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Blom JD. Hallucinations and Vitamin B12 Deficiency: A Systematic Review. Psychopathology 2024:1-12. [PMID: 39047712 DOI: 10.1159/000540003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Vitamin B12 deficiency is primarily associated with pernicious anaemia, polyneuropathy, and spinal-cord disease, but publications on its association with hallucinations are on the rise. METHODS I carried out a systematic literature search on these hallucinations in PubMed, PsycINFO, and Google Scholar, up until July 1, 2023. RESULTS The search yielded 50 case studies published between 1960 and 2023. The hallucinations described therein are predominantly visual and/or auditory in nature, with 20% being specified as complex, compound, or panoramic. They are often described in the context of vitamin B12-related neuropsychiatric conditions such as dementia, delirium, epilepsy, psychotic disorder, schizoaffective disorder, bipolar disorder, depressive disorder, catatonia, or obsessive-compulsive disorder. In the context of such disorders, they tend to appear first and also often appear to be the first to disappear with cobalamin treatment. Within an average of 2 months, full amelioration was thus obtained in 75% of the cases and partial amelioration in the remaining 25%. Remarkably, a quarter of the cases involved therapy-resistant hallucinations that fully resolved under cobalamin monotherapy, while other neuropsychiatric manifestations of vitamin B12 deficiency disappeared in 60% of the treated cases. Only 32% of the cases involved comorbid pernicious anaemia. This suggests that two separate or diverging pathways exist for perceptual and haematological symptoms of vitamin B12 deficiency. CONCLUSION In the light of the high prevalence rate of vitamin B12 deficiency in the general population, the findings here presented should be interpreted with great caution. Nonetheless, they offer cues for further research and experimental application in clinical practice. This may be especially relevant in light of the recent increase in the popularity of vegetarianism and the recreational use of nitrous oxide (laughing gas), which are both risk factors for vitamin B12 deficiency.
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Affiliation(s)
- Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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Elendu C, Jeswani BM, Madekwe CC, Chukwuneta CP, Sidhu AK, Okorie CO, Banerjee AV, Oshin BD. Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients. Ann Med Surg (Lond) 2024; 86:4015-4034. [PMID: 38989169 PMCID: PMC11230812 DOI: 10.1097/ms9.0000000000002159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 07/12/2024] Open
Abstract
Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors' review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.
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Affiliation(s)
| | - Bijay M. Jeswani
- GCS Medical College, Hospital & Research Centre, Ahmedabad, Gujarat, India
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3
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Zold AL, Jourdain MK. Empathy Amplified: Exploring the Transformative Potential of Understanding Auditory Hallucinations Through Staff Training. J Am Psychiatr Nurses Assoc 2024:10783903241252162. [PMID: 38767121 DOI: 10.1177/10783903241252162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Stigmatization of individuals diagnosed with psychosis, especially those who experience auditory hallucinations, is a well-documented issue with negative outcomes on provision of care. Existing research has predominantly concentrated on experiential training for students, leaving a significant gap in knowledge regarding the training's impact on practicing psychiatric nurses and technicians. AIMS This study aims to address this gap by investigating the efficacy of a concise, 1-hour educational activity designed to improve empathy, confidence, competence, and knowledge in psychiatric professionals. METHODS Participants engaged in a 1-hour training session that included simulated activities while listening to distressing voices and completed pretraining and posttraining assessments. RESULTS Results demonstrated a notable increase in empathy toward individuals who hear voices, suggesting that the training had a positive effect. Furthermore, significant differences were observed in the participants' perceptions of the level of difficulty as well as increased levels of confidence and perceived competence in their ability to provide care. CONCLUSIONS The results underscore the practicality and effectiveness of brief hearing voices simulations as a means to enhance the skills of existing health care providers. This approach allows professionals to better express empathy and gain a deeper understanding of the experiences of voice hearers.
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Affiliation(s)
- Amanda Lynn Zold
- Amanda Lynn Zold, PhD, Hartford Hospital, Hartford, CT, USA; The University of Texas Health Science Center, Houston, TX, USA
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4
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Garcia-Marti G, Escarti MJ, Nacher J, Perez-Rando M, Mane A, Usall J, Berrocoso E, Pomarol-Clotet E, Lopez-Ilundain JM, Cuesta MJ, Rodriguez-Jimenez R, Gonzalez-Pinto A, Mar L, Ibañez A, Roldan A, Janssen J, Parellada M, Amoretti S, Bernardo M, Sanjuan J, Aguilar EJ. Progressive loss of cortical gray matter in first episode psychosis patients with auditory hallucinations. Schizophr Res 2024; 267:534-545. [PMID: 38044223 DOI: 10.1016/j.schres.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/18/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Previous longitudinal magnetic resonance imaging studies have shown progressive gray matter (GM) reduction during the earliest phases of schizophrenia. It is unknown whether these progressive processes are homogeneous in all groups of patients. One way to obtain more valid findings is to focus on the symptoms. Auditory hallucinations (AHs) are frequent and reliable symptoms of psychosis. The present study aims to analyze whether longitudinal changes in structural abnormalities in cortical regions are related to the presence of AHs and the intensity of psychotic symptoms in a large sample. METHODS A Magnetic Resonance (MR) voxel-based morphometry analysis was applied to a group of 128 first episodes psychosis (FEP) patients (63 patients with AHs and 65 patients without AHs) and 78 matched healthy controls at baseline and at a 2-year follow-up. RESULTS At baseline, FEP patients exhibited significant GM volume reductions in the temporal, frontal and precentral regions. At follow-up, FEP patients exhibited GM volume changes in the temporal, Rolandic, frontal, precentral and insula regions. At baseline, no significant differences were found between FEP patients with and without AHs. At follow-up, while FEP patients with AHs showed less GM volume in temporal and frontal lobes, non-AH FEP patients showed reductions in the frontal, precentral and fusiform areas. PANSS scores showed statistically significant correlations with GM volume reductions at baseline and follow-up. CONCLUSIONS Brain cortical loss in the early phases of psychosis is not associated with potentially transitory AHs; however, brain structural changes may emerge as AHs appear in chronic patients.
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Affiliation(s)
- Gracian Garcia-Marti
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Biomedical Engineering Unit / Radiology Department, Quirónsalud Hospital, Valencia, Spain; Institute of research of the Clinic Hospital from Valencia (INCLIVA), Valencia, Spain.
| | - Maria J Escarti
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of research of the Clinic Hospital from Valencia (INCLIVA), Valencia, Spain; Unit of Psychiatry, Clinic Hospital Valencia, University of Valencia, Valencia, Spain
| | - Juan Nacher
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of research of the Clinic Hospital from Valencia (INCLIVA), Valencia, Spain; Institute of Biotechnology and Biomedicine (BIOTECMED), Universitat de València, Burjassot, Spain
| | - Marta Perez-Rando
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of research of the Clinic Hospital from Valencia (INCLIVA), Valencia, Spain; Institute of Biotechnology and Biomedicine (BIOTECMED), Universitat de València, Burjassot, Spain
| | - Anna Mane
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Department of Medicine and Life Sciences (MELIS). Universitat Pompeu Fabra, Barcelona, Spain
| | - Judith Usall
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Esther Berrocoso
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, Faculty of Medicine, University of Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Edith Pomarol-Clotet
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Jose M Lopez-Ilundain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | - Roberto Rodriguez-Jimenez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Ana Gonzalez-Pinto
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Bioaraba, Department of Psychiatry, Hospital Universitario de Alava, UPV/EHU, Vitoria, Spain
| | - Lorea Mar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Bioaraba, Department of Psychiatry, Hospital Universitario de Alava, UPV/EHU, Vitoria, Spain
| | - Angela Ibañez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Alexandra Roldan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Psychiatry Department, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Barcelona, Spain
| | - Joost Janssen
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mara Parellada
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Silvia Amoretti
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona; University of Barcelona, Spain; Bipolar and Depressive Disorder Unit, Neuroscience Institute, Hospital Clínic, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Miquel Bernardo
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Julio Sanjuan
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of research of the Clinic Hospital from Valencia (INCLIVA), Valencia, Spain; Unit of Psychiatry, Clinic Hospital Valencia, University of Valencia, Valencia, Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Institute of research of the Clinic Hospital from Valencia (INCLIVA), Valencia, Spain; Unit of Psychiatry, Clinic Hospital Valencia, University of Valencia, Valencia, Spain
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Toh WL, Thomas N, Rossell SL. The Phenomenology of Visual and Other Nonauditory Hallucinations in Affective and Nonaffective Psychosis: A Mixed Methods Analysis. J Nerv Ment Dis 2024; 212:205-212. [PMID: 38090976 DOI: 10.1097/nmd.0000000000001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
ABSTRACT Nonauditory hallucinations in psychosis have not received as much attention relative to voice-hearing experiences. The current paper aimed to document the characteristics of these hallucinations in affective and nonaffective psychosis. Participants were selected from a primary voice-hearing sample, who had endorsed visual, tactile, or olfactory hallucinations ( N = 55-75). A comprehensive, semistructured phenomenological interview was conducted, followed by mixed methods analysis. Visual hallucinations typically occurred daily, for a few minutes per episode, within one's direct line of sight; persons and/or animals were most commonly seen, with low controllability and mostly engendered negative affective outcomes. Tactile and olfactory hallucinations were endorsed by 46.8% and 39.0% of participants, respectively. The affective psychosis group ( n = 33) reported significantly greater awareness and lower functional impairment relative to the nonaffective psychosis group ( n = 42). Qualitative thematic analysis revealed notable themes and subthemes across each of these hallucinations modes. Further phenomenological investigations should be carried out in lesser known hallucination modalities, assisted by the development of appropriate assessment tools.
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Incekara F, Blom JD. Carl Jung: a life on the edge of reality with hypnagogia, hyperphantasia, and hallucinations. Front Psychol 2024; 15:1358329. [PMID: 38515975 PMCID: PMC10954828 DOI: 10.3389/fpsyg.2024.1358329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Whether the Swiss psychiatrist Carl Jung (1875-1961) became psychotic after his mid-thirties is much debated. His recently published Black Books, a seven-volume journal, reveal new insights into this debate. Based on a phenomenological analysis of his self-reports in these books and in other writings, we here identify several types of anomalous perceptual experiences: hypnagogic-hypnopompic experiences, hyperphantasia, hallucinations, personifications, and sensed presence. We argue that these experiences were not indicative of a psychotic disorder, but rather stemmed from extremely vivid mental imagery, or hyperphantasia, a condition Jung's contemporaries and later biographers were unable to take into account because it had not yet been conceptualised. Recently, the degree of vividness of mental imagery and its potential to become indistinguishable from regular sense perception has been the subject of extensive studies. Unknowingly, Jung may have foreshadowed this line of research with his psychoanalytic concept of reality equivalence, i.e., the substitution of an external world for an inner mental reality that he encountered in individuals diagnosed with schizophrenia. There is a need for future research to investigate the possible role of hyperphantasia in psychotic experiences, but to Jung, psychosis was 'a failure to contain and comprehend' the content of one's experiences in the context of one's own life, whereas he himself did manage to put the content of his perceptual experiences into context, to find meaning in them, and to share them with others - to great acknowledgement and acclaim.
