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DOUBLE hallucination and other phenomena
One of the best known types of hallucination is called
"dual phenomenon" (also called autoscopy, heautoscopia, Doppelganger,
etc..). The autoscopy (literally see himself) is defined as the visual
experience in which the subject sees his picture in external space (as if
reflected in a mirror) from their own cuerpo75. Vision may be brief or
persistent, the whole person or parts of it, with a normal consistency or clear
and accompanied by an emotional response. However, little is known about the
natural history, clinical presentation, the meaning and etiology of this experience
is not even clear that should always be considered a hallucination.
This phenomenon has been observed since antiquity. Aristotle, in
his work Meteorological, and told of a man who every time he went for a walk
persistently saw his own image walking towards él76. The consideration of the
phenomenon as abnormal or pathological depends on cultural beliefs about the
limits of self and the ability to view the image itself. So, this experience is
in the mythology of the death and resurrection of some Asian tribes and among
Aboriginal australianos77. In Western culture fads and secular beliefs have
been important since in European folklore autoscópicas experiences were
considered a harbinger of death inminente78. In the nineteenth century romantic
literature there are descriptions of autoscopy and similar experiences in the
works of Jean Paul Richter (Hesperus), Gabriele d'Annunzio (Notturno), Oscar
Wilde (The Picture of Dorian Gray), Guy de Maupassant (The Horla ), Edgar Allan
Poe (William Wilson) and Fyodor Dostoevsky (Twice). Other writers like Alfred
de Musset, Robert Stevenson, Gerard de Nerval, James Hogg or own Maupassant and
Poe's hallucinatory experiences doble76 suffered. In the nineteenth century the
symptom was well known and was called variously 3, 75 Brierre of Boismont
called deuteroscopie; Jean Paul Richter doppelganger used the term to refer to
the 'bi'; autoscopy (Féré; Lemaitre; Sollier) was used in the early twentieth
century, but failed to find the correct perception of the subject itself was
replaced by heautoscopia (Menninger-Lerchenthal; L'Hermitte; Hecaen and
Ajuriaguerra). The terms hallucination speculaire (Féré) and Spiegelphantom
(Conrad) not jelled because the perception of the subject pointed itself.
Dening and Berrios75 considered more appropriate to reserve the term autoscopy
for alterations of visual perception in which subjects see their own image in
the external space from his own physical body.
Autoscópicos phenomena have been described in neurological
diseases such as epilepsy, migraine, tumors, strokes, head injuries and
infecciones75, 79, 80, 81, 82, 83 and psychiatric disorders such as
schizophrenia, depression, anxiety, depersonalization, and dissociative states
identificación75 false syndromes, 78, 79, 84, 85, 86, 87.
It has been suggested that the autoscopy could arise from the
convergence of several variables, such as gender, personality traits,
psychiatric illness and / or neurological, and dissociative states whose
depletion interaction could overcome the normal inhibition lobe activity
temporal73.
Brugger82 group, 88, 89 has proposed a classification of
autoscópicos phenomena including six types:
1. Sense of presence: in this phenomenon
the "double somatestésico ghost" is "sense" but not seen
(similar to phantom limb phenomenon) 90. It also goes by the names of
Anwesenheit91, next falsa92 consciousness and somestésico93 doppelgänger.
2. Hallucination autoscopic: visual
hallucination would double itself dicha94. That is, the double would be seen
only from the body itself, lacking any component somatestésico. Originally
called "hallucinations mirror" 95, 96.
3. Heautoscopia ghost or double vision and
somatestésico: implies the existence of two selves (observer and observed),
although recently described the experience heautoscopia poliópica where the
existence of multiple dobles97. Also called self85 autoalucinación98 and
hallucination. In this case the visual aspects are predominant and twice, seen
also from the body is described as pale, hazy, transparent or ghostly. The most
important is the psychological feeling of affinity towards the second self,
"meaning" and physically recognized as "other me" even when
the visual characteristics do not match their own (heautoscopia dissimilar) 94.
