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PubMed1996

The Misdiagnosis of Hallucinations and Delusions in Persons with Mental Retardation: A Neurodevelopmental Perspective.

The identification of psychotic features in persons with mental retardation is challenging as the presence of hallucinations and delusions are disclosed through verbal self-report. In persons with mental retardation, self-report data is limited in utility because of the neuropsychological impairments that are uniformly reflected in limited communication and linguistic functions. Two major areas of misdiagnosis occur when interpreting reported hallucinations and delusions. First, the patient with mental retardation may experience a true hallucination or delusion, the content of which is very bizarre or disjointed, leading clinicians to identify schizophrenia or psychotic disorders when the condition is far less severe. Second, the patients's reported phenomena are not true hallucinations or delusions, but are instead self-talk, imaginary friends, or fantasy, similar to normal coping mechanisms of children. Mental health professionals must give priority to vegetative symptoms and mood states during the diagnostic assessment. It is also recommended that multiple sources of caregiver data be collected and that psychological projective testing be used as part of the evaluation process. Further, a false-positive strategy should be adopted when initiating treatment, favoring underdiagnosis of psychotic disorders.

Journal Article↗

PubMed2007

On keeping (intrusive) thoughts to one's self: testing a cognitive model of auditory hallucinations.

BACKGROUND: Previous studies have linked intrusive cognitions (hallucinations and obsessions) with inhibitory dysregulation. Combined deficits in intentional inhibition and context memory have been proposed to explain the intrusive nature and perceived nonself origin of auditory hallucinations (Waters et al., 2006). This study tested the prediction, from this model, that individuals with obsessive-compulsive disorder (OCD), who do not mistake the origin of their intrusive thoughts, will show a deficit of intentional inhibition but intact contextual memory. METHOD: The performance of 14 individuals with OCD and 24 healthy controls was compared on two measures of intentional cognitive inhibition and on a context memory task.Results. Participants with OCD were significantly impaired on both measures of inhibition but were not significantly different from controls in any condition of the context memory task. CONCLUSIONS: The predictions were confirmed. Individuals with OCD, like schizophrenia patients with auditory hallucinations, showed impaired intentional inhibition. This impairment might be responsible for the intrusive thoughts reported in both disorders, and might also partially account for the high rates of comorbidity of OCD and schizophrenia. Finally, intact context memory abilities in OCD may contribute to an efficient memory system, and may differentiate this group from those with hallucinations.

Adult↗

PubMed2006

ECT associated musical hallucinations in an elderly patient: a case report.

Electro Convulsive Therapy (ECT) is a medical treatment for severe mental illness in which small, carefully controlled electricity is applied to the brain. This electric stimulation is done in conjunction with anesthesia and muscle relaxant medications to produce a mild generalized seizure. This is used to treat a variety of psychiatric disorders. This is most effective in the treatment of severe depression providing a rapid relief. We report and discuss an unusual presentation of a ninety three year old lady with a diagnosis of Major Depressive Disorder, Recurrent, Severe with Psychotic features (296.34) who experienced musical hallucinations whilst she was treated on ECT. Clinically there was an inverse relationship between the biological symptoms of depression and musical hallucination during the ECT management. Though similar reports have never been reported earlier, we noticed a good association between the initiation of ECT and musical hallucination in our patient. The patient stopped experiencing musical hallucinations and improved of her biological symptoms of depression completely after the full course of ECT.

Journal Article↗

PubMed1984

Complex visual hallucinations and cyclosporine.

Insidious loss of visual acuity and simultaneous onset of complex visual hallucinations were observed in a patient with acute lymphoblastic leukemia who had recently received bone marrow transplantation and was being treated with prednisone and cyclosporine to suppress graft-v-host disease. Problems with visual acuity and visual hallucinations spontaneously ameliorated with reduction and termination of cyclosporine treatment. The complex visual hallucinations caused considerable psychological distress for the patient. These hallucinatory phenomena were placed within the framework of loss of control and decreased competence, often experienced by children with chronic illness. Recommendations for prompt therapeutic intervention were made.

Adult↗

PubMed2000

Visual hallucinations in recovery from cortical blindness: imaging correlates.

