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HISTORICAL NOTES ON THE TERM
The etymology of the word "hallucination" is dark and
difficult determinación4. Joan Corominas5 considered a provenance of allusion
seudoetimología, allucinaris, first used by Cicero Cicero 1499, in 1572 and in
English in French in 1660, the term seems to have been first used in medicine
for a French doctor (Fernel) around 16,748, keeping the previous polysemy until
Esquirol, with its definition hallucination, sets the direction of the palabra9.
Hallucinations in ANTIQUITY
In ancient times the hallucinations were integrated experiences
in culture, possessing great significance and content transmitting messages
about the subject or the world. With the lexicalization of the phenomenon, in
the eighteenth century, missed this semantics. The rankings of the time
regarded the disease hallucinations independent right
is not viewed as "symptoms", is, as fragments of
behavior common to several diseases, until XIX3 century.
There are numerous references classic phenomena that could be
included under the term "hallucination". BC biblical passages can be
found in evidence of a limited concept of hallucination. It even says in the
Greek world of hallucinations may have been the norm at these people lack the
concept of "consciousness" and attribute their own thoughts and
espíritus10 gods, 11, 12. Early Christian thinkers studied, systematically, hallucinatory
experiences. Authors such as Augustine, Thomas Aquinas and Teresa of Avila
analyzed under a number of criteria, the source and content of imaginative and
hallucinatory experiences to distinguish from the influence of divine
inspiration and satánica13.
SOME ASPECTS historical and conceptual
Overall, since the nineteenth century there are two main
theories to explain its origin: sensory (hallucinations and perception) and
sensory (hallucinations as picture) 1, 3, 14. The toxic hallucinatory phenomena
related to electrical stimulation of the brain and sensory deprivation underlie
sensory standpoint. The conception that the hallucinations are manifestations
of repressed desires or fears dysfunction result supports the hypothesis I
cognitiva2.
Jean Etienne Dominique Esquirol
Although not unprecedented use of the term doctor in France, Fernel,
Plater and Linnaeus, in England
As to the origin, to try to distinguish between hallucinations
and illusions, Esquirol says that in the first "everything happens in the
brain in mind. A man who has an intimate conviction actually perceive a sense, when
no external object capable of producing such a sensation appears to the senses,
is in a delusional state, is a visionary. " For Esquirol hallucination is
a "form of delirium (une certaine forme délire) makes the subjects believe
they perceive a sensation in one or more sensory modalities when, in fact, there
is no stimulus (...) Indeed, hallucination is a cerebral or psychological
phenomenon that occurs independently of the senses (...) Hallucinations are
false sensations or illusions or misperceptions sense of organic sensibility (...)
The location of the hallucination is not the peripheral organ of sensation, but
the central body's own sensibility "15. With this emphasis on the origin "core"
of hallucinations, Esquirol departed from peripheral theories of Hartley and
others who dominated the eighteenth century. It also meant an attempt to
internalize the phenomenon, making it part of the psyche and put under the
control of memory and imagination. When considering a delirium hallucination as
distinguished from the sensory errors and approached the subject's personality.
For this reason, Ey said Esquirol "stood close to the subject of
psychiatry hallucinated» 16.
Hallucinations after Esquire
Since the beginning of the nineteenth century French psychiatry
poses in what has been called 'controversy hallucinations "17, 18, revolving
mainly around two dichotomies: first, whether the hallucinations come simply
from' involuntary exercise of memory and imagination "(as noted by Esquire
and defended, after him, as Peisse authors, Sandra's, Briers of Boismont or Bushes),
or whether, by contrast, there is a sensory abnormality, either central or
peripheral (as advocated Baillarger, Michéa, Garnier or Parchappe). The second
question raised the possibility of the existence of psychic hallucinations
without pathology or are always pathological and therefore, would only be in
the madness. This issue is still under discussion in the actualidad19, 20.
