Presence Of Hallucinations Research Articles

Predictors of depressive symptoms among spouse caregivers in Parkinson's disease.

The objective of this work was to determine the predictors of depressive symptoms among spouse caregivers of Parkinson's disease (PD) patients. Little is known about the strain in giving care to PD patients and how the motor, cognitive, and behavioral complications of PD contribute to depression among spouse caregivers. Forty-five consecutive PD patients and their spouse caregivers agreed to be evaluated after a routine clinic visit. Patient demographic data and the presence of hallucinations, delusions, incontinence, and sleep disturbances were obtained. The patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS-motor section), Hoehn and Yahr (H&Y) staging, and the Mini-Mental State Examination (MMSE). Depressive symptoms were assessed using the 17-item Hamilton Depression Scale (HAMD-17) and the Beck Depression Inventory-II (BDI-II) on patients and spouses. Thirty men and 15 women had a mean age of 71.5 years (range 53-85), average PD duration of 10 years (range 1-26), a mean "on" H&Y stage of 2.8 and an MMSE mean score of 26 (range 13-30). There was good correlation between the HAMD-17 and the BDI-II scores in both patients (r = 0.69, P = 0.001) and spouses (r = 0.66, P < 0.001). A moderate correlation was noted between the spouse HAMD-17 score and the patient UPDRS-motor score (r = 0.34; P = 0.02), the age of PD onset (r = 0.33; P = 0.02) and patient HAMD-17 scores (r= 0.29; P = 0.05). A stronger correlation was noted between spouse HAMD-17 scores and the years of PD duration (r= 0.43; P = 0.003). There was a significant difference in the mean spouse HAMD-17 scores among PD patients with sleep disturbances versus those who did not (10.2 vs. 6.4; P = 0.04). However, on stepwise regression analysis, only the duration of PD remained significant (adjusted r = 0.17; P = 0.003). No difference was noted with hallucinations, delusions or incontinence. We concluded that the duration of PD appears to be the strongest predictor of depressive symptoms among spouse-caregivers in this small cohort.

Visual hallucinations in patients with retinal disease

PURPOSE: To investigate the prevalence and phenomenologic nature of visual hallucinations among patients with retinal disease and to investigate whether presence of hallucinations is a significant predictor of functional status, quality of life, and/or emotional distress after adjusting for visual acuity. DESIGN: Cross-sectional study. METHODS: Eighty-six consecutive patients at the Wilmer Ophthalmologic Institute Retinal Vascular Center were interviewed using the Sickness Impact Profile, Community Disability Scale, General Health Questionnaire, Visual Phenomena Interview, Eysenck Personality Questionnaire, and Telephone Interview for Cognitive Status. RESULTS: The prevalence of visual hallucinations was 15.1%. Most were formed hallucinations in clear consciousness that lasted for seconds to minutes. The majority of patients had been experiencing visual hallucinations for less than 1 year (61.5%) or for 1 to 2 years (23.1%). Only two of the 13 patients with hallucinations had informed a physician of their hallucinations. Univariate analyses revealed that variables significantly associated with experiencing hallucinations were female sex, worse visual acuity, bilateral visual impairment, emotional distress, decreased functional status, and decreased quality of life. Regression analysis demonstrated that among patients with relatively good vision, those who experienced hallucinations were more emotionally distressed and had a lower quality of life than patients without hallucinations. CONCLUSIONS: Visual hallucinations among patients with retinal disease are common, underdiagnosed, and not associated with cognitive deficits, abnormal personality traits, or a family or personal history of psychiatric morbidity. Among patients with relatively good vision, hallucinations are associated with increased emotional distress and decreased quality of life.

A Multi‐Institutional Study on a New Five‐Axial Classification Sys‐ tem for Epileptic Psychoses.