4. The out of body experience. This term,
from the para-psychology, replaced previous expressions of the world of
para-normal phenomena as "astral projection," "ectosomática
experience" or "externalization of sensibility" and was related
to statements such as "bi" ( the supposed ability of some people to
be in two places at once), the "astral bodies" (hypothetically body
consisting of a "light stuff") or experiences near the muerte99, 100. In medical and
psychological literature have used other terms like "pseudo autoscopia",
"ego trip", "floating syndrome experience,"
"hallucinations of physical duality" and "split visuo-vestibular
somatosensory body image» 82. The phenomenon is the perception of oneself from
the outside, ie from a visio-spatial parasomática unlike other autoscópicos phenomena
are experienced within the corporate limits and the double is perceived from a
visio-spatial física101. In OBE rarely used the term "double", and
the main feature is the apparent remoteness of body awareness, which is seen or
"seen" in another spatial point. Recently, it has been explained as
poor integration of visual, tactile and proprioceptive body awareness with
information relating to personal space and extrapersonal101, 102, 103, 104.
5. Heautoscopia negative: in this case the
subject is not himself when his image reflected in a mirror. In most cases, is
accompanied aschématie or loss of consciousness itself cuerpo105, 106. Some
authors have proposed replacing the term by 'asomatoscopia »81, 107. Guy de
Maupassant described this phenomenon in The Horla and E. T. A. Hoffman in his
fairy tales.
From neurology, autoscópicos phenomena have been related to the
failure of the integration of proprioceptive, tactile and visual relative to
body (multisensory disintegration in personal space) with vestibular
dysfunction causing further disintegration among staff spaces (vestibular) and
extrapersonal (visual). These disintegrations (personal personal-extrapersonal)
are due to "paroxysmal brain dysfunction" in the temporo-parietal101
intersection, 102, 103. Moreover, it has been proposed that these experiences
and the phantom limb phenomenon related to central representation of bodily
self and suggest that the concept of 'neuromatrix "or" neuromatrix »*
could help explicarlos82, 110. Specifically, there would be a "dissociation
of neuromatrix" consisting temporal dissociation between the visual
components and the neuromatrix somestésicos or between different subcomponents
somatestésico field (for example, between the kinesthetic and tactile
impressions).
* Melzack postulates that in the central
nervous system there is a representation of body image or "neuromatrix
'which modulate cortical activities (affective and cognitive) with
somatosensory afferents, visceral, nociceptive, autonomic, immune and endocrine
generating pain perception. The neuromatrix is a neural network that receives
input and generates a "neurofirma" ("neurosignature") or
print one for each person. Pathways involved there would be three: the first is
sensitive and passes from the thalamus to the somatosensory cortex, the second
is from the reticular formation to the limbic system and the third involves the
parietal lobe where it generates the perception of the "self."
Lilliputian hallucinations
These complex visual hallucinations were described in 1834 by
Leuret in the context of místicas111 experiences. In 1847, Sauvet used the term
"midget" to refer to the vision of small beings that he himself
experienced after poisoning by inhalation éter112 voluntary. They consist of
the vision of "little people, men or women of diminutive height, which may
be accompanied by small animals and objects provided in size" 113, 114.
Hallucinations are usually multiple and people move and wear colored clothes.
Occasionally represent a small puppet theater with miniature scenes and the
patient hears these people speak in a "Lilliputian tone." Leroy said
that unlike other visual hallucinations, the Lilliputians are accompanied by a
pleasant mood and the patient attends funny representation of the world in
miniature. Such hallucinations has little diagnostic value and have been
described mainly in alcoholism and other poisoning as cocaine, cannabis,
atropine, chloral and ether, and brain tumors, infections, vascular injury,
dementia, epilepsy and hypnagogic states. In psychiatry have been described in
schizophrenia and states disociativos115, 116.
Hypnologic hallucinations and hypnopompic
Hypnagogic hallucinations consist vivid perceptual experiences
occurring at sleep onset, while hypnopompic happen to awaken it. For Hamilton
Musical hallucinations
Musical hallucinations are rare and are at the crossroads of
otology practice, neurological and psiquiátrica122, 123, 124. Being so rare
there is no commonly accepted theory on its diagnostic value, classification
and path physiological mechanisms. Usually refers to hearing songs or melodies,
although some authors consider this restrictive definition since music also
includes harmonies, rhythm and timbres. This distinction is important because
if the musical hallucinations causally related to specific brain locations is
essential to know if the processing of information relating to the melody,
harmony, rhythm or timbre locus occurs on a common brain. Also more likely to
describe a musician as "music" more complex hallucinatory experiences
that a person without musical training, so communication of musical
hallucinations will be influenced by the musical knowledge of the patient. This
would also influence the location of brain injury because the representation of
musical information changes nondominant hemisphere dominant learning to
musical125.
