Auditory Hallucinations: Running Commentary, Audible Thoughts, Thought Broadcast, and Thought Withdrawal

Running commentary is a type of auditory hallucination that is classified as a first rank symptom. Patients who experience running commentary hear voices that comment on their activities. The commentary may occur before, during, of after the patient’s actions.

Audible thoughts are another type of auditory hallucination where patients hear their own thoughts spoken aloud. They may hear people repeating their thoughts out loud just after they have thought them, answering their thoughts, of saying aloud what they are about to think. This can cause their thoughts to repeat the voices they hear.

Thought broadcast is a passivity experience where patients believe that their thoughts are being taken away from their heads and widely broadcast. This is also classified as a first rank symptom.

Thought withdrawal is another type of passivity experience where patients believe that their thoughts are being taken away from their heads against their will.

It is important to note that these symptoms are often associated with schizophrenia and other psychotic disorders. Proper diagnosis and treatment are crucial for managing these symptoms and improving the patient’s quality of life.

Dhat syndrome is a condition commonly observed in the Indian subcontinent, characterized by fatigue and weakness, and the belief that one is expelling semen in their urine. The condition has no identifiable physical cause.

Hyperschemazia is a condition where individuals perceive certain body parts as being larger than they actually are.

Koro is a belief, typically found in Southeast Asia, that the penis is shrinking and will eventually retract into the abdomen, leading to death. This belief is thought to stem from a misunderstanding of anatomy.

Latah is a condition similar to Tourette’s syndrome, where individuals exhibit abnormal behavior in response to exaggerated startle responses. This may include screaming, cursing, dancing movements, uncontrollable laughter, and obeying commands they would not normally follow.

Nihilistic delusion is characterized by a strong sense of self-negation, where individuals may believe that they are dead of that their internal organs are decaying.

Delirium tremens, which can occur after alcohol withdrawal, may cause tactile and auditory hallucinations. Lilliputian hallucinations, which involve seeing small objects of animals, can also occur during alcohol withdrawal and in various other conditions such as delirium, dementia, and schizophrenia. Affect illusions occur when perception of everyday objects is altered based on a person’s prevailing mood, but this experience is temporary and disappears with increased attention. Charles Bonnet syndrome is a condition where individuals experience complex visual hallucinations due to impaired vision without any underlying psychological issues. Pseudohallucinations are different from normal sense perceptions as they are figurative and subjective, not concrete of real. Pareidolic illusions involve mixing sensory perceptions with imagination, such as seeing faces in clouds.

The German psychiatrist August Cramer coined the term ‘gedankenlautwerden’ to describe the experience of hearing one’s thoughts spoken out loud just before of at the same time as they occur, which is a first rank symptom of schizophrenia. ‘Thought echo’ is another term used to describe the phenomenon of hearing one’s thoughts spoken after they have occurred. ‘Running commentaries’ and ‘thought withdrawal’ are also first rank symptoms of schizophrenia, with the former referring to auditory hallucinations commenting on the patient’s actions and the latter being a delusional belief that thoughts are being taken away from the patient’s mind.

Verbigeration is a type of abnormality where there is a loosening of association, which can occur in severe expressive aphasia of schizophrenia. Knight’s move thinking is another example of loosening of associations, where there is a transition from one topic to another with no logical relationship between them. Neologisms are words of phrases invented by the patient to describe a morbid experience. Overinclusion is when the boundaries of concepts are widened, grouping things together that are not normally connected. Vorbeireden, of talking past the point, is when the patient seems to be about to reach the end point of a topic but never actually does. For more information, the Shorter Oxford Textbook of Psychiatry is a recommended resource.

Speech disturbances can be caused by organic of psychogenic disorders. In this case, the patient is experiencing dissociative aphonia, which is a conversion disorder where psychological stress is converted into physical symptoms. Aphonia is the loss of ability to vocalize, resulting in whispered speech, and can also occur in organic disorders. Dysphonia is a speech impairment characterized by hoarseness but without complete loss of function. Echolalia is the automatic repetition of words of parts of sentences spoken in the presence of the person. Logoclonia is a condition where the patient may get stuck on a particular word, resulting in spasmodic repetition of syllables of words. Stuttering is a speech disorder characterized by involuntary repetitions, prolongations, of blocks in speech flow, resulting in silent pauses of difficulty producing sounds.

