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PubMed2006

Hypoperfusion of the visual pathway in parkinsonian patients with visual hallucinations.

Little is known about the developing mechanisms of visual hallucinations in Parkinson's disease. This study aimed to investigate perfusion changes in parkinsonian patients with visual hallucinations using n-isopropyl-p-[123I]iodoamphetamine ([123I]IMP) single photon emission computed tomography imaging. A total of 70 consecutive patients, including 31 patients with visual hallucinations, and 39 patients without hallucinations, participated in this study. Patients with severe cognitive impairment (Mini-Mental State Examination score < 20), nonvisual hallucinations, or confusion were excluded. We compared brain perfusion changes between the two groups. We found that hallucinatory patients had significant perfusion reductions in the bilateral inferior parietal lobule, inferior temporal gyrus, precuneus gyrus, and occipital cortex compared to nonhallucinatory patients. These results suggested that hypoperfusion of the visual pathway was closely related to visual hallucinations in Parkinson's disease.

Aged↗
PubMed1991

Distributions of hallucinations in the population.

Hallucinations are often manifestations of severe psychiatric conditions seen clinically. However, little is known about the distribution of incident hallucinations in the community, nor whether there has been a change over the past century. Data from the NIMH Epidemiologic Catchment Area Program is used here to provide descriptive information on the community distribution, and data from the Sidgewick study from a century earlier provides comparative information. In the ECA data, the incidence of visual hallucinations was slightly higher in males (about 20 per 1000 per year) than females (about 13 per 1000 per year) across the age span from 18 to 80 years old, with a subsequent increase in the rate for females (up to about 40 per 1000 per year) after age 80. For auditory hallucinations there was an age 25-30 peak in males with a trough for females, and a later age 40-50 peak for females. Overall, there were substantial gender differences, and the effect of aging to increase the incidence of hallucinations was the most consistent and prominent. The Sidgewick study showed a much higher proportion of visual hallucinations than the ECA program. This might be due to factors affecting brain function as well as social and psychological changes over time, although methodological weaknesses in both studies might also be responsible.

Adolescent↗
PubMed1990

Hallucinations in Parkinson disease: neuropsychological study.

Hallucinations occur fairly frequently in the course of the pharmacological treatment of Parkinson disease. Our aim in this study was to assess first the relation between hallucinations and mental deterioration and second the correlation between the perception disorder and the profile on the Minnesota Multiphasic Personality Inventory (MMPI). Of 304 parkinsonian subjects followed as outpatients at our center 27 (8.88%) had had hallucinations and 17 of these presented marked cognitive deficits (Mini Mental State less than 18) (62.9%) compared with 32 of the other 277 patients (11.5%) (X2 = 55.16, p less than 0.0001). A group of 9 patients who had had hallucinations and 10 controls who had not, all free from marked cognitive deficits, were assessed on the Luria-Nebraska Neuropsychological Battery (LNNB) and on the MMPI. The two groups did not differ significantly in respect of the LNNB but did in respect of the MMPI scales. On this evidence the frequency of mental deterioration is significantly higher in patients who have hallucinated. We discuss the meaning of the MMPI differences both from the biochemical angle and from that of personality factors. These data suggest that the MMPI might be useful for predicting hallucinations in undeteriorated parkinsonian patients on pharmacological therapy.

Aged↗
PubMed2005

Factors associated with drug-induced visual hallucinations in Parkinson's disease.

