Birkeland, Søren F
Paranoia (delusional disorder) is an uncommon chronic condition, characterized by the presence of delusions and the relative absence of other psychopathology. Unlike in schizophrenia, the paranoiac delusions are nonbizarre and concern experiences that can conceivably occur, and the evidence mostly supports the hypothesis that paranoia is a distinct nosologic entity. The article reviews the epidemiology, pathogenesis, diagnosis, clinical manifestations and management of paranoia. It is concluded that further exploration is required and greater diagnostic and therapeutic attention needs to be given to the non-schizophrenic, non-affective, non-organic delusional psychoses.
Kingdon, David G; Ashcroft, Katie; Bhandari, Bharathi; Gleeson, Stefan; Warikoo, Nishchint; Symons, Matthew; Taylor, Lisa; Lucas, Eleanor; Mahendra, Ravi; Ghosh, Soumya; Mason, Anthony; Badrakalimuthu, Raja; Hepworth, Claire; Read, John; Mehta, Raj
This study investigated similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma in schizophrenia and borderline personality disorder (BPD). Patients with clinical diagnoses of schizophrenia or BPD were interviewed using the Structured Clinical Interviews for DSM-IV. Axes 1 and 2 and auditory hallucinations, paranoia, and childhood trauma were assessed. A total of 111 patients participated; 59 met criteria for schizophrenia, 33 for BPD, and 19 for both. The groups were similar in their experiences of voices, including the perceived location of them, but they differed in frequency of paranoid delusions. Those with a diagnosis of BPD, including those with schizophrenia comorbidity, reported more childhood trauma, especially emotional abuse. BPD and schizophrenia frequently coexist, and this comorbidity has implications for diagnostic classification and treatment. Levels of reported childhood trauma are especially high in those with a BPD diagnosis, whether they have schizophrenia or not, and this requires assessment and appropriate management.
Wickham, S; Sitko, K; Bentall, R P
A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms. We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association. Insecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia. It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.
Wickham, Sophie; Taylor, Peter; Shevlin, Mark; Bentall, Richard P
The negative implications of living in a socially unequal society are now well documented. However, there is poor understanding of the pathways from specific environmental risk to symptoms. Here we examine the associations between social deprivation, depression, and psychotic symptoms using the 2007 Adult Psychiatric Morbidity Survey, a cross-sectional dataset including 7,353 individuals. In addition we looked at the mediating role of stress, discrimination, trust and lack of social support. We found that the participants' neighbourhood index of multiple deprivation (IMD) significantly predicted psychosis and depression. On inspection of specific psychotic symptoms, IMD predicted paranoia, but not hallucinations or hypomania. Stress and trust partially mediated the relationship between IMD and paranoid ideation. Stress, trust and a lack of social support fully mediated the relationship between IMD and depression. Future research should focus on the role deprivation and social inequalities plays in specific manifestations of psychopathology and investigate mechanisms to explain those associations that occur. Targeting the mediating mechanisms through appropriate psychological intervention may go some way to dampen the negative consequences of living in an unjust society; ameliorating economic injustice may improve population mental health.
Full Text Available The negative implications of living in a socially unequal society are now well documented. However, there is poor understanding of the pathways from specific environmental risk to symptoms. Here we examine the associations between social deprivation, depression, and psychotic symptoms using the 2007 Adult Psychiatric Morbidity Survey, a cross-sectional dataset including 7,353 individuals. In addition we looked at the mediating role of stress, discrimination, trust and lack of social support. We found that the participants' neighbourhood index of multiple deprivation (IMD significantly predicted psychosis and depression. On inspection of specific psychotic symptoms, IMD predicted paranoia, but not hallucinations or hypomania. Stress and trust partially mediated the relationship between IMD and paranoid ideation. Stress, trust and a lack of social support fully mediated the relationship between IMD and depression. Future research should focus on the role deprivation and social inequalities plays in specific manifestations of psychopathology and investigate mechanisms to explain those associations that occur. Targeting the mediating mechanisms through appropriate psychological intervention may go some way to dampen the negative consequences of living in an unjust society; ameliorating economic injustice may improve population mental health.
Inspired by Alain Robbe-Grillet’s novel La Jalousie (1957), the essay contends that Michael Haneke’s Caché (2005) takes its viewers inside a postcolonial white paranoia which is, arguably, the root cause of the exclusion, segregation and racist discrimination that many immigrants from the former...... colonies – and their children – are experiencing in contemporary France. It suggests that the entire film be read as the protagonist’s paranoid vision that imagines white privileges to be menaced by some non-white conspiracy. His obsession, which hinges on a fear of a reversal of the power inherent in ‘the...
Musical hallucinations have been described in numerous neurologic and psychiatric patients, but their pathophysiologic background is not understood. Analyzing the published cases, five subgroups can be separated according to their etiology: hypacusis, psychiatric disorders, focal brain lesions, epilepsy, and intoxication. There is a female preponderance of about 70%. Musical hallucinations most often occur in patients over age 60 years, although patients whose hallucinations are caused by focal brain lesions are significantly younger. Hemispheric dominance seems to play no major role in the pathogenesis of musical hallucinations, but hypacusis is present in the majority of all patients. Anticonvulsant and antidepressive agents have been effective in the treatment of some musical hallucinations. The discussion on the pathophysiology of musical hallucinations comprises theories of deafferentation (including auditory Charles Bonnet syndrome), of sensory auditory deprivation, of parasitic memory, and of spontaneous activity in a cognitive network module.
For almost 20 years, gay rights advocates and defenders of military anti-gay discrimination engaged in a phony debate about whether allowing open service would undermine unit cohesion. To be sure, a preponderance of evidence showed that open service would not undermine cohesion, and the repeal of don't ask, don't tell (DADT) required advocates to prevail on that point in the court of public opinion. But concerns about cohesion were never the basis of opposition to open service. Rather, opposition was a modern incarnation of the politics of paranoia, a dangerous tradition in American history. Acknowledging that DADT had nothing to do with cohesion and that military leaders allowed the armed forces to be implicated in the politics of paranoia could facilitate disabling paranoia as the basis for other political projects such as anti-immigrant xenophobia. For a video on DADT and paranoia, search for "Donnelly Belkin DADT" on YoutTube.
Savulich, George; Freeman, Daniel; Shergill, Sukhi; Yiend, Jenny
Information in the environment is frequently ambiguous in meaning. Emotional ambiguity, such as the stare of a stranger, or the scream of a child, encompasses possible good or bad emotional consequences. Those with elevated vulnerability to affective disorders tend to interpret such material more negatively than those without, a phenomenon known as "negative interpretation bias." In this study we examined the relationship between vulnerability to psychosis, measured by trait paranoia, and interpretation bias. One set of material permitted broadly positive/negative (valenced) interpretations, while another allowed more or less paranoid interpretations, allowing us to also investigate the content specificity of interpretation biases associated with paranoia. Regression analyses (n=70) revealed that trait paranoia, trait anxiety, and cognitive inflexibility predicted paranoid interpretation bias, whereas trait anxiety and cognitive inflexibility predicted negative interpretation bias. In a group comparison those with high levels of trait paranoia were negatively biased in their interpretations of ambiguous information relative to those with low trait paranoia, and this effect was most pronounced for material directly related to paranoid concerns. Together these data suggest that a negative interpretation bias occurs in those with elevated vulnerability to paranoia, and that this bias may be strongest for material matching paranoid beliefs. We conclude that content-specific biases may be important in the cause and maintenance of paranoid symptoms.
Full Text Available Auditory Hallucination or Paracusia is a form of hallucination that involves perceiving sounds without auditory stimulus. A common is hearing one or more talking voices which is associated with psychotic disorders such as schizophrenia or mania. Hallucination, itself, is the most common feature of perceiving the wrong stimulus or to the better word perception of the absence stimulus. Here we will discuss four definitions of hallucinations:1.Perceiving of a stimulus without the presence of any subject; 2. hallucination proper which are the wrong perceptions that are not the falsification of real perception, Although manifest as a new subject and happen along with and synchronously with a real perception;3. hallucination is an out-of-body perception which has no accordance with a real subjectIn a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid, substantial, and located in external objective space. We are going to discuss it in details here.
Freeman, Daniel; Pugh, Katherine; Vorontsova, Natasha; Southgate, Laura
Insomnia is a potential cause of anxiety, depression, and anomalies of experience; separate research has shown that anxiety, depression and anomalies of experience are predictors of paranoia. Thus insomnia may contribute to the formation and maintenance of persecutory ideation. The aim was to examine for the first time the association of insomnia symptoms and paranoia in the general population and the extent of insomnia in individuals with persecutory delusions attending psychiatric services. Assessments of insomnia, persecutory ideation, anxiety, and depression were completed by 300 individuals from the general population and 30 individuals with persecutory delusions and a diagnosis of non-affective psychosis. Insomnia symptoms were clearly associated with higher levels of persecutory ideation. Consistent with the theoretical understanding of paranoia, the association was partly explained by the presence of anxiety and depression. Moderate or severe insomnia was present in more than 50% of the delusions group. The study provides the first direct evidence that insomnia is common in individuals with high levels of paranoia. It is plausible that sleep difficulties contribute to the development of persecutory ideation. The intriguing implication is that insomnia interventions for this group could have the added benefit of lessening paranoia.
Freeman, Daniel; Pugh, Katherine; Vorontsova, Natasha; Southgate, Laura
Insomnia is a potential cause of anxiety, depression, and anomalies of experience; separate research has shown that anxiety, depression and anomalies of experience are predictors of paranoia. Thus insomnia may contribute to the formation and maintenance of persecutory ideation. The aim was to examine for the first time the association of insomnia symptoms and paranoia in the general population and the extent of insomnia in individuals with persecutory delusions attending psychiatric services. Assessments of insomnia, persecutory ideation, anxiety, and depression were completed by 300 individuals from the general population and 30 individuals with persecutory delusions and a diagnosis of non-affective psychosis. Insomnia symptoms were clearly associated with higher levels of persecutory ideation. Consistent with the theoretical understanding of paranoia, the association was partly explained by the presence of anxiety and depression. Moderate or severe insomnia was present in more than 50% of the delusions group. The study provides the first direct evidence that insomnia is common in individuals with high levels of paranoia. It is plausible that sleep difficulties contribute to the development of persecutory ideation. The intriguing implication is that insomnia interventions for this group could have the added benefit of lessening paranoia. PMID:19097752
Oxman, Thomas E.; And Others
Free speech of subjects with somatization and paranoia was analyzed to identify and compare self-concept dimensions reflected in their lexical choices. The somatization disorder group conveyed a sense of negativism, distress, and preoccupation with an uncertain self-identity. The paranoid patients portrayed an artificially positive, grandiose…
Blom, Jan Dirk
Auditory hallucinations constitute a phenomenologically rich group of endogenously mediated percepts which are associated with psychiatric, neurologic, otologic, and other medical conditions, but which are also experienced by 10-15% of all healthy individuals in the general population. The group of phenomena is probably best known for its verbal auditory subtype, but it also includes musical hallucinations, echo of reading, exploding-head syndrome, and many other types. The subgroup of verbal auditory hallucinations has been studied extensively with the aid of neuroimaging techniques, and from those studies emerges an outline of a functional as well as a structural network of widely distributed brain areas involved in their mediation. The present chapter provides an overview of the various types of auditory hallucination described in the literature, summarizes our current knowledge of the auditory networks involved in their mediation, and draws on ideas from the philosophy of science and network science to reconceptualize the auditory hallucinatory experience, and point out directions for future research into its neurobiologic substrates. In addition, it provides an overview of known associations with various clinical conditions and of the existing evidence for pharmacologic and non-pharmacologic treatments.
The idea of paranoia has existed since Antiquity, but it was only in the 19th centurythat psychiatrists became interested in it and sought to describe it. Delusion and the feeling of persecution are common in all paranoiacs. The origins of the disease can be found in the patient's psychic structure. Establishing and maintaining contact with a caregiver is one way of helping the patient.
With reference to the "clinical case" of Daniel Paul Schreber, possible relationships between mathematics and paranoia are discussed. The piedmontese mathematician Giuseppe Peano seems to be in agreement with the french philosopher and psychiatrist Jacques Lacan.
Full Text Available Hallucinations are a psychopathological phenomenon with neuropsychological, neuroanatomical and pathophysiological correlates in specific brain areas. They can affect any of the senses, but auditory and visual hallucinations predominate. Verbal hallucinations reveal no gross organic lesions while visual hallucinations are connected to defined brain lesions. Functional neuroimaging shows impairments in modality specific sensory systems with the hyperactivity of the surrounding cerebral cortex. Disinhibition and expansion of the inner speech was noted with impaired internal monitoring in auditory verbal hallucinations. The subcortical areas and modal-specific associative cortex and cingulate cortex are essential for the occurrence of hallucinations.
Fenigstein, A; Vanable, P A
A new instrument designed to assess paranoid thought in college students, together with reliability and validity data, was presented in Study 1. A single general factor accounted for a substantial portion of the variance in the full scale. Public self-consciousness was consistently and significantly correlated with the present measure of paranoia. In Study 2, both pretested paranoia and public self-consciousness were related to feelings of being watched (a classical manifestation of paranoia), although public self-consciousness had an effect only when there was a 2-way mirror present. In Study 3, self-attention, experimentally induced using a story construction task, again resulted in a heightened sense of being observed. Discussion focuses on paranoid cognition as characteristic of everyday thought and the implications of self-attention for social perception processes.
Paranoia.Ada is a program to diagnose floating point arithmetic in the context of the Ada programming language. The program evaluates the quality of a floating point arithmetic implementation with respect to the proposed IEEE Standards P754 and P854. Paranoia.Ada is derived from the original BASIC programming language version of Paranoia. The Paranoia.Ada replicates in Ada the test algorithms originally implemented in BASIC and adheres to the evaluation criteria established by W. M. Kahan. Paranoia.Ada incorporates a major structural redesign and employs applicable Ada architectural and stylistic features.
Fornells-Ambrojo, Miriam; Elenbaas, Maaike; Barker, Chris; Swapp, David; Navarro, Xavier; Rovira, Aitor; Sanahuja, Josep Maria Tomàs; Slater, Mel
Contingency in interpersonal relationships is associated with the development of secure attachment and trust, whereas paranoia arises from the overattribution of negative intentions. We used a new virtual reality paradigm to experimentally investigate the impact of contingent behavior on trust along the paranoia continuum. Sixty-one healthy participants were randomly allocated to have a social interaction with a pleasant virtual human (avatar) programmed to be highly responsive or not (high/low contingency). Perceived trustworthiness and trusting behavior were assessed alongside control variables attachment and anxiety. Higher paranoia and dismissive attachment were associated with larger interpersonal distances. Unexpectedly, extremely paranoid individuals experienced the highly contingent avatar as more trustworthy than their low contingency counterpart. Higher dismissive attachment was also associated with more subjective trust in both conditions. Extreme paranoia is associated with hypersensitivity to noncontingent behavior, which might explain experiences of mistrust when others are not highly responsive in everyday social situations.
Full Text Available Visual hallucinations occur in a wide variety of neurological and psychiatric disorders, including toxic disturbances, drug withdrawal syndromes, focal central nervous system lesions, migraine headaches, blindness, schizophrenia, and psychotic mood disorders. Visual hallucinations are generally assumed to characteristically reflect organic disorders and are very rare in affective disorders. Here, we present a case of visual hallucinations in a young female with bipolar illness during the manic phase.
Full Text Available Drug-induced hallucinations are not uncommon, and may be misdiagnosed as psychiatric illness leading to unnecessary treatment with antipsychotics. If a temporal association of use of a drug having the potential to cause hallucinations is present, mere withdrawal of the drug causes complete improvement in the symptoms. There are reports of various untoward central nervous system adverse events following administration of fluoroquinolones, including delirium, hallucinations and psychosis, even after a single dose. We describe a 5-year-old girl who suffered visual hallucinations following ofloxacin use.
Darch, Kayleigh; Ellett, Lyn; Fox, Simone
Previous studies have identified a positive relationship between aggression and paranoia, yet the relationship between the emotion of anger and paranoia in forensic populations has not been examined. Possible confounding variables, such as social desirability and mood, should also be considered. Sixty-six participants who had a violent conviction and mental disorder completed self-report questionnaires that measured anger, paranoid ideation, socially desirable responding, anxiety, and depression. The findings indicated that increased anger was associated with increased paranoia. Partial correlations showed that anger remained significantly associated with paranoia after socially desirable responding, anxiety, depression, gender, and violence history were controlled, suggesting anger and paranoia were not associated due to indirect relationships with these constructs. This could suggest that integrative psychological interventions that consider experiences of both anger and paranoia may be beneficial with forensic populations.
Kendler, Kenneth S
This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions.
Full Text Available Aqui publicamos a tradução brasileira (1905 do capítulo sobre a paranoia, extraído da sétima edição alemã (1904 do tratado (Lehrbuch de psiquiatria de Emil Kraepelin. O autor discute o diagnóstico da paranoia e, particularmente, faz a distinção entre a paranoia e a demência precoce.
Aqui publicamos a tradução brasileira (1905) do capítulo sobre a paranoia, extraído da sétima edição alemã (1904) do tratado (Lehrbuch) de psiquiatria de Emil Kraepelin. O autor discute o diagnóstico da paranoia e, particularmente, faz a distinção entre a paranoia e a demência precoce.
Leamon, Martin H; Flower, Keith; Salo, Ruth E; Nordahl, Thomas E; Kranzler, Henry R; Galloway, Gantt P
Paranoia in methamphetamine (MA) users is not well characterized or understood. To investigate this phenomenon, we created the Methamphetamine Experience Questionnaire (MEQ), and tested its reliability and validity in assessing MA-induced paranoia. We administered the MEQ to 274 MA-dependent subjects. Of the total subjects, 45% (123) first experienced paranoia with MA use; 55% did not. Obtaining or using a weapon while paranoid was common (37% and 11% of subjects with MA-induced paranoia, respectively). Test-retest and inter-rater reliability for MA-induced paranoia showed substantial agreement (kappa = .77, p paranoia occurred more often with intravenous use of MA, and subsequent episodes at higher doses. There was modest correlation between paranoia on the MEQ and the Brief Symptom Inventory (BSI) paranoid ideation scale (rho = .27, p paranoia on the MEQ and the BSI depression scale (rho = .14, p = .07). The MEQ provides useful information on drug use variables that contribute to paranoia commonly associated with MA use. (Am J Addict 2010;00:1-14).
Leamon, Martin H.; Flower, Keith; Salo, Ruth E.; Nordahl, Thomas E.; Kranzler, Henry R.; Galloway, Gantt P.
Paranoia in methamphetamine (MA) users is not well characterized or understood. To investigate this phenomenon, we created the Methamphetamine Experience Questionnaire (MEQ), and tested its reliability and validity in assessing MA-induced paranoia. METHODS: We administered the MEQ to 274 MA-dependent subjects. RESULTS: 45% (123) subjects first experienced paranoia with MA use; 55% did not. Obtaining or using a weapon while paranoid was common (37% and 11% of subjects with MA-induced paranoia, respectively). Test-retest and inter-rater reliability for MA-induced paranoia showed substantial agreement (kappa = 0.77, p < 0.05 and kappa = 0.80, p < 0.05, respectively). First episodes of paranoia occurred more often with intravenous use of MA, and subsequent episodes at higher doses. There was modest correlation between paranoia on the MEQ and the BSI paranoid ideation scale (rho = 0.27, p < 0.05). As expected, there was a poor correlation between paranoia on the MEQ and the BSI depression scale (rho = 0.14, p = 0.07). The MEQ provides useful information on drug use variables that contribute to paranoia commonly associated with MA use. PMID:20163388
Schlier, Björn; Moritz, Steffen; Lincoln, Tania M
Research increasingly assesses momentary changes in paranoia in order to elucidate causal mechanisms. Observed or manipulated changes in postulated causal factors should result in fluctuations in state paranoid ideation. Previous studies often employed a state-adapted Paranoia Checklist (Freeman et al., 2005) to measure state paranoia. This study examined whether the Paranoia Checklist or subsets of its items are appropriate for this purpose. Thirteen studies (N=860) were subjected to meta-analyses of each Paranoia Checklist item. We selected items based on (1) whether they showed pre-to-post change in the expected direction and (2) whether this effect was larger in experimental vs. control conditions. All resulting item selections were cross-validated on a hold-out sample (n=1893). Finally, we explored how much variation in paranoia was captured by the state-adapted version in a brief ambulatory assessment study (N=32). A thirteen item State Paranoia Checklist as well as a five item and a three item Brief State Paranoia Checklist were extracted. Cross validation revealed better model fit and increased sensitivity to change. Multilevel analysis indicated 25-30% of the variance in the Brief State Paranoia Checklists to be due to intra-individual daily fluctuations in paranoia. Our analyses produced reliable and valid revised scales. Increases in change sensitivity indicate that future assessment of state paranoia in experimental and ambulatory assessment studies can be optimized by using the revised scales.
Full Text Available Thirty patients with Parkinson's disease experiencing hallucinations during long-term treatment were compared with 20 parkinsonian patients without hallucinations. No differences were found in the duration of disease, L-dopa treatment or disease severity between the two groups. The hallucinators however, were significantly older and more cognitively impaired. Visual hallucinations occurring only during “off periods of immobility” were relatively common and improved concurrently with parkinsonian disabilities after L-dopa. Although visual hallucinations were commonest auditory hallucinations occurred in one third of the hallucinators.
Terao, T; Matsunaga, K
So far, little attention has been paid to the similarities between musical hallucinations and palinacousis. Since the authors found a 75-year-old woman suffering from both symptoms, the similarities were investigated. As a result, musical hallucinations have all the four components of palinacousis structurally, although there are some differences in content. Thus, there exist substantial similarities. Moreover, both symptoms are often associated with seizure activity and there have been several case reports where anticonvulsants were successfully used to treat both symptoms. These findings indicate the possibility that there may exist a common pathway generating musical hallucinations and palinacousis.
Hallucinations of musical notation may occur in a variety of conditions, including Charles Bonnet syndrome, Parkinson's disease, fever, intoxications, hypnagogic and hypnopompic states. Eight cases are described here, and their possible cerebral mechanisms discussed.
Collip, D; Oorschot, M; Thewissen, V; Van Os, J; Bentall, R; Myin-Germeys, I
Experimental studies have indicated that social contact, even when it is neutral, triggers paranoid thinking in people who score high on clinical or subclinical paranoia. We investigated whether contextual variables are predictive of momentary increases in the intensity of paranoid thinking in a sample of participants ranging across a psychometric paranoia continuum. The sample (n=154) consisted of 30 currently paranoid patients, 34 currently non-paranoid patients, 15 remitted psychotic patients, 38 high-schizotypy participants, and 37 control subjects. Based on their total score on Fenigstein's Paranoia Scale (PS), three groups with different degrees of paranoia were defined. The Experience Sampling Method (ESM), a structured diary technique, was used to assess momentary social context, perceived social threat and paranoia in daily life. There were differences in the effect of social company on momentary levels of paranoia and perceived social threat across the range of trait paranoia. The low and medium paranoia groups reported higher levels of perceived social threat when they were with less-familiar compared to familiar individuals. The medium paranoia group reported more paranoia in less-familiar company. The high paranoia group reported no difference in the perception of social threat or momentary paranoia between familiar and unfamiliar contacts. Paranoid thinking is context dependent in individuals with medium or at-risk levels of trait paranoia. Perceived social threat seems to be context dependent in the low paranoia group. However, at high levels of trait paranoia, momentary paranoia and momentary perceived social threat become autonomous and independent of social reality.
Reeve, Sarah; Sheaves, Bryony; Freeman, Daniel
Background Sleep dysfunction is extremely common in patients with schizophrenia. Recent research indicates that sleep dysfunction may contribute to psychotic experiences such as delusions and hallucinations. Objectives The review aims to evaluate the evidence for a relationship between sleep dysfunction and individual psychotic experiences, make links between the theoretical understanding of each, and highlight areas for future research. Method A systematic search was conducted to identify studies investigating sleep and psychotic experiences across clinical and non-clinical populations. Results 66 papers were identified. This literature robustly supports the co-occurrence of sleep dysfunction and psychotic experiences, particularly insomnia with paranoia. Sleep dysfunction predicting subsequent psychotic experiences receives support from epidemiological surveys, research on the transition to psychosis, and relapse studies. There is also evidence that reducing sleep elicits psychotic experiences in non-clinical individuals, and that improving sleep in individuals with psychosis may lessen psychotic experiences. Anxiety and depression consistently arise as (partial) mediators of the sleep and psychosis relationship. Conclusion Studies are needed that: determine the types of sleep dysfunction linked to individual psychotic experiences; establish a causal connection between sleep and psychotic experiences; and assess treatments for sleep dysfunction in patients with non-affective psychotic disorders such as schizophrenia. PMID:26407540
Shiotsuki, Ippei; Terao, Takeshi; Ishii, Nobuyoshi; Hatano, Koji
A 26-year-old female outpatient presenting with a depressive state suffered from auditory hallucinations at night. Her auditory hallucinations did not respond to blonanserin or paliperidone, but partially responded to risperidone. In view of the possibility that her auditory hallucinations began after starting trazodone, trazodone was discontinued, leading to a complete resolution of her auditory hallucinations. Furthermore, even after risperidone was decreased and discontinued, her auditory hallucinations did not recur. These findings suggest that trazodone may induce auditory hallucinations in some susceptible patients.
Powers, Albert R; Gancsos, Mark G; Finn, Emily S; Morgan, Peter T; Corlett, Philip R
Ketamine, the NMDA glutamate receptor antagonist drug, is increasingly employed as an experimental model of psychosis in healthy volunteers. At subanesthetic doses, it safely and reversibly causes delusion-like ideas, amotivation and perceptual disruptions reminiscent of the aberrant salience experiences that characterize first-episode psychosis. However, auditory verbal hallucinations, a hallmark symptom of schizophrenia, have not been reported consistently in healthy volunteers even at high doses of ketamine. Here we present data from a set of healthy participants who received moderately dosed, placebo-controlled ketamine infusions in the reduced stimulation environment of the magnetic resonance imaging (MRI) scanner. We highlight the phenomenological experiences of 3 participants who experienced particularly vivid hallucinations. Participants in this series reported auditory verbal and musical hallucinations at a ketamine dose that does not induce auditory hallucination outside of the scanner. We interpret the observation of ketamine-induced auditory verbal hallucinations in the context of the reduced perceptual environment of the MRI scanner and offer an explanation grounded in predictive coding models of perception and psychosis - the brain fills in expected perceptual inputs, and it does so more in situations of altered perceptual input. The altered perceptual input of the MRI scanner creates a mismatch between top-down perceptual expectations and the heightened bottom-up signals induced by ketamine. Such circumstances induce aberrant percepts, including musical and auditory verbal hallucinations. We suggest that these circumstances might represent a useful experimental model of auditory verbal hallucinations and highlight the impact of ambient sensory stimuli on psychopathology. © 2015 S. Karger AG, Basel.
The term paranoid is derived from the Greek word paranoia meaning nadnese. It does not only mean self-reference, but there are various personality features as they are hostility, a tendency towards aggressiveness, irritability, a lack of sense of humour, feelings of overestimation of one-self and a tendency towards accusations. These features may appear also within normal psychology and they becomeclinically important after thein increase of intensity and conspicuousness (los sof hearing, long-term abuse of alcohol and psychostimulants) and organic disorders of the brain may contribute to the development of paranoidity. A mechanism of projection is considered as a decivise factor from the point of view of dynamic psychiatry. Clinically unimportant sign sof paranoidity can be observed due to unusual situations. If a paranoid reaction becomes more serious, formation of a paranoid delusion should be taken to account. In our koncept the term paranoid and paranoidity should be used only as a psychopathological term.
Jan, Tiffany; Del Castillo, Jorge
The following is a case of Charles Bonnet syndrome in an 86-year-old woman who presented with visual hallucinations. The differential diagnosis of visual hallucinations is broad and emergency physicians should be knowledgeable of the possible etiologies.
Combs, Dennis R.; Penn, David L.; Cassisi, Jeffrey; Michael, Chris; Wood, Terry; Wanner, Jill; Adams, Scott
Recent theoretical models suggest that perceived racism acts as a stressor for African Americans and may be associated with a variety of negative psychological consequences, notably paranoia. Paranoia among African Americans is believed to reflect the lower end of the paranoia continuum based on experiences with racism. Thus, it may be beneficial…
Warren, J D; Schott, G D
The experience of music is difficult to study objectively. Here we describe a detailed analysis of musical hallucinations developing after a probable brainstem stroke in an 83 year old musician who was able to describe and notate the hallucinations. The hallucinations comprised simple, repetitive melodic and rhythmic motifs that were combined apparently randomly without definite tonality, large-scale structure, or timbre. This observation is consistent with the proposal that musical hallucinations represent abnormal spontaneous activity in auditory cortical areas beyond the primary auditory cortex. This activity may generate novel musical motifs.
Ana Maria Galdini Raimundo Oda
Full Text Available Este artigo comenta um ensaio do médico brasileiro Raimundo Nina-Rodrigues, publicado em 1902, sobre o diagnóstico e a psicopatologia da paranoia, bem como de suas relações com o chamado atavismo psíquico.
Davidjants, Kristiina, 1974-
Lühiarvustused DVD-del ilmunud 2007.a. mängufilmidele : prantsuse "Moliere" (režissöör Laurent Tirard) ja USA põnevusfilm, mis suuresti meenutab A. Hitchcocki "Tagaakent" - "Paranoia" ("Disturbia"; režissöör D.J. Caruso)
Arth, Alfred A.; And Others
The authors discuss "evaluation paranoia" as a fact of life for students and educators. By grades or job evaluations, both are pressured into conformity through fear of the evaluator. Suggested is a new conception of evaluation, based on self-appraisal and mutual goal setting, to promote honesty and personal growth. (SJL)
Ana Maria Galdini Raimundo Oda
Este artigo comenta um ensaio do médico brasileiro Raimundo Nina-Rodrigues, publicado em 1902, sobre o diagnóstico e a psicopatologia da paranoia, bem como de suas relações com o chamado atavismo psíquico.
Full Text Available The following is a case of Charles Bonnet syndrome in an 86-year-old woman who presented with visual hallucinations. The differential diagnosis of visual hallucinations is broad and emergency physicians should be knowledgeable of the possible etiologies.
Nevins, M A
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.
Lamster, Fabian; Lincoln, Tania M; Nittel, Clara M; Rief, Winfried; Mehl, Stephanie
Loneliness and paranoia are related, but the mechanisms that link them to each other remain unclear. Systematic reviews on loneliness propose a social-cognitive model in which loneliness leads to negative evaluations of other persons and a lack of interpersonal trust. However, the data discussed in these reviews are based on healthy individuals. Building on this model, the present study investigated 1) whether negative interpersonal schemata mediate the association between loneliness and paranoia and 2) whether a low level of perceived social support and less frequent social contact are related to loneliness. Using a cross-sectional design, sixty-five participants with a diagnosis of schizophrenia were recruited online and completed questionnaire-based measures of loneliness, paranoia, negative interpersonal schemata, perceived social support and frequency of social contact. Data were analyzed taking a path-analytic approach. The association between loneliness and paranoia was significantly and fully mediated by negative schemata of others. Moreover, a low level of perceived social support was significantly associated with loneliness, whereas self-reported frequency of social contact was not. The present results highlight the potential role of interpersonal negative schemata in the formation and maintenance of paranoia and elucidate the crucial role of loneliness in the way individuals construe themselves within a social environment. Copyright © 2017 Elsevier Inc. All rights reserved.
Tomar, Astha; Cheung, Gary
Dipyridamole is an antiplatelet agent and a vasodilator which is increasingly being used for the secondary prevention of ischaemic stroke and transient ischemic attack, either alone or in combination with acetylsalicylic acid. We describe an 83-year-old woman who had developed musical hallucinations within days of initiating dipyridamole. Her psychiatric and neurological evaluation was otherwise unremarkable. After the discontinuation of dipyridamole the hallucinations ceased within a couple of days. To the best of our knowledge this is the first case of auditory hallucinations associated with dipyridamole reported in the literature.
Murphy, Elizabeth K.; Tully, Sarah; Pyle, Melissa; Gumley, Andrew I.; Kingdon, David; Schwannauer, Matthias; Turkington, Douglas; Morrison, Anthony P.
This study aimed to confirm the factor structure of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia, and to test hypotheses of a metacognitive model. We hypothesised that positive and negative beliefs about paranoia would be associated with severity of suspiciousness, and that the co-occurrence of positive and negative beliefs would be associated with increased suspiciousness. A total of 335 patients meeting criteria for a schizoph...
Akman, Cigdem I; Goodkin, Howard P; Rogers, Donald P; Riviello, James J
Zonisamide is a broad-spectrum antiepileptic drug used to treat various types of seizures. Although visual hallucinations have not been reported as an adverse effect of this agent, we describe three patients who experienced complex visual hallucinations and altered mental status after zonisamide treatment was begun or its dosage increased. All three had been diagnosed earlier with epilepsy, and their electroencephalogram (EEG) findings were abnormal. During monitoring, visual hallucinations did not correlate with EEG readings, nor did video recording capture any of the described events. None of the patients had experienced visual hallucinations before this event. The only recent change in their treatment was the introduction or increased dosage of zonisamide. With either discontinuation or decreased dosage of the drug the symptoms disappeared and did not recur. Further observations and reports will help clarify this adverse effect. Until then, clinicians need to be aware of this possible complication associated with zonisamide.
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.
Musical hallucinations are a rare phenomenon in neurological and psychiatric patients. There are clinical case reports and a few studies which describe the condition. Musical hallucinations have a heterogeneous clinical and pathophysiological aetiology, and have been reported in the elderly and in those with hearing impairment, central nervous system disorders and psychiatric disorders. The psychopathology is reviewed and three cases seen in a psychiatric setting are reported.
Agrawal, A K; Sherman, L K
1 Voriconazole (Vfend) is a second-generation azole antifungal that is increasing in popularity especially for the treatment of invasive aspergillosis as well as empirically for the febrile neutropenic patient. In addition, voriconazole tends to have a mild side effect profile with reversible visual disturbances being the most widely described effect. We describe a patient who had musical hallucinations secondary to voriconazole. The patient was a 78-year-old man admitted for induction of chemotherapy for acute myelogenous leukemia (AML) who began to have auditory hallucinations, specifically of Christmas music, the 2nd day of voriconazole therapy. His psychiatric evaluation was otherwise unremarkable. After discontinuing voriconazole the hallucinations decreased in intensity by the 2nd day and ceased altogether by the 3rd day. An extensive literature search, including Pfizer drug trial safety data, yielded no other reports of auditory hallucinations with voriconazole. Several other interesting cases of musical hallucinations secondary to a variety of causes have been reported in the literature, and are reviewed. Notably, musical hallucinations tend to occur secondary to temporal lobe insults and often are of a religious or patriotic theme.
Vaou, Okeanis; Saint-Hilaire, Marie; Friedman, Joseph
Visual hallucinations are reported in 16-37% of drug-treated patients with Parkinson's disease (PD) and are the most common hallucinations in PD. We report two patients with PD with symptoms that uniquely integrate visual hallucinations and delusions. We report two cases of patients with PD with visual hallucinations who saw the persistence of these hallucinations in photographs. These pictures were taken to prove the absence of these hallucinations. We believe this is the first description of this peculiar phenomenon, in which hallucinations or illusions could be replicated in photographs. Both patients had delusions associated with the images and we speculate that the images they saw in the photographs represent a further delusion, hence a 'delusional hallucination' or 'delusional illusion.' We believe that delusions fostering hallucinations are rare.
Blackshaw, Alison J.; Kinderman, Peter; Hare, Dougal J.; Hatton, Chris
Twenty-five participants (ages 15-40) with Asperger syndrome scored significantly higher on a measure of paranoia and lower on a measure of theory of mind, compared with a control group. They did not differ in self-concept and causal attributions. A regression analysis highlighted private self-consciousness as the only predictor of paranoia.…
... symptoms of prolonged meth use are characterized by paranoia, hallucinations, repetitive behavior patterns, and delusions of parasites ... violent, aggressive behavior is usually coupled with extreme paranoia. New research shows that those who use methamphetamine ...
Full Text Available Auditory hallucinations are uncommon phenomena which can be directly caused by acute stroke, mostly described after lesions of the brain stem, very rarely reported after cortical strokes. The purpose of this study is to determine the frequency of this phenomenon. In a cross sectional study, 641 stroke patients were followed in the period between 1996–2000. Each patient underwent comprehensive investigation and follow-up. Four patients were found to have post cortical stroke auditory hallucinations. All of them occurred after an ischemic lesion of the right temporal lobe. After no more than four months, all patients were symptom-free and without therapy. The fact the auditory hallucinations may be of cortical origin must be taken into consideration in the treatment of stroke patients. The phenomenon may be completely reversible after a couple of months.
Full Text Available Neste artigo, refazemos o percurso freudiano a propósito do conceito de paranoia em sua obra. Esse percurso se fará a partir dos textos considerados pré-psicanalíticos, passando por aquele que é considerado o texto maior de Freud sobre as psicoses (o Caso Schereber, culminando com suas análises que levam em consideração sua segunda teoria sobre o funcionamento psíquico e sobre o conflito pulsional. Nosso objetivo é demonstrar como Freud, em sua elaboração das questões relativas à psicose, e à paranoia, mais especificamente, jamais se furtava a encarar os desafios que a clínica impunha. E por não recuar frente a esses desafios é que a sua própria teoria vai se formulando, em uma relação dialética entre os impasses da prática e a necessidade de estabelecer um rigor teórico. O artigo trata, também, da forma como o rigor teórico permite o estabelecimento de um diagnóstico diferencial entre neurose e psicose, além de assentar as bases para que os psicanalistas pós-freudianos pudessem pensar em um direcionamento para tratar a psicose.
Moritz, Steffen; Göritz, Anja S; Van Quaquebeke, Niels; Andreou, Christina; Jungclaussen, David; Peters, Maarten J V
Studies revealed that patients with paranoid schizophrenia display overconfidence in errors for memory and social cognition tasks. The present investigation examined whether this pattern holds true for visual perception tasks. Nonclinical participants were recruited via an online panel. Individuals were asked to complete a questionnaire that included the Paranoia Checklist and were then presented with 24 blurry pictures; half contained a hidden object while the other half showed snowy (visual) noise. Participants were asked to state whether the visual items contained an object and how confident they were in their judgment. Data from 1966 individuals were included following a conservative selection process. Participants high on core paranoid symptoms showed a poor calibration of confidence for correct versus incorrect responses. In particular, participants high on paranoia displayed overconfidence in incorrect responses and demonstrated a 20% error rate for responses made with high confidence compared to a 12% error rate in participants with low paranoia scores. Interestingly, paranoia scores declined after performance of the task. For the first time, overconfidence in errors was demonstrated among individuals with high levels of paranoia using a visual perception task, tentatively suggesting it is a ubiquitous phenomenon. In view of the significant decline in paranoia across time, bias modification programs may incorporate items such as the one employed here to teach patients with clinical paranoia the fallibility of human cognition, which may foster subsequent symptom improvement.
Westermann, Stefan; Kesting, Marie-Luise; Lincoln, Tania M
Emotion regulation (ER) has become a relevant construct to understanding paranoia. While the ER strategy called expressive suppression (e.g., poker face) may foster state paranoia by increasing arousal, another strategy called reappraisal (e.g., changing the perspective on situations) may reduce negative emotions and state paranoia when adaptively used. However, if reappraisal fails, this could increase paranoia. The aim of this study was to test the proposed effects of the ER strategies on state paranoia in the socially stressful situation of being excluded in paranoia-prone individuals. We conducted an experimental online study with N=116 participants who were randomized to a social inclusion or an exclusion condition using a virtual Cyberball ball-tossing game. They completed questionnaires on paranoia proneness and habitual ER strategies. Before and after the Cyberball task, participants rated their level of state paranoia. The impact of habitual ER strategies, paranoia proneness, and social stress on changes in state paranoia was investigated using linear regression analysis. The three-way interaction of social stress, paranoia proneness, and habitual reappraisal use significantly predicted state paranoia, t(114)=2.62, p=0.010. The decomposition of the interaction term revealed that in the social stress condition, the impact of reappraisal on state paranoia was moderated by the level paranoia proneness. Specifically, in high paranoia-prone individuals the use of reappraisal predicted higher state paranoia. The findings regarding habitual use of suppression were not significant. Although reappraisal is generally considered a functional strategy, its use in distressing social situations seems to be impaired in persons with higher paranoia proneness. A working model of emotion dysregulation in delusions is presented and possible implications for cognitive therapy of psychosis are discussed.
Baba, Akira; Hamada, Hidemichi; Kocha, Hiroki
The musical hallucinations reported by 33 schizophrenics who fulfilled ICD-10 diagnostic criteria were assessed semiologically. The subjects were 24 men and 9 women. The duration of 48 episodes of musical hallucinations varied. They occurred at all times during the course of schizophrenia, and 9 of them (18.8%) occurred before the diagnosis was made. All of the episodes could be divided into three stages: 17 (35.4%) were first stage, close to obsession, 5 (10.4%) were second stage, close to Schneiderian first-rank symptoms, and 26 (54.2%) were third stage, which is the autochthonous experience. The sounds were in a subjective space in 38 episodes and in the majority of cases, their content was familiar. The second stage was associated with xenopathic experience ("gemachtes Erlebnis") and audition of thought, and words were added to melodies that normally had no lyrics. Musical hallucinations in schizophrenia are pseudohallucinations that originate in memory representations, and they may undergo a transition to true hallucinations. The authors think that the three stages are related to the severity of the disease.
Murphy, Elizabeth K; Tully, Sarah; Pyle, Melissa; Gumley, Andrew I; Kingdon, David; Schwannauer, Matthias; Turkington, Douglas; Morrison, Anthony P
This study aimed to confirm the factor structure of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia, and to test hypotheses of a metacognitive model. We hypothesised that positive and negative beliefs about paranoia would be associated with severity of suspiciousness, and that the co-occurrence of positive and negative beliefs would be associated with increased suspiciousness. A total of 335 patients meeting criteria for a schizophrenia spectrum disorder completed the BaPS, the Positive and Negative Syndromes Scale (PANSS), and the Psychotic Symptom Rating Scales (PSYRATS). Confirmatory factor analysis verified that the three BaPS subscales (negative beliefs about paranoia, paranoia as a survival strategy, and normalizing beliefs) were an adequate fit of the data. Ordinal regression showed that positive beliefs about paranoia as a survival strategy and negative beliefs were both associated with severity of suspiciousness. This was the first study to show that the co-occurrence of positive and negative beliefs was associated with increased suspiciousness. All hypotheses were confirmed, suggesting that a metacognitive approach has utility for the conceptualization of paranoia. Clinical implications suggest a role for metacognitive therapy, including strategies such as detached mindfulness and worry postponement.
Blom, Jan Dirk; Sommer, Iris E. C.
Introduction: The literature on the possible neurobiologic correlates of auditory hallucinations is expanding rapidly. For an adequate understanding and linking of this emerging knowledge, a clear and uniform nomenclature is a prerequisite. The primary purpose of the present article is to provide an
Blom, Jan Dirk; Sommer, Iris E. C.
Introduction: The literature on the possible neurobiologic correlates of auditory hallucinations is expanding rapidly. For an adequate understanding and linking of this emerging knowledge, a clear and uniform nomenclature is a prerequisite. The primary purpose of the present article is to provide an
Larøi, Frank; Luhrmann, Tanya Marie; Bell, Vaughan; Christian, William A; Deshpande, Smita; Fernyhough, Charles; Jenkins, Janis; Woods, Angela
A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient's cultural background needs to be taken into account when assessing and treating hallucinations. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Freeman, Daniel; Dunn, Graham; Murray, Robin M.; Evans, Nicole; Lister, Rachel; Antley, Angus; Slater, Mel; Godlewska, Beata; Cornish, Robert; Williams, Jonathan; Di Simplicio, Martina; Igoumenou, Artemis; Brenneisen, Rudolf; Tunbridge, Elizabeth M.; Harrison, Paul J
Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis—∆9-tetrahydrocannabinol (THC)—causes paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying paranoia. A randomized, placebo-controlled...
Stricker, Raphael B; Winger, Edward E
Musical hallucinations are poorly understood auditory hallucinations that occur in patients with otologic or neurologic diseases. We report the first cases of musical hallucinations in two patients with neurologic Lyme disease. Both subjects were women with clinical and laboratory evidence of chronic Lyme disease, progressive neurologic dysfunction, and abnormal magnetic resonance imaging of the brain. There was no evidence of hearing loss in either case. Musical hallucinations had a sudden onset and took the form of patriotic or operatic music. The auditory hallucinations disappeared with intravenous (i.v.) antibiotic therapy in both patients, but the hallucinations recurred when i.v. antibiotic therapy was discontinued in one case. Response to therapy was accompanied by an increase in the CD57 lymphocyte subset in one patient, whereas recurrent hallucinations were associated with persistently low CD57 levels in the other case. We conclude that musical hallucinations may be associated with neurologic Lyme disease. These auditory hallucinations appear to respond to i.v. antibiotic therapy. Patients with musical hallucinations of unknown cause should be tested for infection with the Lyme disease spirochete.
Holroyd, S; Rabins, P V; Finkelstein, D; Nicholson, M C; Chase, G A; Wisniewski, S C
This study was undertaken to determine the prevalence of visual hallucinations in patients with macular degeneration, describe such hallucinations phenomenologically, and possibly determine factors predisposing to their development. Using a case-control design, the authors screened 100 consecutive patients with age-related macular degeneration for visual hallucinations. Each patient with visual hallucinations was matched to the next three patients without hallucinations. The patients and comparison subjects were compared in terms of scores on the Beck Depression Inventory, Eysenck Personality Questionnaire, Telephone Interview for Cognitive Status, and a structured questionnaire including demographic characteristics, family history, and medical and psychiatric history. Ophthalmologic data were obtained by chart review. Of the 100 patients, 13 experienced visual hallucinations. Four variables were significantly associated with having hallucinations: living alone, lower cognition score, history of stroke, and bilaterally worse visual acuity. Hallucinations were not associated with family or personal history of psychiatric disorder or with personality traits. In 11 (84.6%) of the 13 patients, the hallucinations had begun in association with an acute change in vision. These results indicate that visual hallucinations are prevalent among patients with macular degeneration. They appear unrelated to primary psychiatric disorder. The predisposing factors of bilaterally worse vision and living alone support an association with sensory deprivation, while history of stroke and worse cognition support a decreased cortical inhibition theory.
Westermann, Stefan; Lincoln, Tania M
A novel experimental paradigm for measuring state paranoia by means of signal detection theory was evaluated. A liberal response bias, indicating the tendency to recognize facial expressions as threatening, was expected to reflect paranoia. Against theoretical expectations, heightened paranoia questionnaire scores were associated with a non-liberal bias, which was not affected by negative emotion per se. However, subsequent analyses revealed that, if anxious, participants with heightened paranoia adopted a comparatively more liberal response bias. These findings corroborate the eminent role of anxiety in paranoia and demonstrate that state paranoia can be captured with the presented paradigm.
Sinésio Ferraz Bueno
Full Text Available Este artigo aborda a relação entre semiformação, segundo Theodor Adorno, e a paranoia no campo do conhecimento. Para Adorno, a emancipação orienta-se pela crítica da semiformação e da paranoia no conhecimento. Nessa direção, é feita uma análi se crítica das ideias de Adorno sobre a semiformação no campo educativo. Essa análise é inserida no contexto de uma crítica aos pressupostos epistemológicos atualmente hege mônicos no campo dos estudos sobre educação e conhecimento. Nessa categoria do conhecimento assim concebida, pela perspectiva educacional, a razão instrumental é concretamente questionada na sua forma restritiva de conhecimento. Assim, é possível mostrar algumas questões referentes ao problema da educação contemporânea sob a ótica das formulações de Adorno.This paper aims at showing the relationship between semi-formation by Adorno and the paranoia in the field of knowledge. According to Adorno, the emancipation is oriented by the dialectical criticism of the semi-formation and the para noia in knowledge. A critical analysis of Adorno's concepts of the semi-formation in knowledge is presented. This critical analysis is inserted in the critical context of the cur rently hegemonic epistemological ideas in the field of studies on education and knowl edge. In this category of knowledge considered through the educational perspective, the instrumental reason is concretely questioned in its restrictive form of knowledge. Thus, it is possible to show some issues about contemporary education matters discussed under the perspective of the thoughts of Adorno.
In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition o...
Isolan, Gustavo Rassier; Bianchin, Marino Muxfeldt; Bragatti, José Augusto; Torres, Carolina; Schwartsmann, Gilberto
Hallucinations can be auditory, visual, tactile, gustatory, or olfactory, and can be caused by psychiatric (such as schizophrenia and depression), neurological (such as cerebrovascular accidents, neoplasia, and infection), or endocrine and metabolic disorders. Musical hallucinations related to neurological disorders are rare. The authors present a case of a patient with a right insular glioma who developed transient musical hallucinations after microsurgical resection of the tumor.
Lamster, Fabian; Nittel, Clara; Rief, Winfried; Mehl, Stephanie; Lincoln, Tania
Loneliness is a common problem in patients with schizophrenia, and may be particularly linked with persecutory ideation. Nevertheless, its role as a potential risk factor in the formation and maintenance of persecutory delusions is largely unexplored. Loneliness was experimentally manipulated using a false-feedback paradigm in a non-clinical sample (n = 60). Change in state paranoia was compared between the induction of increased loneliness, the induction of reduced loneliness and a control condition. Distinct associations between pre-post scores of loneliness and state paranoia were examined at three (medium/high/low) levels of proneness to psychosis across the experimental conditions. Reduction of loneliness was associated with a significant reduction of present paranoid beliefs, while induction of loneliness lead to more pronounced paranoia on trend significance level. Moreover, proneness to psychosis significantly moderated the impact of loneliness on paranoia. Persons with a pronounced level of proneness to psychosis showed a stronger reduction of paranoid beliefs as a consequence of a decrease in loneliness, than less prone individuals. A limitation is the small size of our sample, which may have limited the power to detect significant within-group changes in state paranoia in the high-loneliness condition and changes in loneliness in the low-loneliness condition. The findings support the feasibility of the experimental design to manipulate loneliness and suggest that loneliness could be a cause of paranoia. However, the findings need to be confirmed in high risk samples to draw conclusions about the role of loneliness in the genesis of clinically relevant levels of paranoia and derive implications for cognitive behaviour therapy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Sanchez, Tanit Ganz; Rocha, Savya Cybelle Milhomem; Knobel, Keila Alessandra Baraldi; Kii, Márcia Akemi; Santos, Rosa Maria Rodrigues dos; Pereira, Cristiana Borges
In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.
