Hallucinations

Hallucinations in any modality can occur, but auditory hallucinations are the most prevalent in schizophrenia. Hearing voices speaking in the third person is the most specific. This experience is listed among the Schneiderian first-rank symptoms. Sometimes the content is mundane, as in the instance when a patient of Bleuler (1) heard a voice saying 'Now she is combing her hair' while she was grooming in the morning. In other instances there is an implied criticism, as in the case reported by Schneider(4) of a woman who heard a voice saying 'Now she is eating; here she is munching again', whenever she wanted to eat.

Second-person auditory hallucinations are also common. In the International Pilot Study of Schizophrenia, (5) voices speaking to the patient were reported in 65 per cent of cases. Such voices are often derogatory, although it is not uncommon for a patient to hear both derogatory and comforting voices. Voices might issue commands that the patient obeys. In some instances, the patient engages in a dialogue with the voices.

During the acute phase of illness, auditory hallucinations usually have the same sensory quality as voices arising from sources in the external world. The patient might change accommodation in a fruitless attempt to escape from them. In some instances the voice is attributed to a radio-transmitter implanted in the body, especially in the teeth. In the chronic phase, the voices are often recognized as coming from within the person's own mind. Kraepelin (6) reports: 'at other times they do not appear to the patient as sense perceptions at all; they are "voices of conscience"; "voices which do not speak with words"'. These experiences are pseudohallucinations, but nonetheless they are a significant feature in many cases.

In schizophrenia, visual hallucinations are less common than auditory hallucinations, but do occur. Somatic hallucinations are also relatively common, and often are associated with a delusional misinterpretation. For example, a young man reported sensations in his belly that he attributed to a snake, which he believed had crawled up his anus.

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