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Koliko su česte vizualne halucinacije u shizofrenika?

Koliko su česte vizualne halucinacije u shizofrenika?


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Tipičan "holivudski" prikaz shizofrenije uključuje žive vizualne halucinacije.

Međutim, u praksi je desetak ljudi s dijagnozom shizofrenije s kojima sam radio imalo samo slušne halucinacije. Ne mogu reći jesu li vizualne halucinacije vrlo rijetke, ili moj odabir nije dovoljno velik.

Postoje li statistički podaci koji pokazuju koji postotak pacijenata s dijagnozom shizofrenije ima vizualne halucinacije, u usporedbi sa slušnim halucinacijama, ili čak uopće nema halucinacija?


Mueser i kolege (1990.) ispitali su 117 DSM-III-R bolesnici sa shizofrenim ili shizoafektivnim poremećajem i izvijestili su o prevalenciji od 16% za vizualne halucinacije. Zanimljivo je da su otkrili da je globalna težina bolesti veća u bolesnika sa shizofrenijom i vizualnim halucinacijama. Teeple i kolege (2009.) primjećuju da ovaj nalaz ima smisla široko varirajućih procjena prevalencije vizualnih halucinacija u shizofrenih pacijenata, budući da se moglo očekivati ​​da će pacijenti s težom bolešću doživjeti više vizualnih halucinacija od onih s lakšom bolešću.


36.2: Fenomenologija shizofrenije i srodnih psihotičnih poremećaja

Većina vas je vjerojatno imala iskustvo hodati ulicom u gradu i vidjeti osobu za koju ste mislili da se čudno ponaša. Možda su bili odjeveni na neobičan način, možda raščupani ili nosili neobičnu kolekciju odjeće, šminke ili nakita za koje se činilo da ne odgovaraju nekoj određenoj skupini ili subkulturi. Možda su razgovarali sami sa sobom ili su vikali na nekoga koga niste mogli vidjeti. Ako ste pokušali razgovarati s njima, možda ih je bilo teško pratiti ili razumjeti, ili su se ponašali paranoično ili počeli pričati bizarnu priču o ljudima koji su kovali spletku protiv njih. Ako je tako, velika je vjerojatnost da ste naišli na osobu sa shizofrenijom ili drugom vrstom psihotičnog poremećaja. Ako ste gledali film Prekrasan um ili Kralj Ribar, također ste vidjeli prikaz nekoga za koga se mislilo da ima shizofreniju. Nažalost, neki od pojedinaca koji su počinili neka od nedavno objavljenih masovnih ubojstava možda su imali shizofreniju, iako većina ljudi koji počine takve zločine nemaju shizofreniju. Također je vjerojatno da ste upoznali ljude sa shizofrenijom, a da to niste ni znali, jer oni mogu patiti u tišini ili ostati izolirani kako bi se zaštitili od strahota koje vide, čuju ili vjeruju da djeluju u vanjskom svijetu. Kako ovi primjeri počinju ilustrirati, psihotični poremećaji uključuju mnoge različite vrste simptoma, uključujući zablude, halucinacije, neorganiziran govor i ponašanje, abnormalno motoričko ponašanje (uključujući katatoniju) i negativne simptome poput anhedonije ili amotivacije i otupljenog afekta/smanjenog govora.

Zablude su lažna uvjerenja koja su često fiksirana, teško ih je promijeniti čak i kada se osobi predoče oprečne informacije, a često su i kulturno utjecana na njihov sadržaj (npr. zablude u koje je uključen Isus u judeo-kršćanskim kulturama, zablude u koje je uključen Allah u muslimanskim kulturama). Oni mogu biti zastrašujući za osobu koja može ostati uvjerena da je istinita čak i kad im voljeni i prijatelji iznesu jasne informacije da ne mogu biti istinite. Postoji mnogo različitih vrsta ili tema zabluda.

Najčešće zablude su progoniteljske i uključuju uvjerenje da pojedinci ili skupine na neki način pokušavaju nauditi ili zavjeriti osobu. To mogu biti ljudi koje ta osoba poznaje (ljudi na poslu, susjedi, članovi obitelji) ili apstraktnije skupine (FBI, CIA, stranci itd.). Druge vrste zabluda uključuju grandiozne zablude, gdje osoba vjeruje da ima neku posebnu moć ili sposobnost (npr. Ja sam novi Buddha, ja sam rock zvijezda) referentne zablude, gdje osoba vjeruje da događaji ili objekti u okruženju imaju posebne značenje za njih (npr. pušta se ta pjesma na radiju posebno za mene) ili druge vrste zabluda u kojima osoba može vjerovati da drugi kontroliraju njihove misli i postupke, da se njihove misli emitiraju naglas ili da im drugi mogu čitati misli (ili mogu čitati misli drugih ljudi & rsquos).

Slika ( PageIndex <1> ): Pod nadzorom: Apstraktne skupine poput policije ili vlade obično su u središtu zabluda progona kod osoba sa shizofrenijom. [& ldquoW beauty & rdquo Thomas Hawk/Flickr licenciran je prema CC BY-NC 2.0.]

Kad vidite osobu na ulici kako razgovara sama sa sobom ili viče na druge ljude, doživljava ih halucinacije. To su perceptivna iskustva koja se događaju čak i kada u vanjskom svijetu nema poticaja koji generira iskustva. Mogu biti slušni, vizualni, mirisni (miris), okusni (okus) ili somatski (dodir). Najčešće halucinacije u psihozi (barem u odraslih) su slušne i mogu uključivati ​​jedan ili više glasova koji govore o osobi, komentiraju njezino ponašanje i daju im naredbe. Sadržaj halucinacija često je negativan (& ldquoyou are the gubitnik, & rdquo & ldquothat je crtež glup, & rdquo & ldquoyou should otići ubiti se & rdquo) i može biti glas nekoga koga osoba poznaje ili potpunog stranca. Ponekad glasovi zvuče kao da dolaze izvan glave osobe. Ponekad se čini da glasovi dolaze iz glave osobe, ali se ne doživljavaju isto kao unutarnje misli osobe ili unutarnji govor.

Slika ( PageIndex <2> ): Ljudi koji pate od shizofrenije mogu svijet vidjeti drugačije. To može uključivati ​​halucinacije, zablude i neorganizirano razmišljanje. [Slika bez naslova tvrtke Noba Project licencirana je prema CC BY-NC-SA 4.0.]

Razgovor s nekim sa shizofrenijom ponekad je težak, jer je možda teško pratiti njegov govor, bilo zato što njihovi odgovori ne proizlaze jasno iz vaših pitanja, bilo zato što jedna rečenica logično ne slijedi iz druge. Ovo se naziva kao neorganiziran govor, a može biti prisutna čak i dok osoba piše. Dezorganizirano ponašanje mogu uključivati ​​neobičnu haljinu, čudnu šminku (npr. ruž s ocrtavanjem usta za 1 inč) ili neobične rituale (npr. ponavljajuće geste rukama). Nenormalno ponašanje motora može uključivati katatonija, koji se odnosi na različita ponašanja koja kao da odražavaju smanjenje reakcije na vanjsko okruženje. To može uključivati ​​dugotrajno držanje neobičnih položaja, propuštanje odgovora na verbalne ili motorne upite druge osobe ili pretjeranu i naizgled besmislenu motoričku aktivnost.

Druge je neke od najsnažnijih simptoma shizofrenije teško uočiti. To uključuje ono što ljudi nazivaju & ldquonegativnim simptomima & rdquo ili odsutnost određenih stvari za koje obično očekujemo da ih ima. Na primjer, anhedonija i amotivacija odražavaju nedostatak očitog interesa ili želje za uključivanjem u društvene ili rekreacijske aktivnosti. Ti se simptomi mogu manifestirati kao velika količina vremena provedenog u fizičkoj nepokretnosti. Ono što je važno, čini se da anhedonija i amotivacija ne odražavaju nedostatak uživanja u ugodnim aktivnostima ili događajima (Cohen & amp Minor, 2010 Kring & amp Moran, 2008 Llerena i sur., 2012), već prije smanjeni nagon ili sposobnost poduzimanja koraka potrebnih za ostvariti potencijalno pozitivne ishode (Barch & amp Dowd, 2010). Ravan utjecaj i smanjeni govor (alogia) odražavaju nedostatak pokazivanja emocija izrazom lica, gestama i intonacijom govora, kao i smanjenu količinu govora te povećanu učestalost i trajanje pauze.

