This document discusses different treatments for auditory hallucinations based on their underlying causes. It recommends starting with the least radical therapies such as psychoeducation, coping techniques, and cognitive behavioral therapy. If those don't work, options include antipsychotic medication, transcranial magnetic stimulation, and electroconvulsive therapy. TMS and antipsychotics can significantly reduce hallucination severity but have high dropout rates. ECT may be effective for medication-resistant cases but the evidence comes from uncontrolled studies. Overall, treatment should be tailored to the individual based on the diagnosis and cause of their auditory hallucinations.

1. The Treatment of Auditory
Hallucinations
Iris Sommer
UMC Utrecht

2. Different Diagnoses need Different
Treatments
Auditory Hallucinations
Psychiatric Disorders:
Neurological disorder:
Schizophrenia
Temporal lobe epilepsy
Hearing Disorders: Schizotypal personality
Parksinson’s disease Healthy Individuals:
Auditory variant of Borderline personality
Dementia 10-15% of population
Bonnett’s syndrome Affective psychosis
Huntington’s disease
Dissociative Disorder
migraine
PTSD

3. Start treatment with least radical
therapy
• Psycho-education: explain what happens
• Teach coping techniques
• Reduce fear and obedience to the voices
with cognitive behavioural therapy (CBT)
• Anti-psychotic medication
• Transcranial Magnetic Stimulation
• Electro-Convulsive Therapy (ECT)

4. Psycho-education
The language areas are The connections between A few seconds prior
active during AVH. There is the frontal speech to the hallucination,
also a lot of activity in the production areas and the the hippocampus is
language production areas, temporal speech perception activated. This
indicating that the own areas are of inferior quality. implies that AVH
brain is making these Therefore, self-generated arise from memory,
words. sentences are not well just like dreams.
recognized.

5. Coping techniques
1. Conversation 73%
2. Singing/ humming 70%
3. Wissling 60%
4. Reading aloud 50%
5. Sleeping 43%
6. Listening to music 30%
7. Shouting 28%
8. Reading silently 30%
9. Chewing gum 25%
10. Hobbies: games, internet, sports, hiking 16%

6. Cognitive Behavioural Therapy
• Reduce belief in the omnipotence of the
voices
• Stop the patient to carry out commands of
the voices
• Reduce fear
• Increase self esteem

7. Is CBT really effective?

8. Antipsychotic medication for
hallucinations
DROP-OUT rate after 12 months was 50%!!
Data from the EUFEST study
Kahn et al, Lancet 2008

9. Medication
• Severity of hallucinations from 4.4 (marked to
severe hallucinations), to 2.5 (minimal to mild
hallucinations) after 4 weeks.
• Severity to 1.5 (absent to minimal hallucinations)
after 6 months of treatment
• The % patients with at least mild hallucinations
from 100% at baseline to 8% after 12 months.
• No differences between amisulpride, olanzapine,
quetiapine and ziprazidone. Trend towards
haloperidol less effective.

10. TMS for hallucinations
Study name Subgroup within study Hedges's g and 95% CI
Hedges's
g p-Value
Slotema b T3P3 0,000 1,000
Brunelin T3P3 1,158 0,008
Vercammen b T3P3 -0,175 0,613
de Jesus T3P3 0,464 0,321
Hoffman T3P3 0,552 0,052
Rosa PANSS pos T3P3 -0,084 0,880
Chibbaro SAH T3P3 1,283 0,014
Saba PANSS pos T3P3 -0,053 0,910
Lee b frequency T3P3 0,498 0,189
Fitzgerald HCS T3P3 0,329 0,344
Jandl c PSYRATS T3P3 0,534 0,154
Loo c T3P3 0,034 0,916
Poulet c T3P3 1,350 0,005
McIntoshc PANSS pos T3P3 0,195 0,573
Hoffman c hcs T3P3 1,219 0,005
0,437 0,000
-2,00 -1,00 0,00 1,00 2,00
sham rTMS
Meta Analysis
Slotema et al. Schiz Res in press

11. Possibility of positive publication
bias

12. TMS usually applied for
medication-resistant patients
• Psycho-education: explain what happens
• Teach coping techniques
• Reduce fear and obedience to the voices
with cognitive behavioural therapy (CBT)
• Anti-psychotic medication
• Transcranial Magnetic Stimulation
• Electro-Convulsive Therapy (ECT)

13. ECT for medication-resistant
hallucinations
A B
* * #
NOT PLACEBO CONTROLLED!!
# *
*
Mean decrease in PANSS, n=17 Mean decrease in P1 (delusions)
P3 (hallucinations) sign. at p<0.05
G6 (depression), G11 (attention)

14. Thank you very much for your
attention!!!!
Voices Clinic at the UMC Utrecht