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PubMed2004

[Migrainous complex hallucinations in 10-year old patient--a case report and review].

OBJECTIVES: Considering a prevalence of three to ten percent migraine in children is not a rare disease. Visual auras as a characteristic of classical migraine are often described in literature. However, most of these are primary hallucinations, whilst descriptions of complex hallucinations are barely to find. As far as we know this work describes the youngest age, at which complex hallucinations occurred in migraine attacks. Reviewing the existing literature possible pathophysiologic mechanisms and differential diagnosis are discussed. METHODS: We introduce a case-report of a 10-year old-patient who reports a complex visual hallucination during a migraine attack. Symptoms, history and diagnostic measures are described. In differential diagnosis to a migrainous aura the "Alice-in-Wonderland-syndrome", "Lilliputian hallucinations", the basilar migraine and epilepsy are discussed. RESULTS: For complex hallucinations an analogical pathomechanism to primary hallucinations in migraine can be assumed. The great variety of the migrainous aura is pointed out.

Beta Rhythm↗
PubMed1998

Delusions and hallucinations in patients with borderline personality disorder.

To clarify the nature of delusional and hallucinatory symptoms in borderline personality disorder (BPD), the authors investigated five patients with BPD who developed those symptoms, and discussed their duration, recurrence, types of variants and relation to the situation. The duration of these symptoms tended to vary widely, although six of 11 episodes lasted more than 7 days. Episodes tended to recur in all patients two or three times. Each episode could be classified into three types of delusions and hallucinations, such as delusions without hallucinations, complicated delusion and hallucination, and hallucinations without delusion. Delusions without hallucination occurred a total of four times in two patients and had a tendency to occur when the patient confronted personal adversities. They projected their feelings directly toward the person concerned. A complicated delusion and hallucination was observed three times in two patients. This type of symptom also tended to occur at the time of interpersonal problems but the patient's attitude was more passive. Hallucination without delusion occurred a total of four times in three patients. This symptom tended to occur when the patient avoided an interpersonal relationship. In this case the patients isolated themselves from others and withdrew.

Adolescent↗
PubMed1987

Gustatory hallucinations in epileptic seizures. Electrophysiological, clinical and anatomical correlates.

Of the 718 patients investigated for intractable epilepsy by stereoelectrocencephalographic (SEEG) exploration, 30 (4%) manifested gustatory hallucinations as part of their seizures. In 20 patients, it was possible to make some electrophysiological, clinical and anatomical correlates. Gustatory hallucinations occurred as one manifestation of parietal, temporal or temporoparietal seizures. A brief isolated gustatory hallucination was induced mainly by electrical stimulation of the parietal or rolandic opercula in patients with gustatory seizures, in 1 epileptic patient with parietotemporal epilepsy who had never experienced gustatory hallucinations and in another with temporal lobe epilepsy with no history of gustatory manifestations. The electrically-induced seizures, which included a gustatory hallucination as one of the ictal events, were obtained mainly by stimulation of the hippocampus and amygdala. The associated ictal events of a seizure with gustatory manifestations differed depending upon the origin of the seizure. During parietal seizures, they consisted of staring reactions, clonic contractions of the face, deviation of the eyes and salivation. During temporal lobe seizures, the associated events included mainly oral movements, autonomic disturbances, purposeless movements and epigastric or other abdominal symptoms. Seizures affecting both the infra- and suprasylvian regions were characterized by symptoms of both categories listed above. Emotional disturbances were observed mainly when there was an involvement of the cingulate gyrus. When care was taken to avoid methodological errors in the interpretation of the clinical signs occurring after electrical stimulation, it became clear that gustatory hallucinations in man were related to the disorganization of the parietal and/or rolandic operculum. electrically-induced temporal lobe seizures which included gustatory hallucinations as an ictal event probably spread to the opercular region by a functional reorganization of the connections within these epileptogenic areas.

Adult↗
PubMed1998

Complex visual hallucinations. Clinical and neurobiological insights.

