Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
One study from as early as 1895 reported that approximately 10% of the population experiences hallucinations. A 1996-1999 survey of over 13,000 people reported a much higher figure, with almost 39% of people reporting hallucinatory experiences, 27% of which daytime hallucinations, mostly outside the context of illness or drug use. From this survey, olfactory (smell) and gustatory (taste) hallucinations seem the most common in the general population.
Hypoacusis is defined as impairment in hearing or deafness. Hypoacusis is one of five etiologies of musical hallucinations, and is the most common in the case studies reviewed by Evers and Ellgers. According to Sanchez et al. 2011, there have been suggestions that pontine lesions could alter the central auditory system's function causing hypoacusis and musical hallucinations.
Investigators have successfully narrowed down the major factors that are associated with musical hallucinations. Evers and Ellgers compiled a significant portion of musical hallucination articles, case studies etc. and were able to categorize five major etiologies:
- Hypoacusis
- Psychiatric disorders
- Focal brain lesion
- Epilepsy
- Intoxication
In 2015 a small survey reported voice hearing in persons with a wide variety of DSM-5 diagnoses, including:
- Bipolar disorder
- Borderline personality disorder
- Depression (mixed)
- Dissociative identity disorder
- Generalized anxiety disorder
- Major depression
- Obsessive compulsive disorder
- Post-traumatic stress disorder
- Psychosis (NOS)
- Schizoaffective disorder
- Schizophrenia
However, numerous persons surveyed reported no diagnosis. In his popular 2012 book "Hallucinations", neurologist Oliver Sacks describes voice hearing in patients with a wide variety of medical conditions, as well as his own personal experience of hearing voices.
A paracusia, or auditory hallucination, is a form of hallucination that involves perceiving sounds without auditory stimulus.
A common form of auditory hallucination involves hearing one or more talking voices. This may be associated with psychotic disorders, and holds special significance in diagnosing these conditions. However, individuals without any psychiatric disease whatsoever may hear voices.
There are three main categories into which the hearing of talking voices often fall: a person hearing a voice speak one's thoughts, a person hearing one or more voices arguing, or a person hearing a voice narrating his/her own actions. These three categories do not account for all types of auditory hallucinations.
Other types of auditory hallucination include exploding head syndrome and musical ear syndrome. In the latter, people will hear music playing in their mind, usually songs they are familiar with. This can be caused by: lesions on the brain stem (often resulting from a stroke); also, sleep disorders such as narcolepsy, tumors, encephalitis, or abscesses. This should be distinguished from the commonly experienced phenomenon of getting a song stuck in one's head. Reports have also mentioned that it is also possible to get musical hallucinations from listening to music for long periods of time. Other reasons include hearing loss and epileptic activity.
In the past, the cause of auditory hallucinations has been attributed to cognitive suppression by way of executive function failure of the fronto-parietal sulcus. Newer research has found that they coincide with the left superior temporal gyrus, suggesting that they are better attributed to speech misrepresentations. It is assumed through research that the neural pathways involved in normal speech perception and production, which are lateralized to the left temporal lobe, also underlie auditory hallucinations . Auditory hallucinations correspond with spontaneous neural activity of the left temporal lobe, and the subsequent primary auditory cortex. The perception of auditory hallucinations correspond to the experience of actual external hearing, despite the absence of physical acoustic output .
Anomalous experiences, such as so-called benign hallucinations, may occur in a person in a state of good mental and physical health, even in the apparent absence of a transient trigger factor such as fatigue, intoxication or sensory deprivation.
The evidence for this statement has been accumulating for more than a century. Studies of benign hallucinatory experiences go back to 1886 and the early work of the Society for Psychical Research, which suggested approximately 10% of the population had experienced at least one hallucinatory episode in the course of their life. More recent studies have validated these findings; the precise incidence found varies with the nature of the episode and the criteria of ‘hallucination’ adopted, but the basic finding is now well-supported.
Studies suggest that the prevalence of paraphrenia in the elderly population is around 2-4%.