Na mnogo načina najteže nam je razumjeti vrste simptoma povezanih s psihozom jer se mogu činiti daleko izvan raspona naših normalnih iskustava. Za razliku od depresije ili tjeskobe, mnogi od nas možda nisu imali iskustva za koja mislimo da su u istom kontinuumu kao i psihoza. Međutim, baš kao i mnogi drugi oblici psihopatologija opisane u ovoj knjizi, vrste psihotičnih simptoma koji karakteriziraju poremećaje poput shizofrenije u kontinuitetu su s & ldquonormalnim & rdquo mentalnim iskustvima. Na primjer, rad Jima van Osa u Nizozemskoj pokazao je da iznenađujuće velik postotak opće populacije (10%+) ima simptome slične psihotičnim, iako mnogo manji broj ima višestruka iskustva i većina ih neće nastaviti osjećati u dugoročno (Verdoux & amp van Os, 2002). Slično, rad u općoj populaciji adolescenata i mladih odraslih osoba u Keniji također je pokazao da relativno visok postotak pojedinaca doživljava jedno ili više psihotičnih iskustava (

19%) u nekom trenutku svog života (Mamah i sur., 2012. Ndetei i sur., 2012.), iako opet većina neće nastaviti razvijati potpuni psihotični poremećaj.

Shizofrenija je primarni poremećaj koji nam pada na pamet kada govorimo o & ldquopsychotic & rdquo poremećajima (vidi tablicu ( PageIndex <1> ) za dijagnostički kriteriji), iako postoji niz drugih poremećaja koji dijele jednu ili više značajki sa shizofrenijom. U nastavku ovog modula koristit ćemo pojmove & ldquopsychosis & rdquo i & ldquoschizphrenia & rdquo pomalo međusobno, s obzirom na to da se većina istraživanja fokusirala na shizofreniju. Osim shizofrenije (vidi tablicu ( PageIndex <1> )), drugi psihotični poremećaji uključuju shizofreniformni poremećaj (kraća verzija shizofrenije), shizoafektivni poremećaj (mješavina psihoze i simptoma depresije/manije), zabludni poremećaj (iskustvo samo zabluda) i kratki psihotični poremećaj (psihotični simptomi koji traju samo nekoliko dana ili tjedana).

Shizofrenija (prevalencija tijekom života oko 0,3% do 0,7%)

  • Dva ili više od sljedećih najmanje 1 mjesec: halucinacije, zablude, neorganiziran govor, izrazito neorganizirano ili katatonično ponašanje, negativni simptomi.
  • Oštećenje u jednom ili više područja funkcije (socijalna, profesionalna, obrazovna samo-skrb) tijekom značajnog vremenskog razdoblja od početka bolesti.
  • Kontinuirani znakovi bolesti tijekom najmanje 6 mjeseci (to može uključivati ​​prodromalne ili rezidualne simptome, koji su oslabljeni oblici gore opisanih simptoma).

Shizofreniformni poremećaj (prevalencija tijekom života slična shizofreniji)

  • Isti simptomi shizofrenije opisani gore koji su prisutni najmanje 1 mjesec, ali manje od 6 mjeseci.

Shizoafektivni poremećaj (prevalencija tijekom života iznad 0,3%)

  • Razdoblje bolesti u kojem osoba ima i psihotične simptome potrebne za zadovoljavanje kriterija za shizofreniju te veliku depresiju ili maničnu epizodu.
  • Osoba doživljava zablude ili halucinacije najmanje 2 tjedna ako nema depresivnu ili maničnu epizodu.
  • Simptomi koji zadovoljavaju kriterije za depresivne ili manične epizode prisutni su više od polovice trajanja bolesti.

Delusionalni poremećaj (prevalencija tijekom života oko 0,2%)

  • Prisutnost barem jedne zablude tijekom najmanje mjesec dana.
  • Osoba nikada nije ispunila kriterije za shizofreniju.
  • Funkcija osobe & rsquos nije narušena izvan specifičnog utjecaja zablude.
  • Trajanje svih depresivnih ili maničnih epizoda bilo je kratko u odnosu na trajanje zablude.

Kratki psihotični poremećaj (učestalost tijekom života nije jasna)

  • Jedan ili više sljedećih simptoma prisutni su najmanje 1 dan, ali manje od 1 mjeseca: zablude, halucinacije, neorganiziran govor, izrazito poremećeno ili katatonično ponašanje.

Umanjeni psihotični poremećaj (u odjeljku III DSM-5, učestalost tijekom života nejasna)


Studije sugeriraju da su halucinacije daleko češće nego što se vjerovalo

Novo istraživanje otkrilo je da su halucinacije daleko češće među općom populacijom nego što većina ljudi shvaća - i nisu ograničene na poremećaje koji su obično povezani s psihozom, poput shizofrenije ili graničnog poremećaja osobnosti.

Istraživanje koje je obuhvatilo više od 7400 ljudi u Velikoj Britaniji pokazalo je da je 4,3 posto sudionika u prošloj godini doživjelo vizualne ili slušne halucinacije - to je uključivalo ljude sa i bez problema s mentalnim zdravljem, te je pokazalo da taj fenomen nije ograničen samo na one s psihozom.

"U psihijatriji postoji opća ideja da su halucinacije obilježje psihoze", rekao je vodeći istraživač Ian Kelleher s Kraljevskog koledža kirurga u Irskoj za Léu Surugue u časopisu International Business Times.

"No, kada smo pogledali čitav niz bolesti mentalnog zdravlja, otkrili smo da su halucinacije simptomi koji se javljaju u širokom rasponu poremećaja mentalnog zdravlja, poput depresije ili tjeskobe."

Općenito, kada govorimo o pitanjima mentalnog zdravlja, postoji razlika između psihotičnih poremećaja, poput graničnog poremećaja ličnosti i shizofrenije, i ne-psihotičnih poremećaja, uključujući depresiju i anksioznost.

Za ovu su studiju istraživači koristili granični poremećaj ličnosti kao primjer psihotičnog poremećaja.

Mnogo je nepotrebne stigme koja okružuje sva ta stanja, ali posebno se osobe s psihotičnim poremećajima obično smatraju jedinstvenima jer vide i čuju stvari kojih nema.

No, nova studija sugerira da ta podjela možda i ne postoji.

Tim je pogledao podatke iz istraživanja o psihijatrijskom morbiditetu za odrasle 2007., koje je uključivalo ankete u razdoblju od godinu dana o mentalnom zdravlju 7.403 osobe u Engleskoj starije od 16 godina.

Kao što ste očekivali, mnogim od ovih sudionika dijagnosticirano je stanje mentalnog zdravlja - u Engleskoj se procjenjuje da svaki šesti čovjek pati od problema s mentalnim zdravljem u bilo kojem tjednu.

No, tim je želio suziti jesu li halucinacije bilo češće među ljudima s psihotičnim poremećajima u odnosu na one s ne-psihotičnim.

Kako bi to učinili, istraživači su pogledali koliko je ljudi s graničnim poremećajem osobnosti (koje je povezano s psihozom) prijavilo da su vidjeli ili čuli stvari koje drugi ljudi nisu mogli u prošloj godini, u usporedbi s brojem sudionika s ne-psihotičnom depresijom ili anksioznost.

Rezultati su pokazali da halucinacije nisu bile značajnije zastupljene kod osoba s graničnim poremećajem osobnosti (13,7 posto) od onih s ne-psihotičnim mentalnim poremećajem (12,6 posto).

I ne samo to, već više od 4 posto svi ispitanici su izvijestili da su čuli ili vidjeli stvari koje drugi nisu mogli - uključujući i one kojima nikada nisu dijagnosticirani problemi s mentalnim zdravljem.

Na temelju rezultata, tim sugerira da halucinacije nisu isključivo simptomi psihoze i da ih ne treba stigmatizirati.

"Halucinacije su češće nego što ljudi shvaćaju. Mogu biti zastrašujuća iskustva, a malo ljudi otvoreno priča o tome", rekla je Kelleher za Surugue.

"Naše je istraživanje vrijedno jer im može pokazati da nisu sami i da posjedovanje ovih simptoma nije nužno povezano s poremećajem mentalnog zdravlja. To ruši tabu."

No ovo je samo jedno istraživanje i ono ima svoja ograničenja - za početak, tim se oslanjao na sudionike da se sami prijave jesu li doživjeli halucinacije ili ne, što nije najpreciznija tehnika.

Iako se radilo o pristojnoj veličini uzorka, istraživači su promatrali samo ljude u Engleskoj, što nije dovoljno raznolika demografija da bi se mogli izvući dalekosežni zaključci o halucinacijama općenito.

No, ovi nalazi podudaraju se s rezultatima mnogo veće studije objavljene 2015., koja se bavila podacima o više od 31.000 ljudi iz 19 zemalja.

