Auditory hallucination- a form of hallucination when the perception of sounds occurs without auditory stimulation. There is a common form of auditory hallucinations in which a person hears one or more voices.

Types of auditory hallucinations

Simple auditory hallucinations

Acoasma

Non-speech hallucinations are characteristic. With this type of hallucination, a person hears individual sounds of noise, hissing, roaring, and buzzing. Often there are the most specific sounds associated with certain objects and phenomena: steps, knocks, creaking floorboards, and so on.

Phonemes

The simplest speech deceptions are typical in the form of shouts, individual syllables or fragments of words.

Complex auditory hallucinations

Hallucinations of musical content

With this type of hallucination, the playing of musical instruments, singing, choirs, known melodies or excerpts thereof, and even unfamiliar music can be heard.

Potential causes of musical hallucinations:

Verbal (verbal) hallucinations

With verbal hallucinations, individual words, conversations, or phrases are heard. The content of statements may be absurd, devoid of any meaning, but most often verbal hallucinations express ideas and thoughts that are not indifferent to patients. S.S. Korsakov considered hallucinations of this kind as thoughts dressed in a bright sensory shell. V. A. Gilyarovsky pointed out that hallucinatory disorders are directly related to a person’s inner world, his state of mind. They express violations mental activity, personal qualities, dynamics of the disease. In particular, in their structure one can detect disorders of other mental processes: thinking (for example, its fragmentation), will (echolalia), and so on.

There are a large number of types of verbal hallucinations, depending on their plot. Among them are:

• Imperative hallucinations. A type of verbal hallucination that is socially dangerous. Contains orders to do something or prohibitions on actions, to commit actions that directly contradict conscious intentions: including attempting suicide or self-harm, refusing to take food, medicine or talking with a doctor, and so on. Patients often take these orders personally.

Potential Causes

One of the main causes of auditory hallucinations, in the case of psychotic patients, is schizophrenia. In such cases, patients exhibit a consistent increase in the activity of the thalamic and subcortical nuclei of the striatum, hypothalamus and paraliminal areas; confirmed by positron emission and magnetic resonance imaging. Another comparative study of patients found increases in temporal white matter and temporal gray matter volumes (regions critical to internal and external speech). The implication is that both functional and structural abnormalities in the brain can cause auditory hallucinations, however both may have a genetic component. It is known that affective disorder can also cause auditory hallucinations, but more mild than those caused by psychosis. Auditory hallucinations are a relatively common complication of serious neurocognitive disorders (dementia), such as Alzheimer's disease.

Research has shown that auditory hallucinations, particularly voices commenting and voices telling people to harm themselves or others, are much more common in psychotic patients who experienced physical or sexual abuse as children than in psychotic patients who were not abused as children. violence. Moreover, the stronger the form of violence (incest or a combination of both physical and sexual abuse of children), the stronger the degree of hallucinations. If there were multiple episodes of violence, this also influenced the risk of developing hallucinations. It has been noted that the content of hallucinations in people who have been victims of childhood sexual abuse includes both elements of flashbacks (flashbacks of memories of a traumatic experience) and more symbolic embodiments of the traumatic experience. For example, a woman who had been sexually abused by her father since age 5 heard "men's voices outside her head and children's voices screaming inside her head." In another case, when a patient experienced hallucinations telling her to kill herself, she identified the voice as that of the perpetrator.

Diagnosis and treatment methods

Pharmaceuticals

The main medications used in the treatment of auditory hallucinations are antipsychotics, which affect dopamine metabolism. If the main diagnosis is an affective disorder, then antidepressants or mood stabilizers are often additionally used. These drugs [ which?] allow a person to function normally, but in essence are not a treatment, since they do not eliminate the root cause of the thinking disorder.

Psychological treatments

Current Research

Non-psychotic symptoms

Research continues into auditory hallucinations that are not a symptom of a particular psychotic illness. Most often, auditory hallucinations occur without psychotic symptoms in prepubertal children. These studies found that a remarkably high percentage of children (up to 14% of respondents) heard sounds or voices without any external cause; although it should also be noted that "sounds" as psychiatrists believe are not examples of auditory hallucinations. It is important to distinguish auditory hallucinations from “sounds” or normal internal dialogue, since these phenomena are not characteristic of mental illness.

Causes

The causes of auditory hallucinations with nonpsychotic symptoms are unclear. Durham University doctor Charles Fernyhough, exploring the role of the inner voice in auditory hallucinations, offers two alternative hypotheses for the origin of auditory hallucinations in people without psychosis. Both versions are based on research into the process of internalization of the inner voice.

Internalization of the inner voice

• First level (external dialogue) makes it possible to maintain an external dialogue with another person, for example when a baby talks to his parents.
• Second level (private speech) includes the ability to conduct external dialogue; It has been observed that children comment on the process of play when playing with dolls or other toys.
• Third level (extended inner speech) is the first internal level of speech. Allows you to conduct internal monologues when reading to yourself or viewing lists.
• Fourth level (condensation of inner speech) is the final level of the internalization process. Allows you to simply think without the need to express thoughts in words to grasp the meaning of the thought.

Internalization disorder

Mixing

The disruption may occur during the normal process of inner voice acquisition, when the person is unable to identify his or her own inner voice. Thus, the first and fourth levels of internalization are mixed.

Extension

The disorder may manifest itself in the internalization of the inner voice when a second one appears. which seems alien to a person; The problem occurs when the fourth and first levels are shifted.

Treatment

Psychopharmacological treatment uses antipsychotic drugs. Research in psychology has shown that the first step in treating a patient is to recognize that the voices he hears are figments of his imagination. Understanding this allows patients to regain control over their lives. Additional psychological intervention may influence the control of auditory hallucinations, but evidence of this is required additional research.

see also

Notes

1. Paracusia | 
2. definition of paracusia by Medical dictionary Zhmurov.
3. general psychopathology. - 2009. Silbersweig D. A., Stern E., Frith C., Cahill C., Holmes A., Grootoonk S., Seaward J., McKenna P., Chua S. E., Schnorr L., Jones T., Frackowiak R. S. J.
4. Neuroanatomy of ‘Hearing Voices’: A Frontotemporal Brain Structural Abnormality Associated with Auditory Hallucinations in Schizophrenia
5. Patricia Boksa. On the neurobiology of hallucinations (English) // Psychiatry Neuroscience: journal. - 2009. - July (vol. 34, no. 4). - P. 260-262.
6. Kevin M. Spencer, Margaret A. Niznikiewicz, Paul G. Nestor, Martha E. Shenton, Robert W. McCarley. Left auditory cortex gamma synchronization and auditory hallucination symptoms in schizophrenia (English) // BMC Neuroscience. - 2009. -

Psychiatric and neurological patients sometimes complain of auditory hallucinations. This is a distorted perception of reality. A person hears sounds that do not exist in reality. There are many types this symptom. Therapy will consist of timely treatment underlying disease.

Diseases characterized by symptoms:

• schizophrenia;
• malignant neoplasms of the brain;
• hallucinatory-delusional syndromes;
• depressive states;
• bipolar affective disorder;
• dementia;
• Alzheimer's disease;
• various vascular diseases(atherosclerosis, circulatory insufficiency of some parts of the brain);
• chronic alcoholism.

What are auditory hallucinations

Auditory or acoustic hallucinations are a perception disorder when a person hears sounds without the stimulus affecting the hearing aid. This means that reality is perceived distorted and incorrect.

Psychiatrists classify auditory hallucinations as productive symptoms, that is, they are a new phenomenon that appears as a result of illness and is absent in healthy people. Such hallucinations can be in the form of:

• sound;
• whistling;
• the sound of a vehicle braking;
• birds singing;
• words;
• a whole sentence.

Why does this disease appear?

The causes of auditory hallucinations are diseases of various etiologies. Psychiatric diseases come to the fore:

• schizophrenia;
• depression;
• bipolar affective disorder, etc.

Other reasons:

• malignant tumors and brain metastases;
• inflammatory processes of the brain;
• cerebrovascular accident.

People suffering from chronic alcoholism may hear “voices” during delirium (popularly called “delirium tremens”).

How do “voices” arise?

The exact mechanism of auditory hallucinations is unknown.

In the course of numerous experiments and studies, it was found that while the patient hears “voices,” Broca’s area is active in the cerebral hemispheres - the center of speech responsible for its reproduction; located in the cortex of the left frontal lobe (in right-handed people).

When a person simply thinks, he also activates Broca's center. This can be called inner speech. To understand that speech comes from the inside, there is a special department in the brain - the Wernicke center. It is located in the temporal and parietal lobes.

It is believed that the patient cannot recognize internal speech, but perceives it as external. That is, there is a dysfunction of the Wernicke center.

What can increase the likelihood of developing this symptom?

Relative risk factors for the development of auditory hallucinations:

• refusal to take prescribed medications;
• independent adjustment of doses of medications taken;
• simultaneous use of medications that inhibit each other’s effects.

There are no absolute risk factors for auditory hallucinations.

What types is it divided into?

Auditory hallucinations, like all others, are divided into elementary, simple and complex.

Elementary hallucinations are of two types: acoasms and phonemes.

