RESUMEN
Hallucination is a sensory perception that occurs in the absence of external stimuli during abnormal neurological disturbances and various mental diseases. Hallucination is recognized as a core psychotic symptom and is particularly more prevalent in individuals with schizophrenia. Strikingly, a significant number of subjects with Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and other neurological diseases like cerebral stroke and epileptic seizure also experience hallucination. While aberrant neurotransmission has been linked to the neuropathogenic events of schizophrenia, the precise cellular mechanism accounting for hallucinations remains obscure. Neurogenesis is a cellular process of producing new neurons from the neural stem cells (NSC)-derived neuroblasts in the brain that contribute to the regulation of pattern separation, mood, olfaction, learning, and memory in adulthood. Impaired neurogenesis in the hippocampus of the adult brain has been linked to stress, anxiety, depression, and dementia. Notably, many neurodegenerative disorders are characterized by the mitotic and functional activation of neuroblasts and cell cycle re-entry of mature neurons leading to a drastic alteration in neurogenic process, known as reactive neuroblastosis. Considering their neurophysiological properties, the abnormal integration of neuroblasts into the existing neural network or withdrawal of their connections can lead to abnormal synaptogenesis, and neurotransmission. Eventually, this would be expected to result in altered perception accounting for hallucination. Thus, this article emphasizes a hypothesis that aberrant neurogenic processes at the level of reactive neuroblastosis could be an underlying mechanism of hallucination in schizophrenia and other neurological diseases.
Asunto(s)
Alucinaciones , Hipocampo , Neurogénesis , Plasticidad Neuronal , Esquizofrenia , Humanos , Esquizofrenia/patología , Esquizofrenia/fisiopatología , Alucinaciones/patología , Alucinaciones/fisiopatología , Plasticidad Neuronal/fisiología , Hipocampo/patología , Neurogénesis/fisiología , Animales , Células-Madre Neurales/patología , Neuronas/patología , Neuronas/metabolismoRESUMEN
BACKGROUND: Persistent auditory verbal hallucinations (pAVHs) are a fundamental manifestation of schizophrenia (SCZ), yet the exact connection between pAVHs and brain structure remains contentious. This study aims to explore the potential correlation between pAVHs and alterations in grey matter volume (GMV) within specific brain regions among individuals diagnosed with SCZ. METHODS: 76 SCZ patients with pAVHs (pAVH group), 57 SCZ patients without AVHs (non-AVH group), and 83 healthy controls (HC group) were investigated using 3 T magnetic resonance imaging. The P3 hallucination item of the Positive and Negative Syndrome Scale was used to assess the severity of pAVHs. Voxel-based morphometry was used to analyze the GMV profile between the three groups. RESULTS: Compared to the non-AVH and HC groups, the pAVH group exhibited extensive reduction in GMV within the frontotemporal cortex. Conversely, no significant difference in GMV was observed between the non-AVH and HC groups. The severity of pAVHs showed a negative correlation with GMV in several regions, including the right fusiform, right inferior temporal, right medial orbitofrontal, right superior frontal, and right temporal pole (p = 0.0036, Bonferroni correction). Stepwise linear regression analysis revealed that GMV in the right temporal pole (ß = -0.29, p = 0.001) and right fusiform (ß = -0.21, p = 0.01) were significantly associated with the severity of pAVHs. CONCLUSIONS: Widespread reduction in GMV is observed within the frontotemporal cortex, particularly involving the right temporal pole and right fusiform, which potentially contribute to the pathogenesis of pAVHs in individuals with chronic SCZ.
