A dimensional approach to the phantom vibration and ringing syndrome during medical internship

Abstract

Phantom vibrations and ringing of mobile phones are prevalent hallucinations in the general population. They might be considered as a “normal” brain mechanism. The aim of this study was to determine if a dimensional approach to identify individuals suffering from these hallucinations was more important than a categorical approach. A prospective longitudinal study of 74 medical interns (male: 46, mean age: 24.8 ± 1.2) was carried out using repeated investigations of the severity of phantom vibrations and ringing, as well as accompanying symptoms of anxiety and depression as measured by Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) before, at the 3rd, 6th, and 12th month during internship, and 2 weeks after internship. We utilized the cognitive and somatic subscales of the BDI, as well as the subjective, somatic and panic subscales of the BAI. The correlation between phantom vibration and ringing was lowest before the internship but became moderate during the internship and high 2 weeks after it. Compared to interns with subclinical phantom ringing and vibrations, interns with severe phantom vibrations and ringing had higher subjective and somatic anxiety and somatic depressive scores at any time point throughout the internship. Only interns with severe phantom ringing had more cognitive/affective depression. A dimensional approach to the phantom vibration and ringing syndrome is a powerful way to identify their correlation, as well as their association with anxiety and depression.

Introduction

Phantom vibrations and ringing of a mobile phone might be two of the most prevalent hallucinations in the general population. The only previous cross sectional study estimated that 68% of a medical staff had had that experience (Rothberg et al., 2010). Our previous longitudinal survey of medical interns also showed that the baseline prevalence rate of phantom vibration was 78.1% before internship, and it significantly increased to 95.9% and 93.2% at the 3rd and 6th months of internship, respectively. The baseline prevalence rate of phantom ringing was 27.4%, and it significantly increased to 84.9–87.7% during internship. Because of the high prevalence of phantom vibrations and ringing, they might be considered as a “normal” brain mechanism. Furthermore, 93% medical staff who experienced phantom vibrations reported the sensation to be not at all or only a little bothersome. However, the other 7% reported it to be bothersome or very bothersome in the pilot study (Rothberg et al., 2010); therefore we postulate a dimensional approach to identify individuals suffering from these hallucinations is more important than a categorical approach.

In using the current categorical approach to diagnosis of the Diagnostic and Statistical Manual of Mental Illness (DSM-IV), clinicians must decide only whether a patient meets the diagnostic criteria set forth for a disorder and diagnose the disorder as present or absent. This categorical approach to the diagnostic threshold constricts the range of clinical information that may be of great importance to treatment planning, prognosis, and monitoring treatment outcomes. Advantages to the incorporation of a dimensional assessment strategy are promoted in the incoming DSM-5. A dimensional approach to psychiatric diagnosis provides clinicians with more information, and, with standardized dimensional rating scales, gives patient self-reports a greater role in the clinical process (Narrow and Kuhl, 2011).

The specific aims of the present prospective longitudinal study were: (1) to use a dimensional approach to investigate the correlation between phantom vibrations and ringing at different time points throughout the internship and (2) to determine whether the severity of phantom vibrations and ringing was associated with interns' symptoms of anxiety and depression.