Acoasms - noise, tapping, rumble, hissing, shooting, ringing - is a separate sound. The symptom is found in the practice of psychiatrists and neurologists. An otolaryngologist or an ENT doctor can also come across this (with Meniere's disease - this is a disease of the inner ear, non-inflammatory in nature, leading to deafness).

Phoneme - individual words, shouts, pronouns, syllables - speech deception. Phonemes do not form speech; they are just individual elements that do not carry a semantic load.

Both acoasms and phonemes are periodic and constant.

Simple auditory hallucinations are a deception of perception that does not affect another analyzer. That is, the patient hears only the sound, but does not see the source.

There are several types of simple ones:

• musical (the patient hears the playing of a guitar, violin or piano, singing, popular or unknown melodies, excerpts of works or entire compositions);
• verbal or verbal (the patient hears conversations, whole phrases or just individual words).

Verbal hallucinations, in turn, are divided into three types:

• commenting or evaluative (patients with such hallucinations listen to voices that judge their actions, assign an assessment to actions, intentions or the past; such “voices” can be either friendly and encouraging, or judgmental and accusatory in nature);
• threatening (quite unpleasant for the patient; the patient hears threats at his own expense, promises of violence, etc.);
• imperative (hallucinations of this type can pose a threat not only to the patient, but also to the people around him).

Imperative hallucinations interfere with the treatment process: “voices” can simply prohibit the patient from listening to the doctor and following his instructions, taking medicines.

There are very rarely cases in the practice of psychiatrists when patients turn to them for treatment on the orders of “voices”. Such a person may not even realize that he is mentally ill.

Complex hallucinations are hallucinations that simultaneously affect the function of several analyzers. For example, a person not only hears the speech of his pursuer, but also sees him in his room.

What are the special types of auditory hallucinations?

Alenshtil's auditory hallucinations are hallucinations in the form of a knock on the door or a bell. Occurs in mental healthy person at the moment of intense anticipation of the corresponding sound.

Antagonistic (contrasting) hallucinations - a person hears several “voices” that express opposing intentions. For example, one “voice” suggests killing someone, and the second dissuades them.

Important! Auditory hallucinations are a symptom of a mental or neurological disease. They can occur in diseases such as schizophrenia, dementia, bipolar affective disorder, and brain tumors. A person hears sounds that are real only to him without the influence of an irritant on the hearing aid. In themselves, such perception disorders are not dangerous, but their content can cause the patient to harm himself or others. Any hallucinations should be a reason to consult a psychiatrist

Auditory hallucinations in older people

Elderly people may experience auditory hallucinations due to deterioration of blood supply, organic brain damage, mental disorders, medicines with a side effect - hallucination.

The most common reasons for older people are:

• isolated auditory hallucinosis of Charles Bonnet - develops after 70 years of age against the background of decreased hearing. At the beginning they appear as acoasms, which over time turn into phrases and sentences with a semantic load. It is extremely rare that “voices” are imperative in nature. Most often, a person “hears” condemnation, threats and insults addressed to him;
• hallucinations as a symptom mental illness(for example, schizophrenia);
• hallucinations in Parkinson's disease (a disease characterized by the destruction of motor cells in the brain that produce the neurotransmitter dopamine);
• side effect medications (drugs that lower blood pressure - antihypertensives, some antibiotics, psychostimulants, tranquilizers, anti-tuberculosis drugs).

Treatment consists of prescribing antipsychotics. In case of hallucinations from medications, the attending physician should discontinue or replace the drug that causes such an unpleasant syndrome.

It is noteworthy that with Charles Bonnet hallucinosis, the symptoms lose their intensity over time, and attacks become increasingly rare. Big problem problems begin to arise from the cognitive function of the brain (memory, attention, etc.).

Auditory hallucinations in children

It is not uncommon for children to experience the first years of school. During this period it turns out that the child significant pressure. The student experiences overwork and stress, often anxiety about grades. This condition leads to the child beginning to hear unreal “voices.”

Other causes of auditory hallucinations in older children include:

• fever;
• food, drug poisoning;
• neurological disease;
• puberty (time of hormonal changes in the body);
• use of alcohol and drugs (relevant for high school students);
• depressive disorder;
• insomnia;
• severe physical and psychological injuries.

Hallucinations in a child should alert the parent. You should consult a doctor immediately to avoid a delay mental development, neurological diseases.

When and which doctor to contact

If a person is bothered by auditory hallucinations, then this is a cause for concern. You must make an appointment with or.

What first aid can be given to a person?

The sequence of actions during an attack should be as follows:

• call an ambulance;
• protect the patient from himself and others;
• try to calm down.

It is impossible to independently provide medical first aid to a person with hallucinations. This can only be done by doctors using specific medications.

How is diagnosis made?

An experienced specialist will only be able to suspect that a patient has auditory hallucinations based on behavior.

Such patients are always on guard, they are constantly listening to something, staring into the empty space of the room. They can whisper something, answer an invisible interlocutor. Under the influence of imperative hallucinations, a person may try to jump out of a window and harm himself or others.

It will be very important for the doctor to understand what kind of hallucinations he sees: true or false. With false hallucinations, the source of the “voices” will be directly in the human body. The patient will claim that they are speaking in his head, his spine. No projection on appearance. False hallucinations or pseudohallucinations have a more unfavorable prognosis and are included in the Kandinsky-Clerambault syndrome (a combination of hallucinations, delusions and phenomena of automatism, when patients are haunted by a feeling of “made” movements or thoughts).

Treatment tactics

Disease or condition	Type of therapy	A drug	Drug group	Mode of application
Alcohol intoxication	Detoxification
	gastric lavage	Activated carbon	Adsorbent	2-3 spoons once
		4% sodium bicarbonate solution	Electrolyte solution	50 ml IV (single dose)
	infusion therapy	40% glucose solution	Solution for intravenous administration	20-40-50 ml IV slowly (single dose)
	symptomatic therapy	10% solution of Sulphocamphocaine	Analeptics (have a stimulating effect on the respiratory center)	2 ml IV (single dose)
		Korglykol	Cardiac glycosides	0.5-1 ml IV slowly over 5-6 minutes (once)
		Clopixol	Neuroleptic	10-50 mg orally (single dose)
		Diazepam	Tranquilizer	5 mg orally (single dose)
Mental disorders	Drug therapy(drug of choice)	Aminazine	Neuroleptics	1-5 ml of a 2.5% solution is administered intramuscularly no more than 3 times a day (take from 2-3 weeks to 2-3 months)
		Triftazin		2-5 mg 2 times a day orally (take 2-3 weeks)
		Haloperidol		10 mg IM 2-3 times a day (take 2-3 months)

For Alzheimer's disease, dementia and others, it is necessary to use specific drugs that improve the course of the underlying disease, while eliminating attacks.

Doctor's advice! Don't be afraid to use antipsychotics. Even though they have side effects, these drugs do an excellent job of improving the patient’s condition and quality of life

What could be the consequences?

Auditory hallucinations are not an independent disease, so they have no direct complications. However, if you do not resort to treatment for this condition, as well as the disease that causes the appearance of such a symptom, the consequences can be depressing.

The progression of the disease leads to social maladjustment and loss of self-care skills.

We must not forget that in some cases, auditory hallucinations can prompt a person to attempt suicide.

How to prevent the occurrence

There is no specific prevention. Prevention of such conditions comes down to the need for timely treatment of specific diseases.

What to Expect After an Episode of Auditory Hallucinations

The prognosis depends on the root cause of the appearance, since they are just a symptom and do not act as an independent disease.

In situations resulting from taking medications or fatigue, the prognosis is quite favorable, since you just need to stop taking medications, rest and reduce the impact of stress on the body.

However, for mental disorders, it is necessary to take medications that eliminate the productive symptoms of the disease. Such drugs have significant side effects and are used exclusively under the prescription of a psychiatrist.

Auditory hallucinations are considered one of the most common symptoms of various mental and physical diseases.

The patient clearly hears sounds, noises or voices that do not actually exist. Despite the seeming harmlessness of this phenomenon, auditory illusions can cause a lot of problems for the patient, causing many unpleasant situations and even aggressive behavior.

Note! Auditory hallucinations can be classified as subjective sounds. They are audible only to the patient, which makes diagnosing and treating this disease very difficult.

Types of auditory hallucinations

• There are several types of extraneous sounds that spontaneously manifest themselves in the patient’s consciousness: Tinnitus
• Acoasma. Standard noise effects resembling buzzing, clicking, whistling, ringing, etc.
• Phonemes. More specific sounds: creaking, drops, music, etc. . Most dangerous hallucinations

, capable of carrying a certain semantic load and directly influencing human behavior. These can be individual words, phrases or voices, which clearly indicates mental problems.

In addition, any illusions (including acoustic ones) are usually divided into true and false: True

hallucinations occur when a person hears all kinds of non-existent sounds in the surrounding space and tries to organically fit them into his worldview. The patient is completely confident in the reality of these sounds and never questions them. false most often for the patient it comes from within. Moreover, sounds are not always heard in a person’s head. Intrusive and commanding voices can come from the stomach, chest, and any other place on the body. Such illusions are considered the most dangerous for the life of the patient and the people around him.

