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PubMed1987

Visual hallucinations associated with pituitary adenoma.

Visual hallucinations were the presenting symptom in three patients with pituitary adenoma. One patient reported only simple unformed hallucinations, which are a well-documented phenomenon occurring in lesions compressing the optic nerves and chiasm. The other two patients, however, experienced complex formed visual hallucinations believed to be of the release type. No evidence of seizure activity responsible for the hallucinations was found; the mechanism producing them is discussed with correlation to operative findings and electrophysiological studies.

Adenoma↗

PubMed2003

Visual hallucinations associated with zonisamide.

Zonisamide is a broad-spectrum antiepileptic drug used to treat various types of seizures. Although visual hallucinations have not been reported as an adverse effect of this agent, we describe three patients who experienced complex visual hallucinations and altered mental status after zonisamide treatment was begun or its dosage increased. All three had been diagnosed earlier with epilepsy, and their electroencephalogram (EEG) findings were abnormal. During monitoring, visual hallucinations did not correlate with EEG readings, nor did video recording capture any of the described events. None of the patients had experienced visual hallucinations before this event. The only recent change in their treatment was the introduction or increased dosage of zonisamide. With either discontinuation or decreased dosage of the drug the symptoms disappeared and did not recur. Further observations and reports will help clarify this adverse effect. Until then, clinicians need to be aware of this possible complication associated with zonisamide.

Adolescent↗

PubMed1990

Persisting hallucinations following childhood sexual abuse.

Hallucinations can persist for many years after childhood sexual abuse. If we recognise this, we will not mis-diagnose psychosis and we may treat with psychotherapy (talk). The hallucinations are distinct from hallucinations in schizophrenia though patients have frequently been given that diagnosis. They would generally be classified as pseudo-hallucinations. They are generally self-referential. They can involve all sensory modalities. Three case reports illustrate this link. Methods for interviewing and providing ongoing help are discussed. Issues in phenomenology and diagnosis are considered. Post-traumatic stress disorder is the best diagnostic fit, though psychotic depression may explain some cases. Freud's case of Frau P (1896) was an early report of this link.

Adolescent↗

PubMed1998

Carbamazepine treatment in a case of musical hallucinations with temporal lobe abnormalities.

OBJECTIVE: The aim of this paper is to describe a case of musical hallucinations with temporal lobe abnormalities responding to carbamazepine treatment. CLINICAL PICTURE: A 63-year-old woman suffered from musical hallucinations accompanied by mild left temporal spike activity. TREATMENT: She received carbamazepine treatment. OUTCOME: Four weeks of carbamazepine treatment diminished her musical hallucinations in parallel with the normalisation of her mild left temporal spike activity. CONCLUSIONS: These findings suggest that carbamazepine can be an effective treatment for musical hallucinations with temporal lobe abnormalities.

Anticonvulsants↗

PubMedDate not supplied

Self-help techniques for auditory hallucinations in schizophrenia.

Even with the best treatment available in the United States, people with schizophrenia often remain troubled by auditory hallucinations. Given the less than optimal results of traditional mental health care, the following exploratory study was conducted. A convenience sample of 33 adult outpatients with schizophrenia were interviewed to elicit what (if any) self-help strategies they used for coping with auditory hallucinations. The patients were all being treated at a community mental health clinic. The self-help strategies reported by the patients included (a) physiological changes, (b) cognitive processes, and (c) behavioral changes. The strategies were then rank-ordered by frequency of use and self-reported effectiveness. Various self-help strategies used by subgroups were examined. Men used techniques that were more isolative, and women used more interpersonal techniques to cope with their auditory hallucinations. Participants hearing hostile "voices" (both men and women) tended to use substances such as alcohol and prescribed medications. The results of this study may be used to increase understanding of socially appropriate self-help coping strategies in patients with schizophrenia who experience auditory hallucinations.

Adaptation, Psychological↗

PubMed2001

Visual hallucinations in giant cell arteritis: association with visual loss.

OBJECTIVE: To evaluate the frequency and characteristics of visual hallucinations (VH) in patients with giant cell arteritis (GCA) and to determine their relationship to other visual phenomena. METHODS: This prospective study included 31 consecutive patients with GCA. All were asked whether they had experienced recent visual phenomena. Patients with visual symptoms underwent a comprehensive ophthalmologic examination. When unusual visual phenomena were reported, patients were asked to describe their nature, duration, and frequency of occurrence. RESULTS: Visual symptoms occurred in 6 patients: permanent visual loss in 5 and amaurosis fugax in one. In 4 of the 5 patients with permanent visual loss, it was preceded by intermittent VH over a period of 1-10 days. Patients were aware of the unreal nature of the visions. Hallucinations disappeared within 2 weeks, but in one patient, recurred 6 months later in association with further visual deterioration. CONCLUSION: The occurrence of visual hallucinations in patients with GCA-associated visual loss is more common than previously appreciated. As hallucinations preceded permanent loss of vision, this phenomenon may serve as a harbinger of imminent visual loss.

