Acting on harmful command hallucinations in psychotic disorders: an integrative approach.
ABSTRACT Although harmful command hallucinations have been linked to violent behavior, few studies have examined factors mediating this relationship. The principal aim of this study was to examine a range of factors potentially associated with acting on harmful command hallucinations using a multivariate approach. The sample comprised 75 participants drawn from community and forensic services. Measures assessing characteristics of the command hallucination and the hallucinator, including forensic risk factors, were administered. Using ordinal logistic regression, we found compliance to be associated with increasing age, viewing the command hallucination as positive, congruent delusions, and reporting low maternal control in childhood. Antipsychotic medication was protective while, contrary to expectations, traditional predictors of violence reduced the odds of compliance with command hallucinations viewed as threatening. The findings suggest that compliance with harmful commands is driven by a complex interaction between beliefs related to the command hallucination and personal characteristics, with risk of compliance increasing with age.
SourceAvailable from: Neil Thomas[Show abstract] [Hide abstract]
ABSTRACT: Background: In people who experience auditory verbal hallucinations, beliefs the person holds about their voices appear to be clinically important as mediators of associated distress and disability. Whilst such beliefs are thought to be influenced by broader schematic representations the person holds about themselves and other people, there has been little empirical examination of this, in particular in relation to beliefs about voice intent and the personal meaning of the voice experience. Method: Thirty-four voice hearers with a diagnosis of schizophrenia or schizoaffective disorder completed the Psychotic Symptom Rating Scales and measures of beliefs about voices (Revised Beliefs About Voices Questionnaire, Interpretation of Voices Inventory) and schemas (Brief Core Schema Scales). Results: Beliefs about voices were correlated with both negative voice content and schemas. After controlling for negative voice content, schemas were estimated to predict between 9% and 35% of variance in the six beliefs about voices that were measured. Negative-self schemas were the strongest predictors, and positive-self and negative-other schemas also showed potential relationships with beliefs about voices. Conclusions: Schemas, particularly those regarding the self, are potentially important in the formation of a range of clinically-relevant beliefs about voices.Behavioural and Cognitive Psychotherapy 10/2013; DOI:10.1017/S1352465813000817 · 1.69 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The paper discusses the relevance of decision-making models for evaluating the impact of mental disorder on legal responsibility. A three-stage model is presented that analyzes decision making in terms of behavioral control. We argue that understanding dysfunctions in each of the three stages of decision making could provide important insights in the relation between mental disorder and legal responsibility. In particular, it is argued that generating options for action constitutes an important but largely ignored stage of the decision-making process, and that dysfunctions in this early stage might undermine the whole process of making decisions (and thus behavioral control) more strongly than dysfunctions in later stages. Lastly, we show how the presented framework could be relevant to the actual psychiatric assessment of a defendant's decision making within the context of an insanity defense.International Journal of Law and Psychiatry 11/2014; DOI:10.1016/j.ijlp.2014.02.034 · 1.19 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: This study was a phenomenological inquiry of the experience of auditory hallucinations as described by 13 Indonesian people diagnosed with schizophrenia. The interviewees included 6 men and 7 women and they were aged between 19 and 56years. Four themes emerged from this study: feeling more like a robot than a human being; voices of contradiction - a point of confusion; tattered relationships and family disarray; and normalizing the presence of voices as part of everyday life. The findings of this study have the potential to contribute to new understandings of how people live with and manage auditory hallucinations and so enhance client-centered nursing care.Archives of psychiatric nursing 12/2013; 27(6):312-8. DOI:10.1016/j.apnu.2013.08.001 · 1.03 Impact Factor