The paradox of command hallucinations.
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Hallucinations↗
Biomedical subjects
J Junginger
Publications and source records attributed to J Junginger.
Delusions and symptom-consistent violence.
OBJECTIVE: The study examined the extent to which delusions motivate violent behavior among psychiatric patients with a history of delusions. METHODS: Fifty-four psychiatric inpatients identified by hospital staff as having delusions were interviewed about their history of delusions and incidents of violence that were concurrent with delusions. Raters used a 5-point scale to estimate the degree to which each reported incident of violence was motivated by a concurrent delusion. A second set of raters used a 5-point scale to estimate the severity of the violent incidents. RESULTS: Raters' mean estimate indicated overall that violent incidents were probably not motivated by concurrent delusions. However, a significant minority of violent subjects (40 percent) reported at least one violent incident that was judged to be probably or definitely motivated by a concurrent delusion. A smaller subgroup of violent subjects (17.5 percent) reported at least one incident that was judged to be both extremely violent and definitely motivated by a concurrent delusion. CONCLUSIONS: Delusional motivation of violence is rare, but a moderate risk exists that delusions will motivate violence at some time during the course of a violent patient's illness.
Adult↗
Psychosis and violence: the case for a content analysis of psychotic experience.
There has been a great deal of debate about the dangers psychiatric patients pose to the general population. Recent studies appear to confirm a moderate but reliable association between mental illness and violence. The nature of this association, however, is unresolved. Considerable evidence suggests that much of the violent behavior observed in the mentally ill is not random but is motivated and directed by psychotic symptoms. In many cases, the behavior appears to be a predictable and in some ways rational response to irrational beliefs (delusions) and perceptions (hallucinations). The content and themes of a psychotic patient's delusion or hallucination often imply a specific course of violent action. Unlike studies of associations between violence and broad categories of subject characteristics (e.g., mental illness), an analysis of the association between violence and the content and themes of psychotic symptoms could be much more informative. Conceivably, such an analysis could identify not only psychiatric patients at risk for committing violence but also those individuals who are at risk for becoming targets of their violence.
Dangerous Behavior↗
Command hallucinations and the prediction of dangerousness.
OBJECTIVES: Recent studies have supported the belief that command hallucinations can induce dangerous behavior. This study tried to replicate previous findings that compliance with the command was associated with delusions related to hallucinations and the ability to identify the hallucinated voice. This study also assessed the association between compliance and the dangerousness of the command, chronicity of illness, a diagnosis of schizophrenia, and past compliance with hallucinated commands. METHODS: The most recent command hallucination reported by 93 psychiatric inpatients was rated for level of dangerousness and level of compliance with the command. RESULTS: Subjects who experienced less dangerous commands or who could identify the hallucinated voice reported higher levels of compliance, although reported compliance with more dangerous commands was not uncommon. Commands experienced in the hospital were less dangerous than those experienced elsewhere and tended to be specific to the hospital environment. Subjects were less likely to comply with commands experienced in the hospital. CONCLUSIONS: Based on their self-reports, psychiatric patients who experience command hallucinations are at risk for dangerous behavior. Ability to identify the hallucinated voice is a fairly reliable predictor of reported compliance. Level of dangerousness resulting from compliance with command hallucinations may be a function of the patient's environment.
Dangerous Behavior↗
Prevalence of psychopathology in elderly persons in nursing homes and in the community.
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Aged↗
Mood theme and bizarreness of delusions in schizophrenia and mood psychosis.
Narratives of the delusions of 83 schizophrenic and 55 nonschizophrenic psychiatric subjects were categorized as of one or more of 12 types. Narratives were also independently assessed along dimensional scales of bizarreness and mood theme. Schneiderian and grandiose types were found to be more common in schizophrenics and mood psychotics, respectively. Dimensional measures showed that the delusions of schizophrenics were more unlikely and that those of mood psychotics had a stronger mood theme. Regression analysis determined that Schneiderian delusions and a dimensional estimate of mood theme best differentiated schizophrenics from mood psychotics. Assessments along dimensions of other parameters, particularly those represented by Schneiderian delusions, may further discriminate the functional psychoses.
Adult↗
Time series analysis of obsessional behavior and mood during self-imposed delay and response prevention.
Time series analysis of more than a year of daily self-report of three subjects showed that self-imposed delay and response prevention was effective in decreasing obsessions and compulsions. The subject-controlled treatment had a varied effect on mood-anxiety decreased in two subjects, but depression increased in one. (A similar worsening of mood after elimination of obsessional behavior was found in a previous case study.) Apparently, successful treatment of obsessional behavior will not necessarily lead to an improvement in mood. Concurrent mood symptoms need to be targeted separately; and, plans should be made to deal with mood symptoms that may occur once obsessional behavior is removed.
