Hallucinations are false or distorted images that prevent a person from adequately perceiving the surrounding reality. They can be caused by fatigue, alcohol, drugs, neurological diseases, and other factors. Often and for a long time, they occur in psychiatric disorders. Let’s find out how and why hallucinations occur in schizophrenia.
Schizophrenia is a complicated mental illness that affects the emotional and volitional qualities of the personality and thinking. This pathology has many forms – sluggish, paranoid, seizure-like, catatonic, etc. Its symptoms characterize each; The most common are delusions and hallucinations.
However, they do not occur in every type of schizophrenia either. Simply 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. Schizophrenia is suspected in the first place.
It is generally detected in about 0.5-1% of people. This disease is endogenous. That is, it has an inner nature. Often it is a question of heredity. Also, provoking schizophrenia can cause trauma, including psychological, alcoholism, drug abuse and other factors. The exact causes remain unknown. However, the neurotransmitters responsible for communication between the brain’s neurons are violated in all cases.
There is no permanent cure for schizophrenia. The diagnosis would remain for life, even if the patient had only one attack, which they managed to stop with medication and psychotherapy.
The most difficult cases are those in which patients from hallucinations. They prevent the patient from adequately perceiving the world and communicating with others. It becomes a source of relationship problems, including family and work. If the prognosis is unfavourable, the person becomes incompetent and remains under the care of specialists forever.
Another distinguishing characteristic of schizophrenia is the unpredictability of its course. It can occur suddenly, and its symptoms are so diverse that it is almost impossible to list all the signs. Let us dwell more on hallucinations, which may have a different character in schizophrenia.
What are hallucinations
Hallucinations are false images appearing in the mind without an external stimulus. The patient may see, hear, touch, or feel with the senses something that does not exist in the real world. It is challenging to convince a person that the images are just an illusion, especially when delusions accompany them.
Hallucinations occur, as a rule, in fits and starts. They are relieved only after taking particular medications. In rare cases, they disappear without medical intervention but soon reappear. Sometimes hallucinations are chronic and do not disappear even in remission.
Types of hallucinations
Hallucinations are classified on various grounds. The most common classification is by sense organs. In this case, they are divided into visual, auditory, olfactory and tactile. Less commonly observed are visceral. Each of these types has its characteristics and varieties.
Visual hallucinations, contrary to popular belief, are uncommon in schizophrenia. If they occur, it is in the form of memories or unusual people, who may be dressed in clothes of past eras. Images related to religion or mysticism are also possible.
Often patients are disturbed by photopsia – flashes, sparks and fireworks in front of the eyes. However, this symptom is nonspecific since it can also develop from eye disease.
- Macro optical, when a person sees some objects with altered dimensions (like Alice in Carroll’s novel);
- mobile and stable, when images move or are always in the same place, for example, in the periphery of vision;
- solitary and multiple (even whole scenes with several objects and people are possible);
- Hypnagogic and hypnopompic occur during the transition from wakefulness to sleep and vice versa.
It is necessary to distinguish hallucinations from illusions. In the first case, we are talking about objects which do not exist. Illusory images may be in one’s field of vision. 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 person’s actions. Entire dialogues may unfold in the patient’s head, and he becomes an involuntary listener.
Auditory hallucinations are of several types:
- akoasms – noise, gunshots, music, crackles, footsteps, etc.;
- phonemes – fragments of words or syllables;
- one-sided – just voices;
- bilateral – dialogue with a voice;
- Verbal – voices of non-existent people.
Hypnagogic and hypnopompic hallucinations are distinguished by analogy with visual hallucinations. However, some of the most dangerous to the patient and others are imperative hallucinations. They are associated with the orders the person receives from the voice. He can order both to attack someone and to harm himself.
Peremptory hallucinations can be grounds for involuntary hospitalization of a person in a psychiatric hospital.
In medical practice, there are known cases of mothers killing their children under the influence of voices. Therefore, it is necessary to show the patient to doctors as soon as possible. The problem is that he may not even consider himself ill.
It is not easy to identify auditory hallucinations, but it is possible to notice that the person constantly talks to himself, listens, whispers, and interrogates. He is also likely to look from left to right frequently, trying to find his “interlocutor.
In olfactory hallucinations, schizophrenic patients hear nonexistent smells, usually unpleasant or even disgusting smells such as rot, decay, or faecal matter. The person constantly smells and wrinkles his nose. He may refuse to eat because his appetite has disappeared.
Some patients have taste hallucinations. They complain about poorly cooked food or “feel” that there is poison in it. Such a symptom is usually combined with delusions of stalking and conspiracy.
Tactile hallucinations in schizophrenia are among the most complex. As a rule, patients claim that insects crawl over them or someone grabs them by the legs. It is complicated to convince the patient of this because he feels the touch on his skin. Even if he does not see the insects, he may believe that they are crawling under the skin.
