Manic depression hearing voices
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Manic Depression and Hearing Voices: A Comprehensive Overview
Prevalence of Auditory Verbal Hallucinations in Bipolar Disorder and Major Depressive Disorder
Auditory verbal hallucinations (AVHs), commonly referred to as "hearing voices," are a significant but often overlooked symptom in both bipolar disorder (BD) and major depressive disorder (MDD). Research indicates that the prevalence of AVHs in BD ranges from 11.3% to 62.8%, while in MDD, it ranges from 5.4% to 40.6% 13. These hallucinations can contribute to clinical distress, poor quality of life, and even suicidal ideation .
Characteristics and Clinical Implications of AVHs
Common Features and Delusional Themes
In BD, AVHs are frequently accompanied by persecutory and grandiose delusions, although the latter do not always occur in conjunction with AVHs . The nature of these hallucinations in mood disorders tends to be less frequent and disabling compared to those in psychotic disorders like schizophrenia (SCZ) and schizoaffective disorder (SZA) . Despite this, the physical characteristics, negative content, controllability, and distress associated with AVHs are largely similar across different diagnoses .
Neuroimaging Insights
A single neuroimaging study has suggested that increased fronto-temporal connectivity may be related to AVHs in BD, indicating potential neural correlates that could be targeted in future research and therapeutic interventions .
Objective Markers and Technological Advances
Voice Analysis as a State Marker
Recent studies have explored the use of voice features collected during phone calls as objective markers of affective states in BD. These voice features have been found to be more accurate, sensitive, and specific in classifying manic or mixed states compared to depressive states . Combining voice features with automatically generated smartphone data on behavioral activities and electronic self-monitored data has been shown to slightly increase the accuracy of these classifications .
Methodological Challenges and Future Directions
Limitations in Current Research
The study of AVHs in mood disorders faces several methodological challenges, including fluctuations in mood states, limited use of validated instruments, and post-episode recall bias . These challenges hinder the collection of meaningful phenomenological information, making it difficult to fully understand the nature and impact of AVHs in BD and MDD 13.
Need for Further Research
Given the central but understudied role of AVHs in mood disorders, there is a pressing need for more comprehensive research. Future studies should focus on the phenomenology and clinical/neural correlates of AVHs to develop better therapeutic applications and improve clinical outcomes 13.
Conclusion
Auditory verbal hallucinations are a significant symptom in both bipolar disorder and major depressive disorder, with varying prevalence and impact. While recent technological advances offer promising objective markers for affective states, methodological challenges continue to impede a full understanding of AVHs. Future research should aim to overcome these barriers to enhance clinical care and therapeutic strategies for individuals experiencing these distressing symptoms.
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