Purpose: The pathophysiology and clinical phenomenology of epileptic psychoses are wide and varied, and an internationally accepted classification system has yet to be established. A multi‐axial classification should be developed to capture the complexity of clinicai situations and to describe the heterogeneity of individuals presenting with the same diagnosis. We propose a new 5‐axial classification system based on a review of the previous literature and evaluate its validity and applicability in Japan by a multi‐institutional design. Methods: According to the ICD‐10 guidelines, psychosis is defined as the presence of hallucination, delusions, or a limited number of behavioral abnormalities, such as gross excitement and overactivity, marked psychomotor retardation, and catatonic behavior, without disturbance of consciousness. Among the patients with epilepsy and psy‐ choses treated by the authors at 6 epilepsy clinics, 128 patients were randomly selected to participate as subjects. Those patients who developed epilepsy after the onset of their psychoses were excluded. The average age of the subjects was 39.4 years, average age of onset of epilepsy was 13.3 years, and average age of onset of psychoses was 27.9 years. Results: The first axis codes the type of epilepsy and laterality of epileptic focus. Temporal lobe epilepsy (48%) and other localization‐related epilepsies (14%) were prevalent, but all types of epilepsy were seen. Left‐sided (29%) and right‐sided foci (27%) were in equal proportion, and bilateral foci (9%) also were found. The second axis codes the type of psychoses and clinical course. Paranoid schizophrenia‐like disorder (41%) and delusional disorder (19%) were prevalent; whereas acute transient psychotic disorder (9%), catatonic disorder (7%), hallucinosis (6%), and hebephrenic schizophrenia‐like disorder (4%) were relatively infrequent. Single episode (24%), recurrent episodes (34%), and chronic course (34%) were found in almost equal proportion. Therc were several cases with chronic course after recurrent episodes (3%). The third axis codes the temporal relationship between seizure occurrence and EEG changes during psychoses. lnterictal onset (69%) was most frequent followed by postictal (15%), para‐ictal (6%), and other (5%). EEG changes during psychoses were seen in 38%, and normalization of the EEG was seen in 4%of patients. In 22%, EEG could not be recorded during psychoses (22%). The fourth axis codes the precipitating factors of psychoses. Specific personality trait (20%), changes in drug‐regimen (l4%), co‐morbidity with other psychiatric disorders (12%), and psychosocial factors (10%) were seen. The fifth axis codes the organic background. Abnormal findings by brain imaging techniques (38%). mild intelligence deficiency (30%), and previous history of brain damage (27%) were noted. Conclusions: The present results demonstrate the heterogeneity of epileptic psychoses. We have proposed a 5‐axial classification that appears to provide a convenient format for organizing and communicating clinical information to assist clinical practice and facilitate research. Using those guidelines, we may be able to improve our under‐ standing of the pathogenesis, develop suitable treatment, predict the prognosis, and ultimately establish appropriate intervention strategies.

Hallucinations, delusions, and cognitive decline in Alzheimer's disease

OBJECTIVESTo examine the occurrence of hallucinations and delusions in Alzheimer's disease over a 4 year period and their association with rate of cognitive decline.METHODSA cohort of 410 persons with clinically...

Predictors of nursing home placement in Parkinson's disease: a population-based, prospective study.

To examine the rate and predictors of nursing home placement in patients with Parkinson's disease. Four-year prospective study. A population-based study in western Norway 178 community-dwelling subjects with Parkinson's disease. Main outcome measure was the time from baseline to nursing home admission. Baseline evaluation of motor symptoms (Unified Parkinson's Disease Rating Scale, UPDRS), cognition (clinical dementia interview, Gottfries, Brane & Steen dementia scale, and Mini-Mental State Examination), depression (clinical interview and the Montgomery & Asberg Depression Rating Scale), and psychotic symptoms (UPDRS Thought Disorder item) were performed. Forty-seven patients (26.4%) were admitted to a nursing home during the 4-year study period. Institutionalized patients were older, had more advanced Parkinson's disease with more severe motor symptoms and impairment of activities of daily living, were cognitively more impaired, were more often living alone, and had more hallucinations than those who continued to live at home. Duration of disease, levodopa dose, and gender distribution did not differ between the two groups. A Cox proportional hazards linear regression analysis showed that old age, functional impairment, dementia, and hallucinations were independent predictors of nursing home admission. Both motor and neuropsychiatric symptoms contributed to institutionalization, but the presence of hallucinations was the strongest predictor. This finding indicates it is possible that effective treatment of hallucinations may reduce the need for institutionalization in patients with Parkinson's disease.