Reasons for appearance

In order to correctly diagnose the type of anomaly and determine approaches to its elimination, it is necessary to understand as clearly as possible the causes of auditory illusions. Various factors can provoke this phenomenon:

• Strong overwork, nervous or physical exhaustion. Overvoltage can cause disruptions in the normal functioning of the brain and changes in a person’s consciousness.
• Feverish conditions, heat. They can cause disturbances in certain body systems. In some cases, this manifests itself in the form of auditory or visual illusions.
• Tumors in the area of ​​the brain. The tumor can put pressure on certain areas auditory system or brain.
• Mental disorders: schizophrenia, psychopathy, all kinds of syndromes.
• Ear diseases, inflammatory processes and even sulfur plugs may well disrupt the functioning of sound-conducting channels and cause extraneous noise.
• Malfunctions of electronic hearing aids. The most harmless reason that can be eliminated by replacing or repairing the device.
• Use of psychotropic substances. Drug addiction or treatment with certain drugs can affect a person's brain activity in a similar way.
• Alcohol abuse. Attacks of delirium tremens often result in visual or auditory hallucinations.

Photo 2. It was the appearance of hallucinations that gave rise to the phrase “getting drunk as hell.” Source: Flickr (bluevinas).

When falling asleep

Oddly enough, but exactly When falling asleep, auditory hallucinations most often disturb patients. It would seem that the body, tired during the day, is as relaxed as possible and is preparing to get a long-awaited rest, but that was not the case. A person begins to hear non-existent sounds or voices.

In medicine, such hallucinations have a separate name - hypnagogic. Their main danger is that at the time of their appearance the patient, as a rule, is alone and in complete silence. The lack of distractions makes a person more vulnerable and unable to resist the voices giving him orders.

Symptoms and signs of hearing hallucinations

The volume of acoustic illusions depends on their type and the patient’s character traits. Sometimes the patient hears a barely audible whisper, in other cases - loud orders that are almost impossible to resist. In the latter case, the patient most likely develops one of the varieties of schizophrenia.

Sometimes the patient hears voices, but is not the subject of their discussion. It is as if he hears from the outside a conversation between two or more non-existent people on abstract topics. Such hallucinations are considered completely harmless, although they cause a lot of inconvenience both to the patient himself and to those around him.

Disturbances are considered more dangerous when the patient hears voices repeating his own thoughts and beliefs.

At the same time, it seems to the patient that these thoughts (often very intimate and impartial) are heard by everyone around him. This can become a reason for aggression.

Note! In some cases, auditory hallucinations can be confused with manifestations of an “inner voice” or actual tinnitus resulting from various diseases.

Diagnostics Auditory hallucinations are not an independent disease, but only a symptom of another disease. The doctor will necessarily begin the diagnosis by collecting an anamnesis. This can be quite difficult to do, since the patient may have an extremely negative and skeptical attitude towards his pathological condition

. If the patient does not want to contact the doctor, you can try interviewing the closest relatives. To exclude the organic nature of the pathology, lab tests urine, blood, spinal cord

. Older patients using hearing amplification devices should additionally check the correct operation of the electronic device. The presence of acoustic hallucinations can also be guessed from the specific behavior of a person.

The patient may hesitate to answer, clearly listening to something. When talking with such a patient, the doctor needs to try to win him over as much as possible and establish a trusting relationship.

Treatment of auditory hallucinations with homeopathy Along with traditional medicine

• , modern homeopathy can offer a number of drugs that can help eliminate such an unpleasant and sometimes dangerous disease for the life and health of the patient: Elapse
• (Elaps). Indicated for extraneous noise, clicking, unbearable itching in the ears. It will help eliminate attacks of deafness at night, accompanied by crackling and roaring in the ears.(Curare). Helps eliminate whistling or ringing noises, sounds reminiscent of animal cries.
• Valerian(Valeriana). The drug is recommended for patients who have ringing in the ears, acoustic illusions, hyperesthesia (increased sensitivity of the senses).
• Eupatorium purpureum(Eupatorium purpureum). Effective for various types of auditory hallucinations, sensations of constant ear congestion, crackling when swallowing.
• Galvanism(Galvanism). Suitable for patients who hear the sounds of gunshots, explosions, a brass band playing, or the sound of bells.
• Anacardium(Anacardium). The drug helps patients who experience voices imposing strange orders or whispering blasphemies.
• Carboneum sulfuratum(Carboneum sulphuratum). Helps eliminate burning ears, singing voices or harp sounds.

Contact qualified specialists who can select the most suitable one for your clinical case drug and prescribe correct dosage and course of admission.

Hallucinations are a cause for concern, whether you experience them yourself or observe them in another person. Mild cases of hallucinations can be successfully treated at home, but severe or chronic cases require mandatory medical intervention.

Steps

Home treatment (self-help)

Understand the nature of hallucinations. Hallucinations can affect any of the five senses - sight, hearing, taste, smell or touch - and can be based on the most different reasons. However, in any case, the person experiences them while conscious, and they seem absolutely real.

• Most hallucinations are disorienting and unpleasant, but some seem interesting or pleasant.
• If you hear voices, such hallucinations are called auditory; if you see non-existent people, objects, light - these are visual hallucinations. The feeling of insects or something else crawling on the skin is a common tactile hallucination.

Take your temperature. High body temperature can cause hallucinations of varying severity, especially in children and the elderly. Even if you're not in one of these age categories, it can cause hallucinations, so it's best to check if you have a fever.

Get enough sleep. Mild to moderate hallucinations can be caused by severe lack of sleep. Severe cases of hallucinations usually have other causes, but lack of sleep can make them worse.

• An adult needs an average of seven to nine hours of sleep a night. If you are currently suffering from severe sleep deprivation, you may even need to increase this amount by a few hours until your body recovers.
• Daytime sleep may be disrupted normal cycle sleep and lead to insomnia and, as a result, to hallucinations. If your sleep pattern is off, try to establish a normal routine.

Manage stress more effectively. Anxiety states is another common cause of mild cases of hallucinations, but can also intensify severe hallucinations caused by other causes. Learning to minimize psychological and physical stress can help reduce the frequency and severity of hallucinations.

• To reduce physical stress, you need to stay hydrated and get enough rest. Regular light to moderate exercise will also improve your overall health and relieve stress-related symptoms, including mild forms of hallucinations.

Recognize when it's time to ask for help. If you are unable to distinguish reality from a hallucination, you should seek emergency medical help immediately.

• If you are experiencing mild hallucinations but these keep happening over and over again, you should also make an appointment with your doctor as they are most likely due to medical reasons. This is especially likely if general measures to improve well-being have had no effect.
• If you are experiencing hallucinations accompanied by other severe symptoms, you also need emergency health care. Such symptoms include discoloration of lips or nails, chest pain, clammy skin, confusion, loss of consciousness, high temperature, vomiting, fast or slow pulse, difficulty breathing, injury, seizures, sharp pain in the stomach or behavioral disorders.

Home treatment (helping others)

1. Learn to recognize the symptoms. People who experience hallucinations may not talk about it openly. In such cases, you need to know how to spot the less obvious signs of hallucinations.

   • A person experiencing auditory hallucinations may not notice others and actively talk to themselves. He may seek solitude or listen to music obsessively in an attempt to drown out the voices.
   • A person whose eyes are focused on something you cannot see may experience visual hallucinations.
   • If a person scratches or shakes off something invisible to the eye, this may be a sign of tactile (tactile) hallucinations, if he pinches his nose for no reason - hallucinations associated with the sense of smell. Spitting out food may be a symptom of taste hallucinations.

2. Keep calm. If you need to help someone who is hallucinating, it is important to remain calm throughout.

   • Hallucinations can become a source of increased anxiety, so that the patient may be in a state of panic. If stress or panic increases because of you, it will only make the situation worse.
   • If someone you know is hallucinating, you should also discuss this with them when they are not hallucinating. Ask what the likely cause might be and what kind of support you can offer.

3. Explain what is really happening. Calmly explain to the patient that you do not see, hear, touch, taste or smell what he is describing.

   • Speak directly and without accusing anything, so as not to upset the patient.
   • If the hallucinations are mild or moderate and the person has experienced hallucinations before, you can also try to explain to them that what they are experiencing is not real.
   • Those who are experiencing hallucinations for the first time, as well as those who suffer from severe hallucinations, may not be able to recognize that they are hallucinating and act aggressively in response to your doubts.

4. Distract the patient. Depending on the circumstances, it can be useful to distract the person by changing the topic of conversation or moving to another location.

   • This advice is suitable for cases of mild to moderate hallucinations, but you may not be able to influence someone who is experiencing severe hallucinations.

5. Encourage the person to seek professional help. If someone you know suffers from recurring hallucinations, strongly encourage them to seek medical or psychological help.

   • Talk to the person when they are not hallucinating. Discuss the severity of the situation and share any knowledge you have regarding possible causes and solutions to the problem. Your approach should be one of love and support. Never take an accusatory position.

6. Continue to monitor the situation. When hallucinations worsen, they can become a threat to the safety of the patient or others.

