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PubMed1997

Musical hallucinations and musical imagery: prevalence and phenomenology in schizophrenic inpatients.

The discussion of auditory hallucinations in schizophrenia has traditionally focused on verbal auditory hallucinations, or 'voices'. Little attention, on the other hand, has been given to the phenomenon of musical hallucinations. In an effort to characterize the prevalence and phenomenology of musical hallucinations, 100 consecutive schizophrenic inpatients were examined for the presence of musical hallucinations and musical imagery. Sixteen patients responded positively, and were engaged in a more thorough interview. They were then divided into two groups: those with musical hallucinations, and those experiencing musical imagery. This determination was made based on the absence or presence, respectively, of volitional control, hypothesizing that lack of volitional control implies a true hallucinatory experience. When lack of volitional control was compared to the various other aspects of the experience, an association with religious content was demonstrated. Religious musical hallucinations also tended to be experienced as distressing, further supporting the hypothesis that the experience was hallucinatory rather than a product of volitional imagery. A selection of sample case vignettes is presented as well.

Adult↗
PubMed1994

Dichotic listening during auditory hallucinations in patients with schizophrenia.

OBJECTIVE: Auditory hallucinations are a serious problem for a large subgroup of psychotic patients who do not respond optimally to neuroleptic medication. It has been hypothesized that hearing imaginary voices involves the same physiological processes as those involved in hearing real voices, but this hypothesis has not been conclusively confirmed. METHOD: In this study a consonant-vowel version of the Dichotic Listening Test was used to assess the functional integration of the left hemisphere in hallucinating and nonhallucinating psychotic patients. The test was administered under three conditions: a nonforced attention condition, a condition in which attention was forced to the left ear, and one in which attention was forced to the right ear. RESULTS: The nonhallucinating patients showed the normal right ear advantage, which indicates a left hemisphere superiority in the processing of linguistic stimuli. In contrast, the hallucinating patients showed no ear advantage. Neither group was able to modify its performance when instructed to attend to either the left or the right ear. A subgroup of patients was tested in both hallucinating and nonhallucinating states, but the ear asymmetry was not noticeably different between these states. CONCLUSIONS: The results suggest that auditory hallucinations are associated with abnormalities in left hemisphere functioning and that these abnormalities might not be limited to the time of the auditory hallucinations. It is hypothesized that a relatively enduring left hemisphere abnormality may leave some patients at risk for auditory hallucinations.

Adult↗
PubMed2000

Central auditory processing in patients with auditory hallucinations.

OBJECTIVE: Data from a full assessment of auditory perception in patients with schizophrenia were used to investigate whether auditory hallucinations are associated with abnormality of central auditory processing. METHOD: Three groups of subjects participated in auditory assessments: 22 patients with psychosis and a recent history of auditory hallucinations, 16 patients with psychosis but no history of auditory hallucinations, and 22 normal subjects. Nine auditory assessments, including auditory brainstem response, monotic and dichotic speech perception tests, and nonspeech perceptual tests, were performed. Statistical analyses for group differences were performed using analysis of variance and Kruskal-Wallis tests. The results of individual patients with test scores in the severely abnormal range (more than three standard deviations from the mean for the normal subjects) were examined for patterns that suggested sites of dysfunction in the central auditory system. RESULTS: The results showed significant individual variability among the subjects in both patient groups. There were no group differences on tests that are sensitive to low brainstem function. Both patient groups performed poorly in tests that are sensitive to cortical or high brainstem function, and hallucinating patients differed from nonhallucinating patients in scores on tests of filtered speech perception and response bias patterns on dichotic speech tests. Six patients in the hallucinating group had scores in the severely abnormal range on more than one test. CONCLUSIONS: Hallucinations may be associated with auditory dysfunction in the right hemisphere or in the interhemispheric pathways. However, comparison of results for the patient groups suggests that the deficits seen in hallucinating patients may represent a greater degree of the same types of deficits seen in nonhallucinating patients.

Adult↗
PubMed2003

Auditory hallucinations in schizophrenic and affective disorder Nigerian patients: phenomenological comparison.

