View source for Auditory hallucination

{{Infobox Disease
 | Name           = Auditory hallucination
 | Image          =
 | Caption        =
 | DiseasesDB     =
 | ICD10          = {{ICD10|R|44|0|r|40}}
 | ICD9           = {{ICD9|780.1}}
 | ICDO           =
 | OMIM           =
 | MedlinePlus    =
 | eMedicineSubj  =
 | eMedicineTopic =
 | MeshID         =
}}
{{neuropsychology}}
{{Portal|Neuroscience}}
An '''auditory hallucination''', or '''paracusia''',<ref>{{cite web | url = http://medical-dictionary.thefreedictionary.com/paracusia | title = Medical dictionary}}</ref> is a form of [[hallucination]] that involves perceiving sounds without auditory [[stimulus (physiology)|stimulus]].  A common form involves hearing one or more talking voices.  This may be associated with [[psychosis|psychotic]] disorders such as [[schizophrenia]] or [[mania]], and holds special significance in diagnosing these conditions.  However, individuals may hear voices without suffering from diagnosable [[mental illness]].<ref>{{cite web | url = http://www.livescience.com/humanbiology/060915_hearing_voices.html | title = Hearing Voices: Some People Like It | last = Thompson | first = Andrea | publisher = LiveScience.com | date = September 15, 2006|accessdate = 2006-11-25 }}</ref>  The [[Hearing Voices Movement]] is a support and advocacy group for people who hallucinate voices, but do not otherwise show signs of mental illness or impairment.

Other types of auditory hallucination include [[exploding head syndrome]] and [[musical ear syndrome]].  In the latter, people will hear music playing in their mind, usually songs they are familiar with. Recent reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time.<ref>{{cite web | url = http://www.vnunet.com/vnunet/news/2140422/ipod-help-produce-musical | title = IPod hallucinations face acid test | last = Young | first = Ken | publisher = Vnunet.com | date = July 27, 2005 | accessdate = 2008-04-10 }}</ref> This can be caused by: [[lesions]] on the [[brain stem]] (often resulting from a [[stroke]]); also, [[tumors]], encephalitis, or [[abscesses]].<ref>{{cite web | url = http://www.sciencedaily.com/releases/2000/08/000809065249.htm | title = Rare Hallucinations Make Music In The Mind | publisher = ScienceDaily.com | date = August 9, 2000 | accessdate = 2006-12-31 }}</ref> Other reasons include hearing loss and epileptic activity.<ref>Engmann, Birk; Reuter, Mike: Spontaneous perception of melodies – hallucination or epilepsy? ''Nervenheilkunde'' 2009 Apr 28: 217-221. ISSN 0722-1541</ref> 

==Famous examples==
'''[[Robert Schumann]]''', a famous music composer, spent the end of his life experiencing auditory hallucinations. Schumann’s diaries state that he suffered perpetually from imagining that he had the note “A5” sounding in his ears. The musical hallucinations became increasingly complex. One night he claimed to have been visited by the ghost of Schubert and wrote down the music that he was hearing. Thereafter, he began making claims that he could hear an angelic choir singing to him. As his condition worsened, the angelic voices transmogrified into demonic voices.<ref name="laqueur">{{cite news  | title=Spirited Away  | author=Laqueur, Thomas  | date=2007-09-03  | pages=36–42 }}</ref>

'''[[Joan of Arc]]''' claimed to hear the voices of Saints who were the force that guided her and was resolved to obey these messages as she believed they were sent directly from God. She first began hearing voices when she was thirteen and soon after had visions of St. Francis, St. Catherine and St. Margaret.<ref name="laqueur" />

==Individual accounts==
The onset of delusional thinking is most often described as being gradual and insidious. Patients described an interest in psychic phenomena progressing to increasingly unusual preoccupations and then to bizarre beliefs "in which I believed wholeheartedly". One author wrote of their hallucinations: "they deceive, derange and force me into a world of crippling paranoia". In many cases, the delusional beliefs could be seen as fairly rational explanations for abnormal experiences: "I increasingly heard voices (which I'd always call ‘loud thoughts’)... I concluded that other people were putting these loud thoughts into my head".<ref name="stanton">{{cite journal |last=Stanton |first= Biba| title= First-person accounts of delusions|journal= Psychiatric Bulletin | volume=20|year=2000|pages= 333–336}}</ref> Some cases have been described as an "auditory ransom note".