Slično ovim najnovijim rezultatima, taj je rad otkrio da je oko 5 posto opće populacije izvijestilo o halucinacijama, bez obzira na to jesu li im dijagnosticirane mentalne bolesti ili ne.

"Nekada smo mislili da samo ljudi s psihozom čuju glasove ili su imali zablude, ali sada znamo da inače zdravi ljudi s visokom funkcionalnošću također prijavljuju ta iskustva", rekao je vodeći istraživač John McGrath s Instituta za mozak Queensland u Australiji, kada je studija je izašla.

Kako se istraživanje halucinacija nastavlja, postaje očito da su mnogi simptomi koje smo nekad povezivali s poremećajima mentalnog zdravlja zapravo češći nego što smo nekad mislili.

Zapravo, zasebna studija koja je objavljena prošlog tjedna pokazala je da su ljudi koji prolaze kroz život bez ikakvih problema s mentalnim zdravljem neobičniji od onih koji to rade.

Daljnjim istraživanjem tko ima, a tko ne doživljava vizualne ili slušne halucinacije i kako se one pojavljuju, znanstvenici će, nadamo se, steći bolju predodžbu o tome tko je u opasnosti od razvoja ozbiljnih stanja mentalnog zdravlja u budućnosti.


Analiza slušnih halucinacija

Na pitanje o emocionalnom tonu glasova, većina ih je izjavila da je ljut (48,32%), dok ih je 21,96% izjavilo da su pogrdne i uvredljive prirode.

Oko 8,01% izvijestilo je da su halucinacije ugodne i umirujuće (hvale o njima ili neki ugodni razgovori koje su imali), dok je 3,1% ispitanika prijavilo glazbene halucinacije koje su ih prilično opuštale.

91,47% izvijestilo je o percepciji slušnih halucinacija u oba uha, dok je 94,57% izvijestilo

prisutnost halucinacija i danju i noću.


Koliko su česte vizualne halucinacije?

Većina knjiga i članaka novinarskog tipa reći će da su čuvene halucinacije daleko češće od vizualnih. Oni će dati različite (niske) postotke koliko ljudi sa shizofrenijom ima vizualne halucinacije.

No, kad čitate o shizofreniji u djetinjstvu, obično ćete pročitati stvari koje govore da se vizualne halucinacije mnogo češće javljaju kod djece sa shizofrenijom, zapravo u većini njih.

Progutao sam to dugo, dugo. No, nakon desetljeća prijateljstva s osobama sa shizofrenijom, mislim da vizualne halucinacije nisu česte kod odraslih osoba sa shizofrenijom. Jednostavno ne mislim da odrasli uvijek žele reći svojim liječnicima o vizualnim halucinacijama. Pretpostavljam da je oko polovice ljudi sa shizofrenijom kod odraslih imalo barem jednu vizualnu halucinaciju.

Re: Koliko su česte vizualne halucinacije?

po adq23 & raquo ned 22. prosinca 2013. 13:44

smithywise je napisao: Većina knjiga i članaka novinarskog tipa reći će da su čuvene halucinacije daleko češće od vizualnih. Oni će dati različite (niske) postotke koliko ljudi sa shizofrenijom ima vizualne halucinacije.

No, kad čitate o shizofreniji u djetinjstvu, obično ćete pročitati stvari koje govore da vizualne halucinacije mnogo češće prijavljuju djeca sa shizofrenijom, zapravo u većini njih.

Progutao sam to dugo, dugo. No, nakon desetljeća prijateljstva s osobama sa shizofrenijom, mislim da vizualne halucinacije nisu česte kod odraslih osoba sa shizofrenijom. Jednostavno ne mislim da odrasli uvijek žele reći svojim liječnicima o vizualnim halucinacijama. Pretpostavljam da je oko polovice ljudi sa shizofrenijom kod odraslih imalo barem jednu vizualnu halucinaciju.

Re: Koliko su česte vizualne halucinacije?

po kovački & raquo ned 22. prosinca 2013. 14:39

smithywise je napisao: Većina knjiga i članaka novinarskog tipa reći će da su čuvene halucinacije daleko češće od vizualnih. Oni će dati različite (niske) postotke koliko ljudi sa shizofrenijom ima vizualne halucinacije.

No, kad čitate o shizofreniji u djetinjstvu, obično ćete pročitati stvari koje govore da se vizualne halucinacije mnogo češće javljaju kod djece sa shizofrenijom, zapravo u većini njih.

Progutao sam to dugo, dugo. No, nakon desetljeća prijateljstva s osobama sa shizofrenijom, mislim da vizualne halucinacije nisu česte kod odraslih osoba sa shizofrenijom. Jednostavno ne mislim da odrasli uvijek žele reći svojim liječnicima o vizualnim halucinacijama. Pretpostavljam da je oko polovice ljudi sa shizofrenijom kod odraslih imalo barem jednu vizualnu halucinaciju.

Pa, da ti kažem nešto o & quotLijep um & quot, lol. John Nash nikada nije imao nikakve vizualne halucinacije po cijelom tijelu. To je sve izmišljeno za film, kako bi film izgledao - sav Hollywood.

Nikada nije imao vizualne halucinacije, samo je čuo glasove. Njegov 50 -godišnji sin ima vizualne halucinacije, iako nije precizirao kako izgledaju.

Nadahnuli ste me pa sam potražio neko istraživanje o halucinacijama. Studije su pokazale da je 35-75% odraslih shizofrenika imalo barem neke vizualne halucinacije. Tako su neke studije pronašle 75%, neke 35%, a druge su dobile brojke između njih. Mislim da to ovisi o tome kako se studija izvodi i koju skupinu zapošljavaju za studij. Mislim da ovisi i o tome koliko se osoba sa shizofrenijom osjeća ugodno raspravljati o svim svojim simptomima.

Čak i dnevne svjetlosne halucinacije po cijelom tijelu nisu uvijek potpuno oblikovane u svim detaljima. Ponekad više podsjeća na osobu ili neku vrstu figure. Ponekad izgledaju nekako sparno, fluidno ili različito.

Mislim da je većina ljudi sa shizofrenijom koja ima vizualne halucinacije, halucinacije su fragmenti stvari, a ne halucinacije po dnevnom svjetlu po cijelom tijelu, kao u "Lijepom umu", iako se to ponekad događa.

Općenito, isprva uključuju primjer kontrasta, neobično jako svjetlo oko objekata koji izgledaju kao da se namjerno naglašavaju, primjer je.

Mislim da je ovo što opisuješ tipičnije. Mogu preći u druge vrste, na što je važno pripaziti. Najvažnije je kako se osjećate i kako ometaju stvari. Nisu svi nužno zastrašujući ili loši. Ponekad su vrlo upijajuće, čak i zavodljivo fascinantne.

Brat mog prijatelja imao je ono što je nazvao 'vrtlozi'. Bili su poput vrtljivih kugli jakog bijelog svjetla. Doista su mu smetali, a došli su zajedno s MNOGO straha i tjeskobe. Mogu se pojaviti na dnevnom svjetlu.

Simptome je počeo imati u dobi od 4 godine i nije opisao nikakve promjene u svojim halucinacijama, ali to je neobično. Općenito, s vremenom se mijenjaju. Oni su blagi kad se vaša bolest počne pokazivati ​​i mogu ostati blagi neko vrijeme. Tijekom onoga što ljudi nazivaju 'psihotičnom epizodom', halucinacije su obično intenzivnije. Neki ljudi imaju male ili nikakve halucinacije, između epizoda.

Moj ukućanin imao je dnevne halucinacije po cijelom tijelu, nije mislio stalno, većinom, čuo je glasove. Vizualni nisu bili lijepi. Izgledali su poput krvavih lica, lebdjeli su u zraku. Puno njih. Također bi vidio stvari na rubovima - poput ruba između zida i stropa, na primjer. I oni su bili na dnevnom svjetlu.

Drugi prijatelj je opisao lica kada ih je pogledao, kapljući dolje, mijenjajući se, dobivajući sve. bruto. Drhtao bi pričajući o njima. Svi su uvijek govorili: 'Hajde čovječe, pogledaj mi lice dok ti pričam!' A on bi bio kao 'hm, hvala, ali mislim da ne'.

Još jedan moj prijatelj ima nešto što izgleda kao crvena linija preko njegovog vidnog polja. Povezuje to s time da je na granici stresa i osjeća kao da će izgubiti samokontrolu. Imao je i mnogo audio halucinacija. Zvučali su poput sitnih eksplozija ili loma stakla, izdaleka, ili glasova.