Although auditory hallucinations are universal phenomena, they show cultural and ethnic variation. We set out to study some differences between auditory hallucinations in Nigerian patients and their foreign counterparts. We also investigated the usefulness of auditory hallucinations in distinguishing between schizophrenia and affective disorders. A semi-structured interview was used to obtain information from 89 patients with auditory hallucinations who met ICD-10 criteria for either schizophrenia or affective psychoses and 10 others with organic mental disorders. Responses were compared with respect to the frequency, form and content of the hallucinatory voices as well as the languages spoken. In this sample, voices speaking exclusively in a foreign language were uncommon. Voices commanding and those discussing patients in the third person were the commonest in schizophrenic patients but not as frequent as in a similar group of patients in the UK studied by other authors. In patients with schizophrenia, voices were more likely to discuss the patient, whereas in affective disorders, voices were more likely to evoke fear, and patients were more likely to carry out commands. In conclusion, only three features of auditory hallucinations distinguished between schizophrenic and affective psychoses patients. Auditory hallucinations may be less harassing in Nigerian schizophrenic patients than in their UK counterparts. These hallucinations are most often perceived in the individual's mother tongue, with or without additional use of English, even when the patients have been 'westernized' through education and religion.

Adolescent↗
PubMed1995

A pilot study of exposure control of chronic auditory hallucinations in schizophrenia.

BACKGROUND: Many patients complain less of their auditory hallucinations per se than of lack of control of the experiences. There is reason to believe that a non-distraction (exposure) approach could help patients gain more control over persistent auditory hallucinations and teach them that their experience is a form of thinking and has no external source. This study is a pilot test of that idea. METHOD: Five DSM-III-R schizophrenic outpatients with medication-resistant auditory hallucinations improved with a mean of 31 hour-long sessions over 3 months of therapist-guided exposure to their hallucinations and situations likely to evoke them. RESULTS: Improvement was greatest in patients' anxiety and sense of control over their hallucinations, less in social use of leisure and hallucinating time. CONCLUSIONS: These mildly encouraging pilot results warrant a controlled study of exposure for drug-resistant chronic auditory hallucinations and other psychotic experiences which are associated with anxious avoidance.

Anxiety↗
PubMed1996

Hypnagogic and hypnopompic hallucinations: pathological phenomena?

BACKGROUND: Hypnagogic and hypnopompic hallucinations are common in narcolepsy. However, the prevalence of these phenomena in the general population is uncertain. METHOD: A representative community sample of 4972 people in the UK, aged 15-100, was interviewed by telephone (79.6% of those contacted). Interviews were performed by lay interviewers using a computerised system that guided the interviewer through the interview process. RESULTS: Thirty-seven per cent of the sample reported experiencing hypnagogic hallucinations and 12.5% reported hypnopompic hallucinations. Both types of hallucinations were significantly more common among subjects with symptoms of insomnia, excessive daytime sleepiness or mental disorders. According to this study, the prevalence of narcolepsy in the UK is 0.04%. CONCLUSIONS: Hypnagogic and hypnopompic hallucinations were much more common than expected, with a prevalence that far exceeds that which can be explained by the association with narcolepsy. Hypnopompic hallucinations may be a better indicator of narcolepsy than hypnagogic hallucinations in subjects reporting excessive daytime sleepiness.

Adolescent↗
PubMed1998

Hallucinations.

Hallucinations, sensory perceptions without environmental stimuli, occur as simple experiences of auditory, gustatory, olfactory, tactile, or visual phenomena as well as mixed- or complex experiences of more than one simple phenomenon. The nature of the hallucination assists localization, differential diagnosis, and treatment planning. In particular, the presence of persistent visual hallucinations of persons with Parkinson's disease predicts dementia, rapid deterioration, permanent nursing home placement, and death. Hallucinations in persons with Alzheimer's disease are often associated with serious behavioral problems and predict a rapid cognitive decline. Theories of the etiology of hallucinations include (1) stimulation, e.g., neurochemical, electrical, seizure, and ephaptic, and (2) inhibition, e.g., destruction of normally inhibitory functions, resulting in disinhibition as in the Charles Bonnet and phantom limb syndromes. Functional neuroimaging procedures suggest anatomical associations for hallucinations. While hallucinations may be a symptom of medical, neurologic, and psychiatric disorders, they may also occur in a wide range of human experiences.

Hallucinations↗
PubMed1981

Neuropsychological correlates of auditory and visual hallucinations.

Investigations of possible mechanisms underlying hallucinations have indicated that abnormal excitation of brain tissue and abnormal regulation of cognitive activity may contribute to hallucinations. The cognitive control deficits in auditory hallucinations are in some ways similar to those in persons with damage to the frontal lobes of the brain. An examination of the Luria-Nebraska Neuropsychological Battery performance of 10 psychiatric patients with auditory hallucinations, 10 patients with visual hallucinations and 20 patients with no hallucinations showed evidence of general cognitive impairment with a left frontal focus in the auditory group and no evidence of neuropsychological impairment in the visual group. Both self-awareness and control of internal speech involve left frontal mediation and the possible contribution of deficiencies in these functions to the appearance of auditory hallucinations is discussed.