AIMS: Visual hallucinations are common in medication-treated Parkinson's disease (PD) patients. Although their etiology is unknown several factors seem to be involved in their pathogenesis. The aim of this study was to identify possible risk factors and determine clinical characteristics associated with the development of visual hallucinations in PD. METHODS: 166 consecutive patients fulfilling clinical criteria for PD were studied. During a semi-structured interview, demographic characteristics and clinical variables were recorded. Motor, cognitive and psychiatric status was also assessed. Patients with and without visual hallucinations were compared using non-parametric tests, and logistic regression was applied to significant data. RESULTS: During the month before evaluation 20.4% of our patients experienced visual hallucinations (11.4% benign, 9% malignant). Logistic regression analysis identified three factors independently associated with visual hallucinations: long duration of Parkinson's disease, dementia, and disease severity as measured by the UPDRS total score. CONCLUSIONS: Our findings indicate that apart from well established risk factors such as cognitive impairment and disease duration, disease severity is also important for the development of visual hallucinations in PD. Furthermore, the presence of bradykinesia and instability, the absence of tremor and the severity of rigidity and bradykinesia (limb and axial) may act as cofactors.

Age of Onset↗
PubMed2004

Voriconazole-induced musical hallucinations.

1 Voriconazole (Vfend) is a second-generation azole antifungal that is increasing in popularity especially for the treatment of invasive aspergillosis as well as empirically for the febrile neutropenic patient. In addition, voriconazole tends to have a mild side effect profile with reversible visual disturbances being the most widely described effect. We describe a patient who had musical hallucinations secondary to voriconazole. The patient was a 78-year-old man admitted for induction of chemotherapy for acute myelogenous leukemia (AML) who began to have auditory hallucinations, specifically of Christmas music, the 2nd day of voriconazole therapy. His psychiatric evaluation was otherwise unremarkable. After discontinuing voriconazole the hallucinations decreased in intensity by the 2nd day and ceased altogether by the 3rd day. An extensive literature search, including Pfizer drug trial safety data, yielded no other reports of auditory hallucinations with voriconazole. Several other interesting cases of musical hallucinations secondary to a variety of causes have been reported in the literature, and are reviewed. Notably, musical hallucinations tend to occur secondary to temporal lobe insults and often are of a religious or patriotic theme.

Aged↗
PubMed2005

Adverse childhood experiences and hallucinations.

OBJECTIVE: Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. We used data from the ACE study to assess this relationship. METHODS: We conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health behaviors and outcomes in adulthood, which was completed by 17,337 adult HMO members in order to assess the independent relationship of 8 adverse childhood experiences and the total number of ACEs (ACE score) to experiencing hallucinations. We used logistic regression to assess the relationship of the ACE score to self-reported hallucinations. RESULTS: We found a statistically significant and graded relationship between histories of childhood trauma and histories of hallucinations that was independent of a history of substance abuse. Compared to persons with 0 ACEs, those with 7 or more ACEs had a five-fold increase in the risk of reporting hallucinations. CONCLUSION: These findings suggest that a history of childhood trauma should be looked for among persons with a history of hallucinations.

Adolescent↗
PubMed2006

Childhood traumas and hallucinations: an analysis of the National Comorbidity Survey.

Data from the National Comorbidity Survey were used to estimate the relationship between occurrences of childhood trauma and self-reported experiences of hallucinations. Variables representing (1) childhood neglect, (2) childhood physical abuse, (3) rape under the age of 16, and (4) molestation under the age of 16 were used to predict experiences of visual, auditory and tactile hallucinations. After controlling for background variables (sex, age, depression, family history of depression, urbanicity, income, drug, and alcohol dependence), a history of childhood rape and molestation were significantly associated with visual, auditory and tactile hallucinations. Additionally, neglect was associated with visual hallucinations and physical abuse with tactile hallucinations. Experiencing multiple types of trauma was associated with increases in the likelihood of reporting each of the three types of hallucinations. Hallucinatory experiences are possible indicators of a traumatic childhood history.

Adolescent↗
PubMed2004

Olfactory and visual hallucinations in Parkinson's disease.

Management of hallucinations in patients with Parkinson disease is a challenge for both the physician and the patient. They occur in more than 30% of patients and they present mostly as visual hallucinations but other forms such as auditory and tactile hallucinations have been reported. We have reported an interesting patient with olfactory hallucinations and visual hallucinations. To our knowledge, olfactory hallucinations have been rarely described in patients with Parkinson's disease and might be added to the late complications of Parkinson's disease.

