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PubMed2003

A novel clinical pattern of visual hallucination after zolpidem use.

BACKGROUND: Zolpidem is a new hypnotic that is supposed to have fewer side effects than traditional benzodiazepines. Some psychotic reactions, such as visual or hypnagogic hallucinations, have been reported to be associated with zolpidem use. CASE REPORT: A young female experienced three episodes of hallucination associated with the use of zolpidem. The visual or hypnagogic hallucination happened after she had stopped zolpidem and then restarted it 2 days later. CONCLUSION: We postulate that hypnagogic or visual hallucinations associated with zolpidem use may be related to rapid withdrawal and restarting of zolpidem. The possible mechanism may be associated with the changes in the GABAA receptor. Avoiding "as needed" use of zolpidem and using the lowest effective dose may prevent these adverse effects.

Adult↗
PubMed2002

A computational morphometric MRI study of schizophrenia: effects of hallucinations.

Quantitative magnetic resonance imaging (MRI) studies in patients with schizophrenia have shown reliable deficits in global tissue volume as well as some regionally specific changes, particularly in the temporal and frontal lobes. Recent technical advances have enabled automated voxel-wise analyses, which have the advantage of facilitating whole brain coverage without the restrictions of anatomically defined regions of interest and imperfect rater reliability. We used such a method to estimate voxel composition from segmentation of bivariate, dual-echo spin-echo data in 72 men with schizophrenia. Of these, 41 had a prominent history of auditory-verbal hallucinations and 31 had no such history. The patients were compared with 32 age, gender, handedness and IQ matched healthy controls. The study revealed localized areas of reduced grey-matter tissue proportion aggregating around the medial temporal lobes, the insulae, orbito-frontal cortex including anterior cingulate, and the precuneus (and lingual) gyri, in the schizophrenia patients as a whole. There were also reductions in white-matter tissue proportion extending along much of the large anterior-posterior frontal tracts in the right hemisphere. Small regions of increased grey matter were also noted in the right inferior parietal lobe. A contrast between the hallucinator and non-hallucinator patient groups showed a single region of reduced grey-matter tissue proportion affecting the left insula and adjacent temporal lobe. These data confirm the utility of voxel-based morphometric methods in schizophrenia research and point towards disruption to a 'paralimbic' neural network, as underlying schizophrenic psychopathology in general, with abnormalities of the left insula specifically related to hallucinations.

Adult↗
PubMed2002

Transient activation of a somatosensory area in painful hallucinations shown by fMRI.

The disturbance of somatosensory perception and bodily experiences, including somatosensory hallucinations, are main features of the coenaesthesia sub-syndrome of schizophrenia. We used functional MRI to study a coenaesthesia patient with rapidly fluctuating painful somatosensory hallucinatory perceptions. Transient brain activations accompanying hallucinations were similar to the pattern elicited in a control experiment (non-painful tactile stimulation). However, an area in the medial parietal cortex, including parts of the precuneus and previously characterised as a supplementary sensory area, was activated significantly stronger during hallucinations than the control condition. This finding demonstrates elevated brain activity in a somatosensory area accompanying painful somatic hallucinations.

Brain Mapping↗
PubMed2004

Cortical activity associated with auditory hallucinations.

Auditory hallucinations are one the most enigmatic and hampering symptoms associated with schizophrenia. Non-invasive functional imaging techniques have begun to delineate the underlying neuronal basis. We investigated the spontaneous magnetoencephalographic activity in a 33-year-old male schizophrenic patient and compared the results to those obtained from 13 healthy controls. Despite current neuroleptic medication (clozapine) the patient was still suffering from auditory hallucinations. Using the dipole density method, we were able to demonstrate an increase of fast MEG activity (12.5-30 Hz) in the left auditory cortex associated with hallucinations. This activity was absent in healthy controls. We conclude that an increase in fast MEG activity in the auditory cortex is a neurophysiologic correlate for auditory hallucinations in schizophrenia.

Adult↗
PubMed1997

Visual hallucinations after enucleation.