The history of musical hallucinations began in 1880s. Although
authors such as Esquirol, Griesinger Baillarger or reports of patients had deaf
hearing voices or music, psychiatrists are less interested in these phenomena
that ENT. For example, stood Erhard126 various locations of these
"subjective auditory sensations' sense of rhythm or pulsation in the
internal carotid, the whispers in the hall, the songs or music in the cochlea,
and tinnitus in the acoustic nerve. To Régis127, musical hallucinations are the
result of positive and negative changes in sensory pathways: the first (eg,
tinnitus) resulted in a sound that served as the point where crystallize
musical hallucination, negative changes (eg deafness) helped create a state of
deafferentation. Régis was forced to introduce other variables such as age or
personality traits to explain why these hallucinations are so infrequent,
although deafness and tinnitus are so common. During this same period, organic
and psychological hypotheses proposed to explain the origin of such
hallucinations. For example, unilateral musical hallucinations were considered
organic aetiology (peripheral), although peripheral lesion could not alone
explain the laterality of hallucination and suggest that there is also a
cortical lesion. For insight Régis presence would serve to distinguish musical
hallucinations of psychotic organic (functional). For example, Claude and Ey128
described the so-called "organic hallucinosis syndrome"-in which
included musical hallucinations-and that is not related to psychotic
hallucinations. At present there is still debate about the origin exclusively
otologic or also could occur from neurológica124 pathology, 129, 130, 131.
In the history of music known several examples of composers who
suffered hallucinations musicales132. The Czech Smetana, who probably suffered
meningovascular neurosyphilis, persistently experienced hearing a high-pitched
musical note he included in his String Quartet. The best known case is that of
composer Robert Schumann, who for years suffered musical hallucinations from
single notes to chords and melodies, which were reflected in works like the
Kreisleriana, the Violin Concerto and the Symphony Spring.
1. By "neuronal irritation"
(excitatory phenomenon).
2. By "perceptual release"
(release phenomenon).
3. By "musical memories parasites',
ie, some memories (eg a song) are never 'unlearned', maintaining therefore
fixed and independent presence in memory so that they become a regular
experience.
Musical hallucinations have been described in different
situations clínicas40, 122, 124, 134: hearing loss, brain damage from
space-occupying processes to epilepsy and encephalitis vascular processes;
psychoactive substance use and psychiatric disorders.
Depending on the etiology hallucinatory experience may vary in
some respects as the form of onset (acute or insidious), the familiarity of
what is heard, the type (instrumental, vocal or both) and genre, the origin of
the perceived (in or outside the head), the location (right, left or bilateral),
the sole presentation accompanied by other symptoms or impaired sensory
perception or other psychiatric symptoms, the experience (pleasant, unpleasant
or neutral) and the degree of insight.
To Berrios122, musical hallucinations are more common in women,
in old age, with deafness and brain injuries most common causes. They tend to
be persistent and continuous, but may be retained fragment and like a broken
record. The most common form of hallucinations are either a cappella songs or
instruments, the music is very common religious or patriotic hymns.
Regarding the specifics of hallucination in ear pathology
hallucinations often accompany progressive onset and otherwise simple acoustic
hallucination. Due to a brain process establishing abruptly, not accompanied by
other hallucinations and insight remains on experience. Furthermore, it appears
that no longer affect the hemisphere dominante135. The latter is very important
because it suggests that the nondominant hemisphere plays an important role in
the development of musical phenomena in patients with brain injury from tumors,
strokes or epileptic foci. This finding is consistent with what is known of the
relationship of music and the brain. It also suggests a dissociation between
musical hallucinations and mechanisms related to verbal hallucinations in
schizophrenia associated with the dominant hemisphere. Finally, the musical
hallucinations in psychiatric disorders appear more frequently reported in
depression, may be associated with other auditory hallucinations, visual and
tactile, and there is usually no insight on them.
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