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A physician experienced an hallucination during the early phase of an acute febrile infection of the urinary tract that was being treated with a cure of ciprofloxacin. He could trace back the visual appearances in the hallucination to elements in a medical journal article that he had read a few weeks previously.
OBJECTIVES: To present the case of a patient with acquired deafness who experienced musical hallucinations (MH) and to conduct a review of the relevant literature. BACKGROUND: Although MH have been known to occur in some people with deafness, literature on this phenomenon, especially from the perspective of etiology and treatment, is limited. METHODS: The case report was prepared using a detailed history, general psychiatric and neurologic examinations, and neurobehavioral assessments, and the pertinent literature from 1965 to 2000 was reviewed. RESULTS: The patient whose case is reported here had acquired deafness and was assessed to have MH and obsessive-compulsive symptoms that responded to the use of nonantipsychotic medication. CONCLUSION: The phenomenon of MH with hearing problems that are either prelingual or acquired can exist separately or be a part of constellation of psychiatric symptoms. No precise etiologic basis is yet clearly identifiable; however, this report offers support for a central mechanism explained by the "Release Theory." Additionally, it appears that such hallucinations might be managed safely with psychotropic medications other than antipsychotics.
Hallucinations, which are experienced in fear-evoking situations of helplessness and (external) danger, are attempts of defence and the realisation of elementary needs of self-preservation and security. The reality-denying self-deception is accompanied by the mobilisation of own protective potencies. Hallucinations are experienced fearfully, so that there is a situation of helplessness and danger. They are--as neurotic symptoms--an attempt to realise libidinous and/or aggressive desires with the manifestation of (condemning and punishing) defence in the projective perception. The self-deception here concerns the denial of own internal conflicts.
PURPOSE/METHODS: To report the occurrence of complex visual hallucinations in a 69-year-old female with bilateral age-related macular degeneration and unilateral cataract. Her orientation and cognition were normal and she showed no evidence of psychiatric symptoms. RESULTS/CONCLUSIONS: A case of a patient who presented with visual symptoms characteristic of the Charles Bonnet syndrome is reported. Various conditions associated with visual hallucinations must be kept in mind by the ophthalmologist (Arch Soc Esp Oftalmol 2003; 78: 327-330).
BACKGROUND: We examined the presence of command auditory hallucinations for suicide (CAHS) in a sample of individuals with schizophrenia or schizoaffective disorder. We examined the relationship between CAHS and demographic and clinical variables. We also investigated the relationship between CAHS and suicide attempts. METHOD: 100 individuals with DSM-IV schizophrenia or schizoaffective disorder hospitalized on an inpatient research unit participated. Information was gathered using the Diagnostic Interview for Genetic Studies and the Harkavy Asnis Suicide Scale. Data were gathered from 1995 to 2001. RESULTS: CAHS were frequent in this sample (22%), as were suicide attempts (33%). Eight percent of the entire sample (36% of those who experienced CAHS) made at least 1 suicide attempt in response to the hallucinations. The presence of CAHS was not related to demographic or clinical measures assessed. The frequency of CAHS was not statistically different for suicide attempters (30%) and nonattempters (18%). However, 80% (8/10) of attempters with CAHS reported at least 1 attempt in response to CAHS. Three of 6 repeat attempters who made at least 1 suicide attempt in response to CAHS also made other attempts that were not in response to CAHS. The presence of CAHS was not associated with a history of depression or substance abuse/dependence. CONCLUSION: The presence of CAHS does not directly predict suicide attempts. However, individuals who are already at risk for suicidal behavior (e.g., past attempters) may be at increased risk for a suicide attempt when experiencing CAHS.
Although factitious disorder has been known for a long time, its diagnosis and treatment continue to be a problem. It is an uncommon condition associated with considerable morbidity and health care expenditure. We present a case of factitious disorder with hallucinations. A 37 year-old single woman has had auditory and olfactory hallucinations for six years. She had been diagnosed with schizophrenia, hospitalized for a short term, taking classical antipsychotic drugs for years. She has been performing her job as a teacher and living with her family. A suitable dose of atypical antipsychotic drugs was administered at a convenient time for her illness (Psychotic Disorder NOS) in psychiatric outpatient clinic of Kocaeli University. She was admitted to inpatient clinic twice in order to allow a clear diagnosis to be made. Psychotic disorder and temporal lobe epilepsy were ruled out. Borderline and histrionic personality traits were determined. Her complaints were unchanged over the course of treatment taking three years. She later started to come into the emergency department with anxiety symptoms, conversion like fits and suicide attempts; hospitalized for these complaints in another hospital. She was diagnosed with factitious disorder because of her unchanged complaints, her adding new complaints to the old ones, her complaints unrelated to psychosocial stressors, her ambitions to come to hospital, her increasing hospital dependence and having no prominent secondary gain. This case emphasizes the need for the careful observation of patients to prevent unnecessary investigations at the diagnosis and treatment stage and to establish a specific management strategy for the patients.