Visual phenomena are frequently reported in patients after ocular trauma, surgery or progressive visual degeneration. In particular, hallucinations are often seen by patients following enucleation. Whereas these visions can be verbally described to the physician, they can never actually be seen. This article focuses on the case of a female artist who experienced visual hallucinations after enucleation of her dominant right eye. In addition to her verbal descriptions, she was able to express these hallucinations visually on canvas. Her case offers insight to caregivers about the nature of visual hallucinations in patients with similar experiences. A review of the general characteristics and etiologies of such visual phenomena is also included.

Aged↗
PubMed2004

Visual hallucinations during prolonged blindfolding in sighted subjects.

The authors report the occurrence of visual hallucinations of varying complexity in 13 normal subjects after sudden, complete, and prolonged visual deprivation. The subjects were all healthy individuals with no history of cognitive dysfunction, psychosis, or ocular pathology. They wore a specially designed blindfold for a period of five consecutive days (96 hours) and were asked to record their daily experiences using a hand-held microcassette recorder. Ten (77%) of the subjects reported visual hallucinations, which were both simple (bright spots of light) and complex (faces, landscapes, ornate objects). The onset of hallucinations was generally after the first day of blindfolding. Subjects were insightful as to their unreal nature. These results indicate that rapid and complete visual deprivation is sufficient to induce visual hallucinations in normal subjects.

Adult↗
PubMed2005

Early psychological intervention for auditory hallucinations: an exploratory study of young people's voices groups.

Twenty to fifty percent of people with a diagnosis of schizophrenia continue to hear voices despite taking neuroleptic medication. Trials of group cognitive behavioral therapy for adults with auditory hallucinations have shown promising results. Auditory hallucinations may be most amenable to psychological intervention during a 3-year critical period after symptom onset. This study evaluates the effectiveness of group cognitive behavioral therapy (CBT) for young people with recent-onset auditory hallucinations (N = 22), using a waiting list control. Outcome measures were administered at four separate time points. Significant reductions in auditory hallucinations occurred over the total treatment phase, but not over the waiting period. Further investigations in the form of randomized controlled trials are warranted.

Adolescent↗
PubMed2004

Visual, tactile, and phobic hallucinations: recognition and management in the emergency department.

OBJECTIVES: The purposes of this case series are to review the acute manifestations of hallucinatory phenomenon in young children, with a focus on visual, tactile, and phobic hallucinations (VTPH) as an important part of the differential diagnosis; and to describe 10 children who presented to the Children's National Medical Center Emergency Department (CNMC ED) with VTPH. METHODS: The medical records of children identified with VTPH who were evaluated during a 20-month period in 1998 to 1999 were reviewed. The diagnosis was established if the hallucinations were well documented as being anxiety-related, not auditory, and with no evidence of underlying organic etiology. All cases were initially screened in the emergency department. Demographic information included age, gender, duration, and description of symptoms, stressors, family psychiatric history, and outpatient treatment. RESULTS: Ten children with this disorder were encountered. VTPH can be differentiated from other causes of hallucinations in that the children are preschool to young school age; their hallucinations are tactile and visual, presenting at night; and symptoms are anxiety-based but short-lived. When toxins, drug reactions, central nervous system, and febrile etiologies are ruled out, timely consultation with the psychiatry team can eliminate costly and time-consuming procedures and avoid further emotional distress for the child and family. CONCLUSIONS: VTPH is a more commonly occurring disorder than previously reported in the pediatric emergency medicine literature. Emergency physicians who recognize the characteristics of this diagnosis are encouraged to seek psychiatric consultation rather than performing unnecessary and costly diagnostic tests.

Anxiety↗
PubMed2001

Brain-mind states: reciprocal variation in thoughts and hallucinations.

The exclusion of thinking from recent studies of sleep mentation has hindered a full appreciation of how cognitive activity differs across the states of waking and sleep. To overcome this limitation, this study investigated thoughts and hallucinations using experience sampling, home-based sleep-wake monitoring, and formal analyses of the psychological data. The prevalence of thoughts decreased gradually from waking through sleep onset and non-REM sleep, to reach its nadir in REM sleep, whereas hallucinations increased sharply across these states. Furthermore, multiple occurrences of hallucinations but not of thoughts increased significantly from sleep onset through non-REM sleep, to a peak in REM sleep. This reciprocity in thoughts and hallucinations might reflect a progressive shift from high to low aminergic-to-cholinergic neuromodulatory ratios across wake-sleep states, accompanied by an array of changes in the regional activation patterns of the brain.

