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PubMed2000

Cognitive factors in predisposition to auditory and visual hallucinations.

OBJECTIVES: This study adapted the Launay Slade Hallucination Scale (LSHS) to measure predisposition to auditory and visual hallucinations and examine the relationship between meta-cognition and predisposition in a non-psychiatric population. It also tested the hypothesis that individuals highly predisposed to hallucination would show positive and negative meta-cognitive beliefs and report the use of different thought control strategies. DESIGN: A within participants correlational design was employed. METHODS: A revised LSHS was administered to 105 normal participants who were also asked to complete questionnaires assessing paranoia, meta-cognitive beliefs, thought control strategies, anxiety, depression and beliefs about unusual perceptual experiences. RESULTS: Two empirically distinct but correlated hallucinatory traits (auditory and visual) were measured by the modified LSHS. Consistent with predictions, it was found that positive beliefs about unusual perceptual experiences were the best predictor of predisposition to auditory and visual hallucinations and that those participants who scored higher on predisposition to hallucination used different thought control strategies and had different negative meta-cognitive beliefs in comparison with participants of low predisposition. CONCLUSIONS: Meta-cognitive beliefs about thoughts and hallucinatory phenomena appear to be implicated in predisposition to hallucination. The theoretical and clinical implications of the findings are discussed.

Adult↗
PubMed2002

Cognitive and emotional predictors of predisposition to hallucinations in non-patients.

BACKGROUND: This study reports the development of a self-report measure to assess interpretations of voices (Interpretations of Voices Inventory: IVI) and a revision of the Launay-Slade Hallucination Scale (RHS) to measure predisposition to hallucinations in non-patients. We aimed to test the specific hypothesis that positive interpretations of voices would predict frequency of hallucinatory experiences. METHOD: There were 132 non-clinical participants who were asked to complete questionnaires assessing interpretations of voices, predisposition to hallucinations, meta-cognitive beliefs, anxiety and delusional ideation. RESULTS: The results showed that three empirically distinct subscales were measured by the IVI (meta-physical beliefs about voices, positive beliefs about voices and interpretations of loss of control). The RHS was also found to have three subscales (vividness of imagination and daydreaming, tendency towards experiencing visual disturbances and hallucinations, and tendency towards experiencing auditory hallucinations). The scales possessed acceptable internal consistency and were moderately stable over a period of 4-6 weeks. Consistent with predictions, it was found that positive beliefs about voices were significantly associated with predisposition to auditory hallucinations, and negative interpretations of voices were associated with endorsing the item assessing troublesome voices. CONCLUSIONS: The theoretical and clinical implications of the findings are discussed.

Adult↗
PubMed2006

The role of meta-cognitions and thought control techniques in predisposition to auditory and visual hallucinations.

OBJECTIVES: This study examines the relationship between a predisposition to hallucinations and meta-cognitive variables and thought-control techniques, controlling for the possible effect of anxiety. In order to do so, we start out with the hypothesis that anxiety does not, in itself, explain the association between meta-cognitions and a predisposition to auditory and visual hallucinations. DESIGN: A within-participants correlational design was employed. METHODS: Four psychometric tests relating to predisposition to hallucinations, anxiety, meta-cognitions and thought-control techniques were administered to 150 participants. RESULTS: It was found that, after controlling for participants' anxiety levels, the 'loss of cognitive confidence' factor predicted the score on the scale of predisposition to both auditory and visual hallucinations. Thought-control strategies based on worry were also found to be predictive of a greater predisposition to hallucinations, regardless of whether or not participants' anxiety level was controlled. CONCLUSIONS: Meta-cognitive variables of cognitive confidence and thought control through worry are positively associated with a predisposition to hallucinations. LIMITATIONS: The correlational nature of the design does not allow inferences about causal relationships.

Adult↗
PubMed2001

Nocturnal hallucinations in ultra-orthodox Jewish Israeli men.

