RESUMEN
Hallucinations are false sensory perceptions that occur in the absence of an external stimulus. Three cases of hallucinations related to obstructive sleep apnea-hypopnea syndrome are reported, 2 of which improved with the initiation of continuous positive airway pressure therapy. So far there are no published reports in the literature that account for this relationship in the absence of primary or structural mental pathology. All 3 reported patients had visual hallucinations that were uncomfortable and frightening. Polysomnography showed moderate-to-severe obstructive sleep apnea-hypopnea syndrome with severe oxygen desaturation. Initiation of continuous positive airway pressure therapy achieved control of hallucinations in 2 patients during follow-up. Very little information is available on the coexistence of obstructive sleep apnea-hypopnea syndrome and hallucinations. Observational and experimental studies are required to clarify whether there is a causal relationship between the 2 pathologies as well as the therapeutic role that continuous positive airway pressure may have. CITATION: Venegas MA, Montoya JS. Hallucinations in patients with obstructive sleep apnea-hypopnea syndrome: report of 3 cases. J Clin Sleep Med. 2024;20(1):165-167.
Asunto(s)
Apnea Obstructiva del Sueño , Humanos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , Síndrome , Presión de las Vías Aéreas Positiva Contínua , Polisomnografía , Alucinaciones/complicacionesRESUMEN
Abstract Objective To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. Methods Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. Results Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. Conclusion Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.
Resumo Objetivos Avaliar o padrão de apego em portadores de esquizofrenia e discutir a relação que tais padrões apresentam com a sintomatologia psicótica e as comorbidades dos pacientes investigados. Métodos Vinte pacientes diagnosticados com esquizofrenia de acordo com os critérios do Manual Diagnóstico e Estatístico de Transtornos Mentais, 5ª edição (DSM-5) foram submetidos a avaliação de sintomas retrospectivos e avaliação cuidadosa do número e modo de mudança de cuidador da infância. A Entrevista Diagnóstica para Psicoses e Transtornos Afetivos (DI-PAD) foi utilizada para avaliar sintomas relacionados à esquizofrenia (sintomas positivos e negativos), depressão e mania. As comorbidades de transtorno de ansiedade foram avaliadas pela Escala de Ansiedade Social de Liebowitz (LSAS), Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS) e Entrevista de Pânico e Esquizofrenia (PaSI). Os instrumentos Questionário das Experiências nas Relações Próximas-Estruturas Relacionais (ECR-RS) e Inventário de Autorrelato de Trauma Precoce - Forma Curta (ETISR-SF) foram utilizados para avaliar padrões de apego e histórico traumático, respectivamente. Resultados Foram identificadas correlações significativas entre a ocorrência de traumas precoces e o apego do tipo ansioso. Também foi verificada a relação entre traumas gerais e sintomas de pânico, constatando-se que as crises de pânico antecipam surtos quando predominam sintomas ansiosos, somáticos, alucinações e ideias delirantes. Foi observado que a ocorrência de traumas precoces contribui para o pânico, elevando o risco de episódios psicóticos. Conclusão . Os resultados indicam que as adversidades ambientais na infância estão associadas com o risco de desenvolvimento de esquizofrenia e de outras psicoses mais tarde na vida.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Apego a Objetos , Escalas de Valoración Psiquiátrica , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Comorbilidad , Factores de Riesgo , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Depresión/complicaciones , Depresión/epidemiología , Alucinaciones/complicaciones , Alucinaciones/epidemiologíaRESUMEN
OBJECTIVE: To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities. METHODS: Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively. RESULTS: Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale. CONCLUSION: Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.