Tactile hallucination is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object. It is caused by the faulty integration of the tactile sensory neural signals generated in the spinal cord and the thalamus and sent to the primary somatosensory cortex (SI) and secondary somatosensory cortex (SII). Tactile hallucinations are recurrent symptoms of neurological diseases such as schizophrenia, Parkinson's disease, Ekbom's syndrome and delerium tremens. Patients who experience phantom limb pains also experience a type of tactile hallucination. Tactile hallucinations are also caused by drugs such as cocaine and alcohol.
While paraphrenia can occur in both men and women, it is more common in women, even after the difference has been adjusted for life expectancies. The ratio of women with paraphrenia to men with paraphrenia is anywhere from 3:1 to 45:2
The occurrence of MES has been suggested to be very high among the hearing impaired through acquired deafness or the ear condition known as tinnitus. Though exact causation is uncertain, it has been theorized that the "release phenomenon" is taken into effect. The "release phenomenon" says that individuals with acquired deafness may experience musical hallucinations because the lack of stimulation, which can give room for the brain to interpret internal sounds as being external.
Sufferers typically hear music or singing and the condition is more common in women. The hallucinatory experiences differ from that commonly experienced in psychotic disorders although there may be some overlap. The most important distinction is the realization that the hallucinations are not real. Delusional beliefs associated with the hallucinations may occur, but some degree of insight should be preserved. There should not be any other psychotic symptoms present, especially hallucinations in other modalities.
A longitudinal study on pregnant females found that 76% of pregnant females experienced significant changes in gustation and olfaction perception. This was found to be caused and linked to their pregnancy. The study concluded that 67% of the pregnant females had reported a higher level of sensitivity to smell, 17% suffered from an olfactory distortion and 14% suffered from phantosmia; these distortions were very minimal towards the last stages of pregnancy and in the majority were not present post partum. Furthermore, 26% of these participants also claimed that they also experienced an increased sensitivity to foods that were bitter and a decreased sensitivity to salt. These findings suggest that pregnant females experience distorted smell and taste perception during pregnancy. It has also been found that 75% of women alter their diets during pregnancy. Further research is being conducted to determine the mechanism behind food cravings during pregnancy.
Musical hallucinations and MES have only become widely recognizable in the last few decades of research, but there are indications throughout history that have described symptoms of musical hallucinations. The Romantic composer Robert Schumann was said to have heard entire symphonies in his head from which he drew as inspiration for his music, but later in his life this phenomenon had diminished to just a note that played ceaselessly within his head. An alternative explanation is that his symptoms were caused by syphilis or mercury poisoning used for its treatment. The Russian composer Dmitri Shostakovich was also recorded as experiencing music hallucinations after some shrapnel was removed from his skull.
Phantosmia has been found to co-exist in patients with other disorders such as schizophrenia, epilepsy, alcoholic psychosis, and depression. It has also been found that many patients may begin to suffer from depression after the occurrence of phantosmia and have looked towards committing suicide. The occurrence of depression resulted from the severe symptoms of phantosmia as everything even food smelled spoilt, rotten and burnt for these patients. By the age of 80, 80% of individuals develop an olfactory disorder. As well 50% of these individuals suffer from anosmia.
Whatever the cause, the bodily related distortions can recur several times a day and may take some time to abate. Understandably, the person can become alarmed, frightened, and panic-stricken throughout the course of the hallucinations—maybe even hurt themselves or others around them. The symptoms of the syndrome themselves are not harmful and are likely to disappear with time.
The average age of the start of Alice in Wonderland syndrome is six but it is very normal for some to experience the syndrome from childhood to their late 20s. It is also thought that this syndrome is hereditary because many parents that have AIWS report their children having it as well.
A pseudohallucination is an involuntary sensory experience vivid enough to be regarded as a hallucination, but recognised by the patient not to be the result of external stimuli. Unlike normal hallucinations, which occurs when one sees, hears, smells, tastes or feels something that is not there, with a compelling feeling or thought that it is real, pseudohallucinations are recognised by the person as unreal.
