Hallucinations are false or distorted images that prevent a person from adequately perceiving the surrounding reality. The cause of their appearance can be fatigue, alcohol, drugs, neurological diseases, and other factors. Often and for a long time, they are in psychiatric disorders. Learn how and why hallucinations occur in schizophrenia.
Schizophrenia is a complex mental illness that affects the emotional and volitional qualities of a person and thinking. There are many forms of this pathology – sluggish, paranoid, paroxysmal, catatonic, etc. Each of them has its own symptoms. The most common are delusions and hallucinations.
However, they do not occur with every type of schizophrenia. Just in cases where they occur too often or do not go away for a long time, the patient is checked for the presence of mental disorders. The first suspect is schizophrenia.
In general, it is detected in about 0.5-1% of people. This disease is endogenous, that is, it has an internal nature. Often it is about heredity. Injuries, including psychological, alcoholism, drug addiction, and other factors, can also provoke schizophrenia. The exact reasons remain still unknown. However, in all cases, there is a violation of the work of neurotransmitters responsible for the connection between brain neurons.
There is no permanent cure for schizophrenia. The diagnosis remains for life, even if the patient had only one attack, which was managed to stop with the help of medications and psychotherapeutic treatment.\
The most difficult are cases when patients develop hallucinations. They make it difficult to adequately perceive the world and communicate with others. This becomes a source of problems in relationships, including family, and at work. With an unfavorable prognosis, a person becomes incapacitated and forever remains under the supervision of specialists.
Another distinguishing characteristic of schizophrenia is the unpredictability of the course. It can occur quite suddenly, and its symptoms are so diverse that it is almost impossible to list all the signs. Let us dwell in more detail on hallucinations, which in schizophrenia can have a different character.
What are Hallucinations
Hallucinations are false images that appear in the mind without a real external stimulus. The patient can see, hear, touch or feel with other senses something that is not in the real world. At the same time, it is quite difficult to convince a person that the images he feels are just an illusion, especially in those cases when they are accompanied by delusional ideas.
Hallucinations occur, usually paroxysmal. Pass only after taking special drugs. In rare cases, they disappear without the intervention of doctors but soon reappear. Sometimes hallucinations are chronic and do not disappear even during remission.
Types of hallucinations
Hallucinations are classified on various grounds. The most common classification is according to the sense organs. In this case, they are divided into visual, auditory, olfactory, and tactile. Less commonly observed visceral. Each of these types has its own characteristics and varieties.
Visual hallucinations, contrary to popular belief, are rare in schizophrenia. If they arise, then in the form of memories or unusual people who can be dressed in clothes of past eras. Also possible are images associated with religion or mysticism.
Often, patients are disturbed by photopsies – flashes, sparks, and fireworks before their eyes. However, this symptom is nonspecific, as it can also develop with eye diseases.
There are several types of visual hallucinations:
- Macro-optical or micro-optical, when a person sees any objects with changed sizes (like Alice in Carroll’s novel);
- Mobile and stable, when images move or are always in the same place, for example, on the periphery of vision;
- Single and multiple (even whole scenes with several objects and people are possible);
- Hypnagogic and hypnopompic, arising from the transition from wakefulness to sleep and vice versa.
Hallucinations must be distinguished from illusions. In the first case, we are talking about objects that do not exist. Illusory images can be in the field of view. Just a person sees them distorted.
Auditory hallucinations in schizophrenia are one of the most common symptoms. Patients hear voices that either give instructions, swear, or simply comment on the actions of a person. Entire dialogues can unfold in the patient’s head, and he becomes an unwitting listener of which.
There are several types of auditory hallucinations:
- Acoasms – noise, shots, music, codes, steps, etc.;
- Phonemes – fragments of words or syllables;
- One-sided – just voices;
- Bilateral – dialogue with voice;
- Verbal – the voices of non-existent people.
By analogy with visual hallucinations, hypnagogic and hypnopompic hallucinations are distinguished. But one of the most dangerous for the patient and others are imperative. They are related to the orders that a person receives from the voice. He can order both to attack someone and to harm himself.
Imperative hallucinations can become the basis for the involuntary hospitalization of a person in a psychiatric hospital.
In medical practice, there are cases when mothers, under the influence of voices, killed their own children. Therefore, the patient should be shown to the doctors as soon as possible. The problem is that he himself may not consider himself sick.
From the outside, identifying auditory hallucinations is not easy, but you can pay attention to the fact that a person constantly talks to himself, listens, speaks in a whisper, and asks again. Also, he is likely to often look from left to right, trying to find his “interlocutor”.
With olfactory hallucinations, schizophrenic patients hear non-existent smells, and they are usually unpleasant or even disgusting – the smells of decay, decay, or feces. From the side, it is noticeable that the person is constantly sniffing and grimacing. He may refuse to eat, as his appetite disappears.
Some patients experience taste hallucinations. They complain about poorly cooked food or “feel” that there is poison in it. A similar symptom is usually associated with delusions associated with persecution and conspiracy.