Complex visual hallucinations may affect some normal individuals on going to sleep and are also seen in pathological states, often in association with a sleep disturbance. The content of these hallucinations is striking and relatively stereotyped, often involving animals and human figures in bright colours and dramatic settings. Conditions causing these hallucinations include narcolepsy-cataplexy syndrome, peduncular hallucinosis, treated idiopathic Parkinson's disease, Lewy body dementia without treatment, migraine coma, Charles Bonnet syndrome (visual hallucinations of the blind), schizophrenia, hallucinogen-induced states and epilepsy. We describe cases of hallucinosis due to several of these causes and expand on previous hypotheses to suggest three mechanisms underlying complex visual hallucinations. (i) Epileptic hallucinations are probably due to a direct irritative process acting on cortical centres integrating complex visual information. (ii) Visual pathway lesions cause defective visual input and may result in hallucinations from defective visual processing or an abnormal cortical release phenomenon. (iii) Brainstem lesions appear to affect ascending cholinergic and serotonergic pathways, and may also be implicated in Parkinson's disease. These brainstem abnormalities are often associated with disturbances of sleep. We discuss how these lesions, outside the primary visual system, may cause defective modulation of thalamocortical relationships leading to a release phenomenon. We suggest that perturbation of a distributed matrix may explain the production of similar, complex mental phenomena by relatively blunt insults at disparate sites.

Brain Diseases↗
PubMed2004

Neuroanatomy of "hearing voices": a frontotemporal brain structural abnormality associated with auditory hallucinations in schizophrenia.

Auditory hallucinations are a frequent symptom in schizophrenia. While functional imaging studies have suggested the association of certain patterns of brain activity with sub-syndromes or single symptoms (e.g. positive symptoms such as hallucinations), there has been only limited evidence from structural imaging or post-mortem studies. In this study, we investigated the relation of local brain structural deficits to severity of auditory hallucinations, particularly in perisylvian areas previously reported to be involved in auditory hallucinations. In order to overcome certain limitations of conventional volumetric methods, we used deformation-based morphometry (DBM), a novel automated whole-brain morphometric technique, to assess local gray and white matter deficits in structural magnetic resonance images of 85 schizophrenia patients. We found severity of auditory hallucinations to be significantly correlated (P < 0.001) with volume loss in the left transverse temporal gyrus of Heschl (primary auditory cortex) and left (inferior) supramarginal gyrus, as well as middle/inferior right prefrontal gyri. This demonstrates a pattern of distributed structural abnormalities specific for auditory hallucinations and suggests hallucination-specific alterations in areas of a frontotemporal network for processing auditory information and language.

Adult↗
PubMed1979

Visual hallucinations during hallucinogenic experience and schizophrenia.

The visual hallucinations experienced by a 26-year-old woman under the influence of hallucinogens and during schizophrenia are described. Three types of hallucinations are delineated: (1) superimposed hallucinations, (2) spatial and depth distortions, and (3) animations. These three types of hallucinations appear to represent consecutive gradations on a continuum of the ego function of reality testing, with superimposed hallucinations revealing the least and animations the greatest degree of disorientation. The findings of the present study indicate the need for a research design that compares the hallucinations of schizophrenics to the toxic hallucinations of nonschizophrenics.

Adult↗
PubMed2006

The perceptual characteristics of voice-hallucinations in deaf people: insights into the nature of subvocal thought and sensory feedback loops.

The study of voice-hallucinations in deaf individuals, who exploit the visuomotor rather than auditory modality for communication, provides rare insight into the relationship between sensory experience and how "voices" are perceived. Relatively little is known about the perceptual characteristics of voice-hallucinations in congenitally deaf people who use lip-reading or sign language as their preferred means of communication. The existing literature on hallucinations in deaf people is reviewed, alongside consideration of how such phenomena may fit into explanatory subvocal articulation hypotheses proposed for auditory verbal hallucinations in hearing people. It is suggested that a failure in subvocal articulation processes may account for voice-hallucinations in both hearing and deaf people but that the distinct way in which hallucinations are experienced may be due to differences in a sensory feedback component, which is influenced by both auditory deprivation and language modality. This article highlights how the study of deaf people may inform wider understanding of auditory verbal hallucinations and subvocal processes generally.