T G Sanchez
Full Text Available In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.
Full Text Available In a time of big data, thinking about how we are seen and how that affects our lives means changing our idea about who does the seeing. Data produced by machines is most often ‘seen’ by other machines; the eye is in question is algorithmic. Algorithmic seeing does not produce a computational panopticon but a mechanism of prediction. The authority of its predictions rests on a slippage of the scientific method in to the world of data. Data science inherits some of the problems of science, especially the disembodied ‘view from above’, and adds new ones of its own. As its core methods like machine learning are based on seeing correlations not understanding causation, it reproduces the prejudices of its input. Rising in to the apparatuses of governance, it reinforces the problematic sides of ‘seeing like a state’ and links to the recursive production of paranoia. It forces us to ask the question ‘what counts as rational seeing?’. Answering this from a position of feminist empiricism reveals different possibilities latent in seeing with machines. Grounded in the idea of conviviality, machine learning may reveal forgotten non-market patterns and enable free and critical learning. It is proposed that a programme to challenge the production of irrational pre-emption is also a search for the possibility of algorithmic conviviality.
Full Text Available In a time of big data, thinking about how we are seen and how that affects our lives means changing our idea about who does the seeing. Data produced by machines is most often ‘seen’ by other machines; the eye is in question is algorithmic. Algorithmic seeing does not produce a computational panopticon but a mechanism of prediction. The authority of its predictions rests on a slippage of the scientific method in to the world of data. Data science inherits some of the problems of science, especially the disembodied ‘view from above’, and adds new ones of its own. As its core methods like machine learning are based on seeing correlations not understanding causation, it reproduces the prejudices of its input. Rising in to the apparatuses of governance, it reinforces the problematic sides of ‘seeing like a state’ and links to the recursive production of paranoia. It forces us to ask the question ‘what counts as rational seeing?’. Answering this from a position of feminist empiricism reveals different possibilities latent in seeing with machines. Grounded in the idea of conviviality, machine learning may reveal forgotten non-market patterns and enable free and critical learning. It is proposed that a programme to challenge the production of irrational pre-emption is also a search for the possibility of algorithmic conviviality.
Simons, C J P; Wichers, M; Derom, C; Thiery, E; Myin-Germeys, I; Krabbendam, L; van Os, J
It has been suggested that genes impact on the degree to which minor daily stressors cause variation in the intensity of subtle paranoid experiences. The objective of the present study was to test the hypothesis that catechol-O-methyltransferase (COMT) Val(158)Met and brain-derived neurotrophic factor (BDNF) Val(66)Met in part mediate genetic effects on paranoid reactivity to minor stressors. In a general population sample of 579 young adult female twins, on the one hand, appraisals of (1) event-related stress and (2) social stress and, on the other hand, feelings of paranoia in the flow of daily life were assessed using momentary assessment technology for five consecutive days. Multilevel regression analyses were used to examine moderation of daily life stress-induced paranoia by COMT Val(158)Met and BDNF Val(66)Met genotypes. Catechol-O-methyltransferase Val carriers displayed more feelings of paranoia in response to event stress compared with Met carriers. Brain-derived neurotrophic factor Met carriers showed more social-stress-induced paranoia than individuals with the Val/Val genotype. Thus, paranoia in the flow of daily life may be the result of gene-environment interactions that can be traced to different types of stress being moderated by different types of genetic variation.
Bentall, Richard P; Taylor, Jayne L
Paranoid delusions have recently become the focus of empirical research. In this article, we review studies of the psychological mechanisms that might be involved in paranoid thinking and discuss their implications for forensic behaviour science. Paranoia has not been consistently associated with any specific neuropsychological abnormality. However, evidence supports three broad types of mechanism that might be involved in delusional thinking in general and paranoia in particular: anomalous perceptual experiences, abnormal reasoning, and motivational factors. There is some evidence that paranoia may be associated with hearing loss, and good evidence that paranoid patients attend excessively to threatening information. Although general reasoning ability seems to be unaffected, there is strong evidence that a jumping- to-conclusions style of reasoning about data is implicated in delusions in general, but less consistent evidence specifically linking paranoia to impaired theory of mind. Finally, there appears to be a strong association between paranoia and negative self-esteem, and some evidence that attempts to protect self-esteem by attributing negative events to external causes are implicated. Some of these processes have recently been implicated in violent behaviour, and they therefore have the potential to explain the apparent association between paranoid delusions and offending.
Full Text Available This article seeks to reopen a major question raised by the Lacanian nosology of the psychoses, by looking closely at Lacan’s formulations of what he never ceased referring to as “paranoia”. While almost all classification systems of modern psychiatry, such as the ICD-10 and the DSM-5, have abandoned the specific category of paranoia, Lacan always viewed paranoia as a major category of “functional psychosis”. He held that paranoia was a qualitatively different disorder than schizophrenia, and considered it to be the principal or exemplary form of psychosis. Furthermore, in the middle period of his work, Lacan thought of paranoia in much broader terms than those of the definition proposed by Kraepelin, which he revisited, point by point, developing his theory of Freud’s concept of “Verwerfung” or foreclosure; the latter became the focal diagnostic criterion in his nosographic construction. Lacan’s privileging of and evolving theoretical views on paranoia provide a structural approach to what he called the “resistant nucleus” of psychosis; his work serves as a counterpoint to the more descriptive neo-Kraepelinian approach of contemporary psychiatric nosology.
Drake, R J; Pickles, A; Bentall, R P; Kinderman, P; Haddock, G; Tarrier, N; Lewis, S W
How insight, paranoia and depression evolve in relation to each other during and after the first episode of schizophrenia is poorly understood but of clinical importance. Serial assessments over 18 months were made using multiple instruments in a consecutive sample of 257 patients with first episode DSM-IV non-affective psychosis. Repeated measures of paranoia, insight, depression and self-esteem were analysed using structural equation modelling, to examine the direction of relationships over time after controlling for confounds. Depression was predicted directly by greater insight, particularly at baseline, and by greater paranoia at every stage of follow-up. Neither relationship was mediated by self-esteem, although there was a weak association of lower self-esteem with greater depression and better insight. Paranoia was not strongly associated with insight. Duration of untreated psychosis and substance use at baseline predicted depression at 18 months. In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.
When a system for communicating with nonverbal, quadriplegic, institutionalized residents was developed, it was discovered that many were experiencing auditory hallucinations. Nine cases are presented in this study. The "voices" described have many similar characteristics, the primary one being that they give authoritarian commands that tell the residents how to behave and to which the residents feel compelled to respond. Both the relationship of this phenomenon to the theoretical work of Julian Jaynes and its effect on the lives of the residents are discussed.
Simonds, John F.
Case histories of ten nonpsychotic patients revealed significant anxiety and depression in a majority of the patients, with five expressing suicidal ideas. Stress factors were primarily family and school. Eight patients had combined auditory and visual hallucinations. The purposes of the hallucinations were multiple, but escape mechanisms were…
Coebergh, Jan A F; Lauw, R F; Bots, R; Sommer, I E C; Blom, J D
BACKGROUND: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. OBJECTIVE: To review the effe
Coebergh, Jan A. F.; Lauw, R. F.; Bots, R.; Sommer, I. E. C.; Blom, J. D.
Background: Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. Objective: To review the effe
Nayani, T H; David, A S
A comprehensive semi-structured questionnaire was administered to 100 psychotic patients who had experienced auditory hallucinations. The aim was to extend the phenomenology of the hallucination into areas of both form and content and also to guide future theoretical development. All subjects heard 'voices' talking to or about them. The location of the voice, its characteristics and the nature of address were described. Precipitants and alleviating factors plus the effect of the hallucinations on the sufferer were identified. Other hallucinatory experiences, thought insertion and insight were examined for their inter-relationships. A pattern emerged of increasing complexity of the auditory-verbal hallucination over time by a process of accretion, with the addition of more voices and extended dialogues, and more intimacy between subject and voice. Such evolution seemed to relate to the lessening of distress and improved coping. These findings should inform both neurological and cognitive accounts of the pathogenesis of auditory hallucinations in psychotic disorders.
Ellett, Lyn; Allen-Crooks, Rhani; Stevens, Adele; Wildschut, Tim; Chadwick, Paul
A growing body of research shows that paranoia is common in the general population. We report three studies that examined the Prisoner's Dilemma Game (PDG) as a paradigm for evaluation of non-clinical paranoia. The PDG captures three key qualities that are at the heart of paranoia--it is interpersonal, it concerns threat, and it concerns the perception of others' intentions towards the self. Study 1 (n=175) found that state paranoia was positively associated with selection of the competitive PDG choice. Study 2 (n=111) found that this association was significant only when participants believed they were playing the PDG against another person, and not when playing against a computer. This finding underscores the interpersonal nature of paranoia and the concomitant necessity of studying paranoia in interpersonal context. In Study 3 (n=152), we assessed both trait and state paranoia, and differentiated between distrust- and greed-based competition. Both trait and state paranoia were positively associated with distrust-based competition (but not with greed-based competition). Crucially, we found that the association between trait paranoia and distrust-based competition was fully mediated by state paranoia. The PDG is a promising paradigm for the study of non-clinical paranoia.
Freeman, Daniel; Evans, Nicole; Lister, Rachel; Antley, Angus; Dunn, Graham; Slater, Mel
Mistrust of others may build upon perceptions of the self as vulnerable, consistent with an association of paranoia with perceived lower social rank. Height is a marker of social status and authority. Therefore we tested the effect of manipulating height, as a proxy for social rank, on paranoia. Height was manipulated within an immersive virtual reality simulation. Sixty females who reported paranoia experienced a virtual reality train ride twice: at their normal and reduced height. Paranoia and social comparison were assessed. Reducing a person's height resulted in more negative views of the self in comparison with other people and increased levels of paranoia. The increase in paranoia was fully mediated by changes in social comparison. The study provides the first demonstration that reducing height in a social situation increases the occurrence of paranoia. The findings indicate that negative social comparison is a cause of mistrust.
... or coming down from such drugs like marijuana , LSD , cocaine (including crack), PCP, amphetamines, heroin, ketamine, and ... 2/2016 Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, ...
Full Text Available AbstractBackground: Despite an increased scientific interest in musical hallucinations throughout the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare.Objective: To review the effects of published treatment methods for musical hallucinations.Methods: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analysed the treatment results in relation to the aetiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion and other pathology, epilepsy or intoxication.Results: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct aetiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g. more acoustic stimulation are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being more helpful than antiepileptics (which are still better than antipsychotics. The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication is the main aetiological factor, it is important to stop or switch the
Rabin, Marie-Paule; Testard, Ingrid; Landazuri, Fernando
Sensitive paranoia, classified by Ernst Kretschmer, is a combination of a paranoid disorder with solitude and mental distress. Sensitive paranoiacs, often depressive and anxious, perceive themselves as being excluded from society while at the same time cultivating a resentment towards it. They also constantly put themselves down. Group therapy can help these patients to find appeasement in their social life.
Singh, Amardeep; Sørensen, Torben Lykke
Charles Bonnet syndrome is characterized by vivid, complex and recurrent visual hallucinations occurring in psychologically normal people. Though not related to any specific eye condition, it commonly affects visually impaired elderly persons and is thus an important differential diagnosis to many conditions which cause visual hallucinations. Patients usually retain insight into the unreal nature of their hallucination. The hallucinatory experiences are generally not distressing, but patients may fear impending insanity. There is no specific treatment for this condition which in most cases is self-limiting.
Skokauskas, Norbert; Pillay, Devina; Moran, Tom; Kahn, David A
In adolescents, hallucinations can be a transient illness or can be associated with non-psychotic psychopathology, psychosocial adversity, or a physical illness. We present the case of a 15-year-old secondary-school student who presented with a 1-month history of first onset auditory hallucinations, which had been increasing in frequency and severity, and mild paranoid ideation. Over a 10-week period, there was a gradual diminution, followed by a complete resolution, of symptoms. We discuss issues regarding the diagnosis and prognosis of auditory hallucinations in adolescents.
E Fischer, Corinne; Marchie, Anthony; Norris, Mireille
Musical hallucinosis is a rare and poorly understood clinical phenomenon. While an association appears to exist between this phenomenon and organic brain pathology, aging and sensory impairment the precise association remains unclear. The authors present two cases of musical hallucinosis, both in elderly patients with mild-moderate cognitive impairment and mild-moderate hearing loss, who subsequently developed auditory hallucinations and in one case command hallucinations. The literature in reference to musical hallucinosis will be reviewed and a theory relating to the development of musical hallucinations will be proposed.
Mittal, Manoj; Giron, Louis T
Hallucinations are common among patients with Parkinson disease (PD). Hallucinations, typically transitory and occurring at night, are classically visual and occur in 30% of treated patients; auditory hallucinations are rare. A musical hallucination (MH) is a rare type of complex auditory hallucination reported in only six PD patients so far. To the best of our knowledge, we present the first reported case of a patient with Parkinson disease who experienced auditory and visual MH.
Shuaib, Taghreed; Al-Hashmi, Nadia; Ghaziuddin, Mohammad; Megdad, Eman; Abebe, Dejene; Al-Saif, Amr; Doubi, Alaa; Aldhalaan, Hesham; Abouzied, Mohei Eldin; Al-Owain, Mohammed
Propionic acidemia, an autosomal recessive disorder, is a common form of organic aciduria resulting from the deficiency of propionyl-CoA carboxylase. It is characterized by frequent and potentially lethal episodes of metabolic acidosis often accompanied by hyperammonemia. A wide range of brain abnormalities have been reported in propionic acidemia. We report recurrent visual hallucinations in 2 children with propionic acidemia. Four visual hallucination events were observed in the 2 patients. Three episodes were preceded by an intercurrent illness, and 2 were associated with mild metabolic decompensation. The 2 events in one patient were associated with a seizure disorder with abnormal electroencephalogram. Brain magnetic resonance imaging showed abnormal basal ganglia and faint temporo-occipital swelling bilaterally. This is probably the first report of visual hallucinations in propionic acidemia and should alert the treating clinicians to look for visual hallucinations in patients with organic acidurias, especially in an unusually anxious child.
Dierks, T; Linden, D E; Jandl, M; Formisano, E; Goebel, R; Lanfermann, H; Singer, W
Apart from being a common feature of mental illness, auditory hallucinations provide an intriguing model for the study of internally generated sensory perceptions that are attributed to external sources...
Coebergh, Jan A F; Lauw, R F; Bots, R; Sommer, I E C; Blom, J D
Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. To review the effects of published treatment methods for musical hallucinations. A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication
The physiological basis for musical hallucinations (MH) is not understood. One obstacle to understanding has been the lack of a method to manipulate the intensity of hallucination during the course of experiment. Residual inhibition, transient suppression of a phantom percept after the offset of a masking stimulus, has been used in the study of tinnitus. We report here a human subject whose MH were residually inhibited by short periods of music. Magnetoencephalography (MEG) allowed us to exam...
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.
Nguyen, Ngoc-Diem; Osterweil, Dan; Hoffman, Janice
Charles Bonnet syndrome (CBS) is characterized by recurrent or persistent complex visual hallucinations that occur in visually impaired individuals with intact cognition and no evidence of psychiatric illness. Patients usually retain insight into the unreal nature of their hallucinations.3,4 CBS is often misdiagnosed, and predominantly affects elderly patients with vision changes (e.g., age-related macular degeneration, glaucoma, and cataract). While many require only the assurance of the benign nature of the hallucinations, nonpharmacological and pharmacological interventions have been reported to be useful in the treatment of CBS. This case involves an 83-year-old female, with a two-year history of CBS, who presented to the clinic with worsening visual hallucinations over the past few months. She was starting to lose insight into her hallucinations secondary to her new diagnosis of dementia. Several pharmacological agents were explored to determine the most appropriate choice for our patient. Ultimately, this patient was started on donepezil (reported to be successful in a CBS case report), which helped improve her cognitive function. At future follow-up visits, her hallucinations improved and her cognitive function stabilized. Pharmacists should be aware of CBS and its treatment options to properly assist physicians in the medication-selection process to alleviate distress experienced by patients with CBS. In patients who may benefit from pharmacological treatment, physicians should weigh the risks and benefits of the different treatment options. Donepezil can be a favorable option in CBS patients with Alzheimer's type dementia.
Udachina, A; Bentall, R P; Varese, F; Rowse, G
The attributional theory of paranoia suggests that paranoid beliefs may protect individuals from low self-esteem and distress (Bentall et al. 2001). The current study tested this theory by investigating a hypothesis that paranoid beliefs in combination with low perceived deservedness of persecution (poor-me beliefs) confer protection against the distress caused by social but not activity related stress. Paranoid symptoms, perceived deservedness of persecution, self-esteem, mood, and stress levels of individuals diagnosed with schizophrenia spectrum disorders (N = 91) and healthy controls (N = 52) were assessed in the context of daily life using the experience sampling method. Individuals holding poor-me beliefs (poor-me individuals) showed blunted sensitivity to social but not activity stress. In contrast, individuals holding paranoid beliefs in combination with high perceived deservedness of persecution (bad-me individuals) showed heightened sensitivity to social stress. No consistent differences in reactions to activity stress emerged. Although both poor-me and bad-me individuals reported low self-esteem, this disturbance was particularly characteristic of bad-me individuals. The results suggest that poor-me paranoid beliefs may protect individuals against the distress associated with unpleasant social situations. The specificity of reactions to social stress is discussed in the context of wider literature. Future directions for research are suggested.
Allen, Paul; Laroi, Frank; McGuire, Philip K.; Aleman, Andre
Hallucinations remains one of the most intriguing phenomena in psychopathology. In the past two decades the advent of neuroimaging techniques have allowed researchers to investigate what is happening in the brain of those who experience hallucinations. In this article we review both structural and f
Freeman, Daniel; Dunn, Graham; Murray, Robin M.; Evans, Nicole; Lister, Rachel; Antley, Angus; Slater, Mel; Godlewska, Beata; Cornish, Robert; Williams, Jonathan; Di Simplicio, Martina; Igoumenou, Artemis; Brenneisen, Rudolf; Tunbridge, Elizabeth M.; Harrison, Paul J.; Harmer, Catherine J.; Cowen, Philip; Morrison, Paul D.
Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis—∆9-tetrahydrocannabinol (THC)—causes paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in paranoia. Working memory changes did not lead to paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing paranoia was the generation of negative affect and anomalous experiences. PMID:25031222
Freeman, Daniel; Dunn, Graham; Murray, Robin M; Evans, Nicole; Lister, Rachel; Antley, Angus; Slater, Mel; Godlewska, Beata; Cornish, Robert; Williams, Jonathan; Di Simplicio, Martina; Igoumenou, Artemis; Brenneisen, Rudolf; Tunbridge, Elizabeth M; Harrison, Paul J; Harmer, Catherine J; Cowen, Philip; Morrison, Paul D
Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis-∆(9)-tetrahydrocannabinol (THC)-causes paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in paranoia. Working memory changes did not lead to paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing paranoia was the generation of negative affect and anomalous experiences.
Udachina, Alisa; Varese, Filippo; Oorschot, Margreet; Myin-Germeys, Inez; Bentall, Richard P
The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved ("poor me"; PM), b) individuals who believed that persecution is justified ("bad me"; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed.
Roberts, D L; Tatini, U; Zimmerman, R S; Bortz, J J; Sirven, J I
Hallucinations are defined as sensory phenomena in the absence of external sensory stimuli. Auditory hallucinations have been shown to arise from many different intracranial lesions, but seizures manifesting as musical hallucinations triggered by unruptured intracranial aneurysms are rare. We present a case of persistent, episodic musical hallucinations associated with seizures that led to the discovery of 2 small intracranial aneurysms. Typical electroencephalographic findings for seizure activity were observed but resolved after surgical clipping of the aneurysms. Concomitantly, the patient's hallucinations resolved. The literature on musical hallucinations is reviewed.
Perelberg, Rosine Jozef
This paper explores the meaning of a patient's hallucinatory experiences in the course of a five times a week analysis. I will locate my understanding within the context of André Green's ideas on the role of the framing structure and the negative hallucination in the structuring of the mind. The understanding of the transference and countertransference was crucial in the creation of meaning and enabling the transformations that took place in the analytic process. Through a detailed analysis of a clinical example the author examines Bion's distinction between hysterical hallucinations and psychotic hallucinations and formulates her own hypothesis about the distinctions between the two. The paper suggests that whilst psychotic hallucinations express a conflict between life and death, in the hysterical hallucination it is between love and hate. The paper also contains some reflections on the dramatic nature of the analytic encounter.
Moritz, Steffen; Laudan, Anna
A number of studies indicate that patients with schizophrenia share a bias for paranoia-relevant material. The presence of an attentional bias for such stimuli would be of utter importance for our pathogenetic understanding of the disorder in view of ample evidence that patients with schizophrenia gather little information before arriving at strong conclusions: A both scarce and affectively biased data selection of available information may heavily distort its inner representation and thus prompt the formation of false beliefs. To date, the profile of this putative attentional bias in schizophrenia (e.g., automatic vs. controlled; hypervigilance towards vs. problems to disengage from such stimuli) is not fully uncovered. To shed light on this aspect of information processing in schizophrenia, we administered a novel task based on the inhibition of return paradigm (IOR). Twenty-four schizophrenia patients and thirty-four healthy controls were presented neutral (e.g., cup), anxiety-relevant (e.g., shark), and paranoia-relevant cue pictures (e.g., gun) at either of two possible locations. Subsequent to either a short or long interval, a target appeared at the same or opposite location. Participants were requested to press a spatially corresponding button. Both currently paranoid and nonparanoid schizophrenia patients responded faster to all kinds of targets following paranoia-relevant pictures, that is, such stimuli speeded reaction times irrespective of the cue-target interval and spatial correspondence. This indicates that paranoia-relevant information generally alerts patients more than other stimuli and facilitates processing of subsequent information. Possible implications of this finding for our understanding of delusion formation and maintenance are outlined.
Valiente, Carmen; Cantero, Dolores; Sánchez, Alvaro; Provencio, María; Wickham, Sophie
Psychological models have implicated negative self-esteem as an important factor underlying paranoia. However, research investigating the role of self-esteem in paranoia suffers from poor conceptual and methodological understanding, resulting in conflicting findings. Central to this problem is the use of measures investigating global self-esteem and self-evaluative beliefs interchangeably. In the present study we aimed to analyze differences in self-esteem domains and self-evaluation. The present study used interviews and questionnaires to compare a clinical sample of participants who were currently paranoid (n = 55) with healthy controls (n = 57) on global self-esteem domains and negative evaluative beliefs, in order to investigate the multi-faceted role of "the self". There was no significant difference in self-esteem domains between groups, highlighting that self-esteem is preserved in currently paranoid individuals. However, the paranoid group had significantly more negative evaluative beliefs. Interestingly, our global measures of self-esteem and measures of negative evaluative beliefs were uncorrelated, highlighting the importance of understanding the differences underlying these concepts. This study does not address dynamic aspects of self-esteem and self-evaluation. The present study provides undeniable evidence to investigate self-concept dimensions separately. These findings must be considered by researchers interested in the role of the self in the onset and maintenance of paranoia. Copyright © 2014 Elsevier Ltd. All rights reserved.
Lake, Charles Raymond
... schizophrenia to psychotic bipolar disorder warrants reevaluation. To address whether paranoia associates more with schizophrenia or mood disorders, a selected literature is reviewed and 11 cases are summarized...
Pawel D. Mankiewicz
Full Text Available The prevalence of diagnostic comorbidity between psychosis and anxiety disorders has been found to be considerable. Cognitive models of psychosis suggest that anxiety does not arise directly from positive symptoms of schizophrenia but rather from an individual interpretation of such experiences. In the United Kingdom, cognitive-behavioural therapy for psychosis (CBTp has been recommended within clinical guidelines as a psychological treatment of choice for those diagnosed with schizophrenia. However, despite empirical evidence supporting CBTp, the treatment provision remains infrequent and not routinely available. This case describes a successful implementation of CBTp. Sixteen sessions were delivered to a 40-year-old male with diagnoses of paranoid schizophrenia and comorbid anxiety, focusing primarily on cognitive restructuring of paranoid appraisals of auditory hallucinations and behavioural experiments employed progressively via graded exposure to anxiety-inducing stimuli. Standardised measurements, behavioural frequency sampling, and subjective data indicated a considerable reduction in both paranoia and anxiety. Also, the client’s psychosocial functioning improved substantially. This report indicates that the treatment may help those with experiences of psychosis and comorbid anxiety reach a significant improvement in their quality of life and offers an encouraging and innovative perspective on direct engagement with the content of paranoia and voices at the onset of therapy.
Mankiewicz, Pawel D; Turner, Colin
The prevalence of diagnostic comorbidity between psychosis and anxiety disorders has been found to be considerable. Cognitive models of psychosis suggest that anxiety does not arise directly from positive symptoms of schizophrenia but rather from an individual interpretation of such experiences. In the United Kingdom, cognitive-behavioural therapy for psychosis (CBTp) has been recommended within clinical guidelines as a psychological treatment of choice for those diagnosed with schizophrenia. However, despite empirical evidence supporting CBTp, the treatment provision remains infrequent and not routinely available. This case describes a successful implementation of CBTp. Sixteen sessions were delivered to a 40-year-old male with diagnoses of paranoid schizophrenia and comorbid anxiety, focusing primarily on cognitive restructuring of paranoid appraisals of auditory hallucinations and behavioural experiments employed progressively via graded exposure to anxiety-inducing stimuli. Standardised measurements, behavioural frequency sampling, and subjective data indicated a considerable reduction in both paranoia and anxiety. Also, the client's psychosocial functioning improved substantially. This report indicates that the treatment may help those with experiences of psychosis and comorbid anxiety reach a significant improvement in their quality of life and offers an encouraging and innovative perspective on direct engagement with the content of paranoia and voices at the onset of therapy.
Evers, Stefan; Ellger, Tanja
Musical hallucinations are a well known although rare phenomenon in neurological and psychiatric patients. Many case reports have been published to date. However, an accepted common theory on the classification and on the pathophysiology of musical hallucinations is still missing. We analysed all cases published to date, including two own cases, with respect to their demographic and clinical features and to the possible pathomechanisms underlying the hallucinations. In total, 132 cases could be analysed statistically and separated into five groups according to their aetiology (hypacusis; psychiatric disorder; focal brain lesion; epilepsy; intoxication). There was a female preponderance of 70% and a mean age of 61.5 years. Patients with focal brain lesions were significantly younger than the other groups, the hemisphere of the lesion did not play a major role. No systematic studies on treatment are available. However, anticonvulsant and antidepressive substances were reported to be effective most consistently. The pathophysiology of musical hallucinations is discussed considering the theories of deafferentiation including the concept of auditory Charles-Bonnet syndrome, of sensory auditory deprivation, of parasitic memory, and of spontaneous activity in a cognitive network module. In conclusion, musical hallucinations are a phenomenon with heterogeneous clinical and pathophysiological backgrounds.
Aynsworth, Charlotte; Collerton, Daniel; Dudley, Robert
Studies designed to investigate visual hallucinations (VH) require reliable and valid measures that can appropriately capture peoples' experiences. This review aimed to assess the psychometric rigour and usefulness of VH measures. A systematic literature search was carried out against inclusion criteria (e.g. more than one specific question on VH, measures for adults in clinical and non-clinical populations). Eighteen measures were identified and rated against an adapted evaluation grid, which included essential criteria such as clear purpose and definition, psychometric properties including reliability and validity, and appropriate exploration of visual hallucinations. Measures could be categorised into 3 groups; those for general psychotic symptoms, those for all hallucinations, or those specifically for visual hallucinations. With one exception (the North East Visual Hallucinations Inventory), the measures were considered to be limited as they often targeted one population and hence lacked generalisability, or were limited in the characteristics of the visions that were described, or that psychometric properties were not adequately evaluated. Measures of VH require further development. The need to establish a clearer definition of VH is essential to provide clarity and consistency within research and practice. Measures need to demonstrate good psychometric properties to indicate robustness whilst being sensitive to change to help in the evaluation of treatments. Other recommendations include developing cross-cultural measures and involving service users in item development. Copyright © 2017 Elsevier Ltd. All rights reserved.
Shergill, S; Cameron, L; Brammer, M; Williams, S; Murray, R; McGuire, P
Somatic hallucinations occur in schizophrenia and other psychotic disorders, although auditory hallucinations are more common. Although the neural correlates of auditory hallucinations have been described in several neuroimaging studies, little is known of the pathophysiology of somatic hallucinations. Functional magnetic resonance imaging (fMRI) was used to compare the distribution of brain activity during somatic and auditory verbal hallucinations, occurring at different times in a 36 year old man with schizophrenia. Somatic hallucinations were associated with activation in the primary somatosensory and posterior parietal cortex, areas that normally mediate tactile perception. Auditory hallucinations were associated with activation in the middle and superior temporal cortex, areas involved in processing external speech. Hallucinations in a given modality seem to involve areas that normally process sensory information in that modality. PMID:11606687
Bartels-Velthuis, A. A.; van de Willige, G.; Jenner, J. A.; Wiersma, D.; van Os, J.
Background. Previous work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful
Jenner, JA; Nienhuis, FJ; Wiersma, D; van de Willige, G
Improvements in psychopathology, subjective burden, and coping with voices after hallucination focused integrative treatment (HIT) were studied in chronic schizophrenic patients with persistent (> 10 years), drug-refractory auditory hallucinations. In a randomized controlled trial, routine care was
Joe, Soohyun; Park, Jangho; Lim, Jongseok; Park, Choongman
To provide a description of musical hallucination associated with hybrid cochlear implantation. Case report. We report a case of musical hallucination secondary to hybrid cochlear implantation. Activation of electrical stimulation was closely related to onset of musical hallucination and deactivation was associated with attenuation of hallucination. Persistent musical hallucination severely impaired speech discrimination in spite of 2 years of listening rehabilitation. The hybrid cochlear implant is a relatively new surgical method, and its side effects have not been well documented. This is the first report of musical hallucination after a hybrid cochlear implantation. Also we provide evidence of the peripheral origin of musical hallucination by reporting lateralization and intensity change of hallucination by activation status of cochlear implant. Copyright © 2015 Elsevier Inc. All rights reserved.
van Lutterveld, Remko; Hillebrand, Arjan; Diederen, Kelly M. J.; Daalman, Kirstin; Kahn, Rene S.; Stam, Cornelis J.; Sommer, Iris E. C.
Background: Auditory verbal hallucinations (AVH), a prominent symptom of schizophrenia, are often highly distressing for patients. Better understanding of the pathogenesis of hallucinations could increase therapeutic options. Magnetoencephalography (MEG) provides direct measures of neuronal activity
Muller, Alana J; Shine, James M; Halliday, Glenda M; Lewis, Simon J G
One of the most challenging tasks in neuroscience is to be able to meaningfully connect information across the different levels of investigation, from molecular or structural biology to the resulting behavior and cognition. Visual hallucinations are a frequent occurrence in Parkinson's disease and significantly contribute to the burden of the disease. Because of the widespread pathological processes implicated in visual hallucinations in Parkinson's disease, a final common mechanism that explains their manifestation will require an integrative approach, in which consideration is taken across all complementary levels of analysis. This review considers the leading hypothetical frameworks for visual hallucinations in Parkinson's disease, summarizing the key aspects of each in an attempt to highlight the aspects of the condition that such a unifying hypothesis must explain. These competing hypotheses include implications of dream imagery intrusion, deficits in reality monitoring, and impairments in visual perception and attention.
Jan Dirk eBlom
Full Text Available Musical hallucinations are relatively rare auditory percepts which, due to their intrusive nature and the accompanying fear of impending mental decline, tend to cause significant distress and impairment. Although their etiology and pathophysiology appear to be heterogeneous and no evidence-based treatment methods are available, case reports indicate that acetylcholinesterase inhibitors may yield positive results in patients with comorbid hearing loss. We present two female patients (aged 76 and 78 years both of whom suffered from hearing impairment and practically incessant musical hallucinations. Both patients were successfully treated with the acetylcholinesterase inhibitor rivastigmine. Based on these two case descriptions and an overview of studies describing the use of acetylcholinesterase inhibitors in similar patients, we discuss possible mechanisms and propose further research on the use of acetylcholinesterase inhibitors for musical hallucinations experienced in concordance with hearing loss.
Kumar, Sukhbinder; Sedley, William; Barnes, Gareth R; Teki, Sundeep; Friston, Karl J; Griffiths, Timothy D
The physiological basis for musical hallucinations (MH) is not understood. One obstacle to understanding has been the lack of a method to manipulate the intensity of hallucination during the course of experiment. Residual inhibition, transient suppression of a phantom percept after the offset of a masking stimulus, has been used in the study of tinnitus. We report here a human subject whose MH were residually inhibited by short periods of music. Magnetoencephalography (MEG) allowed us to examine variation in the underlying oscillatory brain activity in different states. Source-space analysis capable of single-subject inference defined left-lateralised power increases, associated with stronger hallucinations, in the gamma band in left anterior superior temporal gyrus, and in the beta band in motor cortex and posteromedial cortex. The data indicate that these areas form a crucial network in the generation of MH, and are consistent with a model in which MH are generated by persistent reciprocal communication in a predictive coding hierarchy.
Blom, Jan Dirk; Coebergh, Jan Adriaan F; Lauw, René; Sommer, Iris E C
Musical hallucinations are relatively rare auditory percepts which, due to their intrusive nature and the accompanying fear of impending mental decline, tend to cause significant distress and impairment. Although their etiology and pathophysiology appear to be heterogeneous and no evidence-based treatment methods are available, case reports indicate that acetylcholinesterase inhibitors may yield positive results in patients with comorbid hearing loss. We present two female patients (aged 76 and 78 years) both of whom suffered from hearing impairment and practically incessant musical hallucinations. Both patients were successfully treated with the acetylcholinesterase inhibitor rivastigmine. Based on these two case descriptions and an overview of studies describing the use of acetylcholinesterase inhibitors in similar patients, we discuss possible mechanisms and propose further research on the use of acetylcholinesterase inhibitors for musical hallucinations experienced in concordance with hearing loss.
Font, M; Parellada, E; Fernández-Egea, E; Bernardo, M; Lomeña, F
The neurobiological bases underlying the generation of auditory hallucinations, a distressing and paradigmatic symptom of schizophrenia, are still unknown in spite of in-depth phenomenological descriptions. This work aims to make a critical review of the latest published literature in recent years, focusing on functional neuroimaging studies (PET, SPECT, fMRI) of auditory hallucinations. Thus, the studies are classified according to whether they are sensory activation, trait and state. The two main hypotheses proposed to explain the phenomenon, external speech vs. subvocal or inner speech, are also explained. Finally, the latest unitary theory as well as the limitations the studies published are commented on. The need to continue investigating in this field, that is still underdeveloped, is posed in order to understand better the etiopathogenesis of auditory hallucinations in schizophrenia.
Holroyd, Suzanne; Sabeen, Samia
Sensory impairment hallucinations, such as visual hallucinations with visual loss, may not respond to traditional treatments such as antipsychotics. In this case series, the authors describe four patients with either visual or musical hallucinations associated with sensory impairment who were successfully treated with gabapentin.
Sommer, Iris E. C.; Slotema, Christina W.; Daskalakis, Zafiris J.; Derks, Eske M.; Blom, Jan Dirk; van der Gaag, Mark
This article reviews the treatment of hallucinations in schizophrenia. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. Only 8% of first-episode patients still experience mild to moderate hallucinations after c
Darrell-Berry, Hannah; Berry, Katherine; Bucci, Sandra
Aggression in the context of schizophrenia has significant detrimental personal, clinical and societal implications. Whilst understanding the precise pathways to aggression in people with a diagnosis of schizophrenia is critical for risk management and treatment, these pathways remain unclear. A paranoid belief that others intend harm is one psychotic symptom that might contribute to aggressive behaviours. This is the first review to investigate the relationship between paranoia and aggression in psychosis. A systematic review of published literature pertinent to the relationship between paranoia and aggression was conducted. A search of online databases from inception to November 2014 was performed with keywords related to 'schizophrenia', 'paranoia' and 'aggression'. Fifteen studies, primarily cross-sectional in design (n=9), met eligibility criteria. Studies reviewed showed mixed support for an association between paranoia and aggression in both inpatients and community settings. However, when study quality was taken into account, more methodologically rigorous studies tended to show a positive association between factors. Mixed findings are most likely due to important methodological shortcomings, including heterogeneous samples and studies using a diverse range of aggression/violence measures. In light of methodological limitations of individual studies reviewed, further investigation of the relationship between paranoia and aggression in psychosis using robust methodology is needed before definitive clinical recommendations regarding the hypothesised relationship between paranoia and aggression can be made. This paper sets out key recommendations for future studies, including operationalizing the specific components of aggression and paranoia under investigation and methods to delineate important mediators in the paranoia and aggression relationship.
Tiernan, Bridget; Tracey, Rebecca; Shannon, Ciaran
The purpose of the present study was to review systematically, research exploring the relationship between self-concepts and paranoia in psychosis. A literature search was performed by two independent raters in relevant databases (MedLine, PsychInfo and Web of Science) and articles meeting the inclusion criteria were cross-referenced. Following scrutiny according to inclusion criteria, 18 studies were selected for review. A narrative synthesis of findings, in which methodological variability is discussed, is presented relative to three key areas: the nature of the relationship between paranoia and self-concepts; the association between paranoia and discrepancies in self-concepts; the nature of the relationship between paranoia and self-concepts when other, dimensional aspects of these constructs are taken into account. The systematic literature review indicated relatively consistent findings, that paranoia is associated with more negative self-concepts when measured cross-sectionally. Results are somewhat more mixed in regards to research on paranoia and self-concept discrepancies. Studies investigating dimensional aspects of self-concepts and paranoia yield findings of particular interest, especially in regards to the association indicated between instability of self-concepts and paranoia. Limitations in research and of the present systematic review are discussed. Clinical and theoretical implications of findings are outlined and possible directions for future research are suggested.
Fisher, Helen L; Appiah-Kusi, Elizabeth; Grant, Celina
This study examined affective and psychological routes from childhood maltreatment to increased paranoia in adulthood. Recent anxiety and negative beliefs about the self partially accounted for the associations between emotional or physical abuse and paranoia. However, as full mediation did not occur, other psychological, social and biological pathways require exploration.
Fisher, Helen L.; Appiah-Kusi, Elizabeth; Grant, Celina
This study examined affective and psychological routes from childhood maltreatment to increased paranoia in adulthood. Recent anxiety and negative beliefs about the self partially accounted for the associations between emotional or physical abuse and paranoia. However, as full mediation did not occur, other psychological, social and biological pathways require exploration.
Full Text Available Hallucinations are considered as core symptoms of psychosis by both International Classification of Diseases-10 (ICD-10 and Diagnostic and Statistical Manual for the Classification of Psychiatric Disorders - 4 th edition text revised (DSM-IV TR. The most common types of hallucinations in patients with schizophrenia are auditory in nature followed by visual hallucinations. Few patients with schizophrenia have persisting auditory hallucinations despite all other features of schizophrenia having being improved. Here, we report two cases where tiapride was useful as an add-on drug for treating persistent auditory hallucinations.
Serby, Michael J; Hagiwara, Mari; O'Connor, Lisa; Lalwani, Anil K
Three elderly patients experienced musical hallucinations (MH) in the context of hearing loss. In at least two of the cases, the onset was sudden. All three patients had pontine T2/FLAIR hyperintense foci on MR scan after the onset of the MH.
Blom, Jan Dirk; Coebergh, Jan Adriaan F; Lauw, René; Sommer, Iris E C
Musical hallucinations are relatively rare auditory percepts which, due to their intrusive nature and the accompanying fear of impending mental decline, tend to cause significant distress and impairment. Although their etiology and pathophysiology appear to be heterogeneous and no evidence-based tre
Aleman, A; Kahn, RS
We argue that the pivotal role assigned by Northoff to the principle of top-down modulation in catatonia might successfully be applied to other symptoms of schizophrenia, for example, hallucinations. Second, we propose that Northoffs account would benefit from a more comprehensive analysis of the co
Roed Rasmussen, Marie Louise; Prause, Jan U; Rasmussen, Marie Louise Roed
most often white or colored light, as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue, and psychological stress; 54% of patients had the experience more than once a week. Ten patients were so visually disturbed that it interfered......PURPOSE: To describe the prevalence of phantom eye syndrome in eye-amputated patients, to give a description of visual hallucinations, and to identify triggers, stoppers, and emotions related to visual hallucinations. METHODS: The hospital database was screened, using surgery codes for patients who...... hallucinations and pain was performed by one trained questioner (M.L.R.R.). RESULTS: The prevalence of phantom eye syndrome was 51%. Elementary visual hallucinations were present in 36%, complex visual hallucinations in only 1%, and other visual hallucinations in 14%. The elementary visual hallucinations were...
Fisher, C M
Visual hallucinations of remarkable intensity began shortly after intravenous atropine and persisted for 11 days. They were present only when the eyes were closed and were associated with heightened dreaming and disturbed sleep. The patient remained lucid and described his experiences to his attendants. Our patient's hallucinations bore some resemblance to hypnagogic hallucinations and this became the basis for the hypothesis that the hallucinations originated in the sleep-dream system of the brain stem. It is speculated that a similar site--a metabolic locus minoris resistentiae may play a part in other types of visual hallucinations and in delirium.
Oliver John Mason
Full Text Available Delusions involving technology, and specifically the internet, are increasingly common, and fear-reality statistics suggest computer-related fears are very widespread. These fears form a continuum from the widely understandable and realistic to the unrealistic, and frankly paranoid. The present study investigated the validity of this construct in a non-clinical population by constructing a novel self-report measure. The new Cyber-Paranoia and Fear Scale aims to measure the perception of information technology-related threats originating from or enabled by computers, smartphones, social networks and digital surveillance. Psychometric properties of the new Cyber-Paranoia and Fear Scale are reported alongside an established measure of suspiciousness and paranoia in 181 participants including a sub-group of fifty information technology professionals. Exploratory factor analysis suggested the presence of two, related, dimensions that we term Cyber-Fear and Cyber-Paranoia. Both sub-scales were internally consistent and produced a normal distribution of scores. The relationships of the sub-scales with age, gender, trait paranoia, digital literacy and digital inclusion are supportive of construct validity. The distinctiveness of ‘cyber-paranoia’ from general trait paranoia appears to mirror the clinical distinctiveness of ‘internet’ and other technology fuelled delusions. Knowledge provision to increase technological proficiency and awareness may bring about a reduction in cyber-paranoia.
Henke, H; Robinson, P A; Drysdale, P M; Loxley, P N
The thalamus is introduced to a recent model of the visual cortex to examine its effect on pattern formation in general and the generation of temporally oscillating patterns in particular. By successively adding more physiological details to a basic corticothalamic model, it is determined which features are responsible for which effects. In particular, with the addition of a thalamic population, several changes occur in the spatiotemporal power spectrum: power increases at resonances of the corticothalamic loop, while the loop acts as a spatiotemporal low-pass filter, and synaptic and dendritic dynamics temporally low-pass filter the activity more generally. Investigation of the effect of altering parameters and gains reveals new parameter regimes where activity that corresponds to hallucinations is induced by both spatially homogeneous and inhomogeneous temporally oscillating modes. This suggests that the thalamus and corticothalamic loops are essential components of a model of oscillating visual hallucinations.
Zhang, Wei; Cham, Wai-Kuen
In this paper, we propose a novel learning-based face hallucination framework built in the DCT domain, which can produce a high-resolution face image from a single low-resolution one. The problem is formulated as inferring the DCT coefficients in frequency domain instead of estimating pixel intensities in spatial domain. Our study shows that DC coefficients can be estimated fairly accurately by simple interpolation-based methods. AC coefficients, which contain the information of local features of face image, cannot be estimated well using interpolation. A simple but effective learning-based inference model is proposed to infer the ac coefficients. Experiments have been conducted to demonstrate the effectiveness of the proposed method in producing high quality hallucinated face images.
Ukai, Satoshi; Yamamoto, Masakiyo; Tanaka, Michio; Shinosaki, Kazuhiro; Takeda, Masatoshi
Musical hallucinations (MH) typically occur among elderly individuals and are associated with hearing impairment. The authors describe a patient with features of typical MH who was successfully treated with donepezil, a cholinesterase inhibitor, as a combination therapy and who has not shown any subsequent cognitive decline for approximately 5 years. The efficacy of donepezil in this patient indicates that age-dependent dysfunction of cholinergic neurons might be related to the development of MH.
Zhou, Huiling; Lam, Kin-Man
A two-step face-hallucination framework is proposed to reconstruct a high-resolution (HR) version of a face from an input low-resolution (LR) face, based on learning from LR-HR example face pairs using orthogonal canonical correlation analysis (orthogonal CCA) and linear mapping. In the proposed algorithm, face images are first represented using principal component analysis (PCA). Canonical correlation analysis (CCA) with the orthogonality property is then employed, to maximize the correlation between the PCA coefficients of the LR and the HR face pairs to improve the hallucination performance. The original CCA does not own the orthogonality property, which is crucial for information reconstruction. We propose using orthogonal CCA, which is proven by experiments to achieve a better performance in terms of global face reconstruction. In addition, in the residual-compensation process, a linear-mapping method is proposed to include both the inter- and intrainformation about manifolds of different resolutions. Compared with other state-of-the-art approaches, the proposed framework can achieve a comparable, or even better, performance in terms of global face reconstruction and the visual quality of face hallucination. Experiments on images with various parameter settings and blurring distortions show that the proposed approach is robust and has great potential for real-world applications.
Aizawa, Saeko; Terao, Takeshi; Hatano, Koji; Ishii, Nobuyoshi
A 73-year-old woman outpatient with mild cognitive impairment, parasomnia and depressive state with musical hallucinations failed to respond to 400 mg/day of valproate. Once she was admitted to a university hospital, her musical hallucinations partially responded to 1 mg/day of clonazepam and sufficiently improved on 100 mg/day of carbamazepine. Two months after discharge, however, her musical hallucinations recurred probably as a consequence of psychological stress. The increase of carbamazepine from 100 to 200 mg/day completely remitted her musical hallucinations. This case suggests that musical hallucinations respond in a dose-dependent manner to increasing carbamazepine, and that gradual titration from small doses of carbamazepine is required because optimal doses appear to be smaller than those required for epilepsy and bipolar disorder. Further studies are warranted to determine the therapeutic levels of carbamazepine for musical hallucinations.
Crosier, Benjamin Sage; Brian, Rachel Marie; Ben-Zeev, Dror
Background Auditory hallucinations (eg, hearing voices) are relatively common and underreported false sensory experiences that may produce distress and impairment. A large proportion of those who experience auditory hallucinations go unidentified and untreated. Traditional engagement methods oftentimes fall short in reaching the diverse population of people who experience auditory hallucinations. Objective The objective of this proof-of-concept study was to examine the viability of leveraging...
Yamagata, Bun; Kobayashi, Hitomi; Yamamoto, Hideki; Mimura, Masaru
In this report we describe a patient with a clinical diagnosis of dementia with Lewy bodies, who had hallucinations of reading her thoughts in the air although she was alexic and unable to read. She also had severe visuoperceptual deficits and closing-in phenomenon. SPECT imaging demonstrated hypoperfusion of the left parieto-occipital cortices together with hyperperfusion of the left orbitofronto-temporal areas. Her visual text hallucinations may represent another type of textual hallucinations related to syntacto-semantic network hyperactivation, which is implicated in auditory hallucinations in schizophrenia.
Computer Security Team
When the Internet opened its gates to academia in the late 80s and, together with the World Wide Web a few years later, to the general public, computer security was considered somehow irrelevant. People pointing to vulnerabilities and security risks (“hackers”) were labelled as paranoid. But they woke to reality during the outbreak of the “ILOVEYOU” virus in 2000, which caused large scale infections of Windows PCs (including many at CERN). Similarly, warnings about weaknesses and insecure control systems, issued by CERN and others (see our Bulletin article “Hacking control systems, switching lights off!"), were ignored until the “Stuxnet” attack against control systems in Iran proved them right in 2010. Reality beat 'paranoia' again. Last year, the paranoid fear of many security experts that our whole IT infrastructure might have been infiltrated and spied on turned real, if you believe ...
Full Text Available La psicoanalisi lacaniana può essere utilizzata per riflettere sul sottile e invisibile processo di rappresentazione simbolica, nel contesto della stereotipizzazione e della de-umanizzazione che troviamo in opera nello stile paranoico della politica (per esempio, nelle teorie del complotto. L’articolo evidenzia come la pretesa di immunizzazione auto-conservativa sia indispensabile nei processi di soggettivazione politica, ma può produrre un rovesciamento distruttivo. Nella identità comunitaria paranoica, la negatività è cancellata e il male, kakon, proiettato su un Altro persecutorio. L’ultima parte dell’articolo mette a fuoco il nesso tra paranoia e psicosi nelle forme di violenza gratuita, terrorismo e droga, nel sistema post-totalitario neoliberale. Solo l’assunzione del fantasma (che organizza il nostro sguardo sul mondo e il suo attraversamento, può aiutare ad aprire il circolo paranoico dell’identità.
In 1934, I. P. Pavlov conceptualized paranoia within his theory of higher nervous activity. The conceptualization was based on the case study method used in the Psychiatric Clinic where Pavlov observed five cases diagnosed by psychiatrists as paranoid states. Furthermore, experiments with dogs as subjects produced behaviours that appeared analogous to paranoiac characteristics observed in the clinic. Pavlov's paranoia theory did not differ much from Ernst Kretschmer's 1927 explanation of the formation of paranoia. Hereditary predisposition and traumatic life experiences make, according to Pavlov, some centres in the brain more active than nearby areas, which results in preoccupation with certain ideas. Imbalance between neural excitation and inhibition creates a condition where weak external stimuli produce strong reactions, which explains paranoiac overreaction to the feeling of inferiority. Some suggestions as to Pavlov's interest in paranoia are offered.
Varela, Jesica Verónica; Oporto, María Sol
El presente trabajo se propone como objetivo delimitar las relaciones entre la paranoia, la homosexualidad y el narcisismo en el caso Schreber de Freud, abordando así el problema que introduce la hipótesis de la homosexualidad inconsciente en la particularidad de la paranoia. Esta hipótesis conoció relecturas posteriores cuestionadas por su impacto en las intervenciones clínicas.
