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Synaptic elimination, neurodevelopment, and the mechanism of hallucinated "voices" in schizophrenia.

OBJECTIVE: After peaking during childhood, synaptic density in the human frontal cortex declines by 30%-40% during adolescence because of progressive elimination of synaptic connections. The characteristic age at onset of schizophrenia--late adolescence and early adulthood--suggests that the disorder could arise from irregularities involving this neurodevelopmental process. METHOD: A computer simulation of a speech perception neural network was developed. Connections within the working memory component of the network were eliminated on the basis of a "Darwinian rule" in order to model loss of synapses. As a comparison, neuronal cell death, also postulated as being linked to both neurodevelopment and schizophrenia, was simulated. The authors determined whether these alterations at low levels could enhance perceptual capacity and at high levels produce spontaneous speech percepts that simulate hallucinated speech or "voices." RESULTS: Eliminating up to 65% of working memory connections improved perceptual ability; beyond that point, network performance declined and speech hallucinations emerged. Simulating excitotoxic neuronal loss at low levels also improved network performance, but in excess it did not produce hallucinations. CONCLUSIONS: The model demonstrates perceptual advantages of selective synaptic elimination as well as selective neuronal loss, suggesting a functional explanation for these aspects of neurodevelopment. The model predicts that psychosis arises from a pathological extension of one of these neurodevelopmental trends, namely, synaptic elimination.

Auditory Perception↗

Functional anatomy of auditory verbal imagery in schizophrenic patients with auditory hallucinations.

OBJECTIVE: This study investigated the functional neuroanatomy of inner speech and auditory verbal imagery in schizophrenic patients predisposed to auditory hallucinations. METHOD: Eight patients with schizophrenia with a history of prominent auditory hallucinations and six comparison subjects underwent functional magnetic resonance imaging while generating inner speech or imagining external speech. RESULTS: Patients showed no differences while generating inner speech but experienced a relatively attenuated response in the posterior cerebellar cortex, hippocampi, and lenticular nuclei bilaterally and the right thalamus, middle and superior temporal cortex, and left nucleus accumbens during auditory verbal imagery. CONCLUSIONS: Patients with schizophrenia who were prone to auditory hallucinations show attenuated activation when processing inner speech in areas implicated in verbal self-monitoring.

Adult↗

Regional alpha-synuclein aggregation, dopaminergic dysregulation, and the development of drug-related visual hallucinations in Parkinson's disease.

Visual hallucinations in Parkinson's disease are usually treatment-related and occur in at least 30% of patients. Although their clinical and epidemiological features have been extensively reviewed, their etiopathogenesis remains a matter of debate. Based on the current evidence available, this review suggests that regional neurodegeneration of the ventral dopaminergic pathway, as evident in the aggregation of the protein alpha-synuclein, is the main event linked to the development of visual hallucinations in Parkinson's disease. Denervation supersensitivity of dopaminergic receptors in ventral striatal and mesocorticolimbic areas as well as defective synaptic buffering ability due to the loss of dopaminergic presynaptic terminals and dopamine transporter may be among the key factors leading to visual hallucinations in Parkinson's disease.

Antiparkinson Agents↗

Preliminary FMRI evidence of visual system dysfunction in Parkinson's disease patients with visual hallucinations.

Using functional magnetic resonance imaging (fMRI), the authors examined visual cortex function in Parkinson's disease patients who did and did not experience visual hallucinations. Patients with visual hallucinations demonstrated increased activation in the visual association cortex and deficits in the primary visual cortex, suggesting that visual hallucinations are associated with an abnormality of visual-cortex function.

Aged↗

An optical intervention for visual hallucinations associated with visual impairment and dementia in elderly patients.

Onset of visual hallucinations in elderly individuals is a widespread problem with an elusive etiology. Many patients with this problem have visual and cognitive deficits. Intervention with optical aids has not been investigated as a means of treating these hallucinations. The authors report 3 cases in which optical aids were evaluated for efficacy in reducing frequency of visual hallucinations in elderly patients with dementia and visual deficits.