Articulation Disorders↗
PubMed1996

Auditory hallucinations inhibit exogenous activation of auditory association cortex.

Percepts unaccompanied by a veridical stimulus, such as hallucinations, provide an opportunity for mapping the neural correlates of conscious perception. Functional magnetic resonance imaging (fMRI) can reveal localized changes in blood oxygenation in response to actual as well as imagined sensory stimulation. The safe repeatability of fMRI enabled us to study a patient with schizophrenia while he was experiencing auditory hallucinations and when hallucination-free (with supporting data from a second case). Cortical activation was measured in response to periodic exogenous auditory and visual stimulations using time series regression analysis. Functional brain images were obtained in each hallucination condition both while the patient was on and off antipsychotic drugs. The response of the temporal cortex to exogenous auditory stimulation (speech) was markedly reduced when the patient was experiencing hallucinating voices addressing him, regardless of medication. Visual cortical activation (to flashing lights) remained normal over four scans. From the results of this study and previous work on visual hallucinations we conclude that hallucinations coincide with maximal activation of the sensory and association cortex, specific to the modality of the experience.

Acoustic Stimulation↗
PubMed1999

Visual hallucinations and regional cerebral metabolism in dementia with Lewy bodies (DLB).

To investigate the neurobiological bases of visual hallucinations in dementia with Lewy bodies (DLB), regional cerebral glucose metabolism was compared among three patient groups; DLB with visual hallucinations, DLB without visual hallucinations and Alzheimer's disease (AD) without visual hallucinations. The regional metabolism was significantly lower in both DLB groups than in the AD group in the primary visual area and the posterior temporal, parietal and lateral occipital association areas. The hypometabolism in the right posterior temporal and parietal areas was significantly milder in DLB with visual hallucinations than in DLB without hallucinations. The hypometabolism in the primary visual cortex and the relatively preserved metabolism in the right temporoparietal association cortices may be associated with the occurrence of visual hallucinations in DLB patients.

Aged↗
PubMed1986

Strategies of disattention and auditory hallucinations in schizophrenics.

Disattentional strategies used by schizophrenics to attenuate auditory stimulation from the environment were proposed as extraordinary conditions of attention which facilitate the misperception of lexical thought as a voice and create an auditory hallucination. Two strategies were studied. The switching strategy involved concentration upon an external visual display to prevent a clearly audible list of words from registering. The holding strategy required mentally repeating a word in the list so as to ignore the words that followed. Process (N = 32) and reactive (N = 32) schizophrenics, 46 of whom had a history of auditory hallucinations, served as subjects. Effectiveness of the two disattentional strategies was tested by subsequent inability of the schizophrenic to recognize words from the taped list. Process schizophrenics with auditory hallucinations were able to use switching effectively but not holding. In contrast, reactive schizophrenics suffering auditory hallucinations successfully used holding but not switching. Both effects were confirmed relative to hallucinating controls given standard memory instructions. Strategy effects were not apparent in nonhallucinating schizophrenics. These results suggest that different disattentional strategies may have been practiced by hallucinating schizophrenics in keeping with their premorbid status and style of attention deployment. A proposal functionally relating disattention to the genesis of auditory hallucinations was suggested.

Acoustic Stimulation↗
PubMed1991

Dysphoria in male alcoholics with a history of hallucinations.

