During a consultation, your doctor will use various techniques in his assesment of the symptom: Hearing voices. These may include a physical examination or other medical tests. Your doctor may ask several questions when assessing your condition. It is important to remember that your consultation is a two-way process and any extra information you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
Why: to determine if acute or chronic.
Why: may help to determine if content is depressive, grandiose, appropriate for the person's mood e.g. in manic states the content may be grandiose, such as a voice telling the person that they have special powers; whereas in depressive disorders the content is likely to be abusive and consistent with the state of low self esteem. Voices heard in schizophrenia may include two or more people discussing that person or arguing about him in the third person or voices that form a running commentary on that person's behavior or voices that make obscene, threatening, or highly critical comments.
Why: this is called "thought echo" and may occur in schizophrenia.
Why: Delirium is an acute confusional state due to many causes e.g. infection, drug intoxication, alcohol withdrawal, liver failure, kidney failure, hypoxia (reduced oxygen levels in the blood), low blood sugar, stroke, heart attack or head injury. If the onset is chronic a diagnosis of psychiatric illness or dementia may be more likely.
Why: e.g. visual hallucinations (seeing), tactile hallucinations (touch), olfactory hallucinations (smell) or gustatory hallucinations (taste) . These types of hallucinations most commonly occur in organic mental disorders such as delirium or dementia rather than schizophrenia, bipolar disorder or psychotic depression.
Why: this would suggest an organic cause such as delirium, epilepsy or brain tumor.
Why: this is the type of hallucination most commonly associated with schizophrenia but may be associated with bipolar affective disorder, dementia or delirium, and their content tends to be related to the nature of the disorder.
Why: if hallucinations occur in episodes with normal behavior in between, one should consider epilepsy or narcolepsy.
Why: these type of hallucinations are called "hypnogogic" and are common in narcolepsy but may also be seen in normal people.
Why: e.g. hallucinations and other symptoms that are worse in the late afternoon and at night are typical of delirium.
Why: e.g. physical illness, recent surgery, starting a different medication, abstaining from alcohol, tragic event, emotional shock.
Why: e.g. schizophrenia, bipolar affective disorder, paranoid disorder, schizotypal personality disorder, schizoid personality disorder- may be sometimes difficult to differentiate between delirium and these disorders if delusions and hallucinations are present.
Why: certain medications may cause intoxication e.g. anticonvulsants, anticholinergics, antihistamines, antidepressants, anti-anxiety medications, opiates; or may cause delirium on drug withdrawal.
Why: e.g. Alzheimer's disease, Huntington's disease, multiple sclerosis, stroke, heart attack, schizophrenia, bipolar affective disorder and depression, lupus erythematosus, epilepsy.
Why: to assess chance of alcohol withdrawal, delirium tremens, alcohol abuse, alcohol poisoning, Korsakoff's psychosis as the cause of hallucinations. Hallucinations are common during alcohol withdrawal.
Why: amphetamine, marijuana, cocaine, LSD, PCP may cause delirium and may also precipitate acute psychosis.
Sometimes, other symptoms may be present and may help your doctor analyse your condition. These may include:
Why: e.g. delusions, hallucinations and disordered thinking - may suggest schizophrenia or bipolar disorder but these symptoms may also be present with delirium, dementia and severe depression.
Why: may be present in schizophrenia, bipolar affective disorder, psychotic depression, paranoid delusional disorder, paranoid personality disorder, schizotypal personality disorder, brain damage, abuse of stimulant of hallucinogenic drugs, dementia and cultural isolation.
Why: e.g. depressed mood, crying spells, anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping (usually early morning waking), fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt. Severe psychotic depression may feature auditory hallucinations.
Why: e.g. episodes of depression (often psychotic in intensity) and at other times episodes of psychotic excitement (mania or hypomania). Symptoms of psychotic excitement may include elevation of mood, increased activity, grandiose ideas, irritability, disinhibition (which affects social, sexual and financial behavior), rapid speech and racing thought, delusions (persecutory or grandiose) and sometimes hallucinations.
Why: e.g. impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. People with dementia may also have psychiatric symptoms such as delusions, paranoid ideas, hallucinations, mood disturbance and behavioral disturbance.
Why: e.g. impaired conscious level with onset over hours or days, disorientation in time and/or place, unusually quite, drowsy, agitated, delusions, auditory hallucinations, visual hallucinations.
Why: can suggest any infection that may cause delirium or meningitis, encephalitis, brain abscess or brain hemorrhage.
Why: may suggest brain cancer, acute stroke or migraine.
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