Adolescent↗
PubMed1997

Subclinical hallucinations and delusions in nonpsychotic adolescents.

A number of studies have suggested that clinical populations of adolescents may report hallucinations and/or delusions without meeting criteria for a psychotic disorder. The purpose of this study was to provide information about the prevalence and symptom correlates of these subclinical hallucinations and delusions that occur in a nonpsychotic population of adolescents. Thirty-eight adolescents from a residential program and day treatment center were assessed with respect to hallucinatory experiences, ideas of reference, paranoid ideation, dissociative experiences, depressive symptomatology, and schizotypal cognitions. Results of this study indicated that 33% of the participants reported having experienced auditory hallucinations, and 24% reported having had delusional ideas. In addition, the results suggest that subclinical auditory hallucinations may have an especially strong relation with dissociative processes, whereas subclinical delusions appeared to be most strongly correlated with schizotypal thought processes. The results of this study begin to clarify the phenomenon of hallucinatory and delusional experiences in a nonpsychotic population.

Adolescent↗
PubMed1983

Hallucinations in patients admitted to a geriatric psychiatry service: review of 42 cases.

Although hallucinatory experiences may be relatively common among the elderly, isolated, and infirm, their frequency has been the subject of little research. Patient records of admissions to a 12-bed geriatric psychiatry service over three and a half years were reviewed for documented presence of hallucinatory symptoms. Hallucinations were documented in 15 per cent of the cases. Although acute and chronic brain syndromes and schizophrenic disorders were disproportionately represented in the hallucinating sample, affective disorders were also represented. A significant number of persons in this sample were single and had been living alone prior to admission and were described by family members or others as having "independent" or "reclusive" personality styles. In the majority of cases there was no history of psychiatric illness, and the individuals were distressed by the hallucinatory experiences. Symptom management is discussed in the context of factors that appear to affect occurrences and types of hallucinations and the responses to hallucinations in elderly patients.

Aged↗
PubMed1982

Effect of the benzodiazepine derivative estazolam in patients with auditory hallucinations. A multicentre double-blind, cross-over study.

The main aim of this study was to test the effect of the triazolobenzodiazepine, estazolam, on auditory hallucinations. Fifty-eight patients (28 male, 30 female) with auditory hallucinosis that had responded poorly to neuroleptics alone, were included; most patients were chronic schizophrenics, and most patients were maintained on previous neuroleptic treatment during the trial. Each patient was treated for three consecutive 3-week periods, and randomly allocated to receive estazolam (1 + 1 + 4 mg) either in the first and third, or in the second period. Similar-looking placebo tablets were given in the control periods. These were seven drop-outs, three of them due to somnolence on estazolam. In both treatment groups there was a significant (but not significantly different) improvement during the first 3-week period, with regard to both global clinical state and auditory hallucinations. During the second and third periods, however, the two groups differed significantly, in that improvement of global state and hallucinosis was seen on estazolam, and deterioration on placebo. It is concluded that estazolam (as an addition to neuroleptics) had a significantly better effect than placebo on the global clinical state, on the frequency of, and attitude towards the hallucinations, and also on the single symptoms "Compulsive thoughts" and "Visual hallucinations" (items in the Comprehensive Psychopathological Rating Scale). There were few side effects except drowsiness. Possible pharmacokinetic and pharmacodynamic interactions between benzodiazepines and neuroleptics are discussed briefly.

Adult↗
PubMed1992

Persistent auditory hallucinations correlate with the size of the third ventricle in schizophrenic patients.

In a study of psychotherapy in schizophrenic patients, the existence of certain clinical and anamnestic variables, such as persistent auditory hallucinations, was found to correlate with a negative outcome. To test whether these clinical variables could be a sign of organic brain abnormality, the records of 33 schizophrenic patients who had been examined by computerized tomography (CT) were investigated regarding the occurrence of these symptoms. A significant correlation was found between width of the third ventricle and the occurrence of such auditory hallucinations, which also persisted between acute phases. No correlation was found between the CT measures and other clinical characteristics, including hallucinations rated at admission by the Comprehensive Psychopathological Rating Scale (CPRS). The results are interpreted to suggest a disturbance of diencephalic brain regions in a subgroup of schizophrenic patients that are further characterized by persistent auditory hallucinations and a lack of response to psychodynamic psychotherapy.