A 68-year-old man with malignant hypertension of renovascular origin presented with visual impairment and complex visual hallucinations. Four weeks after the hypertension had been controlled by drugs, the hallucinations ceased and electroencephalographic evidence of encephalopathy resolved.
PURPOSE: To assess psychiatric nurses' views of the importance of itemized content represented on an Inventory of Voice Experiences (IVE) for ongoing assessment of atypical auditory sense perception in people who hear voices. METHODS: Over 6 months, 317 experienced psychiatric nurses rated 58 assessment cues for hallucinated voice experiences. Cronbach's alpha, Cohen's kappa, and Bartko's intraclass correlation coefficients were used to measure concordance of the nurses' judgments against two hypothetical standards derived for purposes of the study. FINDINGS: There was moderate support for both the internal consistency of the nurses' judgments concerning the importance of itemized content represented on the IVE and overall equivalence of the content. There was modest-to-moderate concordance of the nurses' original and subsequent judgments but a lack of concordance of the nurses' judgments with equally weighted judgments of the principal investigator even though the judgments of the investigator were based on extant literature and published reports of voice hearers. CONCLUSIONS: Results may reflect the effects of repeated testing, but it also is possible that some nurses did not have enough knowledge or professional experience to quantify judgments about the importance of hallucinated voice descriptions tied to the items on the IVE. The findings are being used to refine the IVE. PRACTICE IMPLICATIONS: Findings provide nurses with opportunities for discerning specific characteristics, antecedents, and consequences of voice hearing along with their implications for health and well-being. Discernment of this information will facilitate identification of more specific and meaningful options for helping voice hearers manage their voices.
Musical hallucinations (MH) are probably more frequent in the elderly than those reported in the literature. We will illustrate the clinical findings of MH with 3 personal cases. The differential diagnosis and the diagnostic tools relevant in clinical practice will be presented as well as the pathogenesis of deafferentiation-induced MH. MH can be considered as a phenomenon of neuronal plasticity and also serve as a model to understand neuronal networks involved in mental representation of music and hallucinations in general.
The aim of the research was to explore the importance of 58 items of descriptive content represented on two parallel forms of an Inventory of Voice Experiences (IVE). A convenience sample of 317 well-educated psychiatric nurses rated descriptions of IVE item content three times over a period of six months according to how the content might relate to the selection of interventions for the management of verbal auditory hallucinations. Cronbach's alpha, Cohen's kappa, Pearson's r, and Bartko's intra-class correlation coefficients were used to measure the internal consistency of the nurses' judgments as well as the concordance of the judgments with a pre-selected standard. Findings from the study revealed modest-to-moderate support for internal consistency and overall equivalence of parallel item content represented on both forms of the IVE within and across three waves of data collection. Also revealed was a relative lack of concordance of the nurses' judgments with the pre-selected standard, and modest-but-consistent concordance of the nurses' original and subsequent judgments. Eight parallel items represented on the IVE demonstrated potential to serve as important cues for making decisions about intervention. This information shall be used to standardize the language and response categories of items tied to the IVE to permit more-definitive decisions about the management of verbal auditory hallucinations.
The Charles Bonnet syndrome (CBS) commonly designates visual hallucinations (VH) occurring in visually impaired patients. However, there is no consensual definition. The existence of an ophthalmic disease and the absence of cognitive impairment are mandatory or not according to the proposed diagnostic criteria. CBS affects 12 to 15% of visually impaired patients. VH are often repetitive and stereotyped, elementary or complex, involving human figures in most cases. The patients had full insight of the unrealistic character of their VH. The main risk factors are old age and severe visual impairment. Functional imagery studies showed that the VH of SCB correlate with cerebral activity in ventral extrastriate visual cortex and that the hallucinations reflect the functional specializations of this region. This activity could represent release phenomena due to deafferentation of the visual associative cortical areas. No systematic therapeutic trial has been performed. Anticonvulsivant drugs may help in some instances. However, reassurance and explanations are sufficient in most cases. The VH in the hemianopic field after a stroke probably share pathophysiologic mechanisms with CBS. Finally, visual impairment appear as a non specific risk factor for VH in some conditions such as late paraphrenia and some neurodegenerative diseases such as Alzheimer's disease or Parkinson's disease.
