Neurosciences approaches could explain the differences between the two samples. Here is what I've found:

http://cercor.oxfordjournals.org/content/21/2/330.full (1)

My question is if we could measure the level of consciousness and differencess to the both sample subjects using signal detection auditory task.

see: http://www.nmr.mgh.harvard.edu/kuperberglab/publications/papers/Ditman&Kuperberg_Harvrev_05.pdf (2) and

https://www.researchgate.net/publication/224931398_Source_monitoring_and_proneness_to_auditory-verbal_hallucinations_A_signal_detection_analysis (3)

Also is interesting to find out if the clinical sample could develop coping strategies or self-awareness behaviours same as the non-clinical sample. If we predict that non-clinical sample will report self-awarness bahaviours, maybe the mindfulness approach could be the answer...

Article Source monitoring and proneness to auditory-verbal hallucina...

This depends on how you define hallucination. If you say that it is a perception without a stimulus then there is no difference by definition. I would suggest that that is the most parsimonious answer.

Maybe we have to rethink our understanding of schizophrenia. What we think of an entity is a construct of 3 dimensions:

- Reality distortion (delusion, hallucinations)

- Psychomotor poverty

- Disorganization

And each of those dimensions reaches far into the range of mental health without clear border between health and disorder.

In clinical practice we diagnose “Schizophrenia” only when each of those dimensions has a clear “severe” expression.

It seems “Schizophrenia” is a combination of 3 independent phenomena in a combined severe expression.

I would hasten you not to reinvent the wheel. There are psychotic-like experiences as well as full-blown psychotic experiences. This continuum was recognized and studied by such researchers as Loren & Jean Chapman (see papers in Schizophrenia Bulletin), and more recently by the researchers (Lisa Phillips, Allison Yung, etc.) who study the at-risk young adults with the CAARMS, etc.

Hallucinations in non-clinical populations have been studied in specific groups such as high altitude climbers or on religious groups. The differences may lie in the content, the emotional quality and the locus of control in the two groups.

You may see these links for non-psychotic hallucinations in non-psychotic conditions.

http://www.ncbi.nlm.nih.gov/pubmed/2804881

DSM-IV criteria for schizophrenia specifically states that only one A criteria is required if "........ if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.". However there is a relevant discussion of the validity of this criteria as many patients with dissociative disorders may also experience this phenomenon.

A growing number of studies indicate higher levels of Schneiderian first rank symptoms among patients with complexs trauma disorders. In difficult differential diagnostic cases level of insight may be helpful. Vague delusions associated with voice-hearing can be more easily rectified in non-psychotic cases.

Paul F Dell has developed an instrument called MID (Multidimensional Inventory of dissociation) that has recently shown different patterns of pathology between patients with dissociative disorders and schizophrenia. See the following link. https://www.researchgate.net/publication/225085323_Dissociation_and_psychosis_in_dissociative_identity_disorder_and_schizophrenia

Article Dissociation and Psychosis in Dissociative Identity Disorder...

in the short run: no. That's the reason Kurt Schneider and Kandinsky & Clerambeault made their statements (I prefer the last)

Eckhard, can you share a reference concerning Kandinsky & Clerambeault's views on hallucinations? I am not aware of anything in English.

Schneider's views on psychosis are certainly better known - sadly they rose and fell, as Akiah points out, with DSM-IV. Unfairly, I think, because DSM-IV fatally commits an error Karl Jaspers warned us against. ("Psychopathology is important" - paraphrasing Jaspers in his "General Psychopathology" - "but when it comes to making a diagnosis, psychopathology is the least important thing.") Within the total context, Schneiderian First Rank Symptoms are, in my opinion, quite helpful - and I would predict -- if we stick with Jaspers - not so difficult to "tease out" in context of schizophrenia vs trauma/dissociateive disorders after all. (And to FO O'Neil, that's my problem with any "parsimonious" definition....) Thanks for the reference to Dell's paper. Deserves a careful and critical read, I think.

I agree with Diane that neuroscience can help us. Thanks for your comments, and the Linden et al reference is fabulous! O had they only compared a dissociative disorder / trauma group with a group with schizophrenia!

Tobias - you would have to convince me that your three independent dimensions are indeed independent. But I agree that we are dealing with a continuum of some sort of "anthropological proportions" So it is kinda like "being very tall" and "very skinny" except the dimensions are not physical. Yes, Diana, a continuum. Still, at a certain point on a continuum, quantitative change can evoke a radically qualitative one. There are MANY examples - i think Schneiderian first rank symptoms in schizophrenia being one of them. (And furthermore - all sorts of experimental evidence is available nowadays that can show us that we are all, in some sense, deceiving ourselves in many ways so much of the time. Move your arm, and there is evidence that it moves before you think you moved it [shades of Schneiderian "somatic passivity experiences...]. Even more generally - if I reflect on myself, the "me" who I think I am is certainly not "I." Indeed, how can I EVER have access to this "I"? So yes, there are continua here, and again, at a certain point on a continuum - a qualitative distinction pops out. And thanks for the reference, Padmavati, I have requested it. Not sure about these distinctions...... I tend to go with Jasper's again - form trumping content. Great and helpful discussion - keep it up!

