What are Hallucinations in Psychosis?

Introduction

Visual hallucinations in psychosis are hallucinations accompanied by delusions, which are abnormal beliefs that are endorsed by patients as real, that persist in spite of evidence to the contrary, and that are not part of a patient’s culture or subculture.

Presentation

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 colourful or in black and white and can be static or have movement.

Simple versus Complex

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 multicoloured lights, colours, geometric shapes, indiscrete objects. Simple visual hallucinations without structure are known as phosphenes and those with geometric structure are known as photopsias. These hallucinations are caused by irritation to the primary visual cortex (Brodmann’s area 17).

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.

Content

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. 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. Individuals often report being surprised when hallucinations occur and are generally helpless to change or stop them. In general, individuals believe that visions are experienced only by themselves.

Causes

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

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 centres responsible for visual processing. Irritation of visual association cortices (Brodmann’s areas 18 and 19) cause complex visual hallucinations.

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.

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.

Prevalence

Hallucinations in those with psychoses are often experienced in colour, 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. The DSM-V lists visual hallucinations as a primary diagnostic criterion for several psychotic disorders, including schizophrenia and schizoaffective disorder.

The lifetime prevalence of all psychotic disorders is 3.48% and that of the different diagnostic groups are as follows:

  • 0.87% 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.
  • 0.21% for psychotic disorders due to a general medical condition.

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. 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.

Book: Wrestling With My Thoughts: A Doctor With Severe Mental Illness Discovers Strength

Book Title:

Wrestling With My Thoughts: A Doctor With Severe Mental Illness Discovers Strength.

Author(s): Sharon Hastings.

Year: 2020.

Edition: First (1st).

Publisher: IVP.

Type(s): Paperback and Kindle.

Synopsis:

She couldn’t believe it. There she was with her medical qualifications sitting on the floor of a mental hospital. She’d offered her life to God, wanted to serve him anywhere, but no, surely not this… Sharon Hastings is absolutely passionate about helping anyone who suffers from ‘severe and enduring mental illness’ (SEMI): schizophrenia, bipolar disorder and schizoaffective disorder. She wants the church to know all about these illnesses: how they devastate ordinary people and how they need to be treated. By telling her story, warts and all, showing her own tortuous, painful journey, she equips us to come alongside loved ones, fellow church members, friends and neighbours, understanding the social and spiritual ramifications of their illnesses, including them in our activities (where appropriate) and encouraging their spiritual growth. A natural storyteller, the author draws us in. We journey with her. With wisdom, kindness and the heart of a bruised survivor, she interweaves her exceptional story with vital teaching which simply cannot be ignored by anyone within the church today.

Book: Heavy Light: A Journey Through Madness, Mania and Healing

Book Title:

Heavy Light: A Journey Through Madness, Mania and Healing.

Author(s): Horatio Clare.

Year: 2021.

Edition: First (1st).

Publisher: Chatto & Windus.

Type(s): Hardcover, Audiobook, and Kindle.

Synopsis:

Heavy Light is the story of a breakdown: a journey through mania, psychosis and treatment in a psychiatric hospital, and onwards to release, recovery and healing.

After a lifetime of ups and downs, Horatio Clare was committed to hospital under Section 2 of the Mental Health Act.

From hypomania in the Alps, to a complete breakdown and a locked ward in Wakefield, this is a gripping account of how the mind loses touch with reality, how we fall apart and how we can be healed – or not – by treatment. A story of the wonder and intensity of the manic experience, as well as its peril and strangeness, it is shot through with the love, kindness, humour and care of those who deal with someone who becomes dangerously ill.

Partly a tribute to those who looked after Horatio, from family and friends to strangers and professionals, and partly an investigation into how we understand and treat acute crises of mental health, Heavy Light’s beauty, power and compassion illuminate a fundamental part of human experience. It asks urgent questions about mental health that affect each and every one of us.

Book: Anti-Oedipus: Capitalism and Schizophrenia

Book Title:

Anti-Oedipus: Capitalism and Schizophrenia (Bloomsbury Revelations).

Author(s): Gilles Deleuze and Felix Guattari.

Year: 2013.

Edition: First (1st).

Publisher: Bloomsbury Academic.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

The collaboration of the philosopher Gilles Deleuze and the psychoanalyst Felix Guattari has been one of the most profoundly influential partnerships in contemporary thought. Anti-Oedipus is the first part of their masterpiece, Capitalism and Schizophrenia. Ranging widely across the radical tradition of 20th Century thought and culture that preceded them – from Foucault, Lacan and Jung to Samuel Beckett and Henry Miller – this revolutionary analysis of the intertwining of desire, reality and capitalist society is an essential read for anyone interested in post-war continental thought.

Book: Surviving Schizophrenia: A Family Manual

Book Title:

Surviving Schizophrenia: A Family Manual.

Author(s): E. Fuller Torrey.

Year: 2019.

Edition: Seventh (7th).

Publisher: HarpPeren.

Type(s): Paperback and Kindle.

Synopsis:

Since its first publication in 1983, Surviving Schizophrenia has become the standard reference book on the disease and has helped thousands of patients, their families, and mental health professionals.

In clear language, this much-praised and important book describes the nature, causes, symptoms, treatment, and course of schizophrenia and also explores living with it from both the patient’s and the family’s point of view. This new, completely updated seventh edition includes the latest research findings on what causes the illness, as well as information about the newest drugs for treatment, and answers the questions most often asked by families, consumers, and providers.

An indispensable guide for those afflicted by schizophrenia as well those who care for them, Surviving Schizophrenia covers every aspect of the condition and sheds new light on an often-misunderstood illness.