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Affiliation(s)
| | - Jan Dirk Blom
- Parnassia Psychiatric Institute, The Hague, Netherlands
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
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7
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Hayward M, Bibby-Jones AM, Thomas N, Paulik G, Mutanda D, Berry C. Multi-modal hallucinations across diagnoses: What relationships do they have with voice-related distress? Schizophr Res 2024; 265:58-65. [PMID: 37230912 DOI: 10.1016/j.schres.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/15/2023] [Accepted: 04/15/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Research into hallucinatory experiences has focused primarily upon hallucinations within the auditory modality, to the relative neglect of other modalities. Furthermore, the exploration of auditory hallucinations (or 'voices') has focused primarily upon the experiences of people with a diagnosis of psychosis. The presence of multi-modal hallucinations may have implications across diagnoses for levels of distress, formulation and the targeting of psychological interventions. METHODS This study presents a cross-sectional analysis of observational data from the PREFER survey (N = 335). Linear regression was used to explore the relationships between voice-related distress and the presence, number, type and timing of multi-modal hallucinations. RESULTS Simple relationships were not found between distress and the presence of hallucinations in visual, tactile, olfactory or gustatory modalities, or in the number of modalities experienced. When considering the degree to which another modality hallucination was experienced simultaneously with voices, there was some evidence that the degree of co-occurrence with visual hallucinations was predictive of distress. CONCLUSIONS The co-occurrence of voices with visual hallucinations may be associated with relatively greater distress, but not consistently, and the association between multimodal hallucinations and clinical impact appear complex and potentially variable from individual to individual. Further study of associated variables such as perceived voice power may further illuminate these relationships.
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Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex, Brighton BN1 9RH, UK.
| | | | - Neil Thomas
- Swinburne University of Technology, Australia.
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Kim JS, Hong SB, Park KW, Lee ATC. Psychotic Symptoms in Patients With Major Neurological Diseases. J Clin Neurol 2024; 20:153-165. [PMID: 38433485 PMCID: PMC10921039 DOI: 10.3988/jcn.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024] Open
Abstract
Neurological diseases often manifest with neuropsychiatric symptoms such as depression, emotional incontinence, anger, apathy and fatigue. In addition, affected patients may also experience psychotic symptoms such as hallucinations and delusions. Various factors contribute to the development of psychotic symptoms, and the mechanisms of psychosis are similar, but still differ among various neurological diseases. Although psychotic symptoms are uncommon, and have been less well investigated, they may annoy patients and their families as well as impair the patients' quality of life and increase the caregiver burden. Therefore, we need to appropriately identify and treat these psychotic symptoms in patients with neurological diseases.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Seung-Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun-Woo Park
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Rogers LW, Yeebo M, Collerton D, Moseley P, Dudley R. Non-clinical hallucinations and mental imagery across sensory modalities. Cogn Neuropsychiatry 2024; 29:87-102. [PMID: 38363282 DOI: 10.1080/13546805.2024.2313467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Vivid mental imagery has been proposed to increase the likelihood of experiencing hallucinations. Typically, studies have employed a modality general approach to mental imagery which compares imagery across multiple domains (e.g., visual, auditory and tactile) to hallucinations in multiple senses. However, modality specific imagery may be a better predictor of hallucinations in the same domain. The study examined the contribution of imagery to hallucinations in a non-clinical sample and specifically whether imagery best predicted hallucinations at a modality general or modality specific level. METHODS In study one, modality general and modality specific accounts of the imagery-hallucination relationship were contrasted through application of self-report measures in a sample of 434 students. Study two used a subsample (n = 103) to extend exploration of the imagery-hallucinations relationship using a performance-based imagery task. RESULTS A small to moderate modality general relationship was observed between self-report imagery and hallucination proneness. There was only evidence of a modality specific relationship in the tactile domain. Performance-based imagery measures were unrelated to hallucinations and self-report imagery. CONCLUSIONS Mental imagery may act as a modality general process increasing hallucination proneness. The observed distinction between self-report and performance-based imagery highlights the difficulty of accurately measuring internal processes.
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Affiliation(s)
- Luke Wilson Rogers
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Mma Yeebo
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Daniel Collerton
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
| | - Peter Moseley
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Upon Tyne, UK
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
- Department of Psychology, University of York, York, UK
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Bere MJ, Rossell SL, Tan EJ, Carruthers SP, Gurvich C, Neill E, Sumner PJ, Van Rheenen TE, Toh WL. Exploring the cognitive profiles related to unimodal auditory versus multisensory hallucinations in schizophrenia-spectrum disorders. Cogn Neuropsychiatry 2024; 29:55-71. [PMID: 38345024 DOI: 10.1080/13546805.2024.2314941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/12/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Hallucinations can be experienced across multiple sensory modalities, but psychiatric studies investigating the cognitive mechanisms of hallucinations have been somewhat restricted to the auditory domain. This study explored the cognitive profiles of individuals experiencing multisensory hallucinations (MH) in schizophrenia-spectrum disorders (SSD) and compared these to those experiencing unimodal auditory hallucinations (AH) or no hallucinations (NH). METHODS Participants included SSD patients (n = 119) stratified by current hallucination status (NH, AH, MH) and nonclinical controls (NCs; n = 113). Group performance was compared across several cognitive domains: speed of processing, attention, working memory, verbal learning, visual learning, reasoning and problem-solving, social cognition, and inhibition. RESULTS The clinical groups performed worse than NCs but differences between the clinical groups were not evident across most cognitive domains. Exploratory analyses revealed that the MH group was more impaired on the visual learning task compared to the NH (but not AH) group. CONCLUSIONS Preliminary results suggest that impaired visual learning may be related to MH. This could be attributed to the presence of visual hallucinations (VH), or greater psychopathology, in this group. However, replication is needed, as well as the investigation of other potential cognitive mechanisms of MH.
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Affiliation(s)
- Mikaela J Bere
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Eric J Tan
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
- Memory Ageing & Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean P Carruthers
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Caroline Gurvich
- Department of Psychiatry, Monash University & Alfred Hospital, Melbourne, Australia
| | - Erica Neill
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Philip J Sumner
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
- Department of Psychology, Alfred Hospital, Melbourne, Australia
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11
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R R, Devtalla H, Rana K, Panda SP, Agrawal A, Kadyan S, Jindal D, Pancham P, Yadav D, Jha NK, Jha SK, Gupta V, Singh M. A comprehensive update on genetic inheritance, epigenetic factors, associated pathology, and recent therapeutic intervention by gene therapy in schizophrenia. Chem Biol Drug Des 2024; 103:e14374. [PMID: 37994213 DOI: 10.1111/cbdd.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 11/24/2023]
Abstract
Schizophrenia is a severe psychological disorder in which reality is interpreted abnormally by the patient. The symptoms of the disease include delusions and hallucinations, associated with extremely disordered behavior and thinking, which may affect the daily lives of the patients. Advancements in technology have led to understanding the dynamics of the disease and the identification of the underlying causes. Multiple investigations prove that it is regulated genetically, and epigenetically, and is affected by environmental factors. The molecular and neural pathways linked to the regulation of schizophrenia have been extensively studied. Over 180 Schizophrenic risk loci have now been recognized due to several genome-wide association studies (GWAS). It has been observed that multiple transcription factors (TF) binding-disrupting single nucleotide polymorphisms (SNPs) have been related to gene expression responsible for the disease in cerebral complexes. Copy number variation, SNP defects, and epigenetic changes in chromosomes may cause overexpression or underexpression of certain genes responsible for the disease. Nowadays, gene therapy is being implemented for its treatment as several of these genetic defects have been identified. Scientists are trying to use viral vectors, miRNA, siRNA, and CRISPR technology. In addition, nanotechnology is also being applied to target such genes. The primary aim of such targeting was to either delete or silence such hyperactive genes or induce certain genes that inhibit the expression of these genes. There are challenges in delivering the gene/DNA to the site of action in the brain, and scientists are working to resolve the same. The present article describes the basics regarding the disease, its causes and factors responsible, and the gene therapy solutions available to treat this disease.
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Affiliation(s)
- Rachana R
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
| | - Harshit Devtalla
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
| | - Karishma Rana
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
| | - Siva Prasad Panda
- Institute of Pharmaceutical Research, GLA University, Mathura, India
| | - Arushi Agrawal
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
| | - Shreya Kadyan
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
| | - Divya Jindal
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
- IIT Bombay Monash Research Academy, IIT - Bombay, Bombay, India
| | - Pranav Pancham
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
| | - Deepshikha Yadav
- Bhartiya Nirdeshak Dravya Division, CSIR-National Physical Laboratory, New Delhi, India
- Physico-Mechanical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Niraj Kumar Jha
- Department of Biotechnology, Sharda School of Engineering and Technology (SSET), Sharda University, Greater Noida, India
- Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, India
- Department of Biotechnology, School of Applied and Life Sciences (SALS), Uttaranchal University, Dehradun, India
- School of Bioengineering & Biosciences, Lovely Professional University, Phagwara, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, Sharda School of Engineering and Technology (SSET), Sharda University, Greater Noida, India
- Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, India
- Department of Biotechnology, School of Applied and Life Sciences (SALS), Uttaranchal University, Dehradun, India
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Vivek Gupta
- Macquarie Medical School, Macquarie University (MQU), Sydney, New South Wales, Australia
| | - Manisha Singh
- Department of Biotechnology, Jaypee Institute of Information Technology, Noida, India
- Faculty of Health, Graduate School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Australian Research Consortium in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, New South Wales, Australia
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12
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Blom JD, van Veen RJB, van Rooijen EHC, Slotema CW. The Diagnostic Spectrum of Sexual Hallucinations. Harv Rev Psychiatry 2024; 32:1-14. [PMID: 38181099 DOI: 10.1097/hrp.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
ABSTRACT Sexual hallucinations are little known, yet often extremely burdening, phenomena. In this systematic review, we summarize what is known about their phenomenology, prevalence, etiopathology, ensuing distress, and treatment options. Sexual hallucinations can be experienced as genital or orgasmic sensations, although other sensory modalities can also be involved. With the notable exception of orgasmic auras in the context of epilepsy, sexual hallucinations tend to be distressing and embarrassing in nature. Our analysis of 79 studies (together describing 390 patients) indicates that sexual hallucinations are more frequent in women than in men, with a sex ratio of 1.4:1, and that they are most prevalent in schizophrenia spectrum disorders, with rates ranging from 1.4% in recently admitted patients to 44% in chronically hospitalized patients. Other underlying conditions include epilepsy, the incubus phenomenon (possibly the most prevalent cause in the general population, associated with sleep paralysis), narcolepsy, and sedative use. As regards the sedative context, we found more medicolegal than purely medical cases, which sadly underlines that not all sexually explicit sensations experienced in anesthesia practice are indeed hallucinations. In the absence of evidence-based treatment protocols for sexual hallucinations, practice-based guidelines tend to focus on the underlying condition. Further research is needed, especially in the fields of substance abuse, posttraumatic stress disorder, and borderline personality disorder, where only anecdotal information on sexual hallucinations is available. Moreover, awareness of sexual hallucinations among health professionals needs to be improved in order to facilitate counseling, diagnosis, and treatment.
