![]() He stated that he had recently been put on the FBI’s list of child sexual predators. He also expressed the fear that he was being set up to look like he had committed suicide. The voices had been keeping him awake at night. A said they were inside his head and could complete his thoughts. ![]() The voices had been worsening at the time of his presentation, Mr. However, 3 weeks earlier, he had begun hearing voices outside of his head. A stated he had been treated for depression for about 9 months with immediate-release bupropion (100 mg b.i.d.), which he described as helpful. He said he could hear the FBI coming after him because he was a sexual predator. A,” a 52-year-old man, was brought to the emergency department by his family because of worsening paranoia and auditory hallucinations. To highlight the importance of taking a thorough history, we present the relevant data longitudinally, in the same manner in which it was obtained. This article recounts the treatment course of a patient with new-onset auditory hallucinations. Although the meaning, significance, and etiology of these voices depend on their context, auditory hallucinations are most often a symptom of severe, disabling psychiatric or neurological illness. Many historical figures, from Socrates and Caesar to Descartes and Joan of Arc, have been reported to “hear voices” (5). Auditory hallucinations have been linked to left-brain alterations in imaging studies, more specifically Broca’s area, the anterior cingulate, the superior temporal lobe, and the primary auditory cortex (4). ![]() Auditory hallucinations have been estimated to occur in 10%–15% of those without neuropsychiatric illness (3). ![]() However, auditory hallucinations have been described in conjunction with many life circumstances and diseases, including religious phenomena, bereavement, drug intoxication, sensory deprivation, and near-death experiences, as well as psychiatric or neurological disorders. Auditory hallucinations are found most often in patients with schizophrenia, with a prevalence of 75% in that population (2). These are the most common forms of hallucinations (1). According to DSM-IV-TR, a hallucination is “a sensory perception that has a compelling sense of reality of a true perception, but occurs without external stimulation of the relevant sensory organ.” Thus, an auditory hallucination is a false perception of sound. ![]()
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