Aged↗
PubMed2004

Therapeutic factors causing hallucination in Parkinson's disease patients, especially those given selegiline.

Selegiline protects nigral dopaminergic neurons and is recommended for the treatment of patients in the early stage of Parkinson's disease (PD). We treated 112 PD patients and noted that those given selegiline had a high incidence of hallucination. Our objective was to determine which clinical therapeutic factors cause such hallucinations. The Kruskal-Wallis and chi-square test showed that in 94 patients, the severity of the hallucinations was significantly related to the duration of illness, Hoehn and Yahr stage, doses of levodopa and cabergoline, whether or not selegiline was used, and whether or not medication for constipation was required. In addition, patients who were treated with a low dose of levodopa (< or =300 mg/day), who had a low Hoehn and Yahr stage, and a short duration of illness (< or =8 years) together with a high dose of selegiline or cabergoline also tended to have hallucinations. MRI findings were not related to the incidence of hallucination. When selegiline is given to patients who have PD of long duration and a high Hoehn and Yahr stage, and who already are receiving levodopa and a dopamine agonist, the doses of levodopa and the dopamine agonists given, as well as the presence of constipation, may be related to the incidence of hallucination.

Adult↗
PubMed2006

Suppression of verbal hallucinations and changes in regional cerebral blood flow after intravenous lidocaine: a case report.

Simple and complex auditory phantom-perceptions such as tinnitus and musical hallucinations occur predominantly in elderly subjects and are often associated with hearing impairment. Isolated verbal hallucinations without other psychotic features are rare. It has been shown that an intravenous (i.v.) injection of lidocaine can transiently suppress tinnitus. Here we present the case of a 74 year old left-handed women with severely distressing, continuous verbal auditory hallucinations without other psychotic features. I.v. injections of 100 mg lidocaine but not saline resulted in substantial transient suppressions of the hallucinations for several hours. Using [(15)O]H(2)O positron-emission tomography (PET) decreased regional cerebral blood flow associated with reduced perception of voices was found in the right angular and supramarginal gyrus, right inferior frontal gyrus, orbitofronal cortex and in major parts of the cingulate cortex. These data suggest to further investigate the clinical relevance of i.v. lidocaine in patients with therapy-resistant verbal hallucinations, support the notion of common pathophysiological mechanisms in different forms of auditory phantom-perception and demonstrate the feasibility of a new strategy for imaging studies on auditory hallucinations.

Aged↗
PubMed1999

Superior temporal gyral volumes and laterality correlates of auditory hallucinations in schizophrenia.

BACKGROUND: Previous studies have reported significant correlations, indicating an emerging relationship, between severity of auditory hallucinations and reduced size of temporal lobe cortical regions implicated in language processing. The present study used high-resolution magnetic resonance imaging (MRI) scanning, along with assessment of functional lateralization via a dichotic listening task (DLT), to extend these findings. METHODS: Thirty patients with schizophrenia and a history of auditory hallucinations participated in the study. All were completely right-handed. Eleven subjects were currently hallucinating at the time of the study. Volumetric T1-weighted MRI scans were obtained and regions of interest were manually traced using the BRAINS package (Andreasen et al 1993). Whole brain, bilateral temporal lobe, and anterior superior temporal gyrus volumes were calculated. Subjects completed a binaural consonant-vowel DLT. RESULTS: Increased severity of hallucinatory experience was significantly associated with smaller left anterior superior temporal gyrus volumes. Current hallucinators demonstrated a reduction in right ear advantage on the DLT. CONCLUSIONS: The results suggest that auditory hallucinations are subserved by a trait-like dysfunction in language-related neural networks, of which the superior temporal cortex forms one component. The findings are also consistent with theories proposing abnormal lateralization in the etiology of auditory hallucinations.

Adult↗
PubMed2001

Visual hallucinations are associated with lower alpha bungarotoxin binding in dementia with Lewy bodies.

