Hallucinations can be symptomatic of different mental health conditions and can be present in schizophrenia, depression, schizoaffective conditions, and bipolar with psychosis. The severity and chronicity of the hallucinations may vary by condition, but nonetheless can impact global functioning. For people with frequent hallucinations, social and occupational functioning can be impacted significantly, resulting in unemployment. Although there are medications and therapeutic treatments available for all of these conditions, some people do not respond well and can experience negative outcomes over long periods of time. Because hallucinations so heavily affect functioning, it is important to determine the trajectory of hallucinations in these psychological conditions and to assess the effect hallucinations have on recovery, outcome, and unemployment.
V.M. Goghari of the Departments of Psychology and Psychiatry at the Hotchkiss Brain Institute of the University of Calgary in Canada recently released data from a 20-year study focused on hallucination trajectory in a sample of 150 individuals with bipolar, depression, schizoaffective conditions, and schizophrenia. Six assessments were made over the two-decade study, the first during the initial hospitalization for hallucinations. Goghari found a direct link between hallucination severity and chronicity during the early course of illness and later recovery. Specifically, the individuals with more hallucinations in the first two years of illness had the highest levels of impairment on global functioning. Further, these individuals also had the worst outcomes and rates of unemployment.
The results revealed that nearly half of the participants with schizophrenia had frequent hallucinations during the entire study period, compared with only 20% of participants with schizoaffective disorder. Individuals with depression or bipolar had even lower rates, with only 6% and 8% respectively reporting chronic hallucinations. Goghari said, “This study provides data on the prospective longitudinal course of hallucinations, which were previously unavailable to the field, and are one of the key features of psychosis in major psychiatric disorders.” Not only does it provide a new look into a specific symptom related to many psychotic conditions; it can also be clinically significant for diagnosis and treatment of such conditions.
Goghari said that the presence and trajectory of hallucinations could help differentiate between schizophrenia and schizoaffective conditions because the individuals with schizophrenia had more hallucinations during the early course of the illness, and more chronicity over the entire 20 years. This new information also provides rationale for the high rates of continuous unemployment among individuals with schizophrenia, even though the most significant decline in functionality occurs in the first few years of illness onset. Although Goghari’s data is novel and long overdue, more exploration into the predictive value of hallucinations and other symptoms should be undertaken as these may prove to be vital indicators of long-term psychological outcome in some clinical populations.
Goghari, V. M., et al. (2013). A 20-year multi-follow-up of hallucinations in schizophrenia, other psychotic, and mood disorders. Psychological Medicine 43.6 (2013): 1151-60. ProQuest. Web.
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