Adult↗
PubMed1998

Zolpidem-associated hallucinations and serotonin reuptake inhibition: a possible interaction.

BACKGROUND: Zolpidem (Ambien) is a sedative believed to act exclusively at the benzodiazepine omega 1 receptor. Sporadic case reports of zolpidem-associated hallucinations have appeared over the past 5 years, and over the past 2 years, the Washington Poison Center received five reports of prolonged visual hallucinations associated with zolpidem. CASE REPORTS: All five patients reported experiencing visual hallucinations lasting from 1-7 hours soon after taking zolpidem. Most had been taking zolpidem for less than a week and all five were concurrently taking an antidepressant: sertraline, desipramine, fluoxetine, bupropion, or venlafaxine; two sought assistance at a hospital. DISCUSSION: The precise mechanism of zolpidem-associated hallucinations remains unknown. In some previously published cases, the zolpidem-associated hallucinations have been short in duration, lasting at most 30 minutes. In contrast, the five patients in our series and in five previously reported cases, the hallucinations were more persistent, lasting up to 7 hours. Of these ten cases with persistent symptoms, nine were concurrently taking antidepressants that inhibit serotonin-reuptake, despite the fact that zolpidem has no known serotonin-mediated mechanisms. CONCLUSIONS: These cases, plus prior case reports, suggest that a pharmacodynamic interaction between serotonin reuptake inhibition and zolpidem may lead to prolonged zolpidem-associated hallucinations in susceptible individuals.

Adolescent↗
PubMedDate not supplied

The apolipoprotein E epsilon 4 allele increases the risk of drug-induced hallucinations in Parkinson's disease.

To determine whether the apolipoprotein E (APOE) epsilon 4 allele is a risk factor of drug-induced hallucinations in nondemented patients with Parkinson's disease (PD), the proportions of patients with hallucinations in groups with and without the APOE epsilon 4 allele were compared with a chi 2 test. The contribution of the APOE epsilon 4 allele to the occurrence of hallucinations was further evaluated by means of logistic regression models, adjusting for potential prognostic variables. Thirteen (76%) of the 17 patients who had the epsilon 4 allele had visual hallucinations, compared with 20 (23%) of the 88 patients without the epsilon 4 allele (p < 0.0001; odds ratio = 11.05; 95% CI 3.24-37.67). In addition, treatment with dopamine agonists also contributed to an increased risk of hallucinations (p = 0.0011). After adjustment for age, severity of parkinsonism, duration of treatment, dose of levodopa, and treatment with dopamine agonists, the association between the presence of the epsilon 4 allele and the occurrence of visual hallucinations remained significant (p = 0.0003). Nondemented PD patients with the APOE epsilon 4 allele have a high risk of developing drug-induced visual hallucinations. Further studies are needed to evaluate which proportion of these patients will end up developing dementia.

Aged↗
PubMed1980

[Negative hallucination, denial of reality and scotomization].

In this paper, the authors intended to outline the history of three psychiatric and psycho-analytical concepts (negative hallucination, disavowal and scotomisation) and to analyse the psychic processes that they stand for. Historical study: Bernheim coined the expression negative hallucination in 1884. Freud used it from 1895 until 1917 when he discarded it. Freud put forward the concept of disavowal in 1914. In its wider meaning it is equivalent to negative hallucination. In its more specific meaning it designates the simultaneous acknowledgement and non-acknowledgement of a traumatic perception. Scotomisation, introduced by Pichon and Laforgue, is identical to negative hallucination. Freud and Laforgue had a long and polemical discussion about it. Psychological, metapsychological and psychopathological study: Only the concepts of negative hallucination and disavowal, in their more specific meaning, ought to be considered here. In their first phases, both processes are identical. The first phase is a "preliminary position", a conception of things, related to wishes and the pleasure principle. The second phase is marked by a stimulus which is unconsciously perceived as "unbearable". During the third phase, perception is suspended by various processes. It is with the fourth phase that the mechanisms differ. In the negative hallucination, the ego keeps the perception unconscious whereas in disavowal (in its specific meaning) it is split, one part acknowledges the perception, the other disavows it. The authors stress the importance of the negative hallucination and disavowal for psychopathology and psychoanalysis.

Denial, Psychological↗
PubMed1997

[Hallucination in opsoclonus-polymyoclonus syndrome].

