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PubMed2004

Hallucinations in Parkinson's disease--a study of forty three patients.

OBJECTIVE: To see the prevalence of hallucinations in patients with Parkinson's disease and to compare the various parameters between hallucinators and non-hallucinators. METHODS: Forty-three patients of Parkinson's disease were included. Detailed motor assessment was done with UPDRS scales. Assessment was done for the presence of depression and sleep disturbances. The patients were enquired for the presence of depression and sleep disturbance. The patients were enquired for the presence of hallucinations. Hallucination types and associated emotional experience were probed into. Comparative analysis was subsequently done between hallucinators and non-hallucinators. RESULTS: The mean age of the patients was 61.47 years while mean duration of symptoms of PD was 4.30 years. The mean UPDRS II and III scores were 15.18 and 38, respectively. Fifteen patients (34.9%) had experienced hallucinations. The hallucinations described were visual as well as auditory in nature. Majority of these patients (12 out of 15, 80%) had not volunteered about their hallucinations on their own. On analysis of various parameters between the hallucinators and non-hallucinators, it was observed that hallucinators were older and had a higher mean duration of symptoms of PD. The patients with hallucinations had a higher severity of motor symptoms and signs. Hallucinators more commonly had depression and sleep disturbances. Mean dosage of L-dopa equivalent dose was higher in patients with hallucinations as compared to those without hallucinations. On statistical analysis, however, only two parameters were found to be different in a statistically significant manner. These were the duration of illness and the Hoen and Yahr scale (p < 0.05). Also, hallucinations occurred independent of dopaminergic drugs. CONCLUSION: Hallucinations are common source of distress but are often neglected. One should always probe actively into the presence of hallucinations.

Delusions↗
PubMed2005

Hallucinations in Parkinson's disease: a follow-up study.

To study prevalence of hallucinations in patients with Parkinson's disease (PD) during a 1-year period, and identify factors predictive of the onset of hallucinations in patients who were hallucination-free at baseline, 141 unselected outpatients with PD were evaluated prospectively for a set of demographic, clinical, and therapeutic variables and the presence of hallucinations during the previous 3 months. Patient groups were compared with nonparametric tests, and logistic regression was applied to significant data. Follow-up data were available for 127 patients. The hallucination prevalence rates (%) at the first and second evaluation were, respectively, 41.7 and 49.6 for hallucinations of all types (NS), 29.1 and 40.2 for minor hallucinations (i.e., presence or passage hallucinations, and illusions) (P = 0.02), 22.8 and 21.2 for formed visual hallucinations (NS), and 8.7 and 8.7 for auditory hallucinations (NS). Hallucinations rarely started or ceased during the study. The most labile forms were minor hallucinations, which developed in 20% of patients and ceased in 9%. During follow-up, 15% of patients started to hallucinate. Three factors, all present at the first evaluation, independently predicted the onset of hallucinations in patients previously free of hallucinations at baseline (odds ratio; 95% confidence interval): severe sleep disturbances (14.3; 2.5-80.9), ocular disorders (9.1; 1.6-52.0), and a high axial motor score (5.7; 1.2-27.4). Hallucinations have a chronic course in most parkinsonian patients. Factors predicting the onset of hallucinations point to a role of extranigral brainstem involvement and a nonspecific, facilitating role of ocular disorders.

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PubMed2001

Prospective longitudinal assessment of hallucinations in Parkinson's disease.

