The role of set-shifting in auditory verbal hallucinations.
Auditory verbal hallucinations (AVHs) are a cardinal characteristic of psychosis. Recent research on the neuropsychological mechanism of AVHs has focused on source monitoring failure, but a few studies have suggested the involvement of attention, working memory, processing speed, verbal learning, memory, and executive functions. In this study we examined the neuropsychological profile of patients with AVHs, assuming that the mechanism underlying this symptom could be a dysfunction of specific cognitive domains.



A large neuropsychological battery including set-shifting, working memory, processing speed, attention, fluency, verbal learning and memory, and executive functions was administered to 90 patients with psychotic disorders and 44 healthy controls. The group of patients was divided into two groups: 46 patients with AVHs in the current episode and 44 who denied auditory hallucinations or other modalities in the current episode. AVHs were assessed with the Psychotic Symptom Rating Scales (PSYRATS); the Launay-Slade Hallucination Scale was used to measure long-term propensity to auditory verbal hallucination-like experiences (HLEs) in the sample.



Patients showed poorer performances on all neuropsychological measures compared to the healthy controls' group. In the original dataset without missing data (n=58), patients with AVHs (n=29) presented poorer set shifting and verbal learning, higher levels of visual attention, and marginally significant poorer semantic fluency compared to patients without AVHs (n=29). In the logistic model on the multiple imputed dataset (n=90, 100 imputed datasets), lower capacity of set shifting and semantic fluency distinguished patients with AVHs from those without them.



Patients experiencing persistent AVHs might fail to shift their attention away from the voices; poorer semantic fluency could be a secondary deficit of set-shifting failure.
Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Faculty of Medicine, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. Electronic address: sara.siddi@pssjd.org.
Sara
S
Siddi
Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy.
Donatella Rita
DR
Petretto
Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy.
Caterina
C
Burrai
Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy.
Rosanna
R
Scanu
Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy.
Antonella
A
Baita
Psychiatric Diagnosis and Treatment Service II, Department of Mental Health, ASL Cagliari, Cagliary, Italy.
Pierfranco
P
Trincas
Psychiatric Diagnosis and Treatment Service II, Department of Mental Health, ASL Cagliari, Cagliary, Italy.
Emanuela
E
Trogu
Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy.
Liliana
L
Campus
Head, Department of Mental Health, ASL Cagliari, Cagliari, Italy.
Augusto
A
Contu
Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy.
Antonio
A
Preti
D000328:Adult; D001288:Attention / Q000502:physiology*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology; D012565:Schizophrenic Psychology; D014706:Verbal Learning / Q000502:physiology*; D055815:Young Adult