Posts tagged hallucinations
Articles and news from the latest research reports.
Visual hallucinations more common than previously thought
Vivid hallucinations experienced by people with sight loss last far longer and have more serious consequences than previously thought, according to new research from King’s College London and the Macular Society.
The study is the largest survey of the phenomenon, known as Charles Bonnet Syndrome, and documented the experiences of 492 visually impaired people who had experienced visual hallucinations. The findings, published in the British Journal of Ophthalmology, show there is a serious discrepancy between medical opinion and the realities of the condition.
Charles Bonnet Syndrome is widely considered by the medical profession to be benign and short-lived. However, the new research shows that 80% of respondents had hallucinations for five years or more and 32% found them predominantly unpleasant, distressing and negative.
The study described this group of people as having “negative outcome Charles Bonnet Syndrome”. The group was more likely to have frequent, fear inducing, longer duration hallucinations, which affected daily activities. They were more likely to attribute hallucinations to serious mental illness and were less likely to have been warned about the possibility of hallucinations before they started.
Of respondents, 38% regarded their hallucinations as startling, terrifying or frightening when they first occurred and 46% said hallucinations had an effect on their ability to complete daily tasks. 36% of people who discussed the issue with a medical professional said the professional was “unsure or did not know” about the diagnosis.
Dr Dominic ffytche, who led the research at the Institute of Psychiatry at King’s, says: “Charles Bonnet Syndrome has been traditionally thought of as benign. Indeed, it has been questioned whether it should even be considered a medical condition given it does not cause problems and goes away by itself. The results of our survey paint a very different picture.
“With no specific treatments for Charles Bonnet Syndrome, the survey highlights the importance of raising awareness to reduce the distress it causes, particularly before symptoms start. All people with Charles Bonnet Syndrome are relieved or reassured to find out about the cause of their hallucinations and our evidence shows the knowledge may help reduce negative outcome.”
People with macular disease are particularly prone to Charles Bonnet hallucinations. They are thought to be a reaction of the brain to the loss of visual stimulation. More than half of people with severe sight loss experience them but many do not tell others for fear they will be thought to have a serious mental illness.
Age-related macular (AMD) degeneration affects the central vision and is the most common cause of sight loss in the UK. Nearly 600,000 people have late-stage AMD today and more people will become affected as our population ages. Around half will have hallucinations at some stage.
Tony Rucinski, Chief Executive, the Macular Society, said: “It is essential that people affected by sight loss are given information about Charles Bonnet Syndrome at diagnosis or as soon after as possible.
“Losing your sight is bad enough without the fear that you have something like dementia as well. We need medical professionals to recognise the seriousness of Charles Bonnet Syndrome and ensure that people don’t suffer unnecessarily. More research is also needed to investigate Charles Bonnet Syndrome and possible ways of reducing its impact.”
Dr ffytche is also leading a large NIHR funded research programme on visual hallucinations to develop a much-needed evidence base to inform NHS practice in managing and treating the symptoms.
Schizophrenia: What’s in my head?
When she’s experiencing hallucinations, artist Sue Morgan feels compelled to draw; to ‘get it out of her head’. Sue was diagnosed with schizophrenia about 20 years ago. The drawing is therapeutic, but it’s also Sue’s way of expressing the complex and sometimes frightening secret world in her head. In this film Sue meets Sukhi Shergill, a clinician and researcher at the Institute of Psychiatry in London. He’s also making pictures, but using MRI to peer inside the brains of schizophrenia patients.
Read more about schizophrenia
Perhaps the most controversial book ever written in the field of psychology, was Julian Janes’ mid-seventies classic, “The Origin of Consciousness in the Breakdown of the Bicameral Mind.” In it, Jaynes reaches the stunning conclusion that the seemingly all-pervasive and demanding gods of the ancients, were not just whimsical personifications of inanimate objects like the sun or moon, nor anthropomorphizations of the various beasts, real and mythical, but rather the culturally-barren inner voices of bilaterally-symmetric brains not yet fully connected, nor conscious, in the way we are today.
