What does a schizophrenic hear

The Propensity to Hear “Voices” in Schizophrenia May Be Established by Infancy, Many Years Before Symptom Onset | Mount Sinai

  • Press Release

Findings reveal how auditory hallucinations may arise in patients with schizophrenia and provide potential new targets for early detection and treatment


  • New York, NY
  • (October 02, 2019)

Some people suffering from severe mental illness, particularly schizophrenia, hear “voices,” known as auditory hallucinations. This symptom, which afflicts more than 80% of patients, is among the most prevalent and distressing symptoms of schizophrenia. Patients “hear voices” speaking to them or about them without anyone actually being there. Auditory hallucinations, which usually begin in adolescence and young adulthood, “sound” very real to patients and can have a devastating impact on their quality of life because the “voices” are typically distressing and distracting, sometimes compelling the sufferer into suicidal or violent actions. Uncovering the biological origins of auditory hallucinations is essential for reducing their contribution to the disease burden of schizophrenia.

To investigate the biological origins of hearing “voices” in patients with schizophrenia, a team led by researchers at the Icahn School of Medicine at Mount Sinai used ultra-high field imaging to compare the auditory cortex of schizophrenic patients with healthy individuals. They found that schizophrenic patients who experienced auditory hallucinations had abnormal tonotopic organization of the auditory cortex. Tonotopy is the ordered representation of sound frequency in the auditory cortex, which is established in utero and infancy and which does not rely on higher-order cognitive operations. The study findings, which appears this week in the Nature Partner Journal NJP Schizophrenia, suggest that the vulnerability to develop “voices” is probably established many years before symptoms begin.

“Since auditory hallucinations feel like real voices, we wanted to test whether patients with such experiences have abnormalities in the auditory cortex, which is the part of the brain that processes real sounds from the external environment,” says Sophia Frangou, MD, PhD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai.

Specifically, the research team used an ultra-high field scanner with a powerful 7 Tesla magnet to obtain high-resolution images of brain activity while study participants listened passively to tones across a range of very low to very high frequencies.  In healthy brains, these sounds are processed in a very organized fashion; each frequency activates a specific part of the auditory cortex forming a tonotopic map. The team obtained tonotopic maps from 16 patients with schizophrenia with a history of recurrent auditory hallucination and 22 healthy study participants. They found that patients showed greater activation in response to most sound frequencies. Additionally, the mapping of most sound frequencies to parts of the auditory cortex appeared “scrambled” in patients with schizophrenia, suggesting that the normal processes for the organized representation of sound in the brain are disrupted in schizophrenia.

“Because the tonotopic map is established when people are still infants and remains stable throughout life, our study findings suggest that the vulnerability to develop “voices” is linked a deviance in the organization of the auditory system that occurs during infancy and precedes speech development and the onset of psychotic symptoms by many years.   This is particularly exciting because it means that it might be possible to identify potential vulnerable individuals, such as the offspring of schizophrenia patients, very early on.”

According to the authors, in addition to helping doctors spot people who are likely to experience hallucinations before the symptoms appear or become severe, the auditory cortex may be an area of consideration for novel neurmodulation methods to help patients who already have symptoms.

Looking ahead, Dr. Frangou’s research team will replicate and expand the current observations in larger samples to determine their relevance to hallucinations across diagnoses and to quantify the association of tonotopic disruption to auditory cortical activation and connectivity during actual hallucinatory experiences.

The study was supported by the National Institutes of Mental Health, the National Cancer Institute, The Netherlands Organisation for Health Research and Development, the Stanley Foundation and the Brain and Behavior Research Foundation.

Tags: Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, Psychiatry, Research, The Friedman Brain Institute, Sophia Frangou, MD, PhD

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U. S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

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Hearing Voices With Schizophrenia

Written by Shishira Sreenivas

In this Article

  • What Treatments Can Help With Hearing Voices?
  • What Are Some Self-Help Tips for Schizophrenia?

If you have schizophrenia and you hear voices, know that it’s not uncommon for people with the condition. Up to 80% of people diagnosed with schizophrenia have this symptom, too.

Doctors call them auditory hallucinations. It’s as if someone is speaking to you, but they’re not actually there. The voices feel very real and can be distracting and stressful. This can affect your overall quality of life. In severe cases, these voices may trigger thoughts of suicide or violence.

While the voices go away for some, for many, they never completely fade. But it’s possible to learn to manage them and take back some control in your day-to-day life.

What Treatments Can Help With Hearing Voices?

Prescription medications and talk therapy can help.

Medications. Antipsychotic medications are commonly prescribed for schizophrenia and can help in a number of ways. The drugs can:

  • Lessen the urge to interact with voices or listen to them
  • Help you ignore some of the criticism you may hear
  • Make the voices less frightening
  • Make the voices less intrusive or “in your face”

Drugs work differently for everyone. Tell your doctor if you don’t think your medication is helping. They may switch you to another one or change the dose. They might also try a combination of drugs.