Adolescent↗
Psychiatric hospitalization and community-based program attendance.
The psychiatric rehabilitation model of community-based treatment programs for chronic psychiatric patients advocates the teaching of community living skills. Learning these skills requires program attendance, and there is some evidence that consistent attenders are less likely to be hospitalized. This study describes a psychiatric rehabilitation program that resulted in a decrease in number of subsequent psychiatric hospitalizations. However, this decrease was unrelated to program attendance; the number of hospitalizations in the year prior to enrollment was by far the best predictor of hospitalization. Changes in perception of the patient's support network by persons making hospitalization decisions was offered as one possible explanation for the effectiveness of some community-based programs.
Activities of Daily Living↗
Predicting compliance with command hallucinations.
Of 44 patients who experienced command hallucinations, those with hallucination-related delusions and hallucinatory voices they could identify were more likely to comply with the commands. The danger of the behaviors specified by the hallucinations did not appear to be a factor in compliance.
Cooperative Behavior↗
Summation of arousal in partial fetishism.
A summation model of classical conditioning was used to describe the deviant sexual arousal pattern of a male psychiatric patient. Penile assessment showed a response to a compound stimulus (radio static plus a picture of a woman) that was approximately equal to the sum of the responses to each component alone. The subject's self-report of sexual arousal followed a similar pattern. A distinction was made between total and partial fetishism. It was suggested that what may be particularly troublesome in partial fetishism is the potential for high levels of summated arousal.
Adult↗
Spontaneous exposure and "self-control" in the treatment of compulsive checking.
This case study describes a treatment developed for an obsessional patient for whom neither in vivo nor verbal exposure was effective in eliciting obsessional thinking. The treatment consisted of increasingly more strict temporal parameters the patient was to impose when obsessional thoughts spontaneously occurred. These parameters stipulated the amount of time he was to wait between the occurrence of obsessional thoughts and compulsive checking, and the amount of time he was to spend checking. Over a period of several months, these self-imposed temporal parameters were effective in completely eliminating persistent and intractable obsessional thinking of 11 years' duration.
Adult↗
Vocal activity in verbal hallucinations.
Vocal and forearm EMGs were recorded from 19 hallucinating and 22 nonhallucinating psychiatric inpatients. A microphone placed close to the lips was used to detect subvocal speech. The subjects' EMG and subvocal responses to pre-recorded statements were also assessed. Subjects who experienced hallucinations during assessment were asked to estimate the frequency of their hallucinations and rate phenomenological of their most recent hallucination. Results essentially replicated studies that found increased vocal potentials in hallucinators, but also showed that these increased potentials were nonsignificant when nonvocal measures are included in the statistical analysis. Subvocal speech and coincident increases in vocal EMG with reports of hallucinations, and with reports of pre-recorded statements, were not found. A significant negative correlation was found between the mean vocal potential of hallucinators and the perceived location of their most recent hallucination. The pre-recorded statements were generally perceived to be louder, clearer and more outside the head than the most recent hallucination.
Adult↗
Self-report of the frequency and phenomenology of verbal hallucinations.
This study was an assessment of several parameters of verbal hallucinations ("voices") based on the self-report of 52 hallucinating psychiatric patients. These subjects were asked to estimate the frequency of their hallucinations and to rate phenomenological aspects (loudness, clarity, location, reality) of their most recent hallucination. Each parameter was assessed with two visual analogue scales which differed in their wording of the dimension. Results showed that the reliability of the subjects' estimates on the parameters differed greatly. Clarity was most reliably reported and reality was least reliably reported. Historical notions that schizophrenics characteristically perceive external "voices" and that such "voices" are perceived as more real were not supported. There was a significant negative correlation between the perceived location and the perceived clarity of hallucinations. No significant differences in mean parameter scores were found between two groups of subjects, schizophrenics and affective psychotics.
Adult↗
Multitreatment of obsessive-compulsive checking in a geriatric patient.
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Aged↗
Reactivity of self-monitoring procedures with retarded adolescents.
The reactivity of self-monitoring procedures with retarded adolescents was investigated using single-case designs. The effects of two variables, social reinforcement and feedback, on the degree of reactivity were also examined. Both subjects monitored a socially undesirable behavior and were asked to self-record for extended periods of time with minimal cues from the environment. The results indicated that self-monitoring produced reactive decreases in the target behavior. Reinforcement had a differential effect across subjects, further altering the target behavior for only one subject. Feedback decreased the behavior for the second subject. The subjects' accuracy in self-recording was quite low.
Adolescent↗