In his view, all people of the day would have “heard voices”, similar to the schizophrenic. They would have been experienced as a hallucinations of sorts, coming from outside themselves as the unignorable voices of gods, rather than as commands originating from the other side of the brain. After a long hiatus, the study the inner voice, and the larger mental baggage that comes along with having one, has returned to the fore. Vaughan Bell, a researcher from King’s College in London, recently published an insightful call to arms in PlOS Biology for psychologists and neurobiologists to create a new understanding of these phenomena.
A coherent inner narrative in synch with our actions, is something most of us take for granted. Yet not everyone can take such possession. The congenitally deaf, for example, may later acquire auditory and communicative function through the use of cochlear implants. However, their inner experiences of sound-powered word, which they acquire through the reattribution of percepts of a previous gestural or visual nature, is something not typically shared or appreciated at the level of the larger public. A similar lack of comprehension at the research community level exists regarding those with physically intact senses, but with some other mental process gone awry. We may note with familiarity the shuffling and muttering of a homeless schizophrenic, yet have no systematic way to comprehend their intuitions, no matter how deluded they may appear.
Bell notes that current neurocognitive theories tend to ignore how those who hear voices first acquire what he describes as “internalized social actors.” In addition to live social interactions, “offline” social interaction with an internal model of those individuals holding significant power in our lives would seem like a handy feature to have. We can readily imagine entirely non-pathological situations where such a model would be of benefit. A young child cut from a school basketball team which they worked hard to make, may be temporality devastated, but hardly traumatized. If they renew their efforts to make the team the next year and practice each day in their backyard, they might imagine the coach who cut them watching their every shot with a critical eye. While this hallucinated guidance would be entirely benign, if the person they imagine is instead an abusive parent or classmate, the internal model might eventually take on a more sinister nature.
It would seem that at least in some individuals, the internal model seems able to get the upper hand, particularly when that hand is forced. We might imagine a school child tasked with the tedium of a seemingly endless recitation—saying the rosary beads, for example, in the catholic school days of yore. The familiar “Hail Mary, full of Grace……” might, after so many repetitions, transform in the mind into something else, despite the earnestness of the professor of faith. “Hail Mary, full of …..” might instead be completed with a different choice word that intrudes from another collective in the brain despite the alarmed child’s efforts to suppress it. In the situation where this is vocalized externally, completely out of control as in full blown Tourette’s syndrome, the child now has a problem.
The idea that separate voices represent separate hemispheres may be a good starting point, but it can readily be dispatched as far as being the whole story. Auditory hallucinations can take the form of multiple social actors, clearly outnumbering our hemispheres, and all with different tones, personalities, and persistence of identity. Attempts have been made to localize brain activity to a particular narrative using EEG recording, or to elicit a hallucination using magnetic stimulation. While the occasional inciteful anecdote may be gleaned from these kinds of investigations, we should not expect much fine detail to ever be had from them. The cortical area known as the temporoparietal junction routinely emerges as a favorite among brain imagers because of its geometric location at the pinnacle of the major fold in the brain. Unfortunately, until there exists a large scale minimally damaging recording technology we are probably going to have to content ourselves with looking closer at what subjects have to say about their own auditory hallucinations, than what their brains might have to say.
As children we learn to talk by talking to ourselves. Unless marooned on an island, we tend to abandon this behavior in polite company for fear of stigmatization, among other things. If the line between normalcy and pathology for hearing voices, or even talking to them, (so long as they do not command undesirable physical actions), is drawn with a greater acceptance for normalcy, a clearer understanding of the inner voice might be sooner in hand.
Help at hand for schizophrenics
Researchers from the Bergen fMRI Group at the University of Bergen (UiB) are working on how to help schizophrenics, who hear voices. The way they do this is by studying people who also hear voices, but who do not suffer from a mental illness. For a five-year period, the group is studying the brain processes causing people to hear voices. A recent report published in Frontiers in Human Neuroscience shows some of the group’s startling results.
– We have found that the primary auditory cortex of healthy people who hear voices, responds less to outside stimulus than the corresponding area of the brain in people who don’t hear voices, says Post Doctor Kristiina Kompus.
