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PubMed2006

Characteristics of visual hallucinations in Parkinson disease dementia and dementia with lewy bodies.

OBJECTIVE: Parkinson disease dementia (PDD) and dementia with Lewy bodies (DLB) have overlapping clinical and pathologic features. Recurrent visual hallucinations (RVH) are common in both disorders. The authors have compared details of hallucination characteristics and associated neuropsychiatric features in DLB and PDD. METHODS: This is a descriptive, cross-sectional study using the Institute of Psychiatry Visual Hallucinations Interview (IP-VHI) to explore self-reported frequency, duration, and phenomenology of RVH in PDD and DLB. The caregivers' ratings of hallucinations and other neuropsychiatric features were elicited with the Neuropsychiatric Inventory (NPI). RESULTS: Fifty-six patients (35 PDD; 21 DLB) with RVH were assessed. Hallucination characteristics were similar in both disorders. Simple hallucinations were rare. Most patients experienced complex hallucinations daily, normally lasting minutes. They commonly saw people or animals and the experiences were usually perceived as unpleasant. NPI anxiety scores were higher in PDD. Neuropsychiatric symptoms coexisting with hallucinations were apathy, sleep disturbance, and anxiety. CONCLUSIONS: Patients with mild to moderate dementia can provide detailed information about their hallucinations. Characteristics of RVH were similar in PDD and DLB, and phenomenology suggests the involvement of dorsal and ventral visual pathways in their generation. The coexistence of RVH with anxiety, apathy, and sleep disturbance is likely to impair patients' quality of life and may have treatment implications.

Aged↗
PubMed1971

The hallucinations of widowhood.

227 widows and 66 widowers were interviewed to determine the extent to which they had hallucinatory experiences of their dead spouse. The people interviewed formed 80.7% of all widowed people resident within a defined area, in mid-Wales, and 94.2% of those suitable, through the absence of incapacitating illness, for interview.Almost half the people interviewed had hallucinations or illusions of the dead spouse. The proportion of men and women who had these experiences was similar. The hallucinations often lasted many years but were most common during the first 10 years of widowhood. Social isolation did not affect the incidence of hallucination, nor was it related to the incidence of known depressive illness. There was no variation within cultural groups and there was no variation with place of residence, whether this was within town, country, or village, or within England and Wales.Young people were less likely to be hallucinated than those widowed after the age of 40. The incidence of hallucination increased with length of marriage and was particularly associated with a happy marriage and parenthood. Members of the "professional and managerial" group were particularly likely to be hallucinated, while widows of "non-manual and sales workers" were the ones least likely to be hallucinated. The incidence was greater with hysteroid than obsessoid people. It was unusual for the hallucinations to have been disclosed, even to close friends or relatives.These hallucinations are considered to be normal and helpful accompaniments of widowhood.

Adult↗
PubMed1995

Command hallucinations and the prediction of dangerousness.

OBJECTIVES: Recent studies have supported the belief that command hallucinations can induce dangerous behavior. This study tried to replicate previous findings that compliance with the command was associated with delusions related to hallucinations and the ability to identify the hallucinated voice. This study also assessed the association between compliance and the dangerousness of the command, chronicity of illness, a diagnosis of schizophrenia, and past compliance with hallucinated commands. METHODS: The most recent command hallucination reported by 93 psychiatric inpatients was rated for level of dangerousness and level of compliance with the command. RESULTS: Subjects who experienced less dangerous commands or who could identify the hallucinated voice reported higher levels of compliance, although reported compliance with more dangerous commands was not uncommon. Commands experienced in the hospital were less dangerous than those experienced elsewhere and tended to be specific to the hospital environment. Subjects were less likely to comply with commands experienced in the hospital. CONCLUSIONS: Based on their self-reports, psychiatric patients who experience command hallucinations are at risk for dangerous behavior. Ability to identify the hallucinated voice is a fairly reliable predictor of reported compliance. Level of dangerousness resulting from compliance with command hallucinations may be a function of the patient's environment.

Dangerous Behavior↗
PubMed1996

The neural correlates of inner speech and auditory verbal imagery in schizophrenia: relationship to auditory verbal hallucinations.