Pinkham, Amy E; Sasson, Noah J; Beaton, Derek; Abdi, Hervé; Kohler, Christian G; Penn, David L
A converging body of clinical and empirical reports indicates that autism features elevated rates of paranoia comparable to those of individuals with paranoid schizophrenia. However, the distinct developmental courses and symptom manifestations of these two disorders suggest that the nature of paranoid ideation may differ between them in important and meaningful ways. To evaluate this hypothesis, we compared patterns of responses on the Paranoia Scale between actively paranoid individuals with schizophrenia (SCZP), individuals with schizophrenia who were not actively paranoid (SCZNP), adults with an Autism Spectrum Disorder (ASD), and healthy controls. Despite an overall similar level of heightened paranoia in the ASD and SCZP groups, discriminant correspondence analysis (DiCA) revealed that these groups were characterized by unique underlying factors. Paranoia in the SCZP group was defined by a factor based upon victimization, suspicion, and threat of harm. Whereas paranoia in the ASD group was partially characterized by this factor, it was distinguished from SCZP by an additional pattern of responses reflective of increased social cynicism. These findings indicate that paranoia in ASD is supported by qualitative factors distinct from schizophrenia and highlight mechanistic differences in the formation of paranoid ideation that may inform the development of disorder-specific treatments.
Hesse, Klaus; Kriston, Levente; Mehl, Stephanie; Wittorf, Andreas; Wiedemann, Wolfgang; Wölwer, Wolfgang; Klingberg, Stefan
Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of p...
Gadit, Amin A Muhammad
This report describes a 26-year-old man who was so emotionally attached to his mother that the mere thought of separating from her caused immense anxiety. The death of his mother after a brief illness resulted in prolonged bereavement. However, the patient started seeing and talking to his mother after her death, which led to huge improvement in his mood and social functioning. His wife brought him in for consultation but no obvious psychopathology was detected. This gave rise to the dilemma of whether to consider this a real psychopathology and treat it, or to disregard this reported hallucination. No active treatment is being given to this patient at the moment.
Barnes, J; Boubert, L
The occurrences of visual hallucinations seem to be more prevalent in low light and hallucinators tend to be more prone to false positive type errors in memory tasks. Here we investigated whether the richness of stimuli does indeed affect recognition differently in hallucinating and nonhallucinating participants, and if so whether this difference extends to identifying spatial context. We compared 36 Parkinson's disease (PD) patients with visual hallucinations, 32 Parkinson's patients without hallucinations, and 36 age-matched controls, on a visual memory task where color and black and white pictures were presented at different locations. Participants had to recognize the pictures among distracters along with the location of the stimulus. Findings revealed clear differences in performance between the groups. Both PD groups had impaired recognition compared to the controls, but those with hallucinations were significantly more impaired on black and white than on color stimuli. In addition, the group with hallucinations was significantly impaired compared to the other two groups on spatial memory. We suggest that not only do PD patients have poorer recognition of pictorial stimuli than controls, those who present with visual hallucinations appear to be more heavily reliant on bottom up sensory input and impaired on spatial ability.
Pearson, Joel; Chiou, Rocco; Rogers, Sebastian; Wicken, Marcus; Heitmann, Stewart; Ermentrout, Bard
Hallucinations occur in both normal and clinical populations. Due to their unpredictability and complexity, the mechanisms underlying hallucinations remain largely untested. Here we show that visual hallucinations can be induced in the normal population by visual flicker, limited to an annulus that constricts content complexity to simple moving grey blobs, allowing objective mechanistic investigation. Hallucination strength peaked at ~11 Hz flicker and was dependent on cortical processing. Hallucinated motion speed increased with flicker rate, when mapped onto visual cortex it was independent of eccentricity, underwent local sensory adaptation and showed the same bistable and mnemonic dynamics as sensory perception. A neural field model with motion selectivity provides a mechanism for both hallucinations and perception. Our results demonstrate that hallucinations can be studied objectively, and they share multiple mechanisms with sensory perception. We anticipate that this assay will be critical to test theories of human consciousness and clinical models of hallucination. DOI: http://dx.doi.org/10.7554/eLife.17072.001 PMID:27726845
Jardri, Renaud; Thomas, Pierre; Delmaire, Christine; Delion, Pierre; Pins, Delphine
The pathophysiology of hallucinations remains mysterious. This research aims to specifically explore the interaction between hallucinations and spontaneous resting-state activity. We used multimodal magnetic resonance imaging during hallucinations occurrence in 20 drug-free adolescents with a "brief psychotic disorder." They were furthermore compared with 20 matched controls at rest or during exteroceptive stimuli. Anatomical and functional symptom-mapping demonstrated reduced cortical thickness and increased blood oxygen level-dependent signal in modality-dependent association sensory cortices during auditory, visual, and multisensory hallucinations. On the contrary, primary-sensory-cortex recruitment was not systematic and was shown to be associated with increased vividness of the hallucinatory experiences. Spatiotemporal activity patterns in the default-mode network (DMN) during hallucinations and symptom-free periods in patients were compared with patterns measured in healthy individuals. A disengagement of the DMN was concomitant to hallucinations, as for exogenous stimulations in healthy participants. Specifically, spatial and temporal instabilities of the DMN correlated with the severity of hallucinations but persisted during symptom-free periods. These results suggest that hallucinatory experiences emerge from a spontaneous DMN withdrawal, providing a convincing model for hallucinations beyond the auditory modality.
David, Christopher N.; Greenstein, Deanna; Clasen, Liv; Gochman, Pete; Miller, Rachel; Tossell, Julia W.; Mattai, Anand A.; Gogtay, Nitin; Rapoport, Judith L.
Objective: To document high rates and clinical correlates of nonauditory hallucinations in childhood onset schizophrenia (COS). Method: Within a sample of 117 pediatric patients (mean age 13.6 years), diagnosed with COS, the presence of auditory, visual, somatic/tactile, and olfactory hallucinations was examined using the Scale for the Assessment…
Diederen, Kelly M. J.; Neggers, Sebastiaan F. W.; Daalman, Kirstin; Blom, Jan Dirk; Goekoop, Rutger; Kahn, Rene S.; Sommer, Iris E. C.
Objective: Activation in a network of language-related regions has been reported during auditory verbal hallucinations. It remains unclear, however, how this activation is triggered. Identifying brain regions that show significant signal changes preceding auditory hallucinations might reveal the ori
Aleman, Andre; Laroi, Frank
Novel strategies are needed in the treatment of hallucinations as a subgroup of patients with pathological hallucinations (>30%) do not respond to antipsychotics or are not compliant with medication. We review recently developed biological and cognitive treatments. Repetitive transcranial magnetic s
Moritz, Steffen; Burnette, Pia; Sperber, Sabine; Köther, Ulf; Hagemann-Goebel, Marion; Hartmann, Maike; Lincoln, Tania M
Sensitivity to stress has long been implicated in the pathogenesis of schizophrenia. It remains unclear, however, which exact mechanisms underlie the progression from vulnerability to psychotic breakdown. For the present study, we hypothesized that the induction of stress would aggravate cognitive biases in schizophrenia. A total of 20 acute and remitted schizophrenia patients and 15 healthy controls were tested with parallel versions of cognitive biases paradigms under 2 laboratory conditions: stress (loud noise, 75 dB) vs no-stress. In the course of both conditions, participants had to fill out a questionnaire that assessed depressive, obsessive-compulsive, and paranoid symptoms. For the patients with acute psychotic symptoms, paranoid but not other psychiatric symptoms were elevated under stress in comparison with no-stress. In contrast, stress somewhat diminished subclinical paranoid symptoms in healthy participants. Jumping to conclusions was evident in schizophrenia under both conditions but significantly more pronounced when stress was applied first in the acute group. A tendency emerged in both acute and remitted patients to attribute events to other people under stress which was not seen in healthy subjects. The present study may serve as a starting point for further research investigating how stress translates vulnerability into acute paranoia and to pinpoint cognitive risk factors that can be modified by treatment.
Langdon, Robyn; Still, Megan; Connors, Michael H; Ward, Philip B; Catts, Stanley V
Attributional biases to externalize blame for negative events (externalizing bias) and to target other people for blame (personalizing bias) may constitute a vulnerability to psychosis. However, most research to date has only examined attributional biases in chronic patients. We examined attributional style, paranoia, and depression in early psychosis patients to assess the primacy of attributional biases in psychosis. A quasi-experimental design was adopted to compare the attributional style of patients and controls. Correlates of attributional style were also examined. Early psychosis patients and age- and gender-matched healthy controls completed the 'Internal, Personal and Situational Attributions Questionnaire'. Paranoid tendencies, suspiciousness, and depression were also assessed in both groups, while severity of current symptoms was assessed in patients. A high proportion of patients had persecutory delusions. These patients, however, did not differ from controls in externalizing or personalizing bias. Whereas suspiciousness and persecutory delusions in patients associated with externalizing bias, no bias measures associated with paranoid tendencies in either patients or controls. Counter to the pattern seen for endogenous depression, depression in patients was associated with an increased tendency to attribute events to self and a decreased tendency to attribute events to circumstances. These preliminary findings raise doubts about the primacy of attributional biases in psychosis. The novel findings with regard to depression warrant further investigation and suggest that young people, who develop depression after the onset of psychosis, may experience a need to re-establish a sense of personal control over life events that appear unpredictable. © 2013 The British Psychological Society.
Full Text Available The essay – after noting the fundamental difference between authority and power in which power must be the expression of authority – points out how authority has always had a sacred or transcendent foundation. In modern society, on the contrary, power has autonomized itself from authority, which has become a mere application procedure. This, in fact, has undermine power, which in times of crisis – in the extremus necessitatis casus – needs a new legitimacy: that of a new authority on which to be based on. This derives from collective unconscious and gives rise to the emergence of a particular figure: the dictator. The dictator resembles the archetypal figure of the Saviour, but in that he does not hold any sacred character, he is at risk of being overwhelmed by the load of his function. He is liable to becoming paranoid. He falls prey to the "paranoia of power", which manifests itself in psychopathological behaviors that are highlighted in the article through the sketch of their phenomenology. These behaviors culminate in a delirium of omnipotence, megalomania and a desire for destruction with effects of enormous danger on society. When the crisis is over, the dictator is doomed to disappear and in its place a (not procedural new and legitimate authority should take over. If not, the risk at issue is that of a continuous instability of power.
Demeulemeester, Morgane; Kochman, Fréderic; Fligans, Benjamin; Tabet, Ahmed J; Thomas, Pierre; Jardri, Renaud
The increasing development of apps for digital devices provides an opportunity for new instruments to assess hallucinations in young individuals. Here we present the Multisensory HAllucinations Scale for Children (MHASC), dedicated to assessing complex early-onset hallucinations. The MHASC will soon be translated into multilanguage versions with the support of the International Consortium of Hallucination Research. Royal College of Psychiatrists.
Telles-Correia, Diogo; Moreira, Ana Lúcia; Gonçalves, João S.
Prior to the seventeenth century, the experiences we now name hallucinations were valued within a cultural context, they could bring meaning to the subject or the world. From mid-seventeenth to eighteenth centuries, they acquire a medical quality in mental and organic illnesses. However, the term was only fully integrated in psychiatry by Esquirol in the eighteenth–nineteenth centuries. By then, a controversy begins on whether hallucinations have a perceptual or intellectual origin. Esquirol favors the intellectual origin, describing them as an involuntary exercise of memory and imagination. By the twentieth century, some authors maintain that hallucinations are a form of delusion (Ey), while others describe them as a change in perception (Jaspers, Fish). More integrated perspectives like those proposed by Alonso Fernandez and Luque, highlights the heterogeneity of hallucinations and the multiplicity of their types and causes. The terms pseudohallucination, illusion, and hallucinosis are grafted into the concept of hallucination. Since its introduction the term pseudohallucination has been used with different meanings. The major characteristics that we found associated with pseudohallucinations were “lack of objectivity” and “presence of insight” (differing from hallucinations). Illusions are unanimously taken as distortions of real objects. Hallucinosis, first described in the context of alcohol consumption, is generally considered egodystonic, in which insight is preserved. These and other controversial aspects regarding the evolution of the term hallucination and all its derivative concepts are discussed in this paper. PMID:26283978
Full Text Available Prior to the 17th century, the experiences we now name hallucinations or others alike were valued within a cultural context, they could bring meaning to the subject or the world. From mid-17th to 18th centuries, they acquire a medical quality in mental and organic illnesses. However, the term was only fully integrated in psychiatry by Esquirol in the 18th-19th centuries. By then, a controversy begins on whether hallucinations have a perceptual or intellectual origin. Esquirol favours the intellectual origin, describing them as an involuntary exercise of memory and imagination.By the twentieth century, some authors maintain that hallucinations are a form of delusion (Ey, while others describe them as a change in perception (Jaspers, Fish. A more integrated perspectives like those proposed by Alonso Fernandez and Luque, highlights the heterogeneity of hallucinations and the multiplicity of their types and causes.The terms pseudohallucination, illusion and hallucinosis are grafted into the concept of hallucination. Since its introduction the term pseudohallucination has been used with different meanings. The major characteristics that we found associated with pseudohallucinations were ‘lack of objectivity’ and ‘presence of insight’ (differing from hallucinations. Illusions are unanimously taken as distortions of real objects. Hallucinosis, first described in the context of alcohol consumption, is generally considered egodystonic, in which insight is preserved.These and other controversial aspects regarding the evolution of the term hallucination and all its derivative concepts are discussed in this paper.
Izumi, Yukiyo; Terao, Takeshi; Ishino, Yoichi; Nakamura, Jun
A 51-year-old male patient suffered from both musical and verbal hallucinations with insight. We performed three single photon emission computed tomographic scans with the patient in different conditions: baseline without hallucinations, musical hallucinations, and verbal hallucinations. Clearly, different patterns of regional cerebral blood flow (rCBF) were observed during musical and verbal hallucinations. The findings suggest that musical and verbal hallucinations are associated with different patterns of rCBF, possibly reflecting the different causes of the two types of hallucinations.
Valiente, Carmen; Romero, Nuria; Hervas, Gonzalo; Espinosa, Regina
This study was aimed to explore the distinct pathways that lead to depression and paranoia. We first examined the association of dysfunctional parenting experiences and negative self-evaluations in depression and paranoia. Furthermore, we also examined whether different self-evaluative beliefs could mediate the relationships between dysfunctional parenting experiences (i.e. parental overprotection or lack of care) and the development of depression and paranoia. A sample composed of 55 paranoid patients, 38 depressed patients and 44 healthy controls completed the Parental Bonding Instrument (PBI), the Evaluative Beliefs Scale (EBS) and some clinical scales. Our analyses revealed that lack of parental care and negative self-self evaluations were associated with depression symptoms. Analyses also revealed that parental overprotection and negative other-self evaluations were associated with paranoid symptoms. Furthermore, negative self-self and other-self evaluations fully mediated the relationship of parental overprotection and paranoia, whereas negative self-self evaluations partially mediated the relationship between lack of parental care and depression. These findings suggest that distinct patterns of parental practices may contribute to the development of different dysfunctional schemas which in turn may lead to either depression or paranoia.
Bloch, J; Morell-Dubois, S; Koch, E; Launay, D; Maillard-Lefebvre, H; Buchdahl, A-L; Hachulla, E; Rouland, J-F; Hatron, P-Y; Lambert, M
In patients with visual hallucinations, diagnostic strategy is unclearly codified. In patients known to have giant cell arteritis, the main diagnostic assumption is disease relapse. Indeed, this should lead to rapid corticosteroid therapy. However, the Charles Bonnet syndrome, that is a poorly known etiology of visual hallucinations usually observed in elderly people, should be part of the differential diagnosis. We report a 87-year-old woman, with a 2-year history of giant cell arteritis who was admitted with an acute onset of visual hallucinations and who met all the criteria for Charles Bonnet syndrome.
Cinar, Nilgun; Sahin, Sevki; Karsidag, Sibel
The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.
Jardri, Renaud; Pins, Delphine; Bubrovszky, Maxime; Lucas, Bernard; Lethuc, Vianney; Delmaire, Christine; Vantyghem, Vincent; Despretz, Pascal; Thomas, Pierre
Although complex hallucinations are extremely vivid, painful symptoms in schizophrenia, little is known about the underlying mechanisms of multisensory integration in such a phenomenon. We investigated the neural basis of these altered states of consciousness in a patient with schizophrenia, by combining state of the art neuroscientific exploratory methods like functional MRI, diffusion tensor imaging, cortical thickness analysis, electrical source reconstruction and trans-cranial magnetic stimulation. The results shed light on the functional architecture of the hallucinatory processes, in which unimodal information from different modalities is strongly functionally connected to higher-order integrative areas.
Henke, H; Robinson, P A; Drysdale, P M
In order to better understand the nature of visual hallucinations, and to test predictions of spatiotemporally oscillating hallucinations from a recent corticothalamic model of visual dynamics, clinical descriptions of hallucinations are used to establish boundaries on the spatiotemporal frequencies observed in various disorders. Detailed comparisons with hallucinations during migraine aura demonstrate that key features are consistent with corticothalamic origin and specific abnormalities, but underline the need for more detailed quantitative data to be obtained on temporally oscillating hallucinations more generally.
Goetz, Christopher G; Stebbins, Glenn T; Ouyang, Bichun
The objective of the study was to assess the development and evolution of visual and nonvisual hallucinations in patients with Parkinson's disease over 10 years. Hallucinations increase over time, but minimal attention has been placed on nonvisual domains. We studied 60 patients with Parkinson's disease who had never hallucinated at baseline and followed them over 10 years. The Rush Hallucination Inventory monitored frequency and type (visual, auditory, tactile, olfactory) of hallucinations at baseline and after 0.5, 1.5, 4, 6, and 10 years. Descriptive statistics were applied, and general estimating equation modeling assessed longitudinal risks. Over 10 years, visual hallucinations were endorsed by patients more frequently than other sensory modalities. Whereas isolated visual hallucinations dominated the early hallucination profile, visual plus nonvisual hallucinations accounted for progressively higher proportions of hallucinators over 10 years: 0.5 years, 0%; 4 years, 26%; 6 years, 47%; 10 years, 60% (odds ratio, 1.17; confidence interval, 1.01-1.37; P = .04). Once visual plus nonvisual hallucinations developed, the risk of continuing to have multidomain hallucinations was high (odds ratio, 3.67; confidence interval, 1.13-11.93; P = .03). Hallucination severity was highly associated with current visual plus nonvisual hallucinations (odds ratio, 4.06; confidence interval, 2.93-5.61; P hallucinations (odds ratio, 1.58; confidence interval, 1.12-2.24; P = .01). Whereas visual hallucinations in isolation are classic in Parkinson's disease, nonvisual hallucinations emerge over time, and the combination of visual with nonvisual hallucinations predominates in late Parkinson's disease. To capture the breadth and severity of hallucinations in chronically hallucinating patients with Parkinson's disease, screening inventories and practice-based interviews must include questions on both visual and nonvisual components.
Hesse, Klaus; Kriston, Levente; Mehl, Stephanie; Wittorf, Andreas; Wiedemann, Wolfgang; Wölwer, Wolfgang; Klingberg, Stefan
Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia. PMID:25925392
Hesse, Klaus; Kriston, Levente; Mehl, Stephanie; Wittorf, Andreas; Wiedemann, Wolfgang; Wölwer, Wolfgang; Klingberg, Stefan
Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia.
Lake, Charles Raymond
Delusional paranoia has been associated with severe mental illness for over a century. Kraepelin introduced a disorder called "paranoid depression," but "paranoid" became linked to schizophrenia, not to mood disorders. Paranoid remains the most common subtype of schizophrenia, but some of these cases, as Kraepelin initially implied, may be unrecognized psychotic mood disorders, so the relationship of paranoid schizophrenia to psychotic bipolar disorder warrants reevaluation. To address whether paranoia associates more with schizophrenia or mood disorders, a selected literature is reviewed and 11 cases are summarized. Comparative clinical and recent molecular genetic data find phenotypic and genotypic commonalities between patients diagnosed with schizophrenia and psychotic bipolar disorder lending support to the idea that paranoid schizophrenia could be the same disorder as psychotic bipolar disorder. A selected clinical literature finds no symptom, course, or characteristic traditionally considered diagnostic of schizophrenia that cannot be accounted for by psychotic bipolar disorder patients. For example, it is hypothesized here that 2 common mood-based symptoms, grandiosity and guilt, may underlie functional paranoia. Mania explains paranoia when there are grandiose delusions that one's possessions are so valuable that others will kill for them. Similarly, depression explains paranoia when delusional guilt convinces patients that they deserve punishment. In both cases, fear becomes the overwhelming emotion but patient and physician focus on the paranoia rather than on underlying mood symptoms can cause misdiagnoses. This study uses a clinical, case-based, hypothesis generation approach that warrants follow-up with a larger representative sample of psychotic patients followed prospectively to determine the degree to which the clinical course observed herein is typical of all such patients. Differential diagnoses, nomenclature, and treatment implications are
In contrast to the developed world little is known regarding the prevalence of ... hallucinations and suicidal ideation as well as patterns of service utilization and ..... Children's self-reported psychotic symptoms and adult schizophreniform ...
Warner, Nick; Aziz, Victor
This is a phenomenological study of 30 consecutive referrals of older people with musical hallucinations concentrating on the names of the melodies heard. Hymns and Christmas carols were the most common experience with 'Abide with Me' particularly frequent.
Rajkumar, Ravi Philip
Functional hallucinations are a rare phenomenon, wherein hallucinations are triggered by a stimulus in the same modality, and co-occur with it. Although hallucinations in schizophrenia are normally treated using antipsychotics, not all patients respond to them. The following is the report of a patient with paranoid schizophrenia who experienced persistent functional hallucinations, triggered by the sound of machines in his factory, in the absence of other psychotic symptoms. These occurred despite adequate doses of risperidone, which had controlled his other symptoms. The addition of sodium valproate, titrated up to 1700 mg/day based on response and tolerability, resulted in a marked improvement in this phenomenon and enabled him to return to work. The implications and possible mechanisms of the patient's response are discussed.
Ravi Philip Rajkumar
Full Text Available Functional hallucinations are a rare phenomenon, wherein hallucinations are triggered by a stimulus in the same modality, and co-occur with it. Although hallucinations in schizophrenia are normally treated using antipsychotics, not all patients respond to them. The following is the report of a patient with paranoid schizophrenia who experienced persistent functional hallucinations, triggered by the sound of machines in his factory, in the absence of other psychotic symptoms. These occurred despite adequate doses of risperidone, which had controlled his other symptoms. The addition of sodium valproate, titrated up to 1700 mg/day based on response and tolerability, resulted in a marked improvement in this phenomenon and enabled him to return to work. The implications and possible mechanisms of the patient′s response are discussed.
Many essential software functions in the mission critical computer resource application domain depend on floating point arithmetic. Numerically intensive functions associated with the Space Station project, such as emphemeris generation or the implementation of Kalman filters, are likely to employ the floating point facilities of Ada. Paranoia.Ada appears to be a valuabe program to insure that Ada environments and their underlying hardware exhibit the precision and correctness required to satisfy mission computational requirements. As a diagnostic tool, Paranoia.Ada reveals many essential characteristics of an Ada floating point implementation. Equipped with such knowledge, programmers need not tremble before the complex task of floating point computation.
A case of musical hallucination (MII) triggered by different antidepressive drugs is described. This is an uncommon side effect, probably more related to individual factors than to high doses. Musical hallucinations seems to be a releasing phenomenon, associated to sensorial deficit and neuronal compensatory activation. The present case report suggests that not only classical tricyclic antidepressives (AD) can cause MH, but also more selective drugs such as the SSRIs and venlafaxine. Aminedip...
Sanne eKoops; Hilde evan den Brink; Sommer, Iris E C
Auditory hallucinations (AH) are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication-resistant group are scarce and most of them focus on coping with the hallucinations. Finding an alternative treatment that can diminish AH is of great importance.Transcranial direct current stimulation (tDCS) is a safe and non-invasive technique that is able to...
Azhar, M Z; Varma, S L; Hakim, H R
Two hundred and seventy patients with schizophrenia (104 patients in Kelantan and 166 patients in Penang) were interviewed using the Present State Examination to elicit the differences in the phenomenology of their hallucinations. The results indicate that there are significant differences in the phenomenology of hallucinations between the Malays of Penang and Kelantan and also among some Chinese patients. These findings indicate that culture does affect the phenomenology of schizophrenia, even among people of the same race but of different regions.
Barnes, Jim; Connelly, Vince; Boubert, Laura; Maravic, Ksenija
Visual Hallucinations are considered to affect about 20%-40% of patients with Parkinson's disease. They are generally seen as a side effect of this long-term illness and can severely affect the daily quality of life of patients. The aim of this study was to determine the coping patterns or strategies used by patients and establish whether the phenomenology and behaviours used by patients enabled control of the phenomenon. Demographic and clinical variables were recorded, including motor measures, cognitive status, and depressive symptoms. Patient with hallucinations were at a more advance stage of the disease and displayed more depressive symptoms than their non-hallucinating counterparts. Most patients used more than one constructive coping strategy, the most common were simple behavioural strategies based around motor action or cognitive approaches resulting in visual modification. In addition, humour was a common technique used by the patients to deal with the phenomenon. Emotional responses varied between patients, but it was found that the actual content of the hallucination was not directly associated with whether it caused trouble to the patient, but perceived stress was strongly correlated with the subjective disturbing nature of visual hallucinations (VHs). This study gives insight into the role of cognitive-behavioural approaches when dealing with VHs and opens up avenues for future studies in helping patient to deal with hallucinations.
Shine, James M; O'Callaghan, Claire; Halliday, Glenda M; Lewis, Simon J G
Visual hallucinations are common across a number of disorders but to date, a unifying pathophysiology underlying these phenomena has not been described. In this manuscript, we combine insights from neuropathological, neuropsychological and neuroimaging studies to propose a testable common neural mechanism for visual hallucinations. We propose that 'simple' visual hallucinations arise from disturbances within regions responsible for the primary processing of visual information, however with no further modulation of perceptual content by attention. In contrast, 'complex' visual hallucinations reflect dysfunction within and between the Attentional Control Networks, leading to the inappropriate interpretation of ambiguous percepts. The incorrect information perceived by hallucinators is often differentially interpreted depending on the time-course and the neuroarchitecture underlying the interpretation. Disorders with 'complex' hallucinations without retained insight are proposed to be associated with a reduction in the activity within the Dorsal Attention Network. The review concludes by showing that a variety of pathological processes can ultimately manifest in any of these three categories, depending on the precise location of the impairment.
El Haj, Mohamad; Roche, Jean; Jardri, Renaud; Kapogiannis, Dimitrios; Gallouj, Karim; Antoine, Pascal
Due to their prevalence, hallucinations are considered as one of the most frequent psychotic symptoms in Alzheimer's disease (AD). These psychotic manifestations reduce patients' well-being, increase the burden of caregivers, contribute to early institutionalization, and are related with the course of cognitive decline in AD. Considering their consequences, we provide a comprehensive account of the current state of knowledge about the prevalence and characteristics of hallucinations in AD. We propose a comprehensive and testable theoretical model about hallucinations in AD: the ALZHA (ALZheimer and HAllucinations) model. In this model, neurological, genetic, cognitive, affective, and iatrogenic factors associated with hallucinations in AD are highlighted. According to the ALZHA model, hallucinations in AD first involve trait markers (i.e., cognitive deficits, neurological deficits, genetic predisposition and/or sensory deficits) to which state markers that may trigger these experiences are added (e.g., psychological distress and/or iatrogenic factors). Finally, we provide recommendations for assessment and management of these psychotic manifestations in AD, with the aim to benefit patients, caregivers, and health professionals.
Full Text Available Hallucinations are complex misperceptions, that principally occur in schizophrenia or after intoxication induced by three main classes of drugs: psychostimulants, psychedelics, and dissociative anesthetics. There are at least three different pharmacological ways to induce hallucinations: (1 activation of dopamine D2 receptors (D2Rs with psychostimulants, (2 activation of serotonin 5HT2A receptors (HT2ARs with psychedelics, and (3 blockage of glutamate NMDA receptors (NMDARs with dissociative anesthetics. In schizophrenia, the relative importance of NMDAR and D2R in the occurrence of hallucinations is still debated. Slight clinical differences are observed for each etiology. Thus, we investigated whether the concept of hallucination is homogenous, both clinically and neurobiologically. A narrative review of the literature is proposed to synthesize how the main contributors in the field have approached and tried to solve these outstanding questions. While some authors prefer one explanatory mechanism, others have proposed more integrated theories based on the different pharmacological psychosis models. In this review, such theories are discussed and faced with the clinical data. In addition, the nosological aspects of hallucinations and psychosis are addressed. We suggest that if there may be common neurobiological pathways between the different pharmacological systems that are responsible for the hallucinations, there may also be unique properties of each system, which explains the clinical differences observed.
Ellett, Lyn; Luzon, Olga; Birchwood, Max; Abbas, Zarina; Harris, Abi; Chadwick, Paul
Command hallucinations are considered to be one of the most distressing and disturbing symptoms of schizophrenia. Building on earlier studies, we compare key attributes in the symptomatic, affective, and cognitive profiles of people diagnosed with schizophrenia and hearing voices that do (n = 77) or do not (n = 74) give commands. The study employed a cross-sectional design, in which we assessed voice severity, distress and control (PSYRATs), anxiety and depression (HADS), beliefs about voices (BAVQ-R), and responsibility beliefs (RIQ). Clinical and demographic variables were also collected. Command hallucinations were found to be more distressing and controlling, perceived as more omnipotent and malevolent, linked to higher anxiety and depression, and resisted more than hallucinations without commands. Commanding voices were also associated with higher conviction ratings for being personally responsible for preventing harm. The findings suggest key differences in the affective and cognitive profiles of people who hear commanding voices, which have important implications for theory and psychological interventions. Command hallucinations are associated with higher distress, malevolence, and omnipotence. Command hallucinations are associated with higher responsibility beliefs for preventing harm. Responsibility beliefs are associated with voice-related distress. Future psychological interventions for command hallucinations might benefit from focussing not only on omnipotence, but also on responsibility beliefs, as is done in psychological therapies for obsessive compulsive disorder. Limitations The cross-sectional design does not assess issues of causality. We did not measure the presence or severity of delusions. © 2017 The British Psychological Society.
Full Text Available Background: In schizophrenic clients, self-care strategies against auditory hallucinations can decrease disturbances results in hallucination. This study was aimed to assess frequency of self-care strategies against auditory hallucinations in paranoid schizophrenic patients, hospitalized in Shafa Hospital.Materials and Method: This was a descriptive study on 201 patients with paranoid schizophrenia hospitalized in psychiatry unit with convenience sampling in Rasht. The gathered data consists of two parts, first unit demographic characteristic and the second part, self- report questionnaire include 38 items about self-care strategies.Results: There were statistically significant relationship between demographic variables and knowledg effect and self-care strategies against auditory hallucinaions. Sex with phisical domain p0.07, marriage status with cognitive domain (p>0.07 and life status with behavioural domain (p>0.01. 53.2% of reported type of our auditory hallucinations were command hallucinations, furtheremore the most effective self-care strategies against auditory hallucinations were from physical domain and substance abuse (82.1% was the most effective strategies in this domain.Conclusion: The client with paranoid schizophrenia used more than physical domain strategies against auditory hallucinaions and this result highlight need those to approprait nursing intervention. Instruction and leading about selection the effective self-care strategies against auditory ha
Jenner, JA; van de Willige, G
Objective: Early intervention in psychosis is considered important in relapse prevention. Limited results of monotherapies prompt to development of multimodular programmes. The present study tests feasibility and effectiveness of HIT, an integrative early intervention treatment for auditory hallucin
Crosier, Benjamin Sage; Brian, Rachel Marie; Ben-Zeev, Dror
Auditory hallucinations (eg, hearing voices) are relatively common and underreported false sensory experiences that may produce distress and impairment. A large proportion of those who experience auditory hallucinations go unidentified and untreated. Traditional engagement methods oftentimes fall short in reaching the diverse population of people who experience auditory hallucinations. The objective of this proof-of-concept study was to examine the viability of leveraging Web-based social media as a method of engaging people who experience auditory hallucinations and to evaluate their attitudes toward using social media platforms as a resource for Web-based support and technology-based treatment. We used Facebook advertisements to recruit individuals who experience auditory hallucinations to complete an 18-item Web-based survey focused on issues related to auditory hallucinations and technology use in American adults. We systematically tested multiple elements of the advertisement and survey layout including image selection, survey pagination, question ordering, and advertising targeting strategy. Each element was evaluated sequentially and the most cost-effective strategy was implemented in the subsequent steps, eventually deriving an optimized approach. Three open-ended question responses were analyzed using conventional inductive content analysis. Coded responses were quantified into binary codes, and frequencies were then calculated. Recruitment netted N=264 total sample over a 6-week period. Ninety-seven participants fully completed all measures at a total cost of $8.14 per participant across testing phases. Systematic adjustments to advertisement design, survey layout, and targeting strategies improved data quality and cost efficiency. People were willing to provide information on what triggered their auditory hallucinations along with strategies they use to cope, as well as provide suggestions to others who experience auditory hallucinations. Women, people
Brian, Rachel Marie; Ben-Zeev, Dror
Background Auditory hallucinations (eg, hearing voices) are relatively common and underreported false sensory experiences that may produce distress and impairment. A large proportion of those who experience auditory hallucinations go unidentified and untreated. Traditional engagement methods oftentimes fall short in reaching the diverse population of people who experience auditory hallucinations. Objective The objective of this proof-of-concept study was to examine the viability of leveraging Web-based social media as a method of engaging people who experience auditory hallucinations and to evaluate their attitudes toward using social media platforms as a resource for Web-based support and technology-based treatment. Methods We used Facebook advertisements to recruit individuals who experience auditory hallucinations to complete an 18-item Web-based survey focused on issues related to auditory hallucinations and technology use in American adults. We systematically tested multiple elements of the advertisement and survey layout including image selection, survey pagination, question ordering, and advertising targeting strategy. Each element was evaluated sequentially and the most cost-effective strategy was implemented in the subsequent steps, eventually deriving an optimized approach. Three open-ended question responses were analyzed using conventional inductive content analysis. Coded responses were quantified into binary codes, and frequencies were then calculated. Results Recruitment netted N=264 total sample over a 6-week period. Ninety-seven participants fully completed all measures at a total cost of $8.14 per participant across testing phases. Systematic adjustments to advertisement design, survey layout, and targeting strategies improved data quality and cost efficiency. People were willing to provide information on what triggered their auditory hallucinations along with strategies they use to cope, as well as provide suggestions to others who experience
Doane, John; Stults, Barry
Four patients experienced visual hallucinations that appear to have been precipitated by lisinopril. Other cases of visual hallucinations have been reported with other angiotensin-converting enzyme (ACE) inhibitors. Older patients, particularly those with a history of either dementia or mild cognitive impairment, may be at higher risk. Hallucinations resolved within 1 to 30 days after cessation of ACE inhibitors. Development of visual hallucinations after initiation of ACE inhibitors should prompt discontinuation of therapy. Visual hallucinations have been reported in one case involving an ARB. Visual hallucinations have not been associated with direct renin inhibitors. Consideration should be given to use of alternative, unrelated antihypertensive drug classes.
Veling, Wim; Pot-Kolder, Roos; Counotte, Jacqueline; van Os, Jim; van der Gaag, Mark
The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 siblings of patients with psychosis, and 53 controls walked 5 times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Paranoia about virtual humans and subjective distress in response to virtual social stress exposures were measured with State Social Paranoia Scale (SSPS) and self-rated momentary subjective distress (SUD), respectively. Pre-existing (subclinical) symptoms were assessed with the Community Assessment of Psychic Experiences (CAPE), Green Paranoid Thoughts Scale (GPTS) and the Social Interaction Anxiety Scale (SIAS). Paranoia and subjective distress increased with degree of social stress in the environment. Psychosis liability and pre-existing symptoms, in particular negative affect, positively impacted the level of paranoia and distress in response to social stress. These results provide experimental evidence that heightened sensitivity to environmental social stress may play an important role in the onset and course of psychosis.
Matthew R. Broome
Full Text Available Psychotic disorders carry social and economic costs for sufferers and society. Recent evidence highlights the risk posed by urban upbringing and social deprivation in the genesis of paranoia and psychosis. Evidence based psychological interventions are often not offered because of a lack of therapists. Virtual reality (VR environments have been used to treat mental health problems. VR may be a way of understanding the aetiological processes in psychosis and increasing psychotherapeutic resources for its treatment. We developed a high-fidelity virtual reality scenario of an urban street scene to test the hypothesis that virtual urban exposure is able to generate paranoia to a comparable or greater extent than scenarios using indoor scenes. Participants (n=32 entered the VR scenario for four minutes, after which time their degree of paranoid ideation was assessed. We demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment. We suggest that this study offers evidence to support the role of exposure to factors in the urban environment in the genesis and maintenance of psychotic experiences and symptoms. The realistic high-fidelity street scene scenario may offer a useful tool for therapists.
Chalus, Gary Anton
Evaluates validity of the Freudian theory of paranoia which states that delusional thinking arises as a result of the reaction-formation and projection of threatening unconscious homosexual wishes. It is concluded that a positive association between paranoid and homosexual tendencies has been found, but only for male paranoid patients. (Author)
Isnanda, Reza Giga; Brinkman, Willem-Paul; Veling, Wim; van der Gaag, Mark; Neerincx, Mark
Although virtual reality exposure has been reported as a method to induce paranoid thought, little is known about mechanisms to control specific virtual stressors. This paper reports on a study that examines the effect of controlling the stream of potential paranoia evoking events in a virtual resta
Hovanitz, Christine A.; And Others
Investigated the relationship between the Minnesota Multiphasic Personality Inventory paranoia subtle, neutral, and obvious subscales and criteria presumed to reflect various paranoid characteristics in a sample of male college students (N=100). Results showed that both the obvious and subtle Pa Items predicted various criteria. (Author/JAC)
Combs, Dennis R.; Tiegreen, Joshua; Nelson, Amelia
Recently, there has been a renewed interested in the treatment of psychosis and it is now appears possible to modify specific symptoms of psychosis such as paranoia and delusions using methods derived from Cognitive-Behavioral Therapy. One specific technique that has received less attention is the use of behavioral experiments. In this paper, we…
Fowler, David; Hodgekins, Joanne; Garety, Philippa; Freeman, Daniel; Kuipers, Elizabeth; Dunn, Graham; Smith, Ben; Bebbington, Paul E.
The role of negative cognition and effect in maintaining psychotic symptoms is increasingly recognized but has yet to be substantiated though longitudinal analysis. Based on an a priori theoretical model, we hypothesized that negative cognition and depressed mood play a direct causal role in maintaining paranoia in people with psychosis and that the effect of mood is mediated by negative cognition. We used data from the 301 patients in the Prevention of Relapse in Psychosis Trial of cognitive behavior therapy. They were recruited from consecutive Community Mental Health Team clients presenting with a recent relapse of psychosis. The teams were located in inner and outer London and the rural county of Norfolk, England. The study followed a longitudinal cohort design, with initial measures repeated at 3 and 12 months. Structural equation modeling was used to investigate the direction of effect between negative cognition, depressed mood, and paranoia. Overall fit was ambiguous in some analyses and confounding by unidentified variables cannot be ruled out. Nevertheless, the most plausible models were those incorporating pathways from negative cognition and depressed mood to paranoid symptoms: There was no evidence whatsoever for pathways in the reverse direction. The link between depressed mood and paranoia appeared to be mediated by negative cognition. Our hypotheses were thus corroborated. This study provides evidence for the role of negative cognition in the maintenance of paranoia, a role of central relevance, both to the design of psychological interventions and to the conceptualizations of psychosis. PMID:21474550
Bratton, Helen; O'Rourke, Suzanne; Tansey, Louise; Hutton, Paul
People diagnosed with schizophrenia have difficulties in emotion recognition and theory of mind, and these may contribute to paranoia. The aim of this study was to determine whether this relationship is evident in patients residing in a secure forensic setting. Twenty-seven male participants with a diagnosis of schizophrenia and a history of offending behaviour were assessed using The Awareness of Social Inference Test (TASIT), The Ambiguous Intentions Hostility Questionnaire (AIHQ) and The Green et al. Paranoid Thought Scales (G-PTS). Individuals were recruited from two medium secure and one high secure forensic hospital in Scotland. Correlation, logistic and multiple regression analyses did not find that emotion recognition and theory of mind were associated with indices of paranoid thinking. Social cognition did not appear to be related to indices of paranoia in this forensic sample. Although participants reported low levels of paranoia overall, the results are consistent with recent conclusions that theory of mind impairments are not specifically linked to paranoia in people diagnosed with schizophrenia. Copyright © 2016 Elsevier B.V. All rights reserved.
Kramer, Roderick M.
Autor kirjeldab erinevate näidete varal, miks liigne usaldus inimese kaitsetuks ja haavatavaks muudab ning kuidas arukas paranoia ehk konstruktiivne kahtlustamine ettevõttele või edasipürgivale juhile kasu võib tuua. Vt. samas: Kuidas paranoiat ärksana hoida?; Kontoriparanoia
Isnanda, Reza Giga; Brinkman, Willem-Paul; Veling, Wim; van der Gaag, Mark; Neerincx, Mark
Although virtual reality exposure has been reported as a method to induce paranoid thought, little is known about mechanisms to control specific virtual stressors. This paper reports on a study that examines the effect of controlling the stream of potential paranoia evoking events in a virtual
Kramer, Roderick M.
Autor kirjeldab erinevate näidete varal, miks liigne usaldus inimese kaitsetuks ja haavatavaks muudab ning kuidas arukas paranoia ehk konstruktiivne kahtlustamine ettevõttele või edasipürgivale juhile kasu võib tuua. Vt. samas: Kuidas paranoiat ärksana hoida?; Kontoriparanoia
Bohlken, M M; Hugdahl, K; Sommer, I E C
Auditory verbal hallucinations (AVH) are a frequently occurring phenomenon in the general population and are considered a psychotic symptom when presented in the context of a psychiatric disorder. Neuroimaging literature has shown that AVH are subserved by a variety of alterations in brain structure and function, which primarily concentrate around brain regions associated with the processing of auditory verbal stimuli and with executive control functions. However, the direction of association between AVH and brain function remains equivocal in certain research areas and needs to be carefully reviewed and interpreted. When AVH have significant impact on daily functioning, several efficacious treatments can be attempted such as antipsychotic medication, brain stimulation and cognitive-behavioural therapy. Interestingly, the neural correlates of these treatments largely overlap with brain regions involved in AVH. This suggests that the efficacy of treatment corresponds to a normalization of AVH-related brain activity. In this selected review, we give a compact yet comprehensive overview of the structural and functional neuroimaging literature on AVH, with a special focus on the neural correlates of efficacious treatment.
Leslie E Horton
Full Text Available Paranoia is a dimension of clinical and subclinical experiences in which others are believed to have harmful intentions. Mild paranoid concerns are relatively common in the general population, and more clinically severe paranoia shares features with social anxiety and is a key characteristic of schizotypy. Given that subclinical manifestations of schizotypy and paranoia may predict the occurrence of more severe symptoms, disentangling the associations of these related constructs may advance our understanding of their etiology; however no known studies to date have comprehensively evaluated how paranoia relates to social anxiety and schizotypy. The current research sought to examine the association of paranoia, assessed across a broad continuum of severity, with 1 the positive and negative schizotypy dimensions and 2 social anxiety. Specifically, the study tested a series of six competing, a priori models using confirmatory factor analysis in a sample of 862 young adults. As hypothesized, the data supported a four-factor model including positive schizotypy, negative schizotypy, social anxiety, and paranoia factors, suggesting that these are distinct constructs with differing patterns of interrelationships. Paranoia had a strong association with positive schizotypy, a moderate association with social anxiety, and a minimal association with negative schizotypy. The results are consistent with paranoia being part of a multidimensional model of schizotypy and schizophrenia. Prior studies treating schizotypy and schizophrenia as homogenous constructs often produce equivocal or non-replicable results because these dimensions are associated with distinct etiologies, presentations, and treatment responses; thus, the present conceptualization of paranoia within a multidimensional schizotypy framework should advance our understanding of these constructs.
Horton, Leslie E.; Barrantes-Vidal, Neus; Silvia, Paul J.; Kwapil, Thomas R.
Paranoia is a dimension of clinical and subclinical experiences in which others are believed to have harmful intentions. Mild paranoid concerns are relatively common in the general population, and more clinically severe paranoia shares features with social anxiety and is a key characteristic of schizotypy. Given that subclinical manifestations of schizotypy and paranoia may predict the occurrence of more severe symptoms, disentangling the associations of these related constructs may advance our understanding of their etiology; however no known studies to date have comprehensively evaluated how paranoia relates to social anxiety and schizotypy. The current research sought to examine the association of paranoia, assessed across a broad continuum of severity, with 1) the positive and negative schizotypy dimensions and 2) social anxiety. Specifically, the study tested a series of six competing, a priori models using confirmatory factor analysis in a sample of 862 young adults. As hypothesized, the data supported a four-factor model including positive schizotypy, negative schizotypy, social anxiety, and paranoia factors, suggesting that these are distinct constructs with differing patterns of interrelationships. Paranoia had a strong association with positive schizotypy, a moderate association with social anxiety, and a minimal association with negative schizotypy. The results are consistent with paranoia being part of a multidimensional model of schizotypy and schizophrenia. Prior studies treating schizotypy and schizophrenia as homogenous constructs often produce equivocal or non-replicable results because these dimensions are associated with distinct etiologies, presentations, and treatment responses; thus, the present conceptualization of paranoia within a multidimensional schizotypy framework should advance our understanding of these constructs. PMID:24914672
Kleiter, Ingo; Luerding, Ralf; Diendorfer, Gerhard; Rek, Helga; Bogdahn, Ulrich; Schalke, Berthold
The case of a 23-year-old mountaineer who was hit by a lightning strike to the occiput causing a large central visual field defect and bilateral tympanic membrane ruptures is described. Owing to extreme agitation, the patient was sent into a drug-induced coma for 3 days. After extubation, she experienced simple and complex visual hallucinations for several days, but otherwise largely recovered. Neuropsychological tests revealed deficits in fast visual detection tasks and non-verbal learning and indicated a right temporal lobe dysfunction, consistent with a right temporal focus on electroencephalography. At 4 months after the accident, she developed a psychological reaction consisting of nightmares, with reappearance of the complex visual hallucinations and a depressive syndrome. Using the European Cooperation for Lightning Detection network, a meteorological system for lightning surveillance, the exact geographical location and nature of the lightning strike were retrospectively retraced PMID:21734915
Korver-Nieberg, Nikie; Fett, Anne-Kathrin J; Meijer, Carin J; Koeter, Maarten W J; Shergill, Sukhi S; de Haan, Lieuwe; Krabbendam, Lydia
Impaired Theory of Mind (ToM) is found in adults with schizophrenia and is associated with paranoid symptoms. Insecure attachment is proposed to underlie impaired ToM as well as paranoia. Insight into associations between insecure attachment and impaired ToM skills may help clinicians and patients to understand interpersonal difficulties and use this knowledge to improve recovery. This study used a visual perspective-taking task to investigate whether cognitive ToM is already impaired in adolescents with early psychosis as compared to controls. Also investigated was whether perspective-taking and paranoia are associated with insecure (adult) attachment. Thirty-two adolescent patients with early psychosis and 78 healthy controls participated in this cross-sectional study design and completed the level 1 perspective-taking task, psychopathology assessments (CAPE, PANSS), paranoid thoughts (GPTS), attachment style (PAM) and the WASI vocabulary. Patients did not significantly differ in level-1 perspective-taking behaviour compared to healthy controls. No significant associations were found between perspective-taking, paranoia and attachment. Insecure attachment was significantly related to paranoid thoughts, after controlling for illness-related symptoms. No impairment of level-1 perspective-taking was found in adolescent patients with early psychosis compared to healthy controls. Results indicate that level-1 perspective-taking is not impaired during the early stages of psychotic illness. The association between paranoia and attachment support previous findings and provide further insight into the nature of psychotic symptoms. Understanding the role of attachment in paranoia may help patients and their care workers to gain insight into the reasons for the development or persistence of symptoms. Future research should compare early psychosis samples with more chronic samples to explore whether perspective-taking deteriorates during the course of the illness.
Garety, Philippa; Waller, Helen; Emsley, Richard; Jolley, Suzanne; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Fowler, David; Hardy, Amy; Freeman, Daniel
Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Gallagher, David A; Parkkinen, Laura; O'Sullivan, Sean S; Spratt, Alexander; Shah, Ameet; Davey, Clare C; Bremner, Fion D; Revesz, Tamas; Williams, David R; Lees, Andrew J; Schrag, Anette
The exact pathogenesis of visual hallucinations in Parkinson's disease is not known but an integrated model has been proposed that includes impaired visual input and central visual processing, impaired brainstem regulation of sleep-wake cycle with fluctuating vigilance, intrusion of rapid eye movement dream imagery into wakefulness and emergence of internally generated imagery, cognitive dysfunction and influence of dopaminergic drugs. In a clinical study, we assessed motor and non-motor function, including sleep, mood, autonomic and global, frontal and visuoperceptive cognitive function in patients with and without visual hallucinations. A subgroup of patients underwent detailed ophthalmological assessment. In a separate pathological study, histological specimens were obtained from cases of pathologically proven Parkinson's disease and a retrospective case notes review was made for reporting of persistent formed visual hallucinations. An assessment of Lewy body and Lewy neurite pathology was carried out in five cortical regions as recommended by diagnostic criteria for dementia with Lewy Bodies and in brainstem nuclei. Ninety-four patients (mean age 67.5 ± 9.5 years) participated in the clinical study of whom 32% experienced visual hallucinations. When corrected for multiple comparisons, patients with visual hallucinations had significantly greater disease duration, treatment duration, motor severity and complications, sleep disturbances, in particular excessive daytime somnolence and rapid eye movement sleep behavioural disorder, disorders of mood, autonomic dysfunction and global, frontal and visuoperceptive cognitive dysfunction. Of the 94 patients, 50 (53%) underwent ophthalmological assessment. There were no differences in ocular pathology between the visual hallucination and non-visual hallucination groups. In a logistic regression model the four independent determinants of visual hallucinations were rapid eye movement sleep behavioural disorder (P = 0
Bernardini, Francesco; Attademo, Luigi; Blackmon, Karen; Devinsky, Orrin
Musical hallucinations are uncommon phenomena characterized by intrusive and frequently distressful auditory musical percepts without an external source, often associated with hypoacusis, psychiatric illness, focal brain lesion, epilepsy, and intoxication/pharmacology. Their physiological basis is thought to involve diverse mechanisms, including "release" from normal sensory or inhibitory inputs as well as stimulation during seizures, or they can be produced by functional or structural disorders in diverse cortical and subcortical areas. The aim of this review is to further explore their pathophysiology, describing the functional neuroimaging findings regarding musical hallucinations. A literature search of the PubMed electronic database was conducted through to 29 December 2015. Search terms included "musical hallucinations" combined with the names of specific functional neuroimaging techniques. A total of 18 articles, all clinical case reports, providing data on 23 patients, comprised the set we reviewed. Diverse pathological processes and patient populations with musical hallucinations were included in the studies. Converging data from multiple studies suggest that the superior temporal sulcus is the most common site and that activation is the most common mechanism. Further neurobiological research is needed to clarify the pathophysiology of musical hallucinations.