==History==
===Ancient history===
====Presentation====

The ancient world viewed hallucinations as it did most of the natural world, with awe and superstition.  As such, it was viewed as either a gift or curse by God, or the gods (depending on the specific culture).  The oracles of ancient Greece were known to experience auditory hallucinations while breathing in certain neurologically active vapors, while the more pervasive delusions and symptomology were often viewed as possession by demonic forces as punishment for misdeeds.<ref name="laqueur" />

====Treatments====

Treatment in the ancient world is ill documented, but there are some cases of therapeutics being used to attempt treatment, while the common treatment was sacrifice and prayer in an attempt to placate the gods.  The Dark Ages saw the most horrific accounts where the suffered of auditory hallucinations were subjected to [[trepanning]] or trial as a witch.<ref name="laqueur" />  In other cases of extreme symptomology individuals were seen as being reduced to animals by a curse, these individuals were either left on the streets or imprisoned in [[insane asylums]].  It was the latter response that eventually led to modern [[psychiatric hospitals]].<ref name="boyer"/>

===Pre-modern===
====Presentation====

Auditory hallucinations, like most everything else in Europe, was rethought during the enlightenment.  As a result, the predominant theory in the western world beginning in the late 18th century was that auditory hallucinations were the result of a disease in the brain and treated as such as mania.<ref name="boyer">Boyer, Paul S: "Insane Asylums." The Oxford Companion to United States History. Oxford University Press. 2001. Encyclopedia.com. 22 Nov. 2009</ref>

====Treatments====

There were no effective treatments for hallucinations at this time.  Conventional thought was that clean food, water, and air would allow the body to heal itself ([[Sanatorium]]).  Beginning in the 16th century [[Insane Asylum]]s were first introduced in order to remove “the mad dogs” from the streets and left them chained to walls and living in their own filth.<ref name="boyer"/>  These asylums acted as prisons until the late 18th century.  This is when doctors began the attempt to treat patients.  Often attending doctors would douse patients in cold water, starve them, or spin patients on a wheel.  Soon, this gave way to brain specific treatments with the most famous examples including [[Lobotomies]], [[Electroconvulsive therapy|shock therapy]] and branding the skull with hot iron.<ref name="boyer"/>

==Conventional views==
===Potential causes===
====Associated diseases====

The premier cause of auditory hallucinations in the case of psychotic patients is [[schizophrenia]].  In these cases, patients show a consistent increase in activity of the thalamic and strietal subcortical nuclei, hypothalamus, and paralimbic regions; confirmed via [[Positron emission tomography|PET]] scan and [[fMRI]].<ref name="Silbersweig">{{cite journal |last=Silbersweig |first=D.A.|title= A functional neuroanatomy of hallucinations in schizophrenia |journal= Nature| volume=378|year=1995|pages= 176–179}}</ref><ref name="Shergill 2004">{{cite journal |last=SHERGILL |first=SUKHWINDER S.| title= Neuroanatomy of ‘Hearing Voices’: A Frontotemporal Brain Structural Abnormality Associated with Auditory Hallucinations in Schizophrenia |journal= Cerebral Cortex | volume=14|year=2004|pages= 91–96}}</ref>  Other research shows an enlargement of temporal white matter, frontal gray matter, and temporal gray matter volumes (those areas crucial to both inner and outer speech) when compared to control patients.<ref name="Shin 2005">{{cite journal |last=Shin |first=Sang-Eun| title= Segmented volumes of cerebrum and cerebellum in first episode schizophrenia with auditory hallucinations
|journal= Psychiatry Research: Neuroimaging| volume=138|year=2005|pages= 33–42}}</ref><ref name="Shergill 2003">{{cite journal |last=SHERGILL |first=SUKHWINDER S.| title= Temporal course of auditory hallucinations |journal= BRITISH JOURNAL OF PSYCHIATRY| volume=182|year=2003|pages= 525–531}}</ref>  This implies both functional and structural abnormalities in the brain can induce auditory hallucinations, both of which may have a genetic component.<ref name="Boksa 2009">{{cite journal |last=Boksa|first=Patricia |title= On the neurobiology of hallucinations |journal= J Psychiatry Neuroscience| volume=34(4)|year=2009|pages= 260–262}}</ref><ref name="Spencer 2009">{{cite journal |last=Spencer|first=Kevin M |title= Left auditory cortex gamma synchronization and auditory hallucination symptoms in schizophrenia|journal= BMC Neuroscience| volume=10:85|year=2009|pages= 1–13}}</ref><ref name="hugdahl">{{cite journal  | title=Auditory hallucinations in schizophrenia: the role of cognitive, brain structural and genetic disturbances in the left temporal lobe  | last=Hugdahl  | first=Kenneth  | journal=Frontiers in Human Neuroscience  | volume=1  | year=2008  | pages=1–10 }}</ref>  [[Mood disorders]] have also been known to cause auditory hallucinations, but tend to be milder than their psychosis induced counterpart.

