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PubMed1995

A functional neuroanatomy of hallucinations in schizophrenia.

Hallucinations, perceptions in the absence of external stimuli, are prominent among the core symptoms of schizophrenia. The neural correlates of these brief, involuntary experiences are not well understood, and have not been imaged selectively. We have used new positron emission tomography (PET) methods to study the brain state associated with the occurrence of hallucinations in six schizophrenic patients. Here we present a group study of five patients with classic auditory verbal hallucinations despite medication, demonstrating activations in subcortical nuclei (thalamic, striatal), limbic structures (especially hippocampus), and paralimbic regions (parahippocampal and cingulate gyri, as well as orbitofrontal cortex). We also present a case study of a unique, drug-naive patient with visual as well as auditory verbal hallucinations, demonstrating activations in visual and auditory/linguistic association cortices as part of a distributed cortical-subcortical network. Activity in deep brain structures, identified with group analysis, may generate or modulate hallucinations, and the particular neocortical regions entrained in individual patients may affect their specific perceptual content. The interaction of these distributed neural systems provides a biological basis for the bizarre reports of schizophrenic patients.

Adult↗
PubMed1999

The signal detection ability of patients with auditory hallucination: analysis using the continuous performance test.

Signal detection theory is appropriate for analyzing the problem of whether auditory hallucination arises from a sensory or judgmental disorder. In the present study the sensory discrimination ability and decision bias of psychiatric patients with auditory hallucination was investigated by using the visual continuous performance test. Based on signal detection theory the d' (d prime) and the lnbeta value (the natural logarithm of the beta value) were calculated. The d' is indicator of discriminating ability, whereas the lnbeta value is an indicator of decision bias. The psychiatric inpatients with the diagnosis of schizophrenia mainly were divided into 11 patients with auditory hallucinations (AH(+)) and 11 patients without hallucinations (AH(-)). As compared with the AH(-) group, the AH(+) group showed the same d' value and a significantly lower lnbeta value. As compared with the normal control group, the AH(+) group showed a significantly lower d' value and a nearly normal lnbeta value. These results suggest that auditory hallucination is characterized by a cognitive deficit of unreasonably maintaining a relatively risk-taking decision bias in spite of decreased discriminating ability, which opposes the interpretation of Bentall and Slade (1985). The AH(+) group was divided into subgroups with bizarre delusions (BD(+)) and without bizarre delusions (BD(-)). The BD(+) group showed a stronger tendency toward a lower d' value and normal lnbeta value, which the AH(+) group had.

Adult↗
PubMed2000

A narcoleptic patient exhibiting hallucinations and delusion.

A female narcoleptic patient with persistent auditory hallucinations and delusion is reported. These psychotic symptoms appeared before the diagnosis of narcolepsy and before the use of pemoline and clomipramine. On admission to the Department of Neuropsychiatry at the Kurume University school of Medicine, the patient's auditory hallucinations were almost the same as the previous hallucinations. The patient's delusional state improved smoothly after haloperidol administration. After that, the patient related well socially. The persistent auditory hallucinations were correlated with rapid eye movement sleep symptoms during her disease process so that we concluded that her persistent auditory hallucinations and delusion of observation were due to narcoleptic symptoms.

Delusions↗
PubMed2001

Recurrent Lilliputian hallucinations as visual aura symptom in migraine.

Since her early 30s a 72-year-old female migraine sufferer has experienced recurrent episodes of Lilliputian hallucinations occurring at the peak of her severe migraine attacks and lasting between 2 min and 5 min, suggesting that her miniature hallucinations represent a visual migraine aura symptom. The existence of Lilliputian hallucinations of a migrainous nature is confirmed by four similar case reports reviewed from the migraine literature. The occurrence of similar Lilliputian hallucinations in the syndrome of peduncular hallucinosis, due to mesencephalic and/or thalamic lesions, supports the notion that the patient's recurrent Lilliputian hallucinations might have been aura symptoms of basilar migraine.

Aged↗
PubMedDate not supplied

Auditory hallucinations associated with migraine.

OBJECTIVE: Two children experienced auditory hallucinations during migraine (one with migraine without aura and one with migraine with aura). These hallucinations only occurred during headache. BACKGROUND: Auditory hallucinations are rarely reported in patients with migraine. These patients often have other psychiatric or neurologic disorders such as affective disorder or epilepsy. METHODS: Case report and a review of the literature. RESULTS: No other neuropsychiatric disorder was identified in either patient at presentation or upon follow-up. CONCLUSIONS: Auditory hallucinations can rarely occur in patients with migraine. Further study of this association might provide insight to any relationship between migraine, auditory hallucinations, and the temporal lobe.

