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On the Interconnectedness and Prognostic Value of Visual and Auditory Hallucinations in First-Episode Psychosis

Published online by Cambridge University Press:  28 January 2017

M.L. Clark ,
F. Waters ,
T.M. Vatskalis  and
A. Jablensky
M.L. Clark
Affiliation:
Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Rear 50 Murray Street, 6000Perth, Australia Cooperative Research Centre for Mental Health, Level 2/161 Barry Street, 3053Carlton South, Australia
F. Waters*
Affiliation:
Clinical Research Centre, North Metropolitan Health Service-Mental Health, John XXIII Avenue, 6010Mount Claremont, Australia
T.M. Vatskalis
Affiliation:
Clinical Research Centre, North Metropolitan Health Service-Mental Health, John XXIII Avenue, 6010Mount Claremont, Australia
A. Jablensky
Affiliation:
Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Rear 50 Murray Street, 6000Perth, Australia
*
⁎Corresponding author. Clinical Research Centre, North Metro Health Service, Graylands Hospital; Perth, Western Australia; and The School of Psychiatry and Clinical Neurosciences, The University of Western Australia (M708), 35, Stirling Highway, 6009 Crawley, WA, Australia. Tel.: +61 8 9347 6650. E-mail addresses:flavie.waters@uwa.edu.au, Flavie.Waters@health.wa.gov.au (F. Waters).
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Abstract

Background

Visual hallucinations (VH) are common symptoms in schizophrenia and other psychoses. An understanding of their cross-sectional and longitudinal patterns of association with auditory hallucinations (AH) is essential for developing accurate models of hallucinatory phenomena.

Objective

This study presents the most comprehensive examination of the association between VH and AH, and its change over time, in 1303 individuals with first-episode psychosis (FEP) and 469 individuals with chronic schizophrenia.

Method

The samples included data from the WHO multicentre study on the Determinants of Outcome of Severe Mental Disorders and the Western Australian Family Study of Schizophrenia (WAFSS). Standardized assessment of symptoms and functioning were used to examine the clinical profile and symptom co-occurrence of hallucinations over time.

Results

VH were approximately half as frequent as AH, almost always co-occurred with AH, and tended to be linked to a more severe psychopathological profile. AH and VH at baseline also predicted higher disability, risk of relapse and duration of psychosis after 1 and 2 years, especially when occurring in combination.

Conclusions

The findings point to three hallucination ‘subtypes’ with different symptom profile. The VH + AH combination signals greater psychopathology and a less favourable prognosis, than hallucinations occurring in isolation, and no hallucinations. This conclusion points to one common mechanism for all hallucinations, which can separate into distinct pathways and modalities. For a more complete clinical picture, clinicians should carefully probe for both auditory and VHs in presenting patients.

Keywords

Schizophrenia and psychosisEpidemiologyPsychotherapy
Type
Original article
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 122 - 128
Copyright
Copyright © European Psychiatric Association 2017

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Footnotes

1

Joint first authors: these authors contributed equally to this work.

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