Cachia, A; Amad, A; Brunelin, J; Krebs, M-O; Plaze, M; Thomas, P; Jardri, R
Hallucinations, and auditory hallucinations (AH) in particular, constitute the most typical and disabling schizophrenia symptoms. Although visual hallucinations (VH) have been largely neglected in psychiatric disorders, a recent review reported a 27% mean prevalence of VH in schizophrenia patients. The pathophysiology underlying VH in schizophrenia remains elusive. Several schizophrenia studies reported a significant effect of age on VH; therefore, we tested the hypothesis that the neurodevelopmental model of schizophrenia may explain VH occurrence. We analyzed cortex sulcation, a marker of brain development, in healthy controls (HCs) and two subgroups of carefully selected schizophrenia patients suffering from hallucinations: patients with only AH (that is, patients who never reported VH) and patients with audio-visual hallucinations (A+VH). Different cortical sulcation and left-right sulcal asymmetry were found between A+VH and AH patients, with decreased sulcation in both A+VH and AH patients in comparison with the HCs. Although a specific association between VH and neurodegenerative mechanisms, for example, in Body-Lewy Dementia or Parkinson's Disease, has previously been reported in the literature, the current study provides the first neuroimaging evidence of an association between VH and neurodevelopmental mechanisms.
Balsavar, Anuradha; Deshpande, Smita N.
The ancient Indian system of medicine “Ayurveda” is a compendium of various health related theories and practices and explained the abnormal state of mind, i.e., psychopathology in various contexts. Hallucinations were deemed abnormal. In Ayurvedic classics, hallucinations were called false perceptions (mithyajnana), illusions (maya), infatuations (moha), or confusion (bhrama). Hallucinations were not independent but a symptom of mental disorder (manasa roga). Hallucinations of different sens...
A descriptive account of musical hallucinations of a series of 19 people is presented. Five people reported the onset of hallucination before adulthood. In this paper we demonstrate that musical hallucinations are not necessarily pathological and can occur as a normal experience in people (children and adults) who have no contact with mental health services and no concurrent mental disorder. This is also the first paper to recognise that children can experience musical hallucinations. Also, w...
Tagai, Kenji; Nagata, Tomoyuki; Shinagawa, Shunichiro; Tsuno, Norifumi; Ozone, Motohiro; Nakayama, Kazuhiko
Psychotic symptoms often occur as a complication in Parkinson's disease patients, and a set of criteria for Parkinson's disease with psychosis (PDPsy) has been established. Among these criteria, hallucinations are one of the specific symptoms, with visual hallucinations being the most common. While atypical antipsychotic agents are often used for the treatment of PDPsy, adverse effects, including extrapyramidal symptoms, often hinder its continuation or tolerance. There have been some reports and reviews indicating that antidepressants may be effective for PDPsy and other forms of dementia with psychosis. In this report, we present a patient with PDPsy who was treated with one of the new-generation antidepressants, mirtazapine. Mirtazapine improved the patient's refractory psychotic symptoms, especially her visual hallucinations, without worsening her motor symptoms.
Focseneanu, B E; Marian, G
Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge.
Needham, W. E.; Taylor, R. E.
Benign visual hallucinations ("phantom vision") were examined in 2 studies, involving a total of 443 adventitiously blinded and sight-impaired veterans. In one study, unusual visual events were reported by 38.7 percent, with 30.6 percent reporting complex hallucinations. Causes of the hallucinations and their treatment are discussed. (Author/JDD)
Ghanbari Jolfaei, Atefeh; Naji, Borzooyeh; Nasr Esfehani, Mehdi
A 29-year-old woman with schizophrenia introduced for application of repetitive transcranial magnetic stimulation for refractory visual hallucinations. Following inhibitory rTMS on visual cortex she reported significant reduction in severity and simplification of complexity of hallucinations, which lasted for three months. rTMS can be considered as a possibly potent treatment for visual hallucinations.
Full Text Available Hallucinations are a core diagnostic criterion for psychotic disorders and have been investigated with regard to its association with childhood trauma in first-episode psychosis samples. Research has largely focused on auditory hallucinations, while specific investigations of visual hallucinations in first-episode psychosis remain scarce.The aims of this study were to describe the prevalence of visual hallucinations, and to explore the association between visual hallucination and childhood trauma in a first-episode psychosis sample.Subjects were included from TIPS-2, a first episode psychosis study in south Rogaland, Norway. Based on the medical journal descriptions of the Positive and Negative Symptoms Scale (PANSS, a separate score for visual and auditory hallucinations was created (N = 204. Patients were grouped according to hallucination severity (none, mild, and psychotic hallucinations and multinomial logistic regression was performed to identify factors associated with visual hallucination group.Visual hallucinations of a psychotic nature were reported by 26.5% of patients. The experience of childhood interpersonal trauma increased the likelihood of having psychotic visual hallucinations.Visual hallucinations are common in first-episode psychosis, and are related to childhood interpersonal trauma.
Lim, Anastasia; Hoek, Hans W.; Deen, Mathijs L.; Blom, Jan Dirk
Background: Auditory hallucinations are experienced by 60-80% of all patients diagnosed with a schizophrenia spectrum disorder. However, in this patient group, the prevalence of hallucinations in multiple sensory modalities, i.e. multimodal hallucinations (MMHs), is unknown. Aims: To assess the
Lim, Anastasia; Hoek, Hans W.; Deen, Mathijs L.; Blom, Jan Dirk; Bruggeman, Richard; Cahn, Wiepke; de Haan, Lieuwe; Kahn, René S.; Meijer, Carin J.; Myin-Germeys, Inez; van Os, Jim; Wiersma, Durk
Background Auditory hallucinations are experienced by 60–80% of all patients diagnosed with a schizophrenia spectrum disorder. However, in this patient group, the prevalence of hallucinations in multiple sensory modalities, i.e. multimodal hallucinations (MMHs), is unknown. Aims To assess the
Elahi, A.; Perez Algorta, G.; Varese, Filippo; McIntyre, J.C.; Bentall, R. P.
Background: There is widespread interest in whether psychosis exists on a continuum with healthy functioning. Previous research has implied that paranoia, a common symptom of psychosis, exists on a continuum but this has not been investigated using samples including both patients and non-patients and up-to-date taxometric methods. Aim: To assess the latent structure of paranoia in a diverse sample using taxometric methods. Method: We obtained data from 2836 participants, including the general...
Zhang, Jason; Waisbren, Emily; Hashemi, Nafiseh; Lee, Andrew G
The Charles Bonnet syndrome (CBS) refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology.
Benaur, Marina; Kahn, David
The authors comment on two case reports of visual hallucinations due to non-psychiatric disorders: retinal detachment in a patient with schizophrenia, and Charles Bonnet syndrome. The physiology of visual misperception is reviewed, based on abnormalities along various points from the eye to the optic tracts to the occipital cortex. The approach to patients with visual hallucinations should include not only an evaluation for psychiatric disorders, but also an appreciation of possible non-psychiatric causes that may have major ramifications for care and potentially for preservation of sight.
Stephenson, P H
Most studies of 'evil eye' link economic and political inequality to the fear of appropriation of property while tying envy (invidia) to paranoia. In both psychiatric and anthropological studies of evil eye, explanation of the phenomenon is problematic because the data are retroductive - involving a rationalization of the part of the patient or informant in terms of either delusions or world-view respectively. In this paper the connection between invidia and paranoia is questioned by grounding the analysis of Hutterian beliefs in evil eye in social interaction rather than retroductive explanation. In the case of the Hutterities it is envy itself which is feared and linked to high anxiety levels and sometimes to anxiety attacks or even depression.
Wilcox, James; Briones, David; Quadri, Syed; Tsuang, Ming
This study follows a group of 174 young people with new onset of schizotypal symptoms and examines factors which may lead to conversion to psychosis. These prodromal subjects were screened for symptoms and later given the Structured Clinical Interview of DSM-III-R at one year, two years and ten years post onset. We also included the Paranoia Scale of Fenigstein and Vanable and the Scale for Thought, Language and Communications of Andreasen in all interviews. Our analysis found that the addition of scales for paranoia and thought disorder enhanced prediction of conversion to psychosis and long term outcome. The early occurrence of ideas of reference and poverty of thought appear to be significant predictors of future deterioration even when considered among other high-risk variables.
Goldman, Jennifer G; Stebbins, Glenn T; Dinh, Vy; Bernard, Bryan; Merkitch, Doug; deToledo-Morrell, Leyla; Goetz, Christopher G
Visual hallucinations are frequent, disabling complications of advanced Parkinson's disease, but their neuroanatomical basis is incompletely understood. Previous structural brain magnetic resonance imaging studies suggest volume loss in the mesial temporal lobe and limbic regions in subjects with Parkinson's disease with visual hallucinations, relative to those without visual hallucinations. However, these studies have not always controlled for the presence of cognitive impairment or dementia, which are common co-morbidities of hallucinations in Parkinson's disease and whose neuroanatomical substrates may involve mesial temporal lobe and limbic regions. Therefore, we used structural magnetic resonance imaging to examine grey matter atrophy patterns associated with visual hallucinations, comparing Parkinson's disease hallucinators to Parkinson's disease non-hallucinators of comparable cognitive function. We studied 50 subjects with Parkinson's disease: 25 classified as current and chronic visual hallucinators and 25 as non-hallucinators, who were matched for cognitive status (demented or non-demented) and age (± 3 years). Subjects underwent (i) clinical evaluations; and (ii) brain MRI scans analysed using whole-brain voxel-based morphometry techniques. Clinically, the Parkinson's disease hallucinators did not differ in their cognitive classification or performance in any of the five assessed cognitive domains, compared with the non-hallucinators. The Parkinson's disease groups also did not differ significantly in age, motor severity, medication use or duration of disease. On imaging analyses, the hallucinators, all of whom experienced visual hallucinations, exhibited grey matter atrophy with significant voxel-wise differences in the cuneus, lingual and fusiform gyri, middle occipital lobe, inferior parietal lobule, and also cingulate, paracentral, and precentral gyri, compared with the non-hallucinators. Grey matter atrophy in the hallucinators occurred
Full Text Available Visual hallucinations are commonly present in various neurological and psychiatric conditions such as schizophrenia and other hallucinatory psychosis. Current conceptualization of hallucinations assume pattern completion model of thalamus to be responsible for the origin of this type of the perceptual abnormality and proposes that central inhibition of such circuits may treat hallucinations. We present a case of chronic hallucinatory psychosis with significantly distressing visual hallucinations, resistant to antipsychotics, which successfully responded to carbamazepine. This case illustrates the novel use of an antiepileptic in the treatment of resistant visual hallucinations. Targeted therapy of this kind can be considered in the future, although more evidence is required in this field.
A patient with a history of Parkinson's disease and severe bilateral peripheral vision loss due to vitreous hemorrhages had complex visual hallucinations that persisted for three days and appeared every morning on awakening. The persistent nature of these hallucinations, the patient's preserved insight, and the presence of severe visual impairment was suggestive for Charles Bonnet syndrome rather than Parkinson-related hallucinations. A treatment with carbamazepine was started and proved to be successful. Physicians treating Parkinson patients should be familiar with Charles Bonnet syndrome and consider it as a potential alternative etiology for visual hallucinations, especially when the patient has severely impaired vision and when the hallucinations are sustained during wakefulness.
Lake, Charles Raymond
Delusional paranoia has been associated with severe mental illness for over a century. Kraepelin introduced a disorder called “paranoid depression,” but “paranoid” became linked to schizophrenia, not to mood disorders. Paranoid remains the most common subtype of schizophrenia, but some of these cases, as Kraepelin initially implied, may be unrecognized psychotic mood disorders, so the relationship of paranoid schizophrenia to psychotic bipolar disorder warrants reevaluation. To address whethe...
Sommer, Iris E. C.; Koops, Sanne; Blom, Jan Dirk
Auditory hallucinations can be experienced in the context of many different disorders and syndromes. The differential diagnosis basically rests on the presence or absence of accompanying symptoms. In terms of clinical relevance, the most important distinction to be made is between auditory hallucina
Koerts, Janneke; Borg, Maarten A. J. P.; Meppelink, Anne Marthe; Leenders, Klaus L.; van Beilen, Marije; van Laar, Teus
Visual hallucinations (VH) are common in Parkinson's Disease (PD). Both deficits of perception and attention seem to play a role in the pathogenesis of VH in PD. However, the possible coexistence of impairments in attention and visual perception in PD with VH is not known. This study investigated bo
Steenhuis, Laura A.; Bartels-Velthuis, Agna A.; Jenner, Jack A.; Aleman, André; Bruggeman, Richard; Nauta, Maaike H.; Pijnenborg, Gerdina H.M.
The current exploratory study examined the associations between auditory vocal hallucinations (AVH) and delusions and religiosity in young adolescents. 337 children from a population-based case-control study with and without AVH, were assessed after five years at age 12 and 13, on the presence and a
To describe a patient who presented with psychopathology in the wake of sleep paralysis and hypnopompic hallucinations, and to discuss the importance of these phenomena to psychiatric diagnoses. Case report. A 25-year-old black South African woman developed paranoid beliefs and a sad and anxious mood in the wake of her first experience of sleep paralysis and hypnic hallucinations. She had no history of other sleep-related events. Reassurance, explanation of the physiological basis of her experience, and a short course of low-dose diazepam were provided. Her mood and sleep improved promptly and she no longer held paranoid beliefs. She did not experience further episodes of sleep paralysis or hypnic hallucinations and improvement was sustained at 6 months. It pays to probe for the core experiences or events that patients may be explaining by devising "delusions". Acute, nocturnal-onset, first-time psychopathology warrants inquiry for sleep paralysis and hypnic hallucinations. Sleep-related side-effects of psychotropic medications need to be studied more closely.
Koops, Sanne; van den Brink, Hilde; Sommer, Iris E C
Auditory hallucinations (AH) are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication resistant group are scarce and most of them focus on coping with
S. V. Ivanov
Full Text Available The paper characterizes paranoic hypochondriacal development, that is comparable with expan-sive paranoia, in patients with a >5-year history of malignancies at examination. A study sample comprised 8 treated out- and inpatients (mean age 55.7±7.02 years diagnosed as having repro-ductive organ malignancies. Their examination was made by the clinical catamnestic technique. Psychopathological disorders in the described cases of expansive paranoia are associated with the development of abnormal querulant activity that is aimed at having the medical care volume inadequate to the somatic status of patients with malignancies.The described variant of development of paranoid disorders enables their determination within the framework of cancer-induced chang- es in personality disorders with the formation and further reinforcement of the psychopathological manifestations of mainly the hy- poparanoia type. The constitutional predictors of hypochondriacal development via expansive paranoia type, which include not only certain types of personality disorders (paranoic, 50%; schizoid–expansive pole, 12.5%; icteric, 37.5%; sensitive, 12.5%, but also ac- centuations (segmental depersonalization accentuation against which the study reactions manifest themselves as a continuation of but ab-normally transformed constitutional properties.
Castiajo, Paula; Pinheiro, Ana P.
The experience of hallucinations is a hallmark of psychotic disorders, but they are also present in other psychiatric and medical conditions, and may be reported in nonclinical individuals. Despite the increased number of studies probing the incidence of nonclinical hallucinations, the underlying phenomenological characteristics are still poorly understood. This study aimed to examine the psychometrics proprieties of the Portuguese adaptation of the 16-item Launay-Slade Hallucinations Scale (LSHS), the phenomenological characteristics of nonclinical hallucinatory experiences in a Portuguese sample, and the relationship between clinical symptoms and hallucination predisposition. Three-hundred-and-fifty-four European Portuguese college students completed the LSHS. Of those, 16 participants with high LSHS scores and 14 with low LSHS scores were further screened for clinical symptoms. A three-factor solution for the LSHS Portuguese version proved to be the most adequate. Intrusive or vivid thoughts and sleep-related hallucinations were the most common. Although, fundamentally perceived as positive experiences, all types of hallucinations were described as uncontrollable and dominating. However, the more pleasant they were perceived, the more controllable they were assessed. In addition, hallucination predisposition was associated with increased clinical symptoms. These results corroborate the lower severity of hallucinations in the general population compared to psychotic individuals. Further, they support an association between clinical symptoms and increased vulnerability to hallucinations. Specifically, increased schizotypal tendencies and negative mood (anxiety and depression) may be related to increased psychotic risk. PMID:28744234
Castiajo, Paula; Pinheiro, Ana P
The experience of hallucinations is a hallmark of psychotic disorders, but they are also present in other psychiatric and medical conditions, and may be reported in nonclinical individuals. Despite the increased number of studies probing the incidence of nonclinical hallucinations, the underlying phenomenological characteristics are still poorly understood. This study aimed to examine the psychometrics proprieties of the Portuguese adaptation of the 16-item Launay-Slade Hallucinations Scale (LSHS), the phenomenological characteristics of nonclinical hallucinatory experiences in a Portuguese sample, and the relationship between clinical symptoms and hallucination predisposition. Three-hundred-and-fifty-four European Portuguese college students completed the LSHS. Of those, 16 participants with high LSHS scores and 14 with low LSHS scores were further screened for clinical symptoms. A three-factor solution for the LSHS Portuguese version proved to be the most adequate. Intrusive or vivid thoughts and sleep-related hallucinations were the most common. Although, fundamentally perceived as positive experiences, all types of hallucinations were described as uncontrollable and dominating. However, the more pleasant they were perceived, the more controllable they were assessed. In addition, hallucination predisposition was associated with increased clinical symptoms. These results corroborate the lower severity of hallucinations in the general population compared to psychotic individuals. Further, they support an association between clinical symptoms and increased vulnerability to hallucinations. Specifically, increased schizotypal tendencies and negative mood (anxiety and depression) may be related to increased psychotic risk.
Goldner Jonathan A
Full Text Available Abstract Introduction Metoprolol is a widely used beta-adrenergic blocker that is commonly prescribed for a variety of cardiovascular syndromes and conditions. While central nervous system adverse effects have been well-described with most beta-blockers (especially lipophilic agents such as propranolol, visual hallucinations have been only rarely described with metoprolol. Case presentations Case 1 was an 84-year-old Caucasian woman with a history of hypertension and osteoarthritis, who suffered from visual hallucinations which she described as people in her bedroom at night. They would be standing in front of the bed or sitting on chairs watching her when she slept. Numerous medications were stopped before her physician realized the metoprolol was the causative agent. The hallucinations resolved only after discontinuation of this medication. Case 2 was a 62-year-old Caucasian man with an inferior wall myocardial infarction complicated by cardiac arrest, who was successfully resuscitated and discharged from the hospital on metoprolol. About 18 months after discharge, he related to his physician that he had been seeing dead people at night. He related his belief that since he 'had died and was brought back to life', he was now seeing people from the after-life. Upon discontinuation of the metoprolol the visual disturbances resolved within several days. Case 3 was a 68 year-old Caucasian woman with a history of severe hypertension and depression, who reported visual hallucinations at night for years while taking metoprolol. These included awakening during the night with people in her bedroom and seeing objects in her room turn into animals. After a new physician switched her from metoprolol to atenolol, the visual hallucinations ceased within four days. Conclusion We suspect that metoprolol-induced visual hallucinations may be under-recognized and under-reported. Patients may frequently fail to acknowledge this adverse effect believing that they
A descriptive account of musical hallucinations of a series of 19 people is presented. Five people reported the onset of hallucination before adulthood. In this paper we demonstrate that musical hallucinations are not necessarily pathological and can occur as a normal experience in people (children and adults) who have no contact with mental health services and no concurrent mental disorder. This is also the first paper to recognise that children can experience musical hallucinations. Also, we show that musical hallucinations are more common than previously thought, but people do not report their occurrence. It seems plausible that in musical hallucinations there is an insult to the ear or brain that produces a change in quality of these images, converting them to a psychotic experience. Musical hallucinations should be regarded as a continuum with normal experiences and clinical syndromes.
Kapidzić-Duraković, Suada; Karabegović, Azra; Halilbegović, Emir; Cićkusić, Amela; Osmanović, Nusret; Kudumović, Zijada
Multidimensional Inventory Check List of Symptoms (SCL-90-r) is based on self-evaluation and it has been used for determination of level of: somatisation, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobias, paranoia and psychosis at persons which are exposed to long term emotional and physical stress. Our goal was to determine relations of physical trauma and psychological changes at persons with lower extremities amputations and to determine factors which influence those changes. Thirty seven persons with lower extremities amputations were examined. The sample included 26 (70.2 %) veterans and 11 (29.7 %) civilians with diseases related amputations. They voluntarily filled Check List of Symptoms SCL-90-r. Symptoms Inventory includes 9 dimensions of primary symptoms: SCL1-somatisation, SCL2-obsessive-compulsive symptoms, SCL3-interpersonal sensitivity, SCL4-depression, SCL5-anxiety, SCL6-hostility, SCL7-phobias, SCL8-paranoia, SCL9-psychosis and SCL10-extra scale. Inventory includes 90 statements, each evaluated with five-level scale of disorder. Every answer is graded with 0-4 points. Thirty seven persons with lower extremities amputations and average chronological age 46.2 +/- 10.92 years were analyzed. Considering marital status 30 (81.1 %) of them were married, 4 (10.8 %) were not married and 3 (8.1 %) were widowers. Considering level of amputation 27 of them (73.0 %) had amputation below knee, 5 (13.5 %) of them amputation above knee and 5 of them (13.5 %) foot amputation. SCL-90-r in both groups determined high level of sensitivity, anxiety, hostility and paranoia. Veterans showed higher level of paranoia comparing to civilians (p<0.002), and younger veterans and married ones had higher level of paranoia comparing to other veterans (p<0.01). Persons with amputations below and above knee showed higher level of paranoia comparing those with foot amputation (p<0.001). Persons with lower extremities amputations have
Luiz Carlos Tarelho
Full Text Available O presente artigo se propõe a discutir o sofrimento psíquico e o papel exercido pela projeção na paranoia. Ele questiona a relação estabelecida por Freud entre paranoia e homossexualidade e traz à tona a questão dos enclaves psicóticos ligados a mensagens parentais, que assumem a forma de injunções paradoxais e não se prestam a uma retomada ativa e simbolizante por parte da criança. Enclaves que tendem a se enquistar no plano do superego, impedindo a evolução deste para o nível edipiano e produzindo um curto-circuito na estruturação da tópica psíquica, uma vez que parte deste superego passa a ocupar um espaço intermediário entre o eu e o mundo externo e a propiciar um tipo de projeção diferente do descrito por Freud, que é próprio do universo psicótico e do grau de certeza que acompanha as produções delirantes subjacentes.Este artículo propone discutir el sufrimiento psíquico y la función ejercida por la proyección en la paranoia. Se cuestiona la relación establecida por Freud entre paranoia y homosexualidad y plantea la cuestión de los enclaves psicóticos asociados a mensajes parentales, que asumen la forma de imposiciones paradójicas y no se prestan a una retomada activa y simbolizante por parte del niño. Enclaves que tienden a enquistarse en el plano del superyó, impidiendo su evolución para el nivel edipiano y produciendo un cortocircuito en la estructuración de la tópica psíquica una vez que una parte de este superyó pasa a ocupar un espacio intermedio entre el yo y el mundo externo y a proporcionar un tipo de proyección diferente de lo descripto por Freud, que es proprio del universo psicótico y del grado de seguridad que acompaña las producciones delirantes subyacentes.The aim of this paper is to discuss psychological suffering and the role of projection in paranoid states. It criticizes the relationship established by Freud between paranoid states and homosexuality, and brings about the
Yao, Nailin; Cheung, Charlton; Pang, Shirley; Shek-kwan Chang, Richard; Lau, Kui Kai; Suckling, John; Yu, Kevin; Ka-Fung Mak, Henry; Chua, Siew Eng; Ho, Shu-Leong; McAlonan, Grainne M
Visual hallucinations carry poor prognosis in Parkinson's disease. Here we tested the hypothesis that the hippocampus and visuospatial memory impairment play a central role in the pathology of PD with visual hallucinations. Multimodal magnetic resonance imaging of the brain was carried out in 12 people with PD and visual hallucinations; 15 PD individuals without hallucinations; and 14 healthy controls. Age, gender, cognitive ability, and education level were matched across the three groups. PD patients were taking dopaminergic medication. Hippocampal volume, shape, mean diffusivity (MD), and functional connectivity within the whole brain were examined. Visuospatial memory was compared between groups, and correlations with hippocampal MD, functional connectivity, and the severity of hallucinations were explored. There were no macrostructural differences across groups, but individuals with hallucinations had higher diffusivity in posterior hippocampus than the other two groups. Visuospatial memory was poorer in both PD groups compared to controls, and was correlated with hallucinations. Finally, hippocampal functional connectivity in the visual cortices was lower in those with hallucinations than other groups, and this correlated with visuospatial memory impairment. In contrast, functional connectivity between the hippocampus and default mode network regions and frontal regions was greater in the PD hallucinators compared to other groups. We suggest that hippocampal pathology, which disrupts visuospatial memory, makes a key contribution to visual hallucinations in PD. These findings may pave the way for future studies of imaging biomarkers to measure treatment response in those with PD who are most at risk of poor outcomes.
Goetz, Christopher G; Ouyang, Bichun; Negron, Alice; Stebbins, Glenn T
To assess prospectively progression and relationship of hallucinations and sleep disorders over a 10-year longitudinal study of patients with Parkinson disease (PD). Eighty-nine patients with PD were recruited to fill cells of normal sleep without hallucinations (n = 20), sleep fragmentation only (n = 20), vivid dreams/nightmares (n = 20), hallucinations with insight (n = 20), and hallucinations without insight (n = 9). At baseline, 0.5, 1.5, 4, 6, and 10 years, sleep disorders and hallucinations were assessed by standardized scales with the longitudinal data analyzed by generalized estimating equations with assumptions of linearity in time. At 10 years, we could account for all subjects (27 interviewed, 61 deceased, and 1 too ill for interview). Hallucination prevalence and severity increased over time (p < 0.0001, p = 0.0001). Acting out dreams also increased over time (p = 0.001). In contrast, presence of vivid dreams/nightmares or sleep fragmentation did not increase over time. For all visits, the prevalence of sleep fragmentation did not differ between subjects with vs without hallucinations (odds ratio [OR] = 1.50, p = 0.09). However, severe sleep fragmentation was associated with concurrent hallucinations (OR 2.01, p = 0.006). The presence of hallucinations was also highly associated with concurrent vivid dreams/nightmares (OR = 2.60, p < 0.0001) and with concurrent acting out dreams (OR = 2.38, p = 0.0004). Among the baseline nonhallucinators, no sleep abnormalities at study entry predicted future development of hallucinations. Hallucinations and sleep abnormalities follow very different patterns of progression in PD over 10 years. Whereas patients with hallucinations often have concurrent sleep aberrations, no sleep problem is predictive of future hallucinations.
Full Text Available Background: Previous research has shown that various memory errors reflecting failure in the self-monitoring of speech were associated with auditory/verbal hallucinations in schizophrenia patients and with proneness to hallucinations in non-clinical individuals. Method: We administered to 57 schizophrenia patients and 60 healthy participants a verbal memory task involving free recall and recognition of lists of words with different structures (high-frequency, low-frequency, and semantically-organisable words. Extra-list intrusions in free recall were tallied, and the response bias reflecting tendency to make false recognitions of non-presented words was computed for each list. Results: In the male patient subsample, extra-list intrusions were positively associated with verbal hallucinations and inversely associated with negative symptoms. In the healthy participants the extra-list intrusions were positively associated with proneness to hallucinations. A liberal response bias in the recognition of the high-frequency words was associated with verbal hallucinations in male patients and with proneness to hallucinations in healthy men. Meanwhile, a conservative response bias for these high-frequency words was associated with negative symptoms in male patients and with social anhedonia in healthy men. Conclusions: Misattribution of inner speech to an external source, reflected by false recollection of familiar material, seems to underlie both clinical and non-clinical hallucinations. Further, both clinical and non-clinical negative symptoms may exert on verbal memory errors an effect opposite to that of hallucinations.
Johnson, Judith; Jones, Christopher; Lin, Ashleigh; Wood, Stephen; Heinze, Kareen; Jackson, Christopher
Shame is associated with a range of psychological disorders, and is a trans-diagnostic moderator of the association between stressors and symptoms of disorder. However, research has yet to investigate shame in relation to specific psychotic symptoms in clinical groups. In order to address this, the present study investigated shame in young adults with mental health problems, to test whether shame was i) directly associated with paranoia, a prevalent psychotic symptom, and ii) a moderator of the association between stress and paranoia. Sixty participants completed measures of stressful events, paranoia, shame, depression and anxiety. Results from a cross-sectional regression analysis suggested that shame was associated with paranoia after the stressful life event measure was entered into the model, and shame moderated the association between stress and paranoia. For individuals scoring high on shame, shame amplified the association between stress and paranoia, but for low-shame individuals, the association between stress and paranoia was non-significant. These findings suggest that high levels of shame could confer vulnerability for paranoia amongst clinical groups, and that resistance to experiencing shame could be a marker of resilience.
Calabrò, Rocco Salvatore; Baglieri, Annalisa; Ferlazzo, Edoardo; Passari, Smeralda; Marino, Silvia; Bramanti, Placido
We reported a case of an elderly female patient affected by musical hallucinations (MHs) as the unique symptom of a right temporal ischemic stroke. A functional magnetic resonance imaging examination was performed in the patient and in five age- and sex-matched normal controls (NC) to detect the complex neural substrate subserving MHs in such a context. Although an activation pattern involving the primary auditory cortex and the temporal associative areas bilaterally was found in the patient and NC, a significant increased activation mostly located in right temporal cortex (in the ischemic area), was observed in the patient. Further functional neuroimaging studies should be performed to detect the complex neural pathways underlying MHs and to find out differences between these hallucinations and real music perception.
Full Text Available The Charles Bonnet syndrome (CBS refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology.
Ma, Xiang; Liu, Junhui; Li, Wenmin
Face hallucination in a single modality environment has been heavily studied, in real-world environments under multiple modalities is still in its early stage. This paper presents a unified framework to solve face hallucination problem across multiple modalities i.e. different expressions, poses, illuminations. Almost all of the state-of-the-art face superresolution methods only generate a single output with the same modality of the low-resolution input. Our proposed framework is able to generate multiple outputs of different new modalities from only a single low-resolution input. It includes a global transformation with diagonal loading for modeling the mappings among different new facial modalities, and a local position-patch based method with weights compensation for incorporating image details. Experimental results illustrate the superiority of our framework.
Biran, I; Steiner, I
Music creation requires a highly orchestrated temporal pattern. The study of a patient with repetitive musical hallucinations enabled us to examine temporal pacemakers in music production. Here, we show that the pattern of faster silent production of a chosen tune compared with its production aloud was reversed when the patient produced the hallucinatory tune. This observation might suggest the utilization of a pacemaker(s), which functions differentially during the disease.
De Masi, Franco; Davalli, Cesare; Giustino, Gabriella; Pergami, Andrea
In this contribution, which takes account of important findings in neuroscientific as well as psychoanalytic research, the authors explore the meaning of the deep-going distortions of psychic functioning occurring in hallucinatory phenomena. Neuroscientific studies have established that hallucinations distort the sense of reality owing to a complex alteration in the balance between top-down and bottom-up brain circuits. The present authors postulate that hallucinatory phenomena represent the outcome of a psychotic's distorted use of the mind over an extended period of time. In the hallucinatory state the psychotic part of the personality uses the mind to generate auto-induced sensations and to achieve a particular sort of regressive pleasure. In these cases, therefore, the mind is not used as an organ of knowledge or as an instrument for fostering relationships with others. The hallucinating psychotic decathects psychic (relational) reality and withdraws into a personal, bodily, and sensory space of his own. The opposing realities are not only external and internal but also psychic and sensory. Visual hallucinations could thus be said to originate from seeing with the 'eyes' of the mind, and auditory hallucinations from hearing with the mind's 'ears'. In these conditions, mental functioning is restricted, cutting out the more mature functions, which are thus no longer able to assign real meaning to the surrounding world and to the subject's psychic experience. The findings of the neurosciences facilitate understanding of how, in the psychotic hallucinatory process, the mind can modify the working of a somatic organ such as the brain.
Yu-Hsuan Lin; Sheng-Hsuan Lin; Peng Li; Wei-Lieh Huang; Ching-Yen Chen
BACKGROUND: Phantom vibration syndrome is a type of hallucination reported among mobile phone users in the general population. Another similar perception, phantom ringing syndrome, has not been previously described in the medical literature. METHODS: A prospective longitudinal study of 74 medical interns (46 males, 28 females; mean age, 24.8±1.2 years) was conducted using repeated investigations of the prevalence and associated factors of phantom vibration and ringing. The accompanying sympto...
Udachina, Alisa; Thewissen, Viviane; Myin-Germeys, Inez; Fitzpatrick, Sam; O'kane, Aisling; Bentall, Richard P
Hypothesized relationships between experiential avoidance (EA), self-esteem, and paranoia were tested using structural equation modeling in a sample of student participants (N = 427). EA in everyday life was also investigated using the Experience Sampling Method in a subsample of students scoring high (N = 17) and low (N = 15) on paranoia. Results showed that paranoid students had lower self-esteem and reported higher levels of EA than nonparanoid participants. The interactive influence of EA and stress predicted negative self-esteem: EA was particularly damaging at high levels of stress. Greater EA and higher social stress independently predicted lower positive self-esteem. Low positive self-esteem predicted engagement in EA. A direct association between EA and paranoia was also found. These results suggest that similar mechanisms may underlie EA and thought suppression. Although people may employ EA to regulate self-esteem, this strategy is maladaptive as it damages self-esteem, incurs cognitive costs, and fosters paranoid thinking.
Aguilar, Eduardo Jesus [Psychiatric Service, Clinic University Hospital, Avda. Blasco Ibanez 17, 46010 Valencia (Spain)], E-mail: email@example.com; Sanjuan, Julio [Psychiatric Unit, Faculty of Medicine, Valencia University, Avda. Blasco Ibanez 17, 46010 Valencia (Spain); Garcia-Marti, Gracian [Department of Radiology, Hospital Quiron, Avda. Blasco Ibanez 14, 46010 Valencia (Spain); Lull, Juan Jose; Robles, Montserrat [ITACA Institute, Polytechnic University of Valencia, Camino de Vera s/n, 46022 Valencia (Spain)
Although many structural and functional abnormalities have been related to schizophrenia, until now, no single biological marker has been of diagnostic clinical utility. One way to obtain more valid findings is to focus on the symptoms instead of the syndrome. Auditory hallucinations (AHs) are one of the most frequent and reliable symptoms of psychosis. We present a review of our main findings, using a multidisciplinary approach, on auditory hallucinations. Firstly, by applying a new auditory emotional paradigm specific for psychosis, we found an enhanced activation of limbic and frontal brain areas in response to emotional words in these patients. Secondly, in a voxel-based morphometric study, we obtained a significant decreased gray matter concentration in the insula (bilateral), superior temporal gyrus (bilateral), and amygdala (left) in patients compared to healthy subjects. This gray matter loss was directly related to the intensity of AH. Thirdly, using a new method for looking at areas of coincidence between gray matter loss and functional activation, large coinciding brain clusters were found in the left and right middle temporal and superior temporal gyri. Finally, we summarized our main findings from our studies of the molecular genetics of auditory hallucinations. Taking these data together, an integrative model to explain the neurobiological basis of this psychotic symptom is presented.
Marino Pérez Álvarez
Full Text Available This work outlines the vision that B.F. Skinner held on hallucinations as psychological phenomena, and defends its validity and relevance nowadays. Our thesis starts with the Skinner’s conception on the behaviors of perceiving, imagining and dreaming. It is highlighted that, in Skinner’s point of view, the differences between perception on one hand and imagination or dreaming in the other, focus on what kind of variables control the behavior in question. Thus, the perceptive behavior would be controlled primarily by stimulus surrounding the person, while the imagination or dreaming would be by variables that are “under the skin” of the subject and, therefore, are private and directly inaccessible to the verbal community. On this basis, Skinner comes to an understanding of hallucinations as perceptual behaviors that occur in the absence of a perceived stimulus, similar to the behavior of imagining or dreaming, but, when hallucinating, the person, for various reasons, does not recognize his / her behaviour as controlled mainly by private stimulation. Finally we made some critical remarks regardingthe lack in Skinner’s psychology of a radical theory on the human person.
Full Text Available In this article, we review recent findings from our laboratory that auditory hallucinations in schizophrenia are internally generated speech mis-representations lateralized to the left superior temporal gyrus and sulcus. Such experiences are, moreover, not cognitively suppressed due to enhanced attention to the voices and failure of fronto-parietal executive control functions. An overview of diagnostic questionnaires for scoring of symptoms is presented, together with a review of behavioural, structural and functional MRI data. Functional imaging data have either shown increased or decreased activation depending on whether patients have been presented an external stimulus or not during scanning. Structural imaging data have shown reduction of grey matter density and volume in the same areas in the temporal lobe. The behavioral and neuroimaging findings are moreover hypothesized to be related to glutamate hypofunction in schizophrenia. We propose a model for the understanding of auditory hallucinations that trace the origin of auditory hallucinations to uncontrolled neuronal firing in the speech areas in the left temporal lobe, which is not suppressed by volitional cognitive control processes, due to dysfunctional fronto-parietal executive cortical networks.
Full Text Available Charles Bonnet syndrome is an underrecognized disease that involves visual hallucinations in visually impaired patients. We present the cases of three patients who experienced complex visual hallucinations following various pathomechanisms. In two cases, diagnosis showed coexistence of occipital lobe damage with ocular damage, while in the third case it showed occipital lobe damage with retrobulbar optic neuritis. Theories of pathogenesis and the neuroanatomical basis of complex visual hallucinations are discussed and supported by literature review.
Full Text Available Abstract Background Hallucinations occur in 20–40% of PD patients and have been associated with unfavorable clinical outcomes (i.e., nursing home placement, increased mortality. Hallucinations, like other non-motor features of PD, are not well recognized in routine primary/secondary clinical practice. So far, there has been no instrument for uniform characterization of hallucinations in PD. To this end, we developed the University of Miami Parkinson's disease Hallucinations Questionnaire (UM-PDHQ that allows comprehensive assessment of hallucinations in clinical or research settings. Methods The UM-PDHQ is composed of 6 quantitative and 14 qualitative items. For our study PD patients of all ages and in all stages of the disease were recruited over an 18-month period. The UPDRS, MMSE, and Beck Depression and Anxiety Inventories were used for comparisons. Results and Discussion Seventy consecutive PD patients were included in the analyses. Thirty-one (44.3% were classified as hallucinators and 39 as non-hallucinators. No significant group differences were observed in terms of demographics, disease characteristics, stage, education, depressive/anxiety scores or cognitive functioning (MMSE between hallucinators and non-hallucinators. Single mode hallucinations were reported in 20/31 (visual/14, auditory/4, olfactory/2 whereas multiple modalities were reported in 11/31 patients. The most common hallucinatory experience was a whole person followed by small animals, insects and reptiles. Conclusion Using the UM-PDHQ, we were able to define the key characteristics of hallucinations in PD in our cohort. Future directions include the validation of the quantitative part of the questionnaire than will serve as a rating scale for severity of hallucinations.
McShane, R; Gedling, K; Reading, M; McDonald, B; Esiri, M M; Hope, T
The presence of hallucinations is included in some, but not all, of the sets of clinical diagnostic criteria that have been proposed for dementia associated with cortical Lewy bodies. These criteria were developed from retrospective casenote analyses. This prospective, longitudinal study suggests that, in patients with Alzheimer's disease, cortical Lewy bodies are associated with more persistent and severe hallucinations, independently of any association with severity of cognitive decline. Poor eyesight contributes to the severity but not the persistence of the hallucinations.
Stewart, C; Rogers, F; Pilch, M; Stewart, I; Barnes-Holmes, Y; Westermann, S
The relationship between self-esteem and paranoia may be influenced by social stress. This study aimed to replicate previous research on the impact ofsocial exclusion on paranoia and self-esteem in a non-clinical sample and to extend this work by examining the effect of exclusion on self-esteem at the 'implicit' level. Non-clinical participants (N = 85) were randomly allocated to the Inclusion or Exclusion condition of a virtual ball-toss game ('Cyberball'). They completed self-reportmeasures of state paranoia and self-esteem, and two implicit measures of self-esteem - theImplicit Association Task (IAT) and Implicit Relational Assessment Procedure (IRAP) -prior to and after exposure to Cyberball. Social exclusion increased state paranoia. This effect was moderated by distress associated with trait paranoia. Exclusion was also associated with decreased self-reported self-esteem, as well as reduced implicit self-esteem on the IAT. Changes in self-reported self-esteem were associated with state paranoia at post-Cyberball. The IRAP indicated that reductions in implicit self-esteem may be due to increases in 'Me-Negative' and 'Others-Positive' biases (rather than reductions in 'Me-Positive' bias). The current study involved a non-clinical sample and so findings cannot be generalized to clinical paranoia. These findings are consistent with previous evidence that paranoia is associated with negative self-evaluations, whereas positive self-evaluations can persist in paranoia. They also provide support for the suggestion that investigations of self-esteem in paranoia should extend beyond global self-esteem and might benefit from a distinction between positive and negative components. Copyright © 2017 Elsevier Ltd. All rights reserved.
Mori, Takaaki; Ikeda, Manabu; Fukuhara, Ryuji; Sugawara, Yoshifumi; Nakata, Shigeru; Matsumoto, Naomi; Nestor, Peter J; Tanabe, Hirotaka
We examined alteration of regional cerebral blood flow (rCBF) in a case of Alzheimer's disease (AD) patient with musical hallucination. To detect regions related to musical hallucination, single-photon emission computed tomography (SPECT) imaging of the patient and nine sex, age, and cognitive function-matched AD patients without delusions and hallucinations were compared using statistical parametric mapping 99 (SPM99). In comparison with controls, the patient had increased rCBF in left temporal regions and left angular gyrus. This profile could be relevant to the neuroanatomical basis of musical hallucinations.
Full Text Available Introduction: Hallucination is a fundamental psychiatric symptom often regarded as a hallmark of psychosis. It can be found in schizophrenia, other psychoses (including delusional disorder, acute and transient psychosis, post-partum psychosis, affective disorders, dementia, substance induced psychotic disorders, and delirium. Aims and objective: This study is a systematic attempt to study and compare the nature and types of hallucination across three different study groups, namely schizophrenia, mania, and other psychosis. Materials and methods: The study was conducted in a total of 90 randomly selected patients of schizophrenia, mania, and other psychotic disorders, i.e. 30 in each study group. The nature and types of hallucination were assessed by using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN. Results and observation: Hallucination was found in 66.67% cases of schizophrenia and 53.33% cases of other psychosis while in case of mania only 13.33% had hallucination. Hallucinations of schizophrenia were more prominent with frequency of hallucination being present every weeks. In majority of cases of schizophrenia (53.33% and other psychosis (33.33%, sound was more or less like real voices whereas special quality of sound (not much like real voices was found in majority of mania (ten per cent patients. Conclusion: In mania, auditory hallucination is comparatively rare as compared to schizophrenia or other psychosis. Hallucinations in schizophrenia were found to be more mood incongruent as compared to mania and other psychosis.
García-Martí, Gracián; Aguilar, Eduardo Jesús; Martí-Bonmatí, Luis; Escartí, M José; Sanjuán, Julio
AIM: To validate a multimodal [structural and functional magnetic resonance (MR)] approach as coincidence brain clusters are hypothesized to correlate with clinical severity of auditory hallucinations.
José Eduardo Martinelli
Full Text Available ABSTRACT Musical hallucination is a type of complex auditory hallucination. Possible etiologies are deafness, psychiatric disorders such as schizophrenia, major depression, use of medication and stress, besides neurologic diseases including epilepsy, stroke and cancer. Uncommon etiologies encompass infectious diseases, metabolic disorders, and sensory deprivation. Although musical hallucinations have a major impact on patients' lives, they have been undervalued and understudied in the literature. We report a case of a 79-year-old woman with musical hallucination (hearing a sung National anthem without cognitive impairment or hearing loss. The patient had preserved insight of her complaint and responded well to neuroleptics.
Full Text Available Este ensayo explora el cuerpo materno en tanto símbolo que materializa las amenazas del autoritarismo. Dos textos disímiles, las memorias de Daniel Paul Schreber, que inspiraron algunos de los principales estudios sobre la paranoia, y la novela Los vigilantes de Diamela Eltit, construyen imágenes del cuerpo materno como respuestas paranoicas al advenimiento en un caso del fascismo y en el otro de un neoliberalismo que apenas enmascara el continuismo de un control dictatorial de los ciudadanos. La división del yo que para Julia Kristeva representa una parte fundamental de la experiencia materna se nos presenta en estos textos como el terreno apropiado para revelar y denunciar las perversiones de dos sociedades tentadas por el autoritarismo.The present article explores the maternal body as a symbol that materializes the threat of authoritarianism. Two very different texts, Daniel Paul Schreber memoir, which inspired some of the main studies on paranoia in the 20th century, and the novel The Custody of the Eyes by Diamela Eltit, present the maternal body as paranoid reactions to the advent of fascism, in the first case, and of a neoliberal regime that thinly veils the dictatorial control of the citizen, in the second one. The split of the ego that constitutes for Julia Kristeva a fundamental part of the maternal experience appears in these texts as the most appropriate medium to reveal and denounce the perversion of two societies under the influence of authoritarianism.
Shaikh, Madiha; Ellett, Lyn; Dutt, Anirban; Day, Fern; Laing, Jennifer; Kroll, Jasmine; Petrella, Sabrina; McGuire, Philip; Valmaggia, Lucia R
Despite a consensus that psychosocial adversity plays a role in the onset of psychosis, the nature of this role in relation to persecutory paranoia remains unclear. This study examined the complex relationship between perceived ethnic discrimination and paranoid ideation in individuals at Ultra High Risk (UHR) for psychosis using a virtual reality paradigm to objectively measure paranoia. Data from 64 UHR participants and 43 healthy volunteers were analysed to investigate the relationship between perceived ethnic discrimination and persecutory ideation in a virtual reality environment. Perceived ethnic discrimination was higher in young adults at UHR in comparison to healthy controls. A positive correlation was observed between perceived ethnic discrimination and paranoid persecutory ideation in the whole sample. Perceived ethnic discrimination was not a significant predictor of paranoid persecutory ideation in the VR environment. Elevated levels of perceived ethnic discrimination are present in individuals at UHR and are consistent with current biopsychosocial models in which psychosocial adversity plays a key role in the development of psychosis and attenuated symptomatology.
Tone, Erin B; Goulding, Sandra M; Compton, Michael T
Recent evidence suggests that normal-range paranoid ideation may be particularly likely to develop in individuals disposed to both social anxiety and perceptual anomalies. This study was designed to test the hypothesis that among college students in an unselected sample, social anxiety and experience of perceptual anomalies would not only each independently predict the experience of self-reported paranoid ideation, but would also interact to predict paranoid patterns of thought. A diverse sample of 644 students completed a large battery of self-report measures, as well as the five-factor Paranoia/Suspiciousness Questionnaire (PSQ). We conducted hierarchical multiple regression analyses predicting scores on each PSQ factor from responses on measures of social anxiety, perceptual aberration, and the interaction between the two constructs. Current general negative affect was covaried in all analyses. We found that both social anxiety and perceptual aberrations, along with negative affect, predicted multiple dimensions of paranoia as measured by the PSQ; the two constructs did not, however, interact significantly to predict any dimensions. Our findings suggest that perceptual aberration and anxiety may contribute to normal-range paranoid ideation in an additive rather than an interactive manner.
Luiz Carlos Tarelho
Full Text Available O presente artigo se propõe a discutir o sofrimento psíquico e o papel exercido pela projeção na paranoia. Ele questiona a relação estabelecida por Freud entre paranoia e homossexualidade e traz à tona a questão dos enclaves psicóticos ligados a mensagens parentais, que assumem a forma de injunções paradoxais e não se prestam a uma retomada ativa e simbolizante por parte da criança. Enclaves que tendem a se enquistar no plano do superego, impedindo a evolução deste para o nível edipiano e produzindo um curto-circuito na estruturação da tópica psíquica, uma vez que parte deste superego passa a ocupar um espaço intermediário entre o eu e o mundo externo e a propiciar um tipo de projeção diferente do descrito por Freud, que é próprio do universo psicótico e do grau de certeza que acompanha as produções delirantes subjacentes.
Morris, Emma; Milner, Philip; Trower, Peter; Peters, Emmanuelle
OBJECTIVE. To test the proposal that 'poor-me' (PM) and 'bad-me' (BM) paranoia can be differentiated in terms of (1) current emotional experience and presence of grandiose delusions and (2) early caregiving and threats to self-construction. METHOD. Participants experiencing persecutory delusions were separated into PM (N= 21) and BM (N= 15) groups on the basis of perceived deservedness of the persecution. The groups were compared on measures examining grandiose delusions, shame and depression, parental care, and threats of alienation and insecurity. RESULTS. As predicted, BM patients scored higher on shame and depression, and lower on grandiose delusions, than PM patients. BM patients reported higher levels of parental overprotection, but PM patients were not characterized by neglect, and the groups did not differ in type of threat to self-construction. Conclusion. The two paranoia types were differentiated on symptomatic and emotional presentation, but predicted differences in early relationships and self-construction were not fully supported.
Waters, Flavie; Woodward, Todd; Allen, Paul; Aleman, Andre; Sommers, Iris
Theories about auditory hallucinations in schizophrenia suggest that these experiences occur because patients fail to recognize thoughts and mental events as self-generated. Different theoretical models have been proposed about the cognitive mechanisms underlying auditory hallucinations. Regardless
Billock, Vincent A.; Tsou, Brian H.
An extraordinary variety of experimental (e.g., flicker, magnetic fields) and clinical (epilepsy, migraine) conditions give rise to a surprisingly common set of elementary hallucinations, including spots, geometric patterns, and jagged lines, some of which also have color, depth, motion, and texture. Many of these simple hallucinations fall into a…
Yellowlees, Peter M.; Cook, James N.