DELUSIONS AND HALLUCINATIONS IN ALZHEIMER'S DISEASE: RESULTS FROM A TWO‐YEAR LONGITUDINAL STUDY

Issues concerning the frequency of psychotic symptoms in Alzheimer's disease and their relation to the degree and decline of cognitive and functional impairment remain controversial. We therefore investigated 78 outpatients with a clinical diagnosis of Alzheimer's disease according to ICD-10 draft research criteria longitudinally with annual evaluations to study the frequency of psychotic symptoms and their relation to severity and progression of cognitive and functional impairment. Psychotic symptoms were assessed by the BEHAVE-AD, a scale specifically designed to measure these symptoms in patients with Alzheimer's disease. Delusional symptoms were present in 50% of the mildly impaired Alzheimer patients and decreased in frequency within the ongoing disease process. The most frequent delusional symptom was the false conviction that people had stolen things. Hallucinations occurred less frequently but increased within the disease course. In contrast to hallucinations, delusional symptoms were associated with severity of cognitive and functional impairment. Furthermore, delusional symptoms were related to a more rapid progression of cognitive and functional decline. The presence of hallucinations was not associated with the progression rate of the disease. This study demonstrates that psychotic symptoms are quite frequent concomitants in Alzheimer's disease. Their presence early in the disease course may help to identify patients who experience a rampant symptom progression, have a greater risk for institutionalization and should be consequently treated psychopharmacologically and by counselling of the family's management of these non-cognitive disturbances.

DELUSIONS AND HALLUCINATIONS IN ALZHEIMER'S DISEASE: RESULTS FROM A TWO-YEAR LONGITUDINAL STUDY

Issues concerning the frequency of psychotic symptoms in Alzheimer's disease and their relation to the degree and decline of cognitive and functional impairment remain controversial. We therefore investigated 78 outpatients with a clinical diagnosis of Alzheimer's disease according to ICD-10 draft research criteria longitudinally with annual evaluations to study the frequency of psychotic symptoms and their relation to severity and progression of cognitive and functional impairment. Psychotic symptoms were assessed by the BEHAVE-AD, a scale specifically designed to measure these symptoms in patients with Alzheimer's disease. Delusional symptoms were present in 50% of the mildly impaired Alzheimer patients and decreased in frequency within the ongoing disease process. The most frequent delusional symptom was the false conviction that people had stolen things. Hallucinations occurred less frequently but increased within the disease course. In contrast to hallucinations, delusional symptoms were associated with severity of cognitive and functional impairment. Furthermore, delusional symptoms were related to a more rapid progression of cognitive and functional decline. The presence of hallucinations was not associated with the progression rate of the disease. This study demonstrates that psychotic symptoms are quite frequent concomitants in Alzheimer's disease. Their presence early in the disease course may help to identify patients who experience a rampant symptom progression, have a greater risk for institutionalization and should be consequently treated psychopharmacologically and by counselling of the family's management of these non-cognitive disturbances.

Aggression in a rural psychogeriatric outreach program

A rural, community-dwelling group of elders referred to a psychogeriatric outreach program were examined for presence of aggressive behaviors. Aggressive patients were compared to non-aggressive patients on the following variables: age, sex, presence of hallucinations and delusions, alcohol use, cognition score, score on Hamilton Depression Scale, physical and instrumental activity of daily living (ADL) scores, general health and quality of life. Of one hundred and fifty-eight patients, 19 (12%) exhibited aggressive behavior. Aggression was significantly associated with presence of hallucinations (p < 0.0001), delusions (p = 0.004), lower physical (p = 0.004), instrumental activity of daily living scores (p < 0.0001) and diagnosis of dementia versus other psychiatric diagnoses. However, lower cognitive score, depressive symptoms, age, gender, alcohol use, quality of life and general health did not differ between aggressive and non-aggressive patients. Aggression is not uncommon in community-dwelling elders in a rural psychogeriatric program. Careful evaluation for treatment of psychotic symptoms should be done in aggressive elders.