Book: Schizophrenia: A Very Short Introduction

Book Title:

Schizophrenia: A Very Short Introduction (Very Short Introductions).

Author(s): Chris Frith and Eve C. Johnstone.

Year: 2003.

Edition: First (1st).

Publisher: OUP Oxford.

Type(s): Paperback and Kindle.

Synopsis:

Schizophrenia is the archetypal form of madness. Schizophrenia is a common disorder and has a devastating effect on sufferers and their families-patients typically hear voices in their heads and hold bizarre beliefs. The schizophrenic patient presented to the public in sensational press reports and lurid films bears little resemblance to reality of the illness. This book describes what schizophrenia is really like, how the illness progresses, and the treatments that have been applied. It also summarises the most up-to-date knowledge available about the biological bases of this disorder. Finally it attempts to give some idea of what it is like to have schizophrenia and what this disorder tells us about the relationship between mind and brain.

Book: The Collected Schizophrenias

Book Title:

The Collected Schizophrenias.

Author(s): Emse Weijun Wang.

Year: 2019.

Edition: First (1st).

Publisher: Penguin.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Esmé Weijun Wang was officially diagnosed with schizoaffective disorder in 2013, although the hallucinations and psychotic episodes had started years before that. In the midst of a high functioning life at Yale, Stanford and the literary world, she would find herself floored by an overwhelming terror that ‘spread like blood’, or convinced that she was dead, or that her friends were robots, or spiders were eating holes in her brain. What happens when your whole conception of yourself is turned upside down? When you’re aware of what is occurring to you, but unable to do anything about it?

Written with immediacy and unflinching honesty, this visceral and moving book is Wang’s story, as she steps both inside and outside of her condition to bring it to light. Following her own diagnosis and the many manifestations of schizophrenia in her life, she ranges over everything from how we label mental illness to her own use of fashion and make-up to present herself as high-functioning, from the failures of the higher education system to how factors such as PTSD and Lyme disease compounded her experiences. Wang’s analytical, intelligent eye, honed as a former lab researcher at Stanford, allows her to balance research with haunting personal narrative. The Collected Schizophrenias cuts right to the core and provides unique insight into a condition long misdiagnosed and much misunderstood.

Book: Schizophrenia for Dummies

Book Title:

Schizophrenia for Dummies.

Author(s): Jerome Levine.

Year: 2008.

Edition: First (1st).

Publisher: Wiley.

Type(s): Paperback and Kindle.

Synopsis:

Schizophrenia is a chronic, severe, and disabling mental disorder that afflicts one percent of the population, an estimated 2.5 million people in America alone. The firsthand advice in this reassuring guide will empower the families and caregivers of schizophrenia patients to take charge, offering expert advice on identifying the warning signs, choosing the right health professional, understanding currently available drugs and those on the horizon (as well as their side effects), and evaluating traditional and alternative therapies.

Book: The Insanity Machine: Living With Paranoid Schizophrenia

Book Title:

The Insanity Machine: Living With Paranoid Schizophrenia.

Author(s): Kenna McKinnon and Austin Mardon.

Year: 2017.

Edition: First (1st).

Publisher: CreateSpace Independent Publishing Platform.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

The Insanity Machine is an introspective look at life with paranoid schizophrenia. This book takes a clinical and observational look at the challenges presented by the condition.

Kenna discusses the definition of paranoid schizophrenia, treatments, living with the disorder, and many other topics surrounding schizophrenia. The Insanity Machine is a nonfiction story about our journey with schizophrenia, which is also well researched and suitable for therapists or family practitioners as a reference book.

The book includes the latest treatments and research, as well as personal vignettes and suggestions which a client or caregiver will find extremely helpful. The book focuses on hope and positive outcomes.

Book: Transactional Analysis of Schizophrenia: The Naked Self.

Book Title:

Transactional Analysis of Schizophrenia: The Naked Self (Innovations in Transactional Analysis: Theory and Practice).

Author(s): Zefiro Mellacqua.

Year: 2020.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

In Transactional Analysis of Schizophrenia: The Naked Self, Zefiro Mellacqua presents a full assessment of the relevance and value of transactional analysis in understanding, conceptualizing and treating schizophrenia in contemporary clinical settings.

Opening with a review of Eric Berne’s ideas, Mellacqua applies theory to the understanding and psychotherapeutic treatment of people suffering from first-episode schizophrenia and to those already living with more long-lasting psychotic levels of self-disturbance. The chapters address a series of crucial methodological themes, including the need for both intensive and extensive analytic sessions; the therapist’s tolerance of uncertainty and not knowing; the informative quality of both therapist’s and patient’s embodiment(s); the emergence of the transference-countertransference relationship; the link between silent transactions and unconscious communication; dream analysis; and the value of regular supervisions. Mellacqua’s approach incorporates meetings with family and caregivers, as well as emphasising multidisciplinary work with patients in a variety of settings, such as in hospitals, outpatient clinics, and psychiatric home treatment. The book is illustrated with engaging clinical case studies throughout, which illuminate the schizophrenic experience and provide examples of how these tools can be used to help patients.

Transactional Analysis of Schizophrenia demonstrates how those who suffer from acute schizophrenia, especially those at their very first episode of psychosis, can make an effective recovery and live a satisfying life through the therapeutic application of transactional analysis. It will be essential reading for transactional analysts, psychodynamically oriented psychotherapists, psychologists, psychiatrists, nurses, social workers, academics and all mental health professionals working with people suffering from schizophrenic psychoses.