====Non-disease associated causes====
Auditory hallucinations have been known to manifest as a result of intense stress, sleep deprivation, drug use, and errors in development of proper psychological processes.<ref name="thinking aloud">Fernyhough, Charles; Jones, Simon R.: “Thinking Aloud About Mental Voices”</ref>  Genetic correlation has been identified with auditory hallucinations,<ref name="hugdahl" /> but most work with non-psychotic causes of auditory hallucinations is still ongoing.<ref name="thinking aloud"/><ref name="Stip 2009">{{cite journal |last=Stip|first=Emmanuel |title= Psychotic Symptoms as a Continuum Between Normality and Pathology |journal= The Canadian Journal of Psychiatry| volume=54|year=2009|pages= 140–151}}</ref>

===Conventional diagnosis and treatments===
====Pharmaceuticals====
The primary means of treating auditory hallucinations is [[antipsychotic]] medications which affect dopamine metabolism. If the primary diagnosis is a mood disorder (with psychotic features), adjunctive medications are often used (e.g., antidepressants or mood stabilizers).

====Psychological therapies====
[[Cognitive-Behavioral Therapy]] has been shown to help decrease the frequency and distressfulness of auditory hallucinations, particularly when other psychotic symptoms were presenting.<ref name="Penn 2008">{{cite journal |last= Penn |first=David L. |title=Professional A randomized controlled trial of group cognitive-behavioral therapy vs. enhanced supportive therapy for auditory hallucinations |journal=Schizophrenia Research | volume=109 |year=2008|pages=52–59}}</ref>  [[Enhanced Supportive Therapy]] has been shown to reduce the frequency of auditory hallucinations, the violent resistance the patient displayed towards said hallucinations, and an overall decrease in the perceived malignancy of the hallucinations.<ref name="Penn 2008"/>  Other cognitive and behavioral therapies have been used with mixed success.<ref name="hayashi">HAYASHI, NAOKI md, phd; IGARASHI, YOSHITO md; SUDA, KIYOKO md; NAKAGAWA, SEISHU md: Auditory hallucination coping techniques and their relationship to psychotic symptomatology ''Psychiatry and Clinical Neurosciences 61” 2007: 640–645</ref><ref name="Shergill 1998">{{cite journal |last=Shergill |first=Sukhwinder S.| title= Auditory hallucinations: a review of psychological treatments|journal= Schizophrenia Research| volume=32|year=1998|pages= 137–150}}</ref>
====Non-conventional therapies====
[[Electroconvulsive therapy]] or ECT has been shown to reduce psychotic symptoms associated with schizophrenia, mania, and depression, and is often used in psychiatric hospitals.

In recent years, repetitive transcranial magnetic stimulation (rTMS) has been studied as a biological method of treatment for auditory hallucinations. rTMS plays a role in altering neural activity over language cortical regions. Studies have shown that when rTMS is used as an adjunct to antipsychotic medication in treatment-resistant cases, the frequency and severity of auditory hallucinations can be reduced.<ref>Waters F. [http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.psychiatrictimes.com%2Fcme%2Fdisplay%2Farticle%2F10168%2F1534546&q=auditory+hallucinations&c=ps&ss=psychTimesLink&p=Convera&fr=true&ds=0&srid=1 Auditory hallucinations in psychiatric illness]. Psychiatric Times. 2010;27(3):54-58.</ref>

==Ongoing research==
===Non-psychotic symptomology===
There is on-going research that supports the prevalence of auditory hallucinations, with a lack of other conventional psychotic symptoms (such as delusions, or paranoia), particularly in pre-pubertal children.<ref name="Askenazy 2007">{{cite journal |last= Askenazy |first=Florence L. |title= Auditory hallucinations in pre-pubertal children: A one-year follow-up, preliminary findings|journal= European Child Adolescence Psychiatry| volume=16 |year=2007|pages= 411–415}}</ref>  These studies indicate a remarkably high percentage of children (up to 14% of the population sampled<ref name="Jones 2007">{{cite journal |last=Jones |first=Simon R.| title= Neural correlates of inner speech and auditory verbal hallucinations: A critical review and theoretical integration|journal= Clinical Psychology Review| volume=27|year=2007|pages= 140–154}}</ref>) experienced sounds or voices without any external cause, though it should also be noted that "sounds" are not considered by psychiatrists to be examples of auditory hallucinations. Differentating actual auditory hallucinations from "sounds" or a normal internal dialogue is important since the latter phenomena are not indicative of mental illness.

