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PubMed2001

[Imperative auditory hallucinations in schizophrenia].

Command hallucinations are a subtype of auditory verbal hallucinations in schizophrenia. More likely than any other schizophrenic symptom, they may have an impact on the individual's behavior. In the forensic literature, aspects of dangerous actions induced by psychotic motivation have been discussed. From the psychiatric point of view, the main problem is the unpredictability of behavioral consequences. The present study examines psychopathological details of command hallucinations in 31 hospitalized schizophrenic patients, 10 females and 21 males, using a questionnaire including 24 items. The predictive accuracy of a distinct set of signs was rated concerning compliance vs. resistance of hallucinated commands. The predictors are: identifying the hallucinated voice, being affected by emotions after hallucinations, and misregarding the voice as being real. In the presence of these conditions, behavioral consequences are predicted by a value which was 6.7 times higher than that without any information about predictors. In the absence of these conditions, resistance of command voices is predicted by a value of 7.

Adolescent↗
PubMed2006

Complex visual hallucinations as post-ictal cortical release phenomena.

Visual hallucinations can be elementary or complex and appear in a wide variety of neurological disorders. Hallucinations associated with seizures can either be ictal or part of a post-ictal cortical release phenomenon, and their features may help distinguish their etiology. We describe two patients with suspected ictal occipital lobe lesions with elementary hallucinations that were followed by post-ictal complex hallucinations.The pathophysiologies of elementary and complex hallucinations are reviewed. The sequential occurrence of these two distinct types of hallucinations in these patients emphasizes the observation that hallucinations associated with seizures can result from both irritative and cortical release mechanisms.

Adolescent↗
PubMed1990

Persistent auditory hallucinations and their relationship to delusions and mood.

Twelve patients who met DSM-III-R criteria for schizophrenia and had persistent auditory hallucinations completed a diary three times daily for 2 to 3 weeks. Using 5-point equal interval rating scales, nearly all patients were able to record consistently the nature of their hallucinations, the intensity of their delusional beliefs, and the mood and clarity of their thinking. For at least half the patients, there was a statistically significant relationship between the loudness and intrusiveness of hallucinations and the intensity of delusional beliefs; the more intrusive and distressing were the hallucinations, the more anxious and depressed were the patients. The findings suggested that more emphasis might be placed on altering patients' mood in the treatment of persistent hallucinations. The diary approach to research into auditory hallucinations appears promising.

Adult↗
PubMedDate not supplied

The relation between visual hallucinations and visual evoked potential in Parkinson disease.

OBJECTIVE: The pathophysiology of hallucinations in Parkinson disease is poorly understood. This study investigated the relation between visual hallucination and visual evoked potentials (VEPs) in Parkinson disease. METHODS: Nineteen patients with Parkinson disease were studied. The authors divided patients into 2 groups: patients with visual hallucinations (VH group) and those without visual hallucinations (no-VH group). VEPs using a checkerboard stimulus were recorded under a drug-free state. RESULTS: On multivariate regression analysis, only the average P100 latency was selected and remained significant after the backward elimination method. CONCLUSION: The authors demonstrated a close association between visual hallucinations and elongated VEP latency in Parkinson disease. VEPs may become one of the predictors for visual hallucination.

Aged↗
PubMed1985

Reality testing and auditory hallucinations: a signal detection analysis.

The hypothesis that hallucinators are deficient in the metacognitive skill of reality testing was tested using the methodology of signal detection theory. In Expt 1 undergraduate subjects scoring high or low on a scale measuring predisposition to hallucination were tested on an auditory signal detection task. High scorers on the scale were found to differ from low scorers on a measure of perceptual bias but not on a measure of sensitivity. In Expt 2 a similar methodology was used with hallucinating and non-hallucinating schizophrenic patients, with similar results. These results support the hypothesis that hallucinators or subjects highly disposed towards hallucination are deficient in reality testing and are therefore prone to identify imaginary events as real.

Adult↗
PubMed1995

The effects of varying information content and speaking aloud on auditory hallucinations.

