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Psychosis as a Personal Crisis seeks to challenge the way people who hear voices are both viewed and treated. This book emphasises the individual variation between people who suffer from psychosis and puts forward the idea that hearing voices is not in itself a sign of mental illness. In this book the editors bring together an international range of expert contributors, who in their daily work, their research or their personal acquaintance, focus on the personal experience of psychosis. Further topics of discussion include: accepting and making sense of hearing voices the relation between trauma and paranoia the limitations of contemporary psychiatry the process of recovery. This book will be essential reading for all mental health professionals, in particular those wanting to learn more about the development of the hearing voices movement and applying these ideas to better understanding those in the voice hearing community.

Scientific and philosophical perspectives on hallucination: essays that draw on empirical evidence from psychology, neuroscience, and cutting-edge philosophical theory. Reflection on the nature of hallucination has relevance for many traditional philosophical debates concerning the nature of the mind, perception, and our knowledge of the world. In recent years, neuroimaging techniques and scientific findings on the nature of hallucination, combined with interest in new philosophical theories of perception such as disjunctivism, have brought the topic of hallucination once more to the forefront of philosophical thinking. Scientific evidence from psychology, neuroscience, and psychiatry sheds light on the functional role and physiology of actual hallucinations; some disjunctivist theories offer a radically new and different philosophical conception of hallucination. This volume offers interdisciplinary perspectives on the nature of hallucination, offering essays by both scientists and philosophers. Contributors first consider topics from psychology and neuroscience, including neurobiological mechanisms of hallucination and the nature and phenomenology of auditory-verbal hallucinations. Philosophical discussions follow, with contributors first considering disjunctivism and then, more generally, the relation between hallucination and the nature of experience. Contributors István Aranyosi, Richard P. Bentall, Paul Coates, Fabian Dorsch, Katalin Farkas, Charles Fernyhough, Dominic H. ffytche, Benj Hellie, Matthew Kennedy, Fiona Macpherson, Ksenija Maravic da Silva, Peter Naish, Simon McCarthy-Jones, Matthew Nudds, Costas Pagondiotis, Ian Phillips, Dimitris Platchias, Howard Robinson, Susanna Schellenberg, Filippo Varese

Introduction Alice in wonderland syndrome (AIWS), also known as Todd’s syndrome, is a neuropsychological condition that causes a set of symptoms with alteration of body image. These distortions include appearing smaller(micropsia) or larger(macropsia) or appearing to be closer or farther than they are. The exact cause of AIWS is currently unknown. Some associations include, migraine, temporal lobe epilepsy, brain tumors, psychoactive drugs or Epstein-Barr-virus. The treatment for this disease primarily aims at treating the underlying reason as to why the patient had the event. Report of case(s) 7-year-old boy presents to sleep clinic for nighttime hallucinations. Nightly episodes described as body parts that seem abnormally large or small and people talking very fast. Events lasted 15 minutes. Patient had full recall and developed anxiety when falling asleep. Medications at presentation: vitamins, melatonin, Montelukast. Montelukast was discontinued. Referred to neurology for video EEG, which was negative for frontal lobe seizures. Due to restless sleep and snoring, sleep study and ferritin was ordered. He was found to have mild OSA with an AHI of 2.2 and a ferritin level of 28. The patient was not considered a surgical candidate for his mild OSA; therefore, watchful waiting and re-initiation of montelukast proceeded with initiation of oral iron. At sleep clinic follow up, family noted improvement of hallucinations for 2-3 months and then restart, with worsening. Upon medication review, Montelukast was the inciting factor to the presence and resolution of hallucinations. Conclusion In this patient the montelukast seemed to be the triggering factor of AIWS. It has been suggested that the inhibition of leukotriene receptors in the brain could be responsible for this drug reaction. No other obvious triggers, or results of work up were able to better explain his resolution once he discontinued montelukast. This just further promotes close pharmacologic vigilance in the pediatric population. Support (if any)

Abstract The recent renaissance of psychedelic science has reignited interest in the similarity of drug-induced experiences to those more commonly observed in psychiatric contexts such as the schizophrenia-spectrum. This report from a multidisciplinary working group of the International Consortium on Hallucinations Research (ICHR) addresses this issue, putting special emphasis on hallucinatory experiences. We review evidence collected at different scales of understanding, from pharmacology to brain-imaging, phenomenology and anthropology, highlighting similarities and differences between hallucinations under psychedelics and in the schizophrenia-spectrum disorders. Finally, we attempt to integrate these findings using computational approaches and conclude with recommendations for future research.

