Furthermore, determination of the presence of 'first-rank' or 'Schneiderian' hallucinations-voices speaking to each other or narrating one's thoughts aloud-should be completed. The clinician's most valuable assessment tool is the mental status examination, addressing mood, affect, appearance, behavior, speech, thought content, thought process, insight, and judgment. The evaluation of paracusias consists of a general psychiatric interview that includes details regarding the evolution of the hallucinations, triggering factors, psychiatric review of systems, past psychiatric diagnosis, history of substance use, family history of psychiatric illness, and history of trauma.Īdditionally, a detailed medical history and medication regimen-including over-the-counter supplements-should be obtained. Neuroimaging studies have demonstrated increased D2 receptor occupancy in the striatal system and 5HT2a receptor occupancy in the caudate nucleus. Īt a neurochemical level, of particular importance are dopamine (D2) and serotonin (5HT2a) receptors. Some data suggest that the thalamus-amygdala pathways are activated, thereby processing an emotional response to the auditory hallucinations, further proved by another study detecting choline and N-acetyl aspirate ratio abnormalities in the thalamus. This mismatch results in the spontaneous firing of sensory neurons in the absence of appropriate inhibitory mechanisms. Ī neurocognitive model called the VOICE model has been offered, which attributes the paracusias to an unbalanced bottom-up limbic hyperexcitation mismatched against a hypoactive prefrontal inhibitory system. įMRI findings have demonstrated spontaneous activation of the auditory network, consisting of the left superior temporal gyrus, transverse temporal gyri (Heschl's gyri), and the left temporal lobe. However, several postulations have been suggested. The precise mechanism by which paracusias occur remains elusive.
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