There remains the problem of subjectivity as always and even when assuming true hallucinatins the problem of intermingled normal psychological contribution remains as outlined for pseudohallucinations, see for example my editorial NPBR 2011, 17:37-38

the influences therfore are multiple, eg TMS, psychology or drugs. Of the latter in my experience fluphenazine is special, eg Bechter K 1994, Nervenarzt,65:798-801 and actual posters at the DGBP Congress Heidelberg Germany Sept 14-15 2012.Tms was speciallly investigated by Strik et al

There is at present a debate whether clinical and non-clinical hallucinations are located on a continuum of psychotic symptoms, ranging from normal perceptual experiences to auditory hallucinations experienced by psychiatric patients. Auditory hallucinations in the general population can then be considered to take a halfway position on this scale.

A recent paper by Daalman et al compared the phenomenology of auditory verbal hallucinations in non-psychotic individuals and persons with schizophrenia. They observed several commonalities and differences. The perceived location of voices (inside/outside the head), the number of voices, loudness, personification and attribution were not different between patients and nonpatients, suggesting a similar phenomenon in both groups. However, the emotional valence of the content, the frequency of hallucinations, and the control subjects had over their hallucinations were different. Also, a large difference in age at onset may suggest a different aetiology.

Interestingly, neuroscience has shown that brain activity during auditory hallucinations is similar in both groups.

See:

http://www.stemmenpoliumcutrecht.nl/PDFjes/Voices%20in%20healthy%20and%20psychotic%20individuals_Daalman-Sommer-JCP.09m05797yel.pdf

http://schizophreniabulletin.oxfordjournals.org/content/early/2011/04/28/schbul.sbr033.short

Psychotic hallucinations are often tightly coupled with delusional ideations, particularly in terms of content.

There is a very interesting recent article from an excellent psychosis research group in Hong Kong describing a scale they designed to assess the phenomenological aspects of delusions, looking at different self-referential themes. I think this could also have relevance to hallucinations and imagine that something comparable could be designed to also explore auditory hallucinations in this detail:

http://www.schres-journal.com/article/S0920-9964(11)00659-1/abstract

In clinical training we do a lot to differentiate true Schneiderian hallucinations from imagery and pseudohallucinations by evaluating the plausibility of a true(you may ask what is true) abnormal experience. The unability to differentiate this otherwise remains in my view and will remain unsuccessful on the presently preferred seemingly objective measures, as truth remains arbitrary though plausible and teachable and communicable. This aspect involves the same problem as involved in the questions whether a free will exists. The latter is involved here as the patient himself makes his own evaluation before talking to anybody.The preattentive and emotional experiences are always before the conscious evaluation, but which is immediately following. Given the earlier nonevaluated mechanisms were assessed exactly in a person, such could allow to separate the mechanisms of evaluation in a specific time frame, and to more exactly differentiate the latter, eg illusion from hallucination and the relative strength of hallucinatory drugs, graded by dose response. Then I would expect that true hallucinations differ from imagery , illusion, anxiety driven reduced accuracy (truth)of evaluation aso . Hoever even lies; see my editorial, cannot safely be differentiated by objective measures, you can separate however some aspects and come to a plausibilty evaluation. When excluding the aspect of subjective evaluation and thus arbitrary free will, the problem cannot be solved in my view. see the literature to free will, eg Gerry Leisman et al.

When excluding all aspects of evaluation processes only the basic pathophysiological processes are left. These are in itself not symptoms though linked to biological abnormalities, eg for hallucinations may involve specific regions , see CG Wible et al .The problem remains that specific pathophysiology is not specific disorder nor specific symptom though may more or less be linked to. Again not least the free will aspects come to some extent into play.

The unspecificity problem is underrecognized in general, see my mild encephalitis hypothesis updated, 2012, Progr NP&BP

Kandinsky was a Russian psychiatrist (19th cent) who had a schizoaffektive psychosis himself. He gave a good description what went wrong with him during the active periods of his illness. May be, his name is written in English another way. Take a look at if possible switch to the Russian text; the core is in the pseudo-hall = "made", "sent", "recieved" hall (other definition than nowadays!). Clerambeaults writings are from the 20ies. Both are taken together in the "syndrome of psychic automatism" = the patient experiences a loss of activity/power in relation to his own psychological instances. All that is a little broader than Schneider. Both syndromes are no proof of schizophrenia - but the psychic automatism is rather seldom in other psychoses. K. Schneider: ... a state with... I CALL a schizophrenia... (at least in German, do not know the English translation). But the early signs of a beginning schizophrenia in a 18 years old contain... - the loss of power of ...

