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We report a case of a man with recurrent depression and persistent second-person auditory hallucinations telling him to kill himself. Using an audiotape cassette and headphones the duration of the hallucinations decreased significantly. Helpfulness of the audiotape continued at 15 months follow-up.
Three cases of stress-induced hallucinations in young soldiers are described. The hallucinatory experience was not accompanied by gross psychopathology. The phenomenology and psychopathological implications of hallucinations following exposure to environmental stress are discussed.
A case of senile dementia that initially presented with complex visual hallucinations in the absence of clinical cognitive impairment or other psychopathology is described. Dementia must be added to the differential diagnosis of isolated visual hallucinations in the elderly.
We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices-fear, reassurance, engagement and resistance-reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either 'benevolent' or 'malevolent'. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31% of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.
We monitored 11 patients with advanced Parkinson's disease (PD) who entered nursing homes over a 5-year period and assessed chronicity of nursing home care, mortality, and hallucinatory status. Two years after the original study's close, none of these patients had ever been discharged from the nursing homes and all were dead. The mortality rate among the nursing home patients was significantly greater than that in 22 community-dwelling subjects with PD who were matched for age, gender, and disease duration. Hallucinatory status was generally stable; 82% of patients had the same hallucinatory status (presence or absence) at the two assessments. Four subjects from the original community-dwelling control group entered nursing homes during the follow-up period. Whereas motor and intellectual impairment scores were similar between these patients and the remaining 18 in the community, the presence of hallucinations was significantly greater among patients transferred to nursing homes. The study demonstrates the permanency of nursing home placement in advanced PD and the high mortality associated with such placement. It also documents the chronicity of hallucinatory behavior in these patients with advanced PD and reinforces our previously reported observations on the relationship between hallucinations and placement in chronic-care facilities.
OBJECTIVES: Building on recent work on the similarities and differences in delusional ideation between psychotic and religious populations (Peters, Day, McKenna, & Orbach, 1999), the experiences of auditory hallucinations in psychotic, evangelical and control groups were examined in this study. METHOD: The incidence and subjective experiences of hearing voices were assessed using questionnaire methods in psychotic out-patients, evangelical Christians and controls (non-psychotic, non-evangelical). RESULTS: Incidence of auditory hallucinations differed significantly across the three groups with psychotics showing the highest levels and controls the lowest levels. The experiences of the evangelical group were significantly more positive than those of the control group, which in turn were significantly more positive than those of the psychotic group. The most recent experience of hearing voices was rated more positively than the first experience by the psychotic and religious groups but not by the control group. These findings were much stronger for affective reactions to the experiences than for perceptions of the voices. CONCLUSION: These results provide only partial support for the findings of Peters et al. (1999) on differences in delusional ideation and possible reasons for this are discussed. The findings for religious and psychotic individuals are discussed further in terms of interpretational and coping mechanisms.
BACKGROUND: This study of patients who experience auditory hallucinations examined the potential role of dissociation as a mediator in the relationship between memories of parental behaviours during childhood and psychopathology in adulthood. METHOD: Thirty-six patients who experienced auditory hallucinations completed standardized measures of recalled parental behaviours, beliefs about voices, depression and dissociation. Regression analyses were used to test for mediating effects. RESULTS: The findings support a model where dissociation mediates the relationship between paternal overprotection and depression. There were no significant findings regarding the relationship between recalled parenting and beliefs about voices. DISCUSSION: The clinical and research implications of the study are outlined, emphasizing dissociation as a potential treatment target.
OBJECTIVES: Visual hallucinations (visions) associated with psychiatric conditions are poorly understood. This study tested the hypothesis that appraisals of visions would predict distress associated with visions. It also aimed to describe typical appraisals of visions. DESIGN: A cross-sectional interview study of people with visual hallucinations. METHOD: Participants (N = 20) who had experienced visions caused by their psychiatric condition (i.e. not by additional pathology such as epilepsy or substance abuse) completed a semi-structured interview and the Beck Depression Inventory (BDI). Possible associations between appraisals of visions (e.g. of controllability or outcome) and distress were examined. Novel categories of appraisal were generated in an attempt to reflect individuals' experiences as closely as possible. RESULTS: Appraisals of negative outcome, but not control, predicted distress. Thus, if individuals believed that the persistence of their visions would result in unpleasant consequences, they experienced more distress. Neither the form nor content of the visions predicted distress, nor was current mood predictive. Five categories of appraisal were generated, and independent raters could assign these reliably. Preliminary analyses showed that where individuals appraised a vision as indicating a special task, gifts or powers, they experienced less distress. CONCLUSIONS: Appraisals of visions predicted the distress associated with visions. 'Objective' characteristics of visions were poorer predictors of distress, and appraisals did not simply follow from the content of the vision. However, current mood may partially determine appraisals. The novel categories of distress require replication but may help to guide clinical practice. Therapeutic interventions aimed at altering appraisals may reduce distress.
