COMMAND HALLUCINATIONS IN OUTPATIENTS WITH SCHIZOPHRENIA

Background: The presence of command hallucinations in individuals with schizophrenia may result in an increase in clinical monitoring to red uce the perceived risk of violent behavior. However, the issue of whet her command hallucinations hold any clinical relevance in relatively s table outpatient samples has not been established. Method: The clinica l and research records of individuals with schizophrenia who participa ted in outpatient research protocols at the University of California, San Diego were reviewed for the presence of command hallucinations. In formation on clinical characteristics was collected in a detailed char t review from 106 patient records. Results: Command hallucinations wer e reported by one half of all patients with auditory hallucinations, a nd these hallucinations often were violent in content. Yet, in over a third of the patients, these hallucinations had not been documented in their clinical charts, but instead were uncovered during a secondary source review. Patients with command hallucinations generally did not differ on prognostic or clinical course variables. However, the 2 pati ents who committed suicide during the study were patients with command hallucinations. Conclusion: Although command hallucinations may be mo re frequent than clinicians generally note, in most cases they have mi nimal influence on the outcome of schizophrenia. However, in outpatien ts with schizophrenia who have a history of suicide attempts, suicidal command hallucinations should be taken seriously.