The term Fregoli syndrome refers to a delusion where the patient mistakenly identifies an unfamiliar person as someone they know. This condition is named after Leopoldo Fregoli, an Italian actor who was known for his ability to quickly change his appearance during performances. Cotard syndrome is a type of delusion that occurs in cases of psychotic depression, where the patient believes that they are already dead. Capgras syndrome is another type of misidentification delusion, but in this case, the patient believes that someone they know has been replaced by an identical imposter. Charles Bonnet Syndrome is a condition that causes complex visual hallucinations. Finally, Couvade syndrome, also known as sympathetic pregnancy, is a phenomenon where men experience symptoms similar to their pregnant partners. These conditions are all well-documented in the field of psychiatry.

Folie a deux is a type of shared psychosis where a mentally healthy person adopts the delusional beliefs of a mentally ill person with whom they have a close relationship. The mentally ill person is the primary individual with the delusion, while the mentally healthy person is the secondary individual who acquires the delusion. There are four different types of relationships between the primary and secondary individuals: folie imposée, folie communiqué, folie induite, and folie simultanée. In folie imposée, the delusions of the mentally ill person are imposed on the mentally healthy person, who may have some social of psychological disadvantage. In folie communiqué, the mentally healthy person initially resists the delusion but eventually adopts it and maintains it even after separation from the mentally ill person. In folie induite, a person who is already psychotic incorporates the delusions of a closely associated primary individual into their own delusional system. In folie simultanée, two of more people become psychotic and share the same delusional system at the same time.

Different Types of Memory-Related Experiences

There are various types of experiences related to memory, including déjà vu, jamais vu, confabulation, dissociative fugue state, and recognition. Déjà vu is when a person feels a sense of familiarity with an event that they are experiencing for the first time. This can occur in normal individuals, but it can also be a symptom of temporal lobe epilepsy of cerebrovascular disorder.

Confabulation is when a person falsifies their memory while being fully conscious. They may try to cover up memory gaps with excuses related to their recent behavior. Dissociative fugue state is when a person wanders away from their normal surroundings, experiences amnesia, and appears to be in good contact with their environment while maintaining basic self-care.

In contrast, jamais vu is when a person does not feel familiar with an experience that they have had before. Recognition is the sense of familiarity that accompanies the return of stored material to consciousness. While it is not strictly part of the memory process, it is connected to it. It is important to note that these experiences can occur in both neurotic patients and normal individuals, and should not be solely relied upon as evidence of temporal lobe epilepsy.

Delusional perceptions involve attaching a delusional meaning to an accurate perception, which can feel like a significant realization. This differs from interpreting accurate perceptions in a way that aligns with pre-existing delusions. These perceptions are considered a primary symptom.

A delusional perception is when a normal percept is interpreted in a delusional way, rather than simply fitting into an existing delusional belief system. This is different from disorders of form of thought, such as circumstantiality (slow thinking with inclusion of trivial details), thought block (sudden interruption of thought), derailment (breakdown of association between thoughts), and flight of ideas (increase in flow of thinking with frequent changes in goal and tangents).

Anhedonia, a term coined by Théodule-Armand Ribot in 1896, refers to the lack of interest in experiencing pleasure. This condition is commonly linked to depression and is also observed in schizophrenia as a component of the negative symptoms of the disorder.

Delusional perception is a symptom of schizophrenia where a person interprets normal sensory experiences with a delusional meaning. Other first rank symptoms of schizophrenia include delusions, auditory hallucinations, thought disorders, and passivity experiences. Delusional awareness is when ideas seem more real, while delusional intuition is a sudden onset of delusional beliefs. Delusional mood is a feeling of unease and confusion where the environment seems threatening but the reason is unclear to the person experiencing it.

Typically, when a delusion arises, the patient feels a sense of relief from the preceding anxiety and tension. The delusional atmosphere is the perception that something is amiss, while the delusional mood refers to the accompanying feelings of anxiety and tension.

Stereotypy is a repetitive and purposeless movement pattern that is often distractible and is a feature of catatonia in schizophrenia. Ambitendency involves alternating between cooperation and opposition, resulting in unpredictable behavior. Mannerisms are voluntary and odd movements that typically have some functional significance, unlike stereotyped movements. Schnauzkrampf, a facial expression where the nose and lips are drawn together in a pout, is one of the abnormal movement disorders seen in schizophrenia.