Adolescent↗
PubMed2000

[Visual hallucinations in Parkinson and Charles Bonnet Syndrome patients. A phenomenological and pathogenetic comparison].

UNLABELLED: Visual hallucinations (VH) are seen in about a third of all patients with Parkinson's disease (PD) and are usually considered to be an early marker or clinical component of a dopaminergic psychosis. Their peculiar phenomenology has not yet been studied in a systematic manner. METHODS: A semi-structured interview was performed twice in 62 PD patients. Different motoric and cognitive disease scales were used. The patients were not demented or depressed and had no other psychotic features other than hallucinations. Their visions was at least 0.6. RESULTS: 22 patients (36%) reported complex visual hallucinations or illusions in both interviews. These patients were not different from the non-hallucinating patients in terms of age, duration and stage of the disease, dosage and type of medication and frequency of cataracts. VH were diurnal in 41% of the patients, nocturnal in 18% of the patients and mixed in 41 patients. They were seen at least once weekly in 67% and they lasted always less than an hour. VH most frequently involved adults, children and pets. They were often mobile and had normal size and physiognomy. Notable emotional reactions were only reported by 18% of the patients. DISCUSSION: The phenomenology of VH in PD differs from VH in exogenous or endogenous psychoses, but is similar to the Charles Bonnet-syndrome (CBS), appearing in elderly patients with different visual deficits. As PD patients suffer regularly from visual deficits of contrast and color perception, a similar pathogenesis to CBS can be hypothesized, with these "minor" and benign VH being due to "release phenomena" in relation to partial visual deprivation. The lack of multimodality hallucinations and of secondary paranoia as well as the clear sensorium are helpful features in distinguishing them from toxic psychosis.

Aged↗
PubMedDate not supplied

[Differential diagnosis of visual hallucinations].

OBJECTIVE: Visual hallucinations in children need a differential diagnostic effort. METHODS AND PATIENTS: In a retrospective cohort study we identified all children, admitted to the Department of Neuropediatrics of a University Hospital between 1.1.2001 and 31.12.2003 suffering from visual hallucinations. All children underwent neurologic examination and electroencephalography (EEG). RESULTS: 14 children with visual hallucinations were identified. Disturbed perception of the size (9 of 14 cases), of the form (5 of 14 cases), and irregular perceptions of movements (5 of 14 cases) were most frequently reported. One child showed a transient hemihypesthesia, the only pathologic finding in the neurologic examination. Three children had features of hypersynchronic activity in EEG: one child undergoing immunosuppressive drug therapy and with a visual hallucination in context of a reversible posterior leucoencephalopathy showed a focal slow background activity, whereas three children had a sharp wave activity. Two of these children fulfilled the criteria for a focal epilepsy, one of them of the frontal lobe, one of the temporal lobe. CONCLUSION: Recurrent visual hallucinations are frequently transient and show clinical and pathophysiologic features reminiscent of infantile migraine. Psychic etiology, focal epilepsy and, under special circumstances, a reversible posterior leucoencephalopathy have to be considered when making a differential diagnosis.

Adolescent↗
PubMedDate not supplied

A source-monitoring account of auditory verbal hallucinations in patients with schizophrenia.

Auditory verbal hallucinations are a common and distressing symptom experienced by patients with schizophrenia. They can be understood as arising from an impairment in reality monitoring-the process by which internally and externally generated events are distinguished. This impairment might arise through primary abnormalities in the reality-monitoring mechanism or through secondary mechanisms (abnormalities in the perceptual characteristics of internally generated events or in the perception of externally generated events). This article examines evidence for and against an association between abnormalities in reality monitoring and auditory verbal hallucinations in schizophrenia. A comprehensive review of the psychological literature suggests that there is little evidence for an association between auditory verbal hallucinations and secondary mechanisms leading to abnormalities in reality monitoring. There is some evidence suggesting that hallucinators show a primary reality-monitoring abnormality that is most apparent when patients are required to distinguish self from other in real time. To draw firmer conclusions, however, it is imperative that future studies select patient populations precisely, match control groups, and use consistent criteria for defining hallucinators.

Attention↗
PubMed1976

Simple formed hallucinations confined to the area of a specific visual field defect.