   • When it comes to safety, immediately call an ambulance.
   • If hallucinations are accompanied by other severe symptoms physical nature, or if the patient is no longer able to distinguish hallucinations from reality, emergency medical attention is also required.

Health care

1. Diagnose and treat the root cause. Hallucinations are typical symptom certain mental disorders, but can also be caused by a number of physiological reasons. The only way to rid a person of hallucinations in the long term is to treat the underlying cause.

   • To the reasons mental properties include schizophrenia, schizoid and schizotypal personality disorder, psychotic depression, post-traumatic disorder and bipolar disorder.
   • Physiological factors affecting the central nervous system can also cause hallucinations. These include brain tumors, delirium, dementia, epilepsy, stroke and Parkinson's disease.
   • Some infectious diseases, such as bladder infections or lung infections, can also cause hallucinations. Some people experience hallucinations during migraines.
   • Using drugs or alcohol can also cause hallucinations, especially when taking large doses or when stopping use (withdrawal syndrome).

2. Take antipsychotic medications. Antipsychotics, also known as antipsychotics, are most often used to help control hallucinations. These medications may be prescribed to treat hallucinations caused by both mental and physiological reasons, especially when other treatments are unavailable or insufficient.

   • Clozapine, an atypical antipsychotic, is usually prescribed in dosages of 6 to 50 mg per day, depending on the severity of the hallucinations. The dose should be increased gradually to prevent complications. Your blood counts should be monitored regularly while being treated with this drug, as it can lower your white blood cell count to dangerous levels.
   • Quetiapine is another atypical antipsychotic used to treat hallucinations. It is generally less effective than clozapine in most cases, but is also safer.
   • Cocaine, LSD, amphetamines, marijuana, heroin, ketamine, phencyclidine, ecstasy are all hallucinogens.
   • Hallucinations can appear not only during drug use, but also when it is abruptly stopped. However, hallucinations caused by withdrawal symptoms can usually be treated with antipsychotic medications.

3. See a therapist regularly. Cognitive behavioral therapy, in particular, may help some patients who suffer from recurring hallucinations, especially those caused by psychological disorders.

   • This therapy examines and evaluates a person's feelings and thoughts. Having discovered probable psychological reasons problem, a professional psychotherapist can develop strategies to help the patient cope with it and reduce symptoms.

4. Find group therapy opportunities. Classes in help and self-help groups can help reduce the severity and frequency of hallucinations, especially auditory hallucinations caused by psychological reasons.

   • Help groups teach patients to stay in touch with reality and help them separate hallucinations from real life.
   • Self-help groups motivate people to take responsibility for their hallucinations, thereby helping them control and cope with them.

Probably every person has talked to himself at least once in his life, and experts do not see anything terrible in this. But when a person begins to think that in response to asking himself the question “Well, when will I start thinking about what I’m saying,” he hears a real voice, and not his own thoughts, they are already talking about the presence of auditory hallucinations. The reasons for them can be very different, but most immediately begin to suspect serious mental illness, and this is wrong.

Causes of auditory hallucinations

As mentioned above, most people associate auditory hallucinations with serious mental illness, for example, or mania. And this may indeed be the case, but only a specialist can make a diagnosis, so if such phenomena are observed for a long time, it is simply necessary to contact him.

But auditory hallucinations can be caused by a number of other reasons, most often this is a prolonged lack of sleep or taking any psychotropic drugs. Also, this phenomenon can be caused by medications; in particular, anti-spasm medications often have this side effect. In addition, sound hallucinations can appear during severe nervous excitement - an attack of jealousy, rage, severe sadness, falling in love, etc. Depression can also be accompanied by hearing disorders. Some diseases (Alzheimer's disease) may also be accompanied by auditory hallucinations. Ear diseases or poor quality hearing aids can also cause a person to hear voices that do not exist in reality.

Sounds that cause hallucinations

It is curious that a person himself can cause hallucinations of this kind; we are not talking about taking alcohol and other psychotropic substances, but about using sounds that cause hallucinations. There is the so-called Ganzfeld method (from German “empty field”), a technique based on the formation of a dream state of consciousness against the background deep relaxation body. The person is asked to lie down, close their eyes (it's best to wear a sleep mask to avoid distractions from light) and relax while listening to white noise - the sound that a radio makes on an empty frequency. Another example of white noise is the sound of a waterfall. After some time, the person relaxes and plunges into a state similar to the deep sleep phase. But since he is not actually sleeping and continues to be aware of what is happening, he begins to experience auditory or visual hallucinations; we can say that in this state a person dreams in reality.

Auditory hallucinations are a type of productive pathology in psychiatry, in which the patient hears various sounds in the absence of their real source. Important characteristic heard precisely as hallucinations - the patient is convinced of their truth. He will never describe imaginary sounds with the word “seemed.”

Types of auditory hallucinations

What is directly audible can be different - the sound of the wind, the sound of a car, the singing of birds, and most characteristically - voices. The characteristics of the voices are also different:

• Voices commenting on the patient's behavior. In most cases, those commenting on hallucinations have a sarcastic tone, which causes dissatisfaction and aggression. If the circumstances are unfortunate, this aggression can spill out on the patient’s relatives.
• Voices talking to each other on topics unrelated to the patient. It's relative safe look auditory hallucinations, in most cases perceived by the patient as a kind of radio.
• Voices repeating the patient's thoughts or confirming his ideas. This is a rather dangerous type of hallucination, it can provoke aggressive behavior. In the case of repetition of thoughts, it seems to the patient that all his thoughts, even impartial or intimate ones, are being disclosed publicly. He may have a desire to eliminate the “witnesses” of mind reading. And if thoughts are confirmed by voices, any, even the most incredible, ideas, when repeated for a long time, seem like reality to the patient. The fleeting thought that his wife might cheat on him, under the influence of hallucinations, turns into a fait accompli. And the fact may be followed by retribution, also invented under the influence of hallucinations.
• Commanding (imperative) voices. The most dangerous type of auditory hallucinations, since the patient lacks criticality. He believes everything he hears in hallucinations, which means he carries out all their orders. And orders can be very different - from cleaning the apartment to going and killing grandma. The combination of delusions and imperative hallucinations is most often a symptom of a severe mental illness, such as schizophrenia.

When deciding how to treat hallucinations, it is extremely important to find out their cause in each case. It is she who plays a decisive role in choosing treatment tactics. The causes of hallucinations can be divided into several main groups:

Hearing aid malfunction. This is a fairly common cause in older people. If an elderly person using a hearing aid complains about voices, first of all you need to check the quality of its work.

Side effects of drugs. Some psychotropic drugs, in overdose or as side effects, can cause hallucinations. Hallucinations are also possible with an illiterate combination of drugs. This happens especially often when self-medicating. When contacting a doctor regarding symptoms of hallucinations, be sure to present full list medications taken by the patient.

Alcohol intoxication and delirium. In this case, recognizing the cause is not difficult. It is necessary to distinguish between hallucinations during alcohol intoxication and delirium. During intoxication, they develop at the height of intoxication, especially when consuming surrogate alcohol, and are neutral in nature. In delirium, hallucinations of a threatening nature occur when alcohol is withdrawn after prolonged use. How to treat auditory hallucinations in this case is quite clear.

Auditory hallucinations as a symptom of mental illness. The most common and most difficult option to treat. It is in this case that all the variety of auditory hallucinations arises. They can be a manifestation of schizophrenia, manic-depressive psychosis, Alzheimer's disease and other diseases.

Treatment of auditory hallucinations

Treatment approaches may vary significantly depending on the cause of the hallucinations. Let's consider how to treat auditory hallucinations according to the reasons listed above.

1. Hallucinations due to a malfunction of the hearing aid. The most favorable variant of diagnostic results. It is treated by replacing or repairing the device. Depending on the type of hearing aid, they can independently imitate noise or reproduce voices due to the fact that the device tunes to a radio wave and transmits it to the patient.
2. Only a specialized specialist can recognize hallucinations that are a side effect of drugs or their combinations. This specialist is not always your local therapist. It may be necessary to contact a psychiatrist, cardiologist, narcologist or other doctor related to the profile of diseases and medications taken. Be sure to keep a record of all medications you take - names, doses and frequency of administration per day. This is especially important in the case of elderly patients who may confuse the medicine or take it again. It is convenient to make a special “prescription calendar” in which to mark the medications taken. When you visit your doctor, be sure to show him this “calendar” or just a list of medications.
   The occurrence of hallucinations as a result of taking medications indicates a severe overdose or long-term use of incompatible drugs. This condition cannot always be eliminated only by stopping medications or changing combinations. Intoxication may be required to speed up the elimination of substances that cause hallucinations. Treatment in this case occurs in a hospital setting. Subsequently, the patient is discharged for further treatment at home and is recommended suitable mode and combinations of medications to continue treatment.
3. Auditory hallucinations during alcohol intoxication or delirium occur acutely and are combined with delusions, visual hallucinations, and persecution mania. In this case, treatment must be immediate and very active. The patient must be hospitalized. Active detoxification therapy, infusions of nutritional and saline solutions are prescribed to quickly remove toxic substances from the patient’s body. With severe aggressiveness, motor agitation, and obsessions with persecution, tranquilizers and antipsychotics may be prescribed. In the future, full psychosocial rehabilitation of the patient, his involvement in work, preventative work with a family.
4. Auditory hallucinations in mental illness are part of a broad symptom complex called productive symptoms. In addition to auditory hallucinations, it includes other types (visual, tactile, pseudohallucinations), crazy ideas of various kinds, obsessive states. Hallucinations in combination with these symptoms are an alarming signal indicating the presence of severe mental pathology. In young people, they may primarily indicate schizophrenia. In the elderly, it may be a manifestation of Alzheimer's disease or senile dementia. The specific nosology can be clarified only with a thorough examination. The choice of treatment tactics also depends on the final diagnosis. In most cases, treatment for such severe symptoms occurs in a hospital. To relieve hallucinatory phenomena, antipsychotics are used, in particular new generation atypical antipsychotics. With pronounced psychomotor agitation it is necessary to prescribe tranquilizers. In the case of pathology in the elderly, treatment to relieve acute hallucinosis is the same as in young people. Further therapy depends on the nosology - there are specific drugs for the treatment of Alzheimer's disease, nootropics for dementia, etc.