A 79-year-old Caucasian woman who had been taking alendronate 10 mg/day for over 2 years to prevent osteoporosis reported hearing "voices in her head" along with red-colored visual disturbances. These auditory hallucinations and visual disturbances began shortly after her regimen was changed from alendronate 10 mg/day to 70 mg once/week. Assessment of causality using the Naranjo and Jones algorithms revealed a "probable" and "highly probable" relationship, respectively, between this adverse drug event and the switch from daily to weekly alendronate therapy. Other bisphosphonates, such as etidronate and pamidronate, have caused both reversible and irreversible auditory, visual, and olfactory hallucinations beginning 2 hours--1 week after drug administration. The mechanism behind these adverse effects is unknown but is thought to be independent of calcium homeostasis. Clinicians should be aware of central nervous system toxicity as a rare but potential adverse effect associated with bisphosphonates.
A 69-year-old male with an intracranial bullet retained in the right occipital lobe for 45 years presented with epileptic seizure occasionally accompanied by visual hallucinations. Neurological examination revealed left homonymous hemianopsia and right hearing loss, and electroencephalography showed slow discharges localized in the lesion. The bullet was removed together with the thickened fibrous capsule. His postoperative course was uneventful, and he has become seizure-free. The bullet caused metal toxicity and progressive gliosis, which caused the epileptogenetic focus and associated hallucinations.
Multiple sclerosis (MS) is a fairly common condition that affects approximately 350,000 people in the United States. It is associated with various neuropsychiatric symptoms including cognitive and behavioral symptoms. However, visual hallucinations are rare in multiple sclerosis without the presence of cognitive deficits. We are describing the case of a 40-year-old married white female with isolated complex visual hallucinations compatible with the Charles Bonnet syndrome (CBS). The patient was successfully treated with the atypical antipsychotic olanzapine.
A rare and unusual case of hallucinations following triazolam administration is reported. A review of the literature suggests that hallucinations following triazolam are rare; this is the first report of such a reaction when triazolam was used for oral conscious sedation in dentistry. A discussion of dental implications follows with emphasis on complete medical history evaluation before administering oral sedatives. We conclude that the proper selection of oral sedation candidates, coupled with recognition and management of adverse events, is essential.
A 78-year-old hearing-impaired woman who presented to hospital with a stroke and a subsequent epileptic seizure later developed unilateral musical hallucinations in her better hearing (right) ear. She was found to have a left-sided temporal epileptic focus and the music ceased after a second anti-convulsant was introduced. Comments are made on unusual features of the hallucination and its probable causation.
A case is described of repetitive familiar activities apparently accompanied by a hallucinated physical environment in an older brain-injured man with an amputation of the left temporal lobe. A parallel is drawn to the 'experiential hallucinations' described in psychomotor seizures and direct stimulation of the cortex.
Levofloxacin-induced-neurological adverse events such as convulsion, involuntary movement (tremor, myoclonus and chorea-like) and visual hallucination in two elderly patients are reported. A 67-year-old man with minor alcoholism and a past-history of gastrectomy and cholecystectomy was given 300 mg/day of oral levofloxacin and fulfenamic acid for an upper respiratory infection. On the 4th day, he reported gradual exacerbation of hand tremor which resembled chorea-like involuntary movement and gait disturbance. He also experienced visual hallucinations. On the 7th day, he suffered generalized convulsions and was admitted. Serum concentration of levofloxacin at this time (3 hours after last administration of a 100 mg tablet of levofloxacin) was 3.6 micrograms/ml. Cessation of the agents promoted complete recovery of these neurological adverse effects within a week. Another 85-year-old man with chronic bronchitis and slight renal impairment received long term administration of 200 mg/day of levofloxacin. On the 68th day of administration, gradual exacerbation of gait disturbance, dysarthria and chorea-like involuntary movement occurred. On the day of admission, 76 days after the start of administration, the serum level of levofloxacin was 2.55 micrograms/ml and that of spinal fluid was 1.12 micrograms/ml (3 hours after the last administration of a 100 mg tablet of levofloxacin). Cessation of the agents promoted complete recovery of these neurological adverse effects within the next two weeks. Both patients had no apparent neurological disorders except age-related brain atrophy. Age-related renal and brain impairment might have contributed to the neurological adverse effects of levofloxacin.
1. The majority of participants reported that they were still using behavioral strategies to manage their auditory hallucinations throughout the 12-month follow-up period and that they had experienced a decrease in symptom severity. 2. The answers to managing the symptom of auditory hallucinations are as individual as the symptom itself. All of the behavioral management strategies worked for at least one participant, but no strategy worked for everyone. 3. Practicing strategies in a group and at home seemed to promote long-term use of the behavioral strategies.
'Hallucinations' were diagnosed in a 41-year-old Turkish woman after the death of her father. The nature of hallucinations is often difficult to understand in patients of Turkish (or Moroccan) origin, as they can be diagnosed as a psychotic feature, or as a sign of dissociation, reexperiences, mourning, personality disorder or depression. Most of the time the symptoms can be regarded as culture-bound phenomena of psychosocial stress, often accompanied by somatoform complaints. In those cases they should be diagnosed as pseudohallucinations. Drug interventions only play a supportive role in the treatment of these symptoms. Joining the patients' explanatory model and exploring the psychological meaning of symptoms may be a rather difficult process which, however, may result in fewer symptoms in the end.
Authors report a case of hallucinations related to clonidine treatment in an elderly man with hypertension and renal failure. The symptoms appeared shortly after treatment is starting. The hallucinations disappeared after clonidine withdrawal. Implications for clinical practice are evocated.