It’s also important to give whatever medication you’re on a chance to do its job. If our doctor says it may take 2 weeks, 3 months, or whatever time frame to work, allow that much time to pass before deciding to try something else.

Cognitive behavioral therapy (CBT). This is when a mental health professional helps you work through what the voices mean, how they make you feel, and how they control what you think about yourself.

CBT can:

  • Lessen anxiety about hearing voices
  • Help you stand up to them
  • Help you build control over the voices

If you can’t go in person, look into telehealth options. This way, you can get help from the comfort of your own home. If you’re not sure how to get started, ask your doctor about it.

Avatar therapy. This is a newer form of talk therapy where computer technology is used to make an avatar, or animated version, of the voices you hear. The avatar can be human or nonhuman. It can also be built to mimic the gender, tone, and accent of the voices you hear. The goal of avatar therapy is to use the computer-generated form of your voices to learn ways to resist them and gain more self-control. The therapist usually sits in another room and is there for support if you need it.

A few small-scale studies have shown that avatar therapy may help make the voices appear less often and ease overall stress. But more research is needed to learn about how effective it is and the long-term effects. This type of therapy may be right for you if you’re still hearing voices even with medication. It usually lasts 6 weeks, with 30-minute sessions once a week.

Support groups. This can help you connect with others who also hear voices or live with similar schizophrenia-related issues. You can build community and find support, while also sharing what works for you to manage your day-to-day life with this condition. The National Alliance on Mental Illness (NAMI) is a good support resource.

Repetitive transcranial magnetic stimulation (RTMS). It’s a painless, noninvasive procedure in which an electromagnetic coil is placed on your scalp near your forehead. The coil sends magnetic pulses that stimulate nerve cells in this area. Experts are not entirely sure how it works, but they think it affects the regions of your brain that control mood and depression. Research suggests RTMS sessions can help make the voices appear less often and make them less intense. It may even keep voices at bay for up to 3 months after treatment. More research is needed.

What Are Some Self-Help Tips for Schizophrenia?

Ways you can try to control the effects of voices include:

Find distractions. Staying busy or focusing on something else to keep your mind occupied may help. This might drown out the voices or distract you from them.

Options include:

  • Puzzles or games
  • Listening to music
  • Reading a book
  • Watching TV
  • Writing
  • Household chores

Try out a few different things to see what works best for you.

Vocalization. Talking out loud might help keep the voices from flooding your thoughts and causing trouble. Besides talking, you can hum tunes, sing, or read out loud.

Keep a diary. Write down each time you hear voices, how they make you feel, and what effect they have on your mental and physical health. Try to write down the date, time, and place. Make a note of what you were doing right before the voices started. This can help you:

  • Recognize a pattern if there is one
  • Build self-awareness
  • Find what triggers the voices

Sharing it with your doctor or therapist can also give them a better idea of the help you need.

Avoid drugs and alcohol. They can worsen symptoms and may trigger paranoia or visual hallucinations (when you see things that aren’t there). Drugs and alcohol can also affect how well your antipsychotic medication works.

Find ways to relax. Schizophrenia symptoms tend to get worse if you’re stressed. Try relaxation techniques like yoga, meditation, or mindful breathing to manage stress and lower anxiety.

Be assertive. If the voices are gaining control over your actions and thoughts, try to confidently speak back. For example, you can say out loud, “I’m too busy to talk right now” or “I can talk after 7 p.m.” This may help you gain some control and “negotiate” or set boundaries with the voices.

Practice selective listening. Voices can often range from positive to negative. Try to pay attention or engage only when the voices are positive. This may take time and practice. Talk to your doctor or therapist if you’re not sure how to do this.

Call 911 or head to the nearest hospital If the voices get too strong, mean, or dangerous.

Scientists have found out how voices appear in the head of schizophrenics - RIA Novosti, 11/29/2016

Scientists have found out how voices arise in the head of schizophrenics

Scientists have discovered an unusual signaling RNA molecule in the human brain, the absence of which leads to the development of schizophrenia and the appearance of voices in the head. nine0003





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discoveries - RIA Science, USA, schizophrenia, genetics

Discoveries - RIA Science, Science, USA, schizophrenia, genetics

MOSCOW, 2 November - RIA Novosti . Scientists have discovered an unusual signaling RNA molecule in the human brain, the absence of which leads to the development of schizophrenia and the appearance of "voices in the head," according to an article published in the journal Nature Medicine.

"Two years ago, we discovered a specific chain of neurons in the brain that is affected by well-known antipsychotic drugs. All of them, however, cause severe side effects. We isolated a micro-RNA molecule, which is a key element in the operation of this chain of cells, and showed that the destruction of these micro-RNAs leads to the development of the disorders that are observed in schizophrenics," said Stanislav Zakharenko from the St. Jude Children's Hospital in Memphis (USA). nine0003

Today, about 24 million people worldwide suffer from schizophrenia. According to WHO statistics, every seven people out of a thousand are schizophrenics, and most of them begin to suffer from such problems between the ages of 15 and 35.

