Interpretation of the resolution of hallucinations in a patient with chronic schizophrenia – case report

Aim. This case report is an analysis of the resolution of psychotic symptoms in the context of the theory of psychosis as a state of aberrant salience. According to the theory, both the formation and treatment of psychotic symptoms can be considered in two interconnected dimensions: the neurobiological perspective of dopamine hyperactivity and the subjective perspective of excessive salience. Method. The case of a patient with chronic schizophrenia, experiencing predominantly auditory hallucinations, is described in this article. The patient has wilfully changed the doses of prescribed medications several times. He then interpreted the presence and disappearance of his hallucinations; he interpreted the “voices” he heard in psychosis as the expression of his being in contact with his “spouse”. Any changes in the intensity of his hallucinations, resulting from the modifications in the treatment, the patient interpreted as the expression of the proximity or remoteness of his “spouse” who, according to him, was with him when he heard the “voices” or in heaven when he no longer heard them. Results. The appearance, resolution and changes in the intensity of the hallucinations experienced by the patient are accompanied by the psychological interpretation of these subjectively perceived changes. Conclusions. The interpretations that appear after the resolution of active symptoms of psychosis may be bizarre and improbable, but they are cognitive explanations rather than psychotic delusions.