Thirteen patients with transient or permanent homonymous visual field defects experienced formed hallucinations localized to the affected part of the visual field. The lesion was occipital in 8 instances (infarction 7, porencephalic cyst 1), parietooccipital in 3 (infarction 2, angioma 1) and probably parietal in 2 (epilepsy 1, encephalitis 1). The disorder involved the right hemisphere in 9 cases, the left hemisphere in 3 cases and both hemispheres sequentially in one patient. Hallucinations were accompanied by palinopsia in 2 cases, metamorphopsia in one case and constriction of one pupil in another case. This particular type of hallucination is considered as an irritative phenomenon of the visual association cortex which can be symptomatic of a parieto-occipital lesion and does not necessarily implicate the temporal lobes. Distinctive features about the visions were that they consisted of people, animals or objects. There was no auditory accompaniment and any action that took place was stereotyped and did not tell a story. In most cases, the hallucinations were not clearly related to any visual memory. It is suggested that the visual association cortex amy be responsible for the organization of visual percepts into broad categories of which people, animals and objects are representative. The occurrence of such hallucinations with a visual field defect suggests that the cells of the association cortex are more likely to discharge spontaneously once they are deprived of their normal afferent inflow from the calcarine cortex.

Adolescent↗
PubMed1990

Subvocal activity and auditory hallucinations: clues for behavioral treatments?

Several investigators have suggested that schizophrenic patients may show an increase in subvocal speech (as measured by electromyographic [EMG] activity) during auditory hallucinations (AH), and that the subvocal activity might be antecedent to the hallucinatory experience. The possible relationship between AH and subvocal activity guided the present approach to studying behavioral interventions for AH. Duration of AH and EMG activity were recorded from 20 frequently hallucinating schizophrenic patients under baseline and experimental conditions. Three conditions were designed to interfere with activity of the speech musculature and two were imposed as controls. The data concerning the temporal relationship between EMG activity and self-report of hallucinations were inconclusive. However, one of the experimental conditions (humming a single note softly) reduced the self-report of hallucinations by 59 percent. This condition also increased EMG amplitude over baseline levels. Possible explanations for the effect of humming on hallucinations are discussed.

Adult↗
PubMed1985

Self-report of the frequency and phenomenology of verbal hallucinations.

This study was an assessment of several parameters of verbal hallucinations ("voices") based on the self-report of 52 hallucinating psychiatric patients. These subjects were asked to estimate the frequency of their hallucinations and to rate phenomenological aspects (loudness, clarity, location, reality) of their most recent hallucination. Each parameter was assessed with two visual analogue scales which differed in their wording of the dimension. Results showed that the reliability of the subjects' estimates on the parameters differed greatly. Clarity was most reliably reported and reality was least reliably reported. Historical notions that schizophrenics characteristically perceive external "voices" and that such "voices" are perceived as more real were not supported. There was a significant negative correlation between the perceived location and the perceived clarity of hallucinations. No significant differences in mean parameter scores were found between two groups of subjects, schizophrenics and affective psychotics.

Adult↗
PubMed1987

The role of brief instructions and suggestibility in the elicitation of auditory and visual hallucinations in normal and psychiatric subjects.

The present study is an investigation of the elicitation of auditory and visual hallucinations by brief instructions and the relationship of the report of hallucinatory-type experiences to standard measures of suggestibility. Two experiments were carried out. The first used normal subjects predisposed or not predisposed to hallucinate, as assessed by the Launay-Slade Hallucination Scale (LSHS-A). The second used hallucinating and nonhallucinating psychiatric patients. The high LSHS-A scorers and the hallucinating psychiatric patients were significantly more likely to hear suggested sounds than were their respective controls. High LSHS-A scorers were also significantly more likely to see suggested objects than were their respective controls, although this finding was not replicated in the psychiatric subjects. No significant differences on measures of suggestibility were found between the groups, although in the psychiatric group Barber Test Suggestion and Subjective Involvement scores correlated positively with LSHS-A scores.

Adult↗
PubMed1996

Patients' strategies for coping with auditory hallucinations.

Many patients with psychotic disorders experience persistent auditory hallucinations despite rigorous pharmacological treatment. The experience of auditory hallucinations can heighten anxiety and depression. The high risk of suicide among patients experiencing auditory hallucinations is well recognized. Research in this area has been restricted to small samples or has collected information only on the use of such strategies without investigating their efficacy. The Mental Health Research Institute Unusual Perceptions Schedule incorporates a module focusing on coping strategies. This schedule was administered to 100 subjects, with the aim of investigating the relationship between strategy use and effectiveness, as well as the characteristics of subjects and their disorders. Eighty-one percent of the subjects were worried or upset by their hallucinations. The majority (66%) of the subjects reported they had ways of managing the voices, and 69% of them described at least some success using one or more strategies. There was a striking lack of correspondence between the number of subjects using a method and its related efficacy. No relationship was found between length of illness and number of strategies used. Multidimensional scaling of use and efficacy data revealed three groups of strategies. These groups do not correspond to previous classifications made on the basis of features of the strategies themselves. The pattern of results also suggests that training methods might be used to increase the options for patients troubled by auditory hallucinations.