Greetings!

1 h ago I had a patient sitting here (I know her for 10 years...) complaining her former boyfriend is telepathically sending her bad sensations in her belly... coenaesthetic hallucinations sent by another person

How about the idea of prof. Linszen, former head of the famous Adolescent clinic at the Academic Medical Center in Amsterdam, the Netherlands? Schizophrenic people who experience (auditory) hallucinations are utterly convinced of their objective reality. People without any DSM-condition who experience such hallucinations [of whom there are roughly ten times as many on a life-time basis (1)], on the other hand, realize they are hallucinating. (2) This would mean that in non-schizophrenics there would be a critical instance in one’s consciousness overseeing and correctly interpreting their experiences. One should not take this difference as too absolute though. Once a psychotic episode has passed, many people with schizophrenia realize ‘with the sanity of hindsight’ what has happened. Another shade of grey in this matter is the history of John Nash, the economics Nobel-laureate after which the film “A beautiful mind” was made. As depicted in the movie, Nash was utterly convinced of the reality of his hallucinations, yet, over the years he learned – helped, no doubt by his impressive intelligence – to make the distinction. It is debatable whether this is enough reason to call him cured in his later years, which doesn’t really matter that much, as long as one appreciates the difference.

(1) Johns & van Os (2004): http://www.sciencedirect.com/science/article/pii/S0272735801001039

(2) In my book “De adolescentenkliniek”, Uitgeverij Augustus, 2005.

@Flip. Indeed, this relates to the point I was trying to make in my previous post, in that the maintenance of hallucinatory experience is upheld and maintained by the belief that the hallucination is a part of reality. If one does not believe that the hallucinated perceptual experience is real, then the intensity of the perceptual experience (i.e. hallucination) may be degraded. Though if one is completely convinced that they are hearing the voice of Jesus, for example, then this could also be framed as a delusional belief (about the auditory hallucination).

@Eckhard. The patient you describe also gives a good example of this in that the hallucinations experienced are directly related to the delusional belief about telepathy.

Though one interesting question would be: is the delusion the product of the hallucination, or is the hallucination a product of the delusion?

Therefore, it may be the case, as Flip states, that the presence of coexisting and complimentary delusional beliefs, that are directly associated with the hallucination, could be one criteria for dissociating between pathological auditory hallucinations in people with schizophrenia and non-pathological voice-hearing in a non-psychotic population.

Reports says about the differences between ''false belief" and "delusions" : "After the revision, 10 percent of patients who were previously deemed schizophrenic were given a new diagnosis, the majority of them because their delusions were no longer bizarre. (1) I didn't find empirical studies, but this report says that: `delusions might not necessarily be false beliefs" (2)

In other line, I think, not only the fact that non-schizophrenics were convinced about their possible "false-belifs", they also reported there were "bizarre". Or schizophrenics could report about their thoughts that are bizzare?

I'm completly agree with Flip Schrameijer argument. I'm only skeptical about the John Nash case, because reports says that the majority of schizophrenics have auditive halucinations (3), or in the movie, he had visual hallucinations. The auditive hallucinations cand be reduced by medications but what about the visual ones? (4) Could IQ predict the early onset of visual hallucinations? Why IQ can't predict the audititory hallucinations ? (5) (my reflection- differentiation is more difficult in auditory hallucinations, even if you have high IQ).

(1) (Aviv, Rachel. (2010) Which way madness lies: Can psychosis be prevented? Harper’s Magazine (December): 35-46. (or access through Rachel’s website).

(2) http://119.93.223.179/ScienceDirect/Cognitive%20Sciences/10-05/sdarticle_005.pdf

(3) Sartorius, N. et al (1974). The international pilot study of schizophrenia. Schizophrenia Bulletin, 2, 21-35.

(4) http://schizophreniabulletin.oxfordjournals.org/content/early/2012/02/24/schbul.sbs034.abstract

(5)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805734/

if my old Kraepelin does not fool me, so "the group of schizophrenia" (sic) is defined not by the productive, "plus"-symptomes, but rather by the chronic and non-productive, "minus"-symptomes? Did he have in mind one has to know the whole life story of a patient?

About the delusions: as I remember there are more them 800 definitions and I guess there is no use to invent the 801. So: what are the differences between an idée fix, an anancasm and a delusion? Are these differences defined by the content (bizarr/not bizarr) or are they defined by the degree of freedom, the inner distance and the critizism the patient experiences in relation to them?

