Phenomenological characteristics of hallucinations and delusions in relation to symptom severity in severe and chronic schizophrenia patients

Abstract

Abstract Hallucinations and delusions in schizophrenia are among the biggest challenges in today’s psychiatry. The present study aimed to investigate the phenomenology of auditory and visual hallucinations and delusions in a sample of patients with chronic and severe schizophrenia, all hospitalized involuntarily in a secured setting. Psychotic symptoms of eight patients were mapped using the Questionnaire for Psychotic Experiences (QPE). Symptom characteristics, severity and internal consistency of the QPE subscales were described. Further, the relation of severity and three clinically relevant variables (insight, compliance to hallucinatory commands and interaction with hallucinations) was investigated. The results showed that the amount of visual hallucinations was remarkably high in our sample compared to other studies: 75%. Further, patients with more severe delusions showed a higher variation of different types of delusions. Internal consistency was higher in the auditory hallucinatory severity scale compared to the visual hallucinatory severity scale. Correlational analyses revealed that when severity of auditory hallucinations was higher, insight was poorer and interaction with hallucinations was higher. However, the tendency to obey auditory commands was lower when hallucinations were more severe. It is concluded that in a schizophrenia population with this kind of severity, research focus should shift from primarily auditory hallucinations to visual and tactile hallucinations as well. Also, adjustments should be made in order to reliable administer the QPE in this type of population. Implications and directions for future research are discussed.