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Abstract
BackgroundVisual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinson's disease and schizophrenia. The lifetime prevalence of visual hallucinations in patients with schizophrenia is much more common than conventionally thought and ranges from 24% to 72%. Cortical acetylcholine (ACh) depletion has been associated with visual hallucinations; the level of depletion being related directly to the severity of the symptoms. Current understanding of neurobiological visual processing and research in diseases with reduced cholinergic function, suggests that AChEI's may prove beneficial in treating visual hallucinations. This offers the potential for targeted drug therapy of clinically symptomatic visual hallucinations in patients with schizophrenia using acetylcholinesterase inhibition.MethodsA systematic review was carried out investigating the evidence for the effects of AChEI's in treating visual hallucinations in Schizophrenia.ResultsNo evidence was found relating to the specific role of AChEI's in treating visual hallucinations in this patient group.DiscussionGiven the use of AChEI's in targeted, symptom specific treatment in other neuropsychiatric disorders, it is surprising to find no related literature in schizophrenia patients. The use of AChEI's in schizophrenia has investigated effects on cognition primarily with non cognitive effects measured more broadly.ConclusionsWe would suggest that more focused research into the effects of AChEI's on positive symptoms of schizophrenia, specifically visual hallucinations, is needed.
Highlights
We would suggest that more focused research into the effects of Acetylcholinesterase Inhibitors (AChEI’s) on positive symptoms of schizophrenia, visual hallucinations, is needed
Visual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinson’s disease and schizophrenia
Dopaminergic neuro-modulation of cholinergic function is considered in this review and contemporary dopaminergic theories of schizophrenia may be integrated into this pathway to conceptualise the formation of visual hallucinations in schizophrenia [6]
Summary
Visual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinson’s disease and schizophrenia. It is proposed that acetylcholine in the human brain modulates the interaction between topdown and bottom-up processing in determining appropriate neural representations for inputs with the levels of ACh reflecting the uncertainty associated with topdown information processing [5]. According to this theory, low levels of cortical ACh would result in the increased salience of top-down information whereas high levels would result in over-processing of bottomup, stimulus driven information. Dopaminergic neuro-modulation of cholinergic function is considered in this review and contemporary dopaminergic theories of schizophrenia may be integrated into this pathway to conceptualise the formation of visual hallucinations in schizophrenia [6]
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