BACKGROUND: Auditory verbal hallucinations are thought to arise from the disordered monitoring of inner speech (thinking in words). We tested the hypothesis that a predisposition to verbal auditory hallucinations would be associated with an abnormal pattern of brain activation during tasks which involved the generation and monitoring of inner speech. METHOD: The neural correlates of tasks which engaged inner speech and auditory verbal imagery were examined using positron emission tomography in (a) schizophrenic patients with a strong predisposition to auditory verbal hallucinations (hallucinators), (b) schizophrenic patients with no history of hallucinations (nonhallucinators), and (c) normal controls. RESULTS: There were few between-group differences in activation during the inner speech task. However, when imagining sentences spoken in another person's voice, which entails the monitoring of inner speech, hallucinators showed reduced activation in the left middle temporal gyrus and the rostral supplementary motor area, regions which were strongly activated by both normal subjects and nonhallucinators (P < 0.001). Conversely, when nonhallucinators imagined speech, they differed from both hallucinators and controls in showing reduced activation in the right parietal operculum. CONCLUSIONS: A predisposition to verbal hallucinations in schizophrenia is associated with a failure to activate areas implicated in the normal monitoring of inner speech, whereas the absence of a history of hallucinations may be linked to reduced activation in an area concerned with verbal prosody.

Adult↗
PubMed2005

Regional cerebral blood flow in Parkinson disease with nonpsychotic visual hallucinations.

BACKGROUND: Patients with Parkinson disease (PD) often experience visual hallucinations (VH) with retained insight (nonpsychotic) but the precise mechanism remains unclear. OBJECTIVE: To clarify which neural substrates participate in nonpsychotic VH in PD, the authors evaluated regional cerebral blood flow (rCBF) changes in patients with PD and VH. METHODS: The authors compared 24 patients with PD who had nonpsychotic VH (hallucinators) and 41 patients with PD who had never experienced VH (non-hallucinators) using SPECT images with N-isopropyl-p-[(123)I]iodoamphetamine. There were no significant differences in age, sex, duration of disease, doses of PD medications, Hoehn and Yahr scale, or Mini-Mental State Examination (MMSE) scores between the two groups. The rCBF data were analyzed using statistical parametric mapping (SPM). RESULTS: The rCBF in the right fusiform gyrus was lower in the hallucinators than in the non-hallucinators (corrected p < 0.05 at cluster levels). The hallucinators revealed higher rCBF in the right superior and middle temporal gyri than the non-hallucinators (uncorrected p < 0.001). These significant differences were demonstrated after MMSE scores and duration of disease, which are the relevant factors associated with VH, were covariated out. CONCLUSIONS: Nonpsychotic visual hallucinations in Parkinson disease (PD) may be associated with hypoperfusion in the right fusiform gyrus and hyperperfusion in the right superior and middle temporal gyri. These temporal regions are important for visual object recognition and these regional cerebral blood flow changes are associated with inappropriate visual processing and are responsible for nonpsychotic visual hallucinations in PD.

Aged↗
PubMed2004

Musical hallucinations: prevalence in psychotic and nonpsychotic outpatients.

BACKGROUND: Musical hallucinations have been considered a rare manifestation of psychotic states or brain and hearing abnormalities. However, an obsessive-compulsive disorder (OCD) assessment tool refers to musical hallucinations and our preliminary study showed that about one third of OCD patients experienced musical hallucinations. AIMS: To elucidate the lifetime prevalence of musical hallucinations among psychotic and nonpsychotic psychiatric outpatients. METHODS: Lifetime experience of musical hallucinations was examined with a specially designed structured interview in 190 consecutive outpatients with diagnoses of anxiety, affective, and schizophrenia disorders. RESULTS: Musical hallucinations occurred in more than one fifth of all diagnoses. The prevalence of musical hallucinations was highest in OCD patients (41%). Musical hallucinations were significantly more frequent with more comorbid disorders, and logistic regression revealed that this finding was mainly due to OCD combined with either social phobia or schizophrenia. CONCLUSION: Musical hallucinations are more common among psychiatric patients than previously reported and are more suggestive of OCD than of other mental disorders.

Adult↗
PubMed1997

The model of functional deficits associated with hallucinations.

OBJECTIVES: The Model of Functional Deficits associated with hallucinations is used as part of the clinical documentation in the San Jose State University Psychosocial Occupational Therapy Clinic. On the basis of this model, hallucinations are classified according to functional deficits and whether the deficits are a result of the content or intrusiveness of the hallucinations. This classification is important because it helps occupational therapists know the full extent of the dysfunction through understanding the underlying pathology. The purpose of this classification is to assist in the development of clinical treatment plans that incorporate techniques for coping with hallucinations. METHOD: The sample included 39 clients seen in the clinic over a 4-year period. Student occupational therapists were responsible for documenting the classifications using the Model of Functional Deficits associated with hallucinations. The clients' charts were then reviewed retrospectively to classify the hallucinations according to the clients' functional deficits. The classification system ranged from Class 0, insufficient information, to Class VI, persistent hallucinations with profound functional deficits. With these classifications, interventions were planned with the clients in order for them to practice coping mechanisms (e.g., self-instruction, decreased stimulation, increased stimulation) to maintain function during their hallucinations. RESULTS: The findings indicated that 54% of the clients continued to experience hallucinations (i.e., Class II-Class V), although all received psychotropic medication, thus necessitating continuing therapeutic intervention. CONCLUSION: This model helps identify specific client experiences that can then be used to develop occupational therapy interventions.