Patients with dementia with Lewy bodies (DLB) commonly experience psychotic symptoms, most notably visual hallucinations. Previously, it has been shown that visual hallucinations in DLB are associated with reduced cortical choline acetyltransferase activity, a marker of cholinergic innervation, but not with predominantly postsynaptic muscarinic M1 receptor binding. In the present investigation, nicotinic acetylcholine receptor (nAChR) levels in the temporal cortex (Brodmann's areas [BA] 20 and 36) were measured in a group of 24 prospectively assessed DLB patients; comparisons were made between groups with or without visual and auditory hallucinations and delusional misidentification. Visual hallucinations and delusional misidentification were associated with lower [(125)I]alpha bungarotoxin binding in areas 36 and 20 (P<.05), but not with changes in [(3)H]epibatidine binding. There were no significant associations with auditory hallucinations. [(3)H]epibatidine, but not [(125)I]alpha bungarotoxin, binding for all DLB cases was reduced compared to controls (P<.001). Loss of cortical alpha 7 nicotinic receptors may contribute to hallucinations and delusional misidentification in DLB, with implications for treatment and understanding the mechanisms of psychotic symptoms in dementia.

Aged↗
PubMed2001

Corpus callosum area and functioning in schizophrenic patients with auditory--verbal hallucinations.

Auditory--verbal hallucinations (AVH) are a characteristic feature of schizophrenia. Patients with AVHs have been found to differ from non-hallucinating patients in volumes of certain asymmetrical brain structures on MRI, and on certain neuropsychological measures. There is also evidence of corpus callosum (CC) abnormalities in schizophrenia, and it has been proposed that abnormalities of inter-hemispheric transmission may underlie hallucinations and other symptoms. The aim of this study was to examine whether patients with AVHs have smaller corpora callosa than those without AVH, and whether CC size is related to performance on neuropsychological tests of functional cerebral asymmetry. Seventy-one DSM-IV male schizophrenics were recruited on the basis of their hallucination history plus 33 matched normal controls. Twenty-nine patients had no history of AVH, and 42 had a strong history of AVH. The mid-sagittal surface area and longitudinal length of the CC were measured from T(1)-weighted spin echo images. Callosal area was divided into four sections. There were no significant differences in any of the measurements between the two patient groups, or between patients with schizophrenia and controls. There was no association between CC measures and handedness, or performance on dichotic listening or finger tapping tasks. The results of this study do not lend support for there being a major morphological abnormality of the corpus callosum in schizophrenic patients, or for a specific relationship to AVH. However, a significant association between CC area and overall grey and white matter volumes was noted in the hallucinating patients and, to a lesser extent, in the non-hallucinators, which may point to differing influences on brain development or degeneration in such patients compared with normal controls.

Adolescent↗
PubMed2003

Cognitive basis of hallucinations in schizophrenia: role of top-down information processing.

Hallucinations in schizophrenia have been regarded to result from the erroneous attribution of internally generated information to an external source. Distortions in mental imagery may underlie such confusions. We investigated performance of 77 subjects on multiple behavioral measures of auditory and visual mental imagery and perception, and a measure of reality monitoring. Comparisons were made between performance of schizophrenia patients with (N=22) and without (N=35) hallucinations and matched normal comparison subjects (N=20), after controlling for attentional factors. No differences emerged on any of the mental imagery measures, nor on reality monitoring accuracy. This suggests that there is no stable disposition towards abnormal mental imagery associated with hallucinations. However, for patients with active hallucinations (N=12), hallucination severity correlated positively with a measure of imagery-perception interaction in the auditory modality, r=0.70, p=0.01. Although preliminary, this finding is consistent with recent theoretical proposals in which hallucinations have been suggested to result from an increased influence of top-down sensory expectations on conscious perception.

Adult↗
PubMed2003

Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia: a PET correlation study.