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Affiliation(s)
- Jan Dirk Blom
- From the Parnassia Psychiatric Institute, The Hague, the Netherlands; Institute of Psychology, Leiden University (Dr. Blom); Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Dr. Blom); Department of Psychology, Education & Child Studies, Erasmus University Rotterdam (Dr. Slotema)
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13
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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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14
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Lüdtke T, Hedelt KS, Westermann S. Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies. J Behav Ther Exp Psychiatry 2023; 81:101885. [PMID: 37354896 DOI: 10.1016/j.jbtep.2023.101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d). METHODS We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994. RESULTS Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data. LIMITATIONS The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations. CONCLUSIONS Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany.
| | | | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Hudon A, Beaudoin M, Phraxayavong K, Potvin S, Dumais A. Enhancing Predictive Power: Integrating a Linear Support Vector Classifier with Logistic Regression for Patient Outcome Prognosis in Virtual Reality Therapy for Treatment-Resistant Schizophrenia. J Pers Med 2023; 13:1660. [PMID: 38138887 PMCID: PMC10744538 DOI: 10.3390/jpm13121660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Approximately 30% of schizophrenia patients are known to be treatment-resistant. For these cases, more personalized approaches must be developed. Virtual reality therapeutic approaches such as avatar therapy (AT) are currently undergoing investigations to address these patients' needs. To further tailor the therapeutic trajectory of patients presenting with this complex presentation of schizophrenia, quantitative insight about the therapeutic process is warranted. The aim of the study is to combine a classification model with a regression model with the aim of predicting the therapeutic outcomes of patients based on the interactions taking place during their first immersive session of virtual reality therapy. (2) Methods: A combination of a Linear Support Vector Classifier and logistic regression was conducted over a dataset comprising 162 verbatims of the immersive sessions of 18 patients who previously underwent AT. As a testing dataset, 17 participants, unknown to the dataset, had their first immersive session presented to the combinatory model to predict their clinical outcome. (3) Results: The model accurately predicted the clinical outcome for 15 out of the 17 participants. Classification of the therapeutic interactions achieved an accuracy of 63%. (4) Conclusion: To our knowledge, this is the first attempt to predict the outcome of psychotherapy patients based on the content of their interactions with their therapist. These results are important as they open the door to personalization of psychotherapy based on quantitative information about the interactions taking place during AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Stéphane Potvin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Dumais
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada; (A.H.); (M.B.); (S.P.)
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada;
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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16
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O’Brien-Venus B, Jenkins T, Chadwick P. Self-dehumanisation in voice hearers: the end of a continuum. Front Psychiatry 2023; 14:1173380. [PMID: 37854440 PMCID: PMC10579558 DOI: 10.3389/fpsyt.2023.1173380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Background Meta-dehumanisation and self-dehumanisation have been identified as potentially relevant phenomena for developing a deeper understanding of distress related to voice-hearing, particularly those experiencing voices as part of psychosis. Chadwick has previously argued that those with psychosis, including those who hear distressing voices, typically feel "dehumanised and set apart by their experiences of psychosis and trauma." The present study explores the subjective experience of self-dehumanisation in people who experience distressing voices, which was selected as a useful starting point to inform future research focused on understanding dehumanisation in people with psychosis. Methods Qualitative data was obtained through twenty semi-structured interviews with self-identifying voice hearers and analysed using reflexive thematic analysis. This followed the recursive six phase procedure of Braun and Clarke, and this was conducted from a critical realist, contextualist position. Results Reflexive thematic analysis of participant's experiences produced a core theme, Dehumanisation as the End of Experiential Continua, and six subthemes: Extent of Distressing Sensory Fragmentation; Sense of Belonging with Other Humans; Integrity of Self as a Private, Coherent Entity; Sense of Worth as a Human Being; Strength of Personal Agency; and Trust in Own Credibility and Reliability. Two further themes, The Push and Pull of Dehumanising Forces and Reclaiming Life through Humanising Forces, were identified. Findings were presented to a panel of five experts by experience, all with lived experience of psychosis and service-use; all five strongly endorsed the themes as fitting with and expressing their own experiences of self-dehumanisation. Conclusion Reflexive thematic analysis of voice hearers' accounts identified self-dehumanisation as the endpoint where six experiential continua coalesce. Experiential movement along these continua was affected by a range of interpersonal, intrapersonal, and societal forces over time, including dehumanising attitudes of others and voice malevolence and omnipotence. Future research might examine if and how psychological therapies aimed at those experiencing distressing voices, such as people experiencing psychosis may address feelings of self-dehumanisation.
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Affiliation(s)
| | | | - Paul Chadwick
- Department of Psychology, University of Bath, Bath, United Kingdom
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17
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Sumi Y, Kawahara S, Fujii K, Yamaji M, Nakajima K, Nakamura T, Horikawa O, Fujita Y, Ozeki Y. Case report: Impact of hyperthyroidism on psychotic symptoms in schizophrenia comorbid with Graves' disease. Front Psychiatry 2023; 14:1219049. [PMID: 37496682 PMCID: PMC10366534 DOI: 10.3389/fpsyt.2023.1219049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Auditory hallucinations are the most common type of hallucinations observed in schizophrenia; however, visual hallucinations are not uncommon. In Graves' disease, depression, hypomania, and psychosis can occur. While the association between Graves' disease and psychosis has been explored, understanding of the specific impact of thyroid dysfunction severity on psychiatric symptom severity is limited. Here, we present a case report of a patient with schizophrenia comorbid with Graves' disease whose psychotic symptoms were impacted by hyperthyroidism. Case The patient was a 32-year-old Japanese woman who presented with auditory and visual hallucinations, agitation, and pressured speech. The patient was diagnosed with schizophrenia comorbid with Graves' disease and thyroid storm. The patient's psychotic symptoms were found to be associated with fluctuations in thyroid hormone levels, and visual hallucinations were observed only during thyroid storms. Treatment involved dexamethasone, potassium iodide, bisoprolol fumarate, and methimazole for thyrotoxicosis, and a blonanserin transdermal patch, paliperidone, and paliperidone palmitate for psychotic symptoms. The patient's auditory and visual hallucinations improved with antipsychotic treatment and decreased thyroid hormone levels. Conclusion This case highlights the importance of monitoring thyroid function in patients with schizophrenia, particularly those with comorbid Graves' disease. The correlation between psychiatric symptoms and thyroid hormone levels was demonstrated on an individual level over time, with symptoms worsening as thyroid hormone levels increased. Additionally, our case suggests that abnormally high thyroid hormone levels may trigger visual hallucinations in individuals with schizophrenia. Further studies are needed to elucidate the underlying mechanisms and potential treatment implications of this association.
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Affiliation(s)
- Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Sanae Kawahara
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kumiko Fujii
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mayu Yamaji
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kou Nakajima
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsubasa Nakamura
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Osamu Horikawa
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukihiro Fujita
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
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18
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Slapø NB, Jørgensen KN, Elvsåshagen T, Nerland S, Roelfs D, Valstad M, Timpe CMF, Richard G, Beck D, Sæther LS, Frogner Werner MC, Lagerberg TV, Andreassen OA, Melle I, Agartz I, Westlye LT, Moberget T, Jönsson EG. Relationship between function and structure in the visual cortex in healthy individuals and in patients with severe mental disorders. Psychiatry Res Neuroimaging 2023; 332:111633. [PMID: 37028226 DOI: 10.1016/j.pscychresns.2023.111633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/12/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
Patients with schizophrenia spectrum disorders (SCZspect) and bipolar disorders (BD) show impaired function in the primary visual cortex (V1), indicated by altered visual evoked potential (VEP). While the neural substrate for altered VEP in these patients remains elusive, altered V1 structure may play a role. One previous study found a positive relationship between the amplitude of the P100 component of the VEP and V1 surface area, but not V1 thickness, in a small sample of healthy individuals. Here, we aimed to replicate these findings in a larger healthy control (HC) sample (n = 307) and to examine the same relationship in patients with SCZspect (n = 30) or BD (n = 45). We also compared the mean P100 amplitude, V1 surface area and V1 thickness between controls and patients and found no significant group differences. In HC only, we found a significant positive P100-V1 surface area association, while there were no significant P100-V1 thickness relationships in HC, SCZspect or BD. Together, our results confirm previous findings of a positive P100-V1 surface area association in HC, whereas larger patient samples are needed to further clarify the function-structure relationship in V1 in SCZspect and BD.
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Affiliation(s)
- Nora Berz Slapø
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kjetil Nordbø Jørgensen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychiatry, Telemark Hospital, Skien, Norway
| | - Torbjørn Elvsåshagen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Neurology, Oslo University Hospital, Norway
| | - Stener Nerland
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Daniel Roelfs
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway
| | - Mathias Valstad
- Department of Mental Disorders, Norwegian Institute of Public Health, Norway
| | - Clara M F Timpe
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway
| | | | - Dani Beck
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University hospital, Norway
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University hospital, Norway
| | - Ingrid Melle
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; NORMENT, Division of Mental Health and Addiction, Oslo University hospital, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Sciences, Stockholm Region, Stockholm, Sweden
| | - Lars T Westlye
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Psychology, University of Oslo, Norway
| | - Torgeir Moberget
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Department of Behavioral Sciences, Faculty of Health Sciences, Oslo Metropolitan University, OsloMet, Oslo, Norway
| | - Erik G Jönsson
- NORMENT, Institute of Clinical Medicine, University of Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Sciences, Stockholm Region, Stockholm, Sweden
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Metta V, Chung-Faye G, Ts Benamer H, Mrudula R, Goyal V, Falup-Pecurariu C, Muralidharan N, Deepak D, Abdulraheem M, Borgohain R, Chaudhuri KR. Hiccups, Hypersalivation, Hallucinations in Parkinson's Disease: New Insights, Mechanisms, Pathophysiology, and Management. J Pers Med 2023; 13:jpm13050711. [PMID: 37240881 DOI: 10.3390/jpm13050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD-hiccups, hypersalivation, and hallucinations-in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32-74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32-63% in PD, and a 55-78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson's disease.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Guy Chung-Faye
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Hani Ts Benamer
- Department of Movement Disorders & Parkinson's Centre of Excellence, Mohammed Bin Rashid University, Dubai 263267, United Arab Emirates
| | - Rukmini Mrudula
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Vinay Goyal
- Institute of Movement Disorders, Medanta Hospitals, India
| | | | | | - Desh Deepak
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | | | - Rupam Borgohain
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
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20
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Yin Y, Tong J, Huang J, Tian B, Chen S, Tan S, Wang Z, Yang F, Tong Y, Fan F, Kochunov P, Tan Y, Hong LE. Auditory Hallucinations, Depressive Symptoms, and Current Suicidal Ideation or Behavior Among Patients with Acute-episode Schizophrenia. Arch Suicide Res 2023; 27:323-338. [PMID: 34689715 PMCID: PMC9682271 DOI: 10.1080/13811118.2021.1993399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Suicide risk and auditory hallucinations are common in schizophrenia, but less is known about its associations. This cross-sectional study aimed to determine whether the presence and severity of auditory hallucinations were associated with current suicidal ideation or behavior (CSIB) among patients with schizophrenia. We interviewed 299 individuals with schizophrenia and acute symptoms and reviewed their medical records. Measurement included the Psychotic Symptom Rating Scale (PSYRATS-AH), the Calgary Depression Scale for Schizophrenia (CDSS), and the Positive and Negative Syndrome Scale. Logistic regression and path analysis were used. The CSIB prevalence was higher among patients with current auditory hallucination than those without (19.5% vs. 8.6%, crude odds ratio = 2.58, p = .009). Lifetime auditory hallucination experience (adjusted odds ratio [AOR] = 3.81; 95% CI: 1.45-10.05) or current auditory hallucination experience (AOR = 3.22; 95% CI: 1.25-8.28) can elevate the likelihood of CSIB while controlling for depressive symptoms and lifetime suicide-attempt history. Among those with auditory hallucinations, the emotional score of the PSYRATS-AH was positively associated with the CDSS score and there was a small indirect effect of the CDSS score on the association between the emotional domain score and CSIB (bias-corrected 95% CI, 0.02-0.20). In conclusion, the presence of auditory hallucinations was strongly associated with CSIB, independent of depressive symptoms and lifetime suicide attempts. Suicide risk assessment should consider auditory hallucination experience and patients' appraisal of its emotional characteristics. Future cohort studies are necessary to provide more conclusive evidence for the mediating pathways between auditory hallucinations and CSIB.HIGHLIGHTSThe presence of auditory hallucinations was associated with current suicidality.Auditory hallucinations' emotional severity was related to depressive symptoms.The severity of auditory hallucination was not directly associated with suicidality.
