On Organically Based Hallucinatory-Delusional Psychoses

Abstract

In an investigation of 70 chronically mentally ill patients in a district psychiatric hospital, 11 cases were discovered which had been diagnosed up to now as schizophrenia, but could now be diagnosed as being of organic origin. In group 1 (cases 1–6) there are dementive states after toxic, inflammatory or early childhood brain damage and familial epileptic malady with slowly progressive brain atrophy. They were easy to recognize clinically in their organic psychosyndromes, dementia, neurological symptoms and CT findings showing extensive, massive brain damage. In group 2 (cases 7–11), in contrast, there are patients with chronic psychoses of remittent course, with brain findings indicative of centrencephalic damage. On superficial examination they give a schizophrenic picture, but can be differentiated from this by the absence of schizophrenic personality changes and thought disturbances, and also by the form of the hallucinations. These are distinguished by their plastic character, and show the criteria which Schroder had already pointed out 60 years ago for the differentiation of exogenous and endogenous hallucinations.

Prevalence and classification of hallucinations in multiple sensory modalities in schizophrenia spectrum disorders

“…A reason why other studies failed to replicate the findings of these authors may be that they did not broaden their scope to include other types of hallucination (Waters et al, 2014) and that the prevalence of MMHs has therefore been systematically underestimated. Secondly, the presence of hallucinations in other sensory modalities has traditionally led to non-psychiatric diagnoses (Waters et al, 2014) such as organic or neurological ones (Roberts, 1984;Albert, 1987). Another explanation may be that the CASH, apart from providing a systematic screening of hallucinations in four sensory modalities, has the advantage of describing their presentstate occurrence as well as their lifetime presence.…”

“…As noted in a review (Waters et al, 2014) the nature of the relationship between hallucinations of different sensory modalities has hardly been examined. Although this situation is not unique for schizophrenia spectrum disorders (Waters et al, 2014), some studies indicate that the prevalence of multimodal hallucinations may be severely underestimated in this group (Goodwin et al, 1971) while others indicate that the presence of MMHs may be indicative of an underlying organic etiology (Roberts, 1984;Albert, 1987), or, in children and adolescents, of a more severe expression of schizophrenia (David et al, 2011;Jardri et al, 2014;Cachia et al, 2015).…”

Auditory Verbal Hallucinations – Breaking the Silence of Inner Dialogue

“…Is there any evidence in brain imaging studies that hallucinations, and especially AVHs, have a sensory basis [Shergill et al, 2000]? Why is it often so difficult for patients to report the acoustic characteristics of their voices -the owner of the voice [Nayani and David, 1996] and the voices' wording, tone, directions, strength [Albert, 1987] -and their physical features -location and ownership [Cutting, 1997]? Why is it so puzzling for them to place them in a Euclidean, intuitive geometric space?…”

Multi-Modal Hallucinations

“…The highly elabo rate way in which they are described and the patients' seeming indifference to their appar ently frightening nature have led some au thors to consider them examples of fantasy thinking rather than being truly hallucinatory. Other authors, however, have taken up an opposite position, and have suggested that this type of hallucination indicates an organic brain syndrome [7].…”

“…Bleuler further states that complex scenic hallucinations vivified by hal lucinations of other senses are restricted to acute twilight states, raising the possibility that these were cases of symptomatic schizo phrenia. Similarly Albert [7] described 11 cases of chronic psychoses, in which multi modal hallucinations were prominent, which were associated with evidence of organic brain damage. Reviewing the German litera ture Albert found that scenic hallucinations involving several modalities were particularly common in paranoid conditions following en cephalitis lethargica and had also been re ported in isolated cases of Huntington's cho rea, carbon monoxide poisoning and hypopi tuitarism.…”