. Rasmussen, “The brown assessment of beliefs scale: reliability and validity,” American Journal of Psychiatry, vol. 155, no. 1, pp. 102–108, 1998.
[29]
P. S. Appelbaum, P. C. Robbins, and L. H. Roth, “Dimensional approach to delusions: comparison across types and diagnoses,” American Journal of Psychiatry, vol. 156, no. 12, pp. 1938–1943, 1999.
[30]
G. Haddock, J. McCarron, N. Tarrier, and E. B. Faragher, “Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS),” Psychological Medicine, vol. 29, no. 4, pp. 879–889, 1999.
[31]
P. D. J. Chadwick and C. F. Lowe, “A cognitive approach to measuring and modifying delusions,” Behaviour Research and Therapy, vol. 32, no. 3, pp. 355–367, 1994.
[32]
D. Freeman and P. A. Garety, “Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations,” Behaviour Research and Therapy, vol. 41, no. 8, pp. 923–947, 2003.
[33]
C. Barrowclough, N. Tarrier, L. Humphreys, J. Ward, L. Gregg, and B. Andrews, “Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology,” Journal of Abnormal Psychology, vol. 112, no. 1, pp. 92–99, 2003.
[34]
P. H. Lysaker, R. S. Lancaster, M. A. Nees, and L. W. Davis, “Neuroticism and visual memory impairments as predictors of the severity of delusions in schizophrenia,” Psychiatry Research, vol. 119, no. 3, pp. 287–292, 2003.
[35]
World Health Organization, The ICD-10 Classification of Mental and Behavioral Disorders Diagnostic Criteria for Research, WHO, Geneva, Switzerland, 1992.
[36]
J. E. Overall and D. R. Gorham, “The brief psychiatric rating scale,” Psychological Reports, vol. 10, pp. 799–812, 1962.
[37]
S. R. Kay, A. Fiszbein, and L. A. Opler, “The positive and negative syndrome scale (PANSS) for schizophrenia,” Schizophrenia Bulletin, vol. 13, no. 2, pp. 261–276, 1987.
[38]
R. Drake, G. Haddock, N. Tarrier, R. Bentall, and S. Lewis, “The psychotic symptom rating scales (PSYRATS): their usefulness and properties in first episode psychosis,” Schizophrenia Research, vol. 89, no. 1–3, pp. 119–122, 2007.
[39]
V. Bell, C. Maiden, A. Mu？oz-Solomando, and V. Reddy, “'Mind control' experiences on the internet: implications for the psychiatric diagnosis of delusions,” Psychopathology, vol. 39, no. 2, pp. 87–91, 2006.
[40]
A. T. Beck, E. Baruch, J. M. Balter, R. A. Steer, and D. M. Warman, “A new instrument for measuring insight: the beck cognitive insight scale,” Schizophrenia Research, vol. 68, no. 2-3, pp. 319–329, 2004.
[41]
G. Launay and P. Slade, “The measurement of hallucinatory predisposition in male and female prisoners,” Personality and Individual Differences, vol. 2, no. 3, pp. 221–234, 1981.
[42]
G. Singh, P. Sharan, and P. Kulhara, “Attitude towards hallucinations in schizophrenia,” Hong Kong Journal of Psychiatry, vol. 12, no. 1, pp. 2–25, 2002.
[43]
G. Singh, P. Sharan, and P. Kulhara, “Phenomenology of hallucinations: a factor analytic approach,” Psychiatry and Clinical Neurosciences, vol. 57, no. 3, pp. 333–336, 2003.
[44]
G. R. Lowe, “The phenomenology of hallucinations as an aid to differential diagnosis,” British Journal of Psychiatry, vol. 123, no. 577, pp. 621–633, 1973.
[45]
P. B. Fitzgerald, J. Benitez, J. Z. Daskalakis et al., “A double-blind sham-controlled trial of repetitive transcranial magnetic stimulation in the treatment of refractory auditory hallucinations,” Journal of Clinical Psychopharmacology, vol. 25, no. 4, pp. 358–362, 2005.
[46]
T. H. Nayani and A. S. David, “The auditory hallucination: a phenomenological survey,” Psychological Medicine, vol. 26, no. 1, pp. 177–189, 1996.
[47]
P. J. D. Chadwick, M. Birchwood, and P. Trower, Cognitive Therapy for Delusions, Voices and Paranoia, John Wiley & Sons, Chichester, UK, 1996.
[48]
H. Close and P. Garety, “Cognitive assessment of voices: further developments in understanding the emotional impact of voices,” British Journal of Clinical Psychology, vol. 37, no. 2, pp. 173–188, 1998.
[49]
J. A. Jenner, S. Rutten, J. Beuckens, N. Boonstra, and S. Sytema, “Positive and useful auditory vocal hallucinations: prevalence, characteristics, attributions, and implications for treatment,” Acta Psychiatrica Scandinavica, vol. 118, no. 3, pp. 238–245, 2008.
[50]
L. C. Johns, S. Rossell, C. Frith et al., “Verbal self-monitoring and auditory verbal hallucinations in patients with schizophrenia,” Psychological Medicine, vol. 31, no. 4, pp. 705–715, 2001.