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Affiliation(s)
- Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Yongsheng Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
- Beijing Suicide Research and Prevention Center, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, P. R. China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
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21
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Quidé Y. Dissociation, trauma and the experience of visual hallucinations in post-traumatic stress disorder and schizophrenia. BJPsych Open 2023; 9:e23. [PMID: 36700248 PMCID: PMC9885325 DOI: 10.1192/bjo.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Dissociative behaviours and hallucinations are often reported in trauma-exposed people with schizophrenia spectrum disorders and post-traumatic stress disorder (PTSD). Auditory hallucinations are the most commonly reported type of hallucination, but often co-occur with experiences in other sensory modalities. The phenomenology and the neurobiological systems involved in visual experiences are not well characterised. Are these experiences similar in nature, content or severity among people with schizophrenia and/or PTSD? What are the neurobiological bases of these visual experiences and what is the role of dissociative behaviours in the formation of these experiences? A study by Wearne and colleagues in BJPsych Open aimed to characterise these phenomenological systems in groups of people with PTSD, schizophrenia or both (schizophrenia + PTSD).
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Affiliation(s)
- Yann Quidé
- NeuroRecovery Research Hub, School of Psychology, UNSW Sydney, Sydney, NSW, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW, Australia
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22
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Allen S, Goodall T, Jones C, James R, Surtees A. What Is the Prevalence of Visual Hallucinations in a First-Episode Psychosis Population? A Systematic Review and Meta-analysis of the Literature. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad002. [PMID: 39145351 PMCID: PMC11207659 DOI: 10.1093/schizbullopen/sgad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis This systematic review and meta-analysis review the literature regarding the prevalence of visual hallucinations in patients with first-episode psychosis. Previous reviews have focused on the prevalence of visual hallucinations in a general psychosis population, highlighting a weighted prevalence of 27%. However, no reviews have focused specifically on the experiences of those with a first episode of psychosis. Understanding "first-episode" experiences is crucial, as intervention during this "critical period" is thought to define long-term outcome. Therefore, it is important that the prevalence of different symptoms during this period is accurately represented. Study Design Systematic searches yielded 15 studies to be meta-analyzed. Information to calculate event rates was extracted. Studies were rated for their methodological quality using a risk of bias tool. The quality of included studies varied; generalizability bias was the domain with the most risk of bias. Study Results Prevalence rates were synthesized from the 15 papers included in the final analysis, which generated a weighted prevalence estimate of 33% of people with first-episode psychosis experiencing visual hallucinations. Subgroup analyses were carried out and did not demonstrate significant associations. Conclusions This meta-analysis provides a robust estimate of 33% for the prevalence of visual hallucinations in first-episode psychosis; highlighting that visual hallucinations are relatively common experiences.
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Affiliation(s)
- Sophie Allen
- School of Psychology, University of Birmingham, Birmingham, UK
- Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | - Chris Jones
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Rachel James
- School of Psychology, University of Birmingham, Birmingham, UK
- Birmingham & Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Andrew Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
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23
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Prevalence and nature of multi-sensory and multi-modal hallucinations in people with first episode psychosis. Psychiatry Res 2023; 319:114988. [PMID: 36463721 DOI: 10.1016/j.psychres.2022.114988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/19/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
Hallucinations can occur in single or multiple sensory modalities. This study explored how common these experiences were in people with first episode of psychosis (n = 82). Particular attention was paid to the number of modalities reported and whether the experiences were seen to be linked temporally and thematically. It was predicted that those people reporting a greater number of hallucinations would report more delusional ideation, greater levels of distress generally and lower functioning. All participants reported hallucinations in the auditory domain, given the nature of the recruitment. The participants also reported a range of other unusual sensory experiences, with visual and tactile hallucinations being reported by over half. Moreover, single sensory experiences or unimodal hallucinations were less common than two or more hallucination modalities which was reported by 78% of the participants. The number of hallucinations was significantly associated with greater delusional ideation and higher levels of general distress, but not with reduced functioning. It is clear there is a need to refine psychological treatments so that they are better matched to the actual experiences reported by people with psychosis. Theoretical implications are also considered.
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24
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Thomas F, Gallea C, Moulier V, Bouaziz N, Valero-Cabré A, Januel D. Local Alterations of Left Arcuate Fasciculus and Transcallosal White Matter Microstructure in Schizophrenia Patients with Medication-resistant Auditory Verbal Hallucinations: A Pilot Study. Neuroscience 2022; 507:1-13. [PMID: 36370935 DOI: 10.1016/j.neuroscience.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Auditory verbal hallucinations (AVH) in schizophrenia (SZ) have been associated with abnormalities of the left arcuate fasciculus and transcallosal white matter projections linking homologous language areas of both hemispheres. While most studies have used a whole-tract approach, here we focused on analyzing local alterations of the above-mentioned pathways in SZ patients suffering medication-resistant AVH. Fractional anisotropy (FA) was estimated along the left arcuate fasciculus and interhemispheric projections of the rostral and caudal corpus callosum. Then, potential associations between white matter tracts and SZ symptoms were explored by correlating local site-by-site FA values and AVH severity estimated via the Auditory Hallucinations Rating Scale (AHRS). Compared to a sample of healthy controls, SZ patients displayed lower FA values in the rostral portion of the left arcuate fasciculus, near the frontal operculum, and in the left and right lateral regions of the rostral portion of the transcallosal pathways. In contrast, SZ patients showed higher FA values than healthy controls in the medial portion of the latter transcallosal pathway and in the midsagittal section of the interhemispheric auditory pathway. Finally, significant correlations were found between local FA values in the left arcuate fasciculus and the severity of the AVH's attentional salience. Contributing to the study of associations between local white matter alterations of language networks and SZ symptoms, our findings highlight local alterations of white matter integrity in these pathways linking language areas in SZ patients with AVH. We also hypothesize a link between the left arcuate fasciculus and the attentional capture of AVH.
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Affiliation(s)
- Fanny Thomas
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France; Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB, Institut du Cerveau, CNRS UMR 7225, INSERM UMRS 1127, France.
| | - Cécile Gallea
- Movement Investigations and Therapeutics, MOVIT, Institut du Cerveau, CNRS UMR 7225, INSERM UMRS 1127, France; Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Virginie Moulier
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France; Centre Hospitalier du Rouvray, University Department of Psychiatry, 76301 Sotteville-lès-Rouen, France
| | - Noomane Bouaziz
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France
| | - Antoni Valero-Cabré
- Cerebral Dynamics, Plasticity and Rehabilitation Group, FRONTLAB, Institut du Cerveau, CNRS UMR 7225, INSERM UMRS 1127, France; Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University School of Medicine, 700 Albany Street, Boston, MA W-702A, USA; Université Pierre et Marie Curie, 47 boulevard de l'Hôpital, 75013 Paris, France
| | - Dominique Januel
- Centre de Recherche Clinique, Établissement Public de Santé de Ville-Evrard, 202 avenue Jean Jaurès, 93330 Neuilly-sur-Marne, France; Université Sorbonne Paris Nord, Campus de Bobigny, 1 rue de Chablis, 93000 Bobigny
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25
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Linszen MMJ, de Boer JN, Schutte MJL, Begemann MJH, de Vries J, Koops S, Blom RE, Bohlken MM, Heringa SM, Blom JD, Sommer IEC. Occurrence and phenomenology of hallucinations in the general population: A large online survey. SCHIZOPHRENIA 2022; 8:41. [PMID: 35853871 PMCID: PMC9261095 DOI: 10.1038/s41537-022-00229-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Although epidemiological studies report that hallucinations occur in 6–15% of the general population, little is known about their phenomenology. To overcome this paucity, this study investigates the phenomenological characteristics of hallucinations in the general population, by using a nationally promoted online survey to assess hallucination phenomenology in four sensory modalities, through a self-report version of the Questionnaire for Psychotic Experiences (QPE), in 10,448 participants (aged 14–88 years). The phenomenology of hallucinations was assessed if hallucinations reportedly occurred in the past month. In the past month, auditory hallucinations were reported most frequently (29.5%), followed by visual (21.5%), tactile (19.9%), and olfactory hallucinations (17.3%); hallucinations in two or more modalities were reported by 47.6%. Substantial numbers of participants rated their hallucinations as severe, due to negative content (16.0–31.6%), previous bothersome experiences (14.8–20.2%), ensuing distress (10.5–16.8%), and/or ensuing disfunctioning (12.7–17.3%). Decreased insight was found in 10.2–11.4%. Hypnagogia was reported by 9.0–10.6%, and bereavement hallucinations by 2.8%. Despite a low prevalence of delusions (7.0%), these phenomena were significantly associated with recent hallucinations, observed in up to 13.4% of the participants with hallucinations during the past week (p < 0.001). Our results indicate a wide variety of the phenomenology of hallucinations in the general population and support the existence of a phenomenological continuum.
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26
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Chang X, Zhao W, Kang J, Xiang S, Xie C, Corona-Hernández H, Palaniyappan L, Feng J. Language abnormalities in schizophrenia: binding core symptoms through contemporary empirical evidence. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:95. [PMID: 36371445 PMCID: PMC9653408 DOI: 10.1038/s41537-022-00308-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Both the ability to speak and to infer complex linguistic messages from sounds have been claimed as uniquely human phenomena. In schizophrenia, formal thought disorder (FTD) and auditory verbal hallucinations (AVHs) are manifestations respectively relating to concrete disruptions of those abilities. From an evolutionary perspective, Crow (1997) proposed that "schizophrenia is the price that Homo sapiens pays for the faculty of language". Epidemiological and experimental evidence points to an overlap between FTD and AVHs, yet a thorough investigation examining their shared neural mechanism in schizophrenia is lacking. In this review, we synthesize observations from three key domains. First, neuroanatomical evidence indicates substantial shared abnormalities in language-processing regions between FTD and AVHs, even in the early phases of schizophrenia. Second, neurochemical studies point to a glutamate-related dysfunction in these language-processing brain regions, contributing to verbal production deficits. Third, genetic findings further show how genes that overlap between schizophrenia and language disorders influence neurodevelopment and neurotransmission. We argue that these observations converge into the possibility that a glutamatergic dysfunction in language-processing brain regions might be a shared neural basis of both FTD and AVHs. Investigations of language pathology in schizophrenia could facilitate the development of diagnostic tools and treatments, so we call for multilevel confirmatory analyses focused on modulations of the language network as a therapeutic goal in schizophrenia.