At least, what are the differences between paranoid, paranoic and paraphren?

Well Alan, I certainly disagree with "lumping." Despite the fact that schizophrenia is a "not a singular category:” 1. Schizophrenia might still reflect syndromal reality - be a bunch of things.... like delirium and dementia - or dropsy. However, syndromes can still have "defining characteristics" even though these hide more fundamental differences. 2. Schizophrenia might still reflect a dimensional reality – blending into other disorders on the one hand and behavioral and experiential norms on the other – nonetheless, quantitative (dimensional) changes can certainly have sudden, dramatic and major qualitative manifestations - color being an example. You cannot maintain that "yellow" is not real because it is melts on a continuum into orange on the one side and green on the other.

It certainly is not easy doing phenomenological and psychopathology research in the Neo-Krapelinian age of DSM. I agree with Nancy Andreassen that DSM has (unintentionally) caused, in recent times, the "death of phenomenology" -- see schizophreniabulletin.oxfordjournals.org/content/33/1/1... --- but in science/culture, death is not necessarily permanent. With the coming fuss over the upcoming 100th anniversary of Karl Jaspers' "General Psychopathology" in 2013, there is an opportunity for this to change (anniversary is being marked all over the world!). Jaspers famously taught us that phenomenology/psychopathology MUST be contextualized as well as fine grained.

Perhaps I misunderstand -- are you really maintaining that the dopamine hypothesis (version III) dictates that we cannot tell the difference between a delirious person who is hearing voices, someone in the midst of trauma based dissociative identity disorder, someone dealing with schizophrenia, etc., and a voice hearer with none of the above?

Eckhard, good questions. I would look to Jaspers, Kraupl-Taylor, Spitzer and others for the answers. More on all that later. To start though with "anancast" i have to first ask how that differs from "obessive/compulsive?" Assuming that this is what you mean (eg see Forrsman's wonderful article on "The Anancastic Syndrome" in Acta Psychiatrica Scandinavica from 1963) - we can go back to the Ecclastical Courts of the Inquisition to grasp the difference between "obsession" and "possession" (today of course the later is seen as "delusion"). Originally - the question for the courts - have the devils and demons "possessed you?" (had you body and importantly soul) - in which case you were - eg., burned at the stake! Or have they merely - "obsessed you?" -- in which case, importantly - you were plagues but RESISTING - and prayer, penitance, etc would be in order. This Ecclesiatical term "obsession" (today re ideas - with "compulsion" reserved for behaviors) is still used in today's psychopathology - with "resistance" still at its heart. Hence we can see the logic also of Jaspers, Kraupl-Taylor's and Spitzer's criteria for delusions. They nicely separate delusions from obsessions and compulsions...

Hallucinations are somewhat more difficult to deal with.....

Thanks, Alan.

The "praecox feeling" is perhaps one place where the rubber meets the road:

http://www.ncbi.nlm.nih.gov/pubmed/20639689

and

http://www.ncbi.nlm.nih.gov/pubmed/16778451

Regarding the "praecox feeling," Ungavi and colleagues sum it up pretty well.....

1. "Diagnostic agreement with the modern gold standard diagnosis of schizophrenia for all raters of praecox-feeling was poor. "

Nonetheless --

2. "several lines of evidence suggest that its existence in clinical practice cannot be denied, which underscores the importance of a subjective element of unknown composition, magnitude and reliability in the diagnostic process that deserves more attention."

Grube's paper also deserves attention....

Michael et al: the thread started wrh the question, how to diff. patients with phonemes and not, who can find the most complicated quotations (if someone wants to continue:: what about phenylaethylamin, what about the phenylalanin-hydroxylase in the thrombocytes... ). One can help a colleague with a quotatian, if he ask for that - but it seams to me everybody has to stand for himaelf or that thread will become aomething like a medieval discussion with quotations of the Book of books how many theeth a horse should have.

So, how ro help the colleague to diff. between patients with phonemes (Michael, if that term is unknown to the american public, please translate it...)

Yes, Eckhard, and thank you - we are asking herein about hearing sounds and voices. (Is that what you mean by phonemes - which are strictly speaking the basic sound units of a language - and can differ from language to language). Thanks for bringing us back into focus.

(An interesting question - how often do auditory hallucinations occur in phonemes that differ from the array constituting the language of the person who is hallucinating? And I know that this is "off the topic' - but do people who "speak in tongues" use phonemes that are non-familiar? Perhaps that should be a separate "topic" somewhere else on this website... )

There very difficulty in distingushing between auditory hallucination in schizophrenia and other , we must see for other factor like delusion , insight , occupational impairment , change in personality of the patient