Age Distribution↗

PubMed2003

Brain modules of hallucination: an analysis of multiple patients with brain lesions.

We systematically reviewed the localization of focal brain lesions that cause isolated hallucination in a single sensory modality. Case reports of post-lesion nonparoxysmal hallucination in 1 (and only 1) of 3 sensory modalities (i.e., visual, auditory, somatic) were reviewed, and the content of the qualitative descriptions was analyzed for each modality. The lesion is practically always located in the brain pathway of the sensory modality of the hallucination. There seem to exist localized sensory brain circuits that in healthy people diminish the intensity of internal sensory representation. After a lesion, hallucinosis seems to be caused also by compensatory overactivation of tissue in the nearby brain sensory pathway. This type of hallucination may indeed be termed a "release" form, whereby patients are aware of the hallucinatory nature of their experience, but not usually of "dream centres" as proposed by Lhermitte. Instead, we propose that it is dreaming that should be considered a special case of neural "release."

Adult↗

PubMed2004

[A case of corticobasal degeneration presenting with visual hallucination].

We report a case of corticobasal degeneration (CBD) presenting with visual hallucination. A 65-year-old woman showed clumsiness of the left hand. Clinical symptoms slowly progressed to include rigidity, which was left side dominant, limb-kinetic apraxia of the left hand, disorder of construction and dressing, unilateral spatial neglect, cortical sensory loss and alien limb phenomenon. Cranial MRI showed atrophy of the parietal and medial aspect of the frontal lobes, which was more severe on the right than on the left. SPECT images showed hypoperfusion in the parietal, frontal and temporal lobes, which were similarly more severe on the right than on the left. We diagnosed the patient as having CBD based on the clinical symptoms. Two years' later, she developed recurrent visual hallucinations that were typically well formed and detailed. Since patients with CBD generally do not experience visual hallucination, this case is considered the very rare and indicates the possibility that visual hallucination may be one of the clinical symptoms of CBD.

Aged↗

PubMed1992

Visual, somatosensory, olfactory, and gustatory hallucinations.

Hallucinations that involve any of the sensory modalities may accompany a number of functional and organic conditions. Although characteristics of the hallucinations are not specific, they are characteristic and suggestive of specific disorders. Appropriate evaluation and treatment require consideration of the past psychiatric, neurologic, and medical history; assessment of accompanying psychiatric and neurologic signs and symptoms; and degree of response to conventional therapy. Any patient with hallucinations of recent onset or presenting a significant change in the nature of prior hallucinations, particularly when the patient does not respond to conventional therapy, deserves an evaluation to rule out treatable organic factors.

Female↗

PubMedDate not supplied

[A role of the basal ganglia in the occurrence of visual hallucinations (a hypothetical mechanism)].

A hypothetical mechanism of the basal ganglia involvement in visual hallucinations is proposed. According to this mechanism, hallucination is the result of modulation of the efficacy of corticostriatal synaptic inputs and changes in spiny cell activity due to the rise of striatal dopamine concentration (or due to other reasons). These changes cause an inhibition of neurons in the substantia nigra pars reticulata and subsequent disinhibition of neurons in the superior colliculus and pedunculopontine nucleus (including its cholinergic cells). In the absence of afferentation from the retina this disinhibition leads to activation of neurons in the lateral geniculate nucleus, pulvinar and other thalamic nuclei projecting to the primary and highest visual cortical areas, prefrontal cortex, and also back to the striatum. Hallucinations as conscious visual patterns are the result of selection of signals circulating in several interconnected loops each of which includes one of above mentioned neocortical areas, one of thalamic nuclei, limbic and one of visual areas of the basal ganglia, superior colliculus and/or pedunculopontine nucleus. According to our model, cannabinoids, opioids and ketamine may lead to hallucinations due to their promotional role in the LTD of cortical inputs to GABAergic spiny cells of striatal striosomes projecting to dopaminergic neurons, disinhibition of the lasts, and increase in striatal dopamine concentration.

Basal Ganglia↗

PubMedDate not supplied

The hallucinating patient and nursing intervention.

This paper has been concerned with a patient's problematic behavior pattern, namely hallucinations. The social and dynamic significance of the behavior for the individual have been explored and analyzed and a formulation of possible developmental processes influencing the patient to utilize hallucinations has been discussed. On the basis of these analyses, formulations for a psychiatric nursing treatment plan of intervention have been presented. In conclusion, it is well to bear in mind that the schizophrenic patient, who is hallucinating, is striving to communicate in as clear and straightforward a way as he knows, the nature of his anxieties and experiences, despite how radically different they are from the nurse's, with speech content that is diffucult to follow. Thus, with this understanding, it behooves us as nurses to intervene accordingly and "decode" the hallucinated messages and thereby assist in breaking into the third stage in the evolutionary cycle of a psychosis, as cited by R.D. Laing: Stage 1 = Good (me); Stage 2 = Bad (me); Stage 3 = Mad (not me).