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Affiliation(s)
- Xiao Chang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Wei Zhao
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, PR China
| | - Jujiao Kang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Shanghai Center for Mathematical Sciences, Shanghai, China
| | - Shitong Xiang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Chao Xie
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Hugo Corona-Hernández
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Zhangjiang Fudan International Innovation Center, Shanghai, China.
- Shanghai Center for Mathematical Sciences, Shanghai, China.
- Department of Computer Science, University of Warwick, Coventry, UK.
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27
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Li W, Zhang Q, Tang Y, Park SC, Park Y, Yang SY, Chen LY, Lin SK, Najoan E, Kallivayalil RA, Viboonma K, Jamaluddin R, Javed A, Thi Quynh Hoa D, Iida H, Sim K, Swe T, He YL, Ahmed HU, De Alwis A, Chiu HFK, Sartorius N, Tan CH, Chong MY, Shinfuku N, Avasthi A, Grover S, Ungvari GS, Ng CH, Xiang YT. Network analysis of psychiatric symptoms in schizophrenia: Findings from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP). Asian J Psychiatr 2022; 75:103200. [PMID: 35850062 DOI: 10.1016/j.ajp.2022.103200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/02/2022]
Abstract
AIMS Schizophrenia is a major mental disorder with a wide range of psychiatric symptoms. This study explored the structure of psychiatric symptoms of schizophrenia using network analysis in a large representative Asian sample based on a survey of clinical features and treatment used in schizophrenia patients across 15 countries/territories in Asia. METHODS Data on the demographic characteristics and psychiatric symptoms in schizophrenia patients were extracted from the dataset of the fourth Research on Asia Psychotropic Prescription for Antipsychotics (REAP-AP) project. The presence of the following psychiatric symptoms including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, social/occupational dysfunction, verbal aggression, physical aggression, and affective symptoms were analyzed. RESULTS A total of 3681 patients were included. The network analysis revealed that verbal aggression, hallucinations, and social/occupational dysfunction were the most central symptoms, while the connections between social/occupational dysfunction and verbal aggression, and between hallucinations and disorganized speech were the two strongest edges. There were significant gender differences in the network structure based on the network structure invariance test (M=0.74, P = 0.03) and invariant edge strength test. The positive correlation between verbal aggression and hallucinations was significantly stronger in the female network than that in the male network (P = 0.03), while a negative correlation between affective symptoms and negative symptoms was found in the female, but not the male network (P < 0.01). CONCLUSION Central symptoms including verbal aggression, hallucinations, and socio-occupational dysfunction should be addressed in developing targeted treatment strategy for schizophrenia patients.
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Affiliation(s)
- Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, China, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yilang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, the Republic of Korea
| | - Yongchon Park
- Department of Psychiatry, Hanyang University, Seoul, the Republic of Korea
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Lian-Yu Chen
- Kunming Prevention and Control Center, Taipei City Hospital; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan
| | - Shih-Ku Lin
- Kunming Prevention and Control Center, Taipei City Hospital; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | | | | | | | - Ruzita Jamaluddin
- Department of Psychiatry & Mental Health, Hospital Tuanku Fauziah, Kangar, Perlis, Malaysia
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Hitoshi Iida
- Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Thiha Swe
- Department of Mental Health, University of Medicine, Magway, Myanmar
| | - Yan-Ling He
- Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China
| | | | | | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung & Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Naotaka Shinfuku
- International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao; Centre for Cognitive and Brain Sciences, University of Macau, Macao; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao.
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28
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Carlisle TC, Birlea M, Restrepo D, Filley CM. Headache-Associated Phantosmia as a Harbinger of Lewy Body Dementia. J Neuropsychiatry Clin Neurosci 2022; 35:92-97. [PMID: 35989571 PMCID: PMC11022529 DOI: 10.1176/appi.neuropsych.21110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Olfactory hallucinations, or phantosmias, can occur in many neurological, psychiatric, and medical conditions, but no widely used standardized approach exists to comprehensively assess qualitative olfactory dysfunction in the clinical setting. Additionally, medical professionals, patients, and their family members may not recognize phantosmia as a potentially neurological problem. Given the many possible etiologies for symptomatic phantosmia, it is important to recognize this unusual presentation and elicit a meaningful history to explore the potential underlying cause. We describe a 77-year-old gentleman with a two-year history of headaches accompanied by smelling a foul odor and discuss the differential diagnosis for new onset and persistent phantosmia. This unusual case ultimately manifested features consistent with Lewy body dementia, highlighting the varied clinical presentations that are possible with this neurodegenerative disorder. We discuss the possible pathophysiology of phantosmia in Lewy body disorders, including a proposed mechanism for olfactory hallucinations arising prior to the typical well-formed hallucinations in Lewy body dementia.
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Affiliation(s)
- Tara C Carlisle
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Marius Birlea
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Diego Restrepo
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
| | - Christopher M Filley
- Departments of Neurology, Behavioral Neurology (Carlisle, Filley) and Headache (Birlea) sections, Psychiatry (Filley), and Cell and Developmental Biology (Restrepo), University of Colorado School of Medicine, Aurora; Marcus Institute for Brain Health, Aurora (Filley)
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29
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Toh WL, Bere M, Rossell SL. Distinguishing multimodal versus multisensory hallucinations in psychosis: Key definitions and a way forward. Aust N Z J Psychiatry 2022; 56:445-450. [PMID: 34256623 DOI: 10.1177/00048674211031455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The study of hallucinations across multiple senses in psychosis has garnered renewed interest. Recent studies have adopted the term multimodal hallucinations to describe these experiences, yet some appear to be investigating a different, but related, phenomenon. In the current paper, we suggest use of the terms multimodal hallucinations and multisensory hallucinations to categorise distinct events that involve unusual sensory experiences across multiple domains. We propose that the constructs of temporality and relatedness are critical to delineating these experiences, where multimodal hallucinations refer to hallucinations in two or more sensory modes occurring concurrently in time and/or with significant thematic overlaps. Multisensory hallucinations conversely denote similar multisensory experiences, but with no temporal or relatedness constraints. This is accompanied by a decision-making framework for identifying whether a set of unusual perceptual experiences constitutes multimodal hallucinations or otherwise. We conclude by suggesting several priorities for future research, including empirical validation of our proposed model, further investigation of phenomenology, developing appropriate assessment tools and investigating underlying cognitive and other aetiological mechanisms.
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Affiliation(s)
- Wei Lin Toh
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Psychology, Alfred Health, Melbourne, VIC, Australia
| | - Mikaela Bere
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Psychiatry, St. Vincent's Mental Health, Fitzroy, VIC, Australia
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30
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Leptourgos P, Bouttier V, Denève S, Jardri R. From hallucinations to synaesthesia: A circular inference account of unimodal and multimodal erroneous percepts in clinical and drug-induced psychosis. Neurosci Biobehav Rev 2022; 135:104593. [PMID: 35217108 DOI: 10.1016/j.neubiorev.2022.104593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
Psychedelics distort perception and induce visual and multimodal hallucinations as well as synaesthesia. This is in contradiction with the high prevalence of distressing voices in schizophrenia. Here we introduce a unifying account of unimodal and multimodal erroneous percepts based on circular inference. We show that amplification of top-down predictions (descending loops) leads to an excessive reliance on priors and aberrant levels of integration of the sensory representations, resulting in crossmodal percepts and stronger illusions. By contrast, amplification of bottom-up information (ascending loops) results in overinterpretation of unreliable sensory inputs and high levels of segregation between sensory modalities, bringing about unimodal hallucinations and reduced vulnerability to illusions. We delineate a canonical microcircuit in which layer-specific inhibition controls the propagation of information across hierarchical levels: inhibitory interneurons in the deep layers exert control over priors, removing descending loops. Conversely, inhibition in the supragranular layers counterbalances the effects of the ascending loops. Overall, we put forward a multiscale and transnosographic account of erroneous percepts with important theoretical, conceptual and clinical implications.
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Affiliation(s)
- Pantelis Leptourgos
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, CT, USA; Laboratoire de Neurosciences Cognitives & Computationnelles (LNC²), ENS, INSERM U-960, PSL Research University, Paris, France.
| | - Vincent Bouttier
- Laboratoire de Neurosciences Cognitives & Computationnelles (LNC²), ENS, INSERM U-960, PSL Research University, Paris, France; Univ Lille, INSERM U-1172, Lille Neurosciences & Cognition Centre, Plasticity and Subjectivity Team, & CHU Lille, Fontan Hospital, CURE Platform, Lille, France
| | - Sophie Denève
- Laboratoire de Neurosciences Cognitives & Computationnelles (LNC²), ENS, INSERM U-960, PSL Research University, Paris, France
| | - Renaud Jardri
- Laboratoire de Neurosciences Cognitives & Computationnelles (LNC²), ENS, INSERM U-960, PSL Research University, Paris, France; Univ Lille, INSERM U-1172, Lille Neurosciences & Cognition Centre, Plasticity and Subjectivity Team, & CHU Lille, Fontan Hospital, CURE Platform, Lille, France.
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Melvin K, Rollins CPE, Cromby J, Crossley J, Garrison JR, Murray GK, Suckling J. Arts-based methods for hallucination research. Cogn Neuropsychiatry 2022; 27:199-218. [PMID: 34708671 DOI: 10.1080/13546805.2021.1993807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Neurocognitive models of hallucinations posit theories of misattribution and deficits in the monitoring of mental or perceptual phenomena but cannot yet account for the subjective experience of hallucinations across individuals and diagnostic categories. Arts-based research methods (ABRM) have potential for advancing research, as art depicts experiences which cognitive neuropsychiatry seeks to explain. METHODS To examine how incorporating ABRM may advance hallucination research and theories, we explore data on the lived experiences of hallucinations in psychiatric and neurological populations. We present a multiple case study of two empirical ABRM studies, which used participant-generated artwork and artist collaborations alongside interviews. RESULTS ABRM combined with interviews illustrated that hallucinations were infused with sensory features, characterised by embodiment, and situated within lived circumstances. These findings advance neurocognitive models of hallucinations by nuancing their multimodal nature, illustrating their embodied feelings, and exploring their content and themes. The process of generating artworks aided in disclosing difficult to discuss hallucinations, promoted participant self-reflection, and clarified multimodal details that may have been misconstrued through interview alone. ABRM were relevant and acceptable for participants and researchers. CONCLUSION ABRM may contribute to the development of neurocognitive models of hallucinations by making hallucination experiences more visible, tangible, and accessible.
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Affiliation(s)
- Katie Melvin
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK.,Innovation, Technology and Operations Division, School of Business, University of Leicester, Leicester, UK
| | | | - John Cromby
- Innovation, Technology and Operations Division, School of Business, University of Leicester, Leicester, UK
| | - Jon Crossley
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK
| | - Jane R Garrison
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Abstract
OBJECTIVE To increase awareness of practising clinicians and researchers to the phenomenological distinctions between visual hallucinations and trauma-based, dissociative, visual re-experiencing phenomena seen in psychiatric disease. CONCLUSIONS The experience of visual hallucinations is not exclusive to psychotic disorders in psychiatry. Different forms of experiences that resemble visual hallucinations may occur in patients with a trauma background and may potentially affect diagnosis. Given the paucity of literature around the subject, it is imperative that further research aims to characterise the distinction between visual hallucinations in psychosis and visual phenomena associated with trauma.
