Command auditory verbal hallucinations in a culturally diverse early intervention in psychosis service: Prevalence, clinical associations and phenomenology.
Elisavet Pappa, Ching So, Jennifer McGowan, Gabrielle Ng, Alysia Sweeney, Athina Servi, Charmayne Tsz Wing Lau, Rozhina Modaresi, Angel Yee Fong Au, Zuri Zhang, Simran Seera, Monica Huerga-Malillos, Ben Gaughan, Amber Gill, Emily Hickson, Anjeza Koruni, Amber Nomani, Harriet Allen, Hollie Edwards, Jacob Barnett, Faaizah Islam, Jonathan Souray, Vaughan Bell, David Raune
Schizophrenia Research October 8, 2026 DOI: 10.1016/j.schres.2026.09.042 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective content analysis of medical records Peer reviewed |
|---|---|
| Sample size | 740 |
| Population | Culturally diverse first-episode psychosis patients with auditory verbal hallucinations in an early intervention in psychosis service |
| Topics | Philosophy of mind |
| Keywords | Early course psychosis First episode psychosis Quality improvement Service evaluation |
| Key points | Command auditory verbal hallucinations were present in 51.4% of first-episode psychosis patients with auditory hallucinations, and 75.0% of these commands involved harmful or life-threatening content, most often physical harm toward the self. Nearly one-third (32.1%) complied with commands; compliance was associated with supernatural or unfamiliar voices and commands directed at relationally close recipients, and harmful commands predicted compliance, particularly harm in the social sphere. |
Abstract
Command auditory verbal hallucinations (CAVH) are a subtype of auditory hallucinations perceived as instructing the hearer to perform specific actions, carrying an elevated risk of harm due to potential compliance with harmful behaviours. Despite the risk, the prevalence, clinical associations and content of CAVH in first episode psychosis (FEP) remain largely underexplored, leaving important gaps in risk assessment and early intervention during this critical illness phase. We conducted a retrospective content analysis of medical records from 740 culturally diverse FEP patients with AVH in an early intervention in psychosis service. Prevalence estimates were calculated for phenomenological predictors of CAVH and compliance, and logistic regression analyses were conducted to examine associations with clinical and demographic factors. Over half of patients (51.4%, N = 380) experienced CAVH, of which 75.0% (N = 285) involved harmful and/or life-threatening content, most commonly physical harm directed toward the self, but also others. Nearly one-third (32.1%) complied with commands. Compliance was associated with several phenomenological features, including supernatural or unfamiliar voices and commands directed toward relationally proximal recipients (e.g., family members), and occurred across bodily, psychological, and social domains. Harmful and/or life-threatening commands significantly predicted compliance, particularly when harm targeted the social sphere. Longer illness duration significantly predicted the presence of CAVH. Findings suggest that CAVH are prevalent and clinically important in FEP, and that incorporating phenomenological predictors can inform compliance prediction. Detailed assessment of CAVH characteristics, combined with personalized early intervention and safeguarding, may help reduce the risk of harmful outcomes.
Comparable studies
Other observational and cohort studies on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The phenomenology of near-death experiences Subjects who reported near-death experiences | 1980 | Retrospective study | n = 78 |
| Visual Phenomenology of the LSD Flashback Persons with a history of LSD use | 1983 | Observational cohort | n = 123 |
| The neurophenomenology of neutral hypnosis. Individuals of high, medium, and low hypnotizability | 2013 | Observational cohort | n = 37 |
| The Phenomenology of Acute Organic Psychosis Patients with acute organic psychosis and acute schizophrenics | 1987 | Observational cohort | n = 148 |
| EEG oscillatory states as neuro-phenomenology of consciousness as revealed from patients in vegetative and minimally conscious states. Brain-damaged patients with disorders of consciousness and healthy-conscious subjects | 2012 | Observational cohort |
Citations in the library
Cites 5
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- Understanding auditory verbal hallucinations: a systematic review of current evidence. Acta Psychiatrica Scandinavica May 2016
- A new phenomenological survey of auditory hallucinations: evidence for subtypes and implications for theory and practice. Schizophrenia Bulletin January 2014
- Childhood trauma and auditory verbal hallucinations. Psychological Medicine December 2012