This controversy began with the work of two authors, one German,
one French, which prepared the ground for discussion XIX1 century. In February 1799 a German bookseller
named Christof Friedrich Nicolai (1733-1811) described his own hallucinatory
experiences in a work entitled Memoir on the Appearance of Spectres or Phantoms
occasioned by Disease, with Psychological Remarks, and presented at the Royal
Society of Berlin. Conservation Awareness reality of these experiences led to
Boismont Brierre appropriate to include in the category of "hallucinations
compatible with reason" 21. On the other hand, Charles Berbiguier
published in 1821 his work Les Fardets, or demons in sont tous les pas de l'autre
monde22, which recounted his complex hallucinations and delusional experiences
and became the paradigm of pathological hallucinations (Berrios, 1996 ) 1.
Johannes Müller
The history of the concept of hallucination has focused
primarily on French psychiatry in the first three decades of the nineteenth
century. This has led to other inputs, such as Germany
Müller's work provides new insights into the early stages of the
naturalization of hallucinations (of how they came to be regarded as' classes
or natural objects ") 23. This process began with a new way of talking
about the phenomenon, with a change in the foundational statements of its
description. At the same time, Müller explains the hallucinations of a novel
way to keep that visions are "fantastic", ie resulting from
overactivity of a supposed faculty or power of "imagination" or "fantasy."
Since each sensory modality has its power and that this power should be
represented in the brain, the sights, sounds and tactile sensations can emerge
from internal stimulation, in turn, can be protopathic (primary or related body
itself) or sympathetic (secondary or originated in another organ and stimulates
the sympathetic target organ) 23.
Ultimately, Müller takes a conceptual analysis of the subjective
aspects of vision and develops a speculative physiology based on two statements:
1.
Each sensory modality is equipped with a specific strength or
energy to express its function (reflecting its belief in vitalism).
2.
There is a direct relationship between the subjective sensation
and the brain substance (reflection of their efforts to overcome the Cartesian
dualism) 23.
Jules Baillarger
In 1844 Baillarger presented to the French Royal Academy of
Medicine entitled Des hallucinations25 memory, divided into five chapters that,
in addition to treating the physiology and pathology of hallucinations, its
relationship to other diseases and medical-legal aspects, described a new
disease, the "madness sensory" (folie sensoriale). Regarding the
nature of hallucinations, Baillarger wondered if they were psychic phenomena or
psychosensorial, if you could explain the changes in the brain or sensory organs.
He proposed two types of hallucinations: a, psychosensorial, complete, composed
of two elements, the result of the dual action of the imagination and the sense
organs, sometimes psychic, due to impaired memory and imagination, completely
foreign to the sense organs, sensory element lacking and therefore incomplete. Baillarger
concluded that the initial component of the hallucinations had to be the "intellect"
as there were insurmountable objections that could be considered as an
excitement of the senses.
The diversity of theoretical positions not simplified the debate
on hallucinations raised in France, in the Medical Psychological Society in 1855-561, in which case continue
these and other critical issues such as if the sensation, hallucination image
and form a continuum, or if hallucinations, dreams, the vivacity of imagination,
somnambulism and trance states are similar states, or the probable cause "psychic"
for hallucinations. The session ended without agreement despite attempts
Baillarger, Michéa and Parchappe1. By this time it is common to refer to
hallucination as a "perception without object," often attributed to
Ball26 expression, but whose author is unknown actually. It is known that
around 1860 it was cited. So Falret, in 1864, states that "the hallucination
is a perception without an object, as has often been repeated" 27. In general, this
definition has been linked to the original concept of Esquirol and yet, it
introduced crucial aspects that have been distorted or simply ignorados4.
Auguste Tamburini
In 1881 Tamburini published a classic paper which argued that
the hallucinations are not a psychiatric problem and offered a single
explanation for all hallucinations (psychiatric and neurological), articulated
a testable hypothesis, legitimized the language and methods of neurophysiology
in the field of pro-madness and put a mechanistic explanation of its origin, avoiding
any interest in his significado28. The first three proposals Tamburini have
persisted over time and have encouraged research, primarily neurological. The
mechanistic explanation, the hallucination as a result of irritation of various
brain centers, was not accepting the current psychodynamic who have defended
the semantic approach. This led to the introduction of the term "hallucinosis"
to refer to all hallucinatory experiences related to neurological diseases. Functional
or psychotic hallucinations returned to semantic way. The fact is that, generally
maintains the distinction between organic and functional hallucinations (psychiatric
psychotic) with the analysis result of neurobiological postpone the latter. Thus,
while neuroscientists continue to explore the phenomenon of hallucinosis
regardless of questions of meaning, neurobiological research has been of little
value in understanding the hallucinations 'psychotic' 14.