Hallucinations that occur predominantly at night are reported in 122 out of a sample of 302 ultra-orthodox Jewish Israeli men referred for psychiatric evaluation. Demographic data and the content of a semistructured interview in 302 ultra-orthodox Jewish young men seen over a 10-year period in Jerusalem were evaluated retrospectively by two researchers. Of the 302 subjects, 122 reported hallucinations predominantly at night, 23 reported hallucinations with no diurnal variation, and 157 did not report hallucinations. Most of those with nocturnal hallucinations were in their late teens, were seen only once or twice, were brought in order to receive an evaluation letter for the Army, and had a reported history of serious learning difficulties. The nocturnal hallucinatory experiences were predominantly visual, and the images were frightening figures from daily life or from folklore. Many of the subjects were withdrawn, monosyllabic, reluctant interviewees. Ultra-orthodox Jewish beliefs include a belief in demons, particularly of dead souls, who visit at night. This cultural group's value on study at Yeshivas away from home places significant pressure on teenage boys with mild or definite subnormality, possibly precipitating the phenomenon at this age in this sex. Although malingering had to be considered as a possible explanation in many cases owing to the circumstances of the evaluation, short-term and long-term follow-up on a limited sample allowed this explanation to be dismissed in a significant number of cases. We suggest therefore that nocturnal hallucinations are a culture-specific phenomenon.

Adolescent↗
PubMedDate not supplied

Choroid plexus calcification as a possible marker of hallucinations in schizophrenia.

Several studies suggest that disturbances of serotonin (5-HT) functions may be involved in the pathophysiology of hallucinations in schizophrenia. It is now well established that the choroid plexus (CP) is innervated by serotonin (5-HT) neurons, which may regulate its activity, and it is possible that decreased 5-HT functions may facilitate the process of its calcification. It is thus conceivable that calcification of the CP may be associated with hallucinations in schizophrenia. I studied in 18 chronic schizophrenic patients the association of CP calcification (CPC) size as ascertained from CT scan, to severity of hallucinations and, for comparison, to four other positive symptoms as well as global psychopathology score. Analysis of variance indicated that CPC size was specifically associated with hallucinations (p < .001) and none of the other psychopathology measures. These findings reveal a relationship between CPC and hallucinations in schizophrenia and suggest that the former may be a neuroradiological marker of hallucinations in the disease.

Adult↗
PubMed2001

Musical hallucinations associated with seizures originating from an intracranial aneurysm.

Hallucinations are defined as sensory phenomena in the absence of external sensory stimuli. Auditory hallucinations have been shown to arise from many different intracranial lesions, but seizures manifesting as musical hallucinations triggered by unruptured intracranial aneurysms are rare. We present a case of persistent, episodic musical hallucinations associated with seizures that led to the discovery of 2 small intracranial aneurysms. Typical electroencephalographic findings for seizure activity were observed but resolved after surgical clipping of the aneurysms. Concomitantly, the patient's hallucinations resolved. The literature on musical hallucinations is reviewed.

Cerebral Angiography↗
PubMedDate not supplied

[The aetiopathogenesis of auditory hallucinations in psychosis].

INTRODUCTION: Auditory hallucinations is one of the core symptoms of psychosis. Two main different approaches have been made in recent years in order to understand this perceptual abnormality. The psycho-social approaches is trying to explain auditory hallucinations as a common human phenomenon that only environmental factors cause them to be pathological. It propose psychotherapeutic techniques based on the cognitive model, paying special attention to the emotional component. The neurobiological approach, specially with neuroimaging techniques, is giving us new information about abnormal activation in specific neural networks, particularly in language areas. It propose biological treatments with antipsychotics and transcranial magnetic stimulation. Neither of these approaches are listening to each other. Neither of them look at the molecular genetic vulnerability to auditory hallucinations in psychosis. DEVELOPMENT: From a review of the literature and our own findings, we present a genetic-environmental model of auditory hallucinations in psychoses. We hypothesize two types of genetic vulnerability: vulnerability to hearing voices -that could be related with genes that are expressed in language areas and are related with language abnormalities (FOXP2)-, and vulnerability to abnormal emotional response to voices -that could be related with genes that are involved in the regulation of dopamine in the limbic system (5-HTT, CCK-AR)-. Finally, environmental and cultural factors explain the content and social adjustment to auditory hallucinations. CONCLUSION: Our model allow the integration of many data from epidemiology and neuroimaging, to psychopharmacology in the understanding of the aetiology of auditory hallucinations.

Brain↗
PubMed1996

[Complex visual hallucinations in the hemianopic field following an ischemic lesion of the occipitotemporal base--confirmation of the lesion by MRI and speculations on the pathophysiology].