Kompus, who works at UiB’s Department of Biological and Medical Psychology, is lead author of the just published study.
Variations in cognitive control
The primary auditory cortex is the region of the brain that processes sound. Kompus’ study shows that healthy people who hear voices share some attributes with schizophrenics, as the cortical region in both groups reacts less to outside stimulus.
However, there is an important difference between people who hear voices. Whilst those with schizophrenia have a reduced ability to regulate the primary auditory cortex using cognitive control, those who hear voices but are healthy are able to do so.
– Because of this cognitive control, healthy people who hear voices are able to direct their attention outwards. This sets them apart from schizophrenics, who have a tendency to direct their attention inwards due to their decreased ability to regulate their primary auditory cortex, says Kompus before adding.
– These discoveries have brought us one step close to understanding the hallucinations of schizophrenics and why the voices become a problem for some people but not for others.
Many healthy people hear voices
So what is the next step for Kompus and her fellow researchers?
– We will do further research on the brain structure of people with auditory hallucinations. In particular, we wish to look at the brain’s networks that process outside voices. This is to establish whether these voice hallucinations and the outside voices occur in the same parts of the brain. We also wish to establish if hearing voices is a genetical trait, she says.
According to the researchers, approximately five per cent of us hear voices in the head, even if otherwise healthy. This number is based on research from several countries and surveys. For their own research, Kompus and her team used local media in Bergen to call for people who hear voices. The results were overwhelming, with around 30 people getting in touch with the researchers to register for the study.
![Hallucinations of musical notation: new paper for neurology journal Brain by Oliver Sacks
Professor of neurology, physician, and author Oliver Sacks M.D. has outlined case studies of hallucinations of musical notation, and commented on the neural basis of such hallucinations, in a new paper for the neurology journal Brain.
In this paper, Dr Sacks is building on work done by Dominic ffytche et al in 2000, which delineates more than a dozen types of hallucinations, particularly in relation to people with Charles Bonnet syndrome (a condition that causes patients with visual loss to have complex visual hallucinations). While ffytche believes that hallucinations of musical notation are rarer than some other types of visual hallucination, Sacks says that his own experience is different.
“Perhaps because I have investigated various musical syndromes,” writes Dr Sacks, “and people often write to me about these… I have seen or corresponded with a dozen or more people whose hallucinations include – and sometimes consist exclusively of – musical notation.”
Sacks goes on to detail eight fascinating case studies of people who have reported experiencing hallucinations of musical notation, including:
A 77 year old woman with glaucoma who wrote of her “musical eyes”. She saw “music, lines, spaces, notes, clefs – in fact written music on everything [she] looked at.”
A surgeon and pianist suffering from macular degeneration, who saw unreadable and unplayable music on a white background.
A Sanskrit scholar who developed Parkinson’s disease in his 60s and later reported hallucinating ornately-written music, occurring with a Sanskrit script. “Despite the exotic nature of the script the result is still western music,” he said.
A woman who reported seeing musical notation on her ceiling upon waking in the morning.
A woman who said she wasn’t a musician, but would hallucinate when she had high fevers as a child. She said that the notes were “angry, and [she] felt unease. The lines and notes were out of control and at times in a ball.”
It is striking that, of Dr Sacks’ eight case studies, seven were gifted musicians. Sacks comments, “This is perhaps a coincidence, but it makes one wonder whether there is something about musical scores that is radically different from verbal texts.” Musical scores are far more visually complex than standard (English) text, with not just a variety of notes, but also many symbols that indicate how the notes should be played.
Dr Sacks also says that he has a mild form of Charles Bonnet syndrome himself, in which he sees a variety of simple forms whenever he gazes at a blank surface. “When I recently returned to playing the piano and to studying scores minutely, I began to ‘see’ showers of flat signs along with the letters and runes on blank surfaces.”
Another striking feature of these hallucinations is that – like text hallucinations – they are generally unreadable. They can seem playable at first, but on closer inspection it transpires that the music is often nonsensical or impossible to play, such as an example reported in one of the case studies: a melody line three or more octaves above middle C, and so may have half a dozen or more ledger lines above the treble staff.
