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Musical hallucinations and palinacousis.

So far, little attention has been paid to the similarities between musical hallucinations and palinacousis. Since the authors found a 75-year-old woman suffering from both symptoms, the similarities were investigated. As a result, musical hallucinations have all the four components of palinacousis structurally, although there are some differences in content. Thus, there exist substantial similarities. Moreover, both symptoms are often associated with seizure activity and there have been several case reports where anticonvulsants were successfully used to treat both symptoms. These findings indicate the possibility that there may exist a common pathway generating musical hallucinations and palinacousis.

Aged↗

Vocalisation in verbal hallucinations: case report and theoretical model.

Perception of one's speech or the speech of others reflects an intrinsic process and should not to be seen as a product of information processing of external sensory input. From this perspective, the perception of one's own or others' speech is fundamentally equivalent to the experience of verbal hallucinations. Speech perception is generated primarily in the focus of attention, but auditory and proprioreceptive input from verbal articulations play an important constraining role, ensuring that perception remains adaptive to interaction with the external world. In verbal hallucinations these constraints may be partially disrupted. Perceptual qualities of hallucinatory voices may be generated in the focus of attention alone (in ignorance of actual acoustic stimulation from the environment), whilst content and grammatical aspects of hallucinatory speech perception may continue to be constrained adequately by proprioreceptive reafferentation from the speech apparatus. Thus subvocal speech may play a role in the elaboration and maintenance of verbal hallucinations.

Afferent Pathways↗

Treating auditory hallucinations by transcranial magnetic stimulation: a randomized controlled cross-over trial.

BACKGROUND: In a previous functional magnetic resonance imaging study, the authors succeeded in demonstrating the activation of Heschl's gyrus during auditory hallucinations (AH). OBJECTIVES: This study aims to treat AH specifically by repetitive transcranial magnetic stimulation (rTMS). METHODS: 16 patients with AH were included in a randomized, cross-over, sham-controlled trial. 1 Hz rTMS was administered over the left and right temporo-parietal cortex and sham position, respectively, on 5 consecutive days; 900 stimuli each, strength 100% of motor threshold. Using the Psychotic Symptom Rating Scales (PSYRATS), the hallucinations during the stimulation periods and 4-week follow-ups were quantified. Electroencephalograms (EEG) were acquired before and after each period. RESULTS: Treatment responses were observed after left hemisphere rTMS only. The 5 patients who showed a response did so already after 2 days. However, group mean hallucination scores did not differ across treatment conditions. No significant changes were found in EEG after rTMS. CONCLUSIONS: A subgroup of patients suffering from AH benefits soon after treatment start from rTMS over the left superior temporal gyrus as revealed by the decrease of AH scores compared to right-sided and sham procedures.

Analysis of Variance↗

L-tryptophan administration in L-dopa-induced hallucinations in elderly Parkinsonian patients.

L-tryptophan (L-T) was added at a dose of 150-450 mg daily to eight Parkinsonian patients who developed visual hallucinations with paranoidal features under L-dopa (L-D) treatment (112.5-75 mg daily) in combination with alpha-methyldopa hydrazine (12.5-75 mg daily). In six patients L-T ameliorated the symptomatology by arresting the visual paranoidal hallucinations or diminishing their frequency and relieving the psychomotor agitation. As a 'side effect', L-T produced new 'pleasurable', 'LSD-like' visual images in three patients. In two patients, in whom L-T did not affect the mental disturbances, amelioration was obtained only by phenothiazines. Theoretical considerations on the role of dopamine in the genesis of visual hallucinations and mental disturbances emphasizes the benefit of L-T administration in this 'organomental' syndrome.

Aged↗

Conversion hallucinations--a possible mental mechanism.

Hallucinations are a well-recognized phenomenon in a dissociative state. In reference to conversion states, sensations may be distorted or inhibited but overstimulation to the extent of hallucination has not yet been recognized. We wish to offer a hypothesis of conversion hallucinations based on two detailed case reports, with a possible mode of action and in combination with the cognitive and dissociative models.

Conversion Disorder↗

Hallucinations and delusions in 1,715 patients with unipolar and bipolar affective disorders.

The prevalence of hallucinations and delusions was studied in 1,715 patients with unipolar or bipolar affective disorders hospitalized at a tertiary care facility. The authors found that the presence of psychotic features was significantly associated with diagnostic subtype. Bipolar manics were more likely than primary depressives, secondary depressives, and bipolar depressives to have hallucinations and/or delusions; primary depressives were significantly more likely than secondary depressives to have psychotic features. Among psychotic patients, bipolar manics were more likely than the other diagnostic groups to have delusions only and less likely to have hallucinations only. Possible explanations for these findings are discussed.

Bipolar Disorder↗

Musical hallucinations: a statistical analysis of 46 cases.

Musical hallucinations remain rare, are more common in women, and their onset is often related to ear pathology, particularly deafness. When brain disease is involved, pathology of the right or non-dominant hemisphere seems overrepresented. Psychosis and personality traits play a minimal role in their development. A discriminant function was constructed that correctly predicted the presence of brain disease (89%) and included the following clinical variables: being male, having acute onset musical hallucinations, and absence of deafness, psychiatric disease, and other forms of hallucination.

Aged↗

Coexistence of the Ekbom syndrome and lilliputian hallucination.