Positive symptoms of psychosis in posttraumatic stress disorder

The possible presence of hallucinations and delusional thoughts in posttraumatic stress disorder (PTSD) was investigated. Other symptom clusters were also assessed in order to further clarify the nature of PTSD. Twenty combat veterans with PTSD were compared to 18 combat veterans without PTSD on symptom rating scales. The subjects with PTSD exhibited a greater degree of depression, anxiety, agitation, anhedonia, and positive symptoms of psychosis than the comparison group. Specifically, the PTSD group manifested increased hallucinations, delusions, and bizarre behavior. Some of these positive symptoms did not appear to be due to reexperiencing of the trauma. The groups were not significantly different on indices of mania, thought disorder, or inertia. The clinical and diagnostic implications of the results are discussed. A diagnosis of PTSD should be considered with patients who have positive symptoms in the absence of thought disorder.

The Misdiagnosis of Hallucinations and Delusions in Persons with Mental Retardation: A Neurodevelopmental Perspective.

The identification of psychotic features in persons with mental retardation is challenging as the presence of hallucinations and delusions are disclosed through verbal self-report. In persons with mental retardation, self-report data is limited in utility because of the neuropsychological impairments that are uniformly reflected in limited communication and linguistic functions. Two major areas of misdiagnosis occur when interpreting reported hallucinations and delusions. First, the patient with mental retardation may experience a true hallucination or delusion, the content of which is very bizarre or disjointed, leading clinicians to identify schizophrenia or psychotic disorders when the condition is far less severe. Second, the patients's reported phenomena are not true hallucinations or delusions, but are instead self-talk, imaginary friends, or fantasy, similar to normal coping mechanisms of children. Mental health professionals must give priority to vegetative symptoms and mood states during the diagnostic assessment. It is also recommended that multiple sources of caregiver data be collected and that psychological projective testing be used as part of the evaluation process. Further, a false-positive strategy should be adopted when initiating treatment, favoring underdiagnosis of psychotic disorders.

Shared Psychotic Disorder: A Critical Review of the Literature

To search the literature to reassess the concept of shared psychotic disorder (SPD) using modern nosology and current biopsychosocial formulation. Analyzing published case reports from 1942 through to 1993 that meet DSM-IV criteria for SPD according to patient age, sex, nature and duration of the relationship with the "primary", length of exposure to primary's psychosis, family psychiatric history, comorbidity, social isolation of the dyad, presence of hallucinations, delusional type, and the diagnosis of the primary. Findings revealed: 1. males and females were affected with equal frequency; 2. there was equal prevalence in younger and older patients; 3. the majority of shared psychoses (90.2%) were equally distributed among married couples, siblings, and parent-child dyads; 4. comorbid dementia, depression, and mental retardation were common; 5. hallucinations were common; 6. the majority of dyads (67.3%) were socially isolated. SPD probably occurs in premorbidly disposed individuals in the context of social isolation which is shared with a psychotic person.

Prospective study of relations between cortical Lewy bodies, poor eyesight, and hallucinations in Alzheimer's disease.

The presence of hallucinations is included in some, but not all, of the sets of clinical diagnostic criteria that have been proposed for dementia associated with cortical Lewy bodies. These criteria were developed from retrospective casenote analyses. This prospective, longitudinal study suggests that, in patients with Alzheimer's disease, cortical Lewy bodies are associated with more persistent and severe hallucinations, independently of any association with severity of cognitive decline. Poor eyesight contributes to the severity but not the persistence of the hallucinations.

Mortality and hallucinations in nursing home patients with advanced Parkinson's disease.