Adult↗
PubMed1993

Bereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life.

Ratings of grief reactions, post-bereavement hallucinations and illusions and quality of life were made during the first year after the death of a spouse among 14 men and 36 women in their early seventies. In both sexes, the reactions were generally moderate or mild and characterized by loneliness, low mood, fatigue, anxiety and cognitive dysfunctioning. Feeling lonely was the most persistent problem during the year. Post-bereavement hallucinations or illusions were very frequent and considered helpful. Half of the subjects felt the presence of the deceased (illusions); about one third reported seeing, hearing and talking to the deceased (hallucinations). Former marital harmony was found to make a person more prone to loneliness, crying and hallucinations or illusions. The quality of life was significantly lower among the bereaved than among married people and those who never married, but equalled that found among divorcees.

Aged↗
PubMed1999

New methods for studying hallucinated 'voices' in schizophrenia.

The mechanism of hallucinated speech or 'voices', a symptom commonly reported by schizophrenic patients, is poorly understood. We have undertaken two types of study to explore the hypothesis that this symptom arises from pathologically altered speech perception networks. The first consists of neural network computer simulations of narrative speech perception. We have shown that if these networks are partially disconnected or undergo a 'monamine' neuromodulatory disturbance, 'hallucinated speech' (speech percepts occurring in the absence of phonetic input) are simulated as well as specific speech perception impairments. The latter finding prompted us to conduct parallel studies of actual schizophrenic patients using a 'masked speech tracking' (MST) task. MST requires subjects to track narrative speech the phonetic clarity of which is reduced with superimposed multispeaker 'babble.' Hallucinators demonstrated speech perception impairments and experimentally induced perceptual 'illusions' which clearly differentiated them from non-hallucinators and normal controls. Our results support the hypothesis that 'voices' are spurious products of altered speech perception networks.

Adolescent↗
PubMed1991

Reality monitoring and psychotic hallucinations.

Hallucinating psychiatric patients, patients with delusions but without a history of hallucinations and normal controls were compared on a reality-monitoring task in which they were first required to generate answers to easy or difficult clues and to listen to low-probability or high-probability paired associates. After an interval of one week, the subjects were presented with a list in which their answers to the clues were mixed with the associates and with words not previously presented, and they were required to identify the source of each item (self-generated, presented by the experimenter or new). The psychiatric patients were generally less accurate in identifying the source of the items in comparison with the normal controls. However, hallucinators more often misattributed high cognitive effort self-generated items (answers to difficult clues) to the experimenter than either the psychiatric or the normal controls. The results are interpreted as consistent with the hypothesis that hallucinations are self-generated events misattributed to an external source.

Adult↗
PubMed1997

Coping with hallucinations: exploring stress and coping framework.

This study explored application of the theoretical framework of Lazarus & Folkman (1984) to coping with hallucinations in schizophrenia. Eighty-one patients were interviewed with a structured schedule. Unprompted reports of coping indicated wide use of both 'hallucination-specific' and 'general' strategies. Factor analysis of a coping checklist produced three factors which were utilized in regression analyses. The active acceptance factor may relate to control of hallucinations, the passive coping factor predicted distress reduction but, surprisingly, the resistance coping factor, which contained hallucination-specific coping strategies, predicted poor distress reduction. Clinical and research implications are noted.

Adaptation, Psychological↗
PubMed1982

Tactile hallucinations: conceptual and historical aspects.

A brief historical analysis of the general concept of hallucination is presented and the suggestion is made that it emerged as the unwarranted generalisation of a perceptual model that was meant to apply only to vision and the "distance senses". Against this background the evolution of tactile hallucinations is considered and its interaction with 19th century psychological theory explored. It is concluded that tactile hallucinations are sui generis phenomena which do not fit the conventional model and whose clinical identification rests on criteria so far unclear. A brief review of their taxonomy and diagnostic usefulness is presented. Some wider implications are drawn which should be relevant to the general concept of hallucination.

Aged↗