Predicting compliance with command hallucinations

Article Abstract:

A disparity has emerged between the results of research studies and clinical impressions regarding the significance of auditory hallucinations. Traditionally, it has been presumed that verbal hallucinations that command the subject to perform a particular action are dangerous. However, research studies have indicated that command hallucinations have little impact upon the subject's behavior; a recent study found no incidence of destructive or dangerous behavior resulting from an auditory hallucination. Psychiatric patients who had reported hearing a voice that gave a command or instruction were interviewed. This exploratory study was performed to assess the variables that separated individuals who complied with the commands of their hallucinations and those who ignored the commands. It was anticipated that the degree of danger involve would be an influential factor, i.e. the patients would be less likely to obey dangerous commands. The 51 psychiatric patients were separated into three groups; 20 reported that they complied with the command; 24 said they did not comply; and seven could not remember. Four major variables were found to be common to whose who complied: the voice in the hallucination was recognized; the voice supported an accepted delusional belief of the patient; the individual was schizophrenic; and the patient was black. Out of these characteristics, the first two factors were the most influential in compliance behavior. Twenty individuals received dangerous commands from a hallucination; out of this group, eight (40 percent) complied. The degree of danger involved in the command hallucination did not appear to affect the patient's behavior. Although these results are preliminary, they support clinical experience reports, rather than research studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Hallucinations and illusions, Hallucinations

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Persistence and remission of depressive symptoms in late life

Article Abstract:

Declining physical health and increasing disability were found to be the primary cause of depression among a representative sample of 1,855 elderly adults. In order to determine the effect of disability and health-related changes on the persistence of depression, the same adults were followed-up and assessed by structured interviews every six months to monitor changes in their health and social circumstances. After 24 months, a depression scale that had been administered to all participants at the onset of the study was administered again. Of the initial 1,855 respondents, only 1,577 were available for retesting at the two-year follow-up. The variables of health, disability, companionship, social support, and types of treatment received for the 97 patients whose depressive symptoms had persisted over the two-year period were then compared with the same variables for 114 patients whose symptoms had improved. Overall, the patients with persistent and unremitting depressive symptoms were older, tended to be Jewish, had more serious and degenerative illnesses and more sleep disturbance than the group with remitting symptoms. Over the 24-month interval, significant levels of depressive symptoms persisted in 6.2 percent of the elderly adults and remitted in 7.2 percent. When these data were assessed in combination with the earlier findings, detrimental health changes, disability and lack of independence were shown to be the only characteristics which significantly contributed to the chronic nature of their depression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Surveys, Depression in old age, Geriatric depression, Geriatric psychiatry, Mentally ill aged, Mentally ill elderly

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The temporal relationship between depressive and psychotic symptoms in recent-onset schizophrenia

Article Abstract:

Symptoms of depression are not uncommon in schizophrenic patients. A study examined the course of both depressive and psychotic symptoms in 27 patients in the early stages of schizophrenia. Ratings were taken every two weeks for each patient for at least one year. The temporal relationship of these psychotic or depressive episodes was examined for patterns that were specific to early-onset schizophrenia. The ratings, which were made by using Brief Psychiatric Rating Scales, indicated that during the first eight-week period that followed the end of a psychotic episode, there was no increase in episodes of depression. Although periods of depression did occur in the postpsychotic period, no increase of depressive episodes was observed during periods of psychosis. These results run contrary to the popular idea that there are specific postpsychotic episodes of depression that occur in schizophrenics. The results do support the concept that the onset of depression occurs at the same time as the onset of psychosis, although with varying magnitudes. Depression may also occur before or after the psychotic episodes, but no specific patterns were detected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychoses, Psychotic disorders

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