Adaptation, Psychological↗
PubMed2000

Atypical Charles Bonnet hallucinations: an elf in the woodshed, a spirit of evil, and the cowboy malefactors.

In this article, the authors review the literature on the Charles Bonnet syndrome (CBS), a condition involving visual hallucinations in normal persons with severe sight loss. Attempts to assess the characteristics of this "phantom vision" have resulted in descriptions of a "typical" CBS hallucination. However, the many exceptions to a modal CBS experience cause the authors to postulate two other general categories of CBS hallucinations: a) the atypical sensory/perceptual (ASP), and b) the atypical psychodynamic (APD) hallucinations. Case studies illustrating these two types are provided. Extending the categories of Charles Bonnet hallucinations allows for more specific diagnosis, treatment, and may result in the possibility of greater precision in future research.

Aged↗
PubMed2000

Mental imagery and perception in hallucination-prone individuals.

College students screened for hallucination-proneness using the Launay-Slade Hallucination Scale (LSHS) were compared on measures of self-report vividness of imagery and on behavioral measures of imagery and perception (visual and auditory). Specifically, we tested the hypothesis whether hallucination-prone individuals would show smaller differences between imagery and perception performance, which may be indicative of increased sensory characteristics of mental images. We replicated earlier findings of higher self-report imagery ratings in the high hallucination-prone group. However, the two groups did not differ on five of six behavioral imagery-perception comparisons. On one visual task, hallucination-proneness was associated with larger imagery-perception differences. Our results reveal a dissociation between the level of subjective experience and the information processing level. Although vividness of mental images may be subjectively associated with mild hallucinatory experiences, we suggest that cognitive processes associated with reality discrimination rather than increased perceptual characteristics of mental images may play a role at the information processing level.

Adult↗
PubMed2003

The management of idiopathic olfactory hallucinations: a study of two patients.

OBJECTIVES/HYPOTHESIS: Idiopathic olfactory hallucination is a rare condition. We report two cases of idiopathic olfactory hallucination and a review of the literature that relates to this condition. STUDY DESIGN: A retrospective case study of two patients with idiopathic olfactory hallucination. METHODS: Records of two patients were retrospectively reviewed. RESULTS: The diagnosis of idiopathic olfactory hallucination was confirmed after excluding any intranasal disease or any central nervous system disorder discernible by an electroencephalogram and magnetic resonance imaging. Both patients were successfully treated with sodium valproate. One patient stopped taking sodium valproate because of side effects, only for the symptoms to return, but these were then controlled by phenytoin sodium. The mean patient follow-up time was 3 years 5 months. CONCLUSIONS: The symptoms of some cases of idiopathic olfactory hallucination may be controlled by sodium valproate or phenytoin sodium. We hypothesize that this disorder may be a central phenomenon attributable to reverberating circuits.

Adult↗
PubMedDate not supplied

Threatening auditory hallucinations and Cotard syndrome in Parkinson disease.

Psychotic symptoms are commonly reported in patients with Parkinson disease (PD). In particular, patients experience nonthreatening visual hallucinations that can occur with insight (so called hallucinosis) or without. Auditory hallucinations are uncommon, and schizophrenialike symptoms such as pejorative and threatening auditory hallucinations and delusions that are persecutory, referential, somatic, religious, or grandiose have rarely been reported. The authors present 2 PD patients who experienced threatening auditory hallucinations, without visual hallucinations, and schizophrenialike delusions with detailed description of the clinical phenomenology including 1 patient with Cotard syndrome.

Aged↗
PubMed2004

Stereotaxic rTMS for the treatment of auditory hallucinations in schizophrenia.

Auditory verbal hallucinations in schizophrenia may be due to dysfunctional inner speech-related cortical areas. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be an effective treatment of hallucinations. In a cross-over sham controlled study, we guided rTMS stereotactically to inner speech-related cortical areas in hallucinating patients. These areas were identified individually prior to rTMS using fMRI in a subgroup of our patients. Active stimulation was applied over Broca's area and over the superior temporal gyrus as determined by fMRI, or according to structural images in the remaining patients. rTMS did not lead to a significant reduction of hallucination severity. Conclusively, rTMS has to be regarded critically as a possible novel tool for the treatment of hallucinations.

Adult↗