Tuesday, October 30, 2012

Historical definition of "phobia" 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 in the sense hallucinate, err, deceive, err, or deviated from the straight path of reason. Roque said Barcia6 double etymology: allucinari in Cicero and Aulus Gellius hallucinari in "AD, near and lucinari, frequentative of Lucere, look." Barcia think this last etymology is false since the Latin allucinari represents an obvious form of Greek (allusso) (have lost the spirit), and believes that "the French, for a mistake that can hardly be explained, took the form of Gellius and Cicero's neglected "(p. 268-269). Monlau7 assumes good hallucinate derivation of ad lucem (ad, near and Lucere, look), underlining the proximity to enlightenment that characterizes the hallucination. This source is the origin of the disparate meanings of hallucination in the seventeenth and eighteenth centuries, "conditions of the cornea" (Fernel), "diplopia" (Plater and Linné), "strange noises, premonitions and apparitions" (Lavater) or "errors of sense" (Sagar). Although Castilian appears around 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, Lavater, Arnold and Hibbert, one can say that the psychiatric sense of hallucination appears Esquirol, who, in 1817, brought together all hallucinatory under one term assuming all hallucinations, regardless of sensory modality are symmetrical and uniformes9 phenomena. This not only created an abstract concept but, when choosing a word whose etymology was linked to vision (five cases described by Esquirol suffered visual hallucinations), imposed a restrictive model of perception in all modalities sensoriales3 ie , as well as vision and hearing, require an external stimulus' functional alterations, brain mechanisms and the clinical context of these three senses (hearing, taste and smell) are the same as in the vision. It is necessary to propose a generic term and the word hallucination "15. This approach, taken from Condillac, assumed to touch, taste and smell also need an external stimulus. The crucial contribution of Esquirol was the proposal that the word hallucination, hitherto used only to describe visual experiences were generalized to refer to all forms of sensory deceptions. But at the same time, this theory has encountered serious difficulties regarding hallucinations gustatory, tactile or kinesthetic, in which the external object can not be elucidated. So, with this definition could not be distinguished, for example, between one and another real3 hallucinated itching.

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, have received less attention. One way to compensate for the imbalance would reanalyze classic works that are not listed in the official history of the alucinación23. Phenomena fantastic vision of Johannes Müller-published in 1826 - would be one of ellos24. This work is well known in the fields of history of the physiology of vision, rarely is mentioned in the history of psychiatry. However, they are critical to understanding how the ancient notion of appearance became the current concept of hallucination and to know the role played by the Naturphilosophie in the new concept.

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.


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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