Također su mi ljudi opisivali halucinacije pri slabom osvjetljenju. To su stvari koje se kreću u uvjetima slabijeg osvjetljenja, na primjer kada se osoba nalazi u svojoj sobi noću, u mraku ili gotovo mraku.

Posebno iznenađujuća vizualna halucinacija je dubinska halucinacija. U ovim slučajevima može vam se činiti da će vam se pojaviti neka figura. Sa slike, postera ili od grupe ljudi koja stoji dalje od vas. Čini se da se može povećati i približiti. Mnogi to vide kao prijetnju.

Glavna ili vrhunska kategorija je, bilo da su na dnevnom svjetlu ili pri slabom svjetlu. Koliko mogu zaključiti, halucinacije pri slabom osvjetljenju uobičajeni su tip ove dvije vrste, ali ne mnogo.


OKVIR 1 Neučinkovite tehnike ometanja: ugušivanje glasova

Pacijenti često pokušavaju prevladati kritičke i uvredljive glasove pomoću disfunkcionalnih (ili beskorisnih) tehnika ometanja. Na primjer, pokušavaju ugušiti glasove slušajući ponavljajući zvuk u slušalicama. Ovdje postoje tri faktora koji podupiru glasovni sluh:

zvuk nije osobno smislen

sadržaj je više bijele buke nego strukturiran

nošenje slušalica smanjuje društveni kontakt i smanjuje vjerojatnost aktiviranja učinkovitijeg suočavanja.


Vizualne halucinacije u psihozama imaju fizička svojstva slična stvarnoj percepciji. Često su prirodne veličine, detaljni i čvrsti, a projicirani su u vanjski svijet. Obično se pojavljuju usidreni u vanjskom prostoru, izvan dosega pojedinaca ili dalje. Mogu imati trodimenzionalne oblike, s dubinom i sjenama, te s različitim rubovima. Mogu biti šarene ili crno -bijele, a mogu biti statične ili se kretati. [2] [3] [4] [5] [6] [7] [8]

Jednostavno vs složeno Uređivanje

Vizualne halucinacije mogu biti jednostavne, ili neoblikovane vizualne halucinacije, ili složene, ili formirane vizualne halucinacije.

Jednostavne vizualne halucinacije također se nazivaju neoformljene ili elementarne vizualne halucinacije. Mogu biti u obliku raznobojnih svjetala, boja, geometrijskih oblika, nediskretnih objekata. Jednostavne vizualne halucinacije bez strukture poznate su kao fosfeni, a one s geometrijskom strukturom kao fotopsije. [9] [10] [11] Ove halucinacije uzrokovane su iritacijom primarnog vidnog korteksa (Brodmannovo područje 17). [12]

Složene vizualne halucinacije također se nazivaju formirane vizualne halucinacije. Obično su jasne, realistične slike ili prizori, poput lica životinja ili ljudi. Ponekad su halucinacije "liliputanske", tj. Pacijenti doživljavaju vizualne halucinacije tamo gdje postoje minijaturni ljudi, često poduzimajući neobične radnje. Liliputanske halucinacije mogu biti popraćene čudom, a ne terorom. [13] [14]

Uređivanje sadržaja

Učestalost halucinacija jako varira od rijetkih do učestalih, kao i trajanje (od sekundi do minuta). Sadržaj halucinacija također varira. Složene (formirane) vizualne halucinacije češće su od jednostavnih (neoblikovane) vizualne halucinacije. [5] [7] Za razliku od halucinacija koje se javljaju u organskim uvjetima, halucinacije doživljene kao simptomi psihoze su više zastrašujuće. Primjer za to bile bi halucinacije koje prikazuju bube, pse, zmije, iskrivljena lica. Vizualne halucinacije mogu biti prisutne i kod osoba s Parkinsonovom bolešću, gdje mogu biti prisutne vizije mrtvih pojedinaca. U psihozama je to relativno rijetko, iako su uobičajene vizije Boga, anđela, đavla, svetaca i vila. [6] [7] Pojedinci često prijavljuju da su iznenađeni kada se jave halucinacije i općenito su bespomoćni promijeniti ih ili zaustaviti. [4] Općenito, pojedinci vjeruju da vizije doživljavaju samo oni sami. [4] [5]

Dva neurotransmitera posebno su važna u vizualnim halucinacijama - serotonin i acetilkolin. Koncentrirani su u vidnim jezgrama talamija i vidnom korteksu. [13]

Sličnost vizualnih halucinacija koje proizlaze iz različitih stanja ukazuju na zajednički put vizualnih halucinacija. Smatra se da to objašnjavaju tri patofiziološka mehanizma.

Prvi mehanizam odnosi se na kortikalne centre odgovorne za vizualnu obradu. Iritacija korteksa vizualne asocijacije (Brodmannova područja 18 i 19) uzrokuje složene vizualne halucinacije. [12] [15]

Drugi mehanizam je deaferencijacija, prekid ili uništavanje aferentnih veza živčanih stanica, vizualnog sustava, uzrokovanih lezijama, što dovodi do uklanjanja normalnih inhibitornih procesa na kortikalnom ulazu u područja vizualne asocijacije, što dovodi do složenih halucinacija kao oslobađanja fenomen. [14] [15]

Treći mehanizam odnosi se na sustav za aktiviranje mreže, koji igra ulogu u održavanju uzbuđenja. Lezije u moždanom deblu mogu uzrokovati vizualne halucinacije. Vizualne halucinacije česte su kod osoba s određenim poremećajima spavanja, a češće se javljaju kada su pospane. To sugerira da retikularni aktivirajući sustav igra ulogu u vizualnim halucinacijama, iako precizan mehanizam još uvijek nije u potpunosti uspostavljen. [13] [15]

Halucinacije u osoba s psihozom često se doživljavaju u boji, a najčešće su multimodalne, a sastoje se od vizualnih i slušnih komponenti. Često prate paranoju ili druge poremećaje mišljenja, a obično se javljaju danju i povezane su s epizodama prekomjerne razdražljivosti. [9] DSM-V navodi vizualne halucinacije kao primarni dijagnostički kriterij za nekoliko psihotičnih poremećaja, uključujući shizofreniju i shizoafektivni poremećaj. [1] Prevalenca svih psihotičnih poremećaja tijekom života je 3,48%, a različita dijagnostička skupina je sljedeća: 0,87% [10] za shizofreniju, 0,32% za shizoafektivni poremećaj, 0,07% za shizofreniformni poremećaj, 0,18% za zabludni poremećaj, 0,24% za bipolarni poremećaj I, 0,35% za veliki depresivni poremećaj s psihotičnim obilježjima, 0,42% za psihotične poremećaje uzrokovane supstancom i 0,21% za psihotične poremećaje zbog općeg zdravstvenog stanja. [16] Vizualne halucinacije se mogu pojaviti kao simptom gore navedenih psihotičnih poremećaja u 24% do 72% pacijenata u nekom trenutku tijekom bolesti. [2] [17] Nemaju svi pojedinci koji dožive halucinacije psihotični poremećaj. Mnogi fizički i psihijatrijski poremećaji mogu se manifestirati halucinacijama, a neki pojedinci mogu imati više od jednog poremećaja koji bi mogao uzrokovati različite vrste halucinacija. [11]


Što je halucinacija

U prošlom stoljeću bili su okrivljeni halucinacije shizofrenija, ali u posljednje dvije godine okrenuli smo se svom poslu, rekao je. Sada pokušavamo shvatiti postoje li različiti oblici halucinacija ili doista oni koji dolaze u različitim aspektima. Nedostatak sna, stres, tuga i šok procesi mogu povećati vjerojatnost da će osoba patiti od halucinacija.

Napomenuo je da kada sve prođe dobro, frontalni režanj je naredba i kontrolira cijeli mozak, ali situacije poput ovih smanjuju njihovu učinkovitost i kada možete stvoriti halucinacije. Objasnio je da kad sve prođe dobro, frontalni režanj mozga kontrolira cjelinu, ali u situacijama poput ovih smanji njihovu učinkovitost i kada možete stvoriti halucinacije.

U prošlom je stoljeću došlo do halucinacija shizofrenije, ali u posljednje dvije godine okrenuli smo se svom poslu, rekao je.

Ova vrsta halucinacija pogađa u prosjeku jednu od 20 osoba u Australiji, koje pokazuju svoje nedostatke percepciju stvarnosti svim osjetilima, iako su vizualni i slušni najčešći. Specijalist je rekao da sada pokušava shvatiti postoje li različiti oblici halucinacija ili se zapravo pojavljuju u različitim aspektima.

Također je napomenuo da nedostatak sna, stres, tuga i procesi šoka mogu povećati vjerojatnost da će osoba patiti od halucinacija.


