What is Auditory Hallucinations?
Auditory hallucinations, also known as paracusias, are when someone hears sounds without any external source. These can include various sounds, but when the sounds are voices, they are specifically called auditory verbal hallucinations. Although these types of hallucinations are often linked to schizophrenia, they aren’t exclusive to it. Other mental and neurological conditions like mood disorders, trauma-related disorders, substance-related disorders can also cause them.
These voices can often be troubling, especially if they are threatening, demeaning, commanding, or haunting. They can affect a person’s social life and their ability to work. Thankfully, these hallucinations usually show a good response to medications used for mental health conditions.
What Causes Auditory Hallucinations?
Auditory hallucinations, or hearing things that aren’t there, can be a symptom of several different disorders. Because of this, experts think there isn’t just one cause for them. These hallucinations are most commonly seen in people with psychosis.
Studies using PET and fMRI scans have shown that people with schizophrenia, a type of psychosis, often have increased activity in certain areas of the brain. These areas include the striatal and thalamic subcortical nuclei (deep structures within the brain), paralimbic regions (areas involved in processing emotions), and hypothalamus (an area responsible for many different functions, such as releasing hormones).
In particular, these studies reveal that there are shortcomings in the functioning of the left temporal lobe, an area of the brain that’s responsible for things like understanding speech. Also, some experts also suggest that there could be problems with the way the brain uses the chemical glutamate, which is used in the brain to send signals between nerve cells. This aligns with the theory that some forms of psychosis may be related to the brain not using glutamate properly.
Risk Factors and Frequency for Auditory Hallucinations
Auditory hallucinations, or hearing things that aren’t there, are quite common. They occur in about 5 to 28% of the general population. They’re seen most often in people with psychosis. In fact, 75% of individuals with schizophrenia, 20-50% of individuals with manic depression, 10% of individuals with major depression, and 40% of individuals with PTSD experience these types of hallucinations.
When it comes to children and teenagers, about 9% of children and 5 to 16% of teenagers experience auditory hallucinations. These hallucinations tend to show up when children are dealing with conduct disorder, migraines, or anxiety. The good news is, every year, about 3 to 40% of teenagers who have auditory hallucinations will stop experiencing them.
- 5 to 28% of the general population experience auditory hallucinations.
- These hallucinations are most common in people with psychosis.
- 75% of individuals with schizophrenia, 20-50% of individuals with manic depression, 10% of individuals with major depression, and 40% of individuals with PTSD have these hallucinations.
- About 9% of children and 5 to 16% of teenagers experience auditory hallucinations.
- In children, these hallucinations often occur along with conduct disorder, migraines, or anxiety.
- Each year, 3 to 40% of teenagers with auditory hallucinations will stop having them.
Signs and Symptoms of Auditory Hallucinations
Paracusias, or auditory hallucinations, can vary greatly in how they are experienced. They might seem to be coming from within the ear, from the body’s surface, from the mind or from the environment. These hallucinations can happen daily or as a single episode. The hallucinations themselves can also differ. They might be loud or soft, or may be incomprehensible noises or clear voices. Depending on the person’s self-awareness, these hallucinations can significantly affect their daily life. They often occur in people with disorders that affect their thought processes, but they can also occur in a variety of other circumstances.
When someone with schizophrenia experiences paracusias, the nature of these hallucinations can change depending on the stage of the condition. For example, in the later pre-illness stages, their internal thoughts may start to feel more like external events.
Testing for Auditory Hallucinations
When examining a person experiencing paracusias (auditory hallucinations), doctors first carry out a general psychiatric interview. This involves discussing how these hallucinations have developed over time, what might trigger them, and any past psychiatric diagnoses, substance use, family history of mental health issues, and trauma history.
It’s also essential to get a detailed medical history from the patient, along with information on any medications and supplements they’re currently taking.
One of the most valuable tools a doctor has when assessing these kinds of hallucinations is the mental status exam. This examines the patient’s mood, emotions, appearance, behavior, speech, thought content and process, as well as the patient’s insight and judgment.
It’s also important to notice if ‘first-rank’ or ‘Schneiderian’ hallucinations are present. These are voices that seem to speak to one another, or seem to narrate the patient’s thoughts aloud. If these are tied to the patient’s emotions, it’s important to see if the hallucinations also match up with the patient’s mood. Finally, to ensure the safety of the patient and others around them, the patient should be asked to describe if the voices command them to do certain actions.
Lastly, doctors aim to rule out medical causes for the hallucinations. They do this through a series of lab tests and brain scans. These tests include:
1. Urine drug testing
2. Complete blood count
3. Vitamin B12 and D level testing
4. Kidney function test
5. Serum electrolytes test
6. Liver function test
7. Blood alcohol level testing
Brain images such as Computed tomography (CT) or magnetic resonance imaging (MRI) may be done if brain abnormalities are suspected. Lastly, electricity activity in the brain may be checked through an Electroencephalography (EEG) to rule out a seizure disorder.
Treatment Options for Auditory Hallucinations
Firstly, it’s important to address and treat any underlying physical diseases. If these diseases initially sparked the hallucinatory experiences, these will likely stop once the disease is effectively managed.
