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Command hallucinations in outpatients with schizophrenia

S Zisook1, D Byrd, J Kuck

  • 1Department of Psychiatry, University of California, San Diego, USA.

The Journal of Clinical Psychiatry
|October 1, 1995
PubMed
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Command hallucinations in schizophrenia patients are common, often violent, and may be underreported. While generally not impacting outcomes, suicidal command hallucinations warrant serious clinical attention, especially in those with prior suicide attempts.

Area of Science:

  • Psychiatry
  • Clinical Psychology

Background:

  • Command hallucinations are a symptom of schizophrenia that may increase clinical monitoring due to perceived risks of violent behavior.
  • The clinical relevance of command hallucinations in stable outpatient schizophrenia samples remains unclear.

Purpose of the Study:

  • To investigate the prevalence and clinical significance of command hallucinations in outpatients with schizophrenia.

Main Methods:

  • A retrospective chart review of 106 patients with schizophrenia participating in outpatient research at UC San Diego.
  • Data collection included clinical characteristics and the presence of command hallucinations.

Main Results:

  • Command hallucinations were reported by 50% of patients with auditory hallucinations, frequently with violent content.

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  • Over one-third of command hallucinations were not documented in clinical charts but discovered through secondary review.
  • Patients with command hallucinations did not significantly differ on prognostic or clinical course variables, except for two suicides among this group.

    • Conclusions:

    • Command hallucinations may be more prevalent than typically recognized by clinicians.
    • In most cases, command hallucinations have minimal impact on schizophrenia outcomes.
    • Suicidal command hallucinations in outpatients with a history of suicide attempts require serious clinical consideration.