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Eaton W.W., Romanoski A., Anthony J.C., Nestadt G. (1991), Screening for psychosis in the general population with a self report interview, Journal of Nervous and Mental Disease, No. 179, pp 689 693
B. Ensink: Confusing Realities: A study of child sexual abuse and psychiatric symptoms Amsterdam, VU University Press (1992) and also Trauma: A study of child abuse and hallucinations, in Accepting Voices Eds M. Romme and S. Escher (1993)
Erkwoh, R., Willmesb, K., Eming-Erdmanna, A., Kunerta, H.J. Command Hallucinations: Who Obeys and Who Resists When? Psychopathology, 2002, 35:272-279
The impact of auditory command hallucinations on the behaviour of schizophrenic patients sometimes appears to be unpredictable. In order to tackle this problem, the psychopathological characteristics of command hallucinations in 31 schizophrenic patients were assessed using a 24-item questionnaire. Using binary data and relative risk analysis methods, predictors were determined for obeying or resisting command hallucinations. Characteristics of voices and the attitude toward the voices appear equally important for prediction. A set of three psychopathological characteristics comprising a voice known to the patient, emotional involvement during the hallucinations, and seeing the voice as real provides significant predictivity of behaviour following command hallucinations. These results are interesting for clinical and forensic psychiatrists.
Sandra Escher; Philippe Delespaul; Marius Romme; Alex Buiks; Jim Van Os., Coping defence and depression in adolescents hearing voices. Journal of Mental Health, Volume 12, Issue 1 February 2003 , pages 91 - 99
Background: The level of self-initiated coping defences in the face of auditory hallucinations reflects the degree to which the psychotic experiences are exceeding the person's resources. As it has been suggested that individuals who feel overwhelmed by their psychotic experiences are also more likely to develop depression, greater levels of self-initiated coping defences should predict onset of depression in the context of auditory hallucinations.
Method: Eighty adolescents (mean age 12.9 years, SD=3.1) who reported hearing voices were examined at baseline and followed-up three times over a period of 3 years. Fifty per cent were receiving professional care, but 50% were not in need of care. Baseline measurement of self-initiated coping defences and psychopathology were used as predictors of depression at follow-up.
Results: Baseline level of self-initiated coping was strongly associated with baseline severity of positive psychotic symptoms. Coping at baseline, with the exception of active problem solving, predicted an increase in the level of depression over the follow-up period (OR=3.0, 95% CI: 1.4, 6.4), independent of baseline psychopathology, demographic characteristics, receipt of professional care and appraisals and attributions related to the voices.
Conclusions: The results suggest that individuals who have a tendency to feel overwhelmed by the experience of voices, as evidenced by a more defensive style of response, are more likely to develop depression.
Sandra Escher , Marius Romme, Alex Buiks, Philippe Delespaul, Jim van Os (2002)., Formation of delusional ideation in adolescents hearing voices: A prospective study. American Journal of Medical Genetics, Neuropsychiatric Genetics, Volume 114, Issue 8 , Pages 913 - 920
Abstract
Previous work suggests that auditory hallucinations in children and adolescents occur frequently in the absence of psychotic illness, although a number of such children go on to develop more severe psychotic symptomatology and need for care. We examined prospectively what factors are associated with formation of delusions in adolescents who are hearing voices. Eighty adolescents (mean age 12.9 years, SD = 3.1) who reported hearing voices were examined at baseline and followed-up three times over a period of 3 years. Fifty percent were receiving professional care, but 50% were not in need of care. Baseline measurement of voice appraisals, attributions, psychopathology, global functioning, dissociation, stressful life events, coping mechanisms, and receipt of professional care were used as predictors of delusion formation, measured as a score of 6 or greater on the extended BPRS items: suspiciousness, unusual thought content and grandiosity. Thirteen children (16%) displayed evidence of delusional ideation over at least one of the three follow-up periods, of which seven (9%) de novo. Adjusting for presence of baseline delusional ideation, delusion formation over the follow-up period was associated with baseline voice appraisals and attributions such as tone of the voice (hazard ratio voice variably friendly and hostile compared to always friendly: HR = 6.8, 95% CI: 1.1, 41.0), perceived location of the voice (outside vs. inside head: HR = 2.9, 95% CI: 1.0, 8.7), and whether the voice resembled that of a parent (HR = 3.5, 95% CI: 1.0, 12.0); baseline BPRS anxiety/depression (HR = 6.4, 95% CI: 1.9, 21.4), baseline BPRS disorganization (HR = 5.0, 95% CI: 0.98, 26.1) and the baseline amount of reported recent stressful life events (HR continuous life events score: 1.8, 95% CI: 1.0, 3.3). In addition, in older children, the perceived influence of the voices on emotions and behavior was strongly associated with delusion formation (HR = 5.1, 95% CI: 1.0, 25.9). Delusion formation in children hearing voices may be responsive to triggering events and facilitated by feelings of anxiety/depression. The results also highlight the role of attributions associated with external sources, authority figures, perceived influence or power over the person, as well as emotional appraisal processes and cognitive disorganization.
A. Escher, M. Romme, (no date); Effects of Mutual Contacts from People with Auditory Hallucinations, Lecture at Manchester, Sheffield and Liverpool Universities
S. Escher, (October, 1993); Talking about voices, Open Mind Magazine
S. Escher, M. Romme, A. Bunks & P. Delespaul, J Van Os; Independent course of childhood auditory hallucinations: a sequential 3-year follow-up study (2004), The British Journal of Psychiatry (2002) 181: s10-s18
Background Childhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes.
Aim To study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status).
Method In a group of 80 children of mean age 12.9 years (s.d.=3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status.
Results The rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place.
Conclusions Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.