Ego↗

PubMed1989

Negative hallucinations, other irretrievable experiences and two functions of consciousness.

After providing a psychodynamic exploration of negative hallucinations in four clinical cases, the focus of this paper was broadened in an attempt to understand the mechanism of negative hallucination. To this end, after defining the term 'irretrievable experiences', two other examples--preconscious perceptions and infantile amnesia, both analogues to negative hallucination--were examined. A discussion followed concerning two types of 'consciousness': 'consciousness' as a synonym for 'awareness' and 'consciousness' as a distinct psychological state. Next, the role of different functions of each sort of consciousness in the processes of conferring, fixing and retrieving mental contents within particular categories of experience was taken up. Finally, integrating developmental aspects of these same functions, explanations were offered regarding the mechanisms involved in preconscious perception, infantile amnesia and negative hallucinations.

Adult↗

PubMed1988

Command hallucinations and criminality: a clinical quandary.

Clinical literature on the role of command hallucinations in producing antisocial behavior is sparse and fragmented. This article reviews exploratory models of auditory hallucinations and the prevalence of command hallucinations in clinical and forensic settings. In addition, clinical guidelines are offered for assessing the authenticity of command hallucinations and their relevance to criminal behavior within the context of forensic evaluations.

Antisocial Personality Disorder↗

PubMed1986

Musical hallucinations, acquired deafness, and depression.

Musical hallucinations associated with acquired deafness are rarely reported in the psychiatric literature. In the few cases studied no evidence of psychiatric disturbance is noted. The authors describe two patients with musical hallucinations while in a state of nonpsychotic depression. One of these suffered from acquired deafness and no organic pathology was demonstrable in the other. Cessation of musical hallucinations occurred concomitantly in both patients with improvement of the affective state. Depression might have a contributory role in the occurrence of such hallucinations.

Aged↗

PubMed1980

Visual hallucinations and cataracts.

Two cases are presented documenting the occurrence of visual hallucinations in patients with dense, bilateral cataracts. The striking curative effect of cataract extraction is cited. A review of the preceptual release theory of the formation of such hallucinations is offered. Finally, the difference between preoperative hallucinations occurring as an isolated phenomenon, is contrasted with postoperative hallucinations which form part of a generalized behavior disturbance.

Adult↗

PubMed1993

Visual illusions and hallucinations.

Visual illusions and hallucinations may accompany a wide variety of disorders with many different aetiologies; therefore, they are non-specific phenomena. Lesions in the visual pathway may be associated with visual misperceptions. In these cases more exact information about the misperceptions--whether they are monocular or binocular, present in the whole visual field or a hemifield--may contribute to diagnostic accuracy and to a more comprehensive understanding of the patient and his state of mind. Illusions such as perseveration, monocular diplopia and polyopia, and dysmorphopsia may also occur in healthy individuals, but they are found most often in patients with epilepsy, migraine and stroke. These phenomena do not permit exact localization and definition of an aetiology, but lesions in the occipital and occipitotemporal regions near the visual pathway are involved in most cases. Hallucinations always represent a pathological form of perception. They are classified as unformed (photopsias) or formed (complex). Photopsias may be described in terms of colour, shape and brightness. Their wide variety makes it difficult, if not impossible, to arrive at an exact description of their aetiology, but it is possible to define their anatomical origin in some cases. Complex hallucinations suggest an occipitotemporal locus. Whether they appear in the whole visual field or in the hemifield may prove decisive in determining pathogenesis. A number of characteristics permit a rough classification of these phenomena. Complex hallucinations accompany physical illness and are susceptible to psychodynamic interpretation.

Diplopia↗

PubMed1993

[Peduncular hallucination in brain stem cavernous angioma: a case report].

A case of brain stem cavernous angioma associated with peduncular hallucination is reported. A 68-year-old man was admitted with complaints of left sensory disturbance. On the evening of the first hospital day, he developed vividly formed hallucinations. The hallucinations were accompanied by sleep disturbance and agitation. At approximately 2:00 am, he began to feel as though he could see his daughter watching television in a room. At one point he saw vivid pictures. MRI revealed a round mass with a mixed signal intensity core surrounded by a low signal intensity rim in the right brain stem. On the 10th hospital day, there were no hallucinations. On October 12th suboccipital craniectomy was performed and cavernous angioma and the surrounding hematoma was partially removed. Soon after that the patient was discharged with improvement of both ocular movement and left-sided sensory disturbance.

Aged↗

PubMed1998

[Visual hallucinations in ophthalmological and neurological diseases].

Visual hallucination can be defined as visual sensory perception without external stimulation, or something that a patient sees that other observers in the same environment do not see. The images may be unformed (lights, streaks, flashes) or formed (objects, people, scenes). Clinical experience indicates that, despite the infrequency with which they are mentioned, visual hallucinations commonly occur in patients with ophthalmological and neurological diseases. Content, duration and timing of visual hallucinations relate to their cause and provide useful clinical information. This paper reviews the topical, pathophysiological and clinical aspects of visual hallucinations.

Eye Diseases↗