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Affiliation(s)
- Jeremiah Ayalde
- University of Western Australia (UWA) School of Medicine, Crawley, WA, Australia
| | - Deborah Wearne
- University of Western Australia (UWA) School of Medicine, Crawley, WA, Australia
| | - Sean Hood
- Faculty of Health & Medical Sciences, M521, University of Western Australia, Crawley, WA, Australia
| | - Flavie Waters
- University of Western Australia (UWA) School of Psychological Sciences, Crawley, WA, Australia.,Clinical Research Centre, Graylands Campus, North Metropolitan Health Service, Nedlands, WA, Australia
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Shen X, Jiang F, Fang X, Yan W, Xie S, Zhang R. Cognitive dysfunction and cortical structural abnormalities in first-episode drug-naïve schizophrenia patients with auditory verbal hallucination. Front Psychiatry 2022; 13:998807. [PMID: 36186860 PMCID: PMC9523744 DOI: 10.3389/fpsyt.2022.998807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/24/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The current study aimed to examine the cognitive profiles and cortical structural alterations in first-episode drug-naïve schizophrenia with AVH (auditory verbal hallucination). METHODS Cortical structural parameters including cortical thickness and local gyrification index (LGI) estimated using FreeSurfer as well as cognitive performance assessed on the MATRICS Consensus Cognitive Battery (MCCB) were acquired from 78 schizophrenia patients with AVH, 74 schizophrenia patients without AVH (non-AVH), and 76 healthy controls (HC). Hoffman Auditory Hallucination Rating Scale (HAHRS) was applied to assess the severity of AVH. RESULTS The results revealed extensive deficits in all cognitive domains among AVH, non-AVH, and HC groups. Compared to non-AVH group, the AVH group showed poorer performance on visual learning and verbal learning domains. There were six brain regions with cortical thinning in the right hemisphere of inferior temporal gyrus, superior temporal gyrus, lateral orbito frontal cortex, rostral anterior cingulate cortex, supramarginal gyrus and insula, and two brain regions with increased LGI in the left hemisphere of superior parietal gyrus and the right hemisphere of caudal anterior cingulate cortex on AVH group relative to non-AVH group. Correlation analysis revealed that the cortical thickness in the right hemisphere of lateral orbito frontal cortex was negatively correlated with the severity of AVH in schizophrenia patients with AVH. CONCLUSION Visual learning, verbal learning dysfunction, and specific disruption of cortical structure may characterize schizophrenia patients with AVH during early stages of the disorder. Right lateral orbito frontal cortical deficits may be the pathological mechanisms underlying AVH in first-episode drug-naïve schizophrenia.
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Affiliation(s)
- Xuran Shen
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Fuli Jiang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xinyu Fang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Yan
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shiping Xie
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Rongrong Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Gill K, Percival C, Roes M, Arreaza L, Chinchani A, Sanford N, Sena W, Mohammadsadeghi H, Menon M, Hughes M, Carruthers S, Sumner P, Woods W, Jardri R, Sommer IE, Rossell SL, Woodward TS. Real-Time Symptom Capture of Hallucinations in Schizophrenia with fMRI: Absence of Duration-Dependent Activity. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac050. [PMID: 39144798 PMCID: PMC11206057 DOI: 10.1093/schizbullopen/sgac050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background While advances in the field of functional magnetic resonance imaging (fMRI) provide new opportunities to study brain networks underlying the experience of hallucinations in psychosis, there are methodological challenges unique to symptom-capture studies. Study Design We extracted brain networks activated during hallucination-capture for schizophrenia patients when fMRI data collected from two sites was merged (combined N = 27). A multidimensional analysis technique was applied, which would allow separation of brain networks involved in the hallucinatory experience itself from those involved in the motor response of indicating the beginning and end of the perceived hallucinatory experience. To avoid reverse inference when attributing a function (e.g., a hallucination) to anatomical regions, it was required that longer hallucinatory experiences produce extended brain responses relative to shorter. Study Results For radio-speech sound files, an auditory perception brain network emerged, and displayed speech-duration-dependent hemodynamic responses (HDRs). However, in the hallucination-capture blocks, no network showed hallucination-duration-dependent HDRs, but a retrieved network that was anatomically classified as motor response emerged. Conclusions During symptom capture of hallucinations during fMRI, no HDR showed duration dependence, but a brain network anatomically matching the motor response network was retrieved. Previous reports on brain networks detected by fMRI during hallucination capture are reviewed in this context; namely, that the brain networks interpreted as involved in hallucinations may in fact be involved only in the motor response indicating the onset of the hallucination.
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Affiliation(s)
- Karanvir Gill
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Chantal Percival
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Meighen Roes
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Leo Arreaza
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
| | - Abhijit Chinchani
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Sanford
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Walter Sena
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Av. Venceslau Braz, 71, Rio de Janeiro, RJ, Brazil
| | | | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Hughes
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Sean Carruthers
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Philip Sumner
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Will Woods
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Renaud Jardri
- Univ Lille, INSERM U-1172, CHU Lille, Lille Neuroscience and Cognition Centre, Plasticity & SubjectivitY Team, Lille, France
| | - Iris E Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands
| | - Susan L Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
- St Vincent’s Mental Health, St Vincent’s Hospital, Melbourne, Australia
| | - Todd S Woodward
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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35
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Caruana N, Seymour K. Objects that induce face pareidolia are prioritized by the visual system. Br J Psychol 2021; 113:496-507. [PMID: 34923634 DOI: 10.1111/bjop.12546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
The human visual system has evolved specialized neural mechanisms to rapidly detect faces. Its broad tuning for facial features is thought to underlie the illusory perception of faces in inanimate objects, a phenomenon called face pareidolia. Recent studies on face pareidolia suggest that the mechanisms underlying face processing, at least at the early stages of visual encoding, may treat objects that resemble faces as real faces; prioritizing their detection. In our study, we used breaking continuous flash suppression (b-CFS) to examine whether the human visual system prioritizes the detection of objects that induce face pareidolia over stimuli matched for object content. Similar to previous b-CFS results using real face stimuli, we found that participants detected the objects with pareidolia faces faster than object-matched control stimuli. Given that face pareidolia has been more frequently reported amongst individuals prone to hallucinations, we also explored whether this rapid prioritization is intact in individuals with schizophrenia, and found evidence suggesting that it was. Our findings suggest that face pareidolia engages a broadly tuned mechanism that facilitates rapid face detection. This may involve the proposed fast subcortical pathway that operates outside of visual awareness.
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Affiliation(s)
- Nathan Caruana
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia.,Perception in Action Research Centre, Macquarie University, Sydney, New South Wales, Australia
| | - Kiley Seymour
- School of Psychology, Western Sydney University, Sydney, New South Wales, Australia.,The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, New South Wales, Australia.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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36
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Shao X, Liao Y, Gu L, Chen W, Tang J. The Etiology of Auditory Hallucinations in Schizophrenia: From Multidimensional Levels. Front Neurosci 2021; 15:755870. [PMID: 34858129 PMCID: PMC8632545 DOI: 10.3389/fnins.2021.755870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
Enormous efforts have been made to unveil the etiology of auditory hallucinations (AHs), and multiple genetic and neural factors have already been shown to have their own roles. Previous studies have shown that AHs in schizophrenia vary from those in other disorders, suggesting that they have unique features and possibly distinguishable mechanisms worthy of further investigation. In this review, we intend to offer a comprehensive summary of current findings related to AHs in schizophrenia from aspects of genetics and transcriptome, neurophysiology (neurometabolic and electroencephalogram studies), and neuroimaging (structural and functional magnetic resonance imaging studies and transcriptome–neuroimaging association study). Main findings include gene polymorphisms, glutamate level change, electroencephalographic alterations, and abnormalities of white matter fasciculi, cortical structure, and cerebral activities, especially in multiple regions, including auditory and language networks. More solid and comparable research is needed to replicate and integrate ongoing findings from multidimensional levels.
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Affiliation(s)
- Xu Shao
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Gu
- RIKEN AIP, Tokyo, Japan.,Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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37
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Julayanont P, Suryadevara U. Psychosis. Continuum (Minneap Minn) 2021; 27:1682-1711. [PMID: 34881732 DOI: 10.1212/con.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Psychosis can manifest in primary psychotic disorders, neurologic diseases, and medical conditions. This article reviews the definition of psychotic symptoms and the evaluation and management of psychosis in primary psychiatric and neurologic disorders frequently seen in neurologic practice. RECENT FINDINGS Emerging evidence supports significant connections between psychosis and structural and functional brain changes in both primary psychotic and neurologic disorders. In addition to antidopaminergic activity, the mechanism of new-generation antipsychotics shifts to act on serotonin receptors, which potentially contributes to their benefits in the treatment of negative symptoms of psychosis and a lesser frequency of extrapyramidal side effects compared with typical antipsychotics. This is also helpful in the treatment of psychosis in patients who have neurodegenerative diseases and are vulnerable to developing extrapyramidal side effects from typical antipsychotics. SUMMARY Even with significant overlap, management of psychosis in primary psychotic disorders differs from the approach of psychosis in neurologic diseases. This article helps clinicians learn how to practically evaluate psychosis from both psychiatric and neurologic perspectives.
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38
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Melvin K, Crossley J, Cromby J. The feeling, embodiment and emotion of hallucinations in first episode psychosis: A prospective phenomenological visual-ecological study using novel multimodal unusual sensory experience (MUSE) maps. EClinicalMedicine 2021; 41:101153. [PMID: 34877510 PMCID: PMC8633969 DOI: 10.1016/j.eclinm.2021.101153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/12/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Research and practice typically focus upon unimodal hallucinations, especially auditory verbal hallucinations. Contemporary research has however indicated that voice-hearing may co-occur within a broader milieu of feelings, and multimodal hallucinations may be more common than previously thought. METHODS An observational design asked participants to prospectively document the feeling and modality of hallucinations for one week prior to an interview. Novel visual diary methods involving drawing, writing and body-mapping generated 42 MUSE maps (multimodal unusual sensory experience), analysed with a participatory qualitative method. Twelve people took part: all experiencing hallucinations daily, accessing early intervention in psychosis services, given psychotic-spectrum diagnoses, and living in the community. The study took place during a seven-month period in 2018 at Leicestershire and Rutland's Psychosis Intervention and Early Recovery service (UK). FINDINGS All documented hallucinations co-occurred with bodily feelings. Feelings were localised to specific body areas, generalised across the body and extended beyond the body into peripersonal space. Co-occurring emotional feelings most commonly related to confusion, fear and frustration. INTERPRETATION Hallucinations were characterised by numerous feelings arising at once, often including multimodal, emotional, and embodied features. Within this study, the immediate feeling of hallucination experiences were readily communicated through prospective, visual, and ecological information gathering methods and particularly those which offer multiple modes of communication (e.g. body-map, visual, written, oral). Uptake of visual, ecological and prospective methods may enhance understandings of lived experiences of hallucinations.Funding: University of Leicester.