Here we report 2 cases of opsoclonus-polymyoclonus syndrome (OPS) associated with viral encephalitis. They had sleep disturbance, and visual hallucination. Case 1 had auditory hallucination in addition, and case 2 had dreamlike behavior. Those hallucination, which were colorful and vivid, usually appeared at the bed time. Their hallucinations were similar to peduncular hallucinations and you may also call hypnagogic hallucinations, which are often seen in patients with narcolepsy. Dreamlike behavior is observed during REM sleep in patients with brainstem damage or sometimes in the healthy elderly people. The presence of sleep disturbance, hypnagogic hallucination, and dreamlike behavior suggests that there may be some relationship between OPS and REM sleep. Considering that REM sleep is suppressed by serotonergic projection of the dorsal raphe nucleus in addition to several reports about brainstem lesion with serotonergic abnormalities in this disorder, we considered that dysfunction of serotonergic neurons of the dorsal raphe nucleus might be related in the development of OPS.

Adolescent↗
PubMedDate not supplied

Auditory hallucinations: Insights and questions from neuroimaging.

INTRODUCTION: The human brain has the capacity to hallucinate but rarely, except in severe neuropsychiatric conditions such as schizophrenia, do they naturally predominate. The neural basis of auditory verbal hallucinations (AVHs) has been investigated using structural and functional neuroimaging techniques. So far, no studies have defined a model that explains why auditory hallucinations are perceived in the absence of an external stimulus. METHODS: A selective literature review was undertaken specifically to focus on: (1) clinical phenomenology; (2) putative brain systems involved in the pathogenesis of auditory hallucinations as suggested by neuroimaging studies; (3) contributions and weaknesses of the neuroimaging findings in potentially bridging the gap between the neuroscience and phenomenology. Throughout, an attempt was made to ask questions as much as to answer them. RESULTS: Functional domains implicated in the genesis of auditory verbal hallucinations include: (1) hearing and language; (2) "sense of reality", including externality of voices; (3) attention and salience; (4) emotional response; (5) memory; (6) volition and self-monitoring; (7) impulse control. Each of these domains can be mapped onto neural "systems" that comprise components that overlap with brain regions known to activate during the experience of auditory hallucinations. CONCLUSIONS: In the next phase of neuroimaging research into the pathogenesis of auditory hallucinations we need to examine component processes that lead to the patient's perception of them as real.

Journal Article↗
PubMed2005

Delusions and hallucinations are associated with worse outcome in Alzheimer disease.

BACKGROUND: Delusions and hallucinations are common in Alzheimer disease (AD) and there are conflicting reports regarding their ability to predict cognitive decline, functional decline, and institutionalization. According to all previous literature, they are not associated with mortality. OBJECTIVE: To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD. DESIGN, SETTING, AND PARTICIPANTS: A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors. MAIN OUTCOME MEASURES: Cognitive (Columbia MMSE score of < or =20/57 [approximate Folstein MMSE score of < or =10/30]), functional (Blessed Dementia Rating Scale [parts I and II] score of > or =10), institutionalization equivalent index, and death. RESULTS: During the full course of follow-up, 38% of patients reached the cognitive, 41% the functional, 54% the institutionalization, and 49% the mortality end point. Delusions were noted for 34% of patients at baseline and 70% at any evaluation. Their presence was associated with increased risk for cognitive (risk ratio [RR], 1.50; 95% confidence interval [CI], 1.07-2.08) and functional decline (RR, 1.41; 95% CI, 1.02-1.94). Hallucinations were present in 7% of patients at initial visit and in 33% at any visit. Their presence was associated with increased risk for cognitive decline (RR, 1.62; 95% CI, 1.06-2.47), functional decline (RR, 2.25; 95% CI, 1.54-2.27), institutionalization (RR, 1.60; 95% CI, 1.13-2.28), and death (RR, 1.49; 95% CI, 1.03-2.14). CONCLUSIONS: Delusions and hallucinations are very common in AD and predict cognitive and functional decline. Presence of hallucinations is also associated with institutionalization and mortality.

Aged↗
PubMed2006

Visual hallucinations during visual recovery after central retinal artery occlusion.