Asunto(s)
Sustancia Gris , Alucinaciones , Imagen por Resonancia Magnética , Esquizofrenia , Lóbulo Temporal , Humanos , Esquizofrenia/diagnóstico por imagen , Esquizofrenia/patología , Alucinaciones/diagnóstico por imagen , Alucinaciones/etiología , Alucinaciones/patología , Alucinaciones/fisiopatología , Masculino , Femenino , Adulto , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Enfermedad Crónica , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/patología , Persona de Mediana Edad , Adulto Joven , China , Pueblos del Este de AsiaRESUMEN
OBJECTIVE: Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic auto-immune disease involving several organs. Neuropsychiatric (NP) SLE (NPSLE) is frequent in j-SLE and associated with increased morbidity/mortality. Although NPSLE classification criteria exist, attributing NP features to j-SLE remains a major challenge. The study objective is to thoroughly describe j-NPSLE patients and assist in their diagnosis. METHODS: This is a 4-year retrospective monocentric study of j-SLE patients. NP events were attributed to j-SLE using standardised diagnostic criteria and multidisciplinary paediatric clinical expertise. Clinical features, brain magnetic resonance imaging (MRI)s and samples analysis including cerebrospinal fluid were assessed. A risk of j-NPSLE score was developed based on multivariable logistic regression analysis. RESULTS: Of 39 patients included, 44% were identified as having j-NPSLE. J-NPSLE diagnosis was established at the onset of j-SLE in 59% of patients. In addition to frequent kidney involvement (76%) and chilblains (65%), all j-NPSLE patients displayed psychiatric features: cognitive symptoms (82%), hallucinations (76%), depressed mood (35%), acute confused state (18%) and catatonia (12%). Neurological involvement was often mild and nonspecific, with headache (53%) in about half of the patients. The main features reported on brain MRI were nonspecific T2/FLAIR white matter hyperintensities (65%), and cerebral atrophy (88%). Upon immunosuppressive treatment, clinical improvement of NP features was observed in all j-NPSLE patients. The score developed to attribute j-NPSLE probability, guide further investigations and appropriate treatments is based on hallucinations, memory, sleep and renal involvement (Sensitivity: 0.95 Specificity: 0.85). Cerebrospinal fluid (CSF) neopterin assessment increases the score sensitivity and specificity. CONCLUSION: Physicians should carefully and systematically assess the presence of NP features at diagnosis and early stages of j-SLE. For j-NPSLE patients with predominant psychiatric features, a multidisciplinary collaboration, including psychiatrists, is essential for the diagnosis, management and follow-up.
Asunto(s)
Lupus Eritematoso Sistémico , Vasculitis por Lupus del Sistema Nervioso Central , Humanos , Niño , Vasculitis por Lupus del Sistema Nervioso Central/patología , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/patología , Estudios Retrospectivos , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Imagen por Resonancia Magnética/métodos , Alucinaciones/complicaciones , Alucinaciones/patologíaRESUMEN
ABSTRACT: Hallucinations can be caused by biological, psychological, neurological, ophthalmological, and environmental factors. This article discusses a selection of the various conditions that can present with visual disturbances and hallucinations including schizophrenia, HIV, neurosyphilis, hyperammonemia, migraine, substance use, brain tumors, sleep disturbances, thyroid disorders, delirium, ophthalmologic conditions, and Lewy body dementia, providing an overview of the differential diagnosis of visual hallucinations. The mechanisms by which these conditions can lead to hallucinations are also discussed, and insight into the recommended medical workup for each is provided.
Asunto(s)
Oftalmopatías , Enfermedad por Cuerpos de Lewy , Trastornos Migrañosos , Humanos , Alucinaciones/etiología , Alucinaciones/patología , Alucinaciones/psicología , Enfermedad por Cuerpos de Lewy/complicaciones , Enfermedad por Cuerpos de Lewy/patología , PercepciónRESUMEN
Although the initial symptoms of corticobasal degeneration (CBD) are varied, psychiatric symptoms are uncommon. Here, we report the autopsy findings of a patient with early CBD who presented with hallucinations. A 68-year-old man developed memory loss and visions of bears and insects. Because of slow vertical eye movement, postural instability, and levodopa-unresponsive parkinsonism, the patient initially was clinically diagnosed with progressive supranuclear palsy. He died of a urinary tract infection 11 months after the onset of the disease. Histopathological examination revealed neuronal loss and gliosis, which were severe in the substantia nigra and moderate in the globus pallidus and subthalamic nucleus. Astrocytic plaques were scattered throughout the amygdala and premotor cortex. The superficial cortical layers lacked ballooned neurons and spongiosis, and tau deposition was greater in glia than in neurons. The amygdala contained a moderate number of argyrophilic grains and pretangles. Western blot analysis showed a 37-kDa band among the low-molecular-weight tau fragments. Because the CBD pathology was mild, we attributed the patient's visual hallucinations to the marked argyrophilic grain pathology. CBD can occur with psychiatric symptoms, including visual hallucinations, and argyrophilic grain pathology may be associated with psychiatric symptoms.