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Affiliation(s)
- Katie Melvin
- University of Leicester, Department of Neuroscience, Psychology and Behaviour, George Davies Centre, University of Leicester, 15 Lancaster Road, Leicester, LE1 7HA
- Leicestershire Partnership National Health Service (NHS) Trust, George Davies Centre, University of Leicester, 15 Lancaster Road, Leicester, LE1 7HA
- University of Leicester, Division of Innovation, Technology and Operations, Brookfield Campus, 266 London Road, Leicester, LE2 1RQ
- Corresponding Author
| | - Jon Crossley
- University of Leicester, Department of Neuroscience, Psychology and Behaviour, George Davies Centre, University of Leicester, 15 Lancaster Road, Leicester, LE1 7HA
- Leicestershire Partnership National Health Service (NHS) Trust, George Davies Centre, University of Leicester, 15 Lancaster Road, Leicester, LE1 7HA
| | - John Cromby
- University of Leicester, Division of Innovation, Technology and Operations, Brookfield Campus, 266 London Road, Leicester, LE2 1RQ
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39
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Grysman N, Grossberg GT. Current Research in the Departments of Neurology and Psychiatry & Behavioral Neuroscience. MISSOURI MEDICINE 2021; 118:506-510. [PMID: 34924612 PMCID: PMC8672949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Noam Grysman
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, Missouri
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, Missouri
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40
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Chinchani AM, Menon M, Roes M, Hwang H, Allen P, Bell V, Bless J, Bortolon C, Cella M, Fernyhough C, Garrison J, Kozáková E, Larøi F, Moffatt J, Say N, Suzuki M, Toh WL, Zaytseva Y, Rossell SL, Moseley P, Woodward TS. Item-specific overlap between hallucinatory experiences and cognition in the general population: A three-step multivariate analysis of international multi-site data. Cortex 2021; 145:131-144. [PMID: 34717270 DOI: 10.1016/j.cortex.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/01/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Hallucinatory experiences (HEs) can be pronounced in psychosis, but similar experiences also occur in nonclinical populations. Cognitive mechanisms hypothesized to underpin HEs include dysfunctional source monitoring, heightened signal detection, and impaired attentional processes. Using data from an international multisite study on non-clinical participants (N = 419), we described the overlap between two sets of variables - one measuring cognition and the other HEs - at the level of individual items. We used a three-step method to extract and examine item-specific signal, which is typically obscured when summary scores are analyzed using traditional methodologies. The three-step method involved: (1) constraining variance in cognition variables to that which is predictable from HE variables, followed by dimension reduction, (2) determining reliable HE items using split-halves and permutation tests, and (3) selecting cognition items for interpretation using a leave-one-out procedure followed by repetition of Steps 1 and 2. The results showed that the overlap between HEs and cognition variables can be conceptualized as bi-dimensional, with two distinct mechanisms emerging as candidates for separate pathways to the development of HEs: HEs involving perceptual distortions on one hand (including voices), underpinned by a low threshold for signal detection in cognition, and HEs involving sensory overload on the other hand, underpinned by reduced laterality in cognition. We propose that these two dimensions of HEs involving distortions/liberal signal detection, and sensation overload/reduced laterality may map onto psychosis-spectrum and dissociation-spectrum anomalous experiences, respectively.
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Affiliation(s)
- Abhijit M Chinchani
- BC Mental Health and Substance Use Services, Vancouver, UK; Department of Bioinformatics, University of British Columbia, Vancouver, UK
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, UK
| | - Meighen Roes
- BC Mental Health and Substance Use Services, Vancouver, UK; Department of Psychology, University of British Columbia, Vancouver, UK
| | - Heungsun Hwang
- Department of Psychology, McGill University, Montreal, UK
| | - Paul Allen
- Department of Psychology, University of Roehampton, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vaughan Bell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Josef Bless
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Catherine Bortolon
- Univ. Grenoble Alpes, Laboratoire Inter-universitaire de Psychologie, University Grenoble Alpes, Grenoble, France
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | | | - Jane Garrison
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Eva Kozáková
- Department of Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liege, Liege, Belgium; NORMENT-Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Jamie Moffatt
- School of Psychology, University of Sussex, Falmer, UK
| | - Nicolas Say
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Mimi Suzuki
- Division of Psychiatry, University College London, London, UK
| | - Wei Lin Toh
- Cognitive Neuropsychiatry Lab, Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Yuliya Zaytseva
- Department of Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany, Czech Republic; Department of Psychiatry and Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Susan L Rossell
- Cognitive Neuropsychiatry Lab, Centre for Mental Health, Swinburne University, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Peter Moseley
- Department of Psychology, Northumbria University, Newcastle-Upon Tyne, UK
| | - Todd S Woodward
- BC Mental Health and Substance Use Services, Vancouver, UK; Department of Bioinformatics, University of British Columbia, Vancouver, UK; Department of Psychiatry, University of British Columbia, Vancouver, UK.
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41
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Lim A, Blom JD. Tactile and Somatic Hallucinations in a Muslim Population of Psychotic Patients. Front Psychiatry 2021; 12:728397. [PMID: 34777040 PMCID: PMC8586517 DOI: 10.3389/fpsyt.2021.728397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Tactile and somatic hallucinations are distressing phenomena that have hardly been researched. The few studies that have been published focus on their occurrence in neurodegenerative disorders and substance use, and, surprisingly, not on schizophrenia spectrum disorders. Objective: To fill this gap in our knowledge, we sought to explore the phenomenological characteristics of tactile and somatic hallucinations in a group of psychotic Muslim patients. Since many Muslims attribute such experiences to jinn (invisible spirits) and jinn are often perceived in multiple sensory modalities, we not only charted the involvement of the tactile and somatic modalities but also their interrelatedness with hallucinations in other sensory modalities. Methods: We performed a cross-sectional study using a semi-structured interview and dedicated questionnaire. Results: Of the 42 Muslim inpatients mostly diagnosed with a schizophrenia spectrum disorder, 62% reported to suffer from tactile and/or somatic hallucinations. Their phenomenological characteristics varied, with 96% being multimodal in nature and 38% taking the form of full-blown entity/jinn encounters. In comparison to other entity experiences, the involvement of the tactile and somatic modalities was exceptionally high, as was the level of ensuing distress. Regarding the order of recruitment of the various sensory modalities, we suggest the involvement of an underlying stochastic process. Conclusion: Muslim patients with severe psychosis can have tactile and somatic hallucinations, of which a large number are multimodal or full-blown entity/jinn encounters, which are almost invariably appreciated as harrowing. On the basis of our findings we make recommendations for further research and clinical practice.
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Affiliation(s)
- Anastasia Lim
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, Netherlands
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Jan Dirk Blom
- Outpatient Clinic for Uncommon Psychiatric Syndromes, Parnassia Psychiatric Institute, The Hague, Netherlands
- Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
- Department of Psychiatry, University of Groningen, Groningen, Netherlands
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42
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Olfactory hallucinations in a population-based sample. Psychiatry Res 2021; 304:114117. [PMID: 34391204 DOI: 10.1016/j.psychres.2021.114117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
Olfactory hallucinations referring to olfactory perceptions in the absence of chemical stimuli, occur in non-clinical and clinical populations. Few studies have investigated their prevalence in the general population and little is known about factors triggering and maintaining them such as substance use, severe life events, and mood. We analyzed self-report data from 2500 community dwelling Norwegians, aged 18-96 years, for occurrence of olfactory hallucinations and co-occurring hallucinations in other modalities (auditory, visual, tactile). Analyses included age, sex, self-reported symptoms of depression and anxiety, mental health status, and experience of severe life-events. The results show that 4.2% (95% CI 3.5-5.1%) reported having experienced olfactory hallucinations, and 56% of individuals experiencing olfactory hallucinations also reported these in combination with hallucinations in other modalities. Prevalence varied significantly in terms of age and sex, in that olfactory hallucinations were most frequently reported by young individuals and females. Self-reported symptoms of anxiety and experience of stressful life events were significantly associated with olfactory hallucinations, suggesting that experiencing olfactory hallucinations may negatively affect functioning and may increase the likelihood of developing psychopathology. Findings underline the need to continue to examine olfactory hallucinations albeit with a more comprehensive assessment in order to increase knowledge on this experience.
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43
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Moriyama TS, Drukker M, Guloksuz S, Ten Have M, de Graaf R, van Dorsselaer S, Gunther N, Bak M, van Os J. Evidence for an interrelated cluster of Hallucinatory experiences in the general population: an incidence study. Psychol Med 2021; 51:2034-2043. [PMID: 32317030 DOI: 10.1017/s0033291720000793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although hallucinations have been studied in terms of prevalence and its associations with psychopathology and functional impairment, very little is known about sensory modalities other than auditory (i.e. haptic, visual and olfactory), as well the incidence of hallucinations, factors predicting incidence and subsequent course. METHODS We examined the incidence, course and risk factors of hallucinatory experiences across different modalities in two unique prospective general population cohorts in the same country using similar methodology and with three interview waves, one over the period 1996-1999 (NEMESIS) and one over the period 2007-2015 (NEMESIS-2). RESULTS In NEMESIS-2, the yearly incidence of self-reported visual hallucinations was highest (0.33%), followed by haptic hallucinations (0.31%), auditory hallucinations (0.26%) and olfactory hallucinations (0.23%). Rates in NEMESIS-1 were similar (respectively: 0.35%, 0.26%, 0.23%, 0.22%). The incidence of clinician-confirmed hallucinations was approximately 60% of the self-reported rate. The persistence rate of incident hallucinations was around 20-30%, increasing to 40-50% for prevalent hallucinations. Incident hallucinations in one modality were very strongly associated with occurrence in another modality (median OR = 59) and all modalities were strongly associated with delusional ideation (median OR = 21). Modalities were approximately equally strongly associated with the presence of any mental disorder (median OR = 4), functioning, indicators of help-seeking and established environmental risk factors for psychotic disorder. CONCLUSIONS Hallucinations across different modalities are a clinically relevant feature of non-psychotic disorders and need to be studied in relation to each other and in relation to delusional ideation, as all appear to have a common underlying mechanism.
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Affiliation(s)
- Tais S Moriyama
- Instituto Bairral, Itapira, Brazil
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Magreet Ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
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Muller AM, Dalal TC, Stevenson RA. Schizotypal personality traits and multisensory integration: An investigation using the McGurk effect. Acta Psychol (Amst) 2021; 218:103354. [PMID: 34174491 DOI: 10.1016/j.actpsy.2021.103354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
Multisensory integration, the process by which sensory information from different sensory modalities are bound together, is hypothesized to contribute to perceptual symptomatology in schizophrenia, in whom multisensory integration differences have been consistently found. Evidence is emerging that these differences extend across the schizophrenia spectrum, including individuals in the general population with higher levels of schizotypal traits. In the current study, we used the McGurk task as a measure of multisensory integration. We measured schizotypal traits using the Schizotypal Personality Questionnaire (SPQ), hypothesizing that higher levels of schizotypal traits, specifically Unusual Perceptual Experiences and Odd Speech subscales, would be associated with decreased multisensory integration of speech. Surprisingly, Unusual Perceptual Experiences were not associated with multisensory integration. However, Odd Speech was associated with multisensory integration, and this association extended more broadly across the Disorganized factor of the SPQ, including Odd or Eccentric Behaviour. Individuals with higher levels of Odd or Eccentric Behaviour scores also demonstrated poorer lip-reading abilities, which partially explained performance in the McGurk task. This suggests that aberrant perceptual processes affecting individuals across the schizophrenia spectrum may relate to disorganized symptomatology.
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Affiliation(s)
- Anne-Marie Muller
- Department of Psychology, University of Western Ontario, London, ON, Canada; Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Tyler C Dalal
- Department of Psychology, University of Western Ontario, London, ON, Canada; Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Ryan A Stevenson
- Department of Psychology, University of Western Ontario, London, ON, Canada; Brain and Mind Institute, University of Western Ontario, London, ON, Canada.
