A diferença no reconhecimento auditivo (voz humana) entre pacientes com duplo diagnóstico (esquizofrenia e dependência química), dependentes químicos, esquizofrênicos e população não clínica (médiuns)

Abstract

Introduction: Cases with double diagnosis have proved to be a major challenge in clinical practice, especially for differential diagnosis. The main objective of this study was to investigate the ability of auditory recognition in clinical (chemical, schizophrenic and double-diagnosed) and non-clinical (medium) patients with auditory hallucination, as well as the possible neuropsychological characteristics that differentiate the groups and their similarities and differences concerning auditory hallucination. Method: A total of 128 subjects [28 participants diagnosed with DSM-IV psychoactive substance abuse who had auditory hallucinations participated in the main study; 8 participants diagnosed with psychoactive substance abuse who had no auditory hallucinations; 25 participants with the diagnosis of schizophrenia; 21 participants with double diagnosis, i.e. cases in which the differential diagnosis between schizophrenia and psychoactive substance abuse was not possible; 20 mentally healthy mediums who had auditory hallucination (listening to immaterial beings) and 26 healthy individuals (controls). A pilot study was conducted, divided into 3 phases. The first phase was based on hearing stimulation, in which 60 healthy participants evaluated familiarity and concreteness levels of 984 words. Later 210 words were selected, recorded in audio form, and tested with 30 people distributed in 3 groups (chemical, schizophrenic and control group). The third phase of the pilot study selected 48 words also tested with the same groups as the previous phase. Participants were screened through aspects of their mental health and psychoactive substance use. Subsequently, a clinical (SCID, PANSS, O-LIFE-R, SDS) and neuropsychological (MoCA, Rey Figures, Trail Test, PSYRATS) evaluation were performed. At the end of the evaluations, the participants were invited to carry out the experimental paradigm. This paradigm was performed with the aid of a computer in which participants heard 48 words immersed in 12 noise levels divided into 4 trials. Participants were asked to press a mouse button each time they could distinguish a word from the noise. To test the differences between the groups regarding clinical scales, neuropsychological tests and hearing recognition, ANOVAS (p = 0.001) were used. Results: Regarding clinical evaluation, PANSS proved to be an important instrument to differentiate participants, especially with respect hallucinatory behavior (p = 0.001). Regarding the neuropsychological assessment, there was no significant difference between the clinical groups, but there was a significant difference between the clinical group and mediums and controls regarding the attention aspect. In the experimental paradigm, there was a significant difference between all groups regarding the proportion of correct answers (p = 0.026), false alarm rate (p = 0.024) and sensitivity (p = 0.001). In particular, the mediums presented higher discriminability score with respect to the sensitivity criterion, that is, the participant's characteristic of distinguishing the auditory stimulus. Conclusion: The content and severity of hallucinations and delusions are an important bias to differentiate clinical groups. Further longitudinal and cross-sectional studies associated with other auditory paradigms and neuroimaging tools are needed to further investigate differentiation between clinical groups.