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Transformations of consciousness. A cartography. I. The perception-hallucination continuum.

Self-awareness emerges from the evolutionary transformation of material structures into magical, mythical and mental structures of consciousness. Western varieties of conscious states may be mapped on a perception-hallucination continuum of increasing ergotropic or hyper-arousal. These levels of subcortical arousal are cortically or cognitively interpreted as normal, creative, hyperhrenic, cataleptic and ecstatic states. During increasing hyper-arousal (characterized by EEG desynchronization): (1) the variability of the EEG amplitude decreases in introverts whereas in extroverts, it increases; (2) exteroception is transformed into an experience of interoception, while willed motor activity becomes increasingly impaired and ultimately inhibited, and (3) information processing during these hallucinatory states is preferentially shifted from the speech dominant and motor-coordinating or "major" toward the nonverbal, gestalt-perceiving, the non-dominant or "minor" cortical hemisphere.

Amnesia↗

Visual hallucinations on eye closure after cardiovascular surgery.

Visual hallucinations on eye closure are very uncommon. The underlying mechanism remains controversial. We report on a new case after carotid endarterectomy and coronary artery bypass graft surgery. The hypothesis of a temporal lobe epilepsy is discussed.

Carotid Artery, External↗

[Left prerolandic infarction with initial epilepsy. Development of chronic hallucination psychosis].

A 34-year-old woman had three tonico-clonic seizures and aphasia revealing a left prerolandic infarct. Three weeks later, she began to develop psychiatric symptoms leading to the diagnosis of chronic hallucination psychosis. These symptoms were probably related to epilepsy and their cause was compatible with the diagnosis of interictal psychosis. It has been suggested that kindling of the mesolimbic system could account for psychosis in epilepsy. In our case, however, the sort time interval between the onset of epilepsy and the appearance of psychosis is not in favour of this mechanism.

Adult↗

About the mechanisms of auditory verbal hallucinations: a positron emission tomographic study.

OBJECTIVE: Auditory verbal hallucinations (AVHs) likely result from disorders, as yet unspecified, of the neural mechanisms of language. Here we examine the functional neuroanatomy of single-word reading in patients with and without a history of AVH. METHOD: Eighteen medicated schizophrenia patients (8 with AVH and 10 without AVH) and 12 healthy control subjects were scanned with PET (15)O-water technique under 2 conditions: reading aloud English nouns and passively looking at English nouns without reading them. RESULTS: The contrast between the 2 conditions shows higher activation in Wernicke's area during the reading condition in the patient group and a reversed laterality index for the supplementary motor area in the AVH group. CONCLUSIONS: These findings provide indications about the possible mechanisms of AVH. We suggest that the abnormal laterality of the supplementary motor area activity accounts for the failure to attribute speech generated by one's own brain to one's self and that the activation of Wernicke's area accounts for the perceptual nature (hearing) of the patient's experience.

Adult↗

[Musical hallucinations in hearing loss in the aged].

An 83-year-old woman experienced the abrupt onset of musical hallucinations. She had had long-standing progressive hearing loss due to otosclerosis. The clinical, psychopathological and pathogenetic aspects of this syndrome are discussed by means of a review of the literature.

Aged↗

[A case of left internal capsular infarction with auditory hallucination and peculiar amnesia and dysgraphia].

A 46-year-old businessman suddenly became to behave curiously on the morning, September 1, 1988. He forgot how to go through an automatic ticket gate, which he used every day. In his company, he also forgot how to open the cash box, and he wrote a meaningless report for his business. From the night on that day, he had experienced auditory hallucination in which whispering words of some criticism to his performance for a few days. On the next day, he was admitted to a psychiatric hospital because he was suggested to have schizophrenia. By day 6 after the onset, his curious symptoms completely disappeared. However, slight verbal memory disturbance and cognitive dysfunction still remained. Because the brain CT on day 6 showed a small localized subcortical infarction in the left hemisphere he was transferred to our clinic on day 20 to elucidate the relation between the abnormal behavior and the infarction. His blood pressure was 116/64 mmHg and pulse was regular 63/min. He was clear and did not have any neurological deficit. He kept his episodic memory regarding the events at the onset and could almost recall them precisely. Results of standard blood tests, electrocardiogram, ultrasound cardiogram, electroencephalogram as well as cerebral angiography were normal. Computed tomography and magnetic resonance imaging showed an infarcted lesion in the genu of the left caudate nucleus, adjacent to the anterior part of the thalamus.(ABSTRACT TRUNCATED AT 250 WORDS)

Agraphia↗

[A case of olfactory hallucination with adult enuresis].

A 22-year-old man was referred to us complaining of enuresis. The excretory urogram and cystogram were almost normal. Spina bifida was not present. The results of the urodynamic examination including uroflowmetry, cystometry, urethral pressure profile, electromyogram and sensory threshold of external urethral sphincter were within normal limits. Amitriptyline hydrochloride and flavoxate hydrochloride showed no effects. Because we found a positive spike wave on the electroencephalogram, the patient was referred to a psychopathologist, and was diagnosed as being in the early stage of schizophrenia. He complained of enuresis as his olfactive hallucination of urine. Psychopathological treatment for 1 year and 2 months resulted in disappearance of his complaining of enuresis.