Usually, the early visual system analyses forms and sends the information it has extracted to higher areas, where it gains coherence and meaning. Normally, in the act of perception, the entire visual system is engaged. Paradoxically, according to Sacks, “one may have to study disorders of the visual system to see how complex perceptual and cognitive processes are analysed and delegated to different levels… and hallucinations of musical notation can provide a very rich field of study here.”](http://40.media.tumblr.com/e182e1d470d6a8cb7c8e6c4b24793fa1/tumblr_mks07enw8j1rog5d1o1_500.jpg)
Hallucinations of musical notation: new paper for neurology journal Brain by Oliver Sacks
Professor of neurology, physician, and author Oliver Sacks M.D. has outlined case studies of hallucinations of musical notation, and commented on the neural basis of such hallucinations, in a new paper for the neurology journal Brain.
In this paper, Dr Sacks is building on work done by Dominic ffytche et al in 2000, which delineates more than a dozen types of hallucinations, particularly in relation to people with Charles Bonnet syndrome (a condition that causes patients with visual loss to have complex visual hallucinations). While ffytche believes that hallucinations of musical notation are rarer than some other types of visual hallucination, Sacks says that his own experience is different.
“Perhaps because I have investigated various musical syndromes,” writes Dr Sacks, “and people often write to me about these… I have seen or corresponded with a dozen or more people whose hallucinations include – and sometimes consist exclusively of – musical notation.”
Sacks goes on to detail eight fascinating case studies of people who have reported experiencing hallucinations of musical notation, including:
- A 77 year old woman with glaucoma who wrote of her “musical eyes”. She saw “music, lines, spaces, notes, clefs – in fact written music on everything [she] looked at.”
- A surgeon and pianist suffering from macular degeneration, who saw unreadable and unplayable music on a white background.
- A Sanskrit scholar who developed Parkinson’s disease in his 60s and later reported hallucinating ornately-written music, occurring with a Sanskrit script. “Despite the exotic nature of the script the result is still western music,” he said.
- A woman who reported seeing musical notation on her ceiling upon waking in the morning.
- A woman who said she wasn’t a musician, but would hallucinate when she had high fevers as a child. She said that the notes were “angry, and [she] felt unease. The lines and notes were out of control and at times in a ball.”
It is striking that, of Dr Sacks’ eight case studies, seven were gifted musicians. Sacks comments, “This is perhaps a coincidence, but it makes one wonder whether there is something about musical scores that is radically different from verbal texts.” Musical scores are far more visually complex than standard (English) text, with not just a variety of notes, but also many symbols that indicate how the notes should be played.
Dr Sacks also says that he has a mild form of Charles Bonnet syndrome himself, in which he sees a variety of simple forms whenever he gazes at a blank surface. “When I recently returned to playing the piano and to studying scores minutely, I began to ‘see’ showers of flat signs along with the letters and runes on blank surfaces.”
Another striking feature of these hallucinations is that – like text hallucinations – they are generally unreadable. They can seem playable at first, but on closer inspection it transpires that the music is often nonsensical or impossible to play, such as an example reported in one of the case studies: a melody line three or more octaves above middle C, and so may have half a dozen or more ledger lines above the treble staff.
Usually, the early visual system analyses forms and sends the information it has extracted to higher areas, where it gains coherence and meaning. Normally, in the act of perception, the entire visual system is engaged. Paradoxically, according to Sacks, “one may have to study disorders of the visual system to see how complex perceptual and cognitive processes are analysed and delegated to different levels… and hallucinations of musical notation can provide a very rich field of study here.”
Acting Out Dreams Linked to Development of Dementia
The strongest predictor of whether a man is developing dementia with Lewy bodies — the second most common form of dementia in the elderly — is whether he acts out his dreams while sleeping, Mayo Clinic researchers have discovered. Patients are five times more likely to have dementia with Lewy bodies if they experience a condition known as rapid eye movement (REM) sleep behavior disorder than if they have one of the risk factors now used to make a diagnosis, such as fluctuating cognition or hallucinations, the study found.