In other words, it is a hallucination that is recognized as a hallucination, as opposed to a "normal" hallucination which would be perceived as real. An example used in psychiatry is the hearing of voices which are "inside the head" according to the patient; in contrast, a hallucination would be indistinguishable to the patient from a real external stimulus, e.g. "people were talking about me".
The term is not widely used in the psychiatric and medical fields, as it is considered ambiguous; the term "nonpsychotic hallucination" is preferred. Pseudohallucinations, then, are more likely to happen with a hallucinogenic drug. But "the current understanding of pseudohallucinations is mostly based on the work of Karl Jaspers".
A further distinction is sometimes made between pseudohallucinations and "parahallucinations", the latter being a result of damage to the peripheral nervous system.
They are considered a feature of conversion disorder, somatization disorder, and dissociative disorders. Also, pseudohallucinations can occur in people with visual/hearing loss, with the typical such type being Charles Bonnet syndrome.
There is evidence that trauma during childhood increases the risk of developing psychosis. One meta-analysis found that 60-70% of those who experience psychosis have experienced childhood trauma (abuse and neglect). The relationship appears to be causal and cumulative one, meaning the more adverse childhood events experienced the greater the likelihood of developing psychosis of one kind of another.
Chronic hallucinatory psychosis is a psychosis subtype, classified under "Other nonorganic psychosis" by the . Other abnormal mental symptoms in the early stages are, as a rule, absent. The patient is most usually quiet and orderly, with a good memory.
It has often been a matter of the greatest difficulty to decide under which heading of the recognized classifications individual members of this group should be placed. As the hallucinations give rise to slight depression, some might possibly be included under melancholia. In others, paranoia may develop. Others, again, might be swept into the widespread net of dementia praecox. This state of affairs cannot be regarded as satisfactory, for they are not truly cases of melancholia, paranoia, dementia praecox or any other described affection.
This disease, as its name suggests, is a hallucinatory case, for it is its main feature. These may be of all senses, but auditory hallucinations are the most prominent. At the beginning, the patient may realize that the hallucination is a morbid phenomenon and unaccountable. They may claim to hear a "voice" speaking, though there is no one in the flesh actually doing so. Such a state of affairs may last for years and possibly, though rarely, for life, and the subject would not be deemed insane in the ordinary sense of the word.
It's probable, however, that this condition forms the first stage of the illness, which eventually develops on definite lines. What usually happens is the patient seeks an explanation for the hallucinations. As none is forthcoming he/she tries to account for their presence and the result is a delusion, and, most frequently, a delusion of persecution. Also, it needs to be noted that the delusion is a comparatively late arrival and is the logical result of the hallucinations.
People with significant vision loss may have vivid, complex recurrent visual hallucinations (fictive visual percepts). One characteristic of these hallucinations is that they usually are "lilliputian" (hallucinations in which the characters or objects are smaller than normal). The most common hallucination is of faces or cartoons. Sufferers understand that the hallucinations are not real, and the hallucinations are only visual, that is, they do not occur in any other senses, e.g. hearing, smell or taste. Among older adults (> 65 years) with significant vision loss, the prevalence of Charles Bonnet syndrome has been reported to be between 10% and 40%; a 2008 Australian study found the prevalence to be 17.5%. Two Asian studies, however, report a much lower prevalence. The high incidence of non-reporting of this disorder is the greatest hindrance to determining the exact prevalence; non-reporting is thought to be a result of sufferers being afraid to discuss the symptoms out of fear that they will be labelled insane.
People suffering from CBS may experience a wide variety of hallucinations. Images of complex colored patterns and images of people are most common, followed by animals, plants or trees and inanimate objects. The hallucinations also often fit into the person's surroundings.
According to some studies, the more often cannabis is used the more likely a person is to develop a psychotic illness, with frequent use being correlated with twice the risk of psychosis and schizophrenia. While cannabis use is accepted as a contributory cause of schizophrenia by some, it remains controversial, with pre-existing vulnerability to psychosis emerging as the key factor that influences the link between cannabis use and psychosis. Some studies indicate that the effects of two active compounds in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), have opposite effects with respect to psychosis. While THC can induce psychotic symptoms in healthy individuals, CBD may reduce the symptoms caused by cannabis.