This paper examines severity of depressive symptoms, as measured by the Beck Depression Inventory, in chronic alcoholics with and without a history of hallucinations. We found a) alcoholics entering alcohol treatment who have experienced hallucinations during detoxification report higher levels of subjective depression than alcoholics who have never experienced hallucinations, b) the level of subjective depression in alcoholics with a history of hallucinations remains higher at the end of inpatient alcohol treatment than in alcoholics without hallucinations, and c) hallucination is the important variable; alcoholics with blackouts, seizures, and delirium tremens, do not experience higher levels of depression during detoxification. The reporting of a significantly higher level of depressive symptoms by alcoholics with a history of experiencing hallucinations during withdrawal suggests that in some alcoholics, there exists a vulnerability for mood abnormalities which includes a predisposition toward other abnormal mental phenomena such as perceptual distortions.

Alcoholism↗
PubMed2006

"Seeing voices": fused visual/auditory verbal hallucinations reported by three persons with schizophrenia-spectrum disorder.

OBJECTIVE: The neurocognitive basis of verbal/auditory hallucinations remains uncertain. A leading hypothesis is that these hallucinations correspond to ordinary inner speech mislabeled as non-self. However, some studies suggest pathogenic activation of receptive language neurocircuitry as the cause. A form of visualized verbal hallucinations not previously reported in the literature is described that may shed light on this controversy. METHOD: Review of three cases. RESULTS: Two patients described visual hallucinations of speech-like lip and mouth movements fused with simultaneous auditory verbal hallucinations superimposed on perceptions of faces of actual persons in their immediate environment. A third patient described similar experiences incorporated into visual hallucinations of human figures who also exhibited finger and hand movements corresponding to American Sign Language. CONCLUSION: These fused, multimodal verbal hallucinations seem unlikely to be due to inner speech mislabeled as non-self, and instead suggest top-down re-shaping of activation in visual processing brain centers by pathogenically active receptive language neurocircuitry.

Adult↗
PubMed2006

Contrast sensitivity and visual hallucinations in patients referred to a low vision rehabilitation clinic.

AIM: To examine the association of reported visual hallucinations and measured visual parameters in adult patients referred for low vision rehabilitation. METHODS: All patients (N = 225) referred to a low vision rehabilitation clinic for a calendar year were asked a standardised question about symptoms of formed visual hallucinations. Best corrected visual acuity and contrast sensitivity using the Pelli-Robson chart were measured. We conducted multiple logistic regression analysis of the association between visual hallucinations and visual parameters. RESULTS: Of the total cohort, 78 (35%) reported visual hallucinations. Visual acuity and contrast sensitivity were considered in four quartiles. In multiple logistic regression controlling for contrast sensitivity, age, gender, report of depression and independence, measured acuity in each of the poorer three categories (compared to the best) was not associated with reported hallucinations. Contrast sensitivity in the three poorer quartiles (compared to the best) was strongly associated with the report of hallucinations (OR 4.1, CI 1.1, 15.9; OR 10.5, CI 2.6, 42.1; OR 28.1, CI 5.6, 140.9) after controlling for acuity, age, sex, depression and independence. CONCLUSIONS: Lowest contrast sensitivity was the strongest predictor of reported hallucinations after adjusting for visual acuity.

Aged↗
PubMed2000

Hallucinations, delusions, and cognitive decline in Alzheimer's disease.

OBJECTIVES: To examine the occurrence of hallucinations and delusions in Alzheimer's disease over a 4 year period and their association with rate of cognitive decline. METHODS: A cohort of 410 persons with clinically diagnosed Alzheimer's disease underwent annual clinical evaluations over a 4 year period. Participation in follow up exceeded 90% in survivors. Evaluations included structured informant interview, from which the presence or absence of hallucinations and delusions was ascertained, and detailed testing of cognitive function. The primary cognitive outcome measure was a composite cognitive score based on 17 individual performance tests. The mini mental state examination (MMSE) and summary measures of memory, visuoconstruction, repetition, and naming were used in secondary analyses. RESULTS: At baseline, hallucinations (present in 41%) and delusions (present in 55%) were common and associated with lower cognitive function. In analyses that controlled for baseline level of cognitive function, demographic variables, parkinsonism, and use of antipsychotic medications, hallucinations, but not delusions, were associated with more rapid cognitive decline on each cognitive measure. In the primary model, there was a 47% increase in the average annual rate of decline on a composite cognitive measure in those with baseline hallucinations compared with those without them. This effect was mainly due to a subgroup with both auditory and visual hallucinations. CONCLUSION: These findings suggest that the presence of hallucinations is selectively associated with more rapid cognitive decline in Alzheimer's disease.

