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General information
Audible thoughts, also called thought sonorisation, is a kind of auditory verbal hallucination. People with this hallucination constantly hear a voice narrating one's own thoughts out loud. This idea was first defined by Kurt Schneider, who included this symptom as one of the“first-rank symptoms”in diagnosing schizophrenia. Although the diagnostic reliability of“first-rank symptoms”has long been questioned, this idea remains important for its historical and descriptive value in psychiatry. Audible thoughts is a positive symptom of schizophrenia according to DSM-5. However, this hallucination is not exclusively found among schizophrenics, but also among patients of bipolar disorder in their manic phase.

Types
Patients who experience audible thought will hear the voice repeating their own thoughts either as or after the thought comes into their minds. The first kind of audible thought, the voice and the thought appear simultaneously, was named by German psychiatry August Cramer as Gedankenlautwerden, a German word stands for“thoughts become aloud".

Example of Gedankenlautwerden:

''A 35-year-old painter heard a quiet voice with an‘Oxford accent'. The volume was slightly lower than that of normal conversation and could be heard equally well with either ear. The voice would say,‘I can't stand that man, the way he holds his brush he looks like a poof.' He immediately experienced whatever the voice was saying as his own thoughts, to the exclusion of all other thoughts.''

And the second kind which the voice comes after the thought appears is called echo de la pensée in French, namely thought echo.

Example of thought echo:

''A 32-year-old housewife complained of a man's voice. The voice would repeat almost all the patient's goal-directed thinking, even banalest thoughts. The patient would think‘I must put the kettle on', and after a pause of not more than one second the voice would say‘I must put the kettle on'.''

If categorized by patients' subjective feelings about where the voices come from, audible thoughts can be either external or internal. Patients report an internal origin of the hallucination claim that the voices are coming from somewhere inside their body, mainly in their own heads, while those report an external origin feel the voice as coming from the environment. The external origins vary in the patients' description: some hear the voice in front of their ears, some attribute the ambient surrounding noise, like running water or wind, as the source. This sometimes influences patients behaviours as they believe people around them can also hear these audible thoughts, therefore they may avoid social events and public places to prevent others from hearing their thoughts. Besides, study suggests that the locus of the voice may change as the patients' hallucination develop. There’s a trend of internalization of external perceptions, which means patients will locate the source of their hallucination from external objects to internal subjectivity over time.

Phenomenological study
According to the study conducted by Tony Nayani and Anthony David in 1996, about half of the patients(46%) who suffered audible thoughts claimed that the hallucination has somehow taken the place of their conscience in making decisions and judgement. They tend to follow the voice’s instruction when confronting dilemmas in their daily lives. The study also suggests that majority of the patients, both male and female, label the sounds they heard as male voices. However, younger patients tend to hear younger voices, which suggests that the voices in the hallucination may share age with the patients but not gender. What’s more, voices in the hallucination usually differ from the patients' own voices in accents. They reported the voices they heard as coming from different regions or social classes with them.

Some patients may develop skills to control their hallucination to a certain extent by some kind of cognitive focusing. They can’t completely eliminate the voices, but through cognitive focusing or suggestive behaviours (e.g. swallowing), they can control the onset and offset of their hallucination.

Pathophysiology
Studies have suggested that damage to specific brain area may relate to the formation of audible thought. Patients who attribute the hallucination to an external locus are more likely to report the voice coming from the right. This unilateral characteristic can be explained by either contralateral temporal lobe disease or ipsilateral ear disease. Researchers also came up with hypotheses that audible thought may result from damage in the right hemisphere, which causes the malfunction of prosodic construction. If this happens, the left hemisphere may misinterpret the patients' own thoughts as alien, leading the patients to misconceive their thoughts as coming from another voice.