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Auditory hallucination download7/18/2023 It is increasingly recognized that hallucinations occur with significant frequency in other psychiatric (eg, post-traumatic stress disorder, personality disorders) and medical conditions (neurodegenerative conditions and eye disease) and that they are especially predictive of multimorbid psychopathology. The emphasis on the clinical significance of hallucinations in DSM-5 5 requires closer examination given our growing understanding of hallucinations that feature outside of psychosis. Although not diagnostic of schizophrenia when occurring in isolation, the presence of persistent auditory hallucinations is sufficient for a diagnosis of Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, if it is combined with clinically significant distress or functional impairment (ref. 3, 4 Hallucinations constitute one of the 5 domains of abnormality of schizophrenia spectrum and other psychotic disorders in DSM-5. Since the earliest clinical texts, auditory hallucinations have been closely linked to schizophrenia. For the experiencer, hallucinations can have important personal meanings, and for clinicians, they are also significant in varied ways, including as diagnostic symptom and as factors which may impact on functioning and prognosis, and therefore potentially the necessity of treatment. The personal, cultural, and clinical significances of hallucinations have changed in the 200 years since they were defined by Esquirol as “the intimate conviction of actually perceiving a sensation for which there is no external object.” 1, 2 There is a growing recognition that hallucinatory experiences attend a wide variety of psychiatric diagnoses and can be part of everyday experience for people who do not meet criteria for mental illness. It is more important to focus instead on the co-occurrence of other symptoms and the value of hallucinations as an indicator of vulnerability. Overall, when considering hallucinations, it is inadvisable to give weight to the presence of any featural properties alone in making a schizophrenia diagnosis. Additional differences rendered the nonclinical groups somewhat distinctive from clinical disorders. Among the 21 features of hallucinations in schizophrenia considered here, 95% were shared with other psychiatric disorders, 85% with medical/neurological conditions, 66% with drugs and alcohol conditions, and 52% with the nonclinical groups. The results showed that no single hallucination feature or characteristic uniquely indicated a diagnosis of schizophrenia, with the sole exception of an age of onset in late adolescence. A total of 43 articles were reviewed, which included hallucinations in 4 major groups (nonclinical groups, drug- and alcohol-related conditions, medical and neurological conditions, and psychiatric disorders). We investigated whether certain featural properties of hallucinations are specifically indicative of schizophrenia by conducting a systematic review of studies showing direct comparisons of the featural and clinical characteristics of (auditory and visual) hallucinations among 2 or more population groups (one of which included schizophrenia). Although specific featural properties of hallucinations (negative voices, talking in the third person, and location in external space) are no longer highlighted in DSM, there is likely a residual assumption that hallucinations in schizophrenia can be identified based on these candidate features. Hallucinations constitute one of the 5 symptom domains of psychotic disorders in DSM-5, suggesting diagnostic significance for that group of disorders.
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