Aged↗
PubMedDate not supplied

Musical hallucinations in schizophrenia.

There have been many reports of musical hallucinations in deafness, organic brain disease and epilepsy, but few reports of their occurrence in schizophrenia. Musical hallucinations tend to be regarded as specific manifestations of deafness and organic brain disease rather than of schizophrenia. However, since schizophrenic musical hallucinations are less distressing to schizophrenic patients than verbal hallucinations and psychiatrists have little interest in them, they may be missed. We treated schizophrenic patients who experienced musical hallucinations and traced the symptomatic changes. They exhibited semeiological changes similar to the changes in verbal hallucinations. Musical hallucinations are clearly a symptom of schizophrenia. By reporting these cases, we encourage concern about this symptom, which may be missed when psychiatrists interview patients.

Adolescent↗
PubMedDate not supplied

Grief hallucinations: true or pseudo? Serious or not? An inquiry into psychopathological and clinical features of a common phenomenon.

An inquiry into the psychopathology and the clinical significance of grief hallucinations is presented and two cases with severe grief hallucinations are described. Unlike many cases in the literature, the two female patients were young (aged 43 and 45, respectively) and both suffered from the loss of a daughter. The heterogeneous concept of grief hallucinations is described and discussed, focusing particularly on the difficulties of reaching a differentiation between hallucination and pseudohallucination. Basic theses of the article are: (1) Contrary to a widely held view, grief hallucinations can display all the characteristics of 'true' hallucinations. (2) The concept of grief hallucinations probably comprises a heterogeneous group of disturbances of perception and of thought processes. They can be experienced as comforting but can also cause considerable distress. (3) There are essentially two definitions of pseudohallucinations and they contradict each other. The extremely vague concept of pseudohallucinations appears to be of questionable value and should be abandoned.

Adult↗
PubMed2004

Hallucinations predict attentional improvements with rivastigmine in dementia with lewy bodies.

The aim of this analysis of the effects of cholinergic therapy in dementia with Lewy bodies was to determine whether rivastigmine-induced benefits in attention and memory could be predicted by the presence of visual hallucinations. At study entry, 74% of patients were hallucinators and 26% were non-hallucinators. The population was analyzed for two-factor scores: power of attention (PoA) and quality of memory (QoM). A significant effect over placebo on PoA was observed in hallucinators at weeks 12 (p = 0.023) and 20 (p = 0.0019), while no treatment effects were seen in non-hallucinators. Significant treatment effects on QoM were not observed in either subgroup. Visual hallucinations predicted greater improvements in PoA, but not QoM. This may reflect the greater cholinergic deficits in areas of the brain responsible for visual hallucinations, offering greater potential for attentional improvement.

Aged↗
PubMed1995

The phenomenology of perceptual hallucinations in alcohol-induced delirium tremens.

In a qualified detoxication, states of anxiety caused by hallucinations can be specifically assimilated and psychologically reduced. Knowledge of the hallucinations experienced promotes the subsequent motivation phase. A semistandardized investigation of 64 patients with alcohol-induced delirium tremens was carried out over a period of 14 months in order to establish the nature of their perceptual hallucinations. Visual hallucinations predominated followed by auditory and tactile perceptual hallucinations. Amongst visual hallucinations pertaining to animals, the well-known 'white mice' were only reported once. Hallucinated cats, dogs, and snakes were most frequent, and were only then followed by mice (in general).

Adult↗