It is not only in schizophrenia that such sensations occur. They also occur in healthy people, especially at an advanced age. Many people fear talking about it, thinking they will be called crazy.
Visceral hallucinations are sometimes called a type of tactile hallucinations. When they occur, the person feels “something wrong” with his internal organs. He believes that snakes are crawling inside him or chips are installed inside, with the help of which special services or aliens are watching his every action.
There are other types of hallucinations as well. This phenomenon is individual and purely subjective. Doctors get most of the information on this topic directly from the sick person. It is important to differentiate true visions from pseudo-hallucinations when diagnosing them, which are also often detected in schizophrenia.
Pseudohallucinations were originally called psychic and apperception hallucinations. The main difference between them and true hallucinations is that the patient understands their unreality. He sees images, as a rule, as imaginary, but they lack spatiality, and, most importantly, the person is aware that they are only illusions.
The main features of pseudohallucinations:
- Inward orientation. Subjective perception generates, so they are not perceived as actual objects of the external world.
- Significance. They are experienced much more strongly than true hallucinations because they represent meaningful images.
- Artificiality. The patient does not have control over them, so they believe they are caused by aliens, wizards, etc.
Visual and auditory pseudohallucinations are common. The following clinical case can be cited as an example. A man with schizophrenia thought he had a gun flying around in his head that was about to go off under the influence of external forces. He believed he was about to be enslaved and threatened to pull the trigger by remote control.
Because the patient is aware of the unreality of the image or voice, he rarely goes to the doctor with such a problem, leading to the pathology’s progression.
In auditory pseudohallucinations, an unusual arrangement of sounds is noted. For example, the patient may hear someone talking in his stomach. At the same time, he distinguishes echoes or echoes. The voices may be talking over or giving orders. Cannabis-Liozner syndrome is often observed when strangers call out in a small, endearing voice in the patient’s head.
Other types of pseudohallucinations are much rarer but still occasionally encountered:
- Motor – the patient’s movements are imposed on him;
- olfactory – artificially created smells and tastes;
- Speech-motor – the patient is forced to say something.
According to the patients, pseudohallucinations resemble memories; however, while the latter occurs consciously, the former is arbitrary and chaotic.
It is not easy to distinguish between pseudohallucinations and true hallucinations in schizophrenia. The patient may believe in the existence of both. However, false visions are not identified with natural objects. In contrast, in hallucinations, people who see devils or aliens believe they are present in the world around them.
There are other differences as well. Pseudohallucinations usually appear in the morning, while true ones can accompany a person around the clock. False images have no clear outlines or localization, while true hallucinations appear in the form of specific objects with spatial orientation.
The behaviour of the patient can also differentiate these symptoms. In pseudohallucinations, he is usually depressed and apathetic, while in 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. They often realize something is wrong with them but hesitate to admit it to others because they don’t want to be labelled schizophrenic. However, hallucinations are not such a specific sign.
It can be observed in:
- Bipolar affective disorder;
- Epileptic psychosis;
- Alcoholic delirium;
- Localized brain lesions;
- Neurodegenerative diseases;
- Acquired deafness, etc.
Hallucinations are also caused artificially by people using hallucinogenic mushrooms and pills.
Any form of schizophrenia requires differential diagnosis, even if most typical signs for this pathology are observed.
Schizophrenia has two types of symptoms, negative and positive. The former include apathy, lack of initiative, interest in anything, depression, etc. Hallucinations are among the positive symptoms because they result from mental activity. Also included in these symptoms are delusions.
Negative symptoms are characteristic of sluggish schizophrenia, and productive symptoms are characteristic of paranoid schizophrenia. The latter is often hallucinatory. On the other hand, hallucinations are relatively rare in the catatonic and hebephrenic forms of schizophrenic disorder. It is further evidence of the complexity and unpredictability of schizophrenia.
The most challenging thing is to refer a patient to a psychiatrist for the first examination, as it is pretty problematic to convince him that he is ill. It is also tricky to recognize schizophrenia from the outside because the person may look healthy most of the time, and the “weirdness” occurs sporadically.
Experts recommend taking a closer look at the following features of the behaviour of a person who may be having hallucinations:
- They look or listen for no apparent reason;
- They talk to themselves or laugh loudly;
- He hands over his ears, closes his eyes, and shakes his head;
- Makes inappropriate movements, such as defensive
- Rushes from one side to the other as if they are looking for something;
- Is trying to hide from someone.
If it is possible to take the person to the hospital, we will prescribe a comprehensive examination. Only after the diagnosis is made will treatment be selected. It is possible to cure the symptoms of schizophrenia, including the removal of hallucinations, with the help of antipsychotic drugs. Therapy is given both during a seizure and in remission.