Persistent auditory hallucinations that are unresponsive to antipsychotic drugs.

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. These are the most common forms of hallucinations (1). Auditory hallucinations are found most often in patients with schizophrenia, with a prevalence of 75% in that population (2). 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 have been estimated to occur in 10%–15% of those without neuropsychiatric illness (3). 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). Many historical figures, from Socrates and Caesar to Descartes and Joan of Arc, have been reported to “hear voices” (5). 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. This article recounts the treatment course of a patient with new-onset 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.