Asunto(s)
Degeneración Corticobasal , Alucinaciones , Humanos , Masculino , Alucinaciones/patología , Alucinaciones/etiología , Anciano , Degeneración Corticobasal/patología , Degeneración Corticobasal/complicacionesRESUMEN
ABSTRACT Alice in Wonderland syndrome (AIWS) is a paroxysmal, perceptual, visual and somesthetic disorder that can be found in patients with migraine, epilepsy, cerebrovascular disease or infections. The condition is relatively rare and unique in its hallucinatory characteristics. Objective: To discuss the potential pathways involved in AIWS. Interest in this subject arose from a patient seen at our service, in which dysmetropsia of body image was reported by the patient, when she saw it in her son. Methods: We reviewed and discussed the medical literature on reported patients with AIWS, possible anatomical pathways involved and functional imaging studies. Results: A complex neural network including the right temporoparietal junction, secondary somatosensory cortex, premotor cortex, right posterior insula, and primary and extrastriate visual cortical regions seem to be involved in AIWS to varying degrees. Conclusions: AIWS is a very complex condition that typically has been described as isolated cases or series of cases.
RESUMO Síndrome de Alice no País das Maravilhas (SAPM) é uma condição paroxística visual perceptiva e somestésica que pode ser encontrada em pacientes com enxaqueca, epilepsia, doença cerebrovascular ou infecções. A condição é relativamente rara e tem características alucinatórias peculiares. Objetivo: Discutir as potenciais vias envolvidas na SAPM. O interesse pelo assunto surgiu com um caso de nosso serviço, onde a distropsia da imagem corporal foi relatada pela paciente, que via isto em seu filho. Métodos: Os autores revisaram e discutiram a literatura médica de casos relatados de SAPM, possíveis vias anatômicas envolvidas e estudos de imagem funcional. Resultados: Uma complexa rede neural incluindo junção temporoparietal direita, córtex somatossensitivo secundário, córtex pré-motor, região posterior da ínsula direita, e regiões do córtex visual primário e extra-estriatal têm diferentes graus de envolvimento na SAPM. Conclusão: SAPM é uma condição complexa que tipicamente foi descrita apenas com casos isolados ou séries de casos.
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Síndrome de Alicia en el País de las Maravillas/patología , Síndrome de Alicia en el País de las Maravillas/diagnóstico por imagen , Alucinaciones/patología , Alucinaciones/diagnóstico por imagen , Imagen por Resonancia Magnética , Neuroimagen/métodos , Cefalea/patología , Cefalea/diagnóstico por imagen , Vías NerviosasRESUMEN
The author studies the psychotic disorder auditory allucinations giving some considerations related to the pathologic mechanisms of this extremely complex syndrome.
Asunto(s)
Humanos , Percepción Auditiva , Alucinaciones/patología , Parapsicología , Telepatía , Trastornos Psicóticos/etiologíaRESUMEN
Neste artigo, os autores descrevem dois casos de síndrome de Charles Bonnet, definida como a percepção de alucinações visuais complexas em pacientes com déficit visual, tendo os pacientes a consciência da natureza irreal do fenômeno. Grande número de casos não é diagnosticado pela ausência do questionamento direto do médico. Em vista do transtorno emocional causado por esta doença, o reconhecimento dos seus sintomas é essencial no manejo destes pacientes.
Asunto(s)
Humanos , Femenino , Anciano , Alucinaciones/patología , Oftalmopatías , Degeneración Macular , Trastornos Mentales , Síndrome , Baja VisiónRESUMEN
Se analizaron las historias clínicas de 20 pacientes diagnosticados como parafrenia. Los casos fueron rediagnosticados según el DSM-III-R y el borrador de la CIE-10. Hubo un predominio de mujeres con una edad promedio de 37.3 años. El perfil clínico fue de un apsicosis delirante-alucinatoria de curso crónico sin deterioro de la voluntad y de la actividad pragmática. Los casos analizados se distribuyeron en varias categorías de la CIE-10 y delDSM-III-R; hubo casos que no pudieron ser diagnosticados según el DSM-III-R. Se discute la utilidad de mantener la independencia nosológica de la parafrenia
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Clasificación Internacional de Enfermedades , Diagnóstico Clínico , Delirio/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Manifestaciones Neurológicas , Trastornos Paranoides/diagnóstico , Esquizofrenia Paranoide/diagnóstico , Antipsicóticos/administración & dosificación , Ficha Clínica , Delirio/patología , Trastorno Depresivo Mayor/tratamiento farmacológico , Alucinaciones/patologíaRESUMEN
O presente trabalho apresenta uma síndrome onde encontram-se associadas perda e alucinaçöes visuais. Tal síndrome ocorre mais frequentemete em indivíduos idosos e com estado mental preservado. Os autores revisam 17 casos discutindo os mecanismos aluninogênicos envolvidos e características diagnósticos sugestivas. Ressaltam a necessidade de considerá-la como parte do diagnóstico diferencial com doenças psiquiátricas e orgânicas manifestadas por alucinaçöes visuais