A [H(2)(15)O] PET correlation analysis technique was employed to correlate brain activations associated with self-reports of auditory hallucinations in hallucinating patients (n=8) and perception of transient, random human speech in non-hallucinating (n=7) patients and normal control subjects (n=8). Perception of externally generated human speech amongst the non-hallucinating and normal control participants was associated with a consistent pattern of extensive bilateral auditory cortex activation (Brodmann areas 40/41/42/22). Hallucinating participants demonstrated a network of cortical activations including bilateral auditory cortex, left limbic regions, right medial frontal and right prefrontal regions. The observed pattern of activation is consistent with models of auditory hallucinations as mis-remembered episodic memories of speech.

Adult↗
PubMed1980

The predisposition to hallucinate.

It is argued that people who are predisposed to mistake a vivid imagination image for a genuine percept (i.e. hallucinators) should show an impaired ability to make clear perceptual-conceptual distinctions (i.e. boundary confusion) and should lack familiarity with internal sources of information. A test of these hypotheses was undertaken by comparing a group of "alcoholic" hallucinators with a group of "alcoholic" non-hallucinators. Some support is claimed for the "boundary confusion" hypothesis but not for the "lack of familiarity" hypothesis. Specifically, it was found that hallucinators performed significantly worse than non-hallucinators on the Embedded Figures Test (a measure of perceptual boundary confusion) and on the Intersensory Time Judgement Test (a measure of conceptual boundary confusion). These results are discussed in relation to other aspects of the predisposition to hallucinate. Some specific research needs are described.

Adult↗
PubMed2002

Diagnostic outcome of self-reported hallucinations in a community sample of adolescents.

OBJECTIVE: We aimed to assess the diagnostic outcome of self-reported hallucinations in adolescents from the general population. METHOD: The sample consisted of 914 adolescents between ages 11-18 participating in an ongoing longitudinal study. The participation rate from the original sample was 70%. Responses on the Youth Self-Report questionnaire were used to ascertain hallucinations in adolescents. Eight years later, Axis 1 DSM-IV diagnoses were assessed using the 12-month version Composite International Diagnostic Interview in 783 (86%) of 914 study subjects. No subjects were diagnosed with schizophreniform disorders or schizophrenia. RESULTS: Hallucinations were reported by 6% of adolescents and 3% of young adults. Self-reported hallucinations were associated with concurrent non-psychotic psychiatric problems in both age groups. Adolescents who reported auditory, but not visual, hallucinations, had higher rates of depressive disorders and substance use disorders, but not psychotic disorders, at follow-up, compared to controls. CONCLUSIONS: Self-reported auditory hallucinations in adolescents are markers of concurrent and future psychiatric impairment due to non-psychotic Axis 1 disorders and possibly Axis 2 disorders. It cannot be excluded that there was selective attrition of children and adolescents who developed Schizophrenic or other psychotic disorders later in life.

Adolescent↗
PubMed1997

Cognitive factors in source monitoring and auditory hallucinations.

BACKGROUND: In order to elucidate further the cognitive processes underlying auditory hallucinations, an experiment investigating delayed and immediate source monitoring for positive, negative and neutral verbal material was conducted with schizophrenic patients. METHODS: Patients experiencing auditory hallucinations, patients not experiencing auditory hallucinations and normal subjects participated in a word association task, rating their responses for how much a self-generated thought was their own, how controllable and involuntary it was and their confidence in these ratings. A delayed source monitoring test in which subjects had to recall the source (self or experimenter) of the words from the association task was also administered. RESULTS: Hallucinators showed a greater bias towards external attribution of their thoughts compared with both control groups for immediate attributions of source, but not for delayed attributions. Hallucinators showed a bias towards external attribution of emotional material for immediate source monitoring and all subjects showed a bias towards misattribution of positive material to an external source and negative material to an internal source for the delayed source monitoring task. CONCLUSIONS: These findings appear to be most consistent with theories proposing that hallucinations result from an external attributional bias for internal events. The implications of these results for research and practice are also discussed.

Adult↗