Hallucinations in PSYCHIATRY
Hallucinations in psychiatric patients differ from pseudo-called
doalucinaciones and neurological hallucinations, and may be accompanied by
other symptoms such as psychotic delirios2.
Although the hypothesis Tamburini, where organic psychiatric and
hallucinations may be equivalentes28 phenomena, this separation has been
maintained by the limitation unit vision clinic. For the clinician
hallucinations "true" or psychiatric possess different properties of
organic hallucinations (hallucinosis) that appear, for example, epileptic auras,
brain stimulation, drug intoxication or tumors.
Hallucinations appear in most of the so-called functional
psychoses and generally formal and resiliency characteristics, duration, frequency,
insight and sensory modality relate to different tables and have more
diagnostic value than the content, which is determined by individual variables
and Cultural Rights, 2 29. However, current approaches for detecting the presence
of hallucinations clinic are not fully developed. Other properties such as
cognitive status, passenger behavior, context of occurrence or absence of an
external stimulus may be important. From the theoretical point of view, this
criterion can acquire crucial since logically from the above definition of
hallucination as a "perception without an object." However, it may
not be clinically relevant. For example, the criterion 'external object' is not
essential for the diagnosis of hallucinations táctiles3, 30. Maybe even not
diagnostic base of visual or auditory hallucinations in general because usually,
psychiatrists do not prove the existence of the hallucinated object in the
external world. The diagnosis is generally made on the basis of accompanying
symptoms, context, and personal history
the quality of hallucinatory experiences described. If this were
so, it would imply that the aspects "perceptual" of hallucination are
not, after all, so important. The diagnostic value of hallucinations is limited
since, most often, are nonspecific: any type of hallucination may appear
different psychiatric conditions.
Visual hallucinations
Visual hallucinations associated with vision defects and organic
disorders such as brain tumors are, seizures, drug-induced states, cerebral
vascular disease, infectious, immunologic and degenerative (L'Hermitte and
Ajuriaguerra, 1936) 31. You may like the vividness dimensions, insight, duration,
originality and content possess any diagnostic value. For example, elementary
visual hallucinations, formless, are associated with occipital lobe pathology, while
performing well formed hallucinations are associated with temporal lobe
pathology. Ffytche32 has suggested hallucination content may be relevant to
know the underlying pathology and, therefore, has proposed two syndromes in
function thereof. In the first, patients describe a range hallucinatory ranging
from lines, dots, or color flashes to strange and complex figures, extravagant
in appearance, and colorful costumes. Hallucinations last seconds or minutes, not
accompanied by any symptoms and are caused by a transient increase in the
activity of the visual cortex that determines the content of the hallucination,
ie the primary pathology lies in the visual pathways or higher visual areas (the
paradigm would macular disease). In the second syndrome, describes animals and
figures for sick relatives, extracampinas hallucinations and visual
hallucinations accompanied by other complex multisensory hallucinations (auditory,
tactile or olfactory) and delusions. They can last hours or days and by the
alteration of the visual cortex also affect other areas involved in the
formation of delusions. In this case, the disease lie in the brainstem and / or
the cholinergic system (PD). However, it would be difficult to classify large
numbers of delusional disorder according to this proposal because their
pathology is uncertain (psychosis) or because they share elements of both
groups.
Some authors believe that visual hallucinations are also common
in esquizofrenia33, 34. In
general, are accompanied by other hallucinations (auditory, kinesthetic) and
delusions insight smaller, normal, level of consciousness have greater
significance personal35.