Cannabis use has increased dramatically over the past few decades whereas the rate of psychosis has not increased. Together, these findings suggest that cannabis use may hasten the onset of psychosis in those who may already be predisposed to psychosis. High-potency cannabis use indeed seems to accelerate the onset of psychosis in predisposed patients. A 2012 study concluded that cannabis plays an important role in the development of psychosis in vulnerable individuals, and that cannabis use in early adolescence should be discouraged.
CBS predominantly affects people with visual impairments due to old age, diabetes or other damage to the eyes or optic pathways. In particular, central vision loss due to a condition such as macular degeneration combined with peripheral vision loss from glaucoma may predispose to CBS, although most people with such deficits do not develop the syndrome.
The syndrome can also develop after bilateral optic nerve damage due to methyl alcohol poisoning.
About 7% of individuals with Parkinson's disease also experience mild or severe types of tactile hallucinations. Most of these hallucinations are based on the sensation of a particular kind of animal. Several case studies were conducted by Fénelon and his colleagues on parkinson's patients that had tactile hallucinations. One of his patients described that he sensed "spiders and cockroaches chewing on his lower limb" which was rather painful. Several other patients felt that there was a parasitic infestation of their skin which caused lesions on their skins due to the obsessive need of itching. Fénelon also analyzed the particular types of tactile hallucinations experienced, the timing of such experience and certain drugs that could eliminate such experience. It was concluded that patients with both Parkinson's disease and tactile hallucinations not only experienced sensations elicited by insects under their skin but also by vivid tactile sensations of people. These hallucinations were aggravated during evening times due to altered arousal states and were alleviated by dopaminergic treatment such as the intake of clozapine. The study also explains that the pathophysiology of tactile hallucinations is uncertain, however, such hallucinations can be attributed to narcoleptic rapid eye movement sleep disorders due to its concordance with visual hallucinations. Moreover, it emphasizes that individuals who have had Parkinson's for a longer period of time have a more severe form of tactile hallucinations than with individuals who have succumbed to this disease for just a short period of time.
Clinical drugs used as an antiparkinsonian agent such as Trihexyphenidyl are known to create tactile hallucinations in parkinson patients.
Peduncular hallucinosis (PH), or Lhermitte's peduncular hallucinosis, is a rare neurological disorder that causes vivid visual hallucinations that typically occur in dark environments, and last for several minutes. Unlike some other kinds of hallucinations, the hallucinations that patients with PH experience are very realistic, and often involve people and environments that are familiar to the affected individuals. Because the content of the hallucinations is never exceptionally bizarre, patients can rarely distinguish between the hallucinations and reality.
In 1922, the French neurologist Jean Lhermitte documented the case of a patient who was experiencing visual hallucinations that were suggestive of localized damage to the midbrain and pons. After other similar case studies were published, this syndrome was labeled "peduncular hallucinosis."
The accumulation of additional cases by Lhermitte and by others influenced academic medical debate about hallucinations and about behavioral neurology.
Lhermitte provided a full account of his work in this area in his book "Les hallucinations: clinique et physiopathologie," which was published in Paris in 1951 by Doin publishing.
Contemporary researchers, with access to new technologies in medical brain imaging, have confirmed the brain localization of these unusual hallucinations.
Schizophrenia disorders in children are rare. Boys are twice as likely to be diagnosed with childhood schizophrenia. There is often an disproportionately large number of males with childhood schizophrenia, because the age of onset of the disorder is earlier in males than females by about 5 years. People have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it.
While very early-onset schizophrenia is a rare event, with prevalence of about 1:10,000, early-onset schizophrenia is manifests more often with an estimated prevalence of 0.5 %.
There is no known single cause or causes of schizophrenia, however, it is a heritable disorder.
Several environmental factors, including perinatal complications and prenatal maternal infections could cause schizophrenia. These factors in a greater severity or frequency could result in an earlier onset of schizophrenia. Maybe a genetic predisposition is a important factor too, familial illness reported for childhood-onset schizophrenic patients.