Halucinacije o gubitku, vizije tuge

When I was a boy and there was a death in the family, the mirrors in our house would be covered with a sheet, as Jewish tradition dictated.

The &ldquoofficial&rdquo explanation of this custom, according to our rabbi, was that gazing at one&rsquos reflection in a mirror is an act of vanity &mdash and there is no place for vanity in a period of mourning. But my family had a different understanding of the practice: the mirrors were covered so that we would not see the face of the deceased instead of our own reflections.

As a psychiatrist, I think this bit of folk wisdom may see more deeply into the human soul than the theological teaching.

Recently, the theologian Bart Ehrman presented a very controversial argument, in his book How Jesus Became God. I have not read the book, but in an interview published in the Boston Globe (April 20, 2014), Ehrman argued that the belief in Jesus&rsquos resurrection may have been founded on visual hallucinations among Jesus&rsquos bereaved and grief-stricken disciples. Ehrman speculated that, &ldquo&hellipthe disciples had some kind of visionary experiences&hellipand that these&hellipled them to conclude that Jesus was still alive.&rdquo

Now, I am no position to support or refute Prof. Ehrman&rsquos provocative hypothesis, but there is no question that after the death of a loved one (bereavement), visual hallucinations of the deceased are quite common. Sometimes, post-bereavement hallucinations may be part of a disordered grieving process, known variously as &ldquopathological grief&rdquo or &ldquocomplicated grief&rdquo &mdash a condition my colleagues have been investigating for many years, and which had been proposed as a new diagnostic category in psychiatry&rsquos diagnostic manual, the DSM-5. (Ultimately, a version of this syndrome was placed among disorders requiring &ldquofurther study.&rdquo)

Though visual hallucinations usually are reported by a single individual, there are reports of &ldquomass hallucinations&rdquo following some traumatic events in such contexts, clinicians often speak of &ldquotraumatic grief.&rdquo A report from Singapore General Hospital noted that, following the massive tsunami tragedy in Thailand (2004), there were many accounts of &ldquoghost sightings&rdquo among survivors and rescuers who had lost loved ones. Some would-be rescuers were so frightened by these perceptions that they ceased their efforts. There may well be a cultural or religious contribution to the Thai experience, since many Thais believe that spirits can be put to rest only by relatives at the scene of the disaster.

But &ldquovisionary experiences&rdquo also may be seen in normal or uncomplicated grief, following the death of a loved one, and appear to be common in many different cultures. In one Swedish study, researcher Agneta Grimby looked at the incidence of hallucinations in elderly widows and widowers, within the first year after the spouse&rsquos death. She found that half of the subjects sometimes &ldquofelt the presence&rdquo of the deceased &mdash an experience often termed an &ldquoillusion.&rdquo About one-third reported actually seeing, hearing and talking to the deceased.

Writing in Scientific American, psychiatrist Vaughn Bell speculated that, among these widows and widowers, it was &ldquo&hellip as if their perception had yet to catch up with the knowledge of their beloved&rsquos passing.&rdquo Since mourners or family members may be alarmed by these phenomena, it&rsquos important for clinicians to understand that such transient hallucinations after bereavement are usually not signs of psychopathology. And, unless the hallucinations are accompanied by a persistent delusion &mdash for example, &ldquoMy dead spouse has come back to haunt me!&rdquo &mdash they do not indicate psychosis.

In recent years, neuroscientists have investigated the underlying brain structures and functions that may account for hallucinations. However, we still don&rsquot fully understand the neurobiology of these experiences, either in pathological states like schizophrenia, or in the context of normal grief.

Some clues may emerge from studying a condition called Charles Bonnet Syndrome (CBS), in which the afflicted person experiences vivid visual hallucinations, usually in the absence of delusions or serious psychological problems.

Often seen in older individuals, CBS may result from damage to the eye itself (e.g., macular degeneration) or to the nerve pathway connecting the eye a part of the brain called the visual cortex. This brain region may play some role in the &ldquonormal&rdquo hallucinations associated with bereavement &mdash but evidence to date is lacking. (Imagine the difficulty of studying transient hallucinations in persons caught up in grieving the loss of a loved one!)

Some case reports theorize that in patients with pre-existing eye disease, the death of a spouse may increase the likelihood of Charles Bonnet Syndrome, suggesting that biological and psychological mechanisms are subtly interwoven.

Whatever the neurobiology of bereavement-related visual hallucinations, it seems plausible that these experiences often serve some kind of psychological function or need. Psychiatrist Dr. Jerome Schneck has theorized that bereavement-related hallucinations represent &ldquo&hellip a compensatory effort to cope with the drastic sense of loss.&rdquo Similarly, neurologist Oliver Sacks has commented that &ldquo&hellip hallucinations can have a positive and comforting role&hellip seeing the face or hearing the voice of one&rsquos deceased spouse, siblings, parents or child&hellip may play an important part in the mourning process.&rdquo

On the one hand, there may be sound psychological reasons why Jewish tradition advises that mirrors be covered during the mourning period for a lost loved one. For some bereaved persons, visualizing the deceased while expecting to see one&rsquos own reflection might be very distressing &mdash even terrifying. On the other hand, such &ldquovisions of grief&rdquo may help some bereaved loved ones cope with an otherwise unbearable loss.

Suggested readings and references

Alroe CJ, McIntyre JN. Visual hallucinations. The Charles Bonnet syndrome and bereavement. Med J Aust. 1983 Dec 10-242(12):674-5.

Bell V: Ghost Stories: Visits from the Deceased. After a loved one dies, most people see ghosts. Scientific American. Dec 2, 2008.

Boksa P: On the neurobiology of hallucinations. J Psihijatrija Neurosci 200934(4):260-2.

Grimby A: Bereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life. Acta Psychiatr Scand. 1993 Jan87(1):72-80.

Ng B.Y. Grief revisited. Ann Acad Med Singapore 200534:352-5.

Sacks O: Seeing Things? Hearing Things? Many of Us Do. New York Times, Sunday Review, November 3, 2012.

Schneck JM: S. Weir Mitchell&rsquos visual hallucinations as a grief reaction. Am J Psihijatrija 1989146:409.

Thanks to Dr. M. Katherine Shear and Dr. Sidney Zisook for their helpful references.


Auditory Hallucination Analysis

When asked about the emotional tone of the voices a majority reported it as angry (48.32%) while 21.96% reported to be derogatory and abusive in nature.

Around 8.01% reported the hallucinations being pleasant and soothing (praises about them or some pleasant conversations they have had) while 3.1% of the subjects reported musical hallucinations which were quite relaxing to them.

91.47% reported the perception of auditory hallucinations in both ears while 94.57% reported

the presence of hallucinations during both day and night.


How common are visual hallucinations?

Most books and journalist-type articles will say that heard hallucinations are far more common than visual ones. And they'll give various (low) percentages for how many people with schizophrenia have visual hallucinations.

But when you read about childhood schizophrenia, you'll usually read stuff that says that visual hallucinations are reported much more often by children with schizophrenia, in fact, in most of them.

I swallowed that for a long, long time. But after decades of being friends with people with schizophrenia, I don't think visual hallucinations are uncommon in adult schizophrenia at all. I just don't think adults always want to tell their doctors about visual hallucinations. My guess is that about half of people with adult onset schizophrenia, have had at least one visual hallucination.

Re: How common are visual hallucinations?

po adq23 » Sun Dec 22, 2013 1:44 pm

smithywise wrote: Most books and journalist-type articles will say that heard hallucinations are far more common than visual ones. And they'll give various (low) percentages for how many people with schizophrenia have visual hallucinations.

But when you read about childhood schizophrenia, you'll usually read stuff that says that visual hallucinations are reported much more often by children with schizophrenia, in fact, in most of them.

I swallowed that for a long, long time. But after decades of being friends with people with schizophrenia, I don't think visual hallucinations are uncommon in adult schizophrenia at all. I just don't think adults always want to tell their doctors about visual hallucinations. My guess is that about half of people with adult onset schizophrenia, have had at least one visual hallucination.

Re: How common are visual hallucinations?

po smithywise » Sun Dec 22, 2013 2:39 pm

smithywise wrote: Most books and journalist-type articles will say that heard hallucinations are far more common than visual ones. And they'll give various (low) percentages for how many people with schizophrenia have visual hallucinations.

But when you read about childhood schizophrenia, you'll usually read stuff that says that visual hallucinations are reported much more often by children with schizophrenia, in fact, in most of them.

