Auditory hallucinations schizophrenia manual#

Recognizing the limitations of older phenomenologic studies along with increasing evidence of broad AVH heterogeneity, 15, 16 McCarthy-Jones and Resnick 17 recently provided an updated list of typical AVH features to guide malingering assessments. In both of these relatively small samples, typical features of AVH such as clarity and external localization would be more accurately described as trends, with nontrivial exceptions and significant variability being the rule.

Auditory hallucinations schizophrenia manual#

12 included 116 hospitalized patients with a variety of diagnoses made according to the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II), 13 including schizophrenia, affective disorder, organic brain syndrome, alcoholism, and hysteria the subsequent survey in 1996 by Nayani and David 14 involved 112 psychiatric outpatients with similarly diverse diagnoses. The oft-cited 1971 study by Goodwin et al. It must be noted, however, that what is typical or atypical for AVH has been largely based on older studies with a limited number of diagnostically heterogeneous patients. 8, –, 11 These guidelines advise clinicians to be globally vigilant for symptoms reported with vagueness, inconsistency, and evasiveness on detailed questioning, as well as any atypical features of endorsed AVH. This article reviews challenges faced in the evaluation of malingered voice-hearing, highlighting differences in forensic and clinical settings, as well as the diagnostic conundrum of nonpsychotic AVH.Ī generation of psychiatrists has relied on published guidelines for the detection of malingered psychosis, most notably those composed by Resnick 3, –, 7 and others following his work. In the absence of the ability to look inside someone's head for a specific biological marker of auditory verbal hallucinations (AVH), evaluators must often perform what are, at best, probabilistic assessments of malingering. Unlike malingered physical injuries that might be thwarted by a private investigator armed with a camera, psychiatric symptoms in general and claims of voice-hearing in particular are relatively easy to feign and largely unverifiable. Although the study has been cited by some as an indictment against the reliability of psychiatric diagnosis, it would be more accurate to regard it as evidence of the difficulty of detecting malingered voice-hearing. psychiatric hospitals based on claims of hearing voices that said “empty,” “hollow,” and “thud.” 1 During an average hospital stay lasting 19 days, the “pseudopatients” were prescribed antipsychotic medications and tricyclic antidepressants, and seven left with a diagnosis of schizophrenia, leading Rosenhan to conclude that “we cannot distinguish the sane from the insane in psychiatric hospitals” (Ref.

In a now well-known social experiment published in 1973, the late Stanford University psychology and law professor David Rosenhan and seven confederates admitted themselves to various U.S. In both clinical and forensic settings, the detection of malingered auditory verbal hallucinations requires detailed exploration of phenomenologic features along with mediating factors that influence the risk of associated violence or suicide. The detection of malingered auditory verbal hallucinations in clinical settings may be particularly vulnerable to false positives and false negatives due to low suspicion on the part of clinicians, low utilization and poor specificity of psychometric testing, and “iatrogenic malingering” that is less likely to include cartoonish claims and more likely to involve voice-hearing as a sole presenting symptom (i.e., monosymptomatic auditory verbal hallucinations). The evaluation of malingered auditory verbal hallucinations is complicated, however, by increasing evidence that voice-hearing is a broadly heterogeneous experience that does not always reflect psychopathology, with atypical features nearly as common as typical characteristics. The gold standard for the detection of malingered psychosis involves expert clinical assessment augmented by standardized psychometric testing.