We monitored 11 patients with advanced Parkinson's disease (PD) who entered nursing homes over a 5-year period and assessed chronicity of nursing home care, mortality, and hallucinatory status. Two years after the original study's close, none of these patients had ever been discharged from the nursing homes and all were dead. The mortality rate among the nursing home patients was significantly greater than that in 22 community-dwelling subjects with PD who were matched for age, gender, and disease duration. Hallucinatory status was generally stable; 82% of patients had the same hallucinatory status (presence or absence) at the two assessments. Four subjects from the original community-dwelling control group entered nursing homes during the follow-up period. Whereas motor and intellectual impairment scores were similar between these patients and the remaining 18 in the community, the presence of hallucinations was significantly greater among patients transferred to nursing homes. The study demonstrates the permanency of nursing home placement in advanced PD and the high mortality associated with such placement. It also documents the chronicity of hallucinatory behavior in these patients with advanced PD and reinforces our previously reported observations on the relationship between hallucinations and placement in chronic-care facilities.

Psychopathology and cognitive decline in dementia.

This study investigated the correlation between the degree and quality of cognitive impairment and the presence and degree of severity of psychopathology. Sixty-four demented outpatients were rated for cognition by the Mental Status Questionnaire and for psychopathology by the BEHAVE-AD Reisberg questionnaire. A statistical analysis of the correlations between the cognitive and psychopathological parameters was performed. The study indicated a high rate of psychopathology (as high as 83% of the patients). No significant correlation was found between the cognitive grading score and the presence of psychopathology, except in the space of declined spatial orientation and the occurrence of hallucinations. Psychopathology is a common phenomenon occurring in the course of dementia in the form of Alzheimer's disease or multi-infarct dementia. There is a certain increase in the degree of psychopathology that correlated with cognitive impairment. The high correlation between impaired spatial orientation and the presence of hallucinations seems to point to a common neuropathological substrate.

Magnetic resonance imaging in schizophrenia: relationship with clinical measures

Relationships were examined between clinical features of schizophrenia and cerebrospinal fluid (CSF) volume in brain obtained by magnetic resonance imaging (MRI) in a sample of 59 patients. The volumes of the cerebral hemispheres and CSF were measured with a computer program designed to separate reliably neural tissue from CSF. The CSF to cranial volume ratios were related to history, symptom profile and outcome functioning. Earlier age of onset was associated with higher sulcal CSF ratio, r=-0.40. The anatomic measures were unrelated to symptom severity. However, patient subtypes differed in the laterality of measures. Higher left hemispheric ratios were seen in patients with severe negative symptoms, and left predominance of ventricular relative to sulcal ratios was associated with the presence of hallucinations and delusions. The results suggest that while higher CSF is related to earlier age of onset, the clinical symptoms are more related to its lateralization. This is consistent with the hypothesis that schizophrenia is a lateralized brain disease.

The Lewy-Body Variant of Alzheimer's Disease

At post-mortem, Lewy bodies (LBs) were found in the brainstem and neocortex of eight out of 65 patients who had been collected during a prospective long-term study on clinically diagnosed Alzheimer's disease. All eight patients had accompanying Alzheimer pathology which was less severe than in a sample of eight age- and sex-matched patients from the same study with neuropathologically verified Alzheimer's disease. Parkinsonian features were more common in patients with LBs. There were no particular differences in duration of illness, severity of cognitive impairment, presence of hallucinations, or fluctuations in the course of illness. Frontal cerebral atrophy was more marked in patients with LBs, as was the loss of neurons in the basal nucleus of Meynert and the substantia nigra. Cognitive performance correlated with the number of pigmented neurons in the substantia nigra. We conclude that the differential diagnosis of LB dementia should be considered in patients satisfying NINCDS-ADRDA criteria for Alzheimer-type dementia who show marked Parkinsonian features and a frontal accentuation of cerebral atrophy.