The findings were being presented at the annual meeting of the American Academy of Neurology in San Diego. REM sleep behavior disorder is caused by loss of the normal muscle paralysis that occurs during REM sleep. It can appear three decades or more before a diagnosis of dementia with Lewy bodies is made in males, the researchers say. The link between dementia with Lewy bodies and the sleep disorder is not as strong in women, they add.
"While it is, of course, true that not everyone who has this sleep disorder develops dementia with Lewy bodies, as many as 75 to 80 percent of men with dementia with Lewy bodies in our Mayo database did experience REM sleep behavior disorder. So it is a very powerful marker for the disease," says lead investigator Melissa Murray, Ph.D., a neuroscientist at Mayo Clinic in Florida.
The study’s findings could improve diagnosis of this dementia, which can lead to beneficial treatment, Dr. Murray says.
"Screening for the sleep disorder in a patient with dementia could help clinicians diagnose either dementia with Lewy bodies or Alzheimer’s disease," she says. "It can sometimes be very difficult to tell the difference between these two dementias, especially in the early stages, but we have found that only 2 to 3 percent of patients with Alzheimer’s disease have a history of this sleep disorder."
Once the diagnosis of dementia with Lewy bodies is made, patients can use drugs that can treat cognitive issues, Dr. Murray says. No cure is currently available.
Researchers at Mayo Clinic in Minnesota and Florida, led by Dr. Murray, examined magnetic resonance imaging, or MRI, scans of the brains of 75 patients diagnosed with probable dementia with Lewy bodies. A low-to-high likelihood of dementia was made upon an autopsy examination of the brain.
The researchers checked the patients’ histories to see if the sleep disorder had been diagnosed while under Mayo care. Using this data and the brain scans, they matched a definitive diagnosis of the sleep disorder with a definite diagnosis of dementia with Lewy bodies five times more often than they could match risk factors, such as loss of brain volume, now used to aid in the diagnosis. The researchers also showed that low-probability dementia with Lewy bodies patients who did not have the sleep disorder had findings characteristic of Alzheimer’s disease.
"When there is greater certainty in the diagnosis, we can treat patients accordingly. Dementia with Lewy bodies patients who lack Alzheimer’s-like atrophy on an MRI scan are more likely to respond to therapy — certain classes of drugs — than those who have some Alzheimer’s pathology," Dr. Murray says.
(Source: mayoclinic.org)
Scary Faces Terrify Woman with Unusual Condition
When the 67-year-old woman came to the hospital, she was deeply afraid of two things — the visions of odd-looking faces that appeared hovering before her, and that the hallucinations might mean she was losing her mind.
But this retired teacher wasn’t going crazy, and laboratory tests also ruled out two common culprits of hallucinations — infection and drug interactions.
"She was absolutely terrified by what she was seeing," said Dr. Bharat Kumar, an internal medicine resident at the University of Kentucky who treated the woman. In fact, the patient and her family were so concerned in the days before she came to the hospital, they asked a priest about performing an exorcism, Kumar said.
The woman drew a picture of what she saw. The faces had large teeth, eyes and ears, and a horizontally elongated shape, like a football.
That peculiar shape and the fact that the patient recognized that she was hallucinating (rather than believing the visions to be real) provided two important clues in making a diagnosis, Kumar said. He determined that the woman had condition called Charles Bonnet syndrome.
Patients with the syndrome may see small people and animals, bright moving shapes or distorted faces. These hallucinations are purely visual; no sounds accompany them.
In the woman’s case, the condition developed because she had macular degeneration. Tissue within the retinas of her eyes was deteriorating, and her ability to see was declining.
Charles Bonnet syndrome results from the absence of such sensory input to the brain. “When it expects sensory input and receives nothing, it often creates its own input,” Kumar explained.
The brain isn’t a sophisticated computer that processes information objectively and efficiently, he said. “It’s more of a wibbly-wobbly, messy-guessy ball of goo.”
There is no treatment for the condition, but in many cases the hallucinations stop happening as the brain becomes used to vision loss. Patients who are very frightened might be given anti-psychotic medications, but these drugs have serious side effects and aren’t appropriate for everyone.
