In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOIC...In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOICE" ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the "voices" having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iP hone/iP od app.展开更多
BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment;however,their effectiveness has been questioned,and it is not possible to predict the response to a specific antipsychotic drug in an indiv...BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment;however,their effectiveness has been questioned,and it is not possible to predict the response to a specific antipsychotic drug in an individual patient.Thus,it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.AIM To investigate the effectiveness of antipsychotic drugs,we examined response trajectories and predictors for belonging to different trajectory groups.METHODS The Bergen-Stavanger-Innsbruck-Trondheim(BeSt InTro)trial compared the effectiveness of three atypical antipsychotics-amisulpride,aripiprazole,and olanzapine-in a prospective,semirandomized,rater-blind,head-to-head design.Adult participants with a schizophrenia spectrum disorder diagnosis,according to international classification of diseases,Tenth Revision(ICD-10)F20–29,were included.Participants were followed for a period of 12 mo,with assessments at baseline;after one,three and six weeks;and after three,six,nine and 12 mo.A latent class mixed model was fitted to our data.The three-trajectory model based on the Positive and Negative Syndrome Scale(PANSS)total score reduction was found to have adequate fit,and the study drugs,as well as various demographic and clinical parameters,were tested as predictors for belonging to the different trajectory groups.RESULTS Overall,144 participants were included,and 41%completed the 12-mo study period.The largest trajectory group,consisting of 74%of participants,showed a PANSS total score reduction of 59%from baseline to 12 mo(Good response group).A trajectory group comprising 13%of participants had their PANSS total score reduced by 82.5%at 12 mo(Strong response group),while the last response trajectory group comprising 13%of the participants had a PANSS total score reduction of 13.6%(Slight response group).The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment,amounting to 45%and 48%reductions from baseline,respectively.The use of amisulpride predicted belonging to the Strong response group,while unemployment,depression,and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group,indicating a poor response to antipsychotic drug treatment.CONCLUSION Most of the participants(87%)had a good outcome after one year.Amisulpride users,more often than aripiprazole and olanzapine users,belonged to the response trajectory group with a strong response.展开更多
基金Supported by European Research Council Advanced Grant,No.#249516Research Council of Norway FRIBIOMED Grant,No.807696SFF Grant,No.222373
文摘In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOICE" ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the "voices" having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iP hone/iP od app.
基金Supported by Drosos P is a Research Fellow with a Grant From the Western Norway Regional Health Trust,No. 912140
文摘BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment;however,their effectiveness has been questioned,and it is not possible to predict the response to a specific antipsychotic drug in an individual patient.Thus,it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.AIM To investigate the effectiveness of antipsychotic drugs,we examined response trajectories and predictors for belonging to different trajectory groups.METHODS The Bergen-Stavanger-Innsbruck-Trondheim(BeSt InTro)trial compared the effectiveness of three atypical antipsychotics-amisulpride,aripiprazole,and olanzapine-in a prospective,semirandomized,rater-blind,head-to-head design.Adult participants with a schizophrenia spectrum disorder diagnosis,according to international classification of diseases,Tenth Revision(ICD-10)F20–29,were included.Participants were followed for a period of 12 mo,with assessments at baseline;after one,three and six weeks;and after three,six,nine and 12 mo.A latent class mixed model was fitted to our data.The three-trajectory model based on the Positive and Negative Syndrome Scale(PANSS)total score reduction was found to have adequate fit,and the study drugs,as well as various demographic and clinical parameters,were tested as predictors for belonging to the different trajectory groups.RESULTS Overall,144 participants were included,and 41%completed the 12-mo study period.The largest trajectory group,consisting of 74%of participants,showed a PANSS total score reduction of 59%from baseline to 12 mo(Good response group).A trajectory group comprising 13%of participants had their PANSS total score reduced by 82.5%at 12 mo(Strong response group),while the last response trajectory group comprising 13%of the participants had a PANSS total score reduction of 13.6%(Slight response group).The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment,amounting to 45%and 48%reductions from baseline,respectively.The use of amisulpride predicted belonging to the Strong response group,while unemployment,depression,and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group,indicating a poor response to antipsychotic drug treatment.CONCLUSION Most of the participants(87%)had a good outcome after one year.Amisulpride users,more often than aripiprazole and olanzapine users,belonged to the response trajectory group with a strong response.
