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Auditory hallucinations are sounds heard without an external source. Most frequently, these are voices. They occur in a multitude of conditions: schizophrenia and other psychotic disorders, severe mood disorders with psychotic aspects, neurological diseases (Parkinson’s, dementias), hearing loss, and intoxication or withdrawal from substances. Hallucinated sounds are varied: single or several voices, dialogues, voices giving commands and commenting, music, and non-verbal sounds. Phenomenology matters: internal thoughts heard but attributed to an external source (thought insertion) are different from clear external voices. Has diagnostic consequences.

The examination includes a review of the patient's history (onset, content, frequency, impact), a mental status exam, a hearing examination, a substance use screen, and a safety risk assessment for self-harm or injury to others.

Management includes symptomatic strategies and treatment of the underlying cause: Antipsychotic medication in the presence of psychosis; optimisation of hearing aids for sensory loss; treatment of mood disorders or withdrawal; and evidence-based psychological interventions, such as cognitive-behavioural therapy for psychosis (CBTp), voice dialogue, and strategies for coping (distraction, reality-testing). Psychoeducation and social support are effective in reducing stigma and distress. In the case of persistent or serious hallucinations, urgent psychiatric referral is indicated. Individualised early treatment enhances functioning and minimises long-term disabilities.