CHARLES BONNET SYNDROME
Visual hallucinations are characteristic of Charles Bonnet
syndrome, a term coined by Morsier in 1936 in honor of the Swiss philosopher who
described the experiences of his grandfather Charles Lullin, magistrate of 89 years,
who for three months saw images of men, birds and buildings changed shape, size
and location, without alteration of consciousness and recognizing the anomaly
phenomenon1, 36. Morsier37 (1967) defined the syndrome by the presence of
visual hallucinations in older people without cognitive impairment without
apparent etiologic relationship with impaired peripheral vision. To Morsier the
cause lay in the brain itself. Charles Bonnet syndrome developed during the
nineteenth century in the paradigm of the existence of visual hallucinations in
subjects sanos38. In 1873, Naville described a similar case, he thought that
visual hallucinations were consistent with the right mind and proposed six
criteria for identifying these hallucinations:
1.
Clearly occur conscience and not mislead the subject.
2.
Combine with normal perceptions.
3.
They are exclusively visual.
4.
Not accompanied by strange sensations.
5.
They appear and disappear with no obvious cause.
6.
Surprised than frightened to sujeto36.
Since the initial descriptions have continued disputes arise
about síndrome39, 40, 41, 42, 43, 44. While some use it to designate any visual
hallucination in old age, regardless of the clinical companion, others, however,
prefer to maintain more restrictive criteria. In this case, the fundamental
characteristics of the syndrome would be the presence of visual hallucinations
experienced, well trained and developed in a person with a visual deficit
partial (in most cases) and preservation of insight about the unreality of what
is seen. Besides, is not accompanied by any symptoms psychotic, altered mental
status or sleep, dementia, intoxication, or metabolic disorder focales45 neurological
injuries. For example, in this sense, Podoll et al46 have proposed the following
diagnostic criteria:
a) The main symptom is the presence of visual hallucinations in
older people with a level of normal consciousness.
b) There are delirium, dementia, organic delusional syndrome or
affective psychosis, intoxication or neurological disease of central visual
pathways or cortex.
c) the vision loss is due, in most cases, an eye disease, but
this is not required.
The content of hallucinations is very diverse. Most often people's
vision, but also described images of faces (distorted or formed), small
costumed figures, animals, shapes, images and other complex figures increased
or decreased in size, black and white or, more often in bright colors. Hallucinations
are located in outer space, are well defined and organized, and are perceived
very clearly, contrasting with blurred perception of real objects. Hallucinations
have also been reported atypical, divided in turn into atypical and atypical
sensoperceptive psicodinámicas47. The former differ from the "typical"
features such as duration, movement, the will or the coexistence of other
senses (considered an exclusion criterion for most). The latter are similar to
dreams, more complex, repetitive and frequently changing content, and hinder
the activity of the subject.
Generally, hallucinations ensue without any exercise of will and
regardless of any trigger. However, in some cases, their appearance can be
promoted by various stimuli and situations as decreased general sensory, fatigue,
stress, poor lighting or excessive. Once emerged, images, still or moving, can
remain for a few seconds, minutes or even hours until fade spontaneously or
after actions like moving or closing your eyes, look directly at the image, go
to or talk with them. The course may be episodic, periodic or continuous for
months or years. Finally disappear when vision loss is total. The content of
the hallucination determines the emotional response of the subject and may
range from pleasure to indifference, curiosity, irritation, anxiety or terror. Santhouse
et al48 described three "psicosíndromes» visual Charles Bonnet syndrome
that correlate with functional brain architecture. The first is to
hallucinations of landscapes and small figures dressed in hats, the second, hallucinations
of faces distorted with prominent eyes and teeth, the third palinopsia
characterized by persevering.
The etiology of the syndrome is variada49. Most often it is due
to damage to the visual system (for example, macular degeneration or age-related
glaucoma), but can also be the result of brain pathology that interrupts the
connection between the eye and the occipital cortex. Ffytche50 from a "neuro-phenomenological"
proposed two syndromes: one directly related to the pathology of the visual
pathway, and another related to the pathology of the brain stem or ascending
neurotransmission pathways. Regarding the pathogenesis various theories have
been proposed. Charles Bonnet himself proposed a very attractive explanation, linked
to "the area of the brain responsible for vision without affecting nerve
fibers associated with the thought that remain in their natural state and
prevent the mind confuse the vision to reality »51. Cogan52 proposed two main
mechanisms of appearance:
a) release (inhibitory structures destroyed).
b) Irritation (excitation abnormal brain structures).
