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Proceeding from the hypothesis that auditory hallucinations in psychotic patients have another biological basis than hallucinations provoked by hypnotic suggestion in healthy persons, we performed a symptom-comparative study by means of 99mTc-HMPAO single photon emission computed tomography. The results confirm the importance of pathogenesis in symptom-oriented psychiatric research.
A case of musical hallucinations in a young non-psychotic female is described. The only presented symptoms were perceptual disturbances accompanied by the fear of having a severe mental disorder. Further investigation disclosed a perforated ear-drum, with subsequent mild hearing deficit but no signs of major psychopathology. It is suggested that a psychiatric diagnosis should be deferred in such patients, before audible deficits had been ruled out. The clinical features of musical hallucinations associated with hearing deficits are discussed.
A patient may experience hallucinations in more than one modality simultaneously or at different times and they may or may not appear to emanate from a single source. Current nomenclature is imprecise, often has particular diagnostic implications and fails to distinguish between these different phenomena. This has resulted in considerable confusion with a tendency to dismiss the importance of these symptoms. The various terms in current usage and the presence of these symptoms in a variety of different conditions are examined. To aid further research and improve clinical practice the authors advocate the use of the term multi-modal hallucinations and suggest operational criteria.
Intrusive, uncontrollable and bizarre thoughts occur in both obsessive-compulsive disorder (OCD) and psychosis. The origin of these mental phenomena and the relationship between them is unclear. A case is described in which long-standing compulsions and the associated resistance temporarily developed the characteristics of command hallucinations, in the absence of any other psychotic symptoms. The implications for psychopathological theories of hallucinations are discussed.
Many observers see geometric visual hallucinations after taking hallucinogens such as LSD, cannabis, mescaline or psilocybin; on viewing bright flickering lights; on waking up or falling asleep; in "near-death" experiences; and in many other syndromes. Klüver organized the images into four groups called form constants: (I) tunnels and funnels, (II) spirals, (III) lattices, including honeycombs and triangles, and (IV) cobwebs. In most cases, the images are seen in both eyes and move with them. We interpret this to mean that they are generated in the brain. Here, we summarize a theory of their origin in visual cortex (area V1), based on the assumption that the form of the retino-cortical map and the architecture of V1 determine their geometry. (A much longer and more detailed mathematical version has been published in Philosophical Transactions of the Royal Society B, 356 [2001].) We model V1 as the continuum limit of a lattice of interconnected hypercolumns, each comprising a number of interconnected iso-orientation columns. Based on anatomical evidence, we assume that the lateral connectivity between hypercolumns exhibits symmetries, rendering it invariant under the action of the Euclidean group E(2), composed of reflections and translations in the plane, and a (novel) shift-twist action. Using this symmetry, we show that the various patterns of activity that spontaneously emerge when V1's spatially uniform resting state becomes unstable correspond to the form constants when transformed to the visual field using the retino-cortical map. The results are sensitive to the detailed specification of the lateral connectivity and suggest that the cortical mechanisms that generate geometric visual hallucinations are closely related to those used to process edges, contours, surfaces, and textures.
Recent neuropathologic investigations in schizophrenia report smaller volume of medial temporal lobe structures. These findings are confirmed by preliminary magnetic resonance imaging (MRI) studies. Direct stimulation of lateral temporal lobe structures in the region of the superior temporal gyrus provokes hallucinations. The authors' MRI study of young schizophrenic patients demonstrates smaller volume of the superior temporal gyrus (an auditory association area) and of the left amygdala. Smaller size of the left superior temporal gyrus and left amygdala is not accounted for by smaller size of the overall brain or temporal lobe. Shrinkage of the left superior temporal gyrus is strongly and selectively correlated with severity of auditory hallucinations.
OBJECTIVE: The authors examined the effect of prolonged clozapine treatment on central serotonergic (5-HT) function in schizophrenia. METHOD: Prolactin responses to the 5-HT releasing agent d-fenfluramine were measured in two groups of 10 schizophrenic subjects. The first group was tested twice, before and after a mean of 10 weeks of clozapine treatment. The second group was tested after a mean of 20 months of clozapine treatment. RESULTS: The prolactin response was significantly blunted in these 20 patients treated with clozapine. There was a significant positive correlation between d-fenfluramine-evoked prolactin release and the overall positive symptom score and the hallucination and delusion subscores of the Scale for the Assessment of Positive Symptoms. CONCLUSIONS: Blunted 5-HT-mediated prolactin responses in schizophrenic patients receiving clozapine monotherapy for up to 20 months were correlated with reductions in positive symptoms. This suggests that 5-HT antagonism is relevant to clozapine's efficacy in alleviating hallucinations and other positive schizophrenic symptoms.
Religious beliefs and superstitions have an important impact on the psychopathology of psychiatric patients. Traditional Chinese religious beliefs and superstitions, such as fortune telling, Buddhist gods, Taoist gods, historical heroic gods and ancestor worship, have important influence on subjective psychotic experiences, in particular delusions and hallucinations. By means of empirical phenomenological case narration, the writer shows that all these traditional Chinese religious beliefs and superstitions tend to affect the contents, manifestation and meaningfulness of delusion and hallucination. They also serve as a means to replace clients' self-identity. They appear in the form of a supernatural force to resolve all difficulties, cause of troubles and misfortune, stress and coping mechanisms.