Adult↗

[Induced visual hallucinations and visual adaptation disorders in patients with delirium tremens].

In 91 cases of alcoholic delirium, acute alcoholic hallucinosis and alcoholic withdrawal conditions, a clinico-experimental study of the formation of evoked visual hallucinations was conducted with the aid of a dozed compression of the eye (a modification of Lippman's test). The following 3 stages in the development of pseudoperception are described: sensorial, hallucinoid, hallucinatory. A parallel study of visual dark adaptation (40 cases) and brain bioelectrical activity (37 patients) detected 7 pathological types of changed time of visual dark adaptation and disorders of brain bioelectrical activity. These factors are connected with conditions of sensorial disadaptation, having a clinico-diagnostic significance.

Acute Disease↗

Command Hallucinations and self-amputation of the penis and hand during a first psychotic break.

An unusual case is presented of a psychotic young man who experienced command auditory hallucinations which directed him to amputate his right hand and distal penis to atone for a "terrible sexual transgression." The existing literature on genital self-mutilation is reviewed as well as some recent work on factors that might be used to predict an episode of self-mutilation. In patients who are felt to be at extremely high risk, careful monitoring and rapid medication schedules might be effective in preventing such an incident.

Adult↗

Musical hallucinations in a deaf middle-aged patient.

A case of musical hallucinations in a deaf middle-aged man is reported. Such a phenomenon is probably secondary to sensory deprivation, and is very rare; ours is probably the first case from the non-western hemisphere.

Deafness↗

Delusional infestation. The interface of delusions and hallucinations.

Delusional infestation represents a unique subtype of the delusional disorder category. This article presents the phenomenology, etiology, and treatment of delusional infestation. This article also reviews historical and theoretical attempts to distinguish tactile sensory phenomena as either hallucinations or delusions.

Delusions↗

[Is there a special indication for fluphenazine in therapy refractory hallucinations?].

On one of our rehabilitation wards, we observed several schizophrenic patients with therapy resistant hallucinations to exhibit complete recovery after being given fluphenazine (2-7.5 mg a day, orally); previously, they were found to be therapy resistant on other potent neuroleptics, including clozapine. It appears that in selected patients fluphenazine has a special antihallucinatory effect.

Clozapine↗

[Possibilities for psychological intervention in persistent delusions and persistent acoustic hallucinations in schizophrenic patients].

In practice the therapy of treatment resistant psychotic symptomatology (delusions and hallucinations) is a difficult and up to now unsolved problem. This overview presents and discusses behaviour therapy oriented studies (in the main part single case studies). The majority of studies show that it is in principle possible to influence this symptomatology. Because of methodological limitations of many studies finally some proposals for future research are discussed.

Adaptation, Psychological↗

A speculation on perversion and hallucination.

This study develops a new explanation for the loss of reality in perversion. It is a speculative effort, and draws heavily on Freud's metapsychology. I have reviewed Freud's concept of the experience of satisfaction, and have described tests of reality implicit in the experience. Freud did not put these forward as reality-tests, but this they logically become from his own arguments. These reality-tests can be shown to be at work in the perverse solution to overwhelming anxiety. In particular, the pervert exploits them to create body or motor hallucinations or delusions which serve to deny castration anxiety and other concomitant traumatic situations.

Anxiety↗

[A case of biopsy-proven sarcoid meningoencephalitis presented with hallucination, nominal aphasia and dementia].

Here we report a 36-year-old male with sarcoid meningoencephalitis who initially presented with hallucination, nominal aphasia and disturbance of consciousness. After the onset, his symptoms fluctuated. He had no meningeal signs, and his cranial nerves were normal except for bilateral papapilledema. Muscle power and tone was normal, and there was no gait disturbance. Deep tendon reflexes were slightly exaggerated in lower extremities, but no pathological reflexes were noted. There was no impairment in extrapyramidal system, cerebellar system and sensory system. The cerebrospinal fluid revealed increased opening pressure, mild lymphocytic pleocytosis, slightly decreased glucose, increased protein to 87mg/dl and increased IgG index to 1.11. Cerebrospinal fluid culture was negative. Marked meningeal thickening and contrast enhancement was shown by CT and MRI. The meningeal biopsy demonstrated characteristic sarcoid nodules and confirmed the diagnosis of neurosarcoidosis. His manifestations were alleviated by oral administration of corticosteroid. Since neurosarcoidosis is a disorder treatable with corticosteroid, it is important to consider the possibility of this disorder in mind when a patient is presenting with psychiatric manifestations and chronic meningitis.

Adult↗

The management of drug-resistant, persistent and unpleasant auditory hallucinations.

This article attempts to give an overview of the main cognitive-behavioral therapeutic approaches in order to reduce persistent, unpleasant and drug-resistant auditory hallucinations. These procedures are based on operant conditioning principles and cognitive self-management techniques. A brief case history is reported to illustrate the therapeutic interventions.

Adult↗