A Review of Multimodal Hallucinations

Categorization, Assessment, Theoretical Perspectives, and Clinical Recommendations

Disclosures

Schizophr Bull. 2021;47(1):237-248. 

In This Article

Clinical Implications

The clinical understanding of hallucinations has primarily focused on the auditory modality (exemplified by the fact that most interventions are predominantly for AHs[84]), with limited considerations of other modalities or of MMHs.

Nevertheless, preliminary data indicate that MMHs are linked to higher levels of adverse mental health outcomes, being perceived as more distressing, frightening, and more veridical than unimodal hallucinations.[13,17] For serial MMHs, related phenomena can make hallucinations appear to have the power to affect the person in different ways: for instance, tactile sensations or visions that are meaningfully connected to a disembodied voice can contribute to beliefs that a voice has power over the individual.[85]

One should consider whether multimodal experiences are connected temporally (eg, "Do you usually see them when they are talking? Do you see them without hearing them?") because it would be of relevance in formulating how hallucinations impact on distress. In psychological interventions, clarifying the temporal sequencing of hallucinatory experiences in different modalities may inform how these episodes unfold over time. For instance, the beliefs that people hold about how different hallucinations are interconnected may be targets for cognitive therapy methods. Furthermore, assessing a person's response to the first hallucinatory episode, and their potential expectation for related experiences to occur, may indicate points of intervention via alternative coping strategies.

Finally, we need to evaluate if MMHs lead to poorer outcomes in treatment trials and research the effectiveness of antipsychotic medication for MMHs compared to unimodal ones. This is for 2 reasons: first, whilst antipsychotic medications have a broad effect on psychotic symptoms, and no drugs specifically target hallucinations,[86] it is not known whether medication may differentially affect MMHs vs unimodal experiences within subjects. This is an area for further research. Second, given the role that antipsychotics have in the management of patients' potential distress caused by hallucinations (which is often what differentiates clinical from nonclinical cases), it is important to extend the investigation of such efficacy beyond unimodal experiences and to the distress experienced by those specifically with MMHs.

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