Visual hallucinations associated with multimodal hallucinations, suicide attempts and morbidity of illness in psychotic disorders

Abstract

Background: Visual hallucinations (VH) are a common, but understudied symptom of psychosis, experienced by individuals across diagnostic categories of psychotic and neuropsychiatric conditions. There are limited data on VH and associated clinical phenotypes in adult idiopathic psychotic disorders, which are needed to elucidate their relevance to psychotic illness paradigms. Method:In this cross-sectional study, we examined clinical risk factors for VH in a wellcharacterized sample of 766 patients with adult psychotic disorders across diagnostic categories of schizophrenia (n=227), schizoaffective disorder (n=210), and bipolar I disorder (n=329). The Structured Clinical Interview for DSM-IV-TR was used for diagnosis and symptom measurements. Results:The prevalence of VH was 26.1% (200/766). Multivariate logistic regression showed that VH were independently associated with the presence of hallucinations in other modalities, including auditory, tactile, olfactory, and gustatory hallucinations. History of a suicide attempt and catatonic behavior were also associated with VH. In addition, specific delusions were associated with VH, in particular, delusions of control, and religious, erotomanic and jealousy delusions. Diagnosis, negative symptoms, and family history of psychosis were not independent predictors of VH.Conclusions: Results showed the clinical and disease relevance of VH as they were associated with severe morbidity of illness, including suicide attempts and catatonic behavior. Findings also suggest a phenotype associated with hallucinations in other modalities and specific types of delusions. Based on our findings, VH may be a significant factor in assessing for suicidality and illness severity, warranting clinical attention and further study of underlying mechanisms.

The Phenomenology and Neurobiology of Visual Distortions and Hallucinations in Schizophrenia: An Update

“…If the content of VH is accepted as real, or possibly real, they can contribute to the formation of delusions (e.g., of control, thought insertion, etc. ), which, in turn, can lead to even greater distress (53) and functional impairment. Even the milder changes that characterize visual distortions can be clinically significant.…”

A psychological intervention for suicide applied to non-affective psychosis: the CARMS (Cognitive AppRoaches to coMbatting Suicidality) randomised controlled trial protocol

“…The risk of suicide fatalities in people who experience severe mental health problems, including those with non-affective psychosis, is extensively elevated compared to suicide fatalities in the general population [8,10,103]. In addition, the distress of experiencing suicidal thoughts and acts can be severe, perhaps, especially when linked with mental health problems, such as, hallucinations and delusions [9,[104][105][106]. Within the existing literature, there has been a tendency to focus on the extent to which therapies, including psychological talking therapies, result in the reduction of symptoms indicative of mental health problems rather than on redressing suicidal experiences [14,30,31,107].…”

Evidence for an interrelated cluster of Hallucinatory experiences in the general population: an incidence study

“…Although hallucinations from different sensory modalities frequently co-occur in clinical samples (Laroi et al, 2019; Lim et al, 2016; Llorca et al, 2016; McCarthy-Jones et al, 2017) and in the general population (Laloyaux et al, 2019), some clinical conditions are more likely to express hallucinations in specific sensory modalities, but as the disorders progress, hallucinations tend to expand to the others. In psychotic disorders, for example, auditory hallucinations are largely acknowledged as the most common sensory modality (Baethge et al, 2005; McCarthy-Jones et al, 2017; Mueser, Bellack, & Brady, 1990; Thomas et al, 2007), while visual, haptic and olfactory hallucinations are less common (Baethge et al, 2005; McCarthy-Jones et al, 2017; Mueser et al, 1990; Thomas et al, 2007) and associated with more severe cases (Chouinard et al, 2019; Clark, Waters, Vatskalis, & Jablensky, 2017; Lewandowski et al, 2009; Thomas et al, 2007). In patients with Parkinson's disease, psychotic experiences in the initial phases are generally visual hallucinations, but as the illness progresses, associations with delusions and non-visual hallucinations emerge (Ffytche et al, 2017).…”