OBJECTIVE: To monitor the evolution of hallucinations over 4 years in a stratified sample of patients with PD. METHODS: Using a modified version of the Unified PD Rating Scale (UPDRS) Thought Disorder question, the authors stratified patients into five baseline behavioral groups. They recruited up to 20 patients for each group to participate in sequential interviews (Rush Hallucination Inventory) at baseline and 6, 18, and 48 months. UPDRS motor examinations and Mini Mental State Examinations (MMSE) were obtained at baseline and 48 months. Data were analyzed with Wilcoxon rank sum tests, Mantel-Haenszel tests, and Spearman correlations. To determine features that influenced the new development of hallucinations, a cumulative logit regression model of hallucination severity over time was fit using generalized estimating equations. RESULTS: Based on the design stratification, 60 patients had no hallucinations at baseline (20 with no behavioral problems, 20 with sleep fragmentation, 20 with altered dream phenomena). Twenty-nine patients had hallucinations (20 with retained insight and 9 with loss of insight). At 48 months, the authors could account for all but two subjects (98% retrieval). In 4 years, the presence of hallucinations increased (33% at baseline, 44% at 18 months, and 63% at 48 months, p < 0.0001). The presence of frequent hallucinations (at least three times weekly) also increased (p = 0.0002). Having hallucinations at baseline or at any given assessment was a strong predictor at all follow-up evaluations of continued hallucinations (p < 0.0001). Hallucinations were not associated with increased mortality (chi(2) = 0.59, df (1), p = 0.47). Among the 60 subjects without hallucinations at baseline, time was the only significant factor influencing the development of hallucination over 48 months. Baseline age, PD duration, sex, medications, and UPDRS or MMSE scores did not influence the incidence of hallucinations. CONCLUSIONS: This prospective, longitudinal study documents the persistent and progressive nature of hallucinations in PD patients on chronic dopaminergic therapy. The consistent association of hallucinations with combined levodopa/agonist therapy suggests that these drugs may play a role in the pathophysiology of hallucinations.

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PubMedDate not supplied

[Effects of listening to previously hallucinated words by schizophrenia patients in remission: a functional magnetic resonance imaging study of six cases].

BACKGROUND: Despite immense importance of auditory verbal hallucinations (AVHs) in the phenomenology of schizophrenia, the neurocognitive and neurophysiological bases of AVHs remain obscure. On the neurocognitive level, it has been proposed that AVHs arise from the disordered monitoring manifested by patients' inability to recognize their inner speech as being their own. On the neurophysiological level, the AVHs have been attributed to the aberrant activity in the primary auditory cortex (Heschl's gyrus). Although interesting, these models cannot account for the very specific and restricted content of AVHs in individual patients. The specific content of AVHs persists across different psychotic episodes even after extended periods of remission. Furthermore, the AVHs are usually triggered by emotionally charged and stressful situations. DESIGN: We hypothesized that even during absence of AVHs, when patients are in remission, the verbal content remains present in the latent, pre-clinical form. In order to elucidate potential cerebral substrates of the dormant AVHs content, we employed functional magnetic resonance imaging (fMRI) in 6 schizophrenia patients in total remission of AVHs for at least 12 months, during listening to the words hallucinated by them in the past. Specifically, we created the list of previously hallucinated words for each patient and matched the words in terms of length, structure, emotional valence, semantic category and frequency of usage with the non-hallucinated words. Moreover, each patient was paired demographically with the control participant who was presented with the same words. We predicted that exposure to the hallucinated versus non-hallucinated words would result in increased activation in cerebral areas associated with cognitive and emotional content of previously experienced AVHs in patients, whereas the same comparison will not produce any significant changes in blood oxygen level-dependent (BOLD) signal in control participants. In addition, based on existing neuroimaging data obtained during experience of AVHs, we hypothesized that previously hallucinated words may elicit greater activation in the primary auditory cortex than the non-hallucinated words in patients. Each pair of participants was analyzed separately. RESULTS: The most consistent finding in patients, absent in all control participants, was significant activation in the orbitofrontal and medial prefrontal cortex (PFC) during listening to previously hallucinated versus non-hallucinated words. The orbitofrontal and medial PFC are both part of corticolimbic system and play an important role in cognitive control of emotion processing. DISCUSSION: Thus, present results imply that previously hallucinated words, even in remission, are associated with inappropriate emotional response on neurophysiological level in schizophrenia patients. The relative hyperactivation of orbitofrontal and medial PFC in patients may stem from and/or may contribute to anomalous neural plasticity and disordered connectivity in the corticolimbic circuitry. This in turn could lead to attribution of excessive emotional salience to normally neutral stimuli and over time via process of sensitization could result in hallucinations. Potential normalization of this dysfunction could reduce patients' susceptibility to experience AVHs in stressful situations. In addition to observed hyperactivations in the PFC, some schizophrenia patients exhibited anomalous BOLD signal in other regions of the corticolimbic system such as anterior cingulate gyrus and parahippocampal gyrus. These additional anomalies could be related to greater affective sensitivity to the hallucinated versus non-hallucinated words in some patients. CONCLUSION: Finally, in contrast to our initial hypothesis we did not observe any significant differences between processing of the hallucinated versus non-hallucinated words in the primary auditory cortex. In retrospect, this result is not surprising because patients did not experience internally generated AVHs while in the scanner, but instead were exposed exclusively to externally generated stimuli.