Hallucinations↗
PubMed1999

[A case of peduncular hallucination after aneurysmal subarachnoid hemorrhage].

We reported a case of peduncular hallucination after aneurysmal subarachnoid hemorrhage (SAH). The patient underwent endovascular embolization of an intracranial aneurysm using the Guglielmi detachable coils (GDCs) 9 days after SAH. On the 11th day, she reported visual hallucination: a maggot was on the ceiling, or a soldier who wore green clothes was standing by a locker. The hallucination was vivid, well-formed and associated with insomnia, suggesting peduncular hallucination. A computed tomographic (CT) scan revealed small infarctions of right frontal lobe, which were not responsible for the visual hallucination. Hyperdynamic therapy relieved the visual hallucination 23 days after SAH. It was conceivable that vasospasm was the cause of the infarction and visual hallucination. Only 4 cases with peduncular hallucination after SAH were reported in conjunction with vasospasm. The symptom may be concealed by disturbance of consciousness. Visual hallucination should be considered as a sign of cerebral vasospasm, and an appropriate treatment should be done at right time.

Aged↗
PubMed1995

[Unilateral auditory hallucinations due to left temporal lobe ischemia: a case report].

Unilateral auditory hallucinations are a rare lateralization phenomenon experienced in one ear or from one direction. We recently encountered a 63-year-old right-handed man who developed transient unilateral auditory hallucinations associated with pure word deafness. The patient had a past history of myocardial infarction, lung cancer and aortic aneurysm, but no previous psychiatric or convulsive disorders. About six months before admission, he developed right hemiparesis and motor aphasia caused by a hemorrhagic left parietal infarct. These symptoms gradually improved over three weeks. Two days before admission, he suddenly lost the ability to understand spoken words. He concurrently experienced auditory hallucinations arising from the right anterior direction. On admission, he was very embarrassed to simple verbal commands. He was unable to comprehend spoken words and repeat speech, although he could fairly follow written commands. Confrontation naming, reading aloud, comprehension, spontaneous writing remained relatively unaffected, although he occasionally made paraphasic errors. He could distinguish environmental sounds such as a telephone ringing or running water. After gradual improvement of his auditory incomprehension, he began to describe auditory hallucinations of verbal, musical and elementary types. He was fully aware of the hallucinatory nature of his experience, and took some notes. Two days before admission, from the right anterior side of his head he heard a familiar radio announcer reporting news about the earthquake in Osaka Prefecture and the recommended places of refuge. After similar experiences over several days, he repetitively heard a familiar Japanese traditional song from the right side, which was followed by elementary auditory hallucinations such as a car engine and a siren. These symptoms spontaneously disappeared after nine days. Besides his auditory hallucinations, visual hallucinations and illusional emotion were temporarily present. The Wechsler adult intelligence scale revealed a verbal IQ of 91 and a performance IQ of 100. Pure tone audiometry revealed bilateral, mild peripheral sensorineural hearing loss. Brainstem auditory evoked potentials were unrevealing. The EEG showed slow activities in the left temporoparietal region. Magnetic resonance imaging of the brain failed to reveal any relevant abnormalities except for an old hemorrhagic parietal infarct. The SPECT with Tc99m-HMPAO, however, showed reduced blood flow in the left temporal lobe including the first temporal convolution as well as in the left parietal lobe. Based on the SPECT findings, unilateral auditory hallucinations in our patient are considered to have resulted from the left temporal lobe ischemia. Our case indicates that unilateral auditory hallucinations may have a clinicoanatomical correlation with contralateral temporal lobe lesions.

Auditory Perception↗
PubMed2004

Visual Hallucinations.