Objective: The authors evaluate an Internet virtual reality technology as an education tool about the hallucinations of psychosis. Method: This is a pilot project using Second Life, an Internet-based virtual reality system, in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients…
Waters, Flavie; Blom, Jan Dirk; Thien Thanh Dang-Vu,; Cheyne, Allan J.; Alderson-Day, Ben; Woodruff, Peter; Collerton, Daniel
By definition, hallucinations occur only in the full waking state. Yet similarities to sleep-related experiences such as hypnagogic and hypnopompic hallucinations, dreams and parasomnias, have been noted since antiquity. These observations have prompted researchers to suggest a common aetiology for
The research reported in this thesis starts from the assumption that hallucinations can be studied in isolation using a cognitive neuropsychiatric approach. The main hypothesis that is investigated states that hallucinations form a continuum from subjective experiences that are common in the n
Waters, Flavie; Blom, Jan Dirk; Thien Thanh Dang-Vu,; Cheyne, Allan J.; Alderson-Day, Ben; Woodruff, Peter; Collerton, Daniel
By definition, hallucinations occur only in the full waking state. Yet similarities to sleep-related experiences such as hypnagogic and hypnopompic hallucinations, dreams and parasomnias, have been noted since antiquity. These observations have prompted researchers to suggest a common aetiology for
Brébion, G; David, A S; Bressan, R A; Ohlsen, R I; Pilowsky, L S
Previous research has demonstrated that various types of verbal source memory error are associated with positive symptoms in patients with schizophrenia. Notably, intrusions in free recall have been associated with hallucinations and delusions. We tested the hypothesis that extra-list intrusions, assumed to arise from poor monitoring of internally generated words, are associated with verbal hallucinations and that intra-list intrusions are associated with global hallucination scores. A sample of 41 patients with schizophrenia was administered four lists of words, followed by free recall. The number of correctly recalled words and the number of extra- and intra-list intrusions were tallied. The verbal hallucination score was significantly correlated with the number of extra-list intrusions, whereas it was unrelated to the number of correctly recalled words. The number of intra-list intrusions was significantly correlated with the global, but not with the verbal, hallucination score in the subsample of hallucinating patients. It was marginally significantly correlated with the delusion score in delusional patients. The data corroborate the view that verbal hallucinations are linked to defective monitoring of internal speech, and that errors in context processing are involved in hallucinations and delusions.
Stant, AD; TenVergert, EM; Groen, H; Jenner, JA; Nienhuis, FJ; van de Willige, G; Wiersma, D
Objective: To examine the cost-effectiveness of Hallucination focused Integrative Treatment (HIT) in patients with schizophrenia and a history of persistent auditory hallucinations. Method: Costs, in and outside the health care sector, and outcomes were registered prospectively during a period of 18
Nagashima, Hideaki; Kobayashi, Toshiyuki
We previously reported two schizophrenic patients with characteristic hallucinations consisting of auditory hallucinations accompanied by visual hallucinations of the speaker's face. The patient sees the face of the hallucinatory speaker in his/her mind and hears the voice talking inwardly. We termed these experiences physiognomy-accompanying auditory hallucinations. In this report, we present 10 patients with schizophrenia showing physiognomy-accompanying auditory hallucinations and evaluate the characteristics of these clinical symptoms. Moreover we consider what the symptoms mean for patients and the metabasis from structural aspects. Lastly, we consider how we can treat these patients living autistic lives with the symptoms. During physiognomy-accompanying auditory hallucinations, the realistic face moves its mouth and talks to the patient expressively. In early onset cases, the faces of various real people appear talking about ordinary things while in late onset cases, the faces can be imaginary but are mainly real people talking about ordinary or delusional things. We suppose that these characteristics of the symptoms unify the schizophrenic world overwhelmed by "a force of non-sense" to "the sense field". "The force of non-sense" is a substantial power but cannot be reduced to the real meaning. And we suppose that not visual reality but the intensity of auditory hallucinations of the face brings about the overwhelming intensity of symptoms and the substantiality of this intensity depends on the states of excessive fullness of "the force of non-sense". With these symptoms patients see the narration of auditory hallucinations through the facial image and the content of auditory hallucinations is compressed into the movement of visual hallucinations of the speaker's face. The form of symptoms is realistic but the speaker's face and voice are beyond ordinary time and space. The symptoms are essentially different from ordinary perception. The visual
Tomita, Tetsu; Yasui-Furukori, Norio; Kaneko, Sunao
Duloxetine is a serotonin-noradrenaline reuptake inhibitor that is effective in the treatment of major depressive disorder (MDD) and chronic pain. The safety of duloxetine has been shown by many previous studies. We report a patient who experienced visual hallucinations after taking duloxetine. The patient experienced insomnia and chronic somatic pain. He began taking duloxetine after a diagnosis of MDD and developed visual hallucinations after the duloxetine dose was increased. The hallucinations disappeared after the duloxetine dose was decreased and then stopped; the dose of quetiapine was increased as an alternative. The specific cause of the duloxetine-induced hallucinations is unclear. In addition to other prescription medications and possible interactions with duloxetine, increasing dopamine by blocking noradrenaline transporters or serotonergic neurotransmission function may contribute to the occurrence of hallucinations.
Full Text Available Rivastigmine is a well-known dual acting acetylcholinesterase and butyrylcholinesterase inhibitor, which is effective on behavioral and psychiatric symptoms including hallucinations, as well as cognitive symptoms of dementia. The most common adverse effects of rivastigmine related to cholinergic stimulation in brain and peripheral tissues are gastrointestinal, cardiorespiratory, extrapyramidal, genitourinary, musculoskeletal symptoms, sleep disturbances, and skin irritations with the transdermal patch form in particular. Despite to the previous reports revealing the improving effects of the drug on hallucinations, we presented a-80 year old women with Alzheimer's disease suffering from visual hallucinations whose complaints began with rivastigmine treatment. Since the patient had recent memory disturbance without any behavioral and/or psychiatric symptoms before rivastigmine administration, and visual hallucinations disappeared with the discontinuation of the drug, visual hallucinations were attributed to rivastigmine.
George, Joseph C.
Reviews Tarasoff vs. Regents of University of California (1976) and several important issues that have emerged from that decision. A review of Hedlund vs. Superior Court (1983) asserts that the Hedlund decision has been misread and that many psychologists are misinformed. (Author/NRB)
Liu, Licheng; Li, Shutao; Chen, C L Philip
Recently, the locality linear coding (LLC) has attracted more and more attentions in the areas of image processing and computer vision. However, the conventional LLC with real setting is just designed for the grayscale image. For the color image, it usually treats each color channel individually or encodes the monochrome image by concatenating all the color channels, which ignores the correlations among different channels. In this paper, we propose a quaternion-based locality-constrained coding (QLC) model for color face hallucination in the quaternion space. In QLC, the face images are represented as quaternion matrices. By transforming the channel images into an orthogonal feature space and encoding the coefficients in the quaternion domain, the proposed QLC is expected to learn the advantages of both quaternion algebra and locality coding scheme. Hence, the QLC cannot only expose the true topology of image patch manifold but also preserve the inherent correlations among different color channels. Experimental results demonstrated that our proposed QLC method achieved superior performance in color face hallucination compared with other state-of-the-art methods.
Gangdev, Prakash; Dua, Varinder; Desjardins, Nina
Usually remembered in the context of Narcolepsy-Cataplexy syndrome, isolated sleep paralysis (SP) and hypnic hallucination are widely prevalent and because of the overlap of symptoms with schizophrenia, their identification is important but unrecognized. To determine the presence of SP and hypnic hallucinations (HH) in people with schizophrenia and schizoaffective disorder. Cross-sectional survey. Participants were patients receiving follow-up care for schizophrenia from Assertive Community Treatment Team. A screening questionnaire was administered during their routine follow-up visits. Of 71 respondents (49 males, 22 females) only 11 (10 males and 1 female), that is, 15% reported SP, and 12 (7 males and 5 females), that is, 16.9% reported HH, a considerably low prevalence. It is difficult to study the presence of SP and HH in patients with active or residual symptoms of schizophrenia, and more refined studies and appropriate questionnaires are required. The possibility of SP and HH confounding or being misdiagnosed as psychotic symptoms needs to be borne in mind.
Woods, Angela; Jones, Nev; Bernini, Marco; Callard, Felicity; Alderson-Day, Ben; Badcock, Johanna C; Bell, Vaughan; Cook, Chris C H; Csordas, Thomas; Humpston, Clara; Krueger, Joel; Larøi, Frank; McCarthy-Jones, Simon; Moseley, Peter; Powell, Hilary; Raballo, Andrea; Smailes, David; Fernyhough, Charles
Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations (AVHs), the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH at 3 contextual levels: (1) cultural, social, and historical; (2) experiential; and (3) biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include (1) informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; (2) "front-loading" research in cognitive neuroscience; and (3) suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences.
Remko van Lutterveld
Full Text Available BACKGROUND: Auditory verbal hallucinations (AVH, a prominent symptom of schizophrenia, are often highly distressing for patients. Better understanding of the pathogenesis of hallucinations could increase therapeutic options. Magnetoencephalography (MEG provides direct measures of neuronal activity and has an excellent temporal resolution, offering a unique opportunity to study AVH pathophysiology. METHODS: Twelve patients (10 paranoid schizophrenia, 2 psychosis not otherwise specified indicated the presence of AVH by button-press while lying in a MEG scanner. As a control condition, patients performed a self-paced button-press task. AVH-state and non-AVH state were contrasted in a region-of-interest (ROI approach. In addition, the two seconds before AVH onset were contrasted with the two seconds after AVH onset to elucidate a possible triggering mechanism. RESULTS: AVH correlated with a decrease in beta-band power in the left temporal cortex. A decrease in alpha-band power was observed in the right inferior frontal gyrus. AVH onset was related to a decrease in theta-band power in the right hippocampus. CONCLUSIONS: These results suggest that AVH are triggered by a short aberration in the theta band in a memory-related structure, followed by activity in language areas accompanying the experience of AVH itself.
Full Text Available Auditory hallucinations (AH are a symptom of several psychiatric disorders, such as schizophrenia. In a significant minority of patients, AH are resistant to antipsychotic medication. Alternative treatment options for this medication-resistant group are scarce and most of them focus on coping with the hallucinations. Finding an alternative treatment that can diminish AH is of great importance.Transcranial direct current stimulation (tDCS is a safe and non-invasive technique that is able to directly influence cortical excitability through the application of very low electric currents. A 1-2 mA direct current is applied between two surface electrodes, one serving as the anode and the other as the cathode. Cortical excitability is increased in the vicinity of the anode and reduced near the cathode. The technique, which has only a few transient side effects and is cheap and portable, is increasingly explored as a treatment for neurological and psychiatric symptoms. It has shown efficacy on symptoms of depression, bipolar disorder, schizophrenia, Alzheimer’s disease, Parkinson’s disease, epilepsy and stroke. However, the application of tDCS as a treatment for AH is relatively new. This article provides an overview of the current knowledge in this field and provides guidelines for future research.
Moritz, Steffen; Göritz, Anja S; Gallinat, Jürgen; Schafschetzy, Milena; Van Quaquebeke, Niels; Peters, Maarten J V; Andreou, Christina
Overconfidence in errors is a well-replicated cognitive bias in psychosis. However, prior studies have sometimes failed to find differences between patients and controls for more difficult tasks. We pursued the hypothesis that overconfidence in errors is exaggerated in participants with a liability to psychosis relative to controls only when they feel competent in the respective topic and/or deem the question easy. Whereas subjective competence likely enhances confidence in those with low psychosis liability as well, we still expected to find more 'residual' caution in the latter group. We adopted a psychometric high-risk approach to circumvent the confounding influence of treatment. A total of 2321 individuals from the general population were administered a task modeled after the "Who wants to be a millionaire" quiz. Participants were requested to endorse one out of four response options, graded for confidence, and were asked to provide ratings regarding subjective competence for the knowledge domain as well as the subjective difficulty of each item. In line with our assumption, overconfidence in errors was increased overall in participants scoring high on the Paranoia Checklist core paranoia subscale (2 SD above the mean). This pattern of results was particularly prominent for items for which participants considered themselves competent and which they rated as easy. Results need to be replicated in a clinical sample. In support of our hypothesis, subjective competence and task difficulty moderate overconfidence in errors in psychosis. Trainings that teach patients the fallibility of human cognition may help reduce delusional ideation. Copyright © 2015. Published by Elsevier Ltd.
Van Quaquebeke, Niels
A six-month, time-lagged online survey among 441 employees in diverse industries was conducted to investigate the role paranoia plays as an antecedent and as a consequence of advancement in organizations...
Shine, James M; Keogh, Rebecca; O'Callaghan, Claire; Muller, Alana J; Lewis, Simon J G; Pearson, Joel
Visual hallucinations occur when our conscious experience does not accurately reflect external reality. However, these dissociations also regularly occur when we imagine the world around us in the absence of visual stimulation. We used two novel behavioural paradigms to objectively measure visual hallucinations and voluntary mental imagery in 19 individuals with Parkinson's disease (ten with visual hallucinations; nine without) and ten healthy, age-matched controls. We then used this behavioural overlap to interrogate the connectivity both within and between the major attentional control networks using resting-state functional magnetic resonance imaging. Patients with visual hallucinations had elevated mental imagery strength compared with patients without hallucinations and controls. Specifically, the sensory strength of imagery predicted the frequency of visual hallucinations. Together, hallucinations and mental imagery predicted multiple abnormalities in functional connectivity both within and between the attentional control networks, as measured with resting-state functional magnetic resonance imaging. However, the two phenomena were also dissociable at the neural level, with both mental imagery and visual misperceptions associated with specific abnormalities in attentional network connectivity. Our results provide the first evidence of both the shared and unique neural correlates of these two similar, yet distinct phenomena.
Carter, Rowena; Ffytche, Dominic H
Our current clinical approach to visual hallucinations is largely derived from work carried out by Georges de Morsier in the 1930s. Now, almost a century after his influential papers, we have the research tools to further explore the ideas he put forward. In this review, we address de Morsier's proposal that visual hallucinations in all clinical conditions have a similar neurological mechanism by comparing structural imaging studies of susceptibility to visual hallucinations in Parkinson's disease, Alzheimer's disease, Dementia with Lewy bodies and schizophrenia. Systematic review of the literature was undertaken using PubMed searches. A total of 18 studies across conditions were identified reporting grey matter differences between patients with and without visual hallucinations. Grey matter changes were categorised into brain regions relevant to current theories of visual hallucinations. The distribution of cortical atrophy supports de Morsier's premise that visual hallucinations are invariably linked to aberrant activity within visual thalamo-cortical networks. Further work is required to determine by what mechanism these networks become predisposed to spontaneous activation, and whether the frontal lobe and hippocampal changes identified are present in all conditions. The findings have implications for the development of effective treatments for visual hallucinations.
Sireteanu, Ruxandra; Oertel, Viola; Mohr, Harald; Linden, David; Singer, Wolf
Visual hallucinations can occur in healthy subjects during prolonged visual deprivation. We investigated the visual percepts and the associated brain activity in a 37-year-old healthy female subject who developed visual hallucinations during three weeks of blindfolding, and then compared this activity with the cortical activity associated with mental imagery of the same patterns. We acquired fMRI data with a Siemens 3T Magnetom Allegra towards the end of the deprivation period to assess hallucination-related activity, and again after recovery from blindfolding to measure imagery-related activity. Detailed subjective descriptions and graphical illustrations were provided by the subject after blindfolding was completed. The subject reported the occurrence of simple and elementary hallucinations, consisting of flashes and coloured and moving patterns during the period of blindfolding. Neural activity related to hallucinations was found in extrastriate occipital, posterior parietal, and several prefrontal regions. In contrast, mental imagery of the same percepts led to activation in prefrontal, but not in posterior, parietal, and occipital regions. These results suggest that deprivation-induced hallucinations result from increased excitability of extrastriate visual areas, while mentally induced imagery involves active read-out under the volitional control of prefrontal structures. This agrees with the subject's report that visual hallucinations were more vivid than mental imagery.
Rolland, Benjamin; Amad, Ali; Poulet, Emmanuel; Bordet, Régis; Vignaud, Alexandre; Bation, Rémy; Delmaire, Christine; Thomas, Pierre; Cottencin, Olivier; Jardri, Renaud
Both auditory hallucinations (AH) and visual hallucinations may occur in schizophrenia. One of the main hypotheses underlying their occurrence involves the increased activity of the mesolimbic pathway, which links the ventral tegmental area (VTA) and the nucleus accumbens (NAcc). However, the precise contribution of the mesolimbic pathway in hallucinations across various sensory modalities has not yet been explored. We compared the resting-state functional connectivity (rs-FC) of the NAcc among 16 schizophrenia patients with pure AH, 15 with both visuoauditory hallucinations (VAH), and 14 without hallucinations (NoH). A between-group comparison was performed using random-effects ANCOVA (rs-FC of the bilateral NAcc as the dependent variable, groups as the between-subjects factor, age and Positive and Negative Syndrome Scale scores as covariates; q(false discovery rate [FDR]) hallucinations, but the NAcc FC patterns changed with the complexity of these experiences (ie, 0, 1, or 2 sensory modalities), rather than with severity. This might support the aberrant salience hypothesis of schizophrenia. Moreover, these findings suggest that future clinical and neurobiological studies of hallucinations should evaluate not only the global severity of symptoms but also their sensorial features.
Goetz, Christopher G; Vaughan, Christina L; Goldman, Jennifer G; Stebbins, Glenn T
Functional neuroimaging studies have described alterations in neural activation in PD patients with chronic hallucinations. These studies have not, however, captured neural activation patterns during an actual hallucinatory event. The objective of this work was to investigate neuroanatomical substrates active during visual hallucinations in a patient with Parkinson's disease (PD). We conducted an event-related functional magnetic resonance imaging (fMRI) case-study examination of a 66-year-old male PD patient with stereotypic, chronic, and frequent visual hallucinations. The patient reported 16 hallucinations during the fMRI scan. Increased activation during hallucinations was found in the cingulate, insula, frontal lobe, thalamus, and brain stem. Decreased activation was found in the lingual and fusiform gyri, inferior occipital gyrus, and middle frontal and superior temporal lobes. To our knowledge, this report is the first published case documenting the cortical activation patterns using fMRI techniques in a PD patient during active hallucinations. Our results suggest that during a visual hallucination, a marked desynchronization occurs between posterior and anterior cortical areas involved in visual processing. Copyright © 2013 Movement Disorder Society.
Saba, P R; Keshavan, M S
The discussion of auditory hallucinations in schizophrenia has traditionally focused on verbal auditory hallucinations, or 'voices'. Little attention, on the other hand, has been given to the phenomenon of musical hallucinations. In an effort to characterize the prevalence and phenomenology of musical hallucinations, 100 consecutive schizophrenic inpatients were examined for the presence of musical hallucinations and musical imagery. Sixteen patients responded positively, and were engaged in a more thorough interview. They were then divided into two groups: those with musical hallucinations, and those experiencing musical imagery. This determination was made based on the absence or presence, respectively, of volitional control, hypothesizing that lack of volitional control implies a true hallucinatory experience. When lack of volitional control was compared to the various other aspects of the experience, an association with religious content was demonstrated. Religious musical hallucinations also tended to be experienced as distressing, further supporting the hypothesis that the experience was hallucinatory rather than a product of volitional imagery. A selection of sample case vignettes is presented as well.
Full Text Available 5.In the current psychiatric classifications, hallucinations (mainly auditory hallucinations are one of the fundamental criteria for establishing a schizophrenia diagnosis or any of the related psychotic disorder’s diagnoses.6.Throughout the history of Psychiatry the conceptual proximity between delusions and hallucinations in the psychiatric patient was maintained until the end of the XIX century,with several supporters during the XX century. Their frontier was not yet definitely defined in terms of Descriptive Psychopathology, and much less so in terms of biochemical and anatomical models.7.In this article we aimed to analyse the dimensions of both hallucinations and delusions in a sample of patients with schizophrenia and schizoaffective disorder. We also intend to find the determinants of the main dimensions of hallucinations.8.One hundred patients with schizophrenia or schizoaffective disorder from both the outpatient and inpatient units of the Psychiatry Department of Hospital of Santa Maria and the Centro Hospitalar Psiquiátrico de Lisboa were assessed by means of the Psychotic Symptom Rating Scales (PSYRATS. 9.In this study we found an empirical based model, where the main dimensions of hallucinations are determined by the central dimensions of delusions. 10.Keywords: Psyrats, Hallucinations, Psychopathology, Psychosis, delusions
Kanemura, Seitetsu; Tanimukai, Hitoshi; Tsuneto, Satoru
The patient was a 57-year-old woman with malignant pleural mesothelioma. She had a past history of anxiety neurosis but not had any history of otological diseases. On admission to our hospice (day 1), she complained of dyspnea and wheezing associated with the progression of her underlying disease. After we started oral betamethasone (2 mg/d), dyspnea was alleviated and the frequency of wheezing was reduced. On day 3, she began to experience musical hallucinations that were manifested in opera/piano concert music and a child's voice. The episodes of musical hallucinations occurred approximately 10 times a day and disappeared spontaneously within several minutes. She had not experienced these symptoms before. We reduced the dose of betamethasone to 1 mg/d, but the musical hallucinations continued. Then on day 11, we switched betamethasone (1 mg/d) to prednisolone (10 mg/d) and we then gradually tapered off prednisolone. The frequency of musical hallucinations decreased and she ceased to experience musical hallucinations on day 29. However, on day 40, her dyspnea was aggravated again, so we started treatment with prednisolone (5 mg/d). Dyspnea was alleviated and no musical hallucinations occurred. On Day 51, dyspnea was worsened and we switched prednisolone to betamethasone (4 mg/d), which she hoped to use. The betamethasone alleviated the dyspnea but she developed musical hallucinations that were similar to the previous episodes. The musical hallucinations disappeared spontaneously 4-5 days later without changing the betamethasone. Musical hallucinations never occurred thereafter. She later died due to the exacerbation of disease.
Kramer, Ingrid; Simons, Claudia J P; Wigman, Johanna T W; Collip, Dina; Jacobs, Nele; Derom, Catherine; Thiery, Evert; van Os, Jim; Myin-Germeys, Inez; Wichers, Marieke
Evidence suggests that affect plays a role in the development of psychosis but the underlying mechanism requires further investigation. This study examines the moment-to-moment dynamics between negative affect (NA) and paranoia prospectively in daily life. A female general population sample (n = 515) participated in an experience sampling study. Time-lagged analyses between increases in momentary NA and subsequent momentary paranoia were examined. The impact of childhood adversity, stress sensitivity (impact of momentary stress on momentary NA), and depressive symptoms on these time-lagged associations, as well as associations with follow-up self-reported psychotic symptoms (Community Assessment of Psychic Experiences and the Symptom Checklist-90-Revised) were investigated. Moments of NA increase resulted in a significant increase in paranoia over 180 subsequent minutes. Both stress sensitivity and depressive symptoms impacted on the transfer of NA to paranoia. Stress sensitivity moderated the level of increase in paranoia during the initial NA increase, while depressive symptoms increased persistence of paranoid feelings from moment to moment. Momentary paranoia responses to NA increases were associated with follow-up psychotic symptoms. Examination of microlevel momentary experience may thus yield new insights into the mechanism underlying co-occurrence of altered mood states and psychosis. Knowledge of the underlying mechanism is required in order to determine source and place where remediation should occur.
Full Text Available Theoretical models ascribe jumping to conclusions (JTCs a prominent role in the pathogenesis of paranoia. While many earlier studies corroborated this account, some newer investigations have found no or only small associations of the JTC bias with paranoid symptoms. The present study examined whether these inconsistencies in part reflect methodological differences across studies. The study was built upon the psychometric high-risk paradigm. A total of 1899 subjects from the general population took part in an online survey and were administered the Paranoia Checklist as well as one of two different variants of the probabilistic reasoning task: one variant with a traditional instruction (a and one novel variant that combines probability estimates with decision judgments (b. Factor analysis of the Paranoia Checklist yielded an unspecific suspiciousness factor and a psychotic paranoia factor. The latter was significantly associated with scores indicating hasty decision making. Subjects scoring two standard deviations above the mean of the Paranoia Checklist showed an abnormal data-gathering style relative to subjects with normal scores. Findings suggest that the so-called decision threshold parameter is more sensitive than the conventional JTC index. For future research the specific contents of paranoid beliefs deserve more consideration in the investigation of decision making in schizophrenia as JTC seems to be associated with core psychosis-prone features of paranoia only.
Evidence suggests that affect plays a role in the development of psychosis but the underlying mechanism requires further investigation. This study examines the moment-to-moment dynamics between negative affect (NA) and paranoia prospectively in daily life. A female general population sample (n = 515) participated in an experience sampling study. Time-lagged analyses between increases in momentary NA and subsequent momentary paranoia were examined. The impact of childhood adversity, stress sensitivity (impact of momentary stress on momentary NA), and depressive symptoms on these time-lagged associations, as well as associations with follow-up self-reported psychotic symptoms (Community Assessment of Psychic Experiences and the Symptom Checklist-90-Revised) were investigated. Moments of NA increase resulted in a significant increase in paranoia over 180 subsequent minutes. Both stress sensitivity and depressive symptoms impacted on the transfer of NA to paranoia. Stress sensitivity moderated the level of increase in paranoia during the initial NA increase, while depressive symptoms increased persistence of paranoid feelings from moment to moment. Momentary paranoia responses to NA increases were associated with follow-up psychotic symptoms. Examination of microlevel momentary experience may thus yield new insights into the mechanism underlying co-occurrence of altered mood states and psychosis. Knowledge of the underlying mechanism is required in order to determine source and place where remediation should occur. PMID:23407984
Palmier-Claus, Jasper; Dunn, Graham; Drake, Richard; Lewis, Shôn
Self-esteem has been implicated in the development of psychotic phenomena, especially paranoia. Recent findings suggest that it may be useful to assess the instability of self-esteem instead of the mean score. We examined this construct as two separate factors: positive beliefs about the self (PBS) and negative beliefs about the self (NBS). Theoretical models have implicated NBS in the development of paranoia, whereas research studies have sometimes found an association between PBS and negative symptoms. The first aim of this study was to investigate associations between change in PBS and NBS, and subsequent change in paranoia and negative symptoms. The second aim was to examine whether fluctuations in PBS and NBS predicted mean paranoia levels. Data from a large sample of individuals with first-episode psychosis (n = 256) assessed at baseline, 6 weeks, 3 months and 18 months was analysed. The data suggest that changes in both PBS and NBS in the early stages of disorder are related to change in negative symptoms, but not paranoia. PBS variability and NBS mean scores significantly predicted average paranoia levels when taken from across all four time points, suggesting potential differences in the associations with psychosis of these two constructs. Self-esteem boosting interventions administered in the first 6 weeks after admission to healthcare services may improve the subsequent course of negative symptoms.
Full Text Available The Charles Bonnet Syndrome (CBS is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.
Full Text Available Musical hallucinations represent a specific form of auditory hallucinations whereby patients experience formed music without an external source. We describe a 60 year-old woman with history of bilateral hearing impairment and tinnitus who experienced both recognizable and non-recognizable songs. Curiously, she was able to reproduce non-recognizable songs in a way that could be recognized by others. This phenomenon is in line with current understanding that musical hallucinations represent abnormal activity in the auditory associative cortices, raising intriguing questions regarding memory, forgetting and access to lost memories.
Kolev, Ognyan I
Previous work has shown that caloric vestibular stimulation may evoke elementary visual hallucinations in healthy humans, such as different colored lines or dots. Surprisingly, the present case report reveals that the same stimulation can evoke visual hallucinations in a patient with cortical blindness, but with fundamentally different characteristics. The visual hallucinations evoked were complex and came from daily life experiences. Moreover, they did not include other senses beyond vision. This case report suggests that in conditions of cerebral pathology, vestibular-visual interaction may stimulate hallucinogenic subcortical, or undamaged cortical structures, and arouse mechanisms that can generate visual images exclusively.
Evers, Stefan; Ellger, Tanja; Ringelstein, Erich B; Knecht, Stefan
It has been suggested that musical hallucinations are often due to a focal brain lesion predominantly of right hemispheric pathologies. We report about two patients with musical hallucinations associated with a brain tumor of the right hemisphere. Although both patients were right-handed, one of them had a right hemispheric dominance for language as proven by the Wada test. The musical ability as measured by the Seashore test was not impaired. We conclude that the language dominance of the hemisphere is not primarily relevant for the development of musical hallucinations.
Vitorovic, Danilo; Biller, José
Musical hallucinations represent a specific form of auditory hallucinations whereby patients experience formed music without an external source. We describe a 60-year-old woman with history of bilateral hearing impairment and tinnitus who experienced both recognizable and non-recognizable songs. Curiously, she was able to reproduce non-recognizable songs in a way that could be recognized by others. This phenomenon is in line with current understanding that musical hallucinations represent abnormal activity in the auditory associative cortices, raising intriguing questions regarding memory, forgetting, and access to lost memories.
Results: Incidence of hallucination in the first group is 36% and in the other group is 8%. Chi- Square test demonstrates a significant statistical difference between the two groups (p.v=0.017 and K.sq=5.71. Conclusions: Analysis of data demostrated that midazolam is more effective than diazpam for prevention of ketamine induced postoperative hallucination. According to the above although postoperative hallucination induced by ketamine has no effective treatment but can be prevented effectively using benzodiazepines especially midazolam.
Lippi, Silvia; Lehaire, Célia; Petit, Laetitia
Taking their inspiration from a case history, the authors explore the effects of a writing workshop led by a professional writer for patients in a psychiatric hospital. This workshop allowed different modes of transference to unfold: transference to the analyst-therapist, transference to the writer who led the workshop, and transference to the other members of the group. The writing activity created conditions in which there could be a movement from hallucination to delusion-a delusion expressed in fiction through the act of writing. Psychotic patients "invent" a writing that remains unfinished and that relates to the experiences of persecution. Writing thus makes it possible for them to tolerate language, through its transformation into writing.
Powers, Albert R; Kelley, Megan; Corlett, Philip R
The problem of whether and how information is integrated across hierarchical brain networks embodies a fundamental tension in contemporary cognitive neuroscience, and by extension, cognitive neuropsychiatry. Indeed, the penetrability of perceptual processes in a 'top-down' manner by higher-level cognition-a natural extension of hierarchical models of perception-may contradict a strictly modular view of mental organization. Furthermore, some in the cognitive science community have challenged cognitive penetration as an unlikely, if not impossible, process. We review the evidence for and against top-down influences in perception, informed by a predictive coding model of perception and drawing heavily upon the literature of computational neuroimaging. We extend these findings to propose a way in which these processes may be altered in mental illness. We propose that hallucinations - perceptions without stimulus - can be understood as top-down effects on perception, mediated by inappropriate perceptual priors.
Cucchi, Marco; Petitta, Marcello; Calmanti, Sandro
High temperatures have an impact on the energy balance of any living organism and on the operational capabilities of critical infrastructures. Heat-wave indicators have been mainly developed with the aim of capturing the potential impacts on specific sectors (agriculture, health, wildfires, transport, power generation and distribution). However, the ability to capture the occurrence of extreme temperature events is an essential property of a multi-hazard extreme climate indicator. Aim of this study is to develop a standardized heat-wave indicator, that can be combined with other indices in order to describe multiple hazards in a single indicator. The proposed approach can be used in order to have a quantified indicator of the strenght of a certain extreme. As a matter of fact, extremes are usually distributed in exponential or exponential-exponential functions and it is difficult to quickly asses how strong was an extreme events considering only its magnitude. The proposed approach simplify the quantitative and qualitative communication of extreme magnitude
Ruth A Wood
Full Text Available Extracampine hallucinations (EH, the sense of a presence or fleeting movement in the absence of an associated visual percept, have been reported in Parkinson’s disease (PD patients but their prevalence, characteristics and temporal relationship to visual hallucinations (VH remain unclear. Given that VH are predictive of cognitive impairment in PD, improved understanding of EH may have significant prognostic implications. The objective of this study was to evaluate the prevalence and characteristics of EH in a large unselected population with PD and to assess the temporal relationship between EH, VH and memory decline. Cross-sectional data were collected using a questionnaire circulated to 414 PD patients via an online patient community. Data were obtained regarding the occurrence, timing and characteristics of VH and EH and symptoms of PD, disease duration, disease severity and medication history. 50.4% of respondents reported EH and 15.5% reported VH. EH were typically experienced alongside, rather than behind, the individual (p<0.001 without clear lateralisation (p=0.438, and were more likely to be of unfamiliar presences (p<0.001. The occurrence of EH was associated with Hoehn and Yahr score (p=0.002 but not disease duration (p=0.158. EH onset was associated with VH onset (p=0.046 and occurred after the onset of anosmia (p<0.001, cognitive decline (p=0.002 and sleep disturbance (p=0.002. The reported prevalence of EH in PD patients was threefold greater than that of VH, with similar timings of onset, suggesting that EH are under-recognised and under-reported. Further work is needed to determine whether EH are predictive of cognitive decline.
Ralph E Hoffman
Full Text Available Functional connectivity (FC studies of brain mechanisms leading to auditory verbal hallucinations (AVHs utilizing functional magnetic resonance imaging (fMRI data are reviewed. Initial FC studies utilized fMRI data collected during performance of various tasks, which suggested frontotemporal disconnection and/or source-monitoring.disturbances. Later FC studies have utilized resting (no-task fMRI data. These studies have produced a mixed picture of disconnection and hyperconnectivity involving different pathways associated with AVHs. Results of our most recent FC study of AVHs are reviewed in detail. This study suggests that the core mechanism producing AVHs involves not a single pathway, but a more complex functional loop. Components of this loop include Wernicke’s area and its right homologue, the left inferior frontal cortex, and the putamen. It is noteworthy that the putamen appears to play a critical role in the generation of spontaneous language, and in determining whether auditory stimuli are registered consciously as percepts. Excessive functional coordination linking this region with the Wernicke’s seed region in patients with schizophrenia could therefore generate an overabundance of potentially conscious language representations. In our model, intact FC in the other two legs of corticostriatal loop (Wernicke’s with left IFG, and left IFG with putamen appeared to allow this disturbance (common to schizophrenia overall to be expressed as a conscious hallucination of speech. Recommendations for future studies are discussed, including inclusion of multiple methodologies applied to the same subjects in order to compare and contrast different mechanistic hypotheses, utilizing EEG to better parse time-course of neural synchronization leading to AVHs, and ascertaining experiential subtypes of AVHs that may reflect distinct mechanisms.
Eng, Marty L; Welty, Timothy E
Hallucinations and psychosis are common in patients with Parkinson's disease (PD), with reported prevalences of up to 48% and 80%, respectively. However, few randomized, double-blind, placebo-controlled trials evaluating the treatment options have appeared in the literature. The studies that have been published were complicated by lack of agreement on the diagnosis of psychosis in PD, poor completion rates, mixed populations that included dementia, and other issues. Several reviews, guidelines, and consensus statements have sought to establish standards for treating these symptoms of PD. In 2006, the American Academy of Neurology (AAN) published a practice guideline (based on articles published up to 2004) for management of depression, psychosis, and dementia in patients with PD. Since then, a number of relevant studies have been published. The purpose of this article was to review data that have appeared in the literature since publication of the AAN guideline regarding the management of hallucinations and psychosis in PD. A literature search of the PubMed, CINAHL, and PsychInfo databases was conducted for human studies published in English from January 2004 to June 2010. All clinical studies were included except case reports and case series. Studies with 10 years. Results of the identified studies suggested that patients with PD might benefit from long-term clozapine therapy. Results of the quetiapine studies were conflicting. However, no statistically significant difference in effectiveness was found between quetiapine and clozapine in comparative trials. The significance of the differences in treatment responses between patients with dementia and those without dementia remains unclear, and it was not possible to draw conclusions for or against other atypical antipsychotics because of insufficient evidence. Further studies are needed to address the methodologic issues in the current trials and to assess safety issues in larger cohorts. Copyright © 2010 Excerpta
The second part of this paper examines the history of querulous paranoia and vexatious litigation in the English-speaking countries from the nineteenth century to today. This study suggests that the lack of thorough research on querulous paranoia in these countries is due to a broad cultural, legal and medical context which has caused unreasonable complainants to be considered a purely legal, rather than a medical issue. To support this hypothesis, I analyse how legal steps have been taken throughout the English-speaking world since 1896 to keep the unreasonable complainants at bay, and I present reasons why medical measures have scarcely been adopted. However, I also submit evidence that this division of responsibilities between the judges and the psychiatrists has taken a new turn since the dawn of the twenty-first century.
Full Text Available Trata-se de discutir as relações entre a constituição da paranoia como categoria clínica e experiências estético-sociais de crise. Esta é uma maneira de se perguntar sobre as relações que categorias clínicas tecem com processos e valores advindos dos campos da política e da estética.
P. Sai Krishna
Full Text Available Zolpidem is a hypnotic drug with rapid -onset and short duration of action. It is popularly used for the induction and maintenance of sleep in adults suffering from insomnia. It supersedes benzodiazepines with better tolerability and has fewer side effects such as less residual sedation and the potential for rebound insomnia and dependence is also less. Adverse neuropsychiatric reactions such as visual hallucinations, amnesia, sleepwalking and nocturnal eating are known to occur with zolpidem. Literature suggests higher incidence of visual hallucinations with zolpidem when used along with selective serotonin reuptake inhibitors. Furthermore, visual hallucinations are one of the causes for drug withdrawal. We are reporting a case of zolpidem induced visual hallucinations when used alone and also which disappeared with proper assurance to the patient in subsequent use. [Int J Basic Clin Pharmacol 2015; 4(2.000: 376-378
Curcic-Blake, Branisalava; Nanetti, Luca; van der Meer, Lisette; Cerliani, Leonardo; Renken, Remco; Pijnenborg, Marieke; Aleman, André
Auditory verbal hallucinations (AVH) in schizophrenia have previously been associated with functional deficiencies in language networks, specifically with functional disconnectivity in fronto-temporal connections in the left hemisphere and in interhemispheric connections between frontal regions. Her
Balsavar, Anuradha; Deshpande, Smita N
The ancient Indian system of medicine "Ayurveda" is a compendium of various health related theories and practices and explained the abnormal state of mind, i.e., psychopathology in various contexts. Hallucinations were deemed abnormal. In Ayurvedic classics, hallucinations were called false perceptions (mithyajnana), illusions (maya), infatuations (moha), or confusion (bhrama). Hallucinations were not independent but a symptom of mental disorder (manasa roga). Hallucinations of different sensory organs were observed and explained. These symptoms could be observed in patients suffering from any illness of tridosha origin, organic disease or psychiatric disorder. False perceptions observed in patients were used as tools to understand the prognosis of the condition. This article may help provide preliminary insight and encourage interdisciplinary study toward understanding one of the main symptoms of schizophrenia.
Newton, Elizabeth; Landau, Sabine; Smith, Patrick; Monks, Paul; Shergill, Sukhi; Wykes, Til
Twenty to fifty percent of people with a diagnosis of schizophrenia continue to hear voices despite taking neuroleptic medication. Trials of group cognitive behavioral therapy for adults with auditory hallucinations have shown promising results. Auditory hallucinations may be most amenable to psychological intervention during a 3-year critical period after symptom onset. This study evaluates the effectiveness of group cognitive behavioral therapy (CBT) for young people with recent-onset auditory hallucinations (N = 22), using a waiting list control. Outcome measures were administered at four separate time points. Significant reductions in auditory hallucinations occurred over the total treatment phase, but not over the waiting period. Further investigations in the form of randomized controlled trials are warranted.
Meppelink, Anne Marthe; de Jong, Bauke M.; Teune, Laura K.; van Laar, Teus
In our previous functional magnetic resonance imaging study, Parkinson's disease (PD) patients with visual hallucinations (VH) showed reduced activations in ventral/ lateral visual association cortices preceding image recognition, compared with both PD patients without VH and healthy controls. The p
Evensen, Julie; Røssberg, Jan Ivar; Haahr, Ulrik
The main aim of this study was to identify subgroups of patients characterized by having hallucinations only or delusions only and to examine whether these groups differed with regard to demographic characteristics, clinical characteristics and outcome factors, including suicidality....
Yellowlees, Peter M; Cook, James N
The authors evaluate an Internet virtual reality technology as an education tool about the hallucinations of psychosis. This is a pilot project using Second Life, an Internet-based virtual reality system, in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients with schizophrenia. Eight hundred sixty-three self-referred users took a self-guided tour. Five hundred seventy-nine (69%) of the users who toured the environment completed a survey. Of the survey responders, 440 (76%) thought the environment improved their understanding of auditory hallucinations, 69% thought it improved their understanding of visual hallucinations, and 82% said they would recommend the environment to a friend. Computer simulations of the perceptual phenomena of psychiatric illness are feasible with existing personal computer technology. Integration of the evaluation survey into the environment itself was possible. The use of Internet-connected graphics environments holds promise for public education about mental illness.
Ćurčić-Blake, Branislava; Nanetti, Luca; van der Meer, Lisette; Cerliani, L.; Renken, Remco; Pijnenborg, Gerdina H M; Aleman, André
Auditory verbal hallucinations (AVH) in schizophrenia have previously been associated with functional deficiencies in language networks, specifically with functional disconnectivity in fronto-temporal connections in the left hemisphere and in interhemispheric connections between frontal regions.
van Lutterveld, Remko; Oranje, Bob; Abramovic, Lucija;
OBJECTIVE: Schizophrenia is associated with aberrant event-related potentials (ERPs) such as reductions in P300, processing negativity and mismatch negativity amplitudes. These deficits may be related to the propensity of schizophrenia patients to experience auditory verbal hallucinations (AVH...
Full Text Available Leukotriene receptor antagonists(montelukast have been used for many years in the treatment of asthma both acute and chronic stages. They are accepted commonly as safe but mostly possible side effects are ignored. However, montelukast also could lead to important adverse reactions like hallucinations. In literature only 2 reports have been found about hallucinations with it. One is a study which reports 3 patients from 48 children and the other is a 29 year-old case report. In our case, psychiatric adverse reactions of montelukast,especially hallucinations are reported similarly. We are presenting a child who had visual hallucinations after starting to use montekulast and after stopping the medicine these complaints disappeared in 48 hours. Although it is a safe drug, it should not be forgotten that it has psychiatric side effects which may be missed easily especially in children.
Daalman, Kirstin; Boks, Marco P. M.; Diederen, Kelly M. J.; de Weijer, Antoin D.; Blom, Jan Dirk; Kahn, Rene S.; Sommer, Iris E. C.
Objective: Whereas auditory verbal hallucinations (AVHs) are most characteristic of schizophrenia, their presence has frequently been described in a continuum, ranging from severely psychotic patients to schizotypal personality disorder patients to otherwise healthy participants. It remains unclear
van Lutterveld, Remko; Oranje, Bob; Abramovic, Lucija;
OBJECTIVE: Schizophrenia is associated with aberrant event-related potentials (ERPs) such as reductions in P300, processing negativity and mismatch negativity amplitudes. These deficits may be related to the propensity of schizophrenia patients to experience auditory verbal hallucinations (AVH). ...
Vita, Maria Gabriella; Batocchi, Anna Paola; Dittoni, Serena; Losurdo, Anna; Cianfoni, Alessandro; Stefanini, Maria Chiara; Vollono, Catello; Della Marca, Giacomo; Mariotti, Paolo
An 11 year-old-boy acutely developed complex visual and acoustic hallucinations. Hallucinations, consisting of visions of a threatening, evil character of the Harry Potter saga, persisted for 3 days. Neurological and psychiatric examinations were normal. Ictal EEG was negative. MRI documented 3 small areas of hyperintense signal in the brainstem, along the paramedian and lateral portions of pontine tegmentum, one of which showed post-contrast enhancement. These lesions were likely of inflammatory origin, and treatment with immunoglobulins was started. Polysomnography was normal, multiple sleep latency test showed a mean sleep latency of 8 minutes, with one sleep-onset REM period. The pontine tegmentum is responsible for REM sleep regulation, and contains definite "REM-on" and "REM-off" regions. The anatomical distribution of the lesions permits us to hypothesize that hallucinations in this boy were consequent to a transient impairment of REM sleep inhibitory mechanisms, with the appearance of dream-like hallucinations during wake.
Johanna C. Badcock
Full Text Available KEY POINTS➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts.➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond.➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood.➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement, highlighting the need for accurate assessment and tailored interventions.Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the
Golden, Erin C; Josephs, Keith A
The phenomenon of musical hallucinations, in which individuals perceive music in the absence of an external auditory stimulus, has been described sparingly in the literature through small case reports and series. Musical hallucinations have been linked to multiple associated conditions, including psychiatric and neurologic disease, brain lesions, drug effect, and hearing impairment. This study aimed to review the demographics of subjects with musical hallucinations and to determine the prevalence of neurological disorders, particularly neurodegenerative disease. Through the Mayo medical record, 393 subjects with musical hallucinations were identified and divided into five categories based on comorbid conditions that have been associated with musical hallucinations: neurological, psychiatric, structural, drug effect and not otherwise classifiable. Variables, including hearing impairment and the presence of visual and other auditory hallucinations, were evaluated independently in all five groups. The mean age at onset of the hallucinations was 56 years, ranging from 18 to 98 years, and 65.4% of the subjects were female. Neurological disease and focal brain lesions were found in 25% and 9% of the total subjects, respectively. Sixty-five subjects were identified with a neurodegenerative disorder, with the Lewy body disorders being the most common. Visual hallucinations were more common in the group with neurological disease compared to the psychiatric, structural, and not otherwise classifiable groups (P musical hallucinations involved both hemispheres with a preference towards the left, and all but two included the temporal lobe. Hearing impairment was common, particularly in the not otherwise classifiable category where 67.2% had documented hearing impairment, more than in any other group (P music, which was often religious and patriotic compared to those with a structural lesion, where more modern music was heard, and those with psychiatric disorders where music was
Lee, Jee-Young; Kim, Jae Min; Ahn, Jeeyun; Kim, Han-Joon; Jeon, Beom S; Kim, Tae Wan
Defective visual information processing from both central and peripheral pathways is one of the suggested mechanisms of visual hallucination in Parkinson's disease (PD). To investigate the role of retinal thinning for visual hallucination in PD, we conducted a case-control study using spectral domain optical coherence tomography. We examined a representative sample of 61 patients with PD and 30 healthy controls who had no history of ophthalmic diseases. General ophthalmologic examinations and optical coherence tomography scans were performed in each participant. Total macular thickness and the thickness of each retinal layer on horizontal scans through the fovea were compared between the groups. In a comparison between patients with PD and healthy controls, there was significant parafoveal inner nuclear layer thinning, whereas other retinal layers, including the retinal nerve fiber layer, as well as total macular thicknesses were not different. In terms of visual hallucinations among the PD subgroups, only retinal nerve fiber layer thickness differed significantly, whereas total macular thickness and the thickness of other retinal layers did not differ. The retinal nerve fiber layer was thinnest in the group that had hallucinations without dementia, followed by the group that had hallucinations with dementia, and the group that had no hallucinations and no dementia. General ophthalmologic examinations did not reveal any significant correlation with hallucinations. There were no significant correlations between retinal thicknesses and duration or severity of PD and medication dosages. The results indicate that retinal nerve fiber layer thinning may be related to visual hallucination in nondemented patients with PD. Replication studies as well as further studies to elucidate the mechanism of thinning are warranted.
Henkin, Robert I.; Potolicchio, Samuel J.; Levy, Lucien M.
Olfactory hallucinations without subsequent myoclonic activity have not been well characterized or understood. Herein we describe, in a retrospective study, two major forms of olfactory hallucinations labeled phantosmias: one, unirhinal, the other, birhinal. To describe these disorders we performed several procedures to elucidate similarities and differences between these processes. From 1272, patients evaluated for taste and smell dysfunction at The Taste and Smell Clinic, Washington, DC wit...
Girard, Todd A
Llewellyn's proposal that rapid eye movement (REM) dreaming reflects elaborative encoding mediated by the hippocampus ("seahorse") offers an interesting perspective for understanding hallucinations accompanying sleep paralysis (SP; "night-mare"). SP arises from anomalous intrusion of REM processes into waking consciousness, including threat-detection systems mediated by the amygdala ("almond"). Unique aspects of SP hallucinations offer additional prospects for investigation of Llewellyn's theory of elaborative encoding.
Kataoka, Hiroshi; Ueno, Satoshi
Abstract Auditory musical hallucinations (AMHs) are rare complex auditory hallucinations in Parkinson's disease (PD) that have been limited previously. The characteristics of AMHs in PD remain uncertain. We describe a 72-year-old woman with PD who presented with AMHs. The AMHs occurred after immediate-release pramipexole was switched to extended-release pramipexole. The AMHs were a quiet piano or often songs on a loud radio or background music over other sounds. The music was unpleasant, but ...
McShane, R.; Gedling, K; Reading, M.; McDonald, B.; Esiri, M M; Hope, T
The presence of hallucinations is included in some, but not all, of the sets of clinical diagnostic criteria that have been proposed for dementia associated with cortical Lewy bodies. These criteria were developed from retrospective casenote analyses. This prospective, longitudinal study suggests that, in patients with Alzheimer's disease, cortical Lewy bodies are associated with more persistent and severe hallucinations, independently of any association with severity of cognitive decline. Po...
Full Text Available Visual hallucinations are a core clinical feature of dementia with Lewy bodies (DLB, and this symptom is important in the differential diagnosis and prediction of treatment response. The pareidolia test is a tool that evokes visual hallucination-like illusions, and these illusions may be a surrogate marker of visual hallucinations in DLB. We created a simplified version of the pareidolia test and examined its validity and reliability to establish the clinical utility of this test.The pareidolia test was administered to 52 patients with DLB, 52 patients with Alzheimer's disease (AD and 20 healthy controls (HCs. We assessed the test-retest/inter-rater reliability using the intra-class correlation coefficient (ICC and the concurrent validity using the Neuropsychiatric Inventory (NPI hallucinations score as a reference. A receiver operating characteristic (ROC analysis was used to evaluate the sensitivity and specificity of the pareidolia test to differentiate DLB from AD and HCs.The pareidolia test required approximately 15 minutes to administer, exhibited good test-retest/inter-rater reliability (ICC of 0.82, and moderately correlated with the NPI hallucinations score (rs = 0.42. Using an optimal cut-off score set according to the ROC analysis, and the pareidolia test differentiated DLB from AD with a sensitivity of 81% and a specificity of 92%.Our study suggests that the simplified version of the pareidolia test is a valid and reliable surrogate marker of visual hallucinations in DLB.
Patel Sachin S
Full Text Available Abstract Background Visual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEI's have been used in the targeted treatment of visual hallucinations in dementia and Parkinson's Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatment Case Presentation We present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully. Conclusions This case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field.