Adult↗
PubMed1993

Patients' attitudes toward hallucinations.

OBJECTIVE: This study examined patients' attitudes toward their hallucinations by assessing their beliefs about the purposes served by hallucinations and the adverse effects of hallucinations. It also investigated whether these attitudes were related to characteristics of the hallucinations or of the patients, whether the attitudes changed after treatment, and whether attitudes before treatment predicted the presence or absence of hallucinations after treatment. METHOD: Fifty hallucinating psychiatric inpatients were given semistructured interviews shortly after admission to the hospital and again shortly before discharge. The interviews elicited detailed descriptions of 12 phenomenologic characteristics of hallucinations and 11 attitude variables. RESULTS: The majority of subjects reported some positive effects of hallucinations. The presence of olfactory hallucinations and the ability to predict hallucinations were significantly related to valuing hallucinations. Attitudes usually did not change with treatment; when they did change they usually became more positive. Subjects who valued hallucinations more before treatment were significantly more likely to be hallucinating after treatment. CONCLUSIONS: The findings are consistent with the idea that psychological factors contribute to the expression of hallucinations. Assessing adaptive functions of hallucinations may predict whether hallucinations will respond to treatment and identify fruitful areas for psychosocial intervention.

Adolescent↗
PubMed1998

[Psychopathological study on "hallucination of soliloquy" in a case of schizophrenia].

We present what appears to be the first reported case of schizophrenia with hallucinatory soliloquy. An appropriate name for this symptom might be "hallucination of soliloquy." A thirty-year-old man had been laboring under delusions of persecution and auditory hallucinations in the form of being blamed by others after changing his job at the age of twenty-eight. He consulted our hospital because of unintentional "soliloquy." He complained that he had been maltreated in his new work place and that this stress made him talk to himself. The contents of his "soliloquies" were nonsensical; for example, he would grumble about his colleagues or the plot of a teleplay that he had seen the previous day. During his "soliloquies" he had the vivid sensation of both speaking and hearing his own voice, but the episodes actually lacked vocalization. As a result of therapy, the patient's disorder gradually shifted from "soliloquy" to "silent soliloquy," then to "breathing hard," before finally disappearing. We are aware of a similar symptom, "delusion of soliloquy" (Y. Kasahara et al.), in which the patient believes that he unintentionally spoke to himself and that everyone learned his secrets through his soliloquy. In comparison, our "hallucination of soliloquy" is unique in that it is an abnormal experience of both speaking and hearing. From the viewpoint of traditional symptomatology, "hallucination of soliloquy" is composed of auditory hallucinations, which are experiences of hearing, and psychomotor hallucinations, which are experiences of speaking. In other words, it is a simultaneous experience of both thought resonance and "hallucination verbale psychomotrice" (J. Séglas) or "Halluzination des Muskelsinns" (A. Cramer) of the speech apparatus. However the overall concept of "hallucination of soliloquy" deviates from both thought resonance and "hallucination verbale psychomotrice" or "Halluzination des Muskelsinns." For a different point of view, we refer to L.S. Vygotsky's studies on inner speech. A comparison of "hallucination of soliloquy" with inner speech suggests that "hallucination of soliloquy" is "inner speech which is converted into outer speech" or "egocentric speech without vocalization." S. Kato notes that two patterns are found in the schizophrenic discourse, mirroring discourse and deviant discourse, which are named after mirroring and deviant characters concerning the ordinary linguistic code. The former simulates the ordinary linguistic code. In mirroring discourse, the patient almost literally imitates and repeats customary discourse such as an authority's speech or television. The latter is characterized by deviation from human actuality or the existing linguistic code and is represented by delusions, neologisms, and incoherent speeches. It has been suggested that mirroring discourse has moments of return to actuality, while in deviant discourse the patient remains entirely in the delusional world. It is said that discourse is realized in the deviant mode in the case of ordinary auditory hallucinations. In the case of "hallucination of soliloquy," the discourse occurs in the patient's own mind and is spoken through his own mouth, in short, it is realized in mirroring mode. We conclude that "hallucination of soliloquy" has the characteristic of mirroring discourse, which is realized in mirroring mode. We suggest that "hallucination of soliloquy" is schizophrenic auditory hallucination that has self-healing moments.