Neurologists and ophthalmologists should be familiar with the causes and treatment of visual hallucinations so that they are able to reassure patients and minimize the anguish associated with untreated visual hallucinations. Hallucinations are under-reported by patients because of the perceived psychiatric implication or because of poor insight into the unreal nature of the hallucinations. In the appropriate setting, physicians should specifically inquire about hallucinations as well as initiate medical treatment. Visual hallucinations have many etiologies and are associated with a variety of disorders. Identification of the associated disorder or cause is necessary to determine the appropriate treatment. Causes and associated disorders include ocular phenomena, migraine, seizures, visual loss (ie, release hallucinations), neurodegenerative disorders, midbrain injury, alcohol and drug effects, narcolepsy, post-traumatic stress disorder, and psychosis. Therapeutic treatment should be directed at the associated disorder or etiology. For instance, antiepileptic drugs may be appropriate for patients with irritative phenomena such as seizures and visual aura of migraine. Depending on the cause, other agents are available and include neuroleptics, cholinesterase inhibitors, and acetazolamide. Well-designed, randomized, controlled clinical trials regarding treatment of visual hallucinations associated with various disorders are lacking. Although complete resolution of visual hallucinations can be difficult, even minimal improvement may be symptomatically beneficial.

Journal Article↗
PubMed1993

Polysomnographic sleep measures in Parkinson's disease patients with treatment-induced hallucinations.

Prior studies of sleep in Parkinson's disease (PD) have been compromised by inadequate comparison groups, mixed medication regimens, and absence of quantitative data collection. This is the first study to compare polysomnographic sleep measures in PD patients on only dopaminergic medications with and without hallucinations. We performed two consecutive nights of polysomnography in 10 nondepressed, nondemented PD patients, 5 with and 5 without hallucinations. All patients were being treated with carbidopa/levodopa and a dopaminergic agonist only. Hallucinators and nonhallucinators were group-matched for age, PD duration, severity, and medication doses. Both groups had abnormal sleep records. In particular, there was a reduction in K-complexes and spindle formation, and the frequent occurrence of motor activation during rapid eye movement (REM) sleep consistent with REM behavior disorder. The hallucinator group had a significantly lower sleep efficiency (0.25 in hallucinators vs 0.61 in nonhallucinators, p = 0.006), a reduced total REM sleep time (mean total REM sleep time, 3 minutes in hallucinators vs 50 in nonhallucinators; p = 0.005), and a reduced REM percentage (mean, 5% in hallucinators vs 20% in nonhallucinators; p = 0.011). This study demonstrates that advanced PD patients treated with dopaminergic agents have abnormal sleep patterns and that those with dopaminergic-induced hallucinations have significantly greater REM aberrations than nonhallucinating PD patients.

Aged↗
PubMed2002

The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic.

BACKGROUND: Studies of auditory hallucinations are scant. METHOD: To determine the prevalence and phenomenology of auditory hallucinations among elderly subjects with hearing impairment. OBJECTIVE: We surveyed 125 men and women aged 65 years and over referred to the Audiology department of a university-affiliated primary acute-care hospital. RESULTS: The prevalence of auditory hallucinations was 32.8% (95% confidence interval (CI) 24.7-41.8). These hallucinations represented a spectrum of phenomenology from elementary personal impressions to complex percepts. The types of auditory hallucinations included humming or buzzing (35.9%), shushing (12.8%), beating or tapping (10.6%), ringing (7.7%), other individual sounds (15.4%), multiple sounds (12.6%), voices (2.5%) or music (2.5%). Subjects with any type of hallucination were younger and had poorer discrimination scores in the left ear and impaired binaural discrimination with lip-reading. Subjects with hallucinations that had more qualities of a true percept heard different types of sounds and had lower reflex thresholds and better air conduction in the right ear. CONCLUSION: Auditory hallucinations are frequent in elderly subjects with hearing impairment and seem to be associated with younger age and asymmetrical hearing impairment.

Aged↗
PubMed1993

Increased blood flow in Broca's area during auditory hallucinations in schizophrenia.

Verbal auditory hallucinations are common in schizophrenia but little is known about how they arise. We have used single photon emission tomography (SPET) to measure regional cerebral blood flow with the aim of identifying brain areas that are especially active during auditory hallucinations. We scanned twelve men with schizophrenia while they were experiencing hallucinations. The subjects were rescanned under identical conditions when their hallucinations had resolved (mean 19 weeks later). Blood flow was significantly greater during hallucinations than in the non-hallucinating state in Broca's area (mean count density on SPET 1.18 [SD 0.04] vs 1.13 [0.06]; p < 0.001); flow was also higher during hallucinations in the left anterior cingulate cortex and regions in the left temporal lobe, but these differences did not achieve significance. The increased flow in Broca's area was not accounted for by changes in other clinical variables nor by changes in the dose of neuroleptic drugs. These findings suggest that the production of auditory hallucinations in schizophrenia is associated with increased activity in a network of cortical areas specialised for language.

Adolescent↗
PubMed2005

Metacognitions in proneness towards hallucinations and delusions.