The goal of primary treatment is to reduce the severity or eliminate hallucinations altogether. At home, follow-up treatment takes place with scheduled medications. In most cases, such patients require lifelong treatment. It is very important to train relatives to recognize the symptoms of exacerbation and monitor the patient’s condition.

"Voices in the head": 81% of people experience auditory hallucinations



The phenomenon of people hearing other people's voices in their heads is actually more complex than previously thought. Researchers from Stanford University and the University of Durham (both UK) published a report in the journal The Lancet Psychiatry. Scientists have discovered that voices are heard not only by people with psychiatric diagnoses, but also by healthy people. Most hear multiple voices, and some experience physical reactions to voices. For example, trembling, tingling, fever.

The researchers say this finding could help change the treatment used for auditory hallucinations. Conventional treatment includes medication, voice therapy, and other techniques. The new proposal is to focus on cognitive behavioral therapy.

Auditory hallucinations are characteristic of many mental disorders - psychosis, schizophrenia, bipolar disorder, but from 5% to 15% of healthy adults also experience auditory hallucinations.

The researchers interviewed 153 respondents. Most of them had a psychiatric diagnosis; 26 people had no history of such illnesses. The vast majority of respondents said that they hear multiple voices - 81%. 66% of respondents noted that voices were accompanied by specific bodily sensations, such as heat or tingling in the arms and legs, 31% of them experienced fear, anxiety and depression, and stress is often associated with voices, another 31% of participants said they felt positive emotions .

“As long as we believe that voices are signs of pathology and disease, it hardly makes sense to study this phenomenon. Instead, we try to suppress or eliminate voices. This study is a step forward. If we want to understand more about auditory hallucinations, we must be willing to change our perception of the phenomenon, said independent consultant Rachel Waddingham. - I would like to live in a world where we are interested in understanding each other and sharing experiences, and not pathologizing. Everyone has their own story, and the world would be a much kinder place if we started listening.”

scientificrussia.ru

Auditory hallucinations

Auditory hallucinations are the most common type of hallucination. As a rule, the patient hears various sounds, conversations and noises.

Sounds can be quiet or loud, and very often cause discomfort. Often auditory hallucinations are of a commanding nature. Many researchers have repeatedly associated the presence of auditory hallucinations with structural and functional disorders in the superior temporal gyrus, especially emphasizing the damage to the anterior part superior gyrus left temporal lobe.

Only a highly qualified psychiatrist can clearly determine whether the sounds and voices arising in the head are an auditory hallucination. The psychiatrist will also identify other disorders in the person’s mental activity. It happens that a completely healthy person, actively thinking, listens to his inner voice. It is a mistake to call this phenomenon a hallucination.

The occurrence of painful sensations and auditory hallucinations may indicate severe mental disorders or neurological pathology. Such symptoms cannot be ignored. It is necessary to seek help from a qualified psychiatrist as soon as possible.

An accurate diagnosis can only be determined with the help of competent and comprehensive survey, after which the doctor prescribes medications for hallucinations, or determines treatment for the underlying disease, for example, a vascular disease or a brain tumor.

Auditory hallucinations in older people

In older people, the occurrence auditory hallucinations usually associated with existing vascular diseases of the brain, or with the side effects of drugs prescribed for the treatment of somatic diseases. In older people, the risk of developing auditory hallucinations increases with age. Also, in elderly patients, the development of auditory hallucinations can occur against the background of somatogenic depression, various types mania, Alzheimer's disease.

Auditory hallucinations in schizophrenia

Sound hallucinations are most characteristic of schizophrenia, and are one of its first manifestations. With schizophrenia, hallucinations of other senses may also occur (“not only steps and threatening voices are heard, directed glances, smells and even the taste of poison are felt”).

In the presence of sound hallucinations, which occur in 75% of patients with schizophrenia, the latter can hear various sounds: noise, ringing, knocking, whistling, thunder, footsteps, “voices.” “Voices” often “voice thoughts”, whisper something, comment, “advise”, conduct a dialogue with each other, threaten, scold, order, call, argue with each other, etc.

Auditory hallucinations in schizophrenia most likely represent the patient's internal or own speech. The words he pronounces in a whisper correspond to their “voices”; we can say that this is the “inaudible speech” of a sick person.

It is possible that hallucinations may be accompanied by hidden inner speech, even if there is no obvious signs that a person with schizophrenia talks while hallucinating.

psyclinic-center.ru

Causes of auditory hallucinations

When auditory hallucinations occur, a person begins to hear various sounds, including voices and conversations, which do not exist in reality. In this case, you should take this violation seriously and seek help from a qualified specialist. As medical practice shows, almost every person has had to talk to himself at least once. For example, having forgotten his phone at home, he may think: “Well, when will I learn to be more collected”! Now imagine that after the phrase has been said, a voice is heard inside the person’s head that says: “Yes, indeed, you are too forgetful.” If something similar happens to a person, then it’s time to suspect that mental health not okay.

In a situation where an individual hears non-existent voices, they say that he has auditory hallucinations, the occurrence of which can be a number of reasons, so without an appropriate examination it is difficult to name the exact cause. First of all, experts suggest that in this case there is a mental disorder of varying severity, as well as a neurological disease. The biggest mistake is that some people take such disorders lightly and put off visiting a doctor until better times.


There is currently a debate among many scientists about the causes of auditory hallucinations. Some experts argue that the auditory hallucinations that sometimes sound in the head are one’s own voiced thoughts, that is, expressed in verbal form. In this regard, the individual begins to perceive this phenomenon as the voice of an unfamiliar and extraneous subject, and sometimes even several. If the cause of an auditory hallucination is a nervous or mental illness, then the patient believes that the voices sounding in his head exist in reality.

What diseases cause auditory hallucinations?


The peculiarity of auditory hallucinations is that a sick person can quite seriously declare that an inner voice ordered him to commit suicide, or gave the order to take the lives of loved ones and acquaintances. The most dangerous thing in this case is that the patient does not consider such orders to be a hallucination, and has no doubt at all that he

obliged to comply with these inadequate instructions. Among the causes of such disorders, schizophrenia is often cited. This is a disease that causes very serious mental disorders. Young patients are most susceptible to schizophrenia. At the same time, auditory hallucinations occur in people suffering from Alzheimer's disease, various manias and depressive states.

Among the reasons that cause auditory hallucinations, a factor such as alcohol abuse is named. This condition may be due to the adoption of certain medications, especially in case of overdose. Sometimes similar side effects are observed when taking antispasmodics. In this case, when going to see a doctor, it is necessary to make a list of all medications taken in advance in order to show it to the attending physician. But we should not forget about such a banal reason as the poor quality of the hearing aid. Therefore, if a patient using a hearing aid begins to hear strange sounds, strange voices, noise, then first of all, you should find out whether the hearing aid is in order.

It is known that auditory hallucinations occur not only in mentally ill people who need serious and immediate help from a psychiatrist. Very often, completely healthy people who do not have mental disorders, but are in a state of severe depression, may experience auditory hallucinations. Basically, they are expressed in the fact that when falling asleep they hear voices, supposedly calling them by name. Doctors say that this factor is not a manifestation of mental illness. In this case, the reason may be the usual nervous tension, overwork, stressful situations at work or in the family.

How to identify the cause of auditory hallucinations


In order to determine what is the real cause of this disorder, the doctor must carry out a detailed examination, talk with the patient, and ask a number of questions necessary in this case. Only after this does the specialist make a conclusion whether there is a need to send the patient for treatment to a psychiatrist. Sometimes, in order to establish the cause, it is enough for a person to visit a therapist. At present, the mechanism of the occurrence of hallucinations has not been sufficiently studied, and some reasons that are selective in nature are not entirely clear.

There is an assumption that in some cases, auditory hallucinations that occur in a healthy person are caused by a special attitude, a peculiar distortion of perception, which is influenced by previous events. Numerous scientific studies have established that the cause of auditory hallucinations is also the excessive excitability of certain areas in the brain. The simplest causes of this pathology include intoxication with substances of medicinal origin, for example, levodopa, ephedrine, and meridil. Drugs used are often to blame

patient. Therefore, when the appropriate irritants are eliminated, the problem can disappear quite quickly, even without special treatment. But in most cases, the patient needs to make efforts to get rid of hallucinations.

