Schizophrenia Daily News Blog

Pleasurable Voices?

Pleasurable auditory hallucinations.

Sanjuan J, Gonzalez JC, Aguilar EJ, Leal C, Os J.
Acta Psychiatr Scand. 2004 Oct;110(4):273-8.

Auditory hallucinations (AH) or voices are one of the most frequent symptoms of schizophrenia. Some studies have suggested that hallucinatory voices can also be heard by members of the non-psychiatric general population. The authors suggest that these AH's may range from a spectrum of those who are at ease with their AH and who are not identified as a patient, to individuals with a severe psychotic disorder who are tormented by intrusive voices. The emotional value of these voices may determine the extent of the distress that they cause. Some researchers have made the point that not many people have investigated voices that are perceived as being pleasurable. As a result, this study aimed to assess the frequency of voices as a pleasurable experience in a patient group and also cross-validate the pleasurable aspect of the experience using established scales.

This study was conducted in Spain. The authors used a standard rating scale (PSYRATS) to ask patients with AHs (89 schizophrenia and 17 other psychoses) who were taking anti-psychotic medications, about their experiences with voices. They added extra items to the questionnaire to inquire if the experience was pleasurable.

They found that 26% of the patients reported the voices as pleasurable at least occasionally, and for 10 individuals the experience of pleasurable voices was the norm and not the exception. Those who said they had pleasurable voices felt like the negative component of the voices was much lower and resulted in better scores on the rating scale. Those who had pleasurable hallucinations had less distress, less negative content, quieter voices and more control over their voices. The authors suggest that these results have implications for therapy. They suggest that since coping training and taking medications can be affected by the presence of pleasurable hallucinations, clinicians need to modify their technique depending on the patient's response to his/her voices. Some individuals might need more psychoeducation, family therapy, cognitive-behavioral interventions that focus on adjustment to daily life, perhaps with conservation of pleasurable hallucinatory experiences.

This study is limited in several ways. First, the relative proportion of those with pleasurable voices was small and hence statistically, the study may have lacked power. Second, the questions that were attached to the standard questionnaire were not standardized (i.e. gone through statistical tests) and as such may have presented a response bias. Also, clinical information was collected based on patient's recollection without corroboration on all occasions. Nevertheless, this study highlights the need for family, doctors and therapists to discuss the possibility of pleasurable AH with all patients before starting any form of treatment.

This study was supported by Spanish grants from Generalitat Valenciana (GV01-93), Red de Genotipaci�n y Psiquiatr�a Gen�tica (ISCIII 2003- G03/184), FISS P.I. 02/0018, and Eli Lilly Company Spain.

Click here to find this article on PubMed

Author: Farzin Irani