We report a patient who presented with complex visual hallucinations in the right hemianopic field following an infarction in the left occipitotemporal base. A 73-year-old right-handed woman developed right homonymous hemianopia. A week after its onset, she noticed a strange man with glasses, or a man wearing a gray hat and a black coat standing in the defective visual field. Such visual images later included a nurse, a large hand extending from the right side to the center, and many pieces of cloth descending from the roof. Most of these objects were unfamiliar to her, but may have been related to previous experiences. Her hallucinations were usually black and white singular and motionless, and sometimes consisted of multiple identical replications of objects. All of the hallucinations vanished when the patient tried looking directly at them. An EEG failed to showed any epileptic discharges. T1-weighted MRI with gadolinium-DTPA performed nine days after the onset revealed a localized high-signal-intensity region suggesting an infarction around the left collateral sulcus that included part of the lingual gyrus and the fusiform gyrus. 123I-IMP SPECT showed hypoperfusion of the left occipitotemporal base. The hallucinations gradually resolved a month after the onset, but the right homonymous hemianopia persisted. The enhanced lesion on T1-weighted images was no longer visible on MRI performed a month after the onset but, remained high-intensity on the T2-weighted images. There have been reports of complex visual hallucinations in hemianopic fields, but there have been only a few reports in which the responsible lesion was discussed on the basis of the CT and MRI findings. The findings in our patient suggest that lesions of the occipitotemporal base are one of the possible causes of this symptom. Taken together with earlier reports, not only pure release phenomena but irritative phenomena in the association visual cortex may be involved in the complex visual hallucinations in the hemianopic field, as Lance and Kölmel suspected.

Aged↗
PubMed1998

Command hallucinations, compliance, and risk assessment.

Command hallucinations are auditory hallucinations that instruct a patient to act in specific ways; these commands can range in seriousness from innocuous to life-threatening. This article summarizes two areas of research regarding command hallucinations: rates of compliance with command hallucinations; and factors associated with compliance. Researchers have reported rates of compliance ranging from 39.2 percent to 88.5 percent. Compliance has not been consistently related to dangerousness of commands. Instead, research suggests that Individuals are more likely to comply with commands if they recognize the hallucinated voice and if their hallucinations are related to a delusion. Implications for risk assessment are discussed in light of the research.

Delusions↗
PubMedDate not supplied

Poor visual discrimination and visual hallucinations in Parkinson's disease.

This study examined the relationship between deficits in color and contrast discrimination and visual hallucinations (VH) in patients with Parkinson's disease (PD) and normal visual acuity. Thirty-five nondemented and nonpsychotic PD patients with normal visual acuity and without major ophthalmologic disease were interviewed twice and divided into two groups: hallucinators (n = 14) and non-hallucinating controls (n = 21). The groups were compared for color vision (assessed by Lanthony D-15 [LD] and Farnsworth-Munsell 100 hue [FM] tests), and for contrast sensitivity (tested by Vis tech tables [VT] and monocular and binocular Pelli-Robson test [PR]). There was no difference in age, duration or stage of PD, or dosage or duration of levodopa therapy between the two groups. Parkinson's disease patients showed impairment on all visual tests, with the hallucinators performing worse than the controls on all tests. This difference was significant for the LD (p < 0.007), the VT at 1.5 and 3 cycles per degree (p < 0.037 and 0.043, respectively) and the monocular PR tests (p < 0.049). The results led the authors to conclude that in patients with normal visual acuity, those with VH show added visual deficits of color and contrast discrimination. These ophthalmopathies may therefore be facilitating factors for visual hallucinations in PD and justify more focused research on the pathophysiology of visual hallucinations in Parkinson's disease.

Aged↗
PubMed2005

Complex visual hallucinations after occipital cortical resection in a patient with epilepsy due to cortical dysplasia.