A patient who showed Ekbom's syndrome, i.e. delusions of parasitosis, and also lilliputian hallucination is described. She was diagnosed as senile dementia based on the diagnostic criteria of DSM-III-R and cerebral imaging techniques. When she was 74 years, she felt a mowworm-like wriggle in her stomach and their travels all over her body. When she was 78 years, she saw dressed-up dwarfs dance or march on her abdomen. Since the case showed simultaneously delusions of parasitosis and lilliputian hallucinations, it cannot be denied that she has undetected lesions in the brainstem. In this case, the delusions and hallucinations seem to have occurred as a part of psychopathological signs of senile dementia.

Aged↗

Delusions and hallucinations in schizophrenic patients.

The Scale for Assessment of Positive Symptoms was used to measure delusions and hallucinations in 115 DSM-III-R schizophrenics. Our factorial analysis of the hallucinations and delusions resulted in three factors with appropriate internal consistency and frequency: a Schneiderian delusional syndrome, an auditory hallucination syndrome, and a paranoid syndrome that tend to be present in schizophrenics with later onset. These results should be cautiously interpreted due to their cross-sectional nature and to the size of the sample which does not ensure the stability of the factors.

Acute Disease↗

Lilliputian and negative hallucinations in a patient with probable encephalomyelitis disseminata.

A patient who showed Lilliputian hallucinations and negative hallucinations in the course of probable disseminated encephalomyelitis is described. At the age of 14 years the patient experienced a transient, flaccid paresis of the right leg. Eighteen years later she suddenly developed paranoid-hallucinatory symptoms accompanied by atypical visual hallucinations. She did not recover completely and until now she has suffered at least once every year from an episode with psychotic symptoms. During the most recent of these episodes, MRI revealed several disseminated supra- and infratentorial foci in the brain. Two of them, in the left cerebral peduncle and in the left occipital white matter are discussed as the cause of her visual hallucinatory symptoms.

Adult↗

Unilateral hallucinations and other psychotic symptoms due to otosclerosis.

We report the case of a 35-year-old man suffering from otosclerosis and unilateral auditory hallucinations as well as other psychotic symptoms that disappeared completely after surgery for otosclerosis. The patient experienced a change of his acoustic sensations: the tinnitus was transformed into music, and 4 months later the music changed into commenting and imperative voices. However, on both occasions the transformation from one form to another occurred during an alcohol withdrawal syndrome characterized mainly by vivid visual hallucinations. Some theoretical considerations on hallucinatory predisposition, development of hallucinations, and psychological factors determining psychotic symptoms will be discussed.

Adult↗

Paranoid hallucinations following ocular surgery.

Paranoid hallucinations were seen in 2 patients following ocular surgery. Following his second cataract surgery, a 77-year-old male patient became disorientated, suffered paranoid hallucinations and fractured his first lumbar vertebra 'falling' from the balcony of the first floor. A 79-year-old female suffered from paranoia and visual hallucinations following goniotrephination surgery.

Aged↗

A cognitive model of hallucinations.

Hallucinations occur in a wide variety of altered states of consciousnes and are an important symptom in various psychiatric syndromes. Several psychological and biological theories of their origin have offered, ranging from the concept of wish fulfillment, to the hypothesis of an electorchemical release of the perceptual system, to denials that hallucinatory phenomena exist. No explanation has completely satisfied clinicans, probably because the word "hallucination" labels a complex set of phenomena. The author accepts this complexity and offers a conceptual analysis of four key dimensions of the halucinatory experience in an attempt to clarify the gamut of experiences that may be called hallucinations.

Affective Symptoms↗

Pharmacology of hallucinations induced by long-term drug therapy.

The authors studied 20 patients with Parkinson's disease and prominent hallucinations related to dopaminergic or anticholinergic therapy. The character of the hallucinations appeared distinct from the classic description of either acute anticholinergic or acute aminergic hallucinatory states. Manipulation of either kind of drug could precipitate or relieve hallucinations in a given patient, which suggests that the dopaminergic/cholinergic systems are reciprocally active in the pathophysiology of long-term drug-induced hallucinatory states in this population.

Antiparkinson Agents↗

Auditory hallucinations treated by radio headphones.

A young man with chronic auditory hallucinations was treated according to the principle that increasing external auditory stimulation decreases the likelihood of auditory hallucinations. Listening to a radio through stereo headphones in conditions of low auditory stimulation eliminated the patient's hallucinations.

Acoustic Stimulation↗

Do we need a new word to supplement "hallucination"?

The word "hallucination" was used originally (and with etymological correctness) to refer to the unshared sensory experiences of persons who are mentally ill. However, many persons who are not mentally ill also have unshared sensory experiences. A few of these convey information paranormally, but the longstanding association of "hallucination" with mental illness inhibits many persons who have such experiences from reporting them so that they can be studied. The author suggests a new word, "idiophany," to designate all unshared sensory experiences. The word "hallucination" could then be restricted, as it originally was, to the unshared sensory experiences of the mentally ill.

Hallucinations↗

Auditory hallucinations and subvocal speech in schizophrenic patients.

Fourteen of 18 hallucinating schizophrenic patients reported that the voices they heard went away when they undertook a maneuver that precluded subvocalization. The same applied to 18 of 21 normal subjects who hallucinated under the influence of hypnotic suggestion. Control maneuvers had no such effect. The authors suggest that auditory hallucinations may be projections of schizophrenic patients' verbal thoughts, subvocalized due to deficient cerebral cortical inhibition.

Adaptation, Psychological↗

Predicting compliance with command hallucinations.

Of 44 patients who experienced command hallucinations, those with hallucination-related delusions and hallucinatory voices they could identify were more likely to comply with the commands. The danger of the behaviors specified by the hallucinations did not appear to be a factor in compliance.

Cooperative Behavior↗