If the hallucinations were caused by a significant mental health disorder, doctors generally turn to a type of medication commonly known as antipsychotics (or neuroleptics in scientific terms). These medications work by blocking receptors in the brain that interact with dopamine, which is thought to help lessen auditory hallucinations.
Typically, there are two categories of antipsychotics, referred to as first-generation and second-generation. First-generation antipsychotics mainly interact with a specific type of dopamine receptor, while second-generation ones work on a wider range of receptors. The choice between these two types usually boils down to considering potential side effects of the medications.
Regardless of the type chosen, hallucinations should decrease within a week of starting the treatment. If they persist, your doctor might add another antipsychotic to the regimen. If, after trying two antipsychotics, hallucinations still continue, a medication called clozapine may be used. Clozapine is often more effective for treating things like hallucinations, delusions, and disorganized behavior. However, it does come with risks and requires careful monitoring because it can affect blood cell production.
If the hallucinations come along with mood disorders like depression or mania, other medications such as antidepressants or mood stabilizers may be given alongside the antipsychotics.
Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), can be used in combination with medication. CBT helps patients change the way they perceive the hallucinations, giving them a greater sense of control. Various coping strategies can also be beneficial such as acceptance and commitment therapy, hallucination-focused treatment, attention retraining, distraction techniques, and self-help groups for people who hear voices.
Emerging treatments include transcranial magnetic stimulation, which involves using magnetic fields to stimulate nerve cells inside the brain. While some studies suggest it may help reduce auditory hallucinations, more research is required to confirm its effectiveness.
What else can Auditory Hallucinations be?
To understand why someone might be experiencing auditory hallucinations, or hearing things that aren’t there, doctors usually consider several factors:
- They look at your detailed medical history and conduct laboratory tests and brain scans to rule out any physical causes.
- They will ask about your use of both illegal and legal substances, including any medications or supplements you take. This will help them determine if a chemical imbalance could be at play.
- They’ll want information about your family mental health history. Several mental health disorders that are inheritable can cause auditory hallucinations.
Various mental health conditions can cause auditory hallucinations. For instance, schizophrenia, bipolar disorder, depression, trauma-related disorders, dissociative disorders, personality disorders, and parasomnias (sleep disorders) are known to potentially cause auditory hallucinations.
In addition, certain neurological conditions can lead to auditory hallucinations. This includes tinnitus (ringing in the ears), cerebral tumors, traumatic brain injury, epilepsy (especially the type that affects the temporal lobe), viral encephalitis (brain inflammation), delirium, and cardiovascular events that affect certain areas of the brain.
Other physical health issues can cause auditory hallucinations. This includes neurodegenerative diseases, conditions that damage the pathways that carry sensory information, such as hearing loss or thyroid dysfunction, nutritional deficiencies, chromosomal abnormalities, autoimmune disorders, and immune system deficiencies.
It’s also important to note that auditory hallucinations can also suddenly occur in response to extreme physical or psychological stress, such as from a disorder like dissociative identity disorder, fatigue, or the grief of losing a loved one.
What to expect with Auditory Hallucinations
If hallucinations are caused by a physical condition, their outcome will depend on the underlying disease. In other words, if the original disease is treated and resolved, the hallucinations should, in theory, also go away. But, if the hallucinations are part of a psychiatric disorder, it’s a bit more tricky. Research shows that schizophrenia symptoms can be managed with certain drugs, but this doesn’t mean the disorder itself is cured. Therefore, even if the hallucinations stop, the underlying mental health disorder may still be present.
There are certain factors that can make it harder to treat hallucinations. These include having the condition at a young age, being male, and having been hospitalized several times.
Possible Complications When Diagnosed with Auditory Hallucinations
Complications can happen when a patient experiences hallucinations that tell them to harm themselves or others. Another concerning issue is when a person dealing with hallucinations starts having serious self-doubt that may lead them to consider suicide. Aside from these, the most common problems are the side effects caused by the antipsychotic medications, which can range from short-term to long-term effects.
Common Side Effects:
- Extrapyramidal symptoms like distorted body movements, involuntary fine motor tics, and symptoms similar to Parkinson’s disease
- Metabolic syndrome, a group of conditions that includes high blood sugar, increased blood pressure, excess body fat around the waist, and abnormal cholesterol levels
People struggling with these issues may not be able to take proper care of themselves and could end up being admitted to the hospital against their will. It is necessary to establish a trusting and respectful relationship with patients to ensure they continue regular check-ups even after they’ve been released from the hospital. This is extremely important as there is a high risk of relapses due to patients not keeping up with their medications and appointments.
Preventing Auditory Hallucinations
It’s important that patients and their families understand the importance of taking their medications as prescribed. Unfortunately, many patients don’t always follow their medication schedules, miss follow-up appointments, and can sometimes relapse and require hospitalization. Hence, it is often crucial for patients with severe illnesses to be a part of an intensive community treatment program. These programs provide treatment, rehabilitation, and various support services.
Support groups that aim to remove the stigma around mental illness can also be beneficial for the patient and their family. Activities such as vocational and art therapy can help improve a patient’s self-esteem and improve their overall functioning.
Lastly, it’s important that patients understand the role of case management services. These services can help by coordinating between doctors and social workers, helping patients keep track of appointments, and carrying out home visits as required.