BACKGROUND: Charles Bonnet syndrome is a rare disorder characterized by complex and recurrent visual hallucinations in elderly patients with visual pathway pathologic defects. To date, to our knowledge, it has not been described in patients undergoing surgical resection for occipital lobe epilepsy due to cortical dysplasia. OBJECTIVE: To describe a patient who experienced complex visual hallucinations following resection of cortical dysplasia on the right occipital lobe and who was diagnosed as having Charles Bonnet syndrome. PATIENT: A 35-year-old woman underwent surgical resection for medically intractable epilepsy caused by cortical dysplasia involving the right occipital lobe. RESULTS: Two months after resection of the epileptogenic zone, complex visual hallucinations in the left visual field not associated with loss of consciousness or delusion developed in the patient. Hallucinations persisted for more than 12 months despite treatment with antiepileptic medications. During hallucination, no electrographic seizures were recorded through long-term video-electroencephalographic monitoring. CONCLUSIONS: Charles Bonnet syndrome may occur in a patient with occipital lobe epilepsy following resection of the diseased brain with a developmental malformation. Charles Bonnet syndrome associated with surgical treatment of occipital lobe epilepsy may have been overlooked.

Adult↗
PubMed2000

Delusions and hallucinations in Alzheimer's disease: prevalence and clinical correlates.

OBJECTIVES: The purpose of this study was to examine the frequency of delusions and hallucinations in patients with Alzheimer's disease (AD) and to investigate factors associated with each or the combination of the two. DESIGN: This was a cross-sectional, case-control study. SETTING: Neuropsychiatry and Memory Group, The Johns Hopkins University, USA. PARTICIPANTS: Three hundred and forty-two community-residing patients with probable AD according to NINCDS/ADRDA criteria were included in the study. MEASURES: Patients were assessed clinically for the presence of psychotic symptoms using the DSM-IV glossary definitions. The patients were also rated on standardized measures of cognitive impairment, depression, extrapyramidal symptoms, functional impairment and general health. RESULTS: Seventy-five (22%) AD patients had delusions only, nine (3%) had hallucinations only and 30 (9%) had both delusions and hallucinations. Hallucinations were associated with less education, African-American race, more severe dementia, longer duration of illness, falls and use of anxiolytics. Delusions were associated with older age, depression, aggression, poor general health and use of antihypertensives. Patients with both delusions and hallucinations were similar to the patients with delusions only. CONCLUSIONS: This study confirms the high prevalence of psychotic symptoms in AD patients encountered in clinical practice and suggests that individual psychotic symptoms have different associations.

Aged↗
PubMed2005

Double-blind, placebo-controlled, unforced titration parallel trial of quetiapine for dopaminergic-induced hallucinations in Parkinson's disease.

We completed a single site, double-blind, placebo-controlled, parallel design study of quetiapine for hallucinations in PD. Thirty-one subjects with PD and prominent visual hallucinations and Mini-Mental State Examination score >21 were randomly assigned in a 2:1 drug to placebo ratio, up to 200 mg daily of quetiapine or matching placebo given in two doses. They were seen at 3 weeks (100 mg/day) and 12 weeks (200 mg/day, with optional dose reduction). Evaluation included the Unified Parkinson's Disease Rating Scale (UPDRS), the Baylor PD Hallucination Questionnaire, and a battery of neuropsychological tests. The demographics between subjects randomized to drug (n = 21) vs. placebo (n = 10) were similar. The final dose of active drug was 200 (n = 11), 150 (n = 2), 100 (n = 3), and 75 (n = 1) mg per day. All placebo subjects were on the equivalent of 200 mg per day. The UPDRS Activities of Daily Living and Motor scores did not significantly change compared to placebo. Compared to placebo, there were no significant changes in our hallucination questionnaire, the Brief Psychiatric Rating Scale (BPRS), or question 12 (hallucination item) of the BPRS. There were no significant changes on any of the neuropsychological measures. Adverse events on drug included sedation (n = 9), but no drug-related adverse events precipitated discontinuation and none were rated as serious. Quetiapine, up to 200 mg daily, was well tolerated and did not worsen UPDRS scores; however, there was no significant improvement in psychosis rating scales compared to placebo. Larger doses of drug and greater sample sizes might be considered in future studies.

Adult↗
PubMed1989

Visual hallucinations. An outline of etiological and pathogenetic concepts.