In searching for the cause of auditory hallucinations, doctors emphasize the special significance of many diseases. For example, attention should be paid if a patient complaining of hallucinations has cardiovascular disease, a tumor of the temporal lobe, various abscesses, temporal arteritis, migraine. Sometimes auditory hallucinations are associated with diseases of the sensory organs and brain damage.

www.psyportal.net

As varied as visual illusions.

Acoasma- elementary and simple auditory hallucinations of non-speech content. Elementary deceptions are felt as noise in the head or coming from the side, whistling, hissing, gurgling, creaking, crackling and other sounds, as if unrelated to certain objects and often unfamiliar to patients.

Simple auditory hallucinations are usually recognizable, have some clear meaning and are attributed to specific objects. These are, for example, slurping, gnashing of teeth, the sound of breaking dishes, the sound of waves, car horns, knocking on the door, sounds of footsteps, rustling of paper, kisses, coughing, squeaking mice, sighs, barking dogs, phone calls, door calls, etc. Thus, the patient reported that in her childhood, in a dream, she heard a doorbell ring. She woke up. The call was repeated. She went to the door and asked who was there. In response I heard: “It’s me, your death.” There were further calls. At home it seemed like it was her call, at her mother’s house it was different.

Often, up to four times a night, she wakes up to the sound of a bell. Some authors believe that such auditory deceptions can arise psychogenically (Alenstiel, 1960). In some cases, the predominance of sounds made by animals becomes so obvious that one can probably talk about such a type of deception as auditory zoological hallucinations, or zooacusis.

Phonemes- elementary and simple speech deceptions of hearing. These are shouts, groans, screams, exclamations, individual words. Some patients hear an inarticulate stream of sounds of low and incomprehensible speech, reminiscent of muttering - persistent hallucinations. Calls by first and last name are especially common, when patients hear that someone is either calling them or letting them know about their presence. In this case, one voice sounds or over time changes to some other one; the voice may be familiar or belong to an unknown person.

There are “silent” calls or calls that patients attribute to some other person. Calls occur rarely and with long intervals. Often during the entire period of occurrence they occur only 2-3 times. Patients often self-identify hearing deception. Sometimes the call is immediately repeated several times in the same way. The first reaction of patients to the appearance of calls is usually alertness and fear of a possible mental disorder. Then the patients calm down, as if they get used to them, try not to notice them, some think that this happens to everyone and there is nothing special about it.

Thus, in childhood, the patient clearly heard someone “calling” her in an unfamiliar male voice several times in a row. She was “scared”, but still went to see who could be hiding behind the tree. As an adult, a year after her father's death, she clearly heard his voice from the street, he was calling her. “I was scared and pleased.” Another patient, also in childhood, once heard a call in the voice of his deceased father. “I was scared, I thought that a dead man had come to life.” After that, for a year, it sometimes seemed to him that his father was alive. Once he even recognized his father in an unfamiliar passerby.

Some patients say that when they hear a call or a knock on the door, they “mechanically” approach it and open it even in the middle of the night, as if forgetting that it is unsafe. Apparently, calls are one of the symptoms of the long-lasting prodromal period of the disease. During the same period of time, in addition to phonemes, disorders such as a feeling of an alien presence, a feeling of someone else's gaze, and sometimes nightmares and other abnormal dreams may occur.

Musical hallucinations- deceptions of hearing with the sound of different music and in different “performances”. It can be sublime, spiritual or “heavenly” music, some popular pop melodies, something simple, primitive, associated with something vulgar, cynical, and unworthy. You can hear choirs, solo singing, the sounds of a violin, the ringing of bells, etc. Musical things known to patients sound, long-forgotten ones emerge, and sometimes these are completely unfamiliar melodies in an equally unfamiliar performance. There are patients who are musically literate and who manage to record hallucinatory melodies. We know of a case when one of these patients managed to publish a collection of songs, the words to which she composed to such melodies.

Some patients report that they can “order” musical hallucinations. To do this, they only need to remember the desired melody or words of the song, and it immediately begins to be broadcast from beginning to end. One of the patients heard such “retro-style concerts” for more than six months. It is not at all necessary that such patients be professional musicians. Musical hallucinations are observed when various diseases, mainly, apparently, in schizophrenia, epilepsy, alcoholic psychoses, as well as drug addiction. Drug addicts seem to have a particularly high frequency of listening to psychedelic music, which they willingly listen to in order to modify the picture of intoxication in a desired way.

Verbal hallucinations- deceptions of hearing in the form of speech. Patients hear phrases, monologues, dialogues, incoherent rows of words in their own language, foreign languages, or unknown to anyone. known languages. Rarely, there are hallucinations in conventional languages ​​known in cryptography. Many patients call verbal deceptions of hearing “voices,” initially surprised by the fact that they hear someone speaking, but do not see anyone. This contradiction does not confuse patients at all, so they do not doubt that someone is really talking, coming up with their own theories about this. It does not bother them that other people do not hear the same “voices” as they do. Usually patients, no matter what the “voices” say, address them to themselves. There are many variations of such hallucinations.

May occur in the context of many disorders and syndromes. Therefore, the choice of treatment depends not only on the type of perceptual deceptions and the impact on daily functioning, but also on the underlying disorder. At times, it can be very difficult to determine the underlying disorder because hallucinations, e.g. borderline disorders personalities, psychotic depression or temporal lobe epilepsies may be indistinguishable from hallucinations within schizophrenia at the phenomenological level.

Associated symptoms such as paroxysmal activity, parkinsonian motor symptoms, vision or hearing loss are the most reliable signs used in differential diagnosis. Some people who hallucinate may simply be concerned that their experience is a sign of a mental disorder, without being concerned about the hallucinations themselves. For others, the burden of hallucinations may not outweigh the side effects of their treatment. As a result, treatment may not be applicable in all cases. This article will look at some of the errors that are often associated with hallucinations, as well as specific treatment options for them.

Hallucinations in schizophrenia

Schizophrenia can be accompanied by hallucinations in any sensory modality. In 70% of cases they are auditory in nature, and in 50% of cases visual hallucinations are observed. Other types of hallucinations are less common.

The only type of medications known to be successfully used to treat hallucinations in schizophrenia are antipsychotics. Only 8% of first-episode psychotic patients still experience hallucinations after 1 year of treatment. However, it has not yet been published clinical trials, which would compare the effectiveness of different antipsychotic drugs for a single and specific indication – hallucinations. Therefore, the analysis used data from the European First Episode Psychotic Study, which assessed the effectiveness of 5 antipsychotic drugs in the treatment of hallucinations. Olanzapine, amisulpride, ziprasidone, and quetiapine were found to be equally effective against hallucinations; haloperidol, according to the study authors, cannot be the drug of first choice.

If the first choice drug does not provide improvement, it is best to switch to another drug after 2-4 weeks of treatment. Clozapine is the drug of choice for patients who are refractory to two adequate courses of antipsychotic medications. To prevent relapse, treatment should be continued with the same antipsychotic and, preferably, at the same dose. Long-acting formulations should be considered for all patients because the risk of non-compliance is very high.

Cognitive behavioral therapy (CBT) may be used in addition to antipsychotic therapy. CBT is aimed at reducing the emotional distress associated with auditory hallucinations, it teaches the patient to ignore the “voices” and focus on future plans and goals, which is reflected in the quality of life of the patients. However, CBT had no effect on the frequency of hallucinations.

On the other hand, transcranial magnetic stimulation (TMS) can reduce the frequency and severity of auditory hallucinations. Several meta-analyses have demonstrated efficacy for low-frequency repetitive TMS of the left temporoparietal region compared with placebo. As a consequence, TMS now has the status of a potentially useful treatment for auditory hallucinations, but only in combination with modern antipsychotic therapy.

Several guidelines mention electroconvulsive therapy (ECT) as the final step in the treatment of treatment-resistant psychoses within schizophrenia. Although several studies have shown clinical improvement following the use of ECT, specific reductions in hallucination severity have never been assessed at the group level.

Treatment of delirium

Delirium is an acute neuropsychiatric syndrome characterized by psychotic symptoms such as hallucinations and delusions in the presence of decreased attention, fluctuations in consciousness and other cognitive functions. This condition is very common in patients admitted to the departments intensive care, with an incidence of 32%, and is markedly associated with poor prognosis and increased mortality.

The only thing etiological treatment delirium – improvement of the patient’s somatic condition. Symptomatic treatment hallucinations and other symptoms of delirium should begin with measures aimed at normalizing the patient's circadian rhythm and orientation. Pharmacological treatment should preferably consist of haloperidol or olanzapine, as recommended in the latest NICE guidelines. Although benzodiazepines are widely used to treat delirium, their use is recommended only for alcoholic delirium. Cholinesterase inhibitors are not recommended, as evidenced by a randomized clinical trial of rivastigmine in patients with delirium admitted to the intensive care unit. This study was stopped at early stage due to a significant increase in mortality and duration of delirium compared with the control group.