The aim of this study was to investigate why requiring hallucinating schizophrenic subjects to read aloud produces large reductions in reports of auditory hallucinations. In Expt 1 hallucinating subjects (N = 9) were required to sort cards quietly into one, two, four, 13 and 26 piles. It was shown that the large reductions in the reports of hallucinations produced by reading aloud could not be accounted for in terms of the information content of the task. In Expt 2 the subjects (N = 7) were required to place the cards into one or two piles quietly or whilst saying the colour of the card aloud. Sorting cards into two piles whilst saying the colour of the card produced the largest reductions in the reports of hallucinations. It was concluded that it was the requirement to make overt motor and verbal response that produced the large reductions in reports of auditory hallucinations in the reading-aloud task.

Adult↗
PubMed1986

Hallucinations: theoretical and clinical overview.

The authors review the literature on hallucinations; provide theoretical background on these phenomena from physiological, biochemical, and psychological points of view; and discuss the presentations of hallucinations in different diagnostic categories. The longstanding notion that hallucinations are to be equated with schizophrenia, they conclude, is clearly unfounded, and hallucinations are never pathognomonic of any given disorder but can be relatively specific for some conditions. Current knowledge and methods of research have produced no single mechanism to account for the etiology or pathogenesis of hallucinations. The authors present an integrated approach toward viewing the etiology and clinical presentation of hallucinations that involves concepts of biological vulnerability and psychological influences.

Alcoholism↗
PubMed1989

High prevalence of visual hallucinations in research subjects with chronic schizophrenia.

The authors examined the prevalence of visual hallucinations in severely ill hospitalized research subjects with carefully diagnosed chronic schizophrenia and found it to be high. A chart review of 100 discharged subjects revealed documentation of visual hallucinations in 32%, and a prospective examination of 43 additional subjects revealed a history of visual hallucinations in 56% (N = 24). Also, the fact that in 43% of the patients with visual hallucinations the history of visual hallucinations was first documented during the research ward work-up suggests that clinicians frequently do not inquire about visual hallucinations in patients with chronic schizophrenia.

Chronic Disease↗
PubMed1990

The clinical presentation of command hallucinations in a forensic population.

In a forensic population, patients with command hallucinations (N = 25) were compared to two groups of psychotic patients: those with noncommand hallucinations (N = 24) and those without hallucinations (N = 16). The three groups did not differ in overall impairment as measured by the Global Assessment Scale and the Social Behavior Rating Schedule. However, the group with command hallucinations differed in the content of their hallucinations (more aggression, dependency, and self-punishment themes), and nearly one-half did not report or denied their command hallucinations to the assessment team. Many patients (N = 11, 44%) reported that they frequently responded to hallucinatory commands with unquestioning obedience.

Adult↗
PubMed1999

Association among visual hallucinations, visual acuity, and specific eye pathologies in Alzheimer's disease: treatment implications.

OBJECTIVE: Studies suggest a link between visual acuity and visual hallucinations in dementia, but links with specific eye pathologies have not been evaluated. METHOD: Fifty patients (20 with visual hallucinations, 30 without) with probable Alzheimer's disease had an evaluation of psychotic symptoms. Visual acuity was measured before and after refractions, and ophthalmological examinations included standardized assessments for cataracts and macular degeneration. RESULTS: Impaired visual acuity and the severity of cognitive impairments were significantly associated with visual hallucinations. No patients with normal acuity (6/5 or 6/6 on the Snellen chart) experienced these symptoms. Impaired acuity improved with refraction in 60% (N = 12) of the patients with visual hallucinations. Of specific eye pathologies, only cataracts were significantly associated with visual hallucinations. Descriptive follow-up information suggests that an optician's assessment for glasses improves outcome. CONCLUSIONS: Glasses and cataract surgery need evaluation as prophylactic or adjunctive treatments for visual hallucinations in patients with probable Alzheimer's disease.

Aged↗
PubMed2005

Hallucinations and mortality in Alzheimer disease.