Abbate, Carlo; Trimarchi, Pietro Davide; Inglese, Silvia; Viti, Niccolò; Cantatore, Alessandra; De Agostini, Lisa; Pirri, Federico; Marino, Lorenza; Bagarolo, Renzo
Objective. We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations. Background. Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood. Methods. The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage. Results. The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB. Conclusions. This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder. PMID:24868122
Full Text Available Introduction. Auditory hallucinations are a common symptom experience of individuals with psychotic disorders and are often experienced as persistent, distressing, and disruptive. This case series examined the lived experiences of four individuals treated (successfully or unsuccessfully with low-frequency (1 Hz rTMS for auditory hallucinations. Methods. A phenomenological approach was used and modified to involve some predetermined data structuring to accommodate for expected cognitive impairments of participants and the impact of rTMS on auditory hallucinations. Data on thoughts and feelings in relation to the helpful, unhelpful, and other effects of rTMS on auditory hallucinations, on well-being, functioning, and the immediate environment were collected using semistructured interviews. Results. All four participants noted some improvements in their well-being following treatment and none reported a worsening of their symptoms. Only two participants noted an improvement in the auditory hallucinations and only one of them reported an improvement that was sustained after treatment completion. Conclusion. We suggest that there are useful findings in the study worth further exploration, specifically in relation to the role of an individual’s acceptance and ownership of the illness process in relation to this biomedical intervention. More mixed methods research is required to examine rTMS for auditory hallucinations.
Full Text Available Objective. We describe a case of dementia with Lewy bodies (DLB that presented long-lasting preclinical complex polymodal hallucinations. Background. Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI- DLB is poorly understood. Methods. The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage. Results. The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS. The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB. Conclusions. This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder.
Abid, Hina; Ahmad, Fayyaz; Lee, Soo Y; Park, Hyun W; Im, Dongmi; Ahmad, Iftikhar; Chaudhary, Safee U
Human beings frequently experience fear, phobia, migraine and hallucinations, however, the cerebral mechanisms underpinning these conditions remain poorly understood. Towards this goal, in this work, we aim to correlate the human ocular perceptions with visual hallucinations, and map them to their cerebral origins. An fMRI study was performed to examine the visual cortical areas including the striate, parastriate and peristriate cortex in the occipital lobe of the human brain. 24 healthy subjects were enrolled and four visual patterns including hallucination circle (HCC), hallucination fan (HCF), retinotopy circle (RTC) and retinotopy cross (RTX) were used towards registering their impact in the aforementioned visual related areas. One-way analysis of variance was used to evaluate the significance of difference between induced activations. Multinomial regression and and K-means were used to cluster activation patterns in visual areas of the brain. Significant activations were observed in the visual cortex as a result of stimulus presentation. The responses induced by visual stimuli were resolved to Brodmann areas 17, 18 and 19. Activation data clustered into independent and mutually exclusive clusters with HCC registering higher activations as compared to HCF, RTC and RTX. We conclude that small circular objects, in rotation, tend to leave greater hallucinating impressions in the visual region. The similarity between observed activation patterns and those reported in conditions such as epilepsy and visual hallucinations can help elucidate the cortical mechanisms underlying these conditions. Trial Registration 1121_GWJUNG.
Berry, Katherine; Bucci, Sandra; Kinderman, Peter; Emsley, Richard; Corcoran, Rhiannon
This study assessed associations between attributional style and ToM measures in patients with paranoid symptoms and non-clinical controls, as well associations between these aspects of social cognition and executive skills. Using a longitudinal design, we further assessed performance on measures following the remission of paranoid symptoms. Patients and controls completed the Internal Personal and Situational Attributions Questionnaire (IPSAQ), ToM tasks, the Stroop, the modified Wisconsin Card Sorting Test (WCST) and a measure of premorbid IQ at time one. Following the remission of paranoid symptoms, the patient group repeated the assessment process. Patients had a higher personalising bias for negative events and impairments in second order false belief and executive skills compared to control participants. Personalising bias for negative events was associated with poorer IQ, a tendency to make perseverative errors, a poorer performance on the second order false belief task and more severe symptoms. Personalising bias for negative events, performance on the second order false belief task or the tendency to make perseverative errors did not significantly change following symptom remission. The findings increase understanding of the mechanisms that potentially underpin the development and maintenance of paranoia. Specifically targeting personalising attributions for negative events in remitted patients may be an important goal of psychological therapy.
Valiente, Carmen; Provencio, Maria; Espinosa, Regina; Duque, Almudena; Everts, Franziska
Evidence suggests that insight in psychosis has been related to treatment adherence, recovery and good prognosis, but also to depression, low self-esteem, and diminished quality of life. Thus, insight might not be advantageous under all circumstances. Internalized-stigma (i.e. self-acceptance of stigmatizing images of illness) and experiential avoidance (i.e. unwillingness to experience negative private events) have been proposed as moderating variables between insight, and psychological health variables and/or distress. We investigated the patterns of association of insight with satisfaction with life, self-esteem, depression, anxiety and psychotic psychopathology as moderated by self-stigmatizing beliefs and experiential avoidance, in a sample of 47 participants with persecutory beliefs and diagnosed with schizophrenia or other psychotic disorder. Moderation analyses confirm the importance of internalized-stigma and experiential avoidance. The presence of insight was associated with more depression when there were high levels of self-stigma. Whereas, the absence of insight was associated with a greater life satisfaction when there were high levels of experiential avoidance. To summarize, our results help understand the complex relationship between insight, psychological health variables and emotional distress, pointing to a differential pattern of moderation for negative and positive outcomes. We discuss the implications of these results for research and treatment of paranoia.
Trémeau, Fabien; Antonius, Daniel; Todorov, Alexander; Rebani, Yasmina; Ferrari, Kelsey; Lee, Sang Han; Calderone, Daniel; Nolan, Karen A; Butler, Pamela; Malaspina, Dolores; Javitt, Daniel C
Although social cognition deficits have been associated with schizophrenia, social trait judgments - or first impressions - have rarely been studied. These first impressions, formed immediately after looking at a person's face, have significant social consequences. Eighty-one individuals with schizophrenia or schizoaffective disorder and 62 control subjects rated 30 neutral faces on 10 positive or negative traits: attractive, mean, trustworthy, intelligent, dominant, fun, sociable, aggressive, emotionally stable and weird. Compared to controls, patients gave higher ratings for positive traits as well as for negative traits. Patients also demonstrated more ambivalence in their ratings. Patients who were exhibiting paranoid symptoms assigned higher intensity ratings for positive social traits than non-paranoid patients. Social trait ratings were negatively correlated with everyday problem solving skills in patients. Although patients appeared to form impressions of others in a manner similar to controls, they tended to assign higher scores for both positive and negative traits. This may help explain the social deficits observed in schizophrenia: first impressions of higher degree are harder to correct, and ambivalent attitudes may impair the motivation to interact with others. Consistent with research on paranoia and self-esteem, actively-paranoid patients' positive social traits judgments were of higher intensity than non-paranoid patients'. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Gromann, Paula M; Heslenfeld, Dirk J; Fett, Anne-Kathrin; Joyce, Dan W; Shergill, Sukhi S; Krabbendam, Lydia
Psychosis is characterized by an elementary lack of trust in others. Trust is an inherently rewarding aspect of successful social interactions and can be examined using neuroeconomic paradigms. This study was aimed at investigating the underlying neural basis of diminished trust in psychosis. Functional magnetic resonance imaging data were acquired from 20 patients with psychosis and 20 healthy control subjects during two multiple-round trust games; one with a cooperative and the other with a deceptive counterpart. An a priori region of interest analysis of the right caudate nucleus, right temporo-parietal junction and medial prefrontal cortex was performed focusing on the repayment phase of the games. For regions with group differences, correlations were calculated between the haemodynamic signal change, behavioural outcomes and patients' symptoms. Patients demonstrated reduced levels of baseline trust, indicated by smaller initial investments. For the caudate nucleus, there was a significant game × group interaction, with controls showing stronger activation for the cooperative game than patients, and no differences for the deceptive game. The temporo-parietal junction was significantly more activated in control subjects than in patients during cooperative and deceptive repayments. There were no significant group differences for the medial prefrontal cortex. Patients' reduced activation within the caudate nucleus correlated negatively with paranoia scores. The temporo-parietal junction signal was positively correlated with positive symptom scores during deceptive repayments. Reduced sensitivity to social reward may explain the basic loss of trust in psychosis, mediated by aberrant activation of the caudate nucleus and the temporo-parietal junction.
Full Text Available Auditory hallucination is a positive symptom of schizophrenia and has significant impacts on the lives of individuals. People with auditory hallucination require considerable assistance from mental health professionals. Apart from medications, they may apply different lay methods to cope with their voice hearing. Results from qualitative interviews showed that people with schizophrenia in the Chinese sociocultural context of Hong Kong were coping with auditory hallucination in different ways, including (a changing social contacts, (b manipulating the voices, and (c changing perception and meaning towards the voices. Implications for recovery from psychiatric illness of individuals with auditory hallucinations are discussed.
Ford, Judith M
In this paper, I explain why I adopted a Research Domain Criteria (RDoC) approach to study the neurobiology of auditory verbal hallucinations (AVH), or voices. I explain that the RDoC construct of "agency" fits well with AVH phenomenology. To the extent that voices sound nonself, voice hearers lack a sense of agency over the voices. Using a vocalization paradigm like those used with nonhuman primates to study mechanisms subserving the sense of agency, we find that the auditory N1 ERP is suppressed during vocalization, that EEG synchrony preceding speech onset is related to N1 suppression, and that both are reduced in patients with schizophrenia. Reduced cortical suppression is also seen across multiple psychotic disorders and in clinically high-risk youth, but it is not related to AVH. The motor activity preceding talking and connectivity between frontal and temporal lobes during talking have both proved sensitive to AVH, suggesting neural activity and connectivity associated with intentions to act may be a better way to study agency and predictions based on agency.
Steenhuis, Laura A; Bartels-Velthuis, Agna A; Jenner, Jack A; Aleman, André; Bruggeman, Richard; Nauta, Maaike H; Pijnenborg, Gerdina H M
The current exploratory study examined the associations between auditory vocal hallucinations (AVH) and delusions and religiosity in young adolescents. 337 children from a population-based case-control study with and without AVH, were assessed after five years at age 12 and 13, on the presence and appraisal of AVH, delusions and religiosity. AVH status (persistent, remittent, incident or control) was examined in relationship to religiosity. Results demonstrated a non-linear association between AVH and religiosity. Moderately religious adolescents were more likely to report AVH than non-religious adolescents (O.R.=2.6). Prospectively, moderately religious adolescents were more likely to have recently developed AVH than non-religious adolescents (O.R.=3.6) and strongly religious adolescents (O.R.=7.9). Of the adolescents reporting voices in this sample (16.3%), more than half reported positive voices. Religious beliefs were often described as supportive, useful or neutral (82%), regardless of the level of religiosity, for both adolescents with and without AVH. Co-occurrence of AVH and delusions, and severity of AVH were not related to religiosity. The present findings suggest there may be a non-linear association between religiosity and hearing voices in young adolescents. A speculative explanation may be that religious practices were adopted in response to AVH as a method of coping. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Santos, Rosa Maria Rodrigues dos
Full Text Available Introduction: Over the last few years, our Tinnitus Research Group has identified an increasing number of patients with tinnitus who also complained of repeated perception of complex sounds, such as music and voices. Such hallucinatory phenomena motivated us to study their possible relation to the patients' psyches. Aims: To assess whether hallucinatory phenomena were related to the patients' psychosis and/or depression, and clarify their content and function in the patients' psyches. Method: Ten subjects (8 women; mean age = 65.7 years were selected by otolaryngologists and evaluated by the same psychologists through semi-structured interviews, the Hamilton Depression Rating Scale, and psychoanalysis interviews. Results: We found no association between auditory hallucinations and psychosis; instead, this phenomenon was associated with depressive aspects. The patients' discourse revealed that hallucinatory phenomena played unconscious roles in their emotional life. In all cases, there was a remarkable and strong tendency to recall/repeat unpleasant facts/situations, which tended to exacerbate the distress caused by the tinnitus and hallucinatory phenomena and worsen depressive aspects. Conclusions: There is an important relationship between tinnitus, hallucinatory phenomena, and depression based on persistent recall of facts/situations leading to psychic distress. The knowledge of such findings represents a further step towards the need to adapt the treatment of this particular subgroup of tinnitus patients through interdisciplinary teamwork. Prospective.
Park, Hee Kyung; Kim, Jae Seung; Im, Ki Chun; Kim, Mi Jung; Lee, Jae-Hong; Lee, Myoung C; Kim, Juhan; Chung, Sun Ju
Visual hallucination (VH) is a common psychotic symptom in patients with Parkinson's disease (PD) and may be a significant predictor of cognitive impairment (CI) in such patients. This study aimed to investigate the pattern of glucose metabolism of VH and the relationship between VH and CI in PD. We studied 28 PD patients, including 15 with VH (PD-VH) and 13 without VH (PD-NVH). Of the 15 PD-VH patients, 8 patients had cognitive impairment (PD-VHCI) whereas 7 did not (PD-VHNCI). All patients underwent [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) followed by statistical parametric mapping (SPM) analyses. Compared to the patients with PDNVH, PD-VHNCI patients showed glucose hypometabolism in the inferior and middle temporal cortices, fusiform gyri, and frontal areas, suggesting the involvement of the ventral visual pathway. Compared to the patients with PDNVH, PD-VHCI patients showed glucose hypometabolism in the temporoparietal association cortices with scattered frontal areas. Dysfunction of ventral visual pathway involving the temporal lobe may play a key role in VH development in PD patients. The evolving distribution from the ventral visual pathway to more extensive posterior cortices in PD-VHCI patients suggests that VH may be a prodromal symptom occurring prior to CI in PD patients.
Raidoo B Mahendri
Full Text Available Abstract Introduction Varenicline is widely used for smoking cessation. It has shown efficacy over placebo and bupropion in manufacturer-sponsored trials. Those with mental illness were excluded from these trials. There are case reports of exacerbation of mental illness and development of psychiatric symptoms with varenicline use. Case presentation A 61-year-old male Caucasian being treated for post-traumatic stress disorder, depression not otherwise specified and alcohol dependence, was prescribed varenicline while he was in a post-traumatic stress disorder/alcohol dual diagnosis treatment program. He developed visual hallucinations, which became worse with titration of the medication. These symptoms resolved upon discontinuation of varenicline. Conclusion Patients with mental illness have a higher incidence of nicotine dependence, and attempts should be made for smoking cessation. Varenicline has not been widely tested in this population. There are reports of exacerbation of mental illness, and probable causation of psychiatric symptoms in the mentally ill. Providers should be aware of this possibility and advise their patients appropriately.
Mørch-Johnsen, Lynn; Nesvåg, Ragnar; Jørgensen, Kjetil N; Lange, Elisabeth H; Hartberg, Cecilie B; Haukvik, Unn K; Kompus, Kristiina; Westerhausen, René; Osnes, Kåre; Andreassen, Ole A; Melle, Ingrid; Hugdahl, Kenneth; Agartz, Ingrid
Neuroimaging studies have demonstrated associations between smaller auditory cortex volume and auditory hallucinations (AH) in schizophrenia. Reduced cortical volume can result from a reduction of either cortical thickness or cortical surface area, which may reflect different neuropathology. We investigate for the first time how thickness and surface area of the auditory cortex relate to AH in a large sample of schizophrenia spectrum patients. Schizophrenia spectrum (n = 194) patients underwent magnetic resonance imaging. Mean cortical thickness and surface area in auditory cortex regions (Heschl's gyrus [HG], planum temporale [PT], and superior temporal gyrus [STG]) were compared between patients with (AH+, n = 145) and without (AH-, n = 49) a lifetime history of AH and 279 healthy controls. AH+ patients showed significantly thinner cortex in the left HG compared to AH- patients (d = 0.43, P = .0096). There were no significant differences between AH+ and AH- patients in cortical thickness in the PT or STG, or in auditory cortex surface area in any of the regions investigated. Group differences in cortical thickness in the left HG was not affected by duration of illness or current antipsychotic medication. AH in schizophrenia patients were related to thinner cortex, but not smaller surface area of the left HG, a region which includes the primary auditory cortex. The results support that structural abnormalities of the auditory cortex underlie AH in schizophrenia. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Donovan, Nancy J; Wadsworth, Lauren P; Lorius, Natacha; Locascio, Joseph J; Rentz, Dorene M; Johnson, Keith A; Sperling, Reisa A; Marshall, Gad A
To examine regions of cortical thinning and cerebrospinal fluid (CSF) Alzheimer disease (AD) biomarkers associated with apathy and hallucinations in a continuum of individuals including clinically normal elderly, mild cognitive impairment, and mild AD dementia. Cross-sectional and longitudinal studies. Fifty-seven research sites across North America. Eight-hundred twelve community-dwelling volunteers; 413 participants in the CSF sub-study. Structural magnetic resonance imaging data and CSF concentrations of amyloid-β 1-42, total tau, and phosphorylated tau derived from the Alzheimer Disease Neuroimaging Initiative database were analyzed. Apathy and hallucinations were measured at baseline and over 3 years using the Neuropsychiatric Inventory-Questionnaire. General linear models and mixed effects models were used to evaluate the relationships among baseline cortical thickness in seven regions, and baseline CSF biomarkers, apathy, and hallucinations at baseline and longitudinally. Covariates included diagnosis, sex, age, apolipoprotein E genotype, premorbid intelligence, memory performance, processing speed, antidepressant use, and AD duration. Reduced baseline inferior temporal cortical thickness was predictive of increasing apathy over time, and reduced supramarginal cortical thickness was predictive of increasing hallucinations over time. There was no association with cortical thickness at baseline. CSF biomarkers were not related to severity of apathy or hallucinations in cross-sectional or longitudinal analyses. These results suggest that greater baseline temporal and parietal atrophy is associated with worsening apathy and hallucinations in a large AD spectrum cohort, while adjusting for multiple disease-related variables. Localized cortical neurodegeneration may contribute to the pathophysiology of apathy and hallucinations and their adverse consequences in AD. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All
Cochen, V; Arnulf, I; Demeret, S; Neulat, M L; Gourlet, V; Drouot, X; Moutereau, S; Derenne, J P; Similowski, T; Willer, J C; Pierrot-Deseiligny, C; Bolgert, F
We conducted a prospective controlled study of the clinical and biological determinants of the mental status abnormalities in 139 patients with Guillain-Barré syndrome (GBS) and 55 patients without GBS placed in the intensive care unit (ICU controls). There were mental status changes in 31% of GBS patients and in 16% of controls (odds ratio = 2.3; P = 0.04). In GBS patients, they included vivid dreams (19%), illusions (30%, including an illusory body tilt), hallucinations (60%, mainly visual) and delusions (70%, mostly paranoid). They appeared a median 9 days after disease onset (range 1-40 days, during the progression or the plateau of the disease), and lasted a median 8 days. Seven (16%) patients experienced the symptoms before their admission to the ICU. Hallucinations were frequently hypnagogic, occurring as soon as the patients closed their eyes. Autonomic dysfunction, assisted ventilation and high CSF protein levels were significant risk factors for abnormal mental status in GBS patients. CSF hypocretin-1 (a hypothalamic neuropeptide deficient in narcolepsy) levels, measured in 20 patients, were lower in GBS patients with hallucinations (555 +/- 132 pg/ml) than in those without (664 +/- 71 pg/ml, P = 0.03). Since the mental status abnormalities had dream-like aspects, we examined their association with rapid eye movement sleep (REM sleep) using continuous sleep monitoring in 13 GBS patients with (n = 7) and without (n = 6) hallucinations and 6 tetraplegic ICU controls without hallucinations. Although sleep was short and fragmented in all groups, REM sleep latency was shorter in GBS patients with hallucinations (56 +/- 115 min) than in GBS patients without hallucinations (153 +/- 130 min) and in controls (207 +/- 179 min, P dreams caused by a sleep and dream-associated disorder (status dissociatus).
Donovan, Nancy J.; Wadsworth, Lauren P.; Lorius, Natacha; Locascio, Joseph J.; Rentz, Dorene M.; Johnson, Keith A.; Sperling, Reisa A.; Marshall, Gad A.
Objectives To examine regions of cortical thinning and cerebrospinal fluid (CSF) Alzheimer’s disease (AD) biomarkers associated with apathy and hallucinations in a continuum of individuals including clinically normal elderly, mild cognitive impairment and mild AD dementia. Design Cross-sectional and longitudinal studies. Setting 57 research sites across North America. Participants 812 community dwelling volunteers; 413 participants in the CSF sub-study. Measurements Structural magnetic resonance imaging data and CSF concentrations of amyloid-β 1-42, total tau and phosphorylated tau derived from the Alzheimer’s Disease Neuroimaging Initiative database were analyzed. Apathy and hallucinations were measured at baseline and over 3 years using the Neuropsychiatric Inventory-Questionnaire. General linear models and mixed effects models were used to evaluate the relationships among baseline cortical thickness in 7 regions, baseline CSF biomarkers and apathy and hallucinations at baseline and longitudinally. Covariates included diagnosis, gender, age, Apolipoprotein E genotype, premorbid intelligence, memory performance, processing speed, antidepressant use, and AD duration. Results Reduced baseline inferior temporal cortical thickness was predictive of increasing apathy over time, while reduced supramarginal cortical thickness was predictive of increasing hallucinations over time. There was no association with cortical thickness at baseline. CSF biomarkers were not related to severity of apathy or hallucinations in cross-sectional or longitudinal analyses. Conclusions These results suggest that greater baseline temporal and parietal atrophy is associated with worsening apathy and hallucinations in a large AD spectrum cohort, while adjusting for multiple disease-related variables. Localized cortical neurodegeneration may contribute to the pathophysiology of apathy and hallucinations and their adverse consequences in AD. PMID:23890751
Coy, Abbie L; Hutton, Samuel B
It has been suggested that certain types of auditory hallucinations may be the by-product of a perceptual system that has evolved to be oversensitive to threat-related stimuli. People with schizophrenia and high schizotypes experience visual as well as auditory hallucinations, and have deficits in processing facial emotions. We sought to determine the relationship between visual hallucination proneness and the tendency to misattribute threat and non-threat related emotions to neutral faces. Participants completed a questionnaire assessing visual hallucination proneness (the Revised Visual Hallucination Scale - RVHS). High scoring individuals (N=64) were compared to low scoring individuals (N=72) on a novel emotion detection task. The high RVHS group made more false positive errors (ascribing emotions to neutral faces) than the low RVHS group, particularly when detecting threat-related emotions. All participants made more false positives when neutral faces were presented to the right visual field than to the left visual field. Our results support continuum models of visual hallucinatory experience in which tolerance for false positives is highest for potentially threatening emotional stimuli and suggest that lateral asymmetries in face processing extend to the misperception of facial emotion.
Modinos, Gemma; Vercammen, Ans; Mechelli, Andrea; Knegtering, Henderikus; McGuire, Philip K.; Aleman, André
Background Neuroimaging studies have indicated that a number of cortical regions express altered patterns of structural covariance in schizophrenia. The relation between these alterations and specific psychotic symptoms is yet to be investigated. We used voxel-based morphometry to examine regional grey matter volumes and structural covariance associated with severity of auditory verbal hallucinations. Methods We applied optimized voxel-based morphometry to volumetric magnetic resonance imaging data from 26 patients with medication-resistant auditory verbal hallucinations (AVHs); statistical inferences were made at p < 0.05 after correction for multiple comparisons. Results Grey matter volume in the left inferior frontal gyrus was positively correlated with severity of AVHs. Hallucination severity influenced the pattern of structural covariance between this region and the left superior/middle temporal gyri, the right inferior frontal gyrus and hippocampus, and the insula bilaterally. Limitations The results are based on self-reported severity of auditory hallucinations. Complementing with a clinician-based instrument could have made the findings more compelling. Future studies would benefit from including a measure to control for other symptoms that may covary with AVHs and for the effects of antipsychotic medication. Conclusion The results revealed that overall severity of AVHs modulated cortical intercorrelations between frontotemporal regions involved in language production and verbal monitoring, supporting the critical role of this network in the pathophysiology of hallucinations. PMID:19949723
Rominger, Christian; Bleier, Angelika; Fitz, Werner; Marksteiner, Josef; Fink, Andreas; Papousek, Ilona; Weiss, Elisabeth M
Social cognitive impairments may represent a core feature of schizophrenia and above all are a strong predictor of positive psychotic symptoms. Previous studies could show that reduced inhibitory top-down control contributes to deficits in theory of mind abilities and is involved in the genesis of hallucinations. The current study aimed to investigate the relationship between auditory inhibition, affective theory of mind and the experience of hallucinations in patients with schizophrenia. In the present study, 20 in-patients with schizophrenia and 20 healthy controls completed a social cognition task (the Reading the Mind in the Eyes Test) and an inhibitory top-down Dichotic Listening Test. Schizophrenia patients with greater severity of hallucinations showed impaired affective theory of mind as well as impaired inhibitory top-down control. More dysfunctional top-down inhibition was associated with poorer affective theory of mind performance, and seemed to mediate the association between impairment to affective theory of mind and severity of hallucinations. The findings support the idea of impaired theory of mind as a trait marker of schizophrenia. In addition, dysfunctional top-down inhibition may give rise to hallucinations and may further impair affective theory of mind skills in schizophrenia.
Ana Maria Galdini Raimundo Oda
Este artigo apresenta o texto de Kraepelin sobre a paranoia, extraído da sétima edição de seu tratado de psiquiatria (1904), traduzido para o português e publicado pela primeira vez em 1905, na revista Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins. Indica-se a posição desta categoria na nosologia de Kraepelin, bem como se discute aspectos da difusão de suas ideias no Brasil.
Ana Maria Galdini Raimundo Oda
Full Text Available Este artigo apresenta o texto de Kraepelin sobre a paranoia, extraído da sétima edição de seu tratado de psiquiatria (1904, traduzido para o português e publicado pela primeira vez em 1905, na revista Arquivos Brasileiros de Psiquiatria, Neurologia e Ciências Afins. Indica-se a posição desta categoria na nosologia de Kraepelin, bem como se discute aspectos da difusão de suas ideias no Brasil.
Full Text Available BACKGROUND: Phantom vibration syndrome is a type of hallucination reported among mobile phone users in the general population. Another similar perception, phantom ringing syndrome, has not been previously described in the medical literature. METHODS: A prospective longitudinal study of 74 medical interns (46 males, 28 females; mean age, 24.8±1.2 years was conducted using repeated investigations of the prevalence and associated factors of phantom vibration and ringing. The accompanying symptoms of anxiety and depression were evaluated with the Beck Anxiety and Depression Inventories before the internship began, and again at the third, sixth, and twelfth internship months, and two weeks after the internship ended. RESULTS: The baseline prevalence of phantom vibration was 78.1%, which increased to 95.9% and 93.2% in the third and sixth internship months. The prevalence returned to 80.8% at the twelfth month and decreased to 50.0% 2 weeks after the internship ended. The baseline prevalence of phantom ringing was 27.4%, which increased to 84.9%, 87.7%, and 86.3% in the third, sixth, and twelfth internship months, respectively. This returned to 54.2% two weeks after the internship ended. The anxiety and depression scores also increased during the internship, and returned to baseline two weeks after the internship. There was no significant correlation between phantom vibration/ringing and symptoms of anxiety or depression. The incidence of both phantom vibration and ringing syndromes significantly increased during the internship, and subsequent recovery. CONCLUSION: This study suggests that phantom vibration and ringing might be entities that are independent of anxiety or depression during evaluation of stress-associated experiences during medical internships.
E.J.O. Kompanje (Erwin)
textabstractHypnagogic and hypnopompic hallucinations are visual, tactile, auditory or other sensory events, usually brief but sometimes prolonged, that occur at the transition from wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic). Hypnagogic and hypnopompic hallucination
Jose Escarti, Maria; de la Iglesia-Vaya, Maria; Marti-Bonmati, Luis; Robles, Montserrat; Carbonell, Jose; Jose Lull, Juan; Garcia-Marti, Gracian; Vicente Manjon, Jose; Jesus Aguilar, Eduardo; Aleman, Andre; Sanjuan, Julio
Objective: Hallucinations in patients with schizophrenia have strong emotional connotations. Functional neuroimaging techniques have been widely used to study brain activity in patients with schizophrenia with hallucinations or emotional impairments. However, few of these Studies have investigated t
Johnston, Olwyn; Gallagher, Anthony G; McMahon, Patrick J; King, David J
This article presents preliminary findings from the first participant to complete an experiment assessing the efficacy of the personal stereo in treating auditory hallucinations. O.C., a 50-year-old woman, took part in a controlled treatment trial in which 1-week baseline, personal stereo, and control treatment (nonfunctioning hearing aid) stages were alternated for 7 weeks. The Positive and Negative Syndrome Scale, Clinical Global Impression Scales, Beliefs About Voices Questionnaire, Rosenberg Self-Esteem Scale, and Topography of Voices Rating Scale were used. The personal stereo led to a decrease in the severity of O.C.'s auditory hallucinations. For example, she rated her voices as being fairly distressing during baseline and control treatment stages but neutral during personal stereo stages. A slight decrease in other psychopathology also occurred during personal stereo stages. Use of the personal stereo did not lead to a decrease in self-esteem, contradicting suggestions that counterstimulation treatments for auditory hallucinations may be disempowering.
Cheyne, J Allan; Girard, Todd A
Previously we reported a three-factor structure for hallucinations accompanying sleep paralysis (SP). These earlier analyses were, however, based on retrospective accounts. In a prospective study, 383 individuals reported individual episodes online providing further evidence for the three-factor structure as well as clearer conceptually meaningful relations among factors than retrospective studies. In addition, reports of individual episodes permitted a more fine-grained analysis of the internal structure of factors to assess predictions based on the hypothesis that a sensed or felt presence (FP) is a core experience affecting other SP hallucinations. Results were generally consistent with this hypothesis. In particular, associations among, and temporal stability of, sensory hallucinations were largely explained by their common association with FP. The findings are consistent with REM initiation of a threat activated vigilance system with pervasive effects on the SP experience and suggest a potential model for the thematic organization of nightmares and dreams more generally.
Bleich-Cohen, Maya; Hendler, Talma; Pashinian, Artashes; Faragian, Sarit; Poyurovsky, Michael
Obsessive-compulsive symptoms (OCS) are relatively common and clinically significant phenomena in schizophrenia patients, suggesting the existence of a separate schizo-obsessive subgroup of the disorder. Although a majority of schizo-obsessive patients have typical ego-dystonic OCS, a meaningful proportion exhibits diagnostically challenging psychopathological phenomena, psychotic in content and obsessive in form. We report the clinical and functional magnetic resonance imaging characteristics of a schizophrenia patient who developed auditory hallucinations with musical content and obsessive in form. We suggest that "obsessive musical hallucinations", that integrate both psychotic and obsessive-compulsive disorder (OCD)-related features, may be mediated by the brain networks believed to be involved in OCD and in auditory musical hallucinations.
Kataoka, Hiroshi; Ueno, Satoshi
Auditory musical hallucinations (AMHs) are rare complex auditory hallucinations in Parkinson's disease (PD) that have been limited previously. The characteristics of AMHs in PD remain uncertain. We describe a 72-year-old woman with PD who presented with AMHs. The AMHs occurred after immediate-release pramipexole was switched to extended-release pramipexole. The AMHs were a quiet piano or often songs on a loud radio or background music over other sounds. The music was unpleasant, but not objectionable, threatening, or ego-syntonic, and it did not interrupt her daily activities. AMHs in PD were non-threatening, and dopaminergic treatment may predispose patients to AMHs or be a unique possible cause of AMHs. The hallucinations can occur after immediate-release pramipexole was switched to extended-release pramipexole.
Sanjuan, Julio; Lull, Juan J; Aguilar, Eduardo J; Martí-Bonmatí, Luis; Moratal, David; Gonzalez, José C; Robles, Montserrat; Keshavan, Matcheri S
Neuroimaging studies of emotional response in schizophrenia have mainly used visual (faces) paradigms and shown globally reduced brain activity. None of these studies have used an auditory paradigm. Our principal aim is to evaluate the emotional response of patients with schizophrenia to neutral and emotional words. An auditory emotional paradigm based on the most frequent words heard by psychotic patients with auditory hallucinations was designed. This paradigm was applied to evaluate cerebral activation with functional magnetic resonance imaging (fMRI) in 11 patients with schizophrenia with persistent hallucinations and 10 healthy subjects. We found a clear enhanced activity of the frontal lobe, temporal cortex, insula, cingulate, and amygdala (mainly right side) in patients when hearing emotional words in comparison with controls. Our findings are consistent with other studies suggesting a relevant role for emotional response in the pathogenesis and treatment of auditory hallucinations.
Vercammen, Ans; Knegtering, Henderikus; Liemburg, Edith J.; den Boer, Johannes A.; Aleman, Andre
Auditory-verbal hallucinations are a hallmark symptom of schizophrenia. In recent years, repetitive transcranial magnetic stimulation (rTMS) targeting speech perception areas has been advanced as a potential treatment of medication-resistant hallucinations. However, the underlying neural processes r
Patel Sachin S
Full Text Available Abstract Background Visual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinson's disease and schizophrenia. The lifetime prevalence of visual hallucinations in patients with schizophrenia is much more common than conventionally thought and ranges from 24% to 72%. Cortical acetylcholine (ACh depletion has been associated with visual hallucinations; the level of depletion being related directly to the severity of the symptoms. Current understanding of neurobiological visual processing and research in diseases with reduced cholinergic function, suggests that AChEI's may prove beneficial in treating visual hallucinations. This offers the potential for targeted drug therapy of clinically symptomatic visual hallucinations in patients with schizophrenia using acetylcholinesterase inhibition. Methods A systematic review was carried out investigating the evidence for the effects of AChEI's in treating visual hallucinations in Schizophrenia. Results No evidence was found relating to the specific role of AChEI's in treating visual hallucinations in this patient group. Discussion Given the use of AChEI's in targeted, symptom specific treatment in other neuropsychiatric disorders, it is surprising to find no related literature in schizophrenia patients. The use of AChEI's in schizophrenia has investigated effects on cognition primarily with non cognitive effects measured more broadly. Conclusions We would suggest that more focused research into the effects of AChEI's on positive symptoms of schizophrenia, specifically visual hallucinations, is needed.
Borelli, Paolo; Vedovello, Marcella; Braga, Massimiliano; Pederzoli, Massimo; Beretta, Sandro
Musical hallucination is a disorder of complex sound processing of instrumental music, songs, choirs, chants, etc. The underlying pathologies include moderate to severe acquired hearing loss (the auditory equivalent of Charles Bonnet syndrome), psychiatric illnesses (depression, schizophrenia), drug intoxication (benzodiazepines, salicylate, pentoxifylline, propranolol), traumatic lesions along the acoustic pathways, and epilepsy. The hallucinations are most likely to begin late in life; 70% of patients are women. Musical hallucination has no known specific therapy. Treating the underlying cause is the most effective approach; neuroleptic and antidepressant medications have only rarely succeeded.Musical hallucination in epilepsy typically presents as simple partial seizures originating in the lateral temporal cortex. To our knowledge, no formal report of musical hallucination in the interictal state has been published before. In contrast, other interictal psychotic features are a relatively common complication, especially in patients with long-standing drug-resistant epilepsy.We describe a 62-year-old woman with a long history of mesial temporal lobe epilepsy whose musical hallucination was solely interictal. We speculate on the possible link between temporal epilepsy and her hallucination. We hypothesize that, as a result of her epileptic activity-induced damage, an imbalance developed between the excitatory and inhibitory projections connecting the mesial temporal cortex to the other auditory structures. These structures may have generated hyperactivity in the lateral temporal cortex through a "release" mechanism that eventually resulted in musical hallucination.
Kalaitzakis, M E; Christian, L M; Moran, L B; Graeber, M B; Pearce, R K B; Gentleman, S M
The pathological basis of dementia and visual hallucinations in Parkinson's disease (PD) is not yet fully understood. To investigate this further we have conducted a clinico-pathological study based on 30 post-mortem PD brains. PD cases were stratified into groups according to clinical characteristics as follows: (1) cognitively intact (n=9); (2) cases with severe dementia and visual hallucinations (n=12); (3) cases with severe dementia and no visual hallucinations (n=4); and (4) cases with severe visual hallucinations and no dementia (n=5). The extent of alpha-synuclein (alphaSyn), tau and amyloid beta peptide (Abeta) deposition was then examined in the CA2 sector of the hippocampus and in neocortical and subcortical areas known to subserve cognitive function. We find that dementia in PD is significantly associated with alphaSyn in the anterior cingulate gyrus, superior frontal gyrus, temporal cortex, entorhinal cortex, amygdaloid complex and CA2 sector of the hippocampus. Abeta in the anterior cingulate gyrus, entorhinal cortex, amygdaloid complex and nucleus basalis of Meynert is also associated with dementia as is tau in the CA2 sector of the hippocampus. alphaSyn burden in the amygdala is strongly related to the presence of visual hallucinations but only in those PD cases with concomitant dementia. Statistical analysis revealed that alphaSyn burden in the anterior cingulate gyrus could differentiate demented from non-demented PD cases with high sensitivity and specificity. We conclude that alphaSyn in limbic regions is related to dementia in PD as well as to visual hallucinations when there is an underlying dementia.
Meppelink, Anne Marthe; de Jong, Bauke M; Renken, Remco; Leenders, Klaus L; Cornelissen, Frans W; van Laar, Teus
Impaired visual processing may play a role in the pathophysiology of visual hallucinations in Parkinson's disease. In order to study involved neuronal circuitry, we assessed cerebral activation patterns both before and during recognition of gradually revealed images in Parkinson's disease patients with visual hallucinations (PDwithVHs), Parkinson's disease patients without visual hallucinations (PDnonVHs) and healthy controls. We hypothesized that, before image recognition, PDwithVHs would show reduced bottom-up visual activation in occipital-temporal areas and increased (pre)frontal activation, reflecting increased top-down demand. Overshoot of the latter has been proposed to play a role in generating visual hallucinations. Nine non-demented PDwithVHs, 14 PDnonVHs and 13 healthy controls were scanned on a 3 Tesla magnetic resonance imaging scanner. Static images of animals and objects gradually appearing out of random visual noise were used in an event-related design paradigm. Analyses were time-locked on the moment of image recognition, indicated by the subjects' button-press. Subjects were asked to press an additional button on a colour-changing fixation dot, to keep attention and motor action constant and to assess reaction times. Data pre-processing and statistical analysis were performed with statistical parametric mapping-5 software. Bilateral activation of the fusiform and lingual gyri was seen during image recognition in all groups (P visual cortices was seen just before image recognition in PDwithVHs. The association between increased vulnerability for visual hallucinations in Parkinson's disease and impaired visual object processing in occipital and temporal extrastriate visual cortices supported the hypothesis of impaired bottom-up visual processing in PDwithVHs. Support for the hypothesized increased top-down frontal activation was not obtained. The finding of activation reductions in ventral/lateral visual association cortices in PDwithVHs before
Focseneanu, BE; Marian, G
Background. Musical hallucinations occur in individuals with and without mental illness, and many patients tend to have intact reality testing. Although literature on musical hallucinations is limited, they have been associated with hearing abnormalities, adverse effects of pharmacological agents, female gender, advances in age and psychiatric illness. Aim. To present the psychiatric management of a case of an old female patient, who suddenly developed verbal and musical hallucinations with a pervasive impact on her daily activities. Method. Female, 71 years old, developed verbal and musical hallucinations 6 months before that have intensified later. She was known with bilateral hypoacusia starting with the age of 45, and magnetic resonance imaging performed 1 year before proved multiple lacunar infarcts. Because of the persistence, most of the time of these auditory hallucinations, the patient experienced pervasive difficulties with her major areas of activities. She was referred to a psychiatric department for evaluation and treatment. Results. The psychiatric consult revealed neither a depressive relapse, nor a mild cognitive impairment, and obsessive-compulsive disorder was suspected with intrusive obsessions. Patient received, as antiobsessional augmentation escitalopram 10mg/ day, an atypical antipsychotic, risperidone, which at 3 mg/ day induced extrapyramidal symptoms and cognitive impairment. Therefore, the dose of risperidone was reduced, extrapyramidal symptoms disappeared, and 300mg/ day of acidum valproicum was initiated. Discussion. Our patient presented with diminished sensory input to the auditory cortex, and it was hard to make a differential diagnosis between an organic and a mental etiology. Conclusion. The integration of musical hallucinations into a psychiatric disorder may be a difficult task, and, their treatment represents a challenge. PMID:26664485
Maeda, Kengo; Yasuda, Hitoshi; Haneda, Masakazu; Kashiwagi, Atsunori
The case of a 56-year-old man who has been blind for 25 years due to retinal degeneration is herein described. The patient complained of elementary visual hallucination, during which it was difficult for him to read Braille. Brain magnetic resonance imaging showed marked atrophy of the bilateral striate cortex. Visual hallucination as a release phenomenon of the primary visual cortex has never been reported to cause alexia for Braille. The present case supports the results of recent functional imaging studies of the recruitment of striate and prestriate cortex for Braille reading.
Shoyama, Masaru; Ukai, Satoshi; Kitabata, Yuji; Yamamoto, Masahiro; Okumura, Masatoshi; Kose, Asami; Tsuji, Tomikimi; Shinosaki, Kazuhiro
A 52-year-old woman with musical hallucinations was examined using brain single photon emission computed tomography (SPECT) with 99mTc-ECD. Changes in regional cerebral blood flow (rCBF) after carbamazepine treatment were assessed using a three-dimensional stereotaxic ROI template. Following treatment, rCBF was decreased in the subcortical structures and increased in the global cortical regions. From our findings, we propose that rCBF values in subcortical structures represent abnormalities similar to those reported in previous reports or other psychiatric disorders, while those in cortical regions suggest background brain dysfunctions that result in generation of musical hallucinations.
Husain, Farhat; Levin, Jeremy; Scott, Jim; Fjeldstad, Cecilie
Musical hallucinations are recognized in certain neurological and psychiatric conditions and can be caused by focal brain disease (Evers and Ellger, 2004). However, the occurrence of primary musical hallucinations in multiple sclerosis (MS) has not been reported previously. We report a case of a 54 year old woman with progressive, relapsing MS who has continuous, unremitting, complex auditory phenomenon for an extended period of time. We believe that MS lesions rather than medications are the cause for this disturbing symptom and we present a brief review of the literature regarding the current views on the neural substrates of musical perception and cognition.
Religious beliefs and superstitions have an important impact on the psychopathology of psychiatric patients. Traditional Chinese religious beliefs and superstitions, such as fortune telling, Buddhist gods, Taoist gods, historical heroic gods and ancestor worship, have important influence on subjective psychotic experiences, in particular delusions and hallucinations. By means of empirical phenomenological case narration, the writer shows that all these traditional Chinese religious beliefs and superstitions tend to affect the contents, manifestation and meaningfulness of delusion and hallucination. They also serve as a means to replace clients' self-identity. They appear in the form of a supernatural force to resolve all difficulties, cause of troubles and misfortune, stress and coping mechanisms.
Corcoran, Rhiannon; Bentall, Richard P; Rowse, Georgina; Moore, Rosanne; Cummins, Sinead; Blackwood, Nigel; Howard, Robert; Shryane, Nick M
INTRODUCTION. This study used Item-Response Theory (IRT) to model the psychometric properties of a false belief picture sequencing task. Consistent with the mental time travel hypothesis of paranoia, we anticipated that performance on this deductive theory of mind (ToM) task would not be associated with the presence of persecutory delusions but would be related to other clinical, cognitive, and demographic factors. METHOD. A large (N=237) and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed 2 ToM tasks: the false belief sequencing task and a ToM stories task that was used to assess the validity of the false belief sequencing task as a measure of ToM. RESULTS. A unidimensional IRT model was found to fit the data well. Latent ToM ability as measured by the false belief sequencing task was negatively related with age and positively with IQ. In contrast to the ToM stories measure, there was no association between clinical diagnosis or symptoms and false belief picture sequencing after controlling for age and IQ. CONCLUSIONS. In line with mental time travel hypothesis of paranoia (Corcoran, 2010 ), performance on this deductive nonverbal ToM task is not related to the presence of paranoid symptoms. This measure is best suited for assessing ToM functioning where participants' performance falls just short of the average latent ToM ability. Furthermore, it is sensitive to the effects of increasing age and decreasing IQ.
Brown, Elliot C; Tas, Cumhur; Kuzu, Duygu; Esen-Danaci, Aysen; Roelofs, Karin; Brüne, Martin
Patients with schizophrenia suffer from dysfunctional social behaviour. Social approach and avoidance (AA) has been associated with motor responses, as the affective valence and gaze direction of facial stimuli can bias push and pull motor tendencies. The aim of this study was to investigate the role of endogenous oxytocin in social AA behaviour in schizophrenia. Basal plasma oxytocin levels were collected from 28 patients who were then given a joystick-based Approach-Avoidance Task (AAT). Reaction times were recorded and AAT effect scores calculated for responses to happy and angry faces, which either had direct or averted gaze. Individual differences in basal oxytocin had a significant relationship with AAT responses, and patients with higher levels of oxytocin tended to avoid angry faces more. Furthermore, greater avoidance of angry faces was correlated with more severe psychotic (positive and general) symptoms and greater paranoia. This suggests that the endogenous effects of oxytocin may be specific to the interpretation of negative threatening emotions in schizophrenia patients, and also provides evidence that psychotic symptoms and paranoia can impact on social AA behaviour by heightening threat avoidance.
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Beirlant, J.; Schoutens, W.; Segers, J.J.J.
In the sixties Mandelbrot already showed that extreme price swings are more likely than some of us think or incorporate in our models.A modern toolbox for analyzing such rare events can be found in the field of extreme value theory.At the core of extreme value theory lies the modelling of maxima
Kramer, Ingrid; Simons, Claudia J. P.; Wigman, Johanna T. W.; Collip, Dina; Jacobs, Nele; Derom, Catherine; Thiery, Evert; van Os, Jim; Myin-Germeys, Inez; Wichers, Marieke
Evidence suggests that affect plays a role in the development of psychosis but the underlying mechanism requires further investigation. This study examines the moment-to-moment dynamics between negative affect (NA) and paranoia prospectively in daily life. A female general population sample (n 515)
Kramer, Ingrid; Simons, Claudia J. P.; Wigman, Johanna T. W.; Collip, Dina; Jacobs, Nele; Derom, Catherine; Thiery, Evert; van Os, Jim; Myin-Germeys, Inez; Wichers, Marieke
Evidence suggests that affect plays a role in the development of psychosis but the underlying mechanism requires further investigation. This study examines the moment-to-moment dynamics between negative affect (NA) and paranoia prospectively in daily life. A female general population sample (n 515)
Van der Feltz-Cornelis CM
Full Text Available Christina M van der Feltz-Cornelis1–3, Henk Biemans1, Jan Timmer11Clinical Centre for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; 2Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands; 3Trimbos Instituut, Utrecht, The NetherlandsObjective: Auditory hallucinations are generally considered to be a psychotic symptom. However, they do occur without other psychotic symptoms in a substantive number of cases in the general population and can cause a lot of individual distress because of the supposed association with schizophrenia. We describe a case of nonpsychotic auditory hallucinations occurring in the context of migraine.Method: Case report and literature review.Results: A 40-year-old man presented with imperative auditory hallucinations that caused depressive and anxiety symptoms. He reported migraine with visual aura as well which started at the same time as the auditory hallucinations. The auditory hallucinations occurred in the context of nocturnal migraine attacks, preceding them as aura. No psychotic disorder was present. After treatment of the migraine with propranolol 40 mg twice daily, explanation of the etiology of the hallucinations, and mirtazapine 45 mg daily, the migraine subsided and no further hallucinations occurred. The patient recovered.Discussion: Visual auras have been described in migraine and occur quite often. Auditory hallucinations as aura in migraine have been described in children without psychosis, but this is the first case describing auditory hallucinations without psychosis as aura in migraine in an adult. For description of this kind of hallucination, DSM-IV lacks an appropriate category.Conclusion: Psychiatrists should consider migraine with acoustic aura as a possible etiological factor in patients without further psychotic symptoms presenting with auditory hallucinations, and they should ask for headache symptoms when they take the history. Prognosis may be
Wiersma, D; Jenner, JA; Nienhuis, FJ; van de Willige, G
Objective: Psychosocial treatment seems to be effective in the management of schizophrenia, although less in the area of quality of life and social functioning. To study the effectiveness of a hallucination focused integrated treatment with cognitive-behaviour therapy and coping training among schiz
Ozcan, Halil; Yucel, Atakan; Ates, Orhan
Sensory visual pathologies, accompanying simple or complex visual hallucinations that occur in visually-impaired individuals due to ophthalmologic or brain pathologies related to visual pathways in patients without mental disorders, are defined as Charles Bonnet syndrome. Between 10% and 60% of the patients having age-related eye diseases involving retina, cornea and the lens, commonly with macular degeneration experience complex visual hallucinations depending on the severity of visual problems. The neurophysiology of the visual hallucinations in Charles Bonnet Syndrome is not clearly known, and they may differ in content and severity over time. In differential diagnoses of Charles Bonnet Syndrome, many aetiologies (drugs, uraemia, exposure to toxic materials, neurodegenerative and psychiatric conditions) need to be ruled out. In the treatment of Charles Bonnet syndrome, first the management of the reason of visual loss should be clarified if possible. If needed, neuroleptics, anticonvulsants, antidepressants, benzodiazepines, cognitive enhancer agents such as cholinesterase inhibitors can be used also. In this case, an 83-year-old female patient experiencing visual hallucinations as burning candles in both eyes' visual field after left eye cataract surgery, treated with 0.5 milligram/day risperidone will be presented.
Shine, James M; Halliday, Glenda M; Naismith, Sharon L; Lewis, Simon J G
Visual misperceptions and hallucinations are a major cause of distress in patients with Parkinson's disease (PD), particularly in the advanced stages of the condition. Recent work has provided a framework for understanding the pathogenesis of these symptoms, implicating impairments from the retina to the integration of external information with preformed internal images. In this article, we propose a novel hypothesis that attempts to explain the presence of visual misperceptions and hallucinations in PD through the aberrant coordination of complimentary yet competing neural networks. We propose that hallucinations in PD reflect the relative inability to recruit activation in the dorsal attention network in the presence of an ambiguous percept, leading to overreliance on default mode network processing and salience arising from the ventral attention network. This inability is proposed to stem from improper function across cortical and subcortical structures secondary to the presence of Lewy body pathology. This hypothesis may be empirically tested by the use of targeted cognitive paradigms. In turn, this may assist our understanding of the pathophysiological mechanisms and cognitive processes contributing to visual misperceptions and hallucinations and ultimately may inform more effective treatment strategies for this troubling symptom.