Hallucinations in Parkinson's disease (PD)

The prevalence of hallucinations and other psychotic symptoms among patients with PD is 80%. In the case of dementia with Lewy bodies, which is pathogenetically closely related to PD, these numbers are even higher, especially for visual hallucinations. Auditory hallucinations are present in 20% of cases.

The pathophysiology of psychosis in PD and dementia with Lewy bodies involves a complex interaction of environmental and disease-related factors, including central dopaminergic activity, imbalances of the dopaminergic and cholinergic neurotransmitter systems, dysfunction of the visual pathways, changes in the regulation of the sleep-wake cycle, and impaired attentional focus. However, the most important external factor in the development of hallucinations within PD is drug treatment.

Treatment strategies: decrease antiparkinsonian medications, increase low-dose “atypical” antipsychotics, and possibly cholinesterase inhibitors. Eng and Welty reviewed 13 studies of antipsychotic treatment in patients with PD and concluded that long-term therapy with clozapine is indeed effective, while results from studies using quetiapine are inconsistent. Only one double-blind, placebo-controlled trial involving 188 patients with PD and hallucinations supports the effectiveness of the cholinesterase inhibitor rivastigmine. Thus, although the use of cholinesterase inhibitors, especially rivastigmine, appears to be a promising treatment for hallucinations in PD, these studies support the use of clozapine alone.

Hallucinations in Alzheimer's disease (AD)

In AD, the occurrence of psychosis in 30–50% of cases has serious consequences for both patients and caregivers. Cholinesterase inhibitors such as donepezil may have a beneficial effect on hallucinations with a relatively mild side effect profile. Another study on the treatment of psychosis in AD examined the effectiveness of olanzapine, quetiapine, risperidone and placebo over 36 weeks. The results showed that risperidone was more effective than the other two drugs and placebo. However, these drugs should be taken with caution due to the increased risk of complications in elderly patients.

As a consequence, it is strongly recommended not to consider antipsychotic drugs as a first choice for the treatment of psychotic symptoms in AD. Extrapyramidal symptoms and arrhythmias due to QT prolongation are common complications of “typical” antipsychotic drugs, while various cerebrovascular pathologies occur more often with the use of “atypical” antipsychotics. However, these medications should be used when the severity of symptoms is extreme or when symptoms do not respond to other types of medications or nonpharmacologic interventions.

Hallucinations in epilepsy

The reported incidence of hallucinations and other psychotic symptoms in epilepsy is 3.3%, and in temporal lobe epilepsy it is as high as 14%. Hallucinations may occur shortly before (aura), during, or after an epileptic seizure, but often occur independently of any motor seizures. Hallucinations often resemble those found in patients diagnosed with schizophrenia and are referred to as “schizophrenic psychoses of epilepsy.”

Treatment of hallucinations should primarily involve minimizing any drug that may mediate these symptoms. Various antiepileptic drugs, such as phenobarbital, zonisamide, levetiracetam and gabapentin, are known to induce hallucinations. In such cases, reducing the dose or switching to another antiepileptic drug can lead to relatively rapid relief of hallucinations.

When antiepileptic drugs cannot be reduced or discontinued, antipsychotics are the drugs of choice. Clozapine and chlorpromazine should be avoided due to their epileptogenic properties, while quetiapine, risperidone and haloperidol are generally well tolerated.

Hallucinations due to sensory deafferentation

Patients with low vision may experience complex visual hallucinations, a condition known as Charles Bonnet syndrome. Likewise, people with progressive hearing loss may develop auditory hallucinations of music, voices, or other sounds.

It is believed that such hallucinations are actually phenomena due to deafferentation of areas of the visual or auditory association cortex of the brain, which can lead to so-called “phantom perceptions.” Cognitive defects and social isolation may act as additional risk factors.

Patients who understand their unrealistic nature tend to suffer less from them, although they may still be distressed by the fear of "inevitable madness." Reassurance and explanation that visual or auditory deceptions do not imply any mental disorder can have a powerful therapeutic effect.

According to the authors, psychotropic treatment is not always necessary, since relief of hallucinations may cease either spontaneously or after the cessation of social isolation. The first choice treatment is to restore vision or hearing, e.g. surgical treatment cataracts, external ear cleaning or hearing aids.

When such interventions are unsuccessful, consideration may be given to pharmacological treatment, although the benefits of treatment do not always outweigh the disadvantages of side effects. Although antipsychotics, antiepileptic drugs, and cholinesterase inhibitors have previously been reported to be effective in these settings, there are currently no randomized studies of the effectiveness of these types of medications in patients with hallucinations as part of sensory deafferentation. If pharmacological treatment is considered necessary, quetiapine or lamotrigine may be the drugs of choice. TMS has also been used for this type of hallucination, but the results remain inconclusive.

The material was prepared as part of the ProSchizophrenia project - a specialized section of the official website of the Russian Society of Psychiatrists dedicated to schizophrenia, modern approaches to its diagnosis and treatment.

Prepared by: Kasyanov E.D.

Psychiatric and neurological patients sometimes complain of auditory hallucinations. This is a distorted perception of reality. A person hears sounds that do not exist in reality. There are many types of this symptom. Therapy will consist of timely treatment of the underlying disease.

Diseases characterized by symptoms:

• schizophrenia;
• malignant neoplasms of the brain;
• hallucinatory-delusional syndromes;
• depressive states;
• bipolar affective disorder;
• dementia;
• Alzheimer's disease;
• various vascular diseases (atherosclerosis, circulatory insufficiency of some parts of the brain);
• chronic alcoholism.

What are auditory hallucinations

Auditory or acoustic hallucinations are a perception disorder when a person hears sounds without the stimulus affecting the hearing aid. This means that reality is perceived distorted and incorrect.

Psychiatrists classify auditory hallucinations as productive symptoms, that is, they are a new phenomenon that appears as a result of illness and is absent in healthy people. Such hallucinations can be in the form of:

• sound;
• whistling;
• the sound of a vehicle braking;
• birds singing;
• words;
• a whole sentence.

Why does this disease appear?

The causes of auditory hallucinations are diseases of various etiologies. Psychiatric diseases come to the fore:

• schizophrenia;
• depression;
• bipolar affective disorder, etc.

Other reasons:

• malignant tumors and brain metastases;
• inflammatory processes of the brain;
• cerebrovascular accident.

People suffering from chronic alcoholism may hear “voices” during delirium (popularly called “delirium tremens”).

How do “voices” arise?

The exact mechanism of auditory hallucinations is unknown.

In the course of numerous experiments and studies, it was found that while the patient hears “voices,” Broca’s area is active in the cerebral hemispheres - the center of speech responsible for its reproduction; located in the cortex of the left frontal lobe (in right-handed people).

When a person simply thinks, he also activates Broca's center. This can be called inner speech. To understand that speech comes from the inside, there is a special department in the brain - the Wernicke center. It is located in the temporal and parietal lobes.

It is believed that the patient cannot recognize internal speech, but perceives it as external. That is, there is a dysfunction of the Wernicke center.

What can increase the likelihood of developing this symptom?

Relative risk factors for the development of auditory hallucinations:

• refusal to take prescribed medications;
• independent adjustment of doses of medications taken;
• simultaneous use of medications that inhibit each other’s effects.

There are no absolute risk factors for auditory hallucinations.

What types is it divided into?

Auditory hallucinations, like all others, are divided into elementary, simple and complex.

Elementary hallucinations are of two types: acoasms and phonemes.

Acoasms - noise, tapping, rumble, hissing, shooting, ringing - is a separate sound. The symptom is found in the practice of psychiatrists and neurologists. An otolaryngologist or an ENT doctor can also come across this (with Meniere's disease - this is a disease of the inner ear, non-inflammatory in nature, leading to deafness).

Phoneme - individual words, shouts, pronouns, syllables - speech deception. Phonemes do not form speech; they are just individual elements that do not carry a semantic load.

Both acoasms and phonemes are periodic and constant.

Simple auditory hallucinations are a deception of perception that does not affect another analyzer. That is, the patient hears only the sound, but does not see the source.

There are several types of simple ones:

• musical (the patient hears the playing of a guitar, violin or piano, singing, popular or unknown melodies, excerpts of works or entire compositions);
• verbal or verbal (the patient hears conversations, whole phrases or just individual words).

Verbal hallucinations, in turn, are divided into three types:

• commenting or evaluative (patients with such hallucinations listen to voices that judge their actions, assign an assessment to actions, intentions or the past; such “voices” can be either friendly and encouraging, or judgmental and accusatory in nature);
• threatening (quite unpleasant for the patient; the patient hears threats at his own expense, promises of violence, etc.);
• imperative (hallucinations of this type can pose a threat not only to the patient, but also to the people around him).

Imperative hallucinations interfere with the treatment process: “voices” can simply prohibit the patient from listening to the doctor and following his instructions, or taking medications.

There are very rarely cases in the practice of psychiatrists when patients turn to them for treatment on the orders of “voices”. Such a person may not even realize that he is mentally ill.

Complex hallucinations are hallucinations that simultaneously affect the function of several analyzers. For example, a person not only hears the speech of his pursuer, but also sees him in his room.

What are the special types of auditory hallucinations?