Tactile hallucinations in schizophrenia are among the most difficult. As a rule, patients claim that insects crawl over them, or someone grabs them by the legs. It is very problematic to dissuade the patient from this since he feels the touch with his skin. Even if he does not see insects, he may believe that they crawl under the skin.
Moreover, such sensations arise not only in schizophrenia. They also occur in healthy people, especially in old age. It’s just that many people are afraid to talk about it, believing that they will be called crazy.
Visceral hallucinations are sometimes referred to as a type of tactile hallucinations. When they appear, it seems to a person that “something is wrong” with his internal organs. He believes that snakes are crawling inside him or chips are installed, with the help of which special services or aliens follow his every action.
There are other types of hallucinations. In fact, this phenomenon is individual and purely subjective. Doctors receive most of the information on this topic directly from a sick person. When diagnosing, it is important to differentiate true visions from pseudohallucinations, which are also often detected in schizophrenia.
Initially, pseudohallucinations were called mental and apperceptive hallucinations. Their main difference from the true ones is that the patient understands their unreality. He sees images, as a rule, as fantasy, but they are devoid of spatiality, and most importantly, the person realizes that these are just illusions.
The main features of pseudohallucinations:
- Direction inward. They are generated by subjective perception, and therefore they are not perceived as real objects of the external world.
- Significance. They are experienced much more strongly than true hallucinations because they are meaningful images.
- Artificiality. The patient has no power over them, therefore, he believes that they are inspired from the outside, introduced into his head by aliens, wizards, etc.
Often there are visual and auditory pseudohallucinations. An example is the following clinical case. It seemed to a man with schizophrenia that a gun was flying in his head, which was about to go off under the influence of external forces. He believed that they wanted to enslave him and threatened him to pull the trigger with the remote control.
Due to the fact that the patient is aware of the unreality of the image or voice, he rarely goes to the doctor with a similar problem, which leads to the progression of the pathology.
With auditory pseudohallucinations, an unusual arrangement of sounds is noted. So, the patient can hear someone talking in his stomach. At the same time, he distinguishes between echoes or echoes. Voices can talk or give orders. Often there is a symptom of Cannabich-Liesner, when the patient has hailed strangers in his head, addressing him in a diminutive form.
Much less often, but still sometimes there are other types of pseudohallucinations:
- Motor – the patient is forced to move;
- Olfactory – artificially created smells and tastes;
- Motor speech – the patient is forced to say something.
According to the stories of patients, pseudo-hallucinations resemble memories, however, if the latter arise consciously, then the former is arbitrary and chaotic.
Distinguishing pseudohallucinations from true hallucinations in schizophrenia is not easy. The patient may believe in the existence of both. However, false visions are not identified with real objects, while with hallucinations a person, if he sees devils or aliens, then believes that they are really present in the world around him.
There are other differences as well. Pseudo-hallucinations usually appear in the morning, while true hallucinations can accompany a person around the clock. False images do not have a clear outline or localization, and real hallucinations appear as specific objects that have a spatial orientation.
Also, these symptoms can be differentiated by the behavior of the patient. With pseudohallucinations, he is usually depressed and apathetic, and with true hallucinations, he is excited and aggressive.
When do hallucinations occur?
One of the problems with this symptom is that people are afraid to talk about it. Often they understand that something is wrong with them, but they do not dare to admit it to others, because they do not want to be known as schizophrenics. However, hallucinations are not such a specific symptom.
It is observed when:
- Bipolar affective disorder;
- Epileptic psychoses;
- Alcoholic delirium;
- Local lesions of the brain;
- Neurodegenerative diseases;
- Acquired deafness, etc.
Also, hallucinations are caused by people artificially with the help of hallucinogenic mushrooms and pills.
Any form of schizophrenia requires a differential diagnosis, even if most of the typical signs for this pathology are observed.
Schizophrenia has two groups of symptoms – negative and positive. Among the first are apathy, lack of initiative, lack of interest in anything, depression, etc. Hallucinations are among the positive signs, as they are a consequence of mental activity. Also, these symptoms include delusional ideas.
Negative symptoms are characteristic of sluggish schizophrenia, and productive – for paranoid. The latter is often hallucinatory. But hallucinations are quite rare in catatonic and hebephrenic forms of schizophrenic disorder. This is further proof of the complexity and unpredictability of schizophrenia.
The most difficult thing is to send the patient for the first examination to a psychiatrist since it is rather problematic to convince him that he is sick. It is also not easy to recognize schizophrenia from the outside, due to the fact that most of the time a person can look healthy, and his “strangeness” occurs sporadically.
Experts recommend looking at the following features of the behavior of a person who may have hallucinations:
- He looks or listens for no apparent reason;
- Talking to himself or laughing out loud;
- Covers his ears with his hands, closes his eyes, and shakes his head;
- Makes inadequate movements, for example, defending;
- Darting from one side to the other, as if looking for something;
- Trying to hide from anyone.
If it is possible to deliver a person to the hospital, he will be prescribed a comprehensive examination. Only after the diagnosis is made, treatment is selected. You can stop the symptoms of schizophrenia, including hallucinations, with the help of antipsychotic drugs. Therapy is carried out both during an attack and during remission.