[The aetiopathogenesis of auditory hallucinations in psychosis]

Auditory hallucinations is one of the core symptoms of psychosis. Two main different approaches have been made in recent years in order to understand this perceptual abnormality. The psycho-social approaches is trying to explain auditory hallucinations as a common human phenomenon that only environmental factors cause them to be pathological. It propose psychotherapeutic techniques based on the cognitive model, paying special attention to the emotional component. The neurobiological approach, specially with neuroimaging techniques, is giving us new information about abnormal activation in specific neural networks, particularly in language areas. It propose biological treatments with antipsychotics and transcranial magnetic stimulation. Neither of these approaches are listening to each other. Neither of them look at the molecular genetic vulnerability to auditory hallucinations in psychosis.

From a review of the literature and our own findings, we present a genetic-environmental model of auditory hallucinations in psychoses. We hypothesize two types of genetic vulnerability: vulnerability to hearing voices -that could be related with genes that are expressed in language areas and are related with language abnormalities (FOXP2)-, and vulnerability to abnormal emotional response to voices -that could be related with genes that are involved in the regulation of dopamine in the limbic system (5-HTT, CCK-AR)-. Finally, environmental and cultural factors explain the content and social adjustment to auditory hallucinations.

Our model allow the integration of many data from epidemiology and neuroimaging, to psychopharmacology in the understanding of the aetiology of auditory hallucinations.