Aged↗

Understanding negative hallucination: toward a developmental classification of disturbances in reality awareness.

Negative hallucinations are explored from a psychodynamic viewpoint in four cases of neurosis. Next, shifting to the level of clinical theory, negative hallucinations are contrasted with five better-studied disturbances in reality awareness. It is noted that all six function as screen phenomena, and all occur in everyday contexts. These and other phenomenological issues lead to an assertion that negative hallucinations are regressive perceptual phenomena, similar in form to both preconscious perceptions and infantile amnesia. Finally, developmental considerations are used to derive a coherent hierarchy of disturbances in reality awareness.

Adult↗

Sociocultural factors in hallucinations.

Sociocultural factors affect both the definition and the sense organs involved in hallucinations. It is suggested that, in addition to the importance of audition in communication on the human level, other sociocultural factors may affect the choice of sense organs in the expression of hallucinatory experience. As compared with non-Western societies, Western attitudes consider hallucinations more shameful and frightening (symptoms of mental illness) and this tend to be more liable to concealment and chronicity. It is proposed that the psychoanalytical approached to the interpretation of dreams or behavioural techniques could be used to overcome the concomitants of Western attitudes toward hallucinations.

Attitude↗

A comparison of public attitudes in Britain and Saudi Arabia towards auditory hallucinations.

BACKGROUND: The successful introduction of community interventions is partly dependent on public beliefs about the aetiology and treatment of psychiatric difficulties and tolerance of community integration. METHOD: This study examined community attitudes towards auditory hallucinations in Saudi Arabia (SA) and the United Kingdom (UK) concerning (a) causes of auditory hallucinations, (b) the efficacy of interventions and (c) levels of social rejection. RESULTS: Responses from 281 patients attending their general practitioners indicated that those living in Saudi Arabia were most likely to believe that hallucinations are caused by Satan or due to magic, while the UK sample were more likely to cite schizophrenia or brain damage. While the Saudi sample believed that religious assistance would be most effective, the UK sample supported medication and psychological therapies. Beliefs about aetiology and treatment were unrelated to educational attainment. There was a greater degree of social rejection of patients in Saudi Arabia, but here educational attainment was of significance. CONCLUSIONS: These results suggest that beliefs about aetiology are related to treatment recommendations and social distancing, and thus have implications for the care of Arabic patients living in Western countries as well as for the use of Western interventions in non-Western cultures.

Adult↗

Hallucinations in psychiatrically disordered children: preliminary communication.

In a retrospective study children with hallucinations and nonorganic psychiatric conditions were compared with matched controls. Hallucinations were found to be a rare symptom except in children with a diagnosis of psychosis of late onset where they were commonly present. Children with hallucinations were older than the majority of subjects seen in the Child Psychiatric Clinic. The perceptual symptoms were associated with precipitants of illness and mood changes. In the nonpsychotic subjects, they were also associated with symptoms suggestive of minor brain dysfunction. The results are discussed and ideas for future research suggested.

Adolescent↗

The efficacy of using a personal stereo to treat auditory hallucinations. Preliminary findings.

This article presents preliminary findings from the first participant to complete an experiment assessing the efficacy of the personal stereo in treating auditory hallucinations. O.C., a 50-year-old woman, took part in a controlled treatment trial in which 1-week baseline, personal stereo, and control treatment (nonfunctioning hearing aid) stages were alternated for 7 weeks. The Positive and Negative Syndrome Scale, Clinical Global Impression Scales, Beliefs About Voices Questionnaire, Rosenberg Self-Esteem Scale, and Topography of Voices Rating Scale were used. The personal stereo led to a decrease in the severity of O.C.'s auditory hallucinations. For example, she rated her voices as being fairly distressing during baseline and control treatment stages but neutral during personal stereo stages. A slight decrease in other psychopathology also occurred during personal stereo stages. Use of the personal stereo did not lead to a decrease in self-esteem, contradicting suggestions that counterstimulation treatments for auditory hallucinations may be disempowering.

