The effect of arousal on auditory threat detection and the relationship to auditory hallucinations.

BACKGROUND AND OBJECTIVES: A recent model of a subtype of auditory verbal hallucinations (AVHs) has proposed such experiences may result from increased arousal altering auditory threat perception. METHODS: This study considered this theory using undergraduate students who undertook a new experimental paradigm, the Auditory Threat Discrimination Task (ATDT). This examined the effects of arousal on auditory threat perception (Study 1), and its relation to hallucination-proneness (Study 2). RESULTS: Study 1 (n = 66) found evidence that the high, as compared to low-arousal condition, was associated with a higher level of accurate and false threat detection (as measured by both number of hits and false-alarms). Study 2 addressed some methodological limitations of Study 1 and also found that the high as compared to low-arousal condition, was associated with a higher level of threat detection. Study 2 also found that high hallucination prone participants (n = 20) reported a higher level of perceived threat (as measured by both number of hits and false-alarms), compared to low hallucination prone participants (n = 20). LIMITATIONS: Overall limitations of the work included use of a non-clinical group. Also the increased arousal induced by the experiment was modest and may not fully represent the processes in operation in clinical participants. CONCLUSIONS: These findings provide some initial evidence that auditory threat detection increases under conditions of arousal, and are consistent with the proposal that some AVHs may result from hypervigilance to auditory threat.

Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland.

OBJECTIVE: To evaluate the impact of a hospital based community liaison pharmacy service on a range of outcomes in patients aged more than 55 years and taking more than 3 prescribed drugs, who had been admitted to the medical unit of a district general hospital in Northern Ireland. METHODS: Having recruited 243 patients, a total of 162 patients completed the full protocol (81 randomly assigned to intervention and 81 to control; mean age of control patients 75 years; mean age of intervention patients 73 years). The interventions by the community liaison pharmacist included: preparation of an accurate medication record following a full review of current medication use; medication counselling; provision of a medicines record sheet informing the patient how to take their drugs; provision of a pharmaceutical discharge letter detailing changes made to drug therapy (this was faxed to the patient's GP and community pharmacist on the day of discharge); provision of a Medicines Helpline. RESULTS: The key findings were as follows: problems were identified in 80% of the intervention patients' prescription charts, 49% of which related to drug omissions from the patients' domiciliary prescriptions. The GP practice record was the most accurate (mean error rate 12.6%) while the GP referral letter was the least accurate (mean error rate 47.3%) source of medication information. Drugs patients brought to hospital were also an inaccurate source (mean error rate 44.0%). The intervention group patients, when compared with control patients, had a significant reduction (P = 0.005) in drug mismatch between drugs prescribed at discharge and taken at home, and had a greater knowledge of their drug regimen 10-14 days after discharge (P < 0.001). The vast majority of patients (96%) felt that the provision of a medicine helpline was a useful service. CONCLUSIONS: The study indicated clear benefits from the involvement of a hospital based community liaison pharmacist in achieving seamless pharmaceutical care between the primary and secondary healthcare settings.