Background Hearing voices (“auditory hallucinations”) is associated with numerous negative outcomes, including hospitalisation, suicidality, and impaired functioning. Currently, the main treatment approaches are antipsychotic medication and cognitive behavioural therapy (CBT), yet both have variable effectiveness and are often unavailable to those without a schizophrenia diagnosis. Furthermore, CBT does not consistently address the role of trauma in voice onset and maintenance. In response to these unmet needs, a feasibility/acceptability trial of a new intervention, Talking With Voices (TWV), was conducted. TWV involves a therapist speaking to the voice(s) while the client repeats its response verbatim, with the aim of promoting recovery and reducing voice-related distress. This prior pilot study ( N  = 50) found excellent feasibility/acceptability data amongst participants with schizophrenia, and signals of positive change in measures of personal recovery and voice relating. The next step is to evaluate treatment mechanisms and clinical efficacy of TWV in a transdiagnostic population. Methods We aim to establish TWV’s clinical efficacy in a multisite RCT for adults with serious mental health problems (SMHP) who hear persistent, distressing voices, and to assess whether improved measures of personal recovery and negative voice impact are mediated via key psychological mechanisms (improved relating to, and beliefs about, voices; and reductions in dissociation and negative self-beliefs). We aim to recruit 296 participants from psychiatric services across 4 UK sites (Manchester, London, Newcastle, and Oxford) who will be randomised to either treatment (TWV + treatment as usual [TAU]) or control (TAU only). The primary outcome is total score on the Questionnaire About the Process of Recovery. Secondary outcomes include overall voice severity and other relevant dimensions of voices and trauma sequalae, with mediational and outcome variables collected at baseline, 8 months (post-treatment), and 14 months. Discussion The study will investigate the clinical efficacy of a novel intervention deliverable within healthcare services, including hypothesised mechanisms of change to identify key psychological targets for ameliorating distressing voices in a transdiagnostic population. Potential benefits include improving the effectiveness and accessibility of evidence-based psychosocial interventions for SMHP. Trial registration ISRCTN, ISRCTN15897915. Registered 13 July 2023.

W artykule przedstawiono opis przypadku 57-letniego pacjenta od ponad 20 lat chornjacego na schizolrenie, z wyslepnjacynri ciezkiini, opornymi na leczenie omamami cenestetycznymi, ktdre sa zlokalizowane w okolicy narzadów plciowych. Ze wzgledn na brak alternatyw terapeutycznych przeprowadzono serie zabiegdw przezczaszkowej stymulacji prüdem stalym, ktdre byly nakierowane na kore soinalosensoryczna reprezeiilnjaca okolice narzadów plciowych. Nasilenie objawdw oceniano za poinoca Clinical Global Impression (CGI, Severity and Improvement), Positive and Negative Syndrome Scale (PANSS) oraz trzech skal wizualno-analogowych, oddzielnie dla nastepiijacych, charakterystycznych cech: „ogdlny dyskomfort\", „uczucie przebijania sic jader\" oraz „bdl\". Po ukohezeniu 3-tygodniowej serii zabiegdw przezczaszkowej stymulacji prüdem stalym nie uzyskano zmian iniedzy poczalkowa a koiicowa ocena kliniczny.