I swallowed that for a long, long time. But after decades of being friends with people with schizophrenia, I don't think visual hallucinations are uncommon in adult schizophrenia at all. I just don't think adults always want to tell their doctors about visual hallucinations. My guess is that about half of people with adult onset schizophrenia, have had at least one visual hallucination.

Well, let me tell you something about "A Beautiful Mind", lol. John Nash never had any full body daylight visual hallucinations. That was all made up for the movie, to make the movie look - all Hollywood.

He never had any visual hallucinations, he just heard voices. His 50 year old son has visual hallucinations, though he hasn't specified exactly how they look.

You inspired me, so I looked up some research on hallucinations. The studies found, anywhere from 35-75% of adult schizophrenics, had at least some visual hallucinations. So some studies found 75%, some found 35%, and others got numbers in between. I think it depends some on how the study is done and what group they recruit for the study. I think it also depends on how much the person with schizophrenia, feels comfortable discussing all, his or her symptoms.

Even full body daylight hallucinations aren't always fully formed in all detail. Sometimes it's more like suggestive of a person or some type of figure. Sometimes they seem kind of steamy, fluid or varying.

I think most people w/ schizophrenia who have visual hallucinations, the hallucinations are fragments of things, rather than full body daylight hallucinations like in "A Beautiful Mind", though sometimes it happens like that.

Generally, at first, they involve contrasts, unusually bright light around objects that seem to be getting emphasized for a purpose, is an example.

I think what you're describing is more typical. They may progress to other types, which is important to watch out for. The most important thing is how they make you feel, and how do they disrupt things. They aren't all necessarily scary or bad. Sometimes they are very absorbing, even seductively fascinating.

My friend's brother had what he called 'whirlers'. They were like spinning balls of bright white light. They really bothered him, and came along with a LOT of fear and anxiety. They could occur in full day light.

He started having symptoms at age 4, and didn't describe any changes in his hallucinations, but that's unusual. Generally, they do change over time. They're slight when your illness starts showing, and they may stay slight for quite some time. During what people call a 'psychotic episode', hallucinations usually are more intense. Some people have little to no hallucinations, between episodes.

My housemate had full body daylight hallucinations, thought not all the time, more of the time, he heard voices. The visual ones were not nice. They looked like bloody faces, floating in the air. Puno njih. He would also see things at edges - like the edge between the wall and ceiling, for example. These were also in daylight.

Another friend described faces when he looked at them, dripping down, morphing, getting all. gross. He would tremble just talking about them. Everyone was always saying, 'come on man, look at my face while I'm talking to you!' And he'd be like 'um, thanks but I think not'.

Another friend of mine has what looks like a red line across his field of vision. He associates it with being at his limit of stress, and feeling like he's about to lose his self control. He also had a lot of audio hallucinations. They sounded like tiny explosions or glass breaking, from far away, or voices.

I've also had people describe to me, low light hallucinations. This is things moving in dimmer light conditions, such as when a person in his or her room at night, in dark or near-dark.

A particularly surprising visual hallucination is the depth hallucination. In these, a figure can seem to pop out at you. From a painting, poster, or from a group of people standing away from you. It can seem to enlarge and get much closer. Many people see these as threatening.

The main or top category is, whether they are in daylight or low light. From what I can tell, low light hallucinations are the commoner type of the two, but not by much.


BOX 1 Ineffective distraction techniques: drowning out the voices

Patients often attempt to overcome critical and abusive voices by using dysfunctional (or unhelpful) distraction techniques. For example, they try to drown out the voices by listening to repetitive sound on headphones. There are three factors here that perpetuate voice hearing:

the sound is not personally meaningful

the content is more white noise than structured

wearing headphones diminishes social contact and reduces the likelihood of activating more efficient coping.


What is hallucination

In the last century were blamed hallucinations schizophrenia, but in the last two years we have taken a turn to our work, he said.Now we try to understand if there are different forms of hallucinations, or indeed one that comes in various aspects.Lack of sleep, stress, grief and shock processes can make a person more likely to suffer hallucinations person.

He noted that when all goes well, the frontal lobe is the command and controls the whole brain, but situations such as these, reduce their efficiency and when you can create hallucination.He explained that when all goes well, the frontal lobe of the brain controls the whole, but in situations such as these, reduce their efficiency and when you can create hallucination.

In the last century hallucinations schizophrenia were struck, but in the last two years we have taken a turn to our work, he said.

This type of hallucinations affects on average one in every 20 people in Australia, who show flaws in their perception of reality by all the senses, although visual and hearing are the most common.The specialist said that now trying to understand if there are different forms of hallucinations, or is actually one that comes in various aspects.

He also noted that the lack of sleep, stress, grief and shock processes can make a person more likely to suffer hallucinations person.


36.2: The Phenomenology Of Schizophrenia And Related Psychotic Disorders

Most of you have probably had the experience of walking down the street in a city and seeing a person you thought was acting oddly. They may have been dressed in an unusual way, perhaps disheveled or wearing an unusual collection of clothes, makeup, or jewelry that did not seem to fit any particular group or subculture. They may have been talking to themselves or yelling at someone you could not see. If you tried to speak to them, they may have been difficult to follow or understand, or they may have acted paranoid or started telling a bizarre story about the people who were plotting against them. If so, chances are that you have encountered an individual with schizophrenia or another type of psychotic disorder. If you have watched the movie A Beautiful Mind ili The Fisher King, you have also seen a portrayal of someone thought to have schizophrenia. Sadly, a few of the individuals who have committed some of the recently highly publicized mass murders may have had schizophrenia, though most people who commit such crimes do not have schizophrenia. It is also likely that you have met people with schizophrenia without ever knowing it, as they may suffer in silence or stay isolated to protect themselves from the horrors they see, hear, or believe are operating in the outside world. As these examples begin to illustrate, psychotic disorders involve many different types of symptoms, including delusions, hallucinations, disorganized speech and behavior, abnormal motor behavior (including catatonia), and negative symptoms such anhedonia or amotivation and blunted affect/reduced speech.

Delusions are false beliefs that are often fixed, hard to change even when the person is presented with conflicting information, and often culturally influenced in their content (e.g., delusions involving Jesus in Judeo-Christian cultures, delusions involving Allah in Muslim cultures). They can be terrifying for the person, who may remain convinced that they are true even when loved ones and friends present them with clear information that they cannot be true. There are many different types or themes to delusions.

The most common delusions are persecutory and involve the belief that individuals or groups are trying to harm or plot against the person in some way. These can be people that the person knows (people at work, the neighbors, family members), or more abstract groups (the FBI, the CIA, aliens, etc.). Other types of delusions include grandiose delusions, where the person believes they have some special power or ability (e.g., I am the new Buddha, I am a rock star) referential delusions, where the person believes that events or objects in the environment have special meaning for them (e.g., that song on the radio is being played specifically for me) or other types of delusions where the person may believe that others are controlling their thoughts and actions, that their thoughts are being broadcast aloud, or that others can read their mind (or they can read other people&rsquos minds).

Figure (PageIndex<1>): Under surveillance: Abstract groups like the police or the government are commonly the focus of persecutory delusions in a person with schizophrenia. [&ldquoW beauty&rdquo by Thomas Hawk/Flickr is licensed under CC BY-NC 2.0.]

When you see a person on the street talking to themselves or shouting at other people, they are experiencing halucinacije. These are perceptual experiences that occur even when there is no stimulus in the outside world generating the experiences. They can be auditory, visual, olfactory (smell), gustatory (taste), or somatic (touch). The most common hallucinations in psychosis (at least in adults) are auditory and can involve one or more voices talking about the person, commenting on the person&rsquos behavior, or giving them orders. The content of the hallucinations is frequently negative (&ldquoyou are a loser,&rdquo &ldquothat drawing is stupid,&rdquo &ldquoyou should go kill your- self &rdquo) and can be the voice of someone the person knows or a complete stranger. Sometimes the voices sound as if they are coming from outside the person&rsquos head. Other times the voices seem to be coming from inside the person&rsquos head, but are not experienced the same as the person&rsquos inner thoughts or inner speech.

Figure (PageIndex<2>): People who suffer from schizophrenia may see the world differently. This can include hallucinations, delusions, and disorganized thinking. [Untitled image by Noba Project is licensed under CC BY-NC-SA 4.0.]

Talking to someone with schizophrenia is sometimes difficult, as their speech may be difficult to follow, either because their answers do not clearly flow from your questions, or because one sentence does not logically follow from another. This is referred to as neorganiziran govor, and it can be present even when the person is writing. Disorganized behavior can include odd dress, odd makeup (e.g., lipstick outlining a mouth for 1 inch), or unusual rituals (e.g., repetitive hand gestures). Abnormal motor behavior can include catatonia, which refers to a variety of behaviors that seem to reflect a reduction in responsiveness to the external environment. This can include holding unusual postures for long periods of time, failing to respond to verbal or motor prompts from another person, or excessive and seemingly purposeless motor activity.