OBJECTIVE: The authors tested the relationship of hallucinations and delusions to mortality in Alzheimer disease (AD). METHODS: A group of 407 persons with clinically diagnosed AD completed a uniform clinical evaluation, after which vital status was monitored for a mean of 3.7 years. At the initial evaluation, a previously established, structured, informant interview was used to ascertain the presence of hallucinations and delusional thinking. The evaluation also included a structured medical history, inspection of all medications, and detailed assessment of cognitive functioning and parkinsonian signs. RESULTS: At study onset, hallucinations were present in 41.0% of participants and delusions in 54.4%. During follow-up, 146 deaths occurred. In a proportional-hazards model adjusted for age, sex, race, and education, hallucinations were associated with a 78% increase in risk of death. The association was not substantially altered in subsequent analyses that controlled for level of cognitive impairment, severity of parkinsonism, use of antipsychotic medications, and the presence of chronic medical conditions. Risk of death was more than doubled in those with both auditory and visual hallucinations. By contrast, we did not find evidence of an association of delusions with mortality. CONCLUSION: Hallucinations are associated with an increased risk of death in AD.

Aged↗
PubMed1999

Hallucinations, delusions, and thought disorder among adult psychiatric inpatients with a history of child abuse.

OBJECTIVE: The relationship between three positive symptoms of schizophrenia-hallucinations, delusions and thought disorder-and childhood physical and sexual abuse among psychiatric inpatients was investigated. METHODS: From the records of 100 consecutive admissions to an acute psychiatric inpatient unit in a New Zealand general hospital, the records of the 22 patients in which a history of either physical or sexual childhood abuse was mentioned were examined for data on the frequency and content of hallucinations, delusions, and thought disorder. RESULTS: Seventeen of the 22 patients exhibited one or more of the three symptoms. Half of the symptoms for which content was recorded appeared to be related to the abuse. An analysis of the relationships between types of abuse and specific symptoms suggested that hallucinations may be more common than delusions or thought disorder among patients who have been sexually abused, particularly among those who have experienced incest, and that delusions may be more related to having been physically abused. CONCLUSIONS: The study findings confirmed previous findings of a high frequency of auditory hallucinations, particularly command hallucinations to kill oneself, and paranoid ideation among inpatients with a history of abuse. The hypothesis that the hallucinations of abuse survivors are "pseudohallucinations" was not supported.

Adult↗
PubMed2004

Command hallucinations among Asian patients with schizophrenia.

OBJECTIVES: The impact of command hallucinations on patients and the determinants of patients' compliance with them are still poorly understood. The extant literature is also divided on their association with violence. This study aimed to establish the prevalence of command hallucinations and to identify the factors that affect compliance with the commands, together with patients' coping methods. METHODS: We recruited 50 consecutive male and 50 consecutive female schizophrenia inpatients who reported hearing voices in the 6 months prior to admission. We interviewed these patients, using a semistructured questionnaire. We collected information on the contents of their auditory hallucinations and their coping methods. RESULTS: Of the patients, 53 (53%) reported command hallucinations. Of these 53 patients, 58% were women and 48% were men; 62% reported complying with the commands. They were also more likely to comply with nonviolent commands. A history of self-harm predicted compliance. Those patients who did not comply with the commands adopted various methods of coping, of which praying was the most common. CONCLUSION: Command hallucinations are common in patients with schizophrenia. Patients with a history of self-harm need closer monitoring because they may be more likely to comply with these hallucinations. Assessment should also include the patient's own coping strategies, which can be incorporated into the treatment.

Adaptation, Psychological↗
PubMed2006

Impaired visual acuity as a risk factor for visual hallucinations in Parkinson's disease.

Pathophysiology of hallucinations in Parkinson's disease is poorly understood. This study investigated relationships between visual hallucinations and visual acuity. Twenty-six consecutive patients with Parkinson's disease participated in this study. Patients were divided into two groups: patients with visual hallucinations (VH group) and those without visual hallucinations (no-VH group). Unaided and corrected eyesight was evaluated in all patients, and if frequent use of prescription glasses or contact lenses was involved, eyesight using these lenses was also measured as the patient's own best eyesight. If a patient did not use prescription glasses or contact lenses, the patient's own best eyesight was defined as the unaided eyesight. Multivariate regression analysis demonstrated that agonist use and best eyesight were different after the backward elimination method. Visual hallucinations were closely related not to uncorrected eyesight or unaided eyesight but to the patient's best eyesight. It is suggested that impaired visual acuity is a risk factor for visual hallucinations.

Aged↗
PubMed2003

Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation.