Auditory hallucinations (AHs) are debilitating and often treatment‐resistant symptoms of schizophrenia (SZ). Real‐time functional magnetic resonance imaging (fMRI) neurofeedback (NFB) is emerging as a flexible brain circuit‐based tool for targeting AH via self‐modulation of brain activity. A better understanding of what baseline characteristics predict NFB success will enhance its clinical utility. Previous work suggests that AH symptomology implicates measures across multiple modalities, including T1 structural MRI (sMRI), diffusion‐weighted MRI (dMRI), and resting‐state fMRI (rsfMRI). Specifically, AH severity and treatment response are associated with thinner superior temporal gyrus (STG), thinner dorsolateral prefrontal cortex (DLPFC), reduced white matter integrity in tracts connecting brain regions implicated in SZ symptomatology, increased within‐default mode network (DMN) connectivity, and reduced DMN–DLPFC anticorrelation. In this study, we tested the individual and combined contributions of multimodal brain features for the prediction of AH change after NFB in adults ( N  = 25, 36.1 ± 10.0 years, 24% females) with SZ spectrum disorders (SZ or schizoaffective disorder) and frequent medication‐resistant AH. Participants underwent a baseline MRI scan (including sMRI, dMRI, and rsfMRI) and were randomly assigned to receive NFB from their STG ( n  = 12, real condition) or NFB from their motor cortex (MC) ( n  = 13, sham condition). NFB success was operationalized as the improvement in AH severity after NFB. We found that higher baseline AH severity, greater STG thickness, decreased dorsal cingulum integrity, increased within‐DMN resting‐state functional connectivity, and increased DMN–DLPFC anticorrelation were each individually correlated with reduction in AH severity. However, in a combined regression model, DMN–DLPFC connectivity emerged as the only independent variable that explained the unique variance in AH change. These results suggest that a specific rsfMRI measure, namely DMN–DLPFC connectivity, may be a promising predictor of NFB success in reducing AH and support the precision medicine approach. Trial Registration: ClinicalTrials.gov identifier: NCT03504579

IntroductionRelief of phantogeusia through ice cube stimulation has not heretofore been noted. METHODS: This 70-year-old left handed (familial) female noted the onset, three and a half years ago, of reduced taste 80 percent of normal, distorted taste, hallucinated metallic taste, and BMS. Upon application of an ice cube to the tongue, both the metallic taste and the BMS resolved for a few seconds, without impairing her true taste ability. With repeat application, the alleviation effect persists. RESULTS: Abnormalities in Neurologic Examination: Sensory Examination: Decreased pinprick and temperature bilateral lower extremities. Reflexes: 3+ throughout. Bilateral positive Hoffman's reflexes. Chemosensory testing: Olfaction: Brief Smell Identification Test: 9 (normosmia). Retronasal Smell Index: 10 (normosmia). Gustation: Propylthiouracil Disc Taste Test: 5 (normogeusia).DiscussionTransient Receptor Potential 5, is expressed in tongue taste buds, facilitating sweet perception, and is temperature dependent (Fujiyama, 2010). Ice may act to reduce such sweet taste receptor discharge, causing an imbalance in taste fiber discharge thus inhibiting the perceived metallic taste. In those who suffer from intractable phantogeusia, a trial of ice cubes or mechanisms to reduce temperature of the tongue is warranted.

The serotonin-receptor modulator pimavanserin reduces psychosis in patients with Parkinson’s disease. In a randomized discontinuation trial involving patients with psychosis related to several types of dementia, the frequency of relapse over a period of 26 weeks was 13% with pimavanserin and 28% with placebo.

Abstract That trauma can play a significant role in the onset and maintenance of voice-hearing is one of the most striking and important developments in the recent study of psychosis. Yet the finding that trauma increases the risk for hallucination and for psychosis is quite different from the claim that trauma is necessary for either to occur. Trauma is often but not always associated with voice-hearing in populations with psychosis; voice-hearing is sometimes associated with willful training and cultivation in nonclinical populations. This article uses ethnographic data among other data to explore the possibility of multiple pathways to voice-hearing for clinical and nonclinical individuals whose voices are not due to known etiological factors such as drugs, sensory deprivation, epilepsy, and so forth. We suggest that trauma sometimes plays a major role in hallucinations, sometimes a minor role, and sometimes no role at all. Our work also finds seemingly distinct phenomenological patterns for voice-hearing, which may reflect the different salience of trauma for those who hear voices.