Visual hallucinations have played an important role in religion, culture, and all concepts of mental disease. A brief review of these phenomena in healthy individuals as well as in clinical medicine is provided. We analyse the pathomechanisms involved in the development of visual hallucinatory experiences and argue that no single model can serve to explain all the phenomena encountered in the field of visual hallucinations. We question the validity of the current distinction between hallucination and illusion, and delineate conditions which are only appreciable psychologically, e.g. the 'imaginary playmates' of childhood and visual hallucinations in the face of a severe grief reaction. At least three putative mechanisms for the genesis of visual hallucinations can be described in biological terminology: irritative phenomena, release phenomena, and processing disturbances within the visual pathways.

Brain Diseases↗
PubMed2002

Tactile hallucinations in Parkinson's disease.

Hallucinations occur in up to 40% of patients with Parkinson's disease (PD) and are mainly of a visual nature. We prospectively studied 8 patients with PD and tactile hallucinations (TH). TH occurred with a clear sensorium, and were long-lasting. In most cases they involved animals, were combined with other types of hallucinations occurring simultaneously (mainly formed visual hallucinations), and predominated in the evening and/or at night. Pharmacological and disease-related factors, including a disorder in rapid-eye-movement sleep mechanisms, could play a part in the pathophysiology of these hallucinations.

Aged↗
PubMed2005

Rapid eye movement sleep, non-rapid eye movement sleep, dreams, and hallucinations.

After the discovery of rapid eye movement (REM) sleep in 1953, oneiric activity was long thought to be associated uniquely with REM sleep. Subsequent evaluation of sleep in humans combining neurophysiologic, psychophysiologic, and, more recently, functional neuroimaging investigations, has instead shown that dreaming also occurs during non-REM (NREM) sleep. It has been documented that hallucinatory activity during sleep is a normal phenomenon that is not constant throughout the night but increases toward morning when it tends to become present to the same extent in REM and NREM sleep. The role of sleep mechanisms in the generation of visual hallucinations is well-recognized in narcolepsy in the case of hypnagogic hallucinations, which are thought to derive from a REM-dissociation state in which dream imagery intrudes into wakefulness. Similar mechanisms have been hypothesized to play a role in the physiopathogenesis of visual hallucinations in various neuropsychiatric disorders. Furthermore, a growing body of evidence indicates that not only REM but also NREM processes, such as arousal-related processes, may play a role in the physiopathogenesis of hallucinations in the aforementioned disorders. The role of these processes has been most extensively documented in visual hallucinations occurring in the context of delirium tremens and Parkinson's disease.

Brain↗
PubMedDate not supplied

Clinical evaluation of 14 patients with the Charles Bonnet syndrome (isolated visual hallucinations).

A group of 14 patients with isolated visual hallucinations who met the criteria proposed by Gold and Rabins for Charles Bonnet syndrome (with the exception of the criterion "hallucinations are stereotyped") underwent psychiatric, neurologic, and ophthalmologic tests. Additional common characteristics of the hallucinations included the absence of personal meaning of the content of the hallucinations and the disappearance of the hallucinations when the patients closed their eyes. There was no evidence for a relationship of the syndrome to psychiatric disorders. In the majority of cases, ocular pathology and neurologic disturbances were diagnosed. There was also evidence that most patients were suffering from social isolation. From these data it is concluded that a combination of factors is probably responsible for the Charles Bonnet syndrome.

Aged↗
PubMed1992

Self-repair in dialogues of schizophrenics: effects of hallucinations and negative symptoms.

This paper concerns the discourse features of verbal hallucinations and negative symptoms of schizophrenia. A total of 46 schizophrenics, varying in verbal hallucination and in negative symptoms status, and 22 controls were tested on the Reporter Test. The frequency with which they issued inadequate instructions, attempted to repair the inadequacies, and the success of repairs were compared. We observed that schizophrenics, on the whole, issued more wrong and incomplete instructions. This was in part related to their worse working memory, but it was not affected by verbal hallucinations or negative symptoms. We observed, further, that schizophrenics had no particular problems monitoring messages for inadequacies. We did find, however, that schizophrenics with verbal hallucinations had a specific problem with self-repairing wrong instructions. We interpret these results in the framework of Hoffman's (1986b) plan disruption-based model of verbal hallucinations; the Frith (1987) and Frith and Done (1988) internal monitoring model of positive and negative symptoms; and finally Frith and Frith's (1990) model of negative and positive schizophrenia and we use the results to specify the models.

Adult↗