Psychiatric disorders in the nursing home: A selective review of studies related to clinical care

AbstractExisting research demonstrates that nursing homes are the modern mental institutions for the elderly in the United States, but that training of staff and physicians, processes of care, and the recognition and treatment of mental disorders lag behind the current state of scientific knowledge. The prevalence of diagnosable psychiatric disorders has been estimated to be 80% or higher. The most common of these disorders are the dementias, primarily Alzheimer's or vascular, that can be uncomplicated or complicated by the presence of hallucinations, delusions, depression or behavioral symptoms. Other common disorders include depression and delirium. Problems currently under investigation include the effectiveness of special care units for patients with dementia, the characterization and treatment of the non‐cognitive, psychiatric symptoms of dementia, including consideration of the appropriate use of psychotropic medications, and the recognition, diagnosis, and treatment of depression. Although there is a clear need for more research, the available data already demonstrate the need for augmented psychiatric input into nursing home care.

The Relationship of Competency to Stand Trial and Criminal Responsibility

Mental health professionals have been accused of confusing the constructs of competency to stand trial and criminal responsibility with each or with a third construct such as psychosis. This investigation examined the relationship between decisions about competency to stand trial and criminal responsibility in a sample of 121 defendants admitted to a state hospital for pretrial evaluation. In addition, the investigation examined correlates of the two kinds of decisions using demographic data, measures of cognitive functioning and psychopathology, and a rating of crime severity. Conclusions about the empirical relationship between competency and responsibility judgments were precluded because examiners classified most incompetent defendants as “undetermined” on the issue of criminal responsibility. Nevertheless, interesting differences in the correlates of the two legal decisions were obtained. Competency decisions showed modest but significant correlations with performance on a test of competency abilities, a measure of intellectual functioning, and psychiatric diagnosis. Responsibility decisions were most strongly correlated with two indices of psychopathology-psychiatric diagnosis and the presence of hallucinations and delusions.

Lateralization of spike and wave complexes produced by hallucinogenic compounds in the cat

The ability of four hallucinogenic compounds—ketamine, phencyclidine, quipazine, and SKF-10 047—to produce some specific electrical pattern in portions of the limbic system and the hemispheric lateralization of such effects were studied in cats with permanently implanted electrodes. Electronic frequency and area integrators were used to analyze the results, and the percentage change in electrographic alterations was calculated. All compounds studied produced trains of spike and wave complexes in the cingulum, rapid discharges in the amygdala complex, and slow-wave synchronous activity in the septal nucleus. Those changes predominated in the left hemisphere. At small but hallucinatory concentrations of these drugs, the cortical EEG was not affected. Exploratory movements directed toward nonexistent objects, classified as hallucinatory-like behavior, appeared simultaneous with these changes in the EEG recordings. We concluded that there could exist a relationship between the appearance of spike and wave complexes in the limbic system without epileptic signs (twitching or myoclonus) and the presence of hallucinations, and that there is a left side hemispheric lateralization of the electrographic effects, viewing cerebral dominance phenomena as a functional and fluctuating state.

Spike and wave complexes produced by four hallucinogenic compounds in the cat

The ability of four hallucinogenic compounds: ketamine, phencyclidine, quipazine and SKF-10,047 to produce spike and wave activity in the limbic system, was studied in cats with permanently implanted electrodes. Electronic frequency integrators were used to analyze the results and the percent of change in electrographic alterations was calculated. All the compounds studied, produced trains of 6/sec spike and waves complexes in the cingulum, rapid synchronous discharges in the amygdaloid complex, and slow wave synchronous activity and spiking in the septal areas. At low but hallucinatory concentrations of these drugs, the cortical EEG was not affected. Exploratory movements directed toward non-existent objects, classified as hallucinatory-like behavior, appeared simultaneous with these changes in the EEG recordings. It was concluded that there could exist a relationship between the appearance of 6/sec spike and wave complexes in the cingulum and the presence of hallucinations, produced by some synthetic drugs in the cat, this activity could be interpreted as the spreading of alterated function of limbic and non-limbic nuclei related with this bundle which explain unspecificity of action.