[A personal diagnosis for patients who hear voices: symptoms can improve in a meaningful context]. / Een persoonlijke diagnose voor patiënten die stemmen horen; van symptoom naar klacht met betekenis in een context.

BACKGROUND: In his controversial book Beyond dsm-5 (written in Dutch) Jim van Os makes a plea for a 'personal diagnosis'. AIM: To describe how a personal diagnosis can be made in the case of patients who hear voices. METHOD: We described and tested extensively how we achieved a personal diagnosis for patients who hear voices. RESULTS: This method enabled us to establish a relationship between hearing voices and events in a patient's personal life. This association plays an important role in the patient's recovery. CONCLUSION: Such a personal diagnosis has important advantages, both for the patient who hear voices and for the professional: it is drawn up with the personal involvement of the patient, and strengthens the working relationship; the patient's personal history plays a central role. A personal diagnosis empowers the patient, it is written in language that the patient can understand. It also reveals possible ways of solving the patient's personal problems and can thereby lead to further treatment and recovery.

A controlled study of temporal lobe structure volumes and P300 responses in schizophrenic patients with persistent auditory hallucinations.

Recent studies of cerebral pathology in patients with schizophrenia have focused on symptomatological and electrophysiological correlates of reduced temporal lobe structure volumes. Volume deficits of the left superior temporal gyrus have been correlated with auditory hallucinations as well as to left-sided P300 amplitude reduction. However, caution is needed to interpret correlational data as evidence of a specific relationship. Therefore, a controlled study was undertaken on schizophrenic patients with and without auditory hallucinations. MRI-defined volumes of the left superior temporal gyrus and other temporal lobe structures were quantified from 3-mm coronal slices in 15 schizophrenic patients with chronic auditory hallucinations (hallucinators), 15 schizophrenic patients without auditory hallucinations (nonhallucinators) and 17 healthy controls. In all subjects a simple oddball paradigm was used to elicit P300 responses at temporal and centro-parietal electrode sites. No evidence was found for volume reductions of temporal lobe structures in the combined patient group compared with controls, or in the hallucinators compared with the nonhallucinators. The patients did show left P300 amplitude reduction compared with controls, particularly in the hallucinator group. Correlations between volumes of left temporal lobe structures and left P300 amplitudes were low and not significant. The results of the present study do not indicate that auditory hallucinations and associated abnormal electrophysiological activity are the consequence of atrophy of localized temporal lobe structures. However, replication in a larger sample of subjects is needed before firm conclusions can be drawn.

Auditory hallucinations: a comparison between patients and nonpatients.

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

Physical illness in chronic psychiatric patients from a community psychiatric unit revisited. A three-year follow-up study.

A group of 156 psychiatric patients from an urban community psychiatric unit for chronic psychiatric patients was routinely medically screened and reported on. Re-evaluation of the medical diseases found in those patients was carried out three years later. Those who were still being treated--73 patients (47%)--were interviewed, as were their psychiatrist and, where necessary, their general practitioner (GP). The implementation of medical recommendations given following the physical screening by the specialist in internal medicine was also assessed. Re-evaluation of the diagnoses confirmed that 36% of this population had one or more physical diseases, rather than the 53% found earlier. The results show that the majority of physical complaints and diseases as well as functional illnesses were as persistent as the psychiatric diagnoses in this patient group. The patients' GP seems to be the person best suited as the primary physician responsible for the patient's physical health.

Coping with hearing voices: an emancipatory approach.

A questionnaire comprising 30 open-ended questions was sent to 450 people with chronic hallucinations of hearing voices who had responded to a request on television. Of the 254 replies, 186 could be used for analysis. It was doubtful whether 13 of these respondents were experiencing true hallucinations. Of the remaining 173 subjects, 115 reported an inability to cope with the voices. Ninety-seven respondents were in psychiatric care, and copers were significantly less often in psychiatric care (24%) than non-copers (49%). Four coping strategies were apparent: distraction, ignoring the voices, selective listening to them, and setting limits on their influence.

Physical illness in chronic psychiatric patients from a community psychiatric unit. The implications for daily practice.

The prevalence and significance of physical diseases, and health-care-seeking behaviour, were examined in a sample of 218 chronic psychiatric patients from an urban community psychiatric unit. Only 14% declined medical screening. Of the respondents, 53% had one or more probable or certain physical diseases warranting further medical attention. The majority of the diseases found were minor and typical of primary care problems. A severe (i.e. life-threatening) disease was present in 7% of respondents. Of the patients, 87% visited their GP at least once a year. The implications are that frequent consultation with primary care specialists and health-care-seeking behaviour should be noted, and included in any evaluation of the medical needs of chronic patients in community psychiatric care.

Hearing voices.

An experiment is described in which people with auditory hallucinations were brought into contact with each other. On an evening television talk show, a patient--diagnosed several times as having schizophrenia--talked about her voices. Four hundred and fifty people who also were hearing voices reacted to the program by telephone. A questionnaire was sent to those who responded to the television program in order to get more information about their way of coping with the voices. From those who filled out the questionnaire, 20 people were selected who explained their experiences in a clear way. A meeting for people hearing voices was organized, and the 20 persons were invited to become the speakers. In this article the experiences described by the participants are reported as well as the many ways in which they coped with these experiences.

Social psychiatry in Zimbabwe or the interplay of culture and psychosocial disorders.

This article describes stresses that affect the social security of patients in a developing country like Zimbabwe and the influence of those stresses on the onset of psychosocial disorder. This is demonstrated in the form of case presentations. The impact on psycho-social disorders reflects a process in which the main factors are social status; stress/support; deprivation; reference.

Problem analysis: an instrument in the rehabilitation of chronic psychiatric patients in the community.

In the light of governmental policy in European countries to enhance and reinforce community psychiatric services, the need to introduce a more systematic approach in the treatment of chronic psychiatric patients by the community psychiatric services is currently being stressed. In this paper the problem analysis (P.A.) is described. It is a practical, treatment-oriented instrument which methodically compiles information on chronic patients and their systems. The systematic acquisition and examination of such information provide clues to a rational rehabilitation plan, one that can be carried out by a multidisciplinary community psychiatric service. Such an approach has the added advantage of making education and research in the field feasible.