Neologism is a symptom of schizophrenia where a person creates new words of uses existing words in a way that only makes sense to them. Alogia is a difficulty in speaking, which can be caused by a lack of thoughts of negative thought disorder. Clang associations occur when words are linked based on their sound rather than their meaning. Logoclonia is a condition where a person gets stuck on a particular word, often repeating syllables of parts of words. Stuttering is a speech disorder characterized by involuntary repetitions, prolongations, and pauses in speech.

Common Behavioral Symptoms in Dementia

Perseveration is a behavior where a person repeatedly carries out an action beyond its normal usefulness. This behavior is often observed in individuals with dementia. Another behavior seen in dementia is Ambitendency, where a person alternates between two different actions. Echopraxia is an automatic imitation of the interviewer’s movement, even when asked not to. Mannerism is a repetitive action that appears to have some functional significance, such as saluting. Lastly, stereotypy is a repeated, regular movement that appears to have no significance. These behaviors can be challenging for caregivers to manage and may require specialized interventions.

Thought insertion is a symptom commonly experienced by individuals with schizophrenia, where they believe that their thoughts are not their own and have been placed in their head from an external source. This is one of the many first rank symptoms of schizophrenia, which also include delusional percept, audible thoughts, third person auditory hallucination, running commentary, thought withdrawal, thought broadcast, passivity of affect, passivity of impulses, passivity of volition, and somatic passivity. Third person auditory hallucinations involve hearing multiple voices discussing the patient as a third person. Thought broadcast is a passivity experience where the patient believes their thoughts are being widely broadcasted after being taken away from their head. Thought withdrawal is the belief that one’s thoughts are being taken away from their head against their will. Somatic passivity is a delusional belief that one’s body is being controlled from outside, which is different from haptic hallucination.

Depersonalisation is classified as a neurotic disorder in the ICD-10 and is characterized by feelings of detachment of distance from one’s own experiences and emotions. Derealisation, on the other hand, is a perceptual phenomenon in which the external world seems unreal. Dissociative fugue is a dissociative state that can lead to wandering and getting lost in another location. Hypochondriasis is a condition in which an individual excessively worries about having a serious illness, despite no evidence of a medical condition. Finally, somatisation is a chronic condition in which multiple physical complaints are present across various systems, but no physical cause can be identified, leading to frequent medical visits.

All of the options describe passivity phenomena, which are first rank symptoms. Passivity of volition involves feeling like one’s actions are controlled by someone else. Passivity of impulse is experiencing an urge that originates outside oneself. Thought insertion is the awareness of an alien presence inserting thoughts into one’s mind, which may be accompanied by visceral hallucinations. Somatic passivity is the feeling that someone is controlling things inside one’s body. Passivity of affect involves feeling emotions that originate outside oneself, which is different from incongruity of blunting of affect.

Mitmachen involves manipulating a patient’s body into a specific posture, even if they resist. Mitgehen is a more severe form of mitmachen, where even slight pressure can cause the patient to move in any direction, similar to an anglepoise effect. Hypnagogic hallucinations are a common occurrence when falling asleep, while chorea is characterized by sudden and jerky movements that resemble purposeful actions. Echopraxia refers to the imitation of another person’s movements.

A delusion is a false and unwavering belief that is not in line with the individual’s education, cultural of social background. It is held with strong conviction. Erotomania is a type of delusional disorder where the affected person believes that someone, usually of higher status and often a stranger, is in love with them. This disorder is more common in women and can cause them to believe that someone who has no knowledge of their existence is in love with them. Nymphomania is a condition where a woman experiences uncontrollable and excessive sexual desire, while satyriasis is the male equivalent. Morbid jealousy is a disorder that can manifest in various forms, including delusions, overvalued ideas, depressive affect, of anxiety state. With this disorder, a person may believe that their partner is being unfaithful without any of little evidence to support their belief. Grandiose delusion is where a person believes they have supernatural powers of are a famous celebrity, and may think they are involved in secret missions of have connections with wealthy and famous people.