Adult↗
PubMed2004

Spatial characteristics of hallucinations associated with sleep paralysis.

INTRODUCTION: Spatial properties of hallucinations have received relatively little systematic investigation. We present evidence from a web-based study of the spatial properties of a broad array of hallucinations associated with sleep paralysis. Predictions regarding spatial characteristics of hallucinations were based on proposed neurophysiological mechanisms underlying different types of hallucinations. METHOD: Distributions in three dimensions as well as distance and dispersion measures were assessed for 279 experient for two general categories of hallucinations: Intruder hallucinations--including presence, visual, and auditory hallucinations; and Vestibular-Motor (V-M) hallucinations--including floating, flying, illusory motor movements, out-of-body experiences (OBEs), and autoscopy. RESULTS: For all spatial measures, Confirmatory Factor Analysis revealed that Intruder and V-M hallucinations constituted distinctive factors. In addition, Intruder hallucinations were experienced as occurring close to, usually within a meter of, the experient, whereas V-M hallucinations involved excursions of considerable distance, often beyond the immediate environment. V-M hallucination distance was positively associated with vividness of V-M hallucinations, whereas Intruder hallucination distance was negatively correlated with theoretically related contact hallucinations (pressure, obstructed breathing, pain, choking, and touch). CONCLUSION: The differences in the spatial characteristics of Intruder and V-M hallucinations largely corroborated predictions based on the respective hypothesised neural substrates of a threat activated vigilance system and a bodily-self neuromatrix.

Journal Article↗
PubMed2005

Frontal dysfunction contributes to the genesis of hallucinations in non-demented Parkinsonian patients.

BACKGROUND: Hallucinations occur in patients with Parkinson's disease (PD) with reported prevalence ranging from 8% to 40%. Hallucinations are significantly associated with dementia in PD, but little is known about possible distinctive cognitive features of non-demented PD patients who develop hallucinations. OBJECTIVE: The aim of the study was to assess selected cognitive abilities in non-demented PD patients with and without hallucinations in order to identify specific neuropsychological correlates of such phenomena. METHODS: Forty-eight consecutive patients with PD and Mini Mental State Examination (MMSE) > or = 23 were examined for the presence of hallucinations and assessed on standardized neuropsychological tasks for semantic and phonological fluency, verbal learning and logical abstract thinking; disease severity was staged according to Hoehn and Yahr scale. RESULTS: Fourteen (29.2%) of 48 patients experienced hallucinations. There was no difference between hallucinators and non-hallucinators on demographic variables, disease severity and dose of any pharmacological treatment. Disease duration was significantly longer in hallucinator vs non-hallucinator patients (p = 0.02). Patients with hallucinations scored significantly lower than patients without hallucinations only on verbal learning-immediate recall task (p = 0.0324), and semantic and phonological fluency tasks (p = 0.0005 and p = 0.0036, respectively). CONCLUSIONS: Our results suggest that PD patients with hallucinations show reduced performance on tasks that explore executive functioning as compared with non-hallucinators. Therefore, executive dysfunction may be considered as a risk factor for the development of hallucinations in non-demented PD patients.

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PubMed2005

Hallucinations in bipolar disorder: characteristics and comparison to unipolar depression and schizophrenia.