The objectives of the present study were to examine the degree of co-existence of hallucinations and delusions in the nonclinical population. In addition, we wished to investigate the role of metacognitions in hallucinations and delusions. Finally, we explored the relative roles of positive and negative metacognitive beliefs in proneness to hallucinations and delusions. Three hundred and thirty-one nonclinical participants completed instruments assessing: hallucination-proneness (Launay-Slade Hallucinations Scale; LSHS), delusion-proneness (21-item version of the Peters et al. Delusions Inventory; PDI-21) and metacognitive beliefs (Meta-Cognitions Questionnaire; MCQ). Participants were successively grouped according to their scores on the LSHS and the PDI-21. Results revealed that hallucination-proneness was positively and significantly associated with delusion-proneness. Furthermore, hallucination-prone and delusion-prone participants scored significantly higher on some sub-scales of the MCQ compared to non-prone participants. Finally, multiple regression analysis revealed that positive and negative beliefs were good predictors of proneness towards hallucinations and delusions.

Adult↗
PubMed2005

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor.

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.

Adult↗
PubMed2005

The spatiotemporal pattern of auditory cortical responses during verbal hallucinations.

Functional magnetic resonance imaging (fMRI) studies can provide insight into the neural correlates of hallucinations. Commonly, such studies require self-reports about the timing of the hallucination events. While many studies have found activity in higher-order sensory cortical areas, only a few have demonstrated activity of the primary auditory cortex during auditory verbal hallucinations. In this case, using self-reports as a model of brain activity may not be sensitive enough to capture all neurophysiological signals related to hallucinations. We used spatial independent component analysis (sICA) to extract the activity patterns associated with auditory verbal hallucinations in six schizophrenia patients. SICA decomposes the functional data set into a set of spatial maps without the use of any input function. The resulting activity patterns from auditory and sensorimotor components were further analyzed in a single-subject fashion using a visualization tool that allows for easy inspection of the variability of regional brain responses. We found bilateral auditory cortex activity, including Heschl's gyrus, during hallucinations of one patient, and unilateral auditory cortex activity in two more patients. The associated time courses showed a large variability in the shape, amplitude, and time of onset relative to the self-reports. However, the average of the time courses during hallucinations showed a clear association with this clinical phenomenon. We suggest that detection of this activity may be facilitated by examining hallucination epochs of sufficient length, in combination with a data-driven approach.

Acoustic Stimulation↗
PubMed2003

Reality monitoring and visual hallucinations in Parkinson's disease.

Between 8 and 40% of Parkinson disease (PD) patients will have visual hallucinations (VHs) during the course of their illness. Although cognitive impairment has been identified as a risk factor for hallucinations, more specific neuropsychological deficits underlying such phenomena have not been established. Research in psychopathology has converged to suggest that hallucinations are associated with confusion between internal representations of events and real events (i.e. impaired-source monitoring). We evaluated three groups: 17 Parkinson's patients with visual hallucinations, 20 Parkinson's patients without hallucinations and 20 age-matched controls, using tests of visual imagery, visual perception and memory, including tests of source monitoring and recollective experience. The study revealed that Parkinson's patients with hallucinations appear to have intact visual imagery processes and spatial perception. However, there were impairments in object perception and recognition memory, and poor recollection of the encoding episode in comparison to both non-hallucinating Parkinson's patients and healthy controls. Errors were especially likely to occur when encoding and retrieval cues were in different modalities. The findings raise the possibility that visual hallucinations in Parkinson's patients could stem from a combination of faulty perceptual processing of environmental stimuli, and less detailed recollection of experience combined with intact image generation.

Aged↗
PubMedDate not supplied

Erythropoietin and visual hallucinations in patients on dialysis.

The authors encountered five patients who first had visual hallucinations while taking erythropoietin. Since this association had not previously been reported, the authors studied a convenience sample of dialysis patients at two institutions to determine the incidence of visual hallucinations in patients on erythropoietin and possible associated risk factors. Eleven percent of the patients had visual hallucinations at one institution with no other factor than erythropoietin as a probable cause and 2% at the other. Significant risk factors for hallucinations included diabetic retinopathy or cataracts (chi 2 = 4.59, df = 1, P = 0.032) and older age (t = 2.24, df = 123, P = 0.27). A multivariate analysis comparing visual hallucinations, eye pathology, and age showed that eye pathology was close to the trend level of significance but that age maintained significance as a risk factor. The visual hallucinations occurred in response to the administration of erythropoietin and appeared to vary in relation to dose. Similarities between the syndrome of visual hallucinations in dialysis patients taking erythropoietin and the syndrome of visual hallucinations in dialysis patients taking erythropoietin and the Charles Bonnet syndrome are discussed.

Age Factors↗