OBJECTIVE: To investigate the cerebral metabolic and functional patterns during recovery from cortical blindness. DESIGN: Follow-up study with serial clinical, metabolic, and functional imaging and visual evoked potentials. CASE PRESENTATION: A 24-year-old woman suffered from cortical blindness after cardiac arrest and recovered over a 6-month period. During recovery, she experienced complex visual hallucinations that could be initiated by visual imagery. RESULTS: Initially, the regional cerebral metabolic rate of glucose was severely reduced in the visual and parieto-occipital cortex bilaterally but recovered almost completely. Visual hallucinations led to significant increases of the regional cerebral blood flow in the initially severely hypometabolic parieto-occipital and temporo-lateral cortex. CONCLUSIONS: Recovery of vision was related to normalization of the postlesionally dysfunctional cortex. Visual hallucinations appeared as the clinical correlate of the electrophysiological hyperexcitability of the recovering partially damaged visual cortex.

Adult↗

PubMed1995

Acetylcholine and hallucinations: disease-related compared to drug-induced alterations in human consciousness.

Newly proposed criteria for Lewy body dementia include alterations in consciousness. Lewy body dementia is also associated with a disturbance in cholinergic transmission; neocortical cholinergic deficits in this disorder are more extensive than in Alzheimer's disease and are correlated with symptoms commonly associated with delirium, such as visual hallucinations. The traditional view that derangements of the basal forebrain cholinergic system in Alzheimer's disease relate specifically to memory impairment is assessed in terms of a more general role for cortical acetylcholine in consciousness. This extends the concept that cortical acetylcholine enhances neuronal signal to noise ratio. It is suggested that muscarinic receptor activation in the cortex is involved in confining the contents of the discrete self-reported conscious "stream." In the absence of cortical acetylcholine, currently irrelevant intrinsic and sensory information, which is constantly processed in parallel at the subconscious level, enters conscious awareness. This is consistent with the ability of anti-muscarinic drugs administered medically, recreationally, or ritualistically to induce visual hallucinations and other perceptual disturbances. The hypothesis is explored through comparisons between muscarinic and nicotinic receptor psychopharmacology and between the pathology of the basal forebrain as opposed to pedunculopontine cholinergic systems in different diseases of the human brain affecting consciousness and cognition. The paradoxical effects of muscarinic receptor blockade to induce hallucinations and of REM sleep-associated cholinergic activation of the thalamus to induce dreaming may be related to the differential distribution and activity of muscarinic receptor subtypes or to the differing responses of intrinsic GABA neurons in cortex and thalamus.

Acetylcholine↗

PubMed2003

[Hallucinations in Parkinson's disease].

The appearance of psychiatric symptoms is not rare in the course and treatment of Parkinson's disease. In particular, therapy with L-dopa or dopamine agonists leads to increased dream activity. As with sleep disturbances, this can be a warning signal of paranoid hallucinatory psychosis.However, isolated visual hallucinations before manifest psychosis in Parkinson's must generally be regarded as resulting from medication. They occur in up to 30% of Parkinson's patients and often involve visual and figurative hallucinations. Visual hallucinations most probably result from the combined effect on dopaminergic and serotonergic systems in the CNS. Therapy consists in normalization of H(2)O and electrolyte levels, control of the accompanying medication, reduction of the evening doses of anti-Parkinson's medications, and serotonin antagonists such as clozapine.

Antiparkinson Agents↗

PubMed2002

Is hemispheric language dominance relevant in musical hallucinations? Two case reports.

It has been suggested that musical hallucinations are often due to a focal brain lesion predominantly of right hemispheric pathologies. We report about two patients with musical hallucinations associated with a brain tumor of the right hemisphere. Although both patients were right-handed, one of them had a right hemispheric dominance for language as proven by the Wada test. The musical ability as measured by the Seashore test was not impaired. We conclude that the language dominance of the hemisphere is not primarily relevant for the development of musical hallucinations.

Adult↗

PubMed2005

Visual hallucinations and the Charles Bonnet syndrome.