Some of the most debilitating symptoms of schizophrenia are difficult for others to see. These include what people refer to as &ldquonegative symptoms&rdquo or the absence of certain things we typically expect most people to have. Na primjer, anhedonia i amotivation reflect a lack of apparent interest in or drive to engage in social or recreational activities. These symptoms can manifest as a great amount of time spent in physical immobility. Importantly, anhedonia and amotivation do not seem to reflect a lack of enjoyment in pleasurable activities or events (Cohen & Minor, 2010 Kring & Moran, 2008 Llerena et al., 2012) but rather a reduced drive or ability to take the steps necessary to obtain the potentially positive outcomes (Barch & Dowd, 2010). Flat affect and reduced speech (alogia) reflect a lack of showing emotions through facial expressions, gestures, and speech intonation, as well as a reduced amount of speech and increased pause frequency and duration.

In many ways, the types of symptoms associated with psychosis are the most difficult for us to understand, as they may seem far outside the range of our normal experiences. Unlike depression or anxiety, many of us may not have had experiences that we think of as on the same continuum as psychosis. However, just like many of the other forms of psihopatologija described in this book, the types of psychotic symptoms that characterize disorders like schizophrenia are on a continuum with &ldquonormal&rdquo mental experiences. For example, work by Jim van Os in the Netherlands has shown that a surprisingly large percentage of the general population (10%+) experience psychotic-like symptoms, though many fewer have multiple experiences and most will not continue to experience these symptoms in the long run (Verdoux & van Os, 2002). Similarly, work in a general population of adolescents and young adults in Kenya has also shown that a relatively high percentage of individuals experience one or more psychotic-like experiences (

19%) at some point in their lives (Mamah et al., 2012 Ndetei et al., 2012), although again most will not go on to develop a full-blown psychotic disorder.

Schizophrenia is the primary disorder that comes to mind when we discuss &ldquopsychotic&rdquo disorders (see Table (PageIndex<1>) for diagnostic criteria), though there are a number of other disorders that share one or more features with schizophrenia. In the remainder of this module, we will use the terms &ldquopsycho- sis&rdquo and &ldquoschizophrenia&rdquo somewhat interchangeably, given that most of the research has focused on schizophrenia. In addition to schizophrenia (see Table (PageIndex<1>)), other psychotic disorders include schizophreniform disorder (a briefer version of schizophrenia), schizoaffective disorder (a mixture of psycho- sis and depression/mania symptoms), delusional disorder (the experience of only delusions), and brief psychotic disorder (psychotic symptoms that last only a few days or weeks).

Shizofrenija (lifetime prevalence about 0.3% to 0.7%)

  • Two or more of the following for at least 1 month: hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.
  • Impairment in one or more areas of function (social, occupational, educational self-care) for a significant period of time since the onset of the illness.
  • Continuous signs of the illness for at least 6 months (this can include prodromal or residual symptoms, which are attenuated forms of the symptoms described above).

Schizophreniform Disorder (lifetime prevalence similar to Schizophrenia)

  • The same symptoms of schizophrenia described above that are present for at least 1 month but less than 6 months.

Schizoaffective Disorder (lifetime prevalence above 0.3%)

  • A period of illness where the person has both the psychotic symptoms necessary to meet criteria for schizophrenia and either a major depression or manic episode.
  • The person experiences either delusions or hallucinations for at least 2 weeks when they are not having a depressive or manic episode.
  • The symptoms that meet criteria for depressive or manic episodes are present for over half of the illness duration.

Delusional Disorder (lifetime prevalence about 0.2%)

  • The presence of at least one delusion for at least a month.
  • The person has never met criteria for schizophrenia.
  • The person&rsquos function is not impaired outside the specific impact of the delusion.
  • The duration of any depressive or manic episodes have been brief relative to the duration of the delusion(s).

Brief Psychotic Disorder (lifetime prevalence unclear)

  • One or more of the following symptoms present for at least 1 day but less than 1 month: delusions, hallucinations, disorganized speech, grossly disordered or catatonic behavior.

Attenuated Psychotic Disorder (in Section III of the DSM-5, lifetime prevalence unclear)


Visual hallucinations in psychoses are reported to have physical properties similar to real perceptions. 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. [2] [3] [4] [5] [6] [7] [8]

Simple vs. complex Edit

Visual hallucinations may be simple, or non-formed visual hallucinations, or complex, or formed visual hallucinations.

Simple visual hallucinations are also referred to as non-formed or elementary visual hallucinations. They can take the form of multicolored lights, colors, geometric shapes, indiscrete objects. Simple visual hallucinations without structure are known as phosphenes and those with geometric structure are known as photopsias. [9] [10] [11] These hallucinations are caused by irritation to the primary visual cortex (Brodmann's area 17). [12]

Complex visual hallucinations are also referred to as formed visual hallucinations. They tend to be clear, lifelike images or scenes, such as faces of animals or people. 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. [13] [14]

Content Edit

The frequency of hallucinations varies widely from rare to frequent, as does duration (seconds to minutes). The content of hallucinations varies as well. Complex (formed) visual hallucinations are more common than Simple (non-formed) visual hallucinations. [5] [7] 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. [6] [7] Individuals often report being surprised when hallucinations occur and are generally helpless to change or stop them. [4] In general, individuals believe that visions are experienced only by themselves. [4] [5]

Two neurotransmitters are particularly important in visual hallucinations – serotonin and acetylcholine. They are concentrated in the visual thalamic nuclei and visual cortex. [13]

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. [12] [15]

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. [14] [15]

The third mechanism has to do with the reticular activating system, which plays a role in the maintenance of arousal. Lesions in the brain stem can cause visual hallucinations. Visual hallucinations are frequent in those with certain sleep disorders, occurring more often when drowsy. This suggests that the reticular activating system plays a part in visual hallucinations, although the precise mechanism has still not fully been established. [13] [15]

Hallucinations in those with psychoses are often experienced in color, and most often are multi-modal, consisting of visual and auditory components. They frequently accompany paranoia or other thought disorders, and tend to occur during the daytime and are associated with episodes of excess excitability. [9] The DSM-V lists visual hallucinations as a primary diagnostic criterion for several psychotic disorders, including schizophrenia and schizoaffective disorder. [1] The lifetime prevalence of all psychotic disorders is 3.48% and that of the different diagnostic groups are as follows: 0.87% [10] for schizophrenia, 0.32% for schizoaffective disorder, 0.07% for schizophreniform disorder, 0.18% for delusional disorder, 0.24% for bipolar I disorder, 0.35% for major depressive disorder with psychotic features, 0.42% for substance-induced psychotic disorders, and 0.21% for psychotic disorders due to a general medical condition. [16] Visual hallucinations can occur as a symptom of the above psychotic disorders in 24% to 72% of patients at some point in the course of their illness. [2] [17] Not all individuals who experience hallucinations have a psychotic disorder. Many physical and psychiatric disorders can manifest with hallucinations, and some individuals may have more than one disorder that could cause different types of hallucinations. [11]


Hallucinations Are Far More Common Than We've Been Led to Believe, Study Suggests

New research has found that hallucinations are far more common among the general population than most people realise - and they aren't limited to disorders commonly associated with psychosis, such as schizophrenia or borderline personality disorder.

A study looking at more than 7,400 people in the UK found that 4.3 percent of participants had experienced either visual or auditory hallucinations in the past year - this included people with and without mental health issues, and showed that the phenomenon wasn't limited to those with psychosis.

"There is a general idea in psychiatry that hallucinations are a feature of psychosis," lead researcher Ian Kelleher from the Royal College of Surgeons in Ireland told Léa Surugue at the International Business Times.

"But when we looked at a whole range of mental health diseases we found that hallucinations are symptoms that occur in a wide range of mental health disorders such as depression or anxiety."

Generally, when we talk about mental health issues, there's a divide between the psychotic disorders, such as borderline personality disorder and schizophrenia, and non-psychotic disorders, including depression and anxiety.

For this study, the researchers used borderline personality disorder as an example of a psychotic disorder.

There's plenty of unnecessary stigma surrounding all of those conditions, but in particular, people with psychotic disorders are usually considered unique in that they see and hear things that aren't there.

But the new study suggests that this divide might not actually exist.

The team looked at data from the 2007 Adult Psychiatric Morbidity survey, which included surveys over the space of a year on the mental health of 7,403 people in England aged over 16.