There is still no consensus among scientists on how such disorders arise and how they should be properly treated. In recent years, geneticists have found several dozen genes relatively loosely associated with schizophrenia, but they have not been able to understand how mutations in these DNA regions cause schizophrenia and its associated effects - hallucinations or "voices in the head". nine0003

June 3, 2015, 07:35 PM

Scientists have discovered the main genetic cause of schizophrenia Comparison of the DNA of tens of thousands of schizophrenics has shown that this psychiatric disorder occurs due to malfunctions of inhibitory neurons in the brain, their incorrect interaction with excitatory nerve cells and associated with these things mutations in the genes.

Zakharenko and his colleagues found that the latter effect could be caused by defects in the assembly of a small RNA molecule known as miR-338-3p. This small sequence of genetic code, as scientists explain, controls the assembly and operation of Drd2 receptors on the surface of nerve cells that read dopamine, one of the main information carriers in the brain and the hormone of pleasure. nine0003

People with a mutation in the gene that assembles this receptor, or micro-RNA, very often suffer from behavioral problems in childhood, and approximately 40% of them become victims of schizophrenia. All this prompted Zakharenko and his colleagues to check how both of these elements of the genome affect the brain by removing or blocking similar regions in the DNA of mice.

Experiments have shown that disabling miR-338-3p leads to a sharp increase in the number of Drd2 receptors in neurons located in the center of hearing in the cerebral cortex of mice, which increases their sensitivity to dopamine molecules. As a result, their connection with the thalamus, the center for processing and distributing information, was disrupted, and the cortex began to work, as it were, on its own. nine0003

August 1, 2016, 12:27

Scientists have discovered what gave rise to the "voices in the head" of Joan of Arc form of epilepsy.

This, according to scientists, can generate voices in the head, since information about perceived sounds usually undergoes primary processing in the thalamus and is probably cleared of noise and random signals.

As the experiment of Zakharenko and his colleagues showed, if the work of miR-338-3p is restored, then this cleaning is resumed, which had a positive effect on the behavior of mice, which, when new sources of sounds appeared, behaved extremely inadequately compared to normal individuals.

Accordingly, miR-338-3p molecules, or mechanisms that stimulate their production, can be used to treat schizophrenia relatively safely, or at least relieve its symptoms. In addition, a decrease in miR-338-3p concentrations in old age may explain why older people are more likely to suffer from schizophrenia and other brain problems than younger people, the authors of the article conclude. nine0003

Auditory hallucinations in schizophrenia

Auditory hallucinations can be a manifestation not only of schizophrenia, but also of a number of other mental disorders. With the exception of acute psychotic states, a person, as a rule, is critical of the voices in his head, that is, he perceives them as something imputed and suffers from their obsession.

The tension that arises in the patient as he tries to silence voices or ignore them by force of will can reach the point of physical discomfort and pain. Not to mention that a person suffering from auditory hallucinations is unable to do anything else. It is difficult for him to fall asleep, it is difficult to concentrate on work, homework, or even an easy hobby that usually does not require special concentration. nine0003

In clinical practice, there are a variety of types of auditory hallucinations in patients with schizophrenia: it can be the voices of one or more people, children and adults, male and female, familiar and unfamiliar - there is no special system here. But there is a systematic approach in the treatment of auditory hallucinations, which has been proving its effectiveness over the past 30 years.

In support of people suffering from auditory hallucinations (and not necessarily mentally ill in the usual sense of these words), at 1987 The Hearing Voices Movement was born. It challenges the accepted correspondence between schizophrenia and auditory hallucinations, promotes the social rehabilitation of people suffering from voices in their heads, and combats their stigmatization.

Among other things, it is to the Hearing Voices movement that patients who hear non-existent voices in their heads owe a therapeutic approach that excludes the active use of medication to combat auditory hallucinations. This approach focuses on cognitive techniques to reduce anxiety and psychological tension when they occur, shift attention to current activities or environmental events, and ultimately reduce the intensity of voices. This treatment is called metacognitive therapy. nine0003

Of particular importance in the psychotherapy of auditory hallucinations are meditative techniques that help to focus on productive activities. At the same time, you should not completely abandon medications - pharmacological support with the right dosage and combination of drugs only contributes to the success of cognitive-behavioral voice therapy.

The content of auditory hallucinations can also be very diverse: some voices talk to the person himself, others talk to each other, voices can comment on the person’s actions and the environment, they can insistently demand to do what the person would not dare to do of his own free will, including violent acts towards oneself and others. Therefore, it is especially difficult to recognize the presence of auditory hallucinations and tell relatives about their content.

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