OBJECTIVE: As there is very little research on the topic, we compared the frequency and the type hallucinations among hospitalized patients diagnosed with bipolar disorder (BPD) versus other major psychiatric illnesses. METHODS: At admission, all patients hospitalized at the Department of Psychiatry at the Freie Universität Berlin (1981-2001) underwent comprehensive assessments using the standardized Association for Methodology and Documentation in Psychiatry (AMDP) system. We used these data to compare risks and types of hallucinations and associated factors by bivariate and multivariate testing in patients diagnosed with BPD, major depression, or schizophrenia. RESULTS: At admission, the cross-sectional prevalence of current hallucinations among 4972 hospitalized subjects ranked: schizophrenia (61.1%), bipolar mixed (22.9%), bipolar manic (11.2%), bipolar depressed (10.5%), unipolar depressed (5.9%). The most frequent hallucinations across all patients were auditory, followed by somatic and visual hallucinations. There were only minor age or sex differences in risk of hallucinations. Compared with patients diagnosed with schizophrenia, hallucinations among patients with BPD were less severe, more visual and less often auditory. Characteristics of hallucinations were similar among manic and both bipolar- and unipolar-depressed subjects. Among patients with major affective disorders, those with hallucinations were less well-educated, had higher anxiety scores, less insight into the illness, and their hospitalizations averaged 17% longer. Across all diagnoses, hallucinations, particularly olfactory, were significantly associated with delusions. Hallucinations in BPD were most often accompanied by persecutory delusions; delusions of grandeur were least associated with hallucinations. CONCLUSIONS: This study provides detailed descriptive data regarding the frequency (cross-sectional) and characteristics of hallucinations in a large sample of patients with BPD, major depression or schizophrenia. Our results suggest a link of lower education and the presence of hallucinations in major affective disorders. The significance of this finding, as well as the role of anxiety in hallucinating patients, requires further study.

Adult↗
PubMed1998

Auditory hallucinations in Parkinson's disease.

Whereas visual hallucinations are often found among patients with Parkinson's disease, the occurrence of auditory hallucinations has never been systematically documented. The occurrence, past and present, of auditory hallucinations has been studied in 121 consecutive patients with Parkinson's disease attending a movement disorders clinic. The cognitive state was evaluated using the short mental test (SMT). Hallucinations were reported for 45 patients (37%); 35 (29%) had only visual hallucinations and 10 (8%) both visual and auditory hallucinations. No patient reported auditory hallucinations unaccompanied by visual hallucinations. The auditory hallucinations occurred repeatedly, consisting of human voices. They were non-imperative (n=9), non-paranoid (n=9), and often incomprehensible (n=5). They were not obviously influenced by the patients' age, duration of disease, or treatment with levodopa. Cognitive impairment was more common among hallucinating patients (64%, 50%, and 25% among patients with visual hallucinations, auditory hallucinations, and nonhallucinating parkinsonian patients respectively). Depression necessitating antidepressants was present in five of 10 and other psychotic features in six patients with auditory hallucinations. It is concluded that auditory hallucinations occur in Parkinson's disease, particularly in patients who also have visual hallucinations and are cognitively impaired.

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PubMed2005

Hallucinations and sleep disorders in PD: six-year prospective longitudinal study.

OBJECTIVE: To prospectively assess the relationship of hallucinations to sleep disorders in patients with Parkinson disease (PD) over 6 years. BACKGROUND: Several studies suggest an association between hallucinations and sleep disruption, but no longitudinal study has examined their progression and relationship, nor whether sleep alterations predict future hallucinations. METHODS: Eighty-nine PD patients were recruited to fill cells of normal sleep without hallucinations (n = 20); sleep fragmentation only (n = 20); vivid dreams/nightmares (n = 20); hallucinations with insight (n = 20); hallucinations without insight (n = 9). At baseline, 6 months, 18 months, 4 years, and 6 years, sleep disorders and hallucinations were assessed by standardized scales with the longitudinal data analyzed by generalized estimating equations and other nonparametric tests. RESULTS: At 6 years, we could account for all subjects (49 interviewed, 40 deceased or too ill for interview). Hallucination prevalence and severity increased over time (p < 0.0001). The odds of being a hallucinator increased by a factor of 1.39 at each successive time point. Sleep disorders, however, fluctuated widely among patients and time points, with no evidence of progression in severity (p = 0.73). The prevalence of sleep fragmentation did not differ between subjects with vs without hallucinations (OR = 1.43, p = 0.13). The presence of vivid dreams/nightmares, however, was highly correlated with the concurrent presence (OR = 2.32) and severity of hallucinations (OR = 3.02, both p < 0.0001). Vivid dreams/nightmares among non-hallucinators did not predict future development of hallucinations (OR = 0.94, p = 0.51). CONCLUSIONS: Hallucinations and global sleep disorders follow different patterns of progression in Parkinson disease and are separate behavioral abnormalities. Sleep alterations are not necessarily harbingers of hallucinations.

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