The woman was grateful to receive her diagnosis and learn that she was not losing her mind, Kumar said. When he followed up with her three months later, she was still having the hallucinations, but they were happening less often.
A 2010 study showed that 10 to 40 percent of elderly patients with visual impairments may have Charles Bonnet syndrome.
Kumar had never before seen a patient with the condition, although he noted that it may occur more commonly than it is diagnosed. “Patients are often hesitant to say that they see things because they are afraid that they will be called crazy,” he said.
The case report was published online Feb. 25 in the journal Age and Aging.
![Hallucinations with Oliver Sacks, November 9, 8 P.M. EST [Live]
The renown neurologist talks about how the brain creates hallucinations — watch this hour-long discussion live and send questions to him via Twitter (using the hashtag #AskOliver to @WorldSciFest).
The conversation, at Cooper Union in New York City, will canvass the rich cultural history and contemporary science of the hallucinatory experience and will also touch on Sacks’ own early psychedelic forays that helped convince him to dedicate his life to neurology and to write about the myriad riddles of the human mind.
Can’t wait? Listen to the Nature podcast interview with Sacks by Kerri Smith, Nature’s podcast editor. Sacks recounts some interesting drug-induced trips, including one in which he has a philosophical discussion with a spider.](http://40.media.tumblr.com/tumblr_md8lgm6Gsm1rog5d1o1_500.jpg)
Hallucinations with Oliver Sacks, November 9, 8 P.M. EST [Live]
The renown neurologist talks about how the brain creates hallucinations — watch this hour-long discussion live and send questions to him via Twitter (using the hashtag #AskOliver to @WorldSciFest).
The conversation, at Cooper Union in New York City, will canvass the rich cultural history and contemporary science of the hallucinatory experience and will also touch on Sacks’ own early psychedelic forays that helped convince him to dedicate his life to neurology and to write about the myriad riddles of the human mind.
Can’t wait? Listen to the Nature podcast interview with Sacks by Kerri Smith, Nature’s podcast editor. Sacks recounts some interesting drug-induced trips, including one in which he has a philosophical discussion with a spider.
(Source: scientificamerican.com)
Seeing Things? Hearing Things? Many of Us Do
are very startling and frightening: you suddenly see, or hear or smell something — something that is not there. Your immediate, bewildered feeling is, what is going on? Where is this coming from? The hallucination is convincingly real, produced by the same neural pathways as actual perception, and yet no one else seems to see it. And then you are forced to the conclusion that something — something unprecedented — is happening in your own brain or mind. Are you going insane, getting , having a ?
In other cultures, hallucinations have been regarded as gifts from the gods or the Muses, but in modern times they seem to carry an ominous significance in the public (and also the medical) mind, as portents of severe mental or neurological disorders. Having hallucinations is a fearful secret for many people — millions of people — never to be mentioned, hardly to be acknowledged to oneself, and yet far from uncommon. The vast majority are benign — and, indeed, in many circumstances, perfectly normal. Most of us have experienced them from time to time, during a or with the sensory monotony of a desert or empty road, or sometimes, seemingly, out of the blue.
Many of us, as we lie in bed with closed eyes, awaiting sleep, have so-called hypnagogic hallucinations — geometric patterns, or faces, sometimes landscapes. Such patterns or scenes may be almost too faint to notice, or they may be very elaborate, brilliantly colored and rapidly changing — people used to compare them to slide shows.
Schizophrenia
Credit: JOHN BAVOSI/SCIENCE PHOTO LIBRARY
Caption: Schizophrenia. Artwork of a man hearing non- existent women’s voices. Auditory hallucinations are one of the most common symptoms of schizophrenia. One explanation for this disease is known as the dopamine hypothesis. Dopamine (the molecules at lower left & right) is a type of neurotransmitter. This chemical (tiny red spheres) is released from the ends (synapses) of nerve cells (neurons, upper left & right) when they pass on nerve impulses to other neurons. In schizophr- enia, however, the dopamine-producing neurons of the brain are overactive. This causes the sufferer to lose contact with reality, suffering from confused thoughts and emotional responses.