New study of auditory hallucinations in people who have bipolar disorder

Bipolar disorder (BD) is a mental health condition that affects approximately two per cent of the population. While many recognize it as a condition characterized by “high” and “low” mood swings, BD symptoms can also include auditory hallucinations. In fact, up to 25 per cent of people who have BD experience auditory hallucinations at some point during their illness. 

Dr. Natalia Jaworska
Dr. Natalia Jaworska, an early-career scientist at the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal.

A better understanding of BD and auditory hallucinations is the focus of a new Canadian Institutes of Health Research (CIHR) funded study co-led by Dr. Natalia Jaworska, an early-career scientist at the University of Ottawa Institute of Mental Health Research (IMHR) at The Royal.

The study will be among the first to examine brain features of people with BD who do versus do not have auditory hallucinations. 

Auditory hallucinations can be scary and confusing, involving sounds and voices of varying intensity that no one else hears, but often feel very real to the person experiencing them. 

Auditory hallucinations also occur in other mental health conditions such as schizophrenia. While there is research on the effects of hallucinations in schizophrenia, they are poorly understood in BD. 

It is believed that people who hear voices might have differences in their brain in regions involved with sound and linguistic processing, but a deeper understanding is needed. What is known, however, is that people who have auditory hallucinations – regardless of diagnosis – struggle with daily living and are less likely to recover. 

Jaworska and her team, including her main collaborator Dr. Derek Fisher in Halifax,  will use electroencephalography (EEG) – or brain electrical activity – brain imaging, and participant interviews and questionnaires to measure the impact of auditory hallucinations in BD on functioning, quality of life and suicide risk. Jaworska also hopes to “categorize” voices heard by people who have BD (for example, looking at frequency, intensity, and negative content). 

“Even though we have data showing that up to 25 per cent of individuals with bipolar disorder experience voices during their illness, we don't really know much about them,” says Jaworska.

Some previous work suggests they might not be as intrusive or debilitating, or simply different in nature, as what is typically observed in people who have schizophrenia.

A better understanding of auditory hallucinations from a biological perspective would improve treatment in the future, ultimately improving the lives of people living with BD.

“Whenever you can learn more about the neurobiology or the mechanisms of a symptom, then you can think about how to better manage that symptom,” says Jaworska.

While this particular study is an initial step within a broader scope of research, Jaworska believes a deeper exploration of auditory hallucinations could lead to non-pharmacological treatments as well as “exponential improvement” in other areas for people who hear voices. 

“By informing ourselves on what happens to the brain, we could develop more creative and targeted add-on therapeutic tools that specifically focus on those auditory hallucinations and can, in turn, improve symptoms, not just with respect to auditory hallucinations but other mental health conditions such as depression and anxiety as well.”