BACKGROUND: Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder. AIMS: To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder. METHOD: A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive-behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis. RESULTS: A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations. CONCLUSIONS: The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.

Adult↗
PubMed2005

Association between family history of dementia and hallucinations in Parkinson disease.

OBJECTIVE: To identify familial risk factors for hallucinations in patients with Parkinson disease (PD). METHODS: Two hundred seventy-six outpatients with PD participated in the study. The presence of hallucinations was determined using a validated questionnaire, including items regarding the occurrence of visual, auditory, or other types of hallucinations. Family history of PD and dementia was determined by a structured interview and examination of medical records and affected family members. Patients with young-onset PD (<50 years) who reported another PD patient among their siblings were tested for parkin mutations. Stepwise logistic regression was applied for the detection of risk factors. The regression model included a set of family history-related variables (family history of PD and of dementia) and a set of disease-related variables (age, age at onset of PD, stage, duration of PD and of l-dopa therapy, l-dopa dose, and number of antiparkinsonian drugs). RESULTS: Hallucinations were present in 32% of the 276 patients. Risk factors for hallucinations included Mini-Mental State Examination score (p < 0.0001) and positive family history of dementia (p = 0.0005). CONCLUSION: Family history of dementia and lower Mini-Mental State Examination scores are risk factors for hallucinations in Parkinson disease.

Age Factors↗
PubMed2006

Hallucinations in Parkinson disease in the prelevodopa era.

Whether chronic hallucinations belong to the natural history of untreated Parkinson disease (PD) remains undetermined. For early authors such as Gowers or Charcot and his followers, hallucinations that occurred in the course of PD either accompanied the final phase of the disease or reflected comorbidities. However, a few authors observed that hallucinations could occur in PD patients with severe depression, confusion, or dementia. Interest in hallucinations with parkinsonism increased with the outbreak of von Economo encephalitis, as they were more frequent than in PD, provoking new pathophysiologic questions. Later studies on mental symptoms in parkinsonism were often based on series that pooled patients with PD and postencephalitic syndromes, confounding a clear analysis. It remains difficult to estimate the prevalence of hallucinations in the natural course of PD before the introduction of levodopa therapy. The lack of prospective studies, the wide early use of anticholinergics and ergots compounds, and the absence of dementia with Lewy bodies in the nosology of the time are further limitations. Even with these limitations, historical descriptions of PD from the prelevodopa era suggest that hallucinations may be part of PD itself, especially in the context of late dementia, depression, or nonspecific encephalopathy.

Affective Symptoms↗
PubMed2000

Olanzapine and clozapine: comparative effects on motor function in hallucinating PD patients.

OBJECTIVE: To compare olanzapine and clozapine for safety and efficacy measures of psychosis and motor function in patients with PD and chronic hallucinations. BACKGROUND: Hallucinations occur in approximately one third of patients with PD treated chronically with dopaminergic drugs. Although clozapine is known to be an effective antipsychotic agent that does not significantly exacerbate parkinsonism, its use requires frequent blood count assessment. Olanzapine is another novel antipsychotic that is not associated with blood dyscrasia, and if equally effective could become the preferred drug for treating hallucinations in subjects with PD. METHODS: A randomized, double-blind, parallel comparison of olanzapine and clozapine in patients with PD with chronic hallucinations was conducted. The primary outcome measure was the Scale for the Assessment of Positive Symptoms (SAPS) for psychotic symptoms. The Unified Parkinson's Disease Rating Scale (UPDRS) motor subscale was used as a secondary outcome measure and as a safety monitoring tool. RESULTS: After 15 patients had completed the study, safety stopping rules were invoked because of exacerbated parkinsonism in olanzapine-treated subjects. UPDRS motor impairment scores from baseline to study end significantly increased with olanzapine treatment, and change scores between the olanzapine and clozapine groups significantly differed. The primary clinical domains responsible for the motor decline were gait and bradykinesia. Even with a smaller patient number than originally anticipated, clozapine significantly improved hallucinations and overall behavioral assessment, whereas olanzapine had no effect. CONCLUSIONS: At the doses studied, olanzapine aggravates parkinsonism in comparison with clozapine and should not be regularly used in the management of hallucinations in patients with PD.

Aged↗