Auditory hallucinations

Question 1

What are the two main types of hallucinations? [2]

Answer 1

verbal auditory hallucinations (VAH):
- hearing voices, phrases or sentences
- These voices might be familiar or unfamiliar to the patient
- The content of the hallucination can vary widely, from benign comments to derogatory remarks or command-type hallucinations instructing the patient to perform certain actions.

non-verbal auditory hallucinations (NVAH)
- perceiving non-speech sounds such as music or ambient noise
- Patient may show signs of distress if they perceive these sounds as real and intrusive.
- Clinical observation should focus on signs of anxiety, agitation and insomnia which could suggest ongoing NVAHs

Question 2

Describe symptoms associated with auditory hallucinations [3]

Answer 2

Anxiety and fear are common emotional responses in individuals experiencing auditory hallucinations. They may feel threatened by the content of the hallucinations or simply by their inexplicable occurrence.

Depression and social withdrawal may also be noted, particularly if the patient is aware of the abnormality of their experiences and fears stigmatisation.

Exhibit paranoid behaviour due to perceived threats from the voices. This can manifest as suspiciousness, hostility or even aggression.

Question 3

Which psychiatric disorders can cause auditory hallucinations? [3]

Answer 3

Schizophrenia:
- Auditory hallucinations, typically in the form of voices, are a hallmark of schizophrenia.
- These can be conversing, commenting or commanding in nature. Patients may show decreased emotional responsiveness and social withdrawal.

Mood disorders:
- In severe depressive or manic episodes, patients may experience auditory hallucinations.
- These are usually congruent with the mood state; so individuals with depression might hear critical or self-deprecating voices.

Post-Traumatic Stress Disorder (PTSD):
- Patients suffering from PTSD can experience auditory hallucinations related to their traumatic experiences.

Question 4

Which neurological disorders can cause auditory hallucinations? [3]

Answer 4

Epilepsy:
- Auditory hallucinations can occur as an ictal phenomenon, especially in temporal lobe epilepsy. They are usually brief and stereotyped for each patient.

Narcolepsy:
- Hypnagogic or hypnopompic hallucinations associated with narcolepsy can be auditory in nature.

Migraine:
- Rarely, complex auditory hallucinations can precede a migraine attack.

Question 5

Which dementia disorders can cause auditory hallucinations? [2]

Answer 5

Lewy body dementia:
- This form of dementia is characterised by vivid visual and occasionally auditory hallucinations along with fluctuating cognitive impairment and parkinsonian motor symptoms.

Parkinson’s disease dementia and Alzheimer’s disease:
- Auditory hallucinations may occur but are less common than visual ones.

Delirium:
- In states of acute confusion, patients may have transient auditory hallucinations.

Question 6

Which substance-related disorders can cause auditory hallucinations? [2]

Answer 6

Alcohol withdrawal:
- During severe withdrawal, patients may experience auditory hallucinations along with other symptoms such as tremors, agitation and seizures.

Cannabis, LSD and other hallucinogens:
- These substances can induce auditory hallucinations during intoxication.