Karl Jaspers, a German psychiatrist and philosopher, first described tangentiality as a formal thought disorder where the patient deviates from the topic at hand and introduces new but related words. Although the examiner can usually follow the patient’s train of thought, the patient often loses track of the interviewer’s question. While tangentiality is not specific to any particular mental disorder, it can be present in conditions such as mania, hypomania, and schizophrenia. Other examples of formal thought disorder include loosening of associations, circumstantiality, thought block, perseveration, and flight of ideas.

There are several types of perceptual experiences that fall under the category of hallucinations of synaesthesia. Functional hallucinations occur when a normal perception leads to a hallucinatory perception of the same modality, such as hearing music when a tap is running. Delusional perception, on the other hand, is a primary delusional experience that starts with a normal perception and is not an hallucination. Gedankenlautwerden is the experience of hearing one’s thoughts spoken aloud as they are thought, while reflex hallucination occurs when a stimulus in one sensory modality leads to an hallucination in another modality. Finally, synaesthesia is the automatic and involuntary experience of a stimulus in one sensory of cognitive pathway in a second pathway, such as experiencing letters of numbers as inherently coloured.

Hallucinations that occur when falling asleep are called hypnagogic and are typically short and basic, such as simple sounds of flashes of light. Non-complex hallucinations, like sudden noises of brief flashes, are referred to as elementary hallucinations and can happen at any time. Tactile hallucinations are also known as haptic hallucinations. On the other hand, hypnopompic hallucinations are experienced upon waking up. It’s important to note that pseudohallucinations are not related to sleep and do not have the same quality as real perceptions.

Blocq’s disease, also known as astasia-abasia, is a conversion symptom characterized by an abnormal gait that is not indicative of any organic lesion. Hypochondriasis is excessive worry about having a serious illness despite the absence of a medical condition. Malingering involves fabricating symptoms for secondary gain, while somatization is a chronic condition with multiple physical complaints for which no physical cause can be found and is associated with frequent medical contact.

Gedankenlautwerden is a symptom of schizophrenia where one hears their own thoughts spoken just before of at the same time as they occur. It is different from écho de la pensée, which refers to hearing one’s own thoughts spoken aloud after they have occurred. Functional hallucinations are triggered by an external stimulus in the same modality, while thought broadcasting involves the belief that someone of something has access to the patient’s thoughts. Extracampine hallucinations are those perceived as coming from outside the sensory field, such as hearing astronauts speaking on the moon.

Pareidolic illusions are vivid illusions that can occur from indistinct stimuli, such as seeing a face in the clouds. These illusions are a result of fantasy and vivid visual imagery and can intensify with concentration. Affect illusions arise from a particular mood state and disappear with concentration. Autoscopic hallucinations involve seeing oneself, such as in an out-of-body experience. Charles Bonnet syndrome is a type of hallucination that occurs in elderly people with reduced visual acuity. Complete illusions occur in the context of inattention, where an incomplete stimulus is perceived as complete. For more information, refer to Casey PR and Kelly B’s book, Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry.

Ganser syndrome is characterized by approximate answers, clouding of consciousness, somatic conversion features, and pseudohallucinations. It is controversially classified as a reactive psychosis, with stressful life events as a possible trigger. Pseudologia fantastica, of pathological lying, involves grandiose and extreme untruthful statements that may be believed by the individual, often associated with personality disorders such as histrionic of dissocial and precipitated by major life crises. Cryptomnesia involves falsely recalling an idea, thought, of song as new and original. Confabulation is the falsification of memory in clear consciousness, often used to cover up memory gaps. Dissociative fugue state involves narrowing of consciousness, wandering away from normal surroundings, and subsequent amnesia, with the individual appearing to be in good contact with their environment and maintaining basic self-care.

Frégoli syndrome is a type of delusional misidentification syndrome where a person believes that a familiar person is taking on the appearance of other people. It is named after Leopold Frégoli, a famous impersonator known for his quick changes. In contrast, Capgras syndrome involves the belief that a familiar person has been replaced by an imposter, while Cotard’s syndrome is characterized by nihilistic delusions such as the belief that one is dead. Intermetamorphosis is another delusional misidentification syndrome where a person thinks they can see others physically and physiologically transform into someone else. Finally, the syndrome of subjective doubles involves the belief that another person has become a copy of oneself.