Spanos, Nicholas P.; And Others
The effects of several attitudinal, cognitive skill, and personality variables in response to auditory and visual hallucination suggestions to hypnotic subjects are assessed. Cooperative attitudes toward hypnosis and involvement in everyday imaginative activities (absorption) correlated with response to auditory and visual hallucination…
Meppelink, Anne Marthe; de Jong, Bauke M.; Renken, Remco; Leenders, Klaus L.; Cornelissen, Frans W.; van Laar, Teus
Impaired visual processing may play a role in the pathophysiology of visual hallucinations in Parkinson's disease. In order to study involved neuronal circuitry, we assessed cerebral activation patterns both before and during recognition of gradually revealed images in Parkinson's disease patients w
Meppelink, Anne Marthe; Koerts, Janneke; Borg, Maarten; Leenders, Klaus Leonard; van Laar, Teus
Visual hallucinations (VH) are common in Parkinson's disease (PD) and are hypothesized to be due to impaired visual perception and attention deficits. We investigated whether PD patients with VH showed attention deficits a more specific impairment of higher order visual perception or both. Forty-two
Brébion, Gildas; Ohlsen, Ruth I; Pilowsky, Lyn S; David, Anthony S
Previous research has suggested that visual hallucinations in schizophrenia are associated with abnormal salience of visual mental images. Since visual imagery is used as a mnemonic strategy to learn lists of words, increased visual imagery might impede the other commonly used strategies of serial and semantic encoding. We had previously published data on the serial and semantic strategies implemented by patients when learning lists of concrete words with different levels of semantic organisation (Brébion et al., 2004). In this paper we present a re-analysis of these data, aiming at investigating the associations between learning strategies and visual hallucinations. Results show that the patients with visual hallucinations presented less serial clustering in the non-organisable list than the other patients. In the semantically organisable list with typical instances, they presented both less serial and less semantic clustering than the other patients. Thus, patients with visual hallucinations demonstrate reduced use of serial and semantic encoding in the lists made up of fairly familiar concrete words, which enable the formation of mental images. Although these results are preliminary, we propose that this different processing of the lists stems from the abnormal salience of the mental images such patients experience from the word stimuli.
Slotema, Christina W.; Blom, Jan; van Lutterveld, Remko; Hoek, Hans W.; Sommer, Iris E. C.
With an increase of the number of studies exploring repetitive transcranial magnetic stimulation (rTMS) for the treatment of auditory verbal hallucinations (AVH), an update is provided on the efficacy of different paradigms. A literature search was performed from 1966 through April 2013. Twenty-five
Waters, Flavie; Collerton, Daniel; Ffytche, Dominic H.; Jardri, Renaud; Pins, Delphine; Dudley, Robert; Blom, Jan Dirk; Mosimann, Urs Peter; Eperjesi, Frank; Ford, Stephen; Laroi, Frank
Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VH
Full Text Available Abstract Electro Convulsive Therapy (ECT is a medical treatment for severe mental illness in which small, carefully controlled electricity is applied to the brain. This electric stimulation is done in conjunction with anesthesia and muscle relaxant medications to produce a mild generalized seizure. This is used to treat a variety of psychiatric disorders. This is most effective in the treatment of severe depression providing a rapid relief. We report and discuss an unusual presentation of a ninety three year old lady with a diagnosis of Major Depressive Disorder, Recurrent, Severe with Psychotic features (296.34 who experienced musical hallucinations whilst she was treated on ECT. Clinically there was an inverse relationship between the biological symptoms of depression and musical hallucination during the ECT management. Though similar reports have never been reported earlier, we noticed a good association between the initiation of ECT and musical hallucination in our patient. The patient stopped experiencing musical hallucinations and improved of her biological symptoms of depression completely after the full course of ECT.
Vercammen, Ans; Knegtering, Henderikus; Bruggeman, Richard; Aleman, Andre
Background: One of the most influential cognitive models of auditory verbal hallucinations (AVH) suggests that a failure to adequately monitor the production of one's own inner speech leads to verbal thought being misidentified as an alien voice. However, it is unclear whether this theory can explai
Meppelink, Anne Marthe; de Jong, Bauke M.; Renken, Remco; Leenders, Klaus L.; Cornelissen, Frans W.; van Laar, Teus
Impaired visual processing may play a role in the pathophysiology of visual hallucinations in Parkinson's disease. In order to study involved neuronal circuitry, we assessed cerebral activation patterns both before and during recognition of gradually revealed images in Parkinson's disease patients
Jardri, Renaud; Bartels-Velthuis, Agna A.; Debbane, Martin; Jenner, Jack A.; Kelleher, Ian; Dauvilliers, Yves; Plazzi, Giuseppe; Demeulemeester, Morgane; David, Christopher N.; Rapoport, Judith; Dobbelaere, Dries; Escher, Sandra; Fernyhough, Charles
Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to
Janakiraman, Raguraman; Wildgoose, Keith; Seelam, Kalyan
Electro Convulsive Therapy (ECT) is a medical treatment for severe mental illness in which small, carefully controlled electricity is applied to the brain. This electric stimulation is done in conjunction with anesthesia and muscle relaxant medications to produce a mild generalized seizure. This is used to treat a variety of psychiatric disorders. This is most effective in the treatment of severe depression providing a rapid relief. We report and discuss an unusual presentation of a ninety three year old lady with a diagnosis of Major Depressive Disorder, Recurrent, Severe with Psychotic features (296.34) who experienced musical hallucinations whilst she was treated on ECT. Clinically there was an inverse relationship between the biological symptoms of depression and musical hallucination during the ECT management. Though similar reports have never been reported earlier, we noticed a good association between the initiation of ECT and musical hallucination in our patient. The patient stopped experiencing musical hallucinations and improved of her biological symptoms of depression completely after the full course of ECT.
Jardri, Renaud; Bartels-Velthuis, Agna A.; Debbané, Martin; Jenner, Jack A.; Kelleher, Ian; Dauvilliers, Yves; Plazzi, Giuseppe; Demeulemeester, Morgane; David, Christopher N.; Rapoport, Judith; Dobbelaere, Dries; Escher, Sandra; Fernyhough, Charles
Typically reported as vivid, multisensory experiences which may spontaneously resolve, hallucinations are present at high rates during childhood. The risk of associated psychopathology is a major cause of concern. On the one hand, the risk of developing further delusional ideation has been shown to be reduced by better theory of mind skills. On the other hand, ideas of reference, passivity phenomena, and misidentification syndrome have been shown to increase the risk of self-injury or heteroaggressive behaviors. Cognitive psychology and brain-imaging studies have advanced our knowledge of the mechanisms underlying these early-onset hallucinations. Notably, specific functional impairments have been associated with certain phenomenological characteristics of hallucinations in youths, including intrusiveness and the sense of reality. In this review, we provide an update of associated epidemiological and phenomenological factors (including sociocultural context, social adversity, and genetics, considered in relation to the psychosis continuum hypothesis), cognitive models, and neurophysiological findings concerning hallucinations in children and adolescents. Key issues that have interfered with progress are considered and recommendations for future studies are provided. PMID:24936083
Jenner, JA; van de Willige, G; Wiersma, D
Objective: To test feasibility and effectiveness of multi-family treatment (MFT) for patients with persistent auditory hallucinations. Method: A naturalistic pilot study with 6-month follow-up of 12 patients and 10 relatives. Pre- and post-treatment assessment concerned compliance, satisfaction, sub
Steinmann, Saskia; Leicht, Gregor; Mulert, Christoph
Auditory verbal hallucinations (AVH) are one of the most common and most distressing symptoms of schizophrenia. Despite fundamental research, the underlying neurocognitive and neurobiological mechanisms are still a matter of debate. Previous studies suggested that "hearing voices" is associated with a number of factors including local deficits in the left auditory cortex and a disturbed connectivity of frontal and temporoparietal language-related areas. In addition, it is hypothesized that the interhemispheric pathways connecting right and left auditory cortices might be involved in the pathogenesis of AVH. Findings based on Diffusion-Tensor-Imaging (DTI) measurements revealed a remarkable interindividual variability in size and shape of the interhemispheric auditory pathways. Interestingly, schizophrenia patients suffering from AVH exhibited increased fractional anisotropy (FA) in the interhemispheric fibers than non-hallucinating patients. Thus, higher FA-values indicate an increased severity of AVH. Moreover, a dichotic listening (DL) task showed that the interindividual variability in the interhemispheric auditory pathways was reflected in the behavioral outcome: stronger pathways supported a better information transfer and consequently improved speech perception. This detection indicates a specific structure-function relationship, which seems to be interindividually variable. This review focuses on recent findings concerning the structure-function relationship of the interhemispheric pathways in controls, hallucinating and non-hallucinating schizophrenia patients and concludes that changes in the structural and functional connectivity of auditory areas are involved in the pathophysiology of AVH.
DeVylder, Jordan E; Hilimire, Matthew R
Individuals with subthreshold psychotic experiences are at increased risk for suicidal thoughts and behavior, similar to those with schizophrenia and other psychotic disorders. This may be explained by shared risk factors such as heightened stress sensitivity or low self-esteem. Understanding the nature of this relationship could inform suicide prevention in social work practice. In this study, authors examined the relationship between self-reported auditory hallucinations and suicidal thoughts, plans, and attempts, in a nonclinical sample of young adults, controlling for scores on the Psychological Stress Index and Rosenberg Self-Esteem Scale. Auditory hallucinations were associated with approximately double the odds of suicidal ideation and plans and four times the odds for suicide attempts. This relationship was not explained by stress sensitivity or self-esteem, which were independently related to hallucinations and suicidality, respectively. Subthreshold auditory hallucinations may be a useful indicator of suicide risk. This association may represent a clinically significant relationship that may be addressed through social work interventions intended to alleviate stress sensitivity or improve self-esteem.
Ahmed, A.I.A.; Mierlo, P.J. van; Waarde, J.A. van; Jansen, P.A.M.
A 71-year-old man had had visual hallucinations and vivid dreams for two years after starting to take metoprolol. When metoprolol was replaced by atenolol the patient's symptoms disappeared within five days. Side-effects of beta-blockers on the central nervous system are relatively uncommon. The mec
Rapin, Lucile; Dohen, Marion; Polosan, Mircea; Perrier, Pascal; Loevenbruck, Hélène
Purpose: "Auditory verbal hallucinations" (AVHs) are speech perceptions in the absence of external stimulation. According to an influential theoretical account of AVHs in schizophrenia, a deficit in inner-speech monitoring may cause the patients' verbal thoughts to be perceived as external voices. The account is based on a…
Alderson-Day, Ben; Diederen, Kelly; Fernyhough, Charles; Ford, Judith M; Horga, Guillermo; Margulies, Daniel S; McCarthy-Jones, Simon; Northoff, Georg; Shine, James M; Turner, Jessica; van de Ven, Vincent; van Lutterveld, Remko; Waters, Flavie; Jardri, Renaud
In recent years, there has been increasing interest in the potential for alterations to the brain's resting-state networks (RSNs) to explain various kinds of psychopathology. RSNs provide an intriguing new explanatory framework for hallucinations, which can occur in different modalities and populati
Spalletta, Gianfranco; Piras, Fabrizio; Alex Rubino, Ivo; Caltagirone, Carlo; Fagioli, Sabrina
Although the psychotic phenomena of schizophrenia have been extensively investigated, somatic delusions and hallucinations have seldom been reported and their mechanisms are substantially unexplored. Here, we aimed to identify the brain structural correlates of somatic psychotic phenomena using combined volumetry and diffusivity structural neuroimaging techniques. Seventy-five individuals with a DSM-IV-TR diagnosis of schizophrenia and 75 healthy controls (HC) underwent a comprehensive clinical assessment, a high-resolution T1-weighted magnetic resonance imaging and a diffusion tensor imaging protocol using a 3T MRI scanner. Voxel-based volumetry and mean diffusivity (MD) of gray matter (GM) and fractional anisotropy (FA) of white matter (WM) of the whole brain were calculated for each subject. Reduced left fronto-insular GM volume was found in patients with somatic delusions compared with patients without somatic delusions and HC. Increased GM volume was found in the bilateral thalami, primarily in the right ventral-anterior thalamic nucleus projecting to the prefrontal-temporal cortices and the bilateral pars triangularis of the inferior frontal lobe, of patients with somatic hallucinations and HC compared with patients without somatic hallucinations. No differences emerged in GM MD and in WM FA between patients with and without psychotic somatic phenomena (i.e. delusions or hallucinations). These findings provide the first evidence that a frontal-thalamic structural perturbation mediates somatic psychotic phenomena in schizophrenia.
Amad, A; Cachia, A; Gorwood, P; Pins, D; Delmaire, C; Rolland, B; Mondino, M; Thomas, P; Jardri, R
Hallucinations constitute one of the most representative and disabling symptoms of schizophrenia. Several Magnetic Resonance Imaging (MRI) findings support the hypothesis that distinct patterns of connectivity, particularly within networks involving the hippocampal complex (HC), could be associated with different hallucinatory modalities. The aim of this study was to investigate HC connectivity as a function of the hallucinatory modality, that is, auditory or visual. Two carefully selected subgroups of schizophrenia patients with only auditory hallucinations (AH) or with audio-visual hallucinations (A+VH) were compared using the following three complementary multimodal MRI methods: resting state functional MRI, diffusion MRI and structural MRI were used to analyze seed-based Functional Connectivity (sb-FC), Tract-Based Spatial Statistics (TBSS) and shape analysis, respectively. Sb-FC was significantly higher between the HC, the medial prefrontal cortex (mPFC) and the caudate nuclei in A+VH patients compared with the AH group. Conversely, AH patients exhibited a higher sb-FC between the HC and the thalamus in comparison with the A+VH group. In the A+VH group, TBSS showed specific higher white matter connectivity in the pathways connecting the HC with visual areas, such as the forceps major and the inferior-fronto-occipital fasciculus than in the AH group. Finally, shape analysis showed localized hippocampal hypertrophy in the A+VH group. Functional results support the fronto-limbic dysconnectivity hypothesis of schizophrenia, while specific structural findings indicate that plastic changes are associated with hallucinations. Together, these results suggest that there are distinct connectivity patterns in patients with schizophrenia that depend on the sensory-modality, with specific involvement of the HC in visual hallucinations.
Ćurčić-Blake, Branislava; Nanetti, Luca; van der Meer, Lisette; Cerliani, Leonardo; Renken, Remco; Pijnenborg, Gerdina H M; Aleman, André
Auditory verbal hallucinations (AVH) in schizophrenia have previously been associated with functional deficiencies in language networks, specifically with functional disconnectivity in fronto-temporal connections in the left hemisphere and in interhemispheric connections between frontal regions. Here, we investigate whether AVH are accompanied by white matter abnormalities in tracts connecting the frontal, parietal and temporal lobes, also engaged during language tasks. We combined diffusion tensor imaging with tract-based spatial statistics and found white matter abnormalities in patients with schizophrenia as compared with healthy controls. The patients showed reduced fractional anisotropy bilaterally: in the anterior thalamic radiation (ATR), body of the corpus callosum (forceps minor), cingulum, temporal part of the superior longitudinal fasciculus (SLF) and a small area in the inferior fronto-occipital fasciculus (IFOF); and in the right hemisphere: in the visual cortex, forceps major, body of the corpus callosum (posterior parts) and inferior parietal cortex. Compared to patients without current hallucinations, patients with hallucinations revealed decreased fractional anisotropy in the left IFOF, uncinate fasciculus, arcuate fasciculus with SLF, corpus callosum (posterior parts-forceps major), cingulate, corticospinal tract and ATR. The severity of hallucinations correlated negatively with white matter integrity in tracts connecting the left frontal lobe with temporal regions (uncinate fasciculus, IFOF, cingulum, arcuate fasciculus anterior and long part and superior long fasciculus frontal part) and in interhemispheric connections (anterior corona radiata). These findings support the hypothesis that hallucinations in schizophrenia are accompanied by a complex pattern of white matter alterations that negatively affect the language, emotion and attention/perception networks.
Iaria, Giuseppe; Fox, Christopher J; Scheel, Michael; Stowe, Robert M; Barton, Jason J S
In this study, we report the case of a patient experiencing hallucinations of faces that could be reliably precipitated by looking at trees. Using functional Magnetic Resonance Imaging (fMRI), we found that face hallucinations were associated with increased and decreased neural activity in a number of cortical regions. Within the same fusiform face area, however, we found significant decreased and increased neural activity according to whether the patient was experiencing hallucinations or veridical perception of faces, respectively. These findings may indicate key differences in how hallucinatory and veridical perceptions lead to the same phenomenological experience of seeing faces.
The first part of this two-part paper presents a comparative history of paranoia querulans, also known as litigants' delusion, in German-speaking countries and France from the nineteenth century onwards. We first focus on two classic literary works which describe litigious behaviours that were later pathologized, then give an insight into the history of Querulantenwahn (litigants' delusion), a term coined in 1857 by Johann Ludwig Casper and adopted by German-speaking psychiatrists and forensic experts. The last section is devoted to its French equivalent, the delusion of the litigious persecuted-persecutors. We show how this category, widely popular among French fin-de-siècle alienists, was replaced by another: the delusion of revendication (litigious subtype). The history of the vexatious litigants in the English-speaking world will be explored in the Part 2.
Grassi, A; Bruni, R; Pileggi, F; Chiappelli, M; Boldrini, M; Franceschi, E; Scarafoni, D
The aim of the study was to show, trough the calculation of the direct costs of supports and treatments actually provided by a NHS Mental Health Department, the presence of associations between four diagnostic groups (schizophrenia, affective psychosis, paranoia and neurotic disorders) and their overall and items (community care, rehabilitation facilities and in-patients services) costs. Mental Health Department and CSM "Scalo" (NHS Mental Centre), AUSL "Città di Bologna", Emilia-Romagna Region. Yearly direct costs were calculated for a sample (n = 75) of all patients (N = 745) who during 365 days had more than four contacts with CSM and also for four randomised diagnostic groups (n = 30 per group). We calculated unit costs of 15 types of services provided by CSM, selected according to the yearly number of services provided and the time spent by each health professional, and the in patient-cost per all days spent in a public or private sector hospital for psychiatric care. The statistic analysis, performed with the help of the Kruskal-Wallis test, showed significantly higher overall costs for the schizophrenic patients than the sample-group and the neurotic disorders-group; besides a significant difference in the item costs for rehabilitation facilities was found between the schizophrenic group and the paranoia, neurotic disorders groups and the sample one, whereas no significant differences in costs of inpatients services and drugs administration were tested between the groups. The results of our study allow to demonstrate that there are cost differences between the diagnosis (direct costs are highest for schizophrenic patients and lowest for those with neurotic disorders) and that the costs evaluation can be used to ensure appropriate provisions to Mental Health Department for support and treatment of a wide range of psychiatric disorders.
Kinson, Rochelle Melina; Lim, Wen Phei; Rahman, Habeebul
Musical hallucinations are a rare phenomenon that renders appropriate identification and treatment a challenge. This case series describes three women who presented with hearing complex, familiar melodies in the absence of external stimuli on a background of hearing impairment.
Huntley, J D; Sandall, A; Philpot, M
We report the case of JW, a 66-year-old woman who presented with musical hallucinations and multiple etiological factors for these rare phenomena. We discuss these factors and the successful amelioration of her symptoms with lamotrigine.
Modinos, Gemma; Costafreda, Sergi G.; van Tol, Marie-Jose; McGuire, Philip K.; Aleman, Andre; Allen, Paul
Introduction: Voxel-based morphometry (VBM) studies demonstrate grey matter volume (GMV) deficits in schizophrenia. This method is also applied for detecting associations between specific psychotic symptoms and brain structure, such as auditory verbal hallucinations (AVHs). However, due to differing
Chen, Cheng-Che; Liu, Hsing-Cheng
We reported a patient who suffered from complex visual hallucinations with left homonymous hemianopsia. Brain imaging showed an acute haemorrhage infarct at the right occipital lobe. Charles Bonnet syndrome (CBS) was suspected and aripiprazole was prescribed at 5 mg daily. After 3 weeks, the symptoms of hallucinations and anxiety were relieved. Although some CBS patients might be self-limited without discomfort, low-dose aripiprazole can be considered as a safe medication for significantly anxious patients with CBS.
The universe is all about extremes. Space has a temperature 270°C below freezing. Stars die in catastrophic supernova explosions a billion times brighter than the Sun. A black hole can generate 10 million trillion volts of electricity. And hypergiants are stars 2 billion kilometres across, larger than the orbit of Jupiter. Extreme Cosmos provides a stunning new view of the way the Universe works, seen through the lens of extremes: the fastest, hottest, heaviest, brightest, oldest, densest and even the loudest. This is an astronomy book that not only offers amazing facts and figures but also re
Plewnia, Christian; Bischof, Felix; Reimold, Matthias
Simple and complex auditory phantom-perceptions such as tinnitus and musical hallucinations occur predominantly in elderly subjects and are often associated with hearing impairment. Isolated verbal hallucinations without other psychotic features are rare. It has been shown that an intravenous (i.v.) injection of lidocaine can transiently suppress tinnitus. Here we present the case of a 74 year old left-handed women with severely distressing, continuous verbal auditory hallucinations without other psychotic features. I.v. injections of 100 mg lidocaine but not saline resulted in substantial transient suppressions of the hallucinations for several hours. Using [(15)O]H(2)O positron-emission tomography (PET) decreased regional cerebral blood flow associated with reduced perception of voices was found in the right angular and supramarginal gyrus, right inferior frontal gyrus, orbitofronal cortex and in major parts of the cingulate cortex. These data suggest to further investigate the clinical relevance of i.v. lidocaine in patients with therapy-resistant verbal hallucinations, support the notion of common pathophysiological mechanisms in different forms of auditory phantom-perception and demonstrate the feasibility of a new strategy for imaging studies on auditory hallucinations.
Full Text Available Cerebral venous sinus thrombosis is an uncommon cause of stroke presenting with varied presentation patterns. We report a case of a 21-year-old woman with superior sagittal sinus (SSS thrombosis (SSST developing after childbirth, presenting with visual hallucinations, severe headache, and tonic-clonic seizures. Time-of-flight magnetic resonance angiography (TOF-MRA demonstrated the presence of thrombus in SSS. She was treated with low molecular weight heparin (LMWH followed by warfarin. She had excellent recovery a few weeks after admission and was regularly followed up. Although this condition can be presented with different neurological symptoms, it does not typically present with hallucinations. We suggest that CSVT should be suspected even when a patient presents with an atypical picture in a category of patients at higher risk.
de Sousa, Paulo; Sellwood, William; Spray, Amy; Fernyhough, Charles; Bentall, Richard P
Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.
M. Duarte Mangas
Full Text Available Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms. We report three female patients with no preexisting history of epilepsy that were unsuccessfully treated as primary psychiatric disorder: one patient was initially diagnosed with somatization and Ekbom syndrome; the second was referred to psychiatrist due to mood instability and visual hallucinations; and the third one was referred for anxiety and hallucinations related to sleep. A carefully taken medical history clarified diagnoses of epilepsy. None of the patients responded to medications aimed at treating psychiatric symptoms, and all the patients had favorable response to antiepileptic treatment. These cases illustrate that epileptic patients may experience nonconvulsive seizures that might be misdiagnosed as primary psychiatric disorder.
Powers, A R; Mathys, C; Corlett, P R
Some people hear voices that others do not, but only some of those people seek treatment. Using a Pavlovian learning task, we induced conditioned hallucinations in four groups of people who differed orthogonally in their voice-hearing and treatment-seeking statuses. People who hear voices were significantly more susceptible to the effect. Using functional neuroimaging and computational modeling of perception, we identified processes that differentiated voice-hearers from non-voice-hearers and treatment-seekers from non-treatment-seekers and characterized a brain circuit that mediated the conditioned hallucinations. These data demonstrate the profound and sometimes pathological impact of top-down cognitive processes on perception and may represent an objective means to discern people with a need for treatment from those without. Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
García-Ptacek, S; García Azorín, D; Sanchez Salmador, R; Cuadrado, M L; Porta-Etessam, J
Hallucinations are frequent in clinical practice, with an incidence of up to 38.7% in the general population. We aim to determine the prevalence of hallucinations among healthy young adults in our environment. We designed an observational study, using as subjects 3rd to 6th year medical students at the Universidad Complutense de Madrid who complete clinical rotations in the Hospital Clínico San Carlos. After a screening questionnaire, an individual interview was conducted via telephone or e-mail to those students who reported hallucinations. We obtained clinical and epidemiological data through a semi-structured clinical interview performed by a third year neurology resident. N=134 (average age was 22.1 years; 77.6% were women). 74 respondents answered affirmatively to one or more screening questions, and 54 completed the follow-up interview. 22.2% described visual phenomena and 64.8%, auditory. The majority reported sleep-related experiences and auditory perceptions related to hyper vigilance, such as hearing the telephone or the doorbell ring when in fact it had not (38.8%). All subjects had good insight into their experiences and none had psychotic symptoms. Two cases were associated with substance abuse. Hallucinations are frequent among the general population. Traditionally, auditory phenomena have been associated with psychotic pathology, and other studies show a low population incidence (0.6%). However, in our sample, short auditory perceptions with immediate analysis were frequent and not pathological. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Abajobir, Amanuel Alemu; Kisely, Steve; Scott, James G; Williams, Gail; Clavarino, Alexandra; Strathearn, Lane; Najman, Jake Moses
Child maltreatment is a widespread public health problem associated with a range of mental health disorders later in life. In order to effectively address these disorders, there is a need to understand more about the mental health consequences of different types of child maltreatment. This study examines the associations between prospectively substantiated child maltreatment (ages 0-14 y) and reports of hallucinations and delusional experiences at 21 years after birth. As well, we examined 12-month and lifetime psychotic disorders using data from a longitudinal birth cohort. The study comprised 3752 participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian prebirth cohort study. Psychotic experiences and 12-month and lifetime psychosis were measured using the Achenbach Young Adults Self-Report, the Peter's Delusions Inventory, and Composite International Diagnostic Interview at the 21-year follow-up. In adjusted analyses, those children who had experienced any maltreatment and who were emotionally abused and neglected were more likely to report (1) hallucinations and lifetime delusional experiences and (2) more likely to experience lifetime psychosis than their nonabused counterparts. In expanded models, those exposed to multiple forms of maltreatment, in particular with emotional abuse and neglect, had an increased likelihood of hallucinations and delusional experiences. There is an association between child maltreatment, especially emotional abuse and neglect, and later hallucinations, delusional experiences, and psychosis. It is, however, relevant to note that the vast majority of children experiencing childhood maltreatment do not appear to develop psychotic experiences or psychotic disorder. Further research to determine the reasons for highly variable outcomes of child maltreatment is warranted. © The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights
Full Text Available We report what we believe is the first case of posterior reversible encephalopathy syndrome (PRES secondary to dialysis disequilibrium syndrome (DDS in patients in whom all other possible causes of PRES were excluded and in whom a transient episode of tactile hallucination also occurred. We believe that this case of DDS was particularly severe, leading to PRES because of the late institution of dialysis therapy and the concomitant severe degree of metabolic acidosis on presentation.
A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the ...
Schott, G D
The visual aura of migraine is a subjective phenomenon, and what the migraineur experiences is necessarily inaccessible to others. Fortunately, however, the sufferer can occasionally reveal what is being seen by means of graphic representation, enabling an otherwise closed 'window' to be opened on the transiently dysfunctioning brain. This article explores the unique contribution that illustration has made to understanding mechanisms subserving the visual aura. The most revealing illustrations are those made by the very few scientists who have recorded and analysed the scotomas, and in particular the expanding fortification spectra, experienced during their migraine attacks. It is solely through illustrations such as these that the uniform nature of many of these hallucinations has been demonstrated. As a result, it follows that there is likely to be a similarly uniform repertoire of processes that generate the hallucinations in the occipital cortex. The precise form of the zigzags that comprise the fortification spectrum, their shimmering appearance, and in particular the speed of the peripheral spread, all of which are entirely dependent on graphic display for their elucidation, enable conclusions to be reached about a number of the underlying pathophysiological mechanisms, including the involvement of spreading cortical depression, that likely occur. Illustration has been pivotal too in revealing uncommon and sometimes curious, if not bizarre, visual hallucinations, the forms of which suggest that extrastriate and temporal lobe involvement contributes to migraine aura in some instances. Illustration can also be valuable in differential diagnosis, depicting other forms of visual hallucination which result from a variety of non-migrainous causes. Illustration, particularly when made during the attack, provides an unusual, little used but powerful tool which uniquely allows the sufferer's subjective visual experiences to inform objective analysis. In turn, this
Full Text Available Visual Hallucinations (VH are a common non-motor symptom of Parkinson’s Disease (PD and the Lewy body dementias (LBD of Parkinson's disease with dementia (PDD and Dementia with Lewy Bodies (DLB. The origin of VH in PD and LBD is debated: earlier studies considered a number of different possible mechanisms underlying VH including visual disorders, Rapid Eye Movement (REM Sleep Intrusions, dysfunctions of top down or bottom up visual pathways, and neurotransmitter imbalance.
Ćurčić-Blake, Branislava; Ford, Judith M; Hubl, Daniela; Orlov, Natasza D; Sommer, Iris E; Waters, Flavie; Allen, Paul; Jardri, Renaud; Woodruff, Peter W; David, Olivier; Mulert, Christoph; Woodward, Todd S; Aleman, André
Auditory verbal hallucinations (AVH) occur in psychotic disorders, but also as a symptom of other conditions and even in healthy people. Several current theories on the origin of AVH converge, with neuroimaging studies suggesting that the language, auditory and memory/limbic networks are of particular relevance. However, reconciliation of these theories with experimental evidence is missing. We review 50 studies investigating functional (EEG and fMRI) and anatomic (diffusion tensor imaging) connectivity in these networks, and explore the evidence supporting abnormal connectivity in these networks associated with AVH. We distinguish between functional connectivity during an actual hallucination experience (symptom capture) and functional connectivity during either the resting state or a task comparing individuals who hallucinate with those who do not (symptom association studies). Symptom capture studies clearly reveal a pattern of increased coupling among the auditory, language and striatal regions. Anatomical and symptom association functional studies suggest that the interhemispheric connectivity between posterior auditory regions may depend on the phase of illness, with increases in non-psychotic individuals and first episode patients and decreases in chronic patients. Leading hypotheses involving concepts as unstable memories, source monitoring, top-down attention, and hybrid models of hallucinations are supported in part by the published connectivity data, although several caveats and inconsistencies remain. Specifically, possible changes in fronto-temporal connectivity are still under debate. Precise hypotheses concerning the directionality of connections deduced from current theoretical approaches should be tested using experimental approaches that allow for discrimination of competing hypotheses. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Singh, Amardeep; Mortzos, Panteleimon; Sørensen, Torben Lykke
A 67-year-old female presented with post-ganglionic Horner's syndrome. In addition to the classical symptoms of Horner's syndrome, the patient reported experiencing frightening complex visual and auditory hallucinations on two different occasions. Magnetic resonance angiography of the cerebrum, n......, neck and upper thorax revealed internal carotid dissection. The symptoms and hallucinatory experiences resolved soon after antiplatelet therapy was commenced. We propose peduncular hallucinosis as the underlying mechanism....
Waters, Flavie; Collerton, Daniel; Ffytche, Dominic H; Jardri, Renaud; Pins, Delphine; Dudley, Robert; Blom, Jan Dirk; Mosimann, Urs Peter; Eperjesi, Frank; Ford, Stephen; Larøi, Frank
Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VHs in the psychosis phenotype and contrast this data with the literature drawn from neurodegenerative disorders and eye disease. The evidence challenges the traditional views that VHs are atypical or uncommon in psychosis. The weighted mean for VHs is 27% in schizophrenia, 15% in affective psychosis, and 7.3% in the general community. VHs are linked to a more severe psychopathological profile and less favorable outcome in psychosis and neurodegenerative conditions. VHs typically co-occur with auditory hallucinations, suggesting a common etiological cause. VHs in psychosis are also remarkably complex, negative in content, and are interpreted to have personal relevance. The cognitive mechanisms of VHs in psychosis have rarely been investigated, but existing studies point to source-monitoring deficits and distortions in top-down mechanisms, although evidence for visual processing deficits, which feature strongly in the organic literature, is lacking. Brain imaging studies point to the activation of visual cortex during hallucinations on a background of structural and connectivity changes within wider brain networks. The relationship between VHs in psychosis, eye disease, and neurodegeneration remains unclear, although the pattern of similarities and differences described in this review suggests that comparative studies may have potentially important clinical and theoretical implications.
de la Iglesia-Vaya, Maria; Escartí, Maria José; Molina-Mateo, Jose; Martí-Bonmatí, Luis; Gadea, Marien; Castellanos, Francisco Xavier; Aguilar García-Iturrospe, Eduardo J.; Robles, Montserrat; Biswal, Bharat B.; Sanjuan, Julio
Auditory hallucinations (AH) are the most frequent positive symptoms in patients with schizophrenia. Hallucinations have been related to emotional processing disturbances, altered functional connectivity and effective connectivity deficits. Previously, we observed that, compared to healthy controls, the limbic network responses of patients with auditory hallucinations differed when the subjects were listening to emotionally charged words. We aimed to compare the synchrony patterns and effective connectivity of task-related networks between schizophrenia patients with and without AH and healthy controls. Schizophrenia patients with AH (n = 27) and without AH (n = 14) were compared with healthy participants (n = 31). We examined functional connectivity by analyzing correlations and cross-correlations among previously detected independent component analysis time courses. Granger causality was used to infer the information flow direction in the brain regions. The results demonstrate that the patterns of cortico-cortical functional synchrony differentiated the patients with AH from the patients without AH and from the healthy participants. Additionally, Granger-causal relationships between the networks clearly differentiated the groups. In the patients with AH, the principal causal source was an occipital–cerebellar component, versus a temporal component in the patients without AH and the healthy controls. These data indicate that an anomalous process of neural connectivity exists when patients with AH process emotional auditory stimuli. Additionally, a central role is suggested for the cerebellum in processing emotional stimuli in patients with persistent AH. PMID:25379429
Reed, Phil; Clarke, Natasha
This study investigated the interaction between the current environment and personality factors associated with religiosity in determining the content of false perceptions (used as a model for hallucinations). A primed word-detection task was used to investigate the effect of a 'religious' context on false perceptions in individuals scoring highly on religiosity. After a subliminal prime, participants viewed letter strings, and stated any words that they saw. The prime and the actual words could have a religious connotation or not. Participants measuring high on religiosity were more likely to report false perceptions of a religious type than participants low on religiosity. It is suggested that context affects the content of false perceptions through the activation of stored beliefs and values, which vary between individuals, offering a mechanism for the effect of context on idiosyncratic content of hallucinations in schizophrenia. The effect of context and individual differences on false-perception content in the current study provides possibilities for future work regarding the underlying nature of hallucinations and their treatment.
Cheyne, J A
Sleep paralysis (SP) entails a period of paralysis upon waking or falling asleep and is often accompanied by terrifying hallucinations. Two situational conditions for sleep paralysis, body position (supine, prone, and left or right lateral decubitus) and timing (beginning, middle, or end of sleep), were investigated in two studies involving 6730 subjects, including 4699 SP experients. A greater number of individuals reported SP in the supine position than all other positions combined. The supine position was also 3-4 times more common during SP than when normally falling asleep. The supine position during SP was reported to be more prevalent at the middle and end of sleep than at the beginning suggesting that the SP episodes at the later times might arise from brief microarousals during REM, possibly induced by apnea. Reported frequency of SP was also greater among those consistently reporting episodes at the beginning and middle of sleep than among those reporting episodes when waking up at the end of sleep. The effects of position and timing of SP on the nature of hallucinations that accompany SP were also examined. Modest effects were found for SP timing, but not body position, and the reported intensity of hallucinations and fear during SP. Thus, body position and timing of SP episodes appear to affect both the incidence and, to a lesser extent, the quality of the SP experience.
Cheyne, J A
Sleep paralysis (SP) episodes are often accompanied by vivid hallucinoid experiences that have been found to fall into three major categories thought to be organized according to intrinsic rapid eye movement (REM) processes. Prior research has, however, combined data for individuals with varying degrees of experience with SP episodes, rendering interpretations of the source of this structure ambiguous. The present study of 5799 current SP experients compares the nature and structure of the hallucinations of novice SP experients with those reporting varying numbers of episodes. Both qualitative and quantitative differences were found in reported hallucinations as a function of episode frequency, although the underlying three-factor structure of the hallucinoid experiences was highly similar for all groups. Novice experients' reports were, however, characterized by clearer differentiation of factors, likely because of a tendency of experienced SP experients to conflate experiences across episodes. Age and age of onset of SP episodes were associated with differences in the variety and types of hallucinations but not their underlying structure. Earlier onset of SP episodes was also associated with more frequent episodes. The results are consistent with the hypothesis that the basic form and patterning of hallucinatory experiences is a result of intrinsic processes, independent of prior experience, likely associated with underlying REM neurophysiology.
Skoy, Elizabeth T; Eukel, Heidi N; Frenzel, Jeanne E; Werremeyer, Amy; McDaniel, Becky
Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness.
Eukel, Heidi N.; Frenzel, Jeanne E.; Werremeyer, Amy; McDaniel, Becky
Objective. To increase student pharmacist empathy through the use of an auditory hallucination simulation. Design. Third-year professional pharmacy students independently completed seven stations requiring skills such as communication, following directions, reading comprehension, and cognition while listening to an audio recording simulating what one experiencing auditory hallucinations may hear. Following the simulation, students participated in a faculty-led debriefing and completed a written reflection. Assessment. The Kiersma-Chen Empathy Scale was completed by each student before and after the simulation to measure changes in empathy. The written reflections were read and qualitatively analyzed. Empathy scores increased significantly after the simulation. Qualitative analysis showed students most frequently reported feeling distracted and frustrated. All student participants recommended the simulation be offered to other student pharmacists, and 99% felt the simulation would impact their future careers. Conclusions. With approximately 10 million adult Americans suffering from serious mental illness, it is important for pharmacy educators to prepare students to provide adequate patient care to this population. This auditory hallucination simulation increased student pharmacist empathy for patients with mental illness. PMID:27899838
Full Text Available Paranoia embodies altered representation of the social environment, fuelling altered feelings of social acceptance leading to further mistrust. Mindfulness-based cognitive therapy (MBCT may relieve paranoia and reduce its impact on social acceptance.To determine whether MBCT alters momentary feeling of paranoia and social acceptance in daily life.Randomized controlled trial of daily-life repeated measures (up to 120 per participant before and after allocation to MBCT or waiting list control.Volunteer sample of 130 eligible men and women with residual affective dysregulation after at least one episode of major depressive disorder.Eight weeks of MBCT in groups of 10-15 participants in addition to participants' usual treatment.Daily-life ratings of paranoia and social acceptance. This manuscript concerns additional analyses of the original trial; hypotheses were developed after data collection (focus initially on depressive symptoms but before data analysis.Sixty-six participants were assigned to the waiting list control group and 64 to the MBCT intervention group, of whom 66 and 61 respectively were included in the per-protocol analyses. Intention-to-treat analyses revealed a significant group by time interaction in the model of momentary paranoia (b = -.18, p<0.001, d = -0.35 and social acceptance (b = .26, p<0.001, d = 0.41. Paranoia levels in the intervention group were significantly reduced (b = -.11, p<0.001 and feelings of social acceptance significantly increased (b = .18, p<0.001, whereas in the Control condition a significant increase in paranoia (b = .07, p = 0.008 and a decrease in social acceptance was apparent (b = -.09, p = 0.013. The detrimental effect of paranoia on social acceptance was significantly reduced in the MBCT, but not the control group (group by time interaction: b = .12, p = 0.022.MBCT confers a substantial benefit on subclinical paranoia and may interrupt the social
Pondé, Pedro H; de Sena, Eduardo P; Camprodon, Joan A; de Araújo, Arão Nogueira; Neto, Mário F; DiBiasi, Melany; Baptista, Abrahão Fontes; Moura, Lidia MVR; Cosmo, Camila
Introduction Auditory hallucinations are defined as experiences of auditory perceptions in the absence of a provoking external stimulus. They are the most prevalent symptoms of schizophrenia with high capacity for chronicity and refractoriness during the course of disease. The transcranial direct current stimulation (tDCS) – a safe, portable, and inexpensive neuromodulation technique – has emerged as a promising treatment for the management of auditory hallucinations. Objective The aim of this study is to analyze the level of evidence in the literature available for the use of tDCS as a treatment for auditory hallucinations in schizophrenia. Methods A systematic review was performed, searching in the main electronic databases including the Cochrane Library and MEDLINE/PubMed. The searches were performed by combining descriptors, applying terms of the Medical Subject Headings (MeSH) of Descriptors of Health Sciences and descriptors contractions. PRISMA protocol was used as a guide and the terms used were the clinical outcomes (“Schizophrenia” OR “Auditory Hallucinations” OR “Auditory Verbal Hallucinations” OR “Psychosis”) searched together (“AND”) with interventions (“transcranial Direct Current Stimulation” OR “tDCS” OR “Brain Polarization”). Results Six randomized controlled trials that evaluated the effects of tDCS on the severity of auditory hallucinations in schizophrenic patients were selected. Analysis of the clinical results of these studies pointed toward incongruence in the information with regard to the therapeutic use of tDCS with a view to reducing the severity of auditory hallucinations in schizophrenia. Only three studies revealed a therapeutic benefit, manifested by reductions in severity and frequency of auditory verbal hallucinations in schizophrenic patients. Conclusion Although tDCS has shown promising results in reducing the severity of auditory hallucinations in schizophrenic patients, this technique cannot
Delusional beliefs are characteristic of psychosis and, of the delusions, the paranoid delusion is the single most common type associated with psychosis. The many years of research focused on neurocognition in schizophrenia, using standardized neurocognitive tests, have failed to find conclusive cognitive deficits in relation to positive symptoms. However, UK-based psychological research has identified sociocognitive anomalies in relation to paranoid thinking in the form of theory of mind (ToM), causal reasoning and threat-related processing anomalies. Drawing from recent neuroscientific research on the default mode network, this paper asserts that the common theme running through the psychological tests that are sensitive to the cognitive impairment of paranoia is the need to cognitively project the self through time, referred to as mental time travel. Such an understanding of the cognitive roots of paranoid ideation provides a synthesis between psychological and biological accounts of psychosis while also retaining the powerful argument that understanding abnormal thinking must start with models of normal cognition. This is the core theme running through the cognitive psychological literature of psychiatric disorders that enables research from this area to inform psychological therapy.
Full Text Available The MMPI-2 is the most frequently used psychological test with parents undergoing child custody evaluations (CCE's. Studies of parents who completed the MMPI-2 in the CCE context have consistently found that, on average, parents portray a very favorable image of themselves as both virtuous and psychologically well-adjusted. Also, on average, Clinical Scale 6 (Paranoia and its counterpart on the Restructured Clinical Scales, RC6, have been the most frequently elevated of the clinical scales on the MMPI-2 in samples of child custody litigants, albeit, the reported scores on these scales are well within the norm. This paper examines the significance of clinically elevated scores on Scale 6 (and RC6 in parents undergoing CCE's, with consideration of both contextual and psychometric features. Based on these considerations, this writer suggests that custody evaluators may encounter the paradox that some parents whose clinical profile suggests mistrust and suspiciousness in interpersonal relations may actually trust enough to report their perceptions in a candid and forthcoming manner. At least some of these parents are not mistrustful in general and are not inclined to model or influence their children toward the development of mistrust. In contrast, other parents may respond to the test in a more defensive and deceptive manner resulting in a "normal" clinical profile, which may be specific to the evaluation context, but may also reflect moral righteousness and a more insidious tactic. The custody evaluator is advised to use caution when interpreting clinically elevated scores on the MMPI-2.
Sugiura, Mayuko; Satoh, Masayuki; Tabei, Ken-ichi; Saito, Tomoki; Mori, Mutsuki; Abe, Makiko; Kida, Hirotaka; Maeda, Masayuki; Sakuma, Hajime; Tomimoto, Hidekazu
Background Little research has been conducted regarding the role of pulvinar nuclei in the pathogenesis of visual hallucinations due to the difficulty of assessing abnormalities in this region using conventional magnetic resonance imaging (MRI). The present study aimed to retrospectively investigate the relative abilities of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted imaging (SWI) to visualize the pulvinar and to ascertain the relationship between pulvinar visualization and visual hallucinations. Methods A retrospective analysis of 3T MRIs from 73 patients (31 males, 42 females; mean age 73.5 ± 12.7 years) of the Memory Clinic of Mie University Hospital was conducted. Correlations between pulvinar visualization and the following were analyzed: age, sex, education, hypertension, hyperlipidemia, diabetes mellitus, Mini-Mental State Examination score, Evans index, and visual hallucinations. Results DWI detected low-signal pulvinar areas in approximately half of the patients (52.1%). Participants with pulvinar visualization were significantly older, and the pulvinar was more frequently visualized in patients who had experienced visual hallucinations compared to those who had not. No significant association was observed between whole brain atrophy and pulvinar visualization. Conclusions The results of the present study indicate that diffusion-weighted 3T MRI is the most suitable method for the detection of pulvinar nuclei in patients with dementia experiencing visual hallucinations.
Hoffman, Ralph E
Auditory/verbal hallucinations (AVHs) are comprised of spoken conversational speech seeming to arise from specific, nonself speakers. One hertz repetitive transcranial magnetic stimulation (rTMS) reduces excitability in the brain region stimulated. Studies utilizing 1-Hz rTMS delivered to the left temporoparietal cortex, a brain area critical to speech perception, have demonstrated statistically significant improvements in AVHs relative to sham simulation. A novel mechanism of AVHs is proposed whereby dramatic pre-psychotic social withdrawal prompts neuroplastic reorganization by the "social brain" to produce spurious social meaning via hallucinations of conversational speech. Preliminary evidence supporting this hypothesis includes a very high rate of social withdrawal emerging prior to the onset of frank psychosis in patients who develop schizophrenia and AVHs. Moreover, reduced AVHs elicited by temporoparietal 1-Hz rTMS are likely to reflect enhanced long-term depression. Some evidence suggests a loss of long-term depression following experimentally-induced deafferentation. Finally, abnormal cortico-cortical coupling is associated with AVHs and also is a common outcome of deafferentation. Auditory/verbal hallucinations (AVHs) of spoken speech or "voices" are reported by 60-80% of persons with schizophrenia at various times during the course of illness. AVHs are associated with high levels of distress, functional disability, and can lead to violent acts. Among patients with AVHs, these symptoms remain poorly or incompletely responsive to currently available treatments in approximately 25% of cases. For patients with AVHs who do respond to antipsychotic drugs, there is a very high likelihood that these experiences will recur in subsequent episodes. A more precise characterization of underlying pathophysiology may lead to more efficacious treatments.
Full Text Available Impaired self-monitoring and abnormalities of cognitive bias have been implicated as cognitive mechanisms of hallucination; regions fundamental to these processes including inferior frontal gyrus (IFG and superior temporal gyrus (STG are abnormally activated in individuals that hallucinate. A recent study showed activation in IFG-STG to be modulated by auditory attractiveness, but no study has investigated whether these IFG-STG activations are impaired in schizophrenia. We aimed to clarify the cerebral function underlying the perception of auditory attractiveness in schizophrenia patients. Cerebral activation was examined in 18 schizophrenia patients and 18 controls when performing Favourability Judgment Task (FJT and Gender Differentiation Task (GDT for pairs of greetings using event-related functional MRI. A full-factorial analysis revealed that the main effect of task was associated with activation of left IFG and STG. The main effect of Group revealed less activation of left STG in schizophrenia compared with controls, whereas significantly greater activation in schizophrenia than in controls was revealed at the left middle frontal gyrus (MFG, right temporo-parietal junction (TPJ, right occipital lobe, and right amygdala (p<0.05, FDR-corrected. A significant positive correlation was observed at the right TPJ and right MFG between cerebral activation under FJT minus GDT contrast and the score of hallucinatory behaviour on the Positive and Negative Symptom Scale. Findings of hypo-activation in the left STG could designate brain dysfunction in accessing vocal attractiveness in schizophrenia, whereas hyper-activation in the right TPJ and MFG may reflect the process of mentalizing other person’s behaviour by auditory hallucination by abnormality of cognitive bias.
Orjuela-Rojas, Juan Manuel; Ramírez-Bermúdez, Jesús; Martínez-Juárez, Iris E; Kerik, Nora Estela; Diaz Meneses, Iván; Pérez-Gay, Fernanda Juárez
The current study describes the case of a woman with symptomatic epilepsy due to brain cysticercosis acquired during childhood. During her adolescence, she developed seizures characterized by metamorphopsia, hallucinations of autobiographic memory and, finally, asomatognosia. Magnetic brain imaging showed a calcified lesion in the right occipitotemporal cortex, and positron emission tomography imaging confirmed the presence of interictal hypometabolism in two regions: the right parietal cortex and the right lateral and posterior temporal cortex. We discuss the link between these brain areas and the symptoms described under the concepts of epileptogenic lesion, epileptogenic zone, functional deficit zone, and symptomatogenic zone.
Two challenges that face popular self-monitoring theories (SMTs) of auditory verbal hallucination (AVH) are that they cannot account for the auditory phenomenology of AVHs and that they cannot account for their variety. In this paper I show that both challenges can be met by adopting a predictive processing framework (PPF), and by viewing AVHs as arising from abnormalities in predictive processing. I show how, within the PPF, both the auditory phenomenology of AVHs, and three subtypes of AVH, can be accounted for.
Kapócs, Gábor; Scholkmann, Felix; Salari, Vahid; Császár, Noémi; Szőke, Henrik; Bókkon, István
Today, there is an increased interest in research on lysergic acid diethylamide (LSD) because it may offer new opportunities in psychotherapy under controlled settings. The more we know about how a drug works in the brain, the more opportunities there will be to exploit it in medicine. Here, based on our previously published papers and investigations, we suggest that LSD-induced visual hallucinations/phosphenes may be due to the transient enhancement of bioluminescent photons in the early retinotopic visual system in blind as well as healthy people.
, in a true interaction, each person in the dialogue is trying to model the mind of the other. For success in such interactions it is not sufficient to model what is in the other’s mind. We must also model what the other thinks is in our mind (closing the loop). The hallucinations and delusions associated...... with schizophrenia are largely the result of over-activity in the mechanisms used to model the mental worlds of other minds. These symptoms are the price we pay for our creative brains, but without such creativity we would never be able to share ideas with other minds....
Harrison, Joshua W; Cherukuri, Ramesh; Buchan, Debra
We present a 66-year-old woman with 2 months of visual hallucinations, unintentional weight loss, and short-term memory decline, whose clinical presentation and EEG supported a diagnosis of limbic encephalitis. Subsequent evaluation for a paraneoplastic etiology revealed a renal mass, which was resected and identified as clear cell renal carcinoma. The patient's clinical condition improved after resection of the mass. When patients present with incongruous subacute neuropsychiatric symptoms, clinicians should be mindful of paraneoplastic neurological disorders, as early diagnosis and treatment of malignancy may lead to symptomatic improvement.
