A data-driven linguistic characterization of hallucinated voices in clinical and non-clinical voice-hearers

Background: Auditory verbal hallucinations (AVHs) are heterogeneous regarding phenomenology and etiology. This has led to the proposal of AVHs subtypes. Distinguishing AVHs subtypes can inform AVHs neurocognitive models and also have implications for clinical practice. A scarcely studied source of heterogeneity relates to the AVHs linguistic characteristics. Therefore, in this study we investigate whether linguistic features distinguish AVHs subtypes, and whether linguistic AVH-subtypes are associated with phenomenology and voice-hearers' clinical status. Methods: Twenty-one clinical and nineteen non-clinical voice-hearers participated in this study. Participants were instructed to repeat verbatim their AVHs just after experiencing them. AVH-repetitions were audio-recorded and transcribed. AVHs phenomenology was assessed using the Auditory Hallucinations Rating Scale of the Psychotic Symptom Rating Scales. Hierarchical clustering analyses without a priori group dichotomization were performed using quantitative measures of sixteen linguistic features to distinguish sets of AVHs. Results: A two-AVHs-cluster solution best partitioned the data. AVHs-clusters significantly differed in linguistic features (p < .001); AVHs phenomenology (p < .001); and distribution of clinical voice-hearers (p < .001). The “expanded-AVHs” cluster was characterized by more determiners, more prepositions, longer utterances (all p < .01), and mainly contained non-clinical voice-hearers. The “compact-AVHs” cluster had fewer determiners and prepositions, shorter utterances (all p < .01), more negative content, higher degree of negativity (both p < .05), and predominantly came from clinical voice-hearers. Discussion: Two voice-speech clusters were recognized, differing in syntactic-grammatical complexity and negative phenomenology. Our results suggest clinical voice-hearers often hear negative, “compact-voices”, understandable under Broca's right hemisphere homologue and memory-based mechanisms. Conversely, non-clinical voice-hearers experience “expanded-voices”, better accounted by inner speech AVHs models

Musical hallucinations and their relation with epilepsy

Musical hallucinations are poorly understood phenomena. Their relation with epilepsy was first described over a century ago, but never systematically explored. We, therefore, reviewed the literature, and assessed all descriptions of musical hallucinations attributed to epileptic activity. Our search yielded 191 articles, which together describe 983 unique patients, with 24 detailed descriptions of musical hallucinations related to epilepsy. We also describe six of our own patients. Based on the phenomenological descriptions and neurophysiological data, we distinguish four subgroups of epilepsy-related musical hallucination, comprising auras/ictal, inter-ictal and post-ictal phenomena, and phenomena related to brain stimulation. The case descriptions suggest that musical hallucinations in epilepsy can be conceptualised as lying on a continuum with other auditory hallucinations, including verbal auditory hallucinations, and—notably—tinnitus. To account for the underlying mechanism we propose a Bayesian model involving top-down and bottom-up prediction errors within the auditory network that incorporates findings from EEG and MEG studies. An analysis of phenomenological characteristics, pharmacological triggers, and treatment effects suggests wider ramifications for understanding musical hallucinations. We, therefore, conclude that musical hallucinations in epilepsy open a window to understanding these phenomena in a variety of conditions.Stress and Psychopatholog

The efficacy of anti-inflammatory medication in postoperative cognitive decline: A meta-analysis

Objective: Post-operative cognitive decline is a surgical complication involving chronic impairments in different cognitive domains. Although the exact mechanisms behind postoperative cognitive decline are still unknown, there is increasing evidence for a key role of neuroinflammation. This meta-analysis aims to investigate the efficacy of anti-inflammatory treatment on postoperative cognitive decline. Participants and Methods: An electronic search was performed using PubMed, Psychinfo, EmBase, Cochrane Database of Systematic Reviews and clinicaltrial.gov (until November 2019). No year or language restrictions were applied. Only randomized, double-blind, placebocontrolled studies that investigated clinical outcome in adult patients who underwent surgery under general anaesthesia (except brain surgery) were included. The search yielded 574 papers, of which nineteen fulfilled the inclusion criteria. Results: The current meta-analysis found a significant effect of different anti-inflammatory agents on the incidence of POCD (OR=0.67, p=0.010). Administration of COX-2 inhibitors (OR=0.31, p&lt;0.0001), ketamine (OR=0.44, p=0.38) and lidocaine (OR=0.79, p=0.33) showed better results than placebo in a meta-analysis of at least two studies. Erythromycin (OR=0.14, p=0.006), erythropoietin (OR=0.15, p=0.07) and dexmedetomidine (OR=0.58, p=0.03) were significant in single studies. No beneficial effects on cognition were found for magnesium, 17βestradiol, dexamethasone and melatonin. Conclusion: The results of this meta-analysis provide evidence for a potential efficacy of anti-inflammatory agents on POCD, but further research is necessary to determine which agents are most appropriate for clinical application

Quantified language connectedness in schizophrenia-spectrum disorders

Language abnormalities are a core symptom of schizophrenia-spectrum disorders and could serve as a potential diagnostic marker. Natural language processing enables quantification of language connectedness, which may be lower in schizophrenia-spectrum disorders. Here, we investigated connectedness of spontaneous speech in schizophrenia-spectrum patients and controls and determine its accuracy in classification. Using a semi-structured interview, speech of 50 patients with a schizophrenia-spectrum disorder and 50 controls was recorded. Language connectedness in a semantic word2vec model was calculated using consecutive word similarity in moving windows of increasing sizes (2-20 words). Mean, minimal and variance of similarity were calculated per window size and used in a random forest classifier to distinguish patients and healthy controls. Classification based on connectedness reached 85% cross-validated accuracy, with 84% specificity and 86% sensitivity. Features that best discriminated patients from controls were variance of similarity at window sizes between 5 and 10. We show impaired connectedness in spontaneous speech of patients with schizophrenia-spectrum disorders even in patients with low ratings of positive symptoms. Effects were most prominent at the level of sentence connectedness. The high sensitivity, specificity and tolerability of this method show that language analysis is an accurate and feasible digital assistant in diagnosing schizophrenia-spectrum disorders