===Causes===
The causes of auditory hallucinations are unclear.

Dr. Charles Fernyhough, of the University of Durham poses one theory among many but stands as a reasonable example of the literature.  Given standing evidence towards involvement of the inner voice in auditory hallucinations,<ref name="Allen 2007">{{cite journal |last=ALLEN|first=PAUL |title= Inner speech models of auditory verbal hallucinations: Evidence from behavioural and neuroimaging studies|journal= International Review of Psychiatry| volume=19(4)|year=2007|pages= 409–417}}</ref> he proposes two alternative hypotheses on the origins of auditory hallucinations in the non-psychotic.  Both of which rely on understanding of the internalization process of the inner voice.<ref name="thinking aloud"/><ref name="Jones 2007"/><ref name="Fernyhough 2004"/>
====Internalization of the inner voice====
The internalization process of the inner voice is the process of creating an inner voice during early childhood, and can be separated into four distinct levels.<ref name="thinking aloud"/><ref name="Jones 2007"/><ref name="Fernyhough 2004"/>

'''Level One (External Dialogue)''' involves the capacity to maintain an external dialogue with another person, i.e. a toddler talking with their parent(s).

'''Level Two (Private Speech)''' involves the capacity to maintain a private external dialogue, as seen in children voicing the actions of play using dolls or other toys.

'''Level Three (Expanded Inner Speech)''' is the first internal level in speech.  This involves the capacity to carry out internal monologues, as seen in reading to ones self, or going over a list silently.

'''Level Four (Condensed Inner Speech)''' is the final level in the internalization process.  It involves the capacity to think in terms of pure meaning without the need to put thoughts into words in order to grasp the meaning of the thought.

====Disruption to internalization====
A disruption could occur during the normal process of internalizing ones’ inner voice, where the individual would not interpret their own voice as belonging to them; a problem that would be interpreted as level one to level four error.<ref name="thinking aloud"/><ref name="Jones 2007"/><ref name="Fernyhough 2004">{{cite journal |last=Fernyhough |first= Charles| title= Alien voices and inner dialogue: towards a developmental account of auditory verbal hallucinations
|journal= New Ideas in Psychology | volume=22|year=2004|pages= 49–68}}</ref>

====Re-expansion====
Alternatively, the disruption could occur during the process of re-externalizing ones inner voice, resulting in an apparent second voice that seems alien to the individual; a problem that would be interpreted as a level four to level one error.<ref name="thinking aloud"/><ref name="Jones 2007"/><ref name="Fernyhough 2004"/>

===Treatments===
Given the current trends in research, a new approach must be taken towards treatment of these hallucinations.  A process that would necessarily begin with the patient being helped to realize that the voices they hear are from their own mind.  This realization would allow them to reclaim a measure of control over their lives, and begin the process of controlling their own alien voices.<ref name="thinking aloud"/>

==References==
{{Reflist|2}}

== Further reading==
*{{cite book |author=Johnson FH |title=The anatomy of hallucinations |publisher=Nelson-Hall Co |location=Chicago |year=1978 |isbn=0-88229-155-6 }}
*{{cite book |author=Bentall RP, Slade PD |title=Sensory deception: a scientific analysis of hallucination |publisher=Croom Helm |location=London |year=1988 |isbn=0-7099-3961-2 }}
*{{cite book |author=Larøi F, Aleman A |title=Hallucinations: The Science of Idiosyncratic Perception |publisher=American Psychological Association (APA) |year=2008 |isbn=1-4338-0311-9 |url=http://books.apa.org/books.cfm?id=4318044}}

==External links==
*[http://www.intervoiceonline.org/ INTERVOICE Online, website of the international hearing voices movement]
*[http://www.hearing-voices.org/ Hearing Voices Network]
*[http://www.psychanalyse-paris.com/843-Anthropology-and.html "Anthropology and Hallucinations"], chapter from ''The Making of Religion''
*[http://www.mind.org.uk/help/medical_and_alternative_care/the_voice_inside_coping_with_hearing_voices "The voice inside: A practical guide to coping with hearing voices"]
*[http://dictionary-psychology.com  Psychology Terms]

{{Bipolar disorder}}
{{Cognition, perception, emotional state and behaviour symptoms and signs}}

{{DEFAULTSORT:Auditory Hallucination}}
[[Category:Psychedelics, dissociatives and deliriants]]
[[Category:Psychosis]]
[[Category:Medical signs]]
[[Category:Symptoms and signs: Cognition, perception, emotional state and behaviour]]

[[es:Alucinación acústica]]
[[Category:2Fix]]