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Musiek FE, Morris S, Ichiba K, Clark L, Davidson AJ. Auditory Hallucinations: An Audiological Horizon? J Am Acad Audiol 2021; 32:195-210. [PMID: 34062609 DOI: 10.1055/s-0041-1722989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Interesting data and theories have emerged regarding auditory hallucinations (AHs) in patients with schizophrenia. The possibility that these patients may have changes in the anatomy of the auditory cortex and/or subcortical structures of the central auditory nervous system and present with deficits on audiological tests is important information to the audiology community. However, it seems clear that, in general, audiologists are not sufficiently aware of these findings. PURPOSE There are two main purposes of this article: (1) to educate audiologists about AHs related to schizophrenia and related issues, and (2) to encourage audiologists and hearing scientists to become involved in the evaluation and research of AHs. This fascinating disorder is one in which audiologists/hearing scientists are well suited to make a significant contribution. RESEARCH DESIGN A review and synthesis of the literature was conducted. Relevant literature was identified through PubMed, Google Scholar, as well as independent book chapters and article searches. Keywords driving the searches were AHs, auditory illusions, verbal and musical hallucinations, schizophrenia, and central auditory disorders. Given the currency of the topic, the information collected was primarily between 1990 and 2020. STUDY SAMPLE The review is organized around categorization, prevalence, models, mechanisms, anatomy, pathophysiology, and audiological correlates related to AHs. DATA COLLECTION AND ANALYSIS Searches were conducted using well-known search engines and manual searches by each author. This information on AHs was then analyzed collectively by the authors for useful background and relevance, as well as important for the field of audiology. RESULTS Several anatomical, physiological, and functional imaging studies have shown compromise of the auditory cortex in those with schizophrenia and AHs. Potentially related to this, are studies that demonstrated sub-par performance on behavioral audiologic measures for this unique clinical population. These findings align well with the kind of hearing disorder for which audiologists are well-trained to make significant contributions. CONCLUSION Neurobiological and audiological evidence is accumulating on patients with schizophrenia and AH potentially rendering it as both an auditory and psychiatric disorder. Audiologists should consider expanding their horizon and playing a role in the clinical investigation of this disorder.
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Affiliation(s)
- Frank E Musiek
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Sarah Morris
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Kayla Ichiba
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Liza Clark
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Alyssa J Davidson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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Arora M, Knott VJ, Labelle A, Fisher DJ. Alterations of Resting EEG in Hallucinating and Nonhallucinating Schizophrenia Patients. Clin EEG Neurosci 2021; 52:159-167. [PMID: 33074718 DOI: 10.1177/1550059420965385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Auditory hallucinations (AHs) are a common symptom of schizophrenia and contribute significantly to disease burden. Research on schizophrenia and AHs is limited and fails to adequately address the effect of AHs on resting EEG in patients with schizophrenia. This study assessed changes in frequency bands (delta, theta, alpha, beta) of resting EEG taken from hallucinating patients (n = 12), nonhallucinating patients (n = 11), and healthy controls (n = 12). Delta and theta activity were unaffected by AHs but differed between patients with schizophrenia and healthy controls. Alpha activity was affected by AHs: nonhallucinators had more alpha activity than hallucinators and healthy controls. Additionally, beta activity was inversely related to trait measures of AHs. These findings contribute to the literature of resting eyes closed EEG recordings of schizophrenia and AHs, and indicate the role of delta, theta, alpha, and beta as markers for schizophrenia and auditory hallucinations.
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Affiliation(s)
- Madhav Arora
- Faculty of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Verner J Knott
- Faculty of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
- The 26624Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Alain Labelle
- Faculty of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
- The 26624Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
| | - Derek J Fisher
- The 26624Royal's Institute of Mental Health Research, Ottawa, Ontario, Canada
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Blom JD. Leroy's elusive little people: A systematic review on lilliputian hallucinations. Neurosci Biobehav Rev 2021; 125:627-636. [PMID: 33676962 DOI: 10.1016/j.neubiorev.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/10/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Lilliputian hallucinations concern hallucinated human, animal or fantasy entities of minute size. Having been famously described by the French psychiatrist Raoul Leroy in 1909, who wrote from personal experience, to date they are mentioned almost routinely in textbooks of psychiatry, albeit with little in-depth knowledge. I therefore systematically reviewed 145 case reports and case series comprising 226 case descriptions, concluding that lilliputian hallucinations are visual (61 %) or multimodal (39 %) in nature. In 97 % of the cases, they are perceived as grounded in the actual environment, thus indicating involvement of higher-level regions of the perceptual network subserving the fusion of sensory and hallucinatory content. Perceptual release and deafferentiation are the most likely underlying mechanisms. Etiology is extremely diverse, with schizophrenia spectrum disorder, alcohol use disorder and loss of vision accounting for 50 % of the cases and neurological disease for 36 %. Recovery was obtained in 62 % of the cases, whereas 18 % of the cases ended in chronicity and 8 % in death. Recommendations are made for clinical practice and future research.
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Affiliation(s)
- Jan Dirk Blom
- Parnassia Psychiatric Institute, Kiwistraat 43, The Hague, 2552 DH, The Netherlands; Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands; Department of Psychiatry, University of Groningen, Groningen, The Netherlands.
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48
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Badcock JC, Brand R, Thomas N, Hayward M, Paulik G. Multimodal versus unimodal auditory hallucinations in clinical practice: Clinical characteristics and treatment outcomes. Psychiatry Res 2021; 297:113754. [PMID: 33524774 DOI: 10.1016/j.psychres.2021.113754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022]
Abstract
Psychological treatments for hallucinations typically target auditory verbal hallucinations (AVH) but neglect the influence of hallucinations in other sensory modalities. This study compared the baseline clinical characteristics and therapeutic outcomes (following brief Coping Strategy Enhancement) of adult clients (N = 100) with multimodal or unimodal (auditory) hallucinations attending an outpatient service for distressing AVH. The results showed that 72.1% of clients reported multimodal hallucinations in the past month. Group comparisons of most baseline clinical characteristics (AVH features, beliefs about AVH, number of traumatic events, personal and social functioning, negative affect) were non-significant. However, in the subgroup (N = 65) reporting ongoing effects of traumatic events, those with multimodal hallucinations reported significantly higher posttraumatic stress symptoms (d = 0.62). Notably, both multimodal and unimodal hallucination groups showed improvement in AVH distress and frequency post-treatment, but group differences in treatment outcomes were not significant. These findings, in a naturalistic service setting, confirm that multimodal hallucinations are common in people seeking help for distressing AVH and may be associated with higher levels of posttraumatic stress symptoms. Importantly, they also suggest that psychological therapy may be suitable and effective for clients experiencing AVH - irrespective of the presence of hallucinations in other sensory modalities.
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Affiliation(s)
- Johanna C Badcock
- Perth Voices Clinic, Murdoch, WA 6150, Australia; School of Psychological Science, University of Western Australia, Crawley, WA 6009, Australia.
| | - Rachel Brand
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, United Kingdom; Research & Development Department, Sussex Partnership NHS Foundation Trust, United Kingdom
| | - Georgie Paulik
- Perth Voices Clinic, Murdoch, WA 6150, Australia; School of Psychological Science, University of Western Australia, Crawley, WA 6009, Australia; School of Psychology and Exercise Science, Murdoch University, Murdoch, WA 6150, Australia
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49
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Dalal TC, Muller AM, Stevenson RA. The Relationship Between Multisensory Temporal Processing and Schizotypal Traits. Multisens Res 2021; 34:1-19. [PMID: 33706260 DOI: 10.1163/22134808-bja10044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022]
Abstract
Recent literature has suggested that deficits in sensory processing are associated with schizophrenia (SCZ), and more specifically hallucination severity. The DSM-5's shift towards a dimensional approach to diagnostic criteria has led to SCZ and schizotypal personality disorder (SPD) being classified as schizophrenia spectrum disorders. With SCZ and SPD overlapping in aetiology and symptomatology, such as sensory abnormalities, it is important to investigate whether these deficits commonly reported in SCZ extend to non-clinical expressions of SPD. In this study, we investigated whether levels of SPD traits were related to audiovisual multisensory temporal processing in a non-clinical sample, revealing two novel findings. First, less precise multisensory temporal processing was related to higher overall levels of SPD symptomatology. Second, this relationship was specific to the cognitive-perceptual domain of SPD symptomatology, and more specifically, the Unusual Perceptual Experiences and Odd Beliefs or Magical Thinking symptomatology. The current study provides an initial look at the relationship between multisensory temporal processing and schizotypal traits. Additionally, it builds on the previous literature by suggesting that less precise multisensory temporal processing is not exclusive to SCZ but may also be related to non-clinical expressions of schizotypal traits in the general population.
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Affiliation(s)
- Tyler C Dalal
- 1Department of Psychology, University of Western Ontario, London, ON, M6G 2N5, Canada
- 2Brain and Mind Institute, University of Western Ontario, London, ON, M6G 2N5, Canada
| | - Anne-Marie Muller
- 1Department of Psychology, University of Western Ontario, London, ON, M6G 2N5, Canada
- 2Brain and Mind Institute, University of Western Ontario, London, ON, M6G 2N5, Canada
| | - Ryan A Stevenson
- 1Department of Psychology, University of Western Ontario, London, ON, M6G 2N5, Canada
- 2Brain and Mind Institute, University of Western Ontario, London, ON, M6G 2N5, Canada
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50
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Silverstein SM, Lai A. The Phenomenology and Neurobiology of Visual Distortions and Hallucinations in Schizophrenia: An Update. Front Psychiatry 2021; 12:684720. [PMID: 34177665 PMCID: PMC8226016 DOI: 10.3389/fpsyt.2021.684720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
Schizophrenia is characterized by visual distortions in ~60% of cases, and visual hallucinations (VH) in ~25-50% of cases, depending on the sample. These symptoms have received relatively little attention in the literature, perhaps due to the higher rate of auditory vs. visual hallucinations in psychotic disorders, which is the reverse of what is found in other neuropsychiatric conditions. Given the clinical significance of these perceptual disturbances, our aim is to help address this gap by updating and expanding upon prior reviews. Specifically, we: (1) present findings on the nature and frequency of VH and distortions in schizophrenia; (2) review proposed syndromes of VH in neuro-ophthalmology and neuropsychiatry, and discuss the extent to which these characterize VH in schizophrenia; (3) review potential cortical mechanisms of VH in schizophrenia; (4) review retinal changes that could contribute to VH in schizophrenia; (5) discuss relationships between findings from laboratory measures of visual processing and VH in schizophrenia; and (6) integrate findings across biological and psychological levels to propose an updated model of VH mechanisms, including how their content is determined, and how they may reflect vulnerabilities in the maintenance of a sense of self. In particular, we emphasize the potential role of alterations at multiple points in the visual pathway, including the retina, the roles of multiple neurotransmitters, and the role of a combination of disinhibited default mode network activity and enhanced state-related apical/contextual drive in determining the onset and content of VH. In short, our goal is to cast a fresh light on the under-studied symptoms of VH and visual distortions in schizophrenia for the purposes of informing future work on mechanisms and the development of targeted therapeutic interventions.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States.,Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States.,Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States.,Center for Visual Science, University of Rochester Medical Center, Rochester, NY, United States
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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