Alenshtil's auditory hallucinations are hallucinations in the form of a knock on the door or a bell. Occurs in a mentally healthy person at a moment of intense anticipation of the corresponding sound.

Antagonistic (contrasting) hallucinations - a person hears several “voices” that express opposing intentions. For example, one “voice” suggests killing someone, and the second dissuades them.

Important! Auditory hallucinations are a symptom of a mental or neurological disease. They can occur in diseases such as schizophrenia, dementia, bipolar affective disorder, and brain tumors. A person hears sounds that are real only to him without the influence of an irritant on the hearing aid. In themselves, such perception disorders are not dangerous, but their content can cause the patient to harm himself or others. Any hallucinations should be a reason to consult a psychiatrist

Auditory hallucinations in older people

Elderly people may experience auditory hallucinations due to deterioration of blood supply, organic brain damage, mental disorders, or taking medications with side effects - hallucinations.

The most common reasons for older people are:

• isolated auditory hallucinosis of Charles Bonnet - develops after 70 years of age against the background of decreased hearing. At the beginning they appear as acoasms, which over time turn into phrases and sentences with a semantic load. It is extremely rare that “voices” are imperative in nature. Most often, a person “hears” condemnation, threats and insults addressed to him;
• hallucinations as a symptom of mental illness (for example, schizophrenia);
• hallucinations in Parkinson's disease (a disease characterized by the destruction of motor cells in the brain that produce the neurotransmitter dopamine);
• side effects of medications (drugs that lower blood pressure - antihypertensives, some antibiotics, psychostimulants, tranquilizers, anti-tuberculosis drugs).

Treatment consists of prescribing antipsychotics. In case of hallucinations from medications, the attending physician should discontinue or replace the drug that causes such an unpleasant syndrome.

It is noteworthy that with Charles Bonnet hallucinosis, the symptoms lose their intensity over time, and attacks become increasingly rare. Problems with the cognitive function of the brain (memory, attention, etc.) begin to pose a big problem.

Auditory hallucinations in children

It is not uncommon for children to experience the first years of school. During this period, the child is under significant pressure. The student experiences overwork and stress, often anxiety about grades. This condition leads to the child beginning to hear unreal “voices.”

Other causes of auditory hallucinations in older children include:

• fever;
• food and drug poisoning;
• neurological disease;
• puberty (time of hormonal changes in the body);
• use of alcohol and drugs (relevant for high school students);
• depressive disorder;
• insomnia;
• severe physical and psychological injuries.

Hallucinations in a child should alert the parent. You should immediately consult a doctor to rule out mental retardation and neurological diseases.

When and which doctor to contact

If a person is bothered by auditory hallucinations, then this is a cause for concern. You must make an appointment with or.

What first aid can be given to a person?

The sequence of actions during an attack should be as follows:

• call an ambulance;
• protect the patient from himself and others;
• try to calm down.

It is impossible to independently provide medical first aid to a person with hallucinations. This can only be done by doctors using specific medications.

How is diagnosis made?

An experienced specialist will only be able to suspect that a patient has auditory hallucinations based on behavior.

Such patients are always on guard, they are constantly listening to something, staring into the empty space of the room. They can whisper something, answer an invisible interlocutor. Under the influence of imperative hallucinations, a person may try to jump out of a window and harm himself or others.

It will be very important for the doctor to understand what kind of hallucinations he sees: true or false. With false hallucinations, the source of the “voices” will be directly in the human body. The patient will claim that they are speaking in his head, his spine. There is no projection on appearance. False hallucinations or pseudohallucinations have a more unfavorable prognosis and are included in the Kandinsky-Clerambault syndrome (a combination of hallucinations, delusions and phenomena of automatism, when patients are haunted by a feeling of “made” movements or thoughts).

Treatment tactics

Disease or condition	Type of therapy	A drug	Drug group	Mode of application
Alcohol intoxication	Detoxification
	gastric lavage	Activated carbon	Adsorbent	2-3 spoons once
		4% sodium bicarbonate solution	Electrolyte solution	50 ml IV (single dose)
	infusion therapy	40% glucose solution	Solution for intravenous administration	20-40-50 ml IV slowly (single dose)
	symptomatic therapy	10% solution of Sulphocamphocaine	Analeptics (have a stimulating effect on the respiratory center)	2 ml IV (single dose)
		Korglykol	Cardiac glycosides	0.5-1 ml IV slowly over 5-6 minutes (once)
		Clopixol	Neuroleptic	10-50 mg orally (single dose)
		Diazepam	Tranquilizer	5 mg orally (single dose)
Mental disorders	Drug therapy (drug of choice)	Aminazine	Neuroleptics	1-5 ml of a 2.5% solution is administered intramuscularly no more than 3 times a day (take from 2-3 weeks to 2-3 months)
		Triftazin		2-5 mg 2 times a day orally (take 2-3 weeks)
		Haloperidol		10 mg IM 2-3 times a day (take 2-3 months)

For Alzheimer's disease, dementia and others, it is necessary to use specific drugs that improve the course of the underlying disease, while eliminating attacks.

Doctor's advice! Don't be afraid to use antipsychotics. Despite the fact that they have side effects, these drugs do an excellent job of improving the patient’s condition and quality of life.

What could be the consequences?

Auditory hallucinations are not an independent disease, so they have no direct complications. However, if you do not resort to treatment for this condition, as well as the disease that causes the appearance of such a symptom, the consequences can be depressing.

The progression of the disease leads to social maladjustment and loss of self-care skills.

We must not forget that in some cases, auditory hallucinations can prompt a person to attempt suicide.

How to prevent the occurrence

There is no specific prevention. Prevention of such conditions comes down to the need for timely treatment of specific diseases.

What to Expect After an Episode of Auditory Hallucinations

The prognosis depends on the root cause of the appearance, since they are just a symptom and do not act as an independent disease.

In situations resulting from taking medications or fatigue, the prognosis is quite favorable, since you just need to stop taking medications, rest and reduce the impact of stress on the body.

However, for mental disorders, it is necessary to take medications that eliminate the productive symptoms of the disease. Such medications have significant side effects and are used exclusively under the prescription of a psychiatrist.

Auditory hallucinations- deceptions of perception or “imaginary perceptions”, in which a sound (or sounds) is perceived and heard, while there is no real sound signal in the surrounding world. Auditory hallucinations are most often of a painful nature.

Note! Auditory hallucinations can be classified as subjective sounds. They are audible only to the patient, which makes diagnosing and treating this disease very difficult.

1. “Voices” are the most common type of auditory hallucination. They can manifest themselves as separate calls of the name, short phrases that occur rarely with long breaks. Entire dialogues and conversations are possible, reminiscent of a radio broadcast. Doctors note such dangerous types of voices as commanding or prohibiting voices (imperative auditory hallucinations); the presence of such a symptom can be life-threatening for the patient and his environment. Endogenous diseases are characterized by so-called “commentary voices” that “discuss, scold or defend the person hearing them.”
2. “Noises” - the sick person hears sounds in the form of crackling, whistling, ringing, clock ticking, etc.
3. “The sound of music” - manifested by constant or episodic perception of musical phrases. We observed in our patients both long-lasting well-known pieces of music and musical phrases that had never been heard before.
4. “Hypnagogic auditory hallucinations” are auditory deceptions of perception that occur during the period of falling asleep or waking up (“hypnapompic hallucinations”).

Causes of auditory hallucinations

The causes are disturbances in the functioning of the brain. Below we present the most common diseases and conditions in which auditory hallucinations can develop:

• Organic mental disorders (consequences of oxygen starvation nervous system, injuries, strokes and heart attacks, vascular diseases of the brain).
• Epilepsy.
• Alcoholism and drug addiction.
• Consequences of poisoning and infections of the nervous system.
• Endogenous diseases (schizophrenia, schizotypal disorder, schizoaffective disorder, psychosis).
• Neurological diseases (neoplasms in brain tissue, autoimmune and atrophic diseases of the nervous system, etc.).
• Overwork, lack of sleep, fasting, deficiency of substances necessary for the nervous system in the diet.

Behavior during auditory hallucinations depends on their severity, as well as on the presence of a critical attitude towards them. With pronounced auditory illusions of perception, the patient may close and plug his ears, hide, turn on loud music, etc.

What to do if you have auditory hallucinations

If you realize that you are experiencing auditory hallucinations, or see that your loved one hears something that you do not hear, then you need to consult a psychiatrist. At the appointment, the psychiatrist will clarify the condition, give recommendations, and tell the patient and his family how to behave.

Nowadays, organizing a consultation with a psychiatrist is quite simple. At your request, a psychiatrist can consult by telephone or answer written questions, come to your home or work for an examination, or make an appointment at the clinic.

Remember, if you experience auditory hallucinations for the first time, you should contact a psychiatrist URGENTLY so as not to miss the development of more severe mental disorders.

The ROSA Clinic helps people with auditory hallucinations. We have modern diagnostic equipment, experienced psychiatrists, neurologists, and psychophysiologists for a full examination. We treat both mild perception disorders and severe psychoses with abnormal behavior.

The clinic is open 24 hours a day. We do not put it on "registration". Anonymously.