As you'd expect, many of these participants had been diagnosed with a mental health condition - in England, it's estimated that one in six people suffer from mental health problems in any given week.

But the team wanted to narrow down whether hallucinations were any more common among people with psychotic disorders compared to those with non-psychotic ones.

To do this, the researchers looked at how many people with borderline personality disorder (which is associated with psychosis) reported seeing or hearing things that other people couldn't in the past year, compared with the number of participants with non-psychotic depression or anxiety.

The results showed that hallucinations weren't significantly more prevalent in individuals with borderline personality disorder (13.7 percent) than those with a non-psychotic mental disorder (12.6 percent).

Not only that, but more than 4 percent of svi respondents reported hearing or seeing things that others couldn't - including those who'd never been diagnosed with mental health issues.

Based on the results, the team suggests that hallucinations aren't exclusively symptoms of psychosis, and shouldn't be stigmatised.

"Hallucinations are more common than people realise. They can be frightening experiences, and few people openly talk about it," Kelleher told Surugue.

"Our research is valuable because it can show them they are not alone and that having these symptoms is not necessarily associated with having a mental health disorder. It breaks the taboo."

But this is just one study and it has its limitations - for starters, the team relied on participants to self-report whether or not they'd experienced hallucinations, which isn't the most accurate technique.

And although it was a decent sample size, the researchers only looked at people in England, which is not a diverse enough demographic to draw any far-reaching conclusions about hallucinations in general.

But the findings echo the results of a much larger study published in 2015, which looked at data on more than 31,000 people from 19 countries.

Similar to these latest results, that paper found that around 5 percent of the general population reported experiencing hallucinations, whether or not they were diagnosed with a mental illness.

"We used to think that only people with psychosis heard voices or had delusions, but now we know that otherwise healthy, high-functioning people also report these experiences," said lead researcher John McGrath, from the Queensland Brain Institute in Australia, when the study came out.

As research into hallucinations continue, it's becoming apparent that many of the symptoms we once associated with mental health disorders are actually more common than we once thought.

In fact, a separate study that came out last week showed that people who go through life without experiencing any mental health problems are more unusual than those who do.

By further investigating who does and doesn't experience visual or auditory hallucinations and how they occur, researchers will hopefully get a better idea of who's at risk of developing serious mental health conditions in future.


Hallucinations of Loss, Visions of Grief

When I was a boy and there was a death in the family, the mirrors in our house would be covered with a sheet, as Jewish tradition dictated.

The &ldquoofficial&rdquo explanation of this custom, according to our rabbi, was that gazing at one&rsquos reflection in a mirror is an act of vanity &mdash and there is no place for vanity in a period of mourning. But my family had a different understanding of the practice: the mirrors were covered so that we would not see the face of the deceased instead of our own reflections.

As a psychiatrist, I think this bit of folk wisdom may see more deeply into the human soul than the theological teaching.

Recently, the theologian Bart Ehrman presented a very controversial argument, in his book How Jesus Became God. I have not read the book, but in an interview published in the Boston Globe (April 20, 2014), Ehrman argued that the belief in Jesus&rsquos resurrection may have been founded on visual hallucinations among Jesus&rsquos bereaved and grief-stricken disciples. Ehrman speculated that, &ldquo&hellipthe disciples had some kind of visionary experiences&hellipand that these&hellipled them to conclude that Jesus was still alive.&rdquo

Now, I am no position to support or refute Prof. Ehrman&rsquos provocative hypothesis, but there is no question that after the death of a loved one (bereavement), visual hallucinations of the deceased are quite common. Sometimes, post-bereavement hallucinations may be part of a disordered grieving process, known variously as &ldquopathological grief&rdquo or &ldquocomplicated grief&rdquo &mdash a condition my colleagues have been investigating for many years, and which had been proposed as a new diagnostic category in psychiatry&rsquos diagnostic manual, the DSM-5. (Ultimately, a version of this syndrome was placed among disorders requiring &ldquofurther study.&rdquo)

Though visual hallucinations usually are reported by a single individual, there are reports of &ldquomass hallucinations&rdquo following some traumatic events in such contexts, clinicians often speak of &ldquotraumatic grief.&rdquo A report from Singapore General Hospital noted that, following the massive tsunami tragedy in Thailand (2004), there were many accounts of &ldquoghost sightings&rdquo among survivors and rescuers who had lost loved ones. Some would-be rescuers were so frightened by these perceptions that they ceased their efforts. There may well be a cultural or religious contribution to the Thai experience, since many Thais believe that spirits can be put to rest only by relatives at the scene of the disaster.

But &ldquovisionary experiences&rdquo also may be seen in normal or uncomplicated grief, following the death of a loved one, and appear to be common in many different cultures. In one Swedish study, researcher Agneta Grimby looked at the incidence of hallucinations in elderly widows and widowers, within the first year after the spouse&rsquos death. She found that half of the subjects sometimes &ldquofelt the presence&rdquo of the deceased &mdash an experience often termed an &ldquoillusion.&rdquo About one-third reported actually seeing, hearing and talking to the deceased.

Writing in Scientific American, psychiatrist Vaughn Bell speculated that, among these widows and widowers, it was &ldquo&hellip as if their perception had yet to catch up with the knowledge of their beloved&rsquos passing.&rdquo Since mourners or family members may be alarmed by these phenomena, it&rsquos important for clinicians to understand that such transient hallucinations after bereavement are usually not signs of psychopathology. And, unless the hallucinations are accompanied by a persistent delusion &mdash for example, &ldquoMy dead spouse has come back to haunt me!&rdquo &mdash they do not indicate psychosis.

In recent years, neuroscientists have investigated the underlying brain structures and functions that may account for hallucinations. However, we still don&rsquot fully understand the neurobiology of these experiences, either in pathological states like schizophrenia, or in the context of normal grief.

Some clues may emerge from studying a condition called Charles Bonnet Syndrome (CBS), in which the afflicted person experiences vivid visual hallucinations, usually in the absence of delusions or serious psychological problems.

Often seen in older individuals, CBS may result from damage to the eye itself (e.g., macular degeneration) or to the nerve pathway connecting the eye a part of the brain called the visual cortex. This brain region may play some role in the &ldquonormal&rdquo hallucinations associated with bereavement &mdash but evidence to date is lacking. (Imagine the difficulty of studying transient hallucinations in persons caught up in grieving the loss of a loved one!)

Some case reports theorize that in patients with pre-existing eye disease, the death of a spouse may increase the likelihood of Charles Bonnet Syndrome, suggesting that biological and psychological mechanisms are subtly interwoven.

Whatever the neurobiology of bereavement-related visual hallucinations, it seems plausible that these experiences often serve some kind of psychological function or need. Psychiatrist Dr. Jerome Schneck has theorized that bereavement-related hallucinations represent &ldquo&hellip a compensatory effort to cope with the drastic sense of loss.&rdquo Similarly, neurologist Oliver Sacks has commented that &ldquo&hellip hallucinations can have a positive and comforting role&hellip seeing the face or hearing the voice of one&rsquos deceased spouse, siblings, parents or child&hellip may play an important part in the mourning process.&rdquo

On the one hand, there may be sound psychological reasons why Jewish tradition advises that mirrors be covered during the mourning period for a lost loved one. For some bereaved persons, visualizing the deceased while expecting to see one&rsquos own reflection might be very distressing &mdash even terrifying. On the other hand, such &ldquovisions of grief&rdquo may help some bereaved loved ones cope with an otherwise unbearable loss.

Suggested readings and references

Alroe CJ, McIntyre JN. Visual hallucinations. The Charles Bonnet syndrome and bereavement. Med J Aust. 1983 Dec 10-242(12):674-5.

Bell V: Ghost Stories: Visits from the Deceased. After a loved one dies, most people see ghosts. Scientific American. Dec 2, 2008.

Boksa P: On the neurobiology of hallucinations. J Psihijatrija Neurosci 200934(4):260-2.

Grimby A: Bereavement among elderly people: grief reactions, post-bereavement hallucinations and quality of life. Acta Psychiatr Scand. 1993 Jan87(1):72-80.

Ng B.Y. Grief revisited. Ann Acad Med Singapore 200534:352-5.

Sacks O: Seeing Things? Hearing Things? Many of Us Do. New York Times, Sunday Review, November 3, 2012.

Schneck JM: S. Weir Mitchell&rsquos visual hallucinations as a grief reaction. Am J Psihijatrija 1989146:409.

Thanks to Dr. M. Katherine Shear and Dr. Sidney Zisook for their helpful references.


Gledaj video: Halucinacije osobe s demencijom (Kolovoz 2022).