Bais, Leonie; Vercammen, Ans; Stewart, Roy; van Es, Frank; Visser, Bert; Aleman, Andre; Knegtering, Henderikus
Background: Repetitive transcranial magnetic stimulation of the left temporo-parietal junction area has been studied as a treatment option for auditory verbal hallucinations. Although the right temporo-parietal junction area has also shown involvement in the genesis of auditory verbal hallucinations
Blom, Jan Dirk; Looijestijn, Jasper; Goekoop, Rutger; Diederen, Kelly M. J.; Rijkaart, Anne-Marije; Slotema, Christina W.; Sommer, Iris E. C.
Background: Alice in Wonderland syndrome (AIWS) is a rare cluster of CNS symptoms characterized by visual distortions (i.e. metamorphopsias), body image distortions, time distortions, and deja experiences. Verbal auditory hallucinations (VAHs) are the most prevalent type of hallucination in adults
Langer, Alvaro I; Cangas, Adolfo J; Serper, Mark
Numerous studies have found that hallucinatory experiences occur in the general population. But to date, few studies have been conducted to compare clinical and nonclinical groups across a broad array of clinical symptoms that may co-occur with hallucinations. Likewise, hallucination-like experiences are measured as a multidimensional construct, with clinical and subclinical components related to vivid daydreams, intrusive thoughts, perceptual disturbance, and clinical hallucinatory experiences. Nevertheless, these individual subcomponents have not been examined across a broad spectrum of clinically disordered and nonclinical groups. The goal of the present study was to analyze the differences and similarities in the distribution of responses to hallucination-like experience in clinical and nonclinical populations and to determine the relation of these hallucination-like experiences with various clinical symptoms. These groups included patients with schizophrenia, non-psychotic clinically disordered patients, and a group of individuals with no psychiatric diagnoses. The results revealed that hallucination-like experiences are related to various clinical symptoms across diverse groups of individuals. Regression analysis found that the Psychoticism dimension of the Symptom Check List (SCL-90-R) was the most important predictor of hallucination-like experiences. Additionally, increased auditory and visual hallucination was the only subcomponent that differentiated schizophrenic patients from other groups. This distribution of responses in the dimensions of hallucination-like experiences suggests that not all the dimensions are characteristic of people hearing voices. Vivid daydreams, intrusive thoughts, and auditory distortions and visual perceptual distortions may represent a state of general vulnerability that does not denote a specific risk for clinical hallucinations. Overall, these results support the notion that hallucination-like experiences are closer to a
Mégevand, Pierre; Groppe, David M; Goldfinger, Matthew S; Hwang, Sean T; Kingsley, Peter B; Davidesco, Ido; Mehta, Ashesh D
In recent years, functional neuroimaging has disclosed a network of cortical areas in the basal temporal lobe that selectively respond to visual scenes, including the parahippocampal place area (PPA). Beyond the observation that lesions involving the PPA cause topographic disorientation, there is little causal evidence linking neural activity in that area to the perception of places. Here, we combined functional magnetic resonance imaging (fMRI) and intracranial EEG (iEEG) recordings to delineate place-selective cortex in a patient implanted with stereo-EEG electrodes for presurgical evaluation of drug-resistant epilepsy. Bipolar direct electrical stimulation of a cortical area in the collateral sulcus and medial fusiform gyrus, which was place-selective according to both fMRI and iEEG, induced a topographic visual hallucination: the patient described seeing indoor and outdoor scenes that included views of the neighborhood he lives in. By contrast, stimulating the more lateral aspect of the basal temporal lobe caused distortion of the patient's perception of faces, as recently reported (Parvizi et al., 2012). Our results support the causal role of the PPA in the perception of visual scenes, demonstrate that electrical stimulation of higher order visual areas can induce complex hallucinations, and also reaffirm direct electrical brain stimulation as a tool to assess the function of the human cerebral cortex.
Thiago Cardoso Vale
Full Text Available Objective: To present an eight-case serie of patients with Charles Bonnet syndrome (CBS. Method: All patients were initially evaluated by an ophthalmologist and then submitted to a neurologic evaluation with exclusion of alternative psychiatric and neurologic diagnoses. Results: Five patients were male (62.5% and the mean age was 52.3+16.0 years. Two patients suffered from severe myopia and glaucoma, three had retinitis pigmentosa, one had anterior ischemic optic neuropathy, one had age-related macular degeneration and one had toxoplasmic retinochoroiditis. Mean visual acuity in the right eye was 1,12 logMAR and in the left eye 0.57 logMAR. A mean delay of 41.7 months occurred until diagnosis. All hallucinations were complexes and mostly ocurred on a weekly-basis (62.5% and lasted for seconds (87.5%. Conclusions: Physicians who care for low vision patients should be aware of CBS and appropriately diagnose its hallucinations after exclusion of psychiatric and neurologic diseases.
de Weijer, Antoin D; Sommer, Iris E C; Lotte Meijering, Anne; Bloemendaal, Mirjam; Neggers, Sebastiaan F W; Daalman, Kirstin; Boezeman, Eduard H J F
The great majority of studies on repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool for auditory verbal hallucinations (AVH) have used 1-Hz stimulation with inconsistent results. Recently, it has been suggested that 20-Hz rTMS has strong therapeutic effects. It is conceivable that this 20-Hz stimulation is more effective than 1-Hz stimulation. The aim of this preliminary study is to investigate the efficacy of 20-Hz rTMS compared with 1-Hz rTMS as a treatment for AVH. Eighteen schizophrenia patients with medication-resistant AVH were randomized over two treatment groups. Each group received either 20 min of 1-Hz rTMS or 13 trains of 20-Hz rTMS daily over 1 week. After week 1, patients received a follow-up treatment once a week for 3 weeks. Stimulation location was based on individual AVH-related activation patterns identified with functional magnetic resonance imaging. Severity of AVH was monitored with the Auditory Hallucination Rating Scale (AHRS). Both groups showed a decrease in AVH after week 1 of rTMS. This decrease was significant for the 20-Hz group and the 1-Hz group. When the two treatment types were compared, no treatment type was superior. Based on these results we cannot conclude whether high frequency rTMS is more effective against AVH than is traditional 1-Hz rTMS. More research is needed to optimize stimulation parameters and to investigate potential target locations for stimulation.
Sugimori, Eriko; Asai, Tomohisa; Tanno, Yoshihiko
This study investigated the effects of imagining speaking aloud, sensorimotor feedback, and auditory feedback on respondents' reports of having spoken aloud and examined the relationship between responses to "spoken aloud" in the reality-monitoring task and the sense of agency over speech. After speaking aloud, lip-synching, or imagining speaking, participants were asked whether each word had actually been spoken. The number of endorsements of "spoken aloud" was higher for words spoken aloud than for those lip-synched and higher for words lip-synched than for those imagined as having been spoken aloud. When participants were prevented by white noise from receiving auditory feedback, the discriminability of words spoken aloud decreased, and when auditory feedback was altered, reports of having spoken aloud decreased even though participants had actually done so. It was also found that those who have had auditory hallucination-like experiences were less able than were those without such experiences to discriminate the words spoken aloud, suggesting that endorsements of having "spoken aloud" in the reality-monitoring task reflected a sense of agency over speech. These results were explained in terms of the source-monitoring framework, and we proposed a revised forward model of speech in order to investigate auditory hallucinations.
Chuan-Jun Zhuo; Jia-Jia Zhu; Chun-Li Wang; Li-Na Wang; Jie Li; Wen Qin
Background:Auditory verbal hallucinations (AVHs) of schizophrenia have been associated with structural and functional alterations of some brain regions.However,the brain regional homogeneity (ReHo) alterations specific to AVHs of schizophrenia remain unclear.In the current study,we aimed to investigate ReHo alterations specific to schizophrenic AVHs.Methods:Thirty-five schizophrenic patients with AVH,41 schizophrenic patients without AVHs,and fifty healthy subjects underwent resting-state functional magnetic resonance imaging.ReHo differences across the three groups were tested using a voxel-wise analysis.Results:Compared with the healthy control group,the two schizophrenia groups showed significantly increased ReHo in the right caudate and inferior temporal gyrus and decreased ReHo in the bilateral postcentral gyrus and thalamus and the right inferior occipital gyrus (false discovery rate corrected,P ＜ 0.05).More importantly,the AVH group exhibited significantly increased ReHo in the left precuneus compared with the non-AVH group.However,using correlation analysis,we did not find any correlation between the auditory hallucination rating scale score and the ReHo of brain regions.Conclusions:Our results suggest that increased ReHo in the left precuneus may be a pathological feature exclusive to schizophrenic AVHs.
Nigel J.T. Thomas
Full Text Available A theory of the structure and cognitive function of the human imagination that attempts to do justice to traditional intuitions about its psychological centrality is developed, largely through a detailed critique of the theory propounded by Colin McGinn. Like McGinn, I eschew the highly deflationary views of imagination, common amongst analytical philosophers, that treat it either as a conceptually incoherent notion, or as psychologically trivial. However, McGinn fails to develop his alternative account satisfactorily because (following Reid, Wittgenstein and Sartre he draws an excessively sharp, qualitative distinction between imagination and perception, and because of his flawed, empirically ungrounded conception of hallucination. His arguments in defense of these views are rebutted in detail, and the traditional, passive, Cartesian view of visual perception, upon which several of them implicitly rely, is criticized in the light of findings from recent cognitive science and neuroscience. It is also argued that the apparent intuitiveness of the passive view of visual perception is a result of mere historical contingency. An understanding of perception (informed by modern visual science as an inherently active process enables us to unify our accounts of perception, mental imagery, dreaming, hallucination, creativity, and other aspects of imagination within a single coherent theoretical framework.
So, Suzanne Ho-wai; Begemann, Marieke J. H.; Gong, Xianmin; Sommer, Iris E.
Neuroticism has been shown to adversely influence the development and outcome of psychosis. However, how this personality trait associates with the individual’s responses to psychotic symptoms is less well known. Auditory verbal hallucinations (AVHs) have been reported by patients with psychosis and non-clinical individuals. There is evidence that voice-hearers who are more distressed by and resistant against the voices, as well as those who appraise the voices as malevolent and powerful, have poorer outcome. This study aimed to examine the mechanistic association of neuroticism with the cognitive-affective reactions to AVH. We assessed 40 psychotic patients experiencing frequent AVHs, 135 non-clinical participants experiencing frequent AVHs, and 126 healthy individuals. In both clinical and non-clinical voice-hearers alike, a higher level of neuroticism was associated with more distress and behavioral resistance in response to AVHs, as well as a stronger tendency to perceive voices as malevolent and powerful. Neuroticism fully mediated the found associations between childhood trauma and the individuals’ cognitive-affective reactions to voices. Our results supported the role of neurotic personality in shaping maladaptive reactions to voices. Neuroticism may also serve as a putative mechanism linking childhood trauma and psychological reactions to voices. Implications for psychological models of hallucinations are discussed. PMID:27698407
So, Suzanne Ho-Wai; Begemann, Marieke J H; Gong, Xianmin; Sommer, Iris E
Neuroticism has been shown to adversely influence the development and outcome of psychosis. However, how this personality trait associates with the individual's responses to psychotic symptoms is less well known. Auditory verbal hallucinations (AVHs) have been reported by patients with psychosis and non-clinical individuals. There is evidence that voice-hearers who are more distressed by and resistant against the voices, as well as those who appraise the voices as malevolent and powerful, have poorer outcome. This study aimed to examine the mechanistic association of neuroticism with the cognitive-affective reactions to AVH. We assessed 40 psychotic patients experiencing frequent AVHs, 135 non-clinical participants experiencing frequent AVHs, and 126 healthy individuals. In both clinical and non-clinical voice-hearers alike, a higher level of neuroticism was associated with more distress and behavioral resistance in response to AVHs, as well as a stronger tendency to perceive voices as malevolent and powerful. Neuroticism fully mediated the found associations between childhood trauma and the individuals' cognitive-affective reactions to voices. Our results supported the role of neurotic personality in shaping maladaptive reactions to voices. Neuroticism may also serve as a putative mechanism linking childhood trauma and psychological reactions to voices. Implications for psychological models of hallucinations are discussed.
Robert I. Henkin
Full Text Available Olfactory hallucinations without subsequent myoclonic activity have not been well characterized or understood. Herein we describe, in a retrospective study, two major forms of olfactory hallucinations labeled phantosmias: one, unirhinal, the other, birhinal. To describe these disorders we performed several procedures to elucidate similarities and differences between these processes. From 1272, patients evaluated for taste and smell dysfunction at The Taste and Smell Clinic, Washington, DC with clinical history, neurological and otolaryngological examinations, evaluations of taste and smell function, EEG and neuroradiological studies 40 exhibited cyclic unirhinal phantosmia (CUP usually without hyposmia whereas 88 exhibited non-cyclic birhinal phantosmia with associated symptomology (BPAS with hyposmia. Patients with CUP developed phantosmia spontaneously or after laughing, coughing or shouting initially with spontaneous inhibition and subsequently with Valsalva maneuvers, sleep or nasal water inhalation; they had frequent EEG changes usually ipsilateral sharp waves. Patients with BPAS developed phantosmia secondary to several clinical events usually after hyposmia onset with few EEG changes; their phantosmia could not be initiated or inhibited by any physiological maneuver. CUP is uncommonly encountered and represents a newly defined clinical syndrome. BPAS is commonly encountered, has been observed previously but has not been clearly defined. Mechanisms responsible for phantosmia in each group were related to decreased gamma-aminobutyric acid (GABA activity in specific brain regions. Treatment which activated brain GABA inhibited phantosmia in both groups.
Hu, Yu; Lam, Kin-Man; Qiu, Guoping; Shen, Tingzhi
We have developed a new face hallucination framework termed from local pixel structure to global image super-resolution (LPS-GIS). Based on the assumption that two similar face images should have similar local pixel structures, the new framework first uses the input low-resolution (LR) face image to search a face database for similar example high-resolution (HR) faces in order to learn the local pixel structures for the target HR face. It then uses the input LR face and the learned pixel structures as priors to estimate the target HR face. We present a three-step implementation procedure for the framework. Step 1 searches the database for K example faces that are the most similar to the input, and then warps the K example images to the input using optical flow. Step 2 uses the warped HR version of the K example faces to learn the local pixel structures for the target HR face. An effective method for learning local pixel structures from an individual face, and an adaptive procedure for fusing the local pixel structures of different example faces to reduce the influence of warping errors, have been developed. Step 3 estimates the target HR face by solving a constrained optimization problem by means of an iterative procedure. Experimental results show that our new method can provide good performances for face hallucination, both in terms of reconstruction error and visual quality; and that it is competitive with existing state-of-the-art methods.
Nanda, Tavish; Rasool, Nailyn; Callahan, Alison B; Stamper, Robert L; Odel, Jeffrey G
Systemic absorption and central nervous system (CNS) penetration of timolol drops are a well-studied phenomenon, resulting in common side effects such as bradycardia, bronchospasm, fatigue, and confusion. More serious CNS side effects, such as psychosis and depression, however, are rarely attributed to eye drops. We report a case series in which patients developed visual hallucinations secondary to topical ocular timolol use. This study is a case series and review of the literature. Four patients with glaucoma developed visual hallucinations while using topical timolol. The patients were all elderly, caucasian females with associated CNS pathology. All patients had resolution of symptoms upon discontinuation and a positive retrial test to confirm the association. The rarity of this side effect and its anecdotal predilection for elderly, caucasian females with underlying neurological dysfunction, may involve a yet unknown predisposition or hypersensitivity to beta blocker action, such as blood brain barrier disruption leading to increased susceptibility to the medication. This case series highlights an important, although rare, side effect of this medication which clinicians should be aware of especially when using it in elderly patients who may have coexisting CNS pathology. It is important that this side effect be recognized and appropriately managed to prevent otherwise unnecessary investigations and treatment.
Aleman, Andre; Sommer, Iris E.; Kahn, Rene S.
Objective: Slow repetitive transcranial magnetic stimulation (rTMS), at a frequency of 1 Hz, has been proposed as a treatment for auditory hallucinations. Several studies have now been reported regarding the efficacy of TMS treatment, but results were inconsistent. Therefore, meta-analytic integrati
Geerligs, Linda; Meppelink, Anne Marthe; Brouwer, Wiebo H.; van Laar, Teus
Visual hallucinations (VHs) often occur in patients with advanced Parkinson disease (PD). Overstimulation of dopamine receptors has been considered as one of the causes for VHs in PD. However, several clinical studies suggested that apomorphine infusion did not worsen existing VHs in PD, but could e
Geerligs, Linda; Meppelink, Anne Marthe; Brouwer, Wiebo H.; van Laar, Teus
Visual hallucinations (VHs) often occur in patients with advanced Parkinson disease (PD). Overstimulation of dopamine receptors has been considered as one of the causes for VHs in PD. However, several clinical studies suggested that apomorphine infusion did not worsen existing VHs in PD, but could
Lincoln, Tania M; Mehl, Stephanie; Ziegler, Michael; Kesting, Marie-Luise; Exner, Cornelia; Rief, Winfried
The assumption that a low sense of self-worth can give rise to paranoid delusions is relevant from a therapeutic perspective, but research has been inconsistent. The present study sought to investigate how interpersonal self-concepts and global self-worth relate to psychotic and depressive psychopathology in persons with psychosis. Participants with psychosis (n=83) and healthy controls (n=33) were assessed for global self-worth, interpersonal self-concepts, and dysfunctional beliefs using the Frankfurt Self-Concept Scale and the Dysfunctional Attitude Scale. Symptoms were assessed with the Positive and Negative Syndrome Scale, the Peters et al. Delusions Inventory, the Paranoia Checklist, and the Beck Depression Inventory. We hypothesized that perceived threat to self-worth, as expressed in dysfunctional acceptance beliefs and negative interpersonal self-concepts, would be uniquely associated with persecutory delusions. In contrast, low global self-worth would be strongly associated with symptoms of depression. Multiple regression analyses were used to investigate the association between symptoms and self-concepts. As expected, low global self-worth was associated with depression, whereas the more specific perception of not being accepted by relevant others was most clearly related to psychotic symptoms. Almost half of the variance in paranoia scores was explained by negative interpersonal self-concepts and the interaction between negative interpersonal self-concepts and dysfunctional acceptance beliefs. Thus, cognitive interventions for delusions might be improved by focusing more on interpersonal self-concepts.
Onofrj, M; Taylor, J P; Monaco, D; Franciotti, R; Anzellotti, F; Bonanni, L; Onofrj, V; Thomas, A
Visual Hallucinations (VH) are a common non-motor symptom of Parkinson's Disease (PD) and the Lewy body dementias (LBD) of Parkinson's disease with dementia (PDD) and Dementia with Lewy Bodies (DLB). The origin of VH in PD and LBD is debated: earlier studies considered a number of different possible mechanisms underlying VH including visual disorders, Rapid Eye Movement (REM) Sleep Intrusions, dysfunctions of top down or bottom up visual pathways, and neurotransmitter imbalance. More recently newer hypotheses introduce, among the possible mechanisms of VH, the role of attention networks (ventral and dorsal) and of the Default Mode Network (DMN) a network that is inhibited during attentional tasks and becomes active during rest and self referential imagery. Persistent DMN activity during active tasks with dysfunctional imbalance of dorsal and ventral attentional networks represents a new hypothesis on the mechanism of VH. We review the different methods used to classify VH and discuss reports supporting or challenging the different hypothetical mechanisms of VH.
Aarli, J A
The Norwegian author Tryggve Andersen (1867-1920) had epilepsy, but was not aware of the diagnosis until late in life. In one novel, Towards Night (Mot Kvaeld), published in 1900, he described in detail nocturnal attacks with formed visual hallucinations as the initial event, seeing always the same face. He was familiar with the works of Ernst Hoffmann and probably also with those of Fiodor Dostoyevsky, but deduction of the literary influence leaves a precise description corresponding to an epileptogenic focus in the right posterotemporal region. Knowledge of his work may elucidate the subjective experience of initial epileptic manifestations, uncontaminated by previous knowledge of what can be expected in epilepsy. The descriptions provided by Andersen's writings are compared with more formal contemporary definitions of seizure events.
Butler, Thomas Charles; Benayoun, Marc; Wallace, Edward; van Drongelen, Wim; Goldenfeld, Nigel; Cowan, Jack
In the cat or primate primary visual cortex (V1), normal vision corresponds to a state where neural excitation patterns are driven by external visual stimuli. A spectacular failure mode of V1 occurs when such patterns are overwhelmed by spontaneously generated spatially self-organized patterns of neural excitation. These are experienced as geometric visual hallucinations. The problem of identifying the mechanisms by which V1 avoids this failure is made acute by recent advances in the statistical mechanics of pattern formation, which suggest that the hallucinatory state should be very robust. Here, we report how incorporating physiologically realistic long-range connections between inhibitory neurons changes the behavior of a model of V1. We find that the sparsity of long-range inhibition in V1 plays a previously unrecognized but key functional role in preserving the normal vision state. Surprisingly, it also contributes to the observed regularity of geometric visual hallucinations. Our results provide an explanation for the observed sparsity of long-range inhibition in V1--this generic architectural feature is an evolutionary adaptation that tunes V1 to the normal vision state. In addition, it has been shown that exactly the same long-range connections play a key role in the development of orientation preference maps. Thus V1's most striking long-range features--patchy excitatory connections and sparse inhibitory connections--are strongly constrained by two requirements: the need for the visual state to be robust and the developmental requirements of the orientational preference map.
Maupassant excelled as a realist writer of the nineteenth century, with fantastical short stories being an outstanding example of his literary genius. We have analysed four of his fantastical stories from a neurological point of view. In "Le Horla," his masterpiece, we have found nightmares, sleep paralysis, a hemianopic pattern of loss and recovery of vision, and palinopsia. In "Qui sait" and in "La main" there is also an illusory movement of the objects in the visual field, although in a dreamlike complex pattern. In "Lui," autoscopy and hypnagogic hallucinations emerge as fantastical key elements. The writer suffered from severe migraine and neurosyphilis involving the optic nerve, which led to his death by general paralysis of the insane (GPI). Visual loss and visual hallucinations affected the author in his last years, before a delirant state confined him to a nursing home. Our original hypothesis, which stated that he could have translated his sensorial experiences coming from this source to his works, had to be revised by analyzing some of his earliest works, notably "Le Docteur Héraclius Gloss" and "La main d'écorché" (1875). We found hallucinatory symptoms, adopting the form of autoscopy and other elaborated visual misperceptions, in stories written at age 25, when Maupassant was allegedly healthy. Therefore, we hypothesize that they may be related to his hypersensitive disposition, assuming that no pathology is necessary to experience such vivid experiences. In addition, Maupassant's abuse of drugs, as illustrated in "Rêves," could have provided an additional element to outline his painstaking visual depictions. All these factors, in addition to his up-to-date neurological knowledge and attendance at Charcot's lectures at "La Salpêtrière," armed the author for repetitive and enriched hallucinatory experiences, which were transferred relentlessly into his works from the beginning of his career.
Vignal, Jean-Pierre; Maillard, Louis; McGonigal, Aileen; Chauvel, Patrick
Using results from cortical stimulations, as well as the symptoms of spontaneous epileptic seizures recorded by stereoelectroencephalography we re-studied the phenomenon of the dreamy state, as described by Jackson (Jackson JH. Selected writings of John Hughlins Jackson. Vol 1. On epilepsy and epileptiform convulsions. Taylor J, editor. London: Hodder and Stoughton; 1931). A total of 15 sensations of déjà vécu, 35 visual hallucinations consisting of the image of a scene and 5 'feelings of strangeness' occurred. These were recorded during 40 stimulations in 16 subjects, and 15 seizures in 5 subjects. Forty-five per cent of dreamy states were evoked by stimulation of the amygdala, 37.5% by the hippocampus and 17.5% by the para-hippocampal gyrus. During both spontaneous and provoked dreamy state, the electrical discharge was localized within mesial temporal lobe structures, without involvement of the temporal neocortex. Early spread of the discharge to the temporal neocortex appeared to prevent the occurrence of the dreamy state. Semiological analysis showed a clinical continuity between déjà vécu and visual hallucinations, the latter often consisting of a personal memory that was 'relived' by the subject; such memories could be recent, distant or from childhood. With one exception, the particular memory evoked differed from one seizure to another, but were always drawn from the same period of the subject's life. Given the role of the amygdala and hippocampus in autobiographic memory, their pathological activation during seizures may trigger memory recall. This study of the dreamy state is in keeping with other evidence demonstrating the constant and central role of the amygdala and hippocampus (right as much as left) in the recall of recent and distant memories. It demonstrates the existence of large neural networks that produce recall of memories via activation of the hippocampus, amygdala and rhinal cortex.
van Tol, Marie-Jose; van der Meer, Lisette; Bruggeman, Richard; Modinos, Gemma; Knegtering, Henderikus; Aleman, André
Introduction: Auditory verbal hallucinations (AVH) in schizophrenia (SZ) have been proposed to result from abnormal local, interregional and interhemispheric integration of brain signals in regions involved in language production and perception. This abnormal functional integration may find its base
E.J.O. Kompanje (Erwin)
textabstractHypnagogic and hypnopompic hallucinations are visual, tactile, auditory or other sensory events, usually brief but sometimes prolonged, that occur at the transition from wakefulness to sleep (hypnagogic) or from sleep to wakefulness (hypnopompic). Hypnagogic and hypnopompic
Le Maléfan, Pascal; Sommer, Andreas
Recent research on the professionalization of psychology at the end of the nineteenth century shows how objects of knowledge which appear illegitimate to us today shaped the institutionalization of disciplines. The veridical or telepathic hallucination was one of these objects, constituting a field both of division and exchange between nascent psychology and disciplines known as 'psychic sciences' in France, and 'psychical research' in the Anglo-American context. In France, Leon Marillier (1862-1901) was the main protagonist in discussions concerning the concept of the veridical hallucination, which gave rise to criticisms by mental specialists and psychopathologists. After all, not only were these hallucinations supposed to occur in healthy subjects, but they also failed to correspond to the Esquirolian definition of hallucinations through being corroborated by their representation of external, objective events.
Laroi, Frank; Sommer, Iris E.; Blom, Jan Dirk; Fernyhough, Charles; Ffytche, Dominic H.; Hugdahl, Kenneth; Johns, Louise C.; McCarthy-Jones, Simon; Preti, Antonio; Raballo, Andrea; Slotema, Christina W.; Stephane, Massoud; Waters, Flavie
Despite a growing interest in auditory verbal hallucinations (AVHs) in different clinical and nonclinical groups, the phenomenological characteristics of such experiences have not yet been reviewed and contrasted, limiting our understanding of these phenomena on multiple empirical, theoretical, and
Waters, Flavie; Aleman, André; Fernyhough, Charles; Allen, Paul
This article presents a report on the first meeting of the International Consortium on Hallucination Research, which took place on September 13–14, 2011 at the Institute of Psychiatry, London. The first day of the meeting served to reflect on the current state of knowledge regarding auditory hallucinations in different diagnostic groups, based on the presentations from the phenomenology, cognition, emotion, electrophysiology, neurochemical, neuroimaging, genetics, treatment, and computational modeling working groups. The second day comprised a discussion forum where the most important and urgent questions for future research were identified. The meeting recognized that a lot has been achieved in auditory hallucination research but that much still remains to be done. Here, we outline the top 16 goals for research on auditory hallucinations, which cover topics of conceptual importance, academic and treatment issues, scientific rigor, and cross-disciplinary collaboration. Concerted and coordinated actions will be required to make substantial research progress. PMID:22223735
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Paulus, Karin, 1975-
Jeruusalemmast toodi kivi, millest üks tükk läks Karu tänavale ehitatava sünagoogi nurgakiviks ja teine uue kunstimuuseumi KUMU sümboolseks lukukiviks. Pikemalt kivi üleandmisega seotud seiklustest Voldemar Prometile. Vabamüürluse ning ehituskunsti seostest
On 4 October 1957 the world was stunned when the Soviet Union lofted the first artificial satellite into Earth orbit. For three days, Sputnik (Russian for "traveller") circled the globe, triggering hysteria in Main Street America as people realized that the "evil empire" was now in a position to drop nuclear bombs on them "like rocks from a highway overpass" in US President Lyndon Johnson's famous words.
Rozsnafszky, Jane; Hendel, Darwin D.
The present report describes the results of an evaluation study of the first course in the new Women's Studies program at the University of Minnesota and the resistance of the teaching assistants for the course to the evaluation. A hypothesis to explain this resistance is that an outside evaluator may face inherent difficulties in evaluating new…
“Strah” je resnični problem z resnično rešitvijo, medtem ko je “paranoja” nekaj kar je nezavedno ustvarjeno v naših mislih in jih lahko tako popolnoma prevzame, je t.i. “naprava moči”, kot v svoji teoriji navaja Michel Foucault. Na področju umetnosti, se je s tem fenomenom ukvarjalo že mnogo umetnikov, med katerimi so umetniško gibanje Preraphaelites, Vincent Van Gogh, ekspresionizem z Edvardom Munchem, Jamesom Ensorjem, Emilom Noldom, Egonom Schielom in Oskarjem Kokoshko, p...
Full Text Available Much has been written on the concept of ‘the fear of Yhwh’ in biblical wisdom literature. The scope thereof is said to include anything from sheer terror before the deity to pious respect for benevolence. In this article, a different necessary property of the basic disposition is identified. It is argued that if as many texts in the Hebrew Bible state a wisdom involves the fear of Yhwh, and that b possessing knowledge of some sort is a necessary condition for having wisdom, and that c all knowledge is essentially paranoiac as Lacanian psycho-epistemology suggests, then it follows that d the quest for wisdom itself is partly driven by paranoia. doi: 10.7833/111-1-26
视幻觉是帕金森病进展中最常见的一种精神症状，最新的研究发现30%~60%的帕金森患者并发视幻觉。视幻觉的发生与很多因素有关，包括多巴胺药物使用剂量，认知功能下降等。本文就帕金森病视幻觉的研究进展作一概述。%Visual hallucinations are the most common psychotic symptoms in Parkinson disease (PD), and recent studies have estimated approximately 30%- 60% of PD patients experiencing VHs as a feature of PD. The occurrence of visual illusions associates with many factors, including dopamine drugs dosage, cognitive decline and so on. The research progresses of visual hallucinations of Parkinson's disease are summarized in this paper.
Speth, Jana; Frenzel, Clemens; Voss, Ursula
We present Activity Analysis as a new method for the quantification of subjective reports of altered states of consciousness with regard to the indicated level of simulated motor activity. Empirical linguistic activity analysis was conducted with dream reports conceived immediately after EEG-controlled periods of hypnagogic hallucinations and REM-sleep in the sleep laboratory. Reports of REM-dreams exhibited a significantly higher level of simulated physical dreamer activity, while hypnagogic hallucinations appear to be experienced mostly from the point of passive observer. This study lays the groundwork for clinical research on the level of simulated activity in pathologically altered states of subjective experience, for example in the REM-dreams of clinically depressed patients, or in intrusions and dreams of patients diagnosed with PTSD.
Full Text Available Pedro H Pondé,1 Eduardo P de Sena,2 Joan A Camprodon,3 Arão Nogueira de Araújo,2 Mário F Neto,4 Melany DiBiasi,5 Abrahão Fontes Baptista,6,7 Lidia MVR Moura,8 Camila Cosmo2,3,6,9,10 1Dynamics of Neuromusculoskeletal System Laboratory, Bahiana School of Medicine and Public Health, 2Postgraduate Program in Interactive Process of Organs and Systems, Federal University of Bahia, Salvador, Bahia, Brazil; 3Laboratory for Neuropsychiatry and Neuromodulation and Transcranial Magnetic Stimulation Clinical Service, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 4Scientific Training Center Department, School of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil; 5Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; 6Functional Electrostimulation Laboratory, Biomorphology Department, 7Postgraduate Program on Medicine and Human Health, School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil; 8Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 9Center for Technological Innovation in Rehabilitation, Federal University of Bahia, 10Bahia State Health Department (SESAB, Salvador, Bahia, Brazil Introduction: Auditory hallucinations are defined as experiences of auditory perceptions in the absence of a provoking external stimulus. They are the most prevalent symptoms of schizophrenia with high capacity for chronicity and refractoriness during the course of disease. The transcranial direct current stimulation (tDCS – a safe, portable, and inexpensive neuromodulation technique – has emerged as a promising treatment for the management of auditory hallucinations. Objective: The aim of this study is to analyze the level of evidence in the literature available for the use of tDCS as a treatment for auditory hallucinations in schizophrenia. Methods: A systematic review was performed
Niels Van Quaquebeke
Full Text Available A six-month, time-lagged online survey among 441 employees in diverse industries was conducted to investigate the role paranoia plays as an antecedent and as a consequence of advancement in organizations. The background of the study is the argument that it requires active social sense-making and behavioral adaptability to advance in organizations. The present paper thus explores the extent to which employees’ paranoid cognitions—representative of a heightened albeit suspicious sense-making and behavioral adaptability—link with their advancement in organizations (operationalized as changes in afforded span of control, both as an antecedent and an outcome. Following the strategy to illuminate the process by interaction analysis, both conditions (antecedent and outcome are examined in interaction with employees’ self-monitoring, which is considered representative of a heightened but healthy sense-making and behavioral adaptability. Results support the expected interference interaction between paranoid cognitions and self-monitoring in that each can to some degree compensate for the other in explaining employees’ organizational advancement. Reversely, changes in span of control also affected paranoid cognitions. In particular, low self-monitors, i.e. those low in adaptive sense-making, reacted with heightened paranoid cognitions when demoted. In effect, the present study is thus the first to empirically support that paranoid cognitions can be a consequence but also a prerequisite for getting ahead in organizations. Practical advice should, however, be suspended until it is better understood whether and under what circumstances paranoia may relate not only to personally getting ahead but also to an increased effectiveness for the benefit of the organization.
Van Quaquebeke, Niels
A 6-month, time-lagged online survey among 441 employees in diverse industries was conducted to investigate the role paranoia plays as an antecedent and as a consequence of advancement in organizations. The background of the study is the argument that it requires active social sense-making and behavioral adaptability to advance in organizations. The present paper thus explores the extent to which employees’ paranoid cognitions—representative of a heightened albeit suspicious sense-making and behavioral adaptability—link with their advancement in organizations (operationalized as changes in afforded span of control), both as an antecedent and an outcome. Following the strategy to illuminate the process by interaction analysis, both conditions (antecedent and outcome) are examined in interaction with employees’ self-monitoring, which is considered representative of a heightened but healthy sense-making and behavioral adaptability. Results support the expected interference interaction between paranoid cognitions and self-monitoring in that each can to some degree compensate for the other in explaining employees’ organizational advancement. Reversely, changes in span of control also affected paranoid cognitions. In particular, low self-monitors, i.e., those low in adaptive sense-making, reacted with heightened paranoid cognitions when demoted. In effect, the present study is thus the first to empirically support that paranoid cognitions can be a consequence but also a prerequisite for getting ahead in organizations. Practical advice should, however, be suspended until it is better understood whether and under what circumstances paranoia may relate not only to personally getting ahead but also to an increased effectiveness for the benefit of the organization. PMID:27713724
Gama, Romulo Lopes; Bruin, Veralice Meireles Sales; Távora, Daniel Gurgel Fernandes; Duran, Fábio L S; Bittencourt, Lia; Tufik, Sergio
The objective is to evaluate clinical characteristics and cerebral alterations in Parkinson's disease (PD) patients with diurnal visual hallucinations (VHs). Assessment was performed using magnetic resonance image (MRI) and voxel-based morphometry (VBM). Thirty-nine patients with PD (53.8%) and ten controls were studied. Voxel based morphology analysis was performed. Eleven patients presented diurnal VHs and among these, six had cognitive dysfunction. Patients with VHs performed worse in the mentation-related UPDRS I (p=0.005) and motor-related UPDRS III (p=0.02). Patients with VHs showed significant clusters of reduced grey matter volume compared to controls in the left opercula frontal gyrus and left superior frontal gyrus. PD without hallucinations demonstrated reduced grey matter volume in the left superior frontal gyrus compared to controls. Comparisons between patients with VHs regarding the presence of cognitive dysfunction showed that cases with cognitive dysfunction as compared to those without cognitive dysfunction showed significant clusters of reduced grey matter volume in the left opercular frontal gyrus. Cases without cognitive dysfunction had reduced grey matter substance in the left insula and left trigonal frontal gyrus. Judging from our findings, an abnormal frontal cortex, particularly left sided insula, frontal opercular, trigonal frontal gyrus and orbital frontal would make PD patients vulnerable to hallucinations. Compromise of the left operculum distinguished cases with VHs and cognitive dysfunction. Our findings reinforce the theoretical concept of a top-down visual processing in the genesis of VHs in PD.
Johanna C. Badcock
Full Text Available The National Institute of Mental Health initiative called the Research Domain Criteria (RDoC project aims to provide a new approach to understanding mental illness grounded in the fundamental domains of human behaviour and psychological functioning. To this end the RDoC framework encourages researchers and clinicians to think outside the [diagnostic]box, by studying symptoms, behaviours or biomarkers that cut across traditional mental illness categories. In this article we examine and discuss how the RDoC framework can improve our understanding of psychopathology by zeroing in on hallucinations- now widely recognized as a symptom that occurs in a range of clinical and non-clinical groups. We focus on a single domain of functioning - namely cognitive [inhibitory] control - and assimilate key findings structured around the basic RDoC units of analysis, which span the range from observable behaviour to molecular genetics. Our synthesis and critique of the literature provides a deeper understanding of the mechanisms involved in the emergence of auditory hallucinations, linked to the individual dynamics of inhibitory development before and after puberty; favours separate developmental trajectories for clinical and nonclinical hallucinations; yields new insights into co-occurring emotional and behavioural problems; and suggests some novel avenues for treatment.
Full Text Available Parkinson’s disease (PD is characterized by motor and nonmotor symptoms. Nonmotor symptoms include primarily visual hallucinations (VH. The aim of our study was to establish whether patients with PD and visual hallucinations (PDH+ have structural changes of retina detected by an optical coherence tomography (OCT in comparison with PD patients without visual hallucinations (PDH−. We examined 52 PD patients (18 with VH, 34 without VH and 15 age and sex matched healthy controls. Retinal nerve fiber layer (RNFL thickness and macular thickness and volume were assessed by OCT. Functional impairment of retina was assessed using 2.5% contrast sensitivity test. For OCT outcomes we analyzed 15 PDH+ and 15 PDH− subjects matched for age, gender, and PD duration. For contrast sensitivity we analyzed 8 pairs of patients matched for age, gender, and visual acuity. There was no significant difference in RNFL thickness and macular thickness and macular volume between 15 PDH+ and 15 PDH− subjects, and also between a group of 44 PD patients (both PDH+ and PDH− and 15 age and gender matched healthy controls. No significant difference was found for 2.5% contrast sensitivity test values between PDH+ and PDH− subjects. Therefore we conclude that functional and structural changes in retina play no role in genesis of VH in PD.
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Full Text Available BACKGROUND: Though infections are associated with psychotic symptoms, whether or not subclinical inflammation is associated with hallucinations is not known in Parkinson's disease (PD. PURPOSE: To investigate the association of illusions/hallucinations and plasma CRP levels in PD patients without symptomatic infections. METHODS: PD patients not diagnosed as having infections were assessed for illusions and hallucinations using the Parkinson Psychosis Questionnaire (PPQ. It comprises four-domain questions: PPQ-A for sleep problems, PPQ-B for hallucinations/illusions, PPQ-C for delusions, and PPQ-D for disorientation. Assigning patients with ≥1 points in the PPQ-B score to be cases and others as controls, the association of hallucinations/illusions and clinical features (age, sex, duration of PD, Unified Parkinson's Disease Rating Scale part 3 (UPDRS-3, Mini-Mental State Examination (MMSE score, sleep disturbance (PPQ-A score as well as daily doses of L-Dopa, dopamine agonists, amantadine, and selegiline were analyzed using a case-control design. RESULTS: A total of 111 patients were examined and plasma CRP levels were <0.1-6.0 mg/L. Hallucinations or illusions were detected in 28 (25.2%. There were significant differences in age, UPDRS-3 score, MMSE score, PPQ-A, daily doses of L-Dopa and dopamine agonists and plasma CRP levels between cases and controls. A multivariate logistic regression model revealed that UPDRS-3 scores and plasma CRP levels were significantly associated with hallucinations/illusions with an adjusted odds ratio of 1.96 (95% confidence interval (CI 1.20-3.20 per 10 points and 1.57 (95% confidence interval 1.13-2.16 per two-fold, respectively. Dividing patients into thirds by CRP levels (≤0.2, 0.3-0.6, ≥0.7 mg/L, the prevalence of hallucinations/illusions was 13.2%, 21.6%, and 41.7%, in the bottom-, middle-, and top-thirds, respectively (for trend p = 0.012. CONCLUSIONS: Subclinical elevation of plasma CRP levels was
Dyck, Miriam S; Mathiak, Krystyna A; Bergert, Susanne; Sarkheil, Pegah; Koush, Yury; Alawi, Eliza M; Zvyagintsev, Mikhail; Gaebler, Arnim J; Shergill, Sukhi S; Mathiak, Klaus
Auditory verbal hallucinations (AVHs) are a hallmark of schizophrenia and can significantly impair patients' emotional, social, and occupational functioning. Despite progress in psychopharmacology, over 25% of schizophrenia patients suffer from treatment-resistant hallucinations. In the search for alternative treatment methods, neurofeedback (NF) emerges as a promising therapy tool. NF based on real-time functional magnetic resonance imaging (rt-fMRI) allows voluntarily change of the activity in a selected brain region - even in patients with schizophrenia. This study explored effects of NF on ongoing AVHs. The selected participants were trained in the self-regulation of activity in the anterior cingulate cortex (ACC), a key monitoring region involved in generation and intensity modulation of AVHs. Using rt-fMRI, three right-handed patients, suffering from schizophrenia and ongoing, treatment-resistant AVHs, learned control over ACC activity on three separate days. The effect of NF training on hallucinations' severity was assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS) and on the affective state - with the Positive and Negative Affect Schedule (PANAS). All patients yielded significant upregulation of the ACC and reported subjective improvement in some aspects of AVHs (AVHRS) such as disturbance and suffering from the voices. In general, mood (PANAS) improved during NF training, though two patients reported worse mood after NF on the third day. ACC and reward system activity during NF learning and specific effects on mood and symptoms varied across the participants. None of them profited from the last training set in the prolonged three-session training. Moreover, individual differences emerged in brain networks activated with NF and in symptom changes, which were related to the patients' symptomatology and disease history. NF based on rt-fMRI seems a promising tool in therapy of AVHs. The patients, who suffered from continuous hallucinations for
Full Text Available Auditory verbal hallucinations (AVHs are the experience of hearing a voice in the absence of any speaker. Results from recent attempts to treat AVHs with neurostimulation (rTMS or tDCS to the left temporoparietal junction have not been conclusive, but suggest that it may be a promising treatment option for some individuals. Some evidence suggests that the therapeutic effect of neurostimulation on AVHs may result from modulation of cortical areas involved in the ability to monitor the source of self-generated information. Here, we provide a brief overview of cognitive models and neurostimulation paradigms associated with treatment of AVHs, and discuss techniques that could be explored in the future to improve the efficacy of treatment, including alternating current and random noise stimulation. Technical issues surrounding the use of neurostimulation as a treatment option are discussed (including methods to localise the targeted cortical area, and the state-dependent effects of brain stimulation, as are issues surrounding the acceptability of neurostimulation for adolescent populations and individuals who experience qualitatively different types of AVH.
Lenka, Abhishek; Jhunjhunwala, Ketan Ramakant; Saini, Jitender; Pal, Pramod Kumar
Patients with Parkinson's disease (PD) may develop various non-motor symptoms (NMS) during the course of the illness and psychosis is one of the common NMS of PD. Visual hallucinations (VH) are the most common manifestation of psychosis in PD. The exact pathogenesis of VH in patients with PD is not clearly understood. Presence of VH has been described to be associated with rapid cognitive decline and increased nursing home placements in PD patients. A large number of structural and functional neuroimaging studies have been conducted to understand the cerebral basis of VH in PD. Structural imaging studies (Voxel Based Morphometry) have reported grey matter atrophy in multiple regions of the brain such as primary visual cortex, visual association cortex, limbic regions, cholinergic structures such as pedunculopontine nucleus and substantia innominata, which conclude possible alterations of brain regions associated with functions such as visuospatial-perception, attention control and memory. Most functional neuroimaging studies (functional MRI, positron emission tomography and single photon emission computerized tomography) have reported altered activation, blood flow, or reduced metabolism in both dorsal and ventral visual pathways, which probably indicates an alteration in the normal bottom-top visual processing and the presence of an aberrant top-down visual processing. This review critically analyzes the published studies on the structural and functional neuroimaging in PD patients with VH.
Kayser, Jürgen; Tenke, Craig E; Kroppmann, Christopher J; Alschuler, Daniel M; Fekri, Shiva; Gil, Roberto; Jarskog, L Fredrik; Harkavy-Friedman, Jill M; Bruder, Gerard E
Existing 67-channel event-related potentials, obtained during recognition and working memory paradigms with words or faces, were used to examine early visual processing in schizophrenia patients prone to auditory hallucinations (AH, n = 26) or not (NH, n = 49) and healthy controls (HC, n = 46). Current source density (CSD) transforms revealed distinct, strongly left- (words) or right-lateralized (faces; N170) inferior-temporal N1 sinks (150 ms) in each group. N1 was quantified by temporal PCA of peak-adjusted CSDs. For words and faces in both paradigms, N1 was substantially reduced in AH compared with NH and HC, who did not differ from each other. The difference in N1 between AH and NH was not due to overall symptom severity or performance accuracy, with both groups showing comparable memory deficits. Our findings extend prior reports of reduced auditory N1 in AH, suggesting a broader early perceptual integration deficit that is not limited to the auditory modality.
Ibarretxe-Bilbao, Naroa; Junque, Carme; Marti, Maria J; Tolosa, Eduardo
The presence of visual hallucinations (VH) is a significant predictor of dementia in Parkinson's disease (PD) and it is associated with a more rapid cognitive decline. Non-demented PD patients with VH present greater neuropsychological impairment than those without VH in domains such as verbal and visual memory, language comprehension, and visuospatial and visuoperceptive functions. Frontal dysfunction has also been described in PD with VH, including deficits in verbal fluency, sustained attention, and inhibition. In PD with VH, structural and functional abnormalities within the primary visual system and visual association areas, including ventral and dorsal pathways, have been reported. Structural MRI studies have shown that non-demented PD patients with VH present grey matter reduction in parieto-occipital areas and the hippocampal head. A follow-up study performed at a mean of 30 months revealed that unlike PD patients without VH, PD patients with VH frequently develop dementia associated with progressive atrophy in limbic, paralimbic and neocortical areas. Functional MRI (fMRI) studies have revealed altered activation in occipito-temporal and frontal areas in response to simple and complex visual stimuli in PD patients with VH, suggesting a marked impairment in bottom-up visual processing, as well as an attentional deficit in the pathophysiology of VH in PD.
Auditory verbal hallucinations (AVHs) are experienced by individuals with various clinical diagnoses, such as psychosis, but also a significant minority of healthy individuals from the general population may experience them. Although much research has been carried out the past few decades, the mechanisms and factors underlying the emergence of AVHs is still poorly understood. One way of clarifying this issue involves comparing AVHs in patient and non-patient populations. In particular, differences between these groups will provide important information concerning the emergence of AVHs. After a general presentation and discussion of the notion of a continuum hypothesis, studies comparing patients with non-patients experiencing AVHs will be reviewed. This will comprise studies examining the phenomenological characteristics of AVHs in addition to neuroimaging and cognitive studies. Although we are beginning to elucidate important differences on a phenomenological level between these two types of AVHs, far too few studies have directly compared patient and non-patient AVHs in terms of underlying cerebral correlates and cognitive mechanisms. Nevertheless, and based on recent research on phenomenological differences, two issues stand out that need to be addressed, namely, the highly negative emotional content of AVHs in patients and the early onset of AVHs in non-patients populations. Suggestions for future research will be discussed.
Kubera, Katharina M.; Barth, Anja; Hirjak, Dusan; Thomann, Philipp A.; Wolf, Robert C.
This mini-review focuses on noninvasive brain stimulation techniques as an augmentation method for the treatment of persistent auditory verbal hallucinations (AVH) in patients with schizophrenia. Paradigmatically, we place emphasis on transcranial magnetic stimulation (TMS). We specifically discuss rationales of stimulation and consider methodological questions together with issues of phenotypic diversity in individuals with drug-refractory and persistent AVH. Eventually, we provide a brief outlook for future investigations and treatment directions. Taken together, current evidence suggests TMS as a promising method in the treatment of AVH. Low-frequency stimulation of the superior temporal cortex (STC) may reduce symptom severity and frequency. Yet clinical effects are of relatively short duration and effect sizes appear to decrease over time along with publication of larger trials. Apart from considering other innovative stimulation techniques, such as transcranial Direct Current Stimulation (tDCS), and optimizing stimulation protocols, treatment of AVH using noninvasive brain stimulation will essentially rely on accurate identification of potential responders and non-responders for these treatment modalities. In this regard, future studies will need to consider distinct phenotypic presentations of AVH in patients with schizophrenia, together with the putative functional neurocircuitry underlying these phenotypes. PMID:26528145
Mainardi, Federico; Rapoport, Alan; Zanchin, Giorgio; Maggioni, Ferdinando
Introduction Olfactory hallucination during a migraine attack (OHM) is a rare phenomenon. At present, it is not considered a manifestation of migraine aura. Material and methods The clinical features of OHM were collected in 11 patients. Results Of the 11 patients, 10 had migraine without aura and one migraine with aura associated with OHM. Mean age at onset of headache and at appearance of OHM were respectively 17.8 and 32.3 years. Migraine average frequency was 3.9 attacks/month, 19% of them being associated with OHM. The temporal pattern of OHM maintained the same characteristics in the different attacks. OHM onset was described as sudden ( n = 5), gradual ( n = 3), initially sudden and then gradual ( n = 2), or developing in a few seconds ( n = 1). In most of the cases ( n = 8) OHM lasted from 3 to 10 minutes; it persisted during the pain phase (2-24 hours) in only three patients. The type of the perceived smell was invariably constant in nine patients. Conclusion OHM features fulfilled the ICHD-III beta criteria for typical aura.