Antipsychotic Agents↗

"Hitting" voices of schizophrenia patients may lastingly reduce persistent auditory hallucinations and their burden: 18-month outcome of a randomized controlled trial.

OBJECTIVE: This study aimed to investigate the outcome of an 18-month randomized controlled trial (RCT) on subjective burden and psychopathology of patients suffering from schizophrenia. METHOD: An RCT was used to compare hallucination-focused integrative treatment (HIT) and routine treatment (RT) in schizophrenia patients who persistently hear voices. We performed an intent-to-treat analysis on each of the 63 patients who were assessed at baseline, 9, and 18 months. On each of the 3 occasions, the differential effects of the treatment conditions were tested repeatedly. Sex, age, education, and illness (hallucination) duration were used as covariates. RESULTS: Patients in the experimental group retained improvements over time. Improvements in hallucinations, distress, and negative content of voices remained significant at the 5% level. CONCLUSION: HIT seems to be an effective treatment strategy with long-lasting effects for treatment-refractory voice-hearing patients.

Adaptation, Psychological↗

Musical hallucinations: report of two unusual cases.

Two elderly patients with musical hallucinations are described. In the first case, the musical hallucinations were precipitated by the administration of benzodiazepines. The symptoms in the second case resembled those described in cases of visual hallucinosis (Charles Bonnet syndrome) in the elderly. Issues related to the presentation and course of musical hallucinations are discussed.

Aged↗

Complex visual hallucinations in macular degeneration.

A previously healthy elderly patient with a recent onset of macular degeneration presented for evaluation of elaborate complex visual hallucinations. The patient's psychiatric evaluation and level of cognitive functioning were normal. A diagnosis of organic hallucinosis secondary to macular degeneration was made, and the hallucinations ceased with increased sensory stimulation in the hospital. Numerous diagnoses were considered and are discussed, including Charles Bonnet hallucinations and peduncular hallucinosis.

Aged↗

Quetiapine for hypnogogic musical release hallucinations.

Musical release hallucinations are complex auditory phenomena, affecting mostly the deaf geriatric population, in which individuals hear vocal or instrumental music. Progressive hearing loss from otosclerosis disrupts the usual external sensory stimuli necessary to inhibit the emergence of memory traces within the brain, thereby "releasing" previously recorded perceptions. Responses to conventional antipsychotic agents have been variable and extrapyramidal and other side effects have limited their use. We report the first case of hypnogogic release hallucinations successfully treated with the atypical antipsychotic quetiapine. The patient is an 88-year-old woman with progressive deafness who complained of hearing the piano, drums, or a full orchestra every time she was about to fall asleep. She accused her neighbor of hosting loud parties. Physical, neurologic, and psychiatric examination and work-up were unremarkable. She was treated with low-dose quetiapine affording near total resolution of hallucinations without adverse effects.

Aged↗

The frequency of visual hallucinations in schizophrenic patients in Saudi Arabia.

Sixty-nine schizophrenic patients (52 men and 17 women) who were consecutive admissions to Shehar Psychiatric Hospital, Taif, Saudi Arabia, were investigated for the phenomenology and frequency of visual hallucinations. Of these patients 43 (62 per cent) were visually hallucinated. It is concluded that visual hallucinations in schizophrenia are of common occurrence in this country. The need for further investigation as to the part played by cultural and other factors is emphasized.

Adult↗

Complex visual hallucinations in partial blindness due to eye disease.

Three patients experienced complex formed hallucinations during progressive visual failure from eye disease. The hallucinations began abruptly, were brightly coloured stereotyped figures, animals or objects, and appeared to be provoked by light. As blindness progressed the clarity, frequency and duration of the hallucinations faded. The patients had no abnormalities other than their eye disease, which in two cases was macula degeneration, and choroideraemia in the third.

Aged↗

The experimental treatment of two cases of auditory hallucinations.

Two cases are described where auditory hallucinations persisted, in spite of medication, in two schizophrenic patients, one with acute onset and one with a severe chronic illness. The hallucinations were treated successfully by methods derived from Green's theory that auditory hallucinations are represented in the non-dominant hemisphere.

Adult↗