Cholinergic arousal mechanisms predispose thalamic and cortical neurons to fire action potentials at gamma rhythms, which have a tendency to resonate in thalamocortical networks, thereby forming coherent assemblies under constraints of sensory input to specific thalamic nuclei, on the one hand, and prefrontal and limbic attentional mechanisms, on the other. Perception may be based on sustained assemblies of coherent gamma oscillations in thalamocortical circuits. In schizophrenia, the impact of sensory input on self-organization of thalamocortical activity may be generally reduced. As a result, processes underlying perception can become uncoupled from sensory input, particularly at times of hyperarousal, leading to domination of attentional mechanisms and the emergence of hallucinations. Evidence is reviewed that implicates excessive neuronal noise in specific thalamic nuclei in the generation of hallucinations in schizophrenia. Nicotinic receptor abnormalities, dopaminergic hyperactivity and glutamate-receptor hypofunction are reconciled within a model of psychotic symptom generation that places crucial emphasis on dysfunction of the reticular thalamic nucleus.
A patient presented with a 15 year history of schizophrenia with auditory hallucinations. Though unresponsive to prolonged trials of neuroleptics, the auditory hallucinations disappeared with etizolam.
Visual hallucinations (VHs) are common psychiatric symptoms in patients with long-standing Parkinson's disease (PD). Treatment with neuroleptics or withdrawal of anti-PD drugs may improve VHs but will worsen motor dysfunctions. The authors report on 3 patients with long-standing PD who were treated with the cholinesterase inhibitor donepezil for the treatment of VHs. Each received a daily dose of 5 mg of donepezil, after reducing or discontinuing anti-PD medications had failed to relieve the VHs. In 2 patients (patient 1, 2), donepezil decreased VHs without worsening motor dysfunctions. In addition, the cognitive status of patient 2 improved. In patient 3, donepezil also resolved VHs, but delusions developed during treatment. After discontinuing donepezil, delusions disappeared and VHs reappeared. Donepezil may ameliorate visual hallucinations in PD patients, but controlled, double-blind trials are necessary to further clarify the effect of this drug on VHs in PD.
The purpose of this study was to determine the phenomenology and treatment of idiopathic musical hallucinations in the elderly by reviewing all relevant case reports. A systematic literature search yielded 32 case reports that met the following four inclusion criteria: (1) published in English, French, or Italian; (2) cases aged 65 years of age or older; (3) absence of major focal neurologic disease; and (4) absence of drug toxicity. Information was subsequently abstracted from each case reported and tabulated. Idiopathic musical hallucinations in the elderly occurred predominantly in females who had a hearing impairment, one third of whom were depressed. Treatment of depressed patients with antidepressants and nondepressed patients with anticonvulsants/anxiolytics seemed to result in improvement of many cases.
Parkinson's disease patients may suffer from cognitive impairment and behavioural problems such as apathy, personality changes, speech disturbances and visual hallucinations (Parkinson's disease dementia). However, there is currently no recommended treatment for Parkinson's disease dementia and antipsychotic agents can worsen extrapyramidal symptoms, making them unsuitable for patients with this condition. The observation that patients with Parkinson's disease dementia have extensive cholinergic deficits led to the hypothesis that cholinesterase inhibitors may provide benefits for patients with this condition. Here, we present a case series of patients with Parkinson's disease and dementia who we treated with rivastigmine, a dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) that shows brain region-selectivity. The introduction of rivastigmine led to improvements in cognitive and functional abilities, as well as the resolution of behavioural problems and visual hallucinations. Rivastigmine was well tolerated by our patients when the dose was escalated slowly, including one patient who had previously experienced severe side-effects with the AChE-selective inhibitor donepezil. Despite the large number and range of concomitant medications being received by the patients, no side-effects thought to be related to drug-drug interactions were reported. A large, placebo-controlled study is warranted to ascertain the full clinical profile of rivastigmine in Parkinson's disease dementia.
A schizophrenic patient whose severe level of auditory hallucinations had proved refractory to neuroleptic medication was given two treatment techniques derived from Green's theory that hallucinations represent verbal activity in the non-dominant hemisphere. Voice activity was markedly reduced in frequency and severity over a six-month period, and led to general improvements in interpersonal functioning. There was evidence for independent and additive effects of the two techniques.
Conversive hallucinations are rare in the psychiatric literature. The authors present a case which demonstrates the psychogenesis and phenomenology of conversive hallucinations in a young female patient.
Earlier, we reported that true hallucinations may present as a conversion symptom. We here reiterate this and suggest that cultural sanction may be one factor that can lead to hallucinations being classified as true in non-psychotic psychiatric states.
Musical hallucinations had caused an 86-year-old deaf woman to become anxious and depressed. She was admitted, and tranquilizing and hypnotic drugs afforded some slight improvement. The use of her hearing aid to increase ambient noise levels reduced the intensity of the hallucinations, and the patient improved.
A sample of 46 subjects experiencing musical hallucinations was analysed - 10 new cases in addition to 36 culled from the literature. When compared with controls, it was found that musical hallucinations are far more common in females, and that age, deafness, and brain disease affecting the non-dominant hemisphere play an important role in their development. Psychiatric illness and personality factors were found to be unimportant.