After dividing clinicians for almost 70 years, Charles Bonnet syndrome has reached an impasse. Defined by a neurologist in the 1930s, the syndrome was intended to eponymize the association of visual hallucinations with age, but evolved into one describing their association with eye disease or, more recently, an etiologically neutral phenomenologic description. Each tradition has its merits but none has defined a specific clinical entity or accounted for visual hallucinations across the spectrum of associated clinical conditions. Recent insights into the neurobiology of vision have shed new light on the problem. Viewed from a neuro-phenomenologic perspective, clinical evidence reveals two distinct hallucination syndromes: one directly related to visual system pathology, the other to pathology in the brainstem or ascending neurotransmitter pathways. The implication is of two independent but interacting pathophysiologic mechanisms and of a need to reassess the classification and management of this common psychopathologic symptom.

Aged↗

PubMed1984

Formed visual hallucinations after metrizamide myelography.

About 12 hours after 77-year-old woman underwent metrizamide myelography of the posterior fossa to elucidate the cause of downbeat nystagmus, she developed formed visual hallucinations consisting primarily of brightly colored geometric shapes, cloud formations, and human figures. Her white blood cell count was 26,000/mm3 and her serum creatine phosphokinase level was markedly increased to 438 units/liter. Two days later, the hallucinations had subsided, the white blood cell count had decreased to 17,000/mm3, and the serum creatine phosphokinase level had decreased to 105 units/liter. The hallucinations were probably caused by penetration of the metrizamide into the temporal lobe and visual association cortex.

Aged↗

PubMedDate not supplied

Isolated visual hallucinations and the Charles Bonnet syndrome: a review of the literature and presentation of six cases.

Vivid visual hallucinations without other psychopathology have been reported for several hundred years. However, there is no consensus on whether these hallucinations should be considered a separate syndrome, the Charles Bonnet syndrome, or whether eye disease or brain disease is a necessary or exclusionary criterion for diagnosing this syndrome. In an attempt to resolve these issues, this article reviews the literature on isolated visual hallucinations and presents follow-up data from six cases. Criteria for diagnosing the Charles Bonnet syndrome are suggested.

Aged↗

PubMedDate not supplied

Auditory hallucinations, posttraumatic stress disorder, and ethnicity.

The occurrence of intrusive auditory perceptions has rarely been addressed in the study of posttraumatic stress disorder. This study examined the background of 59 individuals with combat-related posttraumatic stress disorder. Subjects with and without auditory hallucinations were compared on demographic military and symptom variables. The occurrence of hallucinations among veterans with posttraumatic stress disorder appears to be more frequent among subjects of Hispanic ethnicity. This may have been related to higher combat exposure or social stresses. The occurrence of hallucinations was unrelated to drug abuse and did not appear to be associated with any particular war.

Acculturation↗

PubMed1994

Lilliputian hallucinations and medical illness.

Lilliputian hallucinations have been described in patients with delirium, schizophrenia, seizure disorders, visual disturbances, and brain tumors. The authors report two cases of patients with lilliputian hallucinations, one with AIDS-dementia complex and the other with dementia following head trauma. This is the first time that lilliputian hallucinations have been described in association with such medical conditions.

AIDS Dementia Complex↗

PubMed1985

Hallucinations in patients with major depression. Interactions between CSF monoaminergic and endorphinergic indices.

CSF levels of radioreceptorassayed endorphins Fraction I (EndFI, n = 92) and homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) (n = 118) were measured in patients with major depressive disorders according to Research Diagnostic Criteria (18% were psychotic; 11% hallucinated during the peak of the depressive episode). CSF measures (both "raw" variables and ranks) were uni- and multivariately correlated with both dichotomized and scored measures of hallucinations of any type. Hallucinations were statistically strongly associated with higher HVA levels, irrespective of prior medication with neuroleptics, and with the interactive product HVA X EndFI and the interactive ratio HVA/5-HIAA. Results suggest interactions between dopaminergic, serotonergic and endorphinergic neurotransmission being involved in the biochemical substrate of depressive hallucinatory episodes.

Adult↗

PubMedDate not supplied

Visual "release" hallucinations in juvenile neuronal ceroid-lipofuscinosis.

