Visual hallucination

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A visual hallucination is a vivid visual experience occurring without corresponding external stimuli in an awake state. These experiences are involuntary and possess a degree of perceived reality sufficient to resemble authentic visual perception. [1] Unlike illusions, which involve the misinterpretation of actual external stimuli, visual hallucinations are entirely independent of external visual input. [2] They may include fully formed images, such as human figures or scenes, angelic figures, or unformed phenomena, like flashes of light or geometric patterns. [2] [3]

Contents

Visual hallucinations are not restricted to the transitional states of awakening or falling asleep and are a hallmark of various neurological and psychiatric conditions. [3] They are documented in schizophrenia, toxic encephalopathies, migraines, substance withdrawal syndromes, focal central nervous system lesions, and psychotic mood disorders. [3] Although traditionally linked with organic aetiologies, visual hallucinations occur in approximately 25% to 50% of individuals with schizophrenia. In such cases, they frequently co-occur with auditory hallucinations, though they may also manifest independently. [3]

Approximately one-third of individuals with psychotic disorders experience visual hallucinations. [1] Despite their prevalence, the underlying mechanisms remain poorly understood, which hinders the development of targeted therapeutic approaches. [1]

Presentation

Visual hallucinations in psychosis are reported to have physical properties similar to real perceptions. [4] They are often life-sized, detailed, and solid, and are projected into the external world. They typically appear anchored in external space, just beyond the reach of individuals, or further away. They can have three-dimensional shapes, with depth and shadows, and distinct edges. They can be colorful or in black and white and can be static or have movement. [5] [6] [7] [8] [9] [10] [11]

Conditions

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies hallucinations as a critical diagnostic criterion for psychotic disorders, including schizophrenia and schizoaffective disorder. Conditions causing complex visual hallucinations include schizophrenia, Charles Bonnet syndrome, migraine coma, treated idiopathic Parkinson's disease, epilepsy, narcolepsy-cataplexy syndrome, Lewy body dementia without treatment, peduncular hallucinosis, and hallucinogen-induced states. [12]

In delirium, visual hallucinations are the most common type. [13] Stimulant intoxication (e.g., cocaine or methamphetamine) is frequently accompanied by visual hallucinations, which may involve perceptions of crawling insects due to associated tactile disturbances. [14] Visual hallucinations are also linked to migraine headaches, presenting as classic auras or less common manifestations like migraine coma and familial hemiplegic migraine. [14] Peduncular hallucinosis involves visual hallucinations following a midbrain infarct. [14] In dementia with Lewy bodies, visual hallucinations feature objects appearing to move when they are still, as well as complex scenes involving people and inanimate objects that do not exist. [14] Charles Bonnet syndrome is characterized by visual hallucinations in visually impaired individuals, often depicting clear and detailed images of people, faces, animals, and objects. [14]

Simple vs. complex

Visual hallucinations may be simple/non-formed visual hallucinations, or complex/formed visual hallucinations. [15]

Simple visual hallucinations without structure are known as phosphenes and those with geometric structure are known as photopsias. [16] These hallucinations are caused by irritation to the primary visual cortex (Brodmann's area 17). [17]

Sometimes, hallucinations are 'Lilliputian', i.e., patients experience visual hallucinations where there are miniature people, often undertaking unusual actions. Lilliputian hallucinations may be accompanied by wonder, rather than terror. [18] [19]

Most people have multiple VH types. [4] Complex VH were most prevalent, mainly consisting of people and animals, followed by simple, then geometric VH. Few patients experienced only simple VH.[ citation needed ]

Content

The frequency of hallucinations varies widely from rare to frequent, as does duration (seconds to minutes). It is common that the visual hallucinations typically occurred daily, for afew minutes per episode. [20] The content of hallucinations varies as well. Preliminary research has found that most individuals had multiple types of visual hallucinations. [20] Scenes involving people and/or animals were the most common, followed by simple geometric images. [4]

Complex (formed) visual hallucinations are more common than Simple (non-formed) visual hallucinations. [8] [10] In contrast to hallucinations experienced in organic conditions, hallucinations experienced as symptoms of psychoses tend to be more frightening. An example of this would be hallucinations that have imagery of bugs, dogs, snakes, distorted faces. Visual hallucinations may also be present in those with Parkinson's, where visions of dead individuals can be present. In psychoses, this is relatively rare, although visions of God, angels, the devil, saints, and fairies are common. [9] [10] Individuals often report being surprised when hallucinations occur and are generally helpless to change or stop them. [7] In general, individuals believe that visions are experienced only by themselves. [7] [8]

Primary Visual Cortex

V1's functional connection with other brain regions is reduced in psychotic patients who experience visual hallucinations. [1] This contrasts with the expectation that V1 would be active during conscious visual perception. [1]

Causes

Two neurotransmitters are particularly important in visual hallucinations – serotonin and acetylcholine. They are concentrated in the visual thalamic nuclei and visual cortex. [18]

The similarity of visual hallucinations that stem from diverse conditions suggest a common pathway for visual hallucinations. Three pathophysiologic mechanisms are thought to explain this.