In the first case, the hallucinations are repetitive, stereotyped
and fleeting, while in the second, often elaborate, well formed and sustained. Cogan
maintained that complex visual hallucinations in patients with visual
impairment multifactorial represent release phenomena secondary to visual
sensory input attenuation due to a disease in any part of the visual pathway, and
thus have a lower value of localization the irritation. Many authors argue that
hallucinations in the Charles Bonnet syndrome are liberación35 phenomena, 42, 52,
53, 54. That is, they produce disinhibition or release of stored visual
sensorial40 result of deafferentation, 55. He also noted that it could be due
to ictal activity center central36 irritating.
Peduncular hallucinosis
Peduncular hallucinosis is complex and vivid visual
hallucinations as a result of injuries in the midbrain and / or tálamo56. It
was described by L'Hermitte in 1922,
in several cases with florid visual hallucinations, without
consciousness of reality, accompanied by stirring and L'Hermitte attributed to
injury in the red nucleus and / or areas próximas57, 58. In 1927 Van Bogaert59 coined
the term 'peduncular hallucinosis "and confirmed the location of
postmortem pathologic infarct lesions in the midbrain cough. Morsier60 expanded
in 1936 to include syndrome thalamic lesions. Therefore, the alu-ci peduncular
stenosis is associated with various pathologies: vascular lesions and
infections of the brain medio61, thalamic lesions and pontinas62, 63, bleeding
subaracnoidea64, tumores65, 66, 67, and after interventions and angiografía69 quirúrgicas68.
Hallucinations are complex, vivid, well-formed, usually
involving the entire visual field, but sometimes limited to one hemifield. Sometimes
accompanied by auditory hallucinations and táctiles35, 70. Recently, Bemke70 has
reviewed the phenomenon from five cases and concludes that peduncular
hallucinosis is a syndrome consisting of symptoms such as hallucinations and
other oculomotor abnormalities, deficiency of brain activation, dysarthria and
ataxia. Furthermore, it is accompanied by a severe episodic memory impairment (although
the memory of hallucinations remains intact) with occasional confabulations, deficits
in attention and executive function, confusion and false identifications of
people and places. Hallucinations appear at dusk and at night, but they can
also do it during the day, with an alert state of consciousness and normal. The
content is diverse, including Lilliputian figures, and the appearance of
familiar people and places, causing a large effect of "reality." This
leads to intense emotional reaction, which is dominated anxiety, fear or panic,
and infrequently the joy and euphoria. Some authors35, 71 claim that insight
about these experiences is total and that once understood the nature of the
adaptation phenomenon is complete. By contrast, al.70 believe that insight is
null and patients maintain an absolute conviction that their perceptions are
real.
It has been suggested that the peduncular hallucinosis phenomenon
could be due to a release due to a partial or complete loss of normal visual
ability triggers vivid images of animals, scenes or figures geométricas72. It
has also been suggested that the hallucinations would occur for any injuries
ascending reticular activating system that integrates information from the
visual cortex to tálamo73. It is also possible that the states of drowsiness
accompanied by disorientation reflect the altered stem reticular formation
encéfalo74. Finally, peduncular hallucinosis Benke70 included within
subcortical hallucinations, caused by a loss of control by the brain stem on
the cortex, and points to two possible mechanisms responsible. In the first, there
would be an imbalance between the cholinergic system, serotonin and other
transmission systems that would damage the mechanisms controlling the inputs
from the brainstem to the thalamus, thalamic and modifying access the filters
to the visual cortex and other sensory areas. In the second, will damage the
circuit linking the temporal lobe and the basal ganglia resulting in increased
thalamic input to the visual areas of the temporal lobe.
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