A child with juvenile neuronal ceroid-lipofuscinosis developed formed and unformed visual hallucinations with the development of blindness. The hallucinations lasted for prolonged periods, were of simple, varied, and novel content and were not associated with any ictal manifestations. The clinical features support a "release" mechanism for the hallucinations.

Adolescent↗

PubMed2006

Hallucination proneness, schizotypy and meta-cognition.

Disordered or maladaptive meta-cognitive processing appears to be a prominent feature for some individuals with a diagnosis of schizophrenia. We sought to establish whether healthy individuals distinguished either in terms hallucination proneness (HP) or level of schizotypy could also be differentiated on the sub-scales of the Meta-cognitions Questionnaire (MCQ), or a modified version of it in which items about worry were replaced with items specifically related to thinking. A total of 106 healthy volunteers completed the Oxford and Liverpool Inventory of Feelings and Experiences and Launay-Slade hallucination scale, the Schizotypal Personality Questionnaire and two versions of the MCQ: the original which assesses five domains of meta-cognition and an adapted version in which items relating to worry had been replaced by items relating to thinking or reflecting on thinking (MCQ-th). ANOVA indicated highly significant differences between three groups of individuals differentiated in terms of high, medium and low proneness to hallucinations on four of the five MCQ sub-scales, and three of the four MCQ-th factors. Regression analyses indicated that the MCQ factors encompassing (1) a sense of uncontrollability of thinking (and the perceived attendant dangers of this) and (2) negative beliefs about thinking related to suspicion and punishment were the strongest predictors of high schizotypy. Individuals who score higher on a measure of HP are more likely to display patterns of meta-cognitive processing that resemble, in certain respects, those reported in individuals with a diagnosis of schizophrenia. High schizotypy predicts a negative appraisal about both the controllability and consequences of thinking.

Adolescent↗

PubMed2005

Frontal nonconvulsive status epilepticus manifesting somatic hallucinations.

Somatic hallucinations are subjective experience of false, strange sensations of things occurring in or to the body. They can be seen in psychotic disorders, but have not been well described as an ictal psychosis in patients with nonconvulsive status epilepticus (NCSE) of frontal origin. We reported a 69-year-old woman who had NCSE of frontal origin manifesting prolonged somatic hallucinations mimicking a psychiatric disorder and initially treated as such. Ictal EEG revealed the frontal focus and ictal single-photon emission computed tomography (SPECT) showed the activation, not only in the frontal area but also in the parietal area as the projected regions, both of which might be associated with the development of her symptoms. She also had two generalized tonic-chronic seizures out of psychosis. Her psychosis and ictal rhythmic discharges on EEG ceased with valproate and she has since remained free from the symptoms. The current case suggests that long-lasting somatic hallucinations could be an ictal psychosis in frontal NCSE and thus an EEG study is needed for an early diagnosis and treatment.

Aged↗

PubMed2005

Change in perfusion, hallucinations and fluctuations in consciousness in dementia with Lewy bodies.

Fluctuations in consciousness and visual hallucinations are common neuropsychiatric features of dementia with Lewy bodies and Parkinson's disease dementia. To investigate potential neural correlates, we compared how changes in brain perfusion over a 1-year period were related to changes in the severity of these key clinical features. We recruited 29 subjects with either Parkinson's disease with dementia (15 subjects) or dementia with Lewy bodies (14 subjects). Cerebral perfusion was measured using HMPAO SPECT at baseline, and repeated 1 year later. The presence of hallucinations (Neuropsychiatric Inventory), severity of fluctuations in consciousness (fluctuation assessment scale) and cognitive ability (CAMCOG) were assessed at both time points. After controlling for changes in cognitive ability and effect of cholinesterase medication, we found a significant correlation between an increase in perfusion in midline posterior cingulate and decrease in hallucination severity. There was also a significant correlation between increased fluctuations of consciousness and increased thalamic and decreased inferior occipital perfusion. We have identified important neural correlates of key clinical features in Lewy body dementia and postulate that the associations can be understood through the influence of the cholinergic system on attention.

Aged↗