BACKGROUND: Charles Bonnet syndrome is characterized by complex, formed visual hallucinations that occur in patients without psychiatric disorders. To the best of our knowledge, it has not been described following central retinal artery occlusion. OBJECTIVE: To describe 2 patients who experienced formed visual hallucinations characteristic of Charles Bonnet syndrome after sudden, severe visual loss precipitated by central retinal artery occlusion. PATIENTS: Two patients, aged 77 and 63 years respectively, experienced sudden deterioration of vision following central retinal artery occlusion. Formed visual hallucinations occurred in patient 1 six days later and in patient 2 two days later. RESULTS: The hallucinations appeared both within and at the borders of the patients' residual intact visual fields. They occurred during periods when the patients experienced partial visual recovery associated with enlargement of their visual fields. The visual recovery and hallucinations both ceased at the same time. CONCLUSIONS: We propose that the hallucinations are likely the result of deafferentation and their occurrence during visual recovery suggests that they are a correlate of visual system plasticity.

Aged↗
PubMed2003

Prevalence and relationship to delusions and hallucinations of anxiety disorders in schizophrenia.

We investigated the prevalence of anxiety disorders in a sample of individuals with chronic schizophrenia, controlling for anxiety symptoms that may be related to delusions and hallucinations, and the possible differences in clinical variables between the groups. Individuals with a diagnosis of schizophrenia and able to give informed consent were recruited from the community. The Mini International Neuropsychiatric Interview (MINI) was administered to both confirm the DSM-IV diagnosis of schizophrenia and screen for comorbid anxiety disorders. If a comorbid anxiety disorder was found, its relation to the individual's delusions and hallucinations was examined. Clinical rating scales for schizophrenia were administered as well as rating scales for specific anxiety disorders where appropriate. Overall, anxiety disorders ranged from 0% [ for Post Traumatic Stress Disorder (PTSD)] to 26.7% [ for generalized anxiety disorder (GAD) and agoraphobia without panic] with lower rates when controlled for anxiety symptoms related to delusions and hallucinations. In investigating clinical variables, the cohort was initially divided into schizophrenics with no anxiety disorders and those with an anxiety disorder; with further analyses including schizophrenics with anxiety disorders related to delusions and hallucinations and those with anxiety disorders not related to delusions and hallucinations. The most consistent difference between all the groups was on the PANSS-G subscale. No significant differences were found on the remaining clinical variables. Comorbid anxiety disorders in schizophrenia can be related to the individual's delusions and hallucinations, though anxiety disorders can occur exclusive of these positive symptoms. Clinicians must be aware that this comorbidity exists in order to optimize an individual's treatment.

Adult↗
PubMed2004

Visual hallucination in Parkinson's disease with FDG PET.

To determine the characteristics of cerebral glucose metabolism in Parkinson's disease patients with visual hallucinations, group comparison studies using [18F]fluorodeoxyglucose positron emission tomography were performed. Nondemented Parkinson's disease patients in advanced stages were classified into two groups: (1) patients without visual hallucinations; (2) patients with visual hallucinations. Compared to patients without hallucinations, the relative regional cerebral glucose metabolic rate was greater in the frontal areas in patients with visual hallucinations, and the increase reached a significant level in the left superior frontal gyrus. Relative frontal hypermetabolism may be a feature of Parkinson's disease patients with visual hallucinations.

Aged↗
PubMed2005

Apolipoprotein E epsilon4 and catechol-O-methyltransferase alleles in autopsy-proven Parkinson's disease: relationship to dementia and hallucinations.

We determined whether apolipoprotein E epsilon4 (ApoE4) or catechol-O-methyltransferase (COMT) genotypes were associated with dementia, hallucinations, Alzheimer's disease pathological findings (AP), or cortical Lewy bodies (CLBs) in autopsy-confirmed cases of Parkinson's disease (PD). Outcomes were obtained from medical records. Pathology reports identified AP and CLBs. Brain tissue was genotyped. A total of 47 subjects (33 men, 14 women) had PD onset at 62.4 +/- 8.7 years of age and died at 77.8 +/- 5.6 years of age. Demented and hallucinating patients did not differ in age at onset (AO) of PD or age at death, or the proportion ApoE4+, AP+, or CLB+ compared to nondemented patients or non-hallucinating patients. ApoE4 and COMT (low metabolizer [LH], intermediate metabolizer [HL], or high metabolizer [HH]) did not influence AO, death, or dementia- or hallucination-free survival, based on age or duration of treatment. All seven subjects with AP were demented and had hallucinations. CLBs were associated with dementia but not hallucinations. In Cox regression models adjusting for AO and duration of treatment, increased risk of dementia was associated with male sex but not significantly with ApoE4; inclusion of AP in the model did not affect the results; COMT was not a risk factor for dementia. Psychosis risk was not associated with ApoE4, COMT, or sex. The observation that males have increased dementia risk and the trend for ApoE4 requires confirmation in larger prospective autopsy studies.

Age of Onset↗