INTRODUCTION: Abnormal synaptic pruning has been proposed by some authors as a theory to explain schizophrenia. It has been studied in different ways, some of which are computerized models. METHODS: A PC computer with MATLAB version 5.3 and Neural Networks Toolbox programs were used. To reproduce the model we used Elman's network for neuronal unit and McGlashan and Hoffman's network. RESULTS: The corrected percentage of detection improved as synapses were prunned. It increased from 68% to 91 %, reaching the highest detection level when 60% of the synapses were eliminated. Detection capacity was reduced when synaptic elimination continued and the program started detecting words in the absence of input. This was considered as a hallucination. When pruning reached from 80% to 95%, hallucinations occurred more frequently. CONCLUSIONS: The computer simulation model provides a symptom formation model, and also a way of understanding pruning's adaptative utility. When the neuronal units were eliminated (instead of connections), there was only progressive worsening in word perception. This confirms the hypothesis proposed that schizophrenia pathophysiology underlies neuronal connections, not the neurons.
Musical hallucinations developed in a healthy 57-year-old man after using hypnotic triazolam (Halcion) for eight nights; the hallucinations continued for over one year. Although a causal relationship to triazolam cannot be proved, use of this drug has been associated with other bizarre alterations of memory.
The case of an alcoholic patient with auditory hallucination is reported in which [123I] iodoamphetamine (IMP) brain imaging demonstrated increased accumulation in the left superior temporal lobe which corresponded to the left primary and secondary auditory areas. Thus, IMP brain scans seem to have the potential to objectively localize the brain abnormalities in auditory hallucination.
Since the publication by Jean Lhermitte in 1922 of his paper on hallucinosis, the peduncular type has been described as a purely visual phenomenon. However, limited brain stem lesions can give rise to analogous manifestations in the auditory field. Five cases of auditory hallucinosis are reviewed, the first four resulting from a lesion of tegmentum of pons responsible for contralateral hemi-anesthesia and homolateral facial palsy with paralysis of laterality. Central type hypoacusis and a severe disorder of localization of sounds revealed a lesion of trapezoid body. The fifth case resulted from a peduncular lesion in region supplied by superior cerebellar artery, the auditory deficit being related to a lesion of inferior corpus quadrigeminum. In one patient, the auditory hallucinosis was followed by a period of visual hallucinations and oneiric delusions. Both auditory and visual hallucinosis can be related to hypnagogic hallucinations. Dream mechanisms (the geniculo-occipital spikes system) escape from normal inhibitory control exerted by the raphe nuclei. Auditory deafferentation could predispose to auditory hallucinosis.
Two cases of Charles Bonnet Syndrome (CBS) showing an unusual history are reported. In a 67-year-old man visual hallucinations developed 38 years after bilateral optic nerve damage due to methyl alcohol poisoning. A 78-year-old woman suffering from bilateral advanced cataract experienced visual hallucinations which ceased after improvement of vision resulting from cataract extraction. Sensory deprivation and--possibly--central neurophysiological disturbance are to be regarded as important pathogenetic factors. Signs of cerebral dysfunction which could be relevant to the pathogenesis of CBS were revealed by the EEG.
A 32 year old man affected by grade 1 astrocytoma of the right sylvian region and epileptic seizures, presented gustatory hallucinations as a post-ictal symptom. Spikes of very low voltage during sleep were the only epileptic abnormalities found on his EEG. It is suggested that post-ictal as well as ictal gustatory hallucinations may be a localizing symptom of glioma involving the sylvian region. Furthermore, if systematically searched for, sleep related microspikes may become an EEG sign useful for the diagnosis of brain tumour in patients with epileptic seizures and no epileptic discharges on the awake EEG.
Visual hallucinations occur in diverse clinical circumstances including ophthalmologic diseases, neurologic disorders, toxic and metabolic disorders and idiopathic psychiatric illnesses. Their content, duration and timing relate to their cause and provide useful differential diagnostic information. Hallucinations must be distinguished from delusions and confabulation. A systematic approach to differentiating among hallucinatory syndromes may improve diagnostic accuracy.