[51]
P. P. Allen, L. C. Johns, C. H. Y. Fu, M. R. Broome, G. N. Vythelingum, and P. K. McGuire, “Misattribution of external speech in patients with hallucinations and delusions,” Schizophrenia Research, vol. 69, no. 2-3, pp. 277–287, 2004.
[52]
P. G. Oulis, V. G. Mavreas, J. M. Mamounas, and C. N. Stefanis, “Clinical characteristics of auditory hallucinations,” Acta Psychiatrica Scandinavica, vol. 92, no. 2, pp. 97–102, 1995.
[53]
I. Leudar, P. Thomas, D. Mcnally, and A. Glinski, “What voices can do with words: pragmatics of verbal hallucinations,” Psychological Medicine, vol. 27, no. 4, pp. 885–898, 1997.
[54]
B. A. Gaudiano and J. D. Herbert, “Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients,” Behavioural and Cognitive Psychotherapy, vol. 34, no. 4, pp. 497–502, 2006.
[55]
M. Hayward, “Interpersonal relating and voice hearing: to what extent does relating to the voice reflect social relating?” Psychology and Psychotherapy: Theory, Research and Practice, vol. 76, no. 4, pp. 369–383, 2003.
[56]
D. Copolov, T. Trauer, and A. Mackinnon, “On the non-significance of internal versus external auditory hallucinations,” Schizophrenia Research, vol. 69, no. 1, pp. 1–6, 2004.
[57]
P. Cheung, I. Schweitzer, K. Crowley, and V. Tuckwell, “Violence in schizophrenia: role of hallucinations and delusions,” Schizophrenia Research, vol. 26, no. 2-3, pp. 181–190, 1997.
[58]
D. L. Copolov, A. Mackinnon, and T. Trauer, “Correlates of the affective impact of auditory hallucinations in psychotic disorders,” Schizophrenia Bulletin, vol. 30, no. 1, pp. 163–171, 2004.
[59]
K. Schneider, Clinical Psychopathologyed, Grune & Stratton, New York, NY, USA, 5th edition, 1959.
[60]
A. Thorup, L. Petersen, P. Jeppesen, and M. Nordentoft, “Frequency and predictive values of first rank symptoms at baseline among 362 young adult patients with first-episode schizophrenia. Results from the Danish OPUS study,” Schizophrenia Research, vol. 97, no. 1–3, pp. 60–67, 2007.
[61]
X. F. Amador, M. Flaum, N. C. Andreasen et al., “Awareness of illness in schizophrenia and schizoaffective and mood disorders,” Archives of General Psychiatry, vol. 51, no. 10, pp. 826–836, 1994.
[62]
G. Lera, N. Herrero, J. González, E. Aguilar, J. Sanjuán, and C. Leal, “Insight among psychotic patients with auditory hallucinations,” Journal of Clinical Psychology, vol. 67, no. 7, pp. 701–708, 2011.
[63]
M. Sanz, G. Constable, I. Lopez-Ibor, R. Kemp, and A. S. David, “A comparative study of insight scales and their relationship to psychopathological and clinical variables,” Psychological Medicine, vol. 28, no. 2, pp. 437–446, 1998.
[64]
A. A. Collins, G. J. Remington, K. Coulter, and K. Birkett, “Insight, neurocognitive function and symptom clusters in chronic schizophrenia,” Schizophrenia Research, vol. 27, no. 1, pp. 37–44, 1997.
[65]
R. C. Schwartz, “Symptomatology and insight in schizophrenia,” Psychological Reports, vol. 82, no. 1, pp. 227–233, 1998.
[66]
Y. Kim, K. Sakamoto, T. Kamo, Y. Sakamura, and H. Miyaoka, “Insight and clinical correlates in Schizophrenia,” Comprehensive Psychiatry, vol. 38, no. 2, pp. 117–123, 1997.
[67]
T. E. Smith, J. W. Hull, and L. Santos, “The relationship between symptoms and insight in schizophrenia: a longitudinal perspective,” Schizophrenia Research, vol. 33, no. 1-2, pp. 63–67, 1998.
[68]
A. Carroll, S. Fattah, Z. Clyde, I. Coffey, D. G. C. Owens, and E. C. Johnstone, “Correlates of insight and insight change in schizophrenia,” Schizophrenia Research, vol. 35, no. 3, pp. 247–253, 1999.
[69]
R. W. Goldberg, L. D. Green-Paden, A. F. Lehman, and J. M. Gold, “Correlates of insight in serious mental illness,” Journal of Nervous and Mental Disease, vol. 189, no. 3, pp. 137–145, 2001.
[70]
A. R. Mintz, K. S. Dobson, and D. M. Romney, “Insight in schizophrenia: a meta-analysis,” Schizophrenia Research, vol. 61, no. 1, pp. 75–88, 2003.
[71]
B. Saravanan, K. S. Jacob, S. Johnson, M. Prince, D. Bhugra, and A. S. David, “Assessing insight in schizophrenia: East meets West,” British Journal of Psychiatry, vol. 190, pp. 243–247, 2007.