The first mechanism has to do with cortical centers responsible for visual processing. Irritation of visual association cortices (Brodmann's areas 18 and 19) cause complex visual hallucinations. [17] [21]

The second mechanism is deafferentation, the interruption or destruction of the afferent connections of nerve cells, of the visual system, caused by lesions, leading to the removal of normal inhibitory processes on cortical input to visual association areas, leading to complex hallucinations as a release phenomenon. [19] [21]

Prevalence

Studies show that visual hallucinations are present in 16%–72% of patients with schizophrenia and schizoaffective disorder. [5] [22] [16] [14] In delirium, visual hallucinations have been observed in 27% of patients. [14] [13] Furthermore, visual hallucinations are reported in over 20% of individuals with dementia with Lewy bodies. [14] [23]

Related Research Articles

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized variously by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood, anxiety, and substance use disorders, as well as obsessive–compulsive disorder (OCD).

<span class="mw-page-title-main">Hallucination</span> Perception that only seems real

A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

Capgras delusion or Capgras syndrome is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, other close family member, or pet has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), the French psychiatrist who first described the disorder.

Stimulant psychosis is a mental disorder characterized by psychotic symptoms. It involves and typically occurs following an overdose or several day binge on psychostimulants, although it can occur in the course of stimulant therapy, particularly at higher doses. One study reported occurrences at regularly prescribed doses in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain, depend upon genetics and may persist for months or years. Psychosis may also result from withdrawal from stimulants, particularly when psychotic symptoms were present during use.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.

Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.

Oneiroid syndrome (OS) is a psychiatric condition marked by dream-like disturbances of consciousness. It is characterised by vivid scenic hallucinations, catatonic symptoms (ranging from stupor to agitation), delusions, and kaleidoscopic psychopathological experiences. The term originates from the Ancient Greek words "ὄνειρος" (óneiros, meaning "dream") and "εἶδος" (eîdos, meaning "form" or "likeness"), translating to "dream-like" or "oneiric" (occasionally described as "nightmare-like").

An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment.

In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. More specifically, it refers to the period between the first recognition of a disease's symptom until it reaches its more severe form. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

Brief psychotic disorder—according to the classifications of mental disorders DSM-IV-TR and DSM-5—is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.

<span class="mw-page-title-main">Postpartum psychosis</span> Rare psychiatric emergency beginning suddenly in the first two weeks after childbirth

Postpartum psychosis (PPP), also known as puerperal psychosis or peripartum psychosis, involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks postpartum. PPP is a condition currently represented under "Brief Psychotic Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Volume V (DSM-V). Symptoms may include delusions, hallucinations, disorganized speech, and/or abnormal motor behavior. Other symptoms frequently associated with PPP include confusion, disorganized thought, severe difficulty sleeping, variations of mood disorders, as well as cognitive features such as consciousness that comes and goes or disorientation.

Substance-induced psychosis is a form of psychosis that is attributed to substance intoxication, withdrawal or recent consumption of psychoactive drugs. It is a psychosis that results from the effects of various substances, such as medicinal and nonmedicinal substances, legal and illegal drugs, chemicals, and plants. Various psychoactive substances have been implicated in causing or worsening psychosis in users.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

Unitary psychosis (Einheitspsychose) refers to the 19th-century belief prevalent in German psychiatry until the era of Emil Kraepelin that all forms of psychosis were surface variations of a single underlying disease process. According to this model, there were no distinct disease entities in psychiatry but only varieties of a single universal madness and the boundaries between these variants were fluid. The prevalence of the concept in Germany during the mid-19th century can be understood in terms of a general resistance to Cartesian dualism and faculty psychology as expressed in Naturphilosophie and other Romantic doctrines that emphasised the unity of body, mind and spirit.

Simple-type schizophrenia is a sub-type of schizophrenia included in the International Classification of Diseases (ICD-10), in which it is classified as a mental and behaviour disorder. It is not included in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the upcoming ICD-11, effective 1 January 2022. Simple-type schizophrenia is characterized by negative ("deficit") symptoms, such as avolition, apathy, anhedonia, reduced affect display, lack of initiative, lack of motivation, low activity; with absence of hallucinations or delusions of any kind.

The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes. Religious experiences often involve reports of auditory and/or visual phenomena, which sounds seemingly similar to those with schizophrenia who also commonly report hallucinations and delusions. These symptoms may resemble the events found within a religious experience. However, the people who report these religious visual and audio hallucinations also claim to have not perceived them with their five senses, rather, they conclude these hallucinations were an entirely internal process.

References

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  22. ↑ Mott, Richard H; Small, Iver F; Anderson, John M (June 1965). "Comparative Study Of Hallucinations". Archives of General Psychiatry. 12 (6): 595–601. doi:10.1001/archpsyc.1965.01720360067011. PMID   14286889.
  23. ↑ Ala, T A; Yang, K H; Sung, J H; Frey, W H (1997-01-01). "Hallucinations and signs of parkinsonism help distinguish patients with dementia and cortical Lewy bodies from patients with Alzheimer's disease at presentation: a clinicopathological study" (PDF). Journal of Neurology, Neurosurgery & Psychiatry. 62 (1): 16–21. doi: 10.1136/jnnp.62.1.16 . ISSN   0022-3050. PMC   486689 . PMID   9010394 . Retrieved 2025-01-12.
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