Asunto(s)
Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Apego a Objetos , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adulto , Trastorno Bipolar/complicaciones , Trastorno Bipolar/epidemiología , Comorbilidad , Depresión/complicaciones , Depresión/epidemiología , Femenino , Alucinaciones/complicaciones , Alucinaciones/epidemiología , Humanos , Masculino , Trastorno de Pánico/complicaciones , Trastorno de Pánico/epidemiología , Escalas de Valoración Psiquiátrica , Factores de RiesgoRESUMEN
BACKGROUND: Folie à deux is a very rare psychiatric syndrome in which a psychotic symptom is transmitted from one individual to another. We present a case of folie à deux occurring during childhood, which is not an usual presentation of this syndrome. In this case, the disorder is correlated with child abuse and neglect, which possibly had a role in the development of the symptoms in our case. CASE PRESENTATION: We present a case of folie à deux between an "induced" 9-year-old black Brazilian boy and the "inducer", his grandmother. They were found to be sharing similar auditory and visual hallucinations and delusional beliefs. The boy was neglected by his parents and was being cared for by his grandmother, who had a history of mental disorder. CONCLUSIONS: The close relationship between the boy and his grandmother, the family history of first-degree psychosis, and the child abuse and neglect suffered by the boy may have altered his vulnerability to early-onset psychosis and, in this case, folie à deux.
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Maltrato a los Niños/psicología , Abuelos/psicología , Trastorno Paranoide Compartido/complicaciones , Trastorno Paranoide Compartido/diagnóstico , Estrés Psicológico/complicaciones , Estrés Psicológico/diagnóstico , Edad de Inicio , Anticonvulsivantes/uso terapéutico , Carbamazepina/uso terapéutico , Niño , Deluciones/complicaciones , Alucinaciones/complicaciones , Humanos , Masculino , Trastorno Paranoide Compartido/tratamiento farmacológico , Trastorno Paranoide Compartido/psicología , Medio Social , Estrés Psicológico/tratamiento farmacológico , Estrés Psicológico/psicologíaRESUMEN
Objective: Approximately one-half of all patients affected by bipolar disorder present with psychotic features on at least one occasion. Several studies have found that alterations in the activity of mesolimbic and prefrontal regions are related to aberrant salience in psychotic patients. The aim of the present study was to investigate the structural correlates of a history of hallucinations in a sample of euthymic patients with bipolar I disorder (BD-I). Methods: The sample consisted of 21 euthymic patients with BD-I and no comorbid axis I DSM-IV-TR disorders. Voxel based morphometry (VBM) was used to compare patients with and without a lifetime history of hallucinations. Preprocessing was performed using the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) algorithm for VBM in SPM8. Images were processed using optimized VBM. Results: The main finding of the present study was a reduction in gray matter volume in the right posterior insular cortex of patients with BD-I and a lifetime history of hallucinations, as compared to subjects with the same diagnosis but no history of hallucinations. Conclusions: This finding supports the presence of abnormalities in the salience network in BD patients with a lifetime history of hallucinations. These alterations may be associated with an aberrant assignment of salience to the elements of one’s own experience, which could result in psychotic symptoms.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Trastorno Bipolar/fisiopatología , Sustancia Gris/patología , Alucinaciones/fisiopatología , Tamaño de los Órganos , Trastorno Bipolar/complicaciones , Trastorno Bipolar/diagnóstico por imagen , Imagen por Resonancia Magnética , Corteza Cerebral/fisiopatología , Corteza Cerebral/diagnóstico por imagen , Estudios Transversales , Sustancia Gris/diagnóstico por imagen , Alucinaciones/complicaciones , Persona de Mediana EdadRESUMEN
OBJECTIVE: Approximately one-half of all patients affected by bipolar disorder present with psychotic features on at least one occasion. Several studies have found that alterations in the activity of mesolimbic and prefrontal regions are related to aberrant salience in psychotic patients. The aim of the present study was to investigate the structural correlates of a history of hallucinations in a sample of euthymic patients with bipolar I disorder (BD-I). METHODS: The sample consisted of 21 euthymic patients with BD-I and no comorbid axis I DSM-IV-TR disorders. Voxel based morphometry (VBM) was used to compare patients with and without a lifetime history of hallucinations. Preprocessing was performed using the Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) algorithm for VBM in SPM8. Images were processed using optimized VBM. RESULTS: The main finding of the present study was a reduction in gray matter volume in the right posterior insular cortex of patients with BD-I and a lifetime history of hallucinations, as compared to subjects with the same diagnosis but no history of hallucinations. CONCLUSIONS: This finding supports the presence of abnormalities in the salience network in BD patients with a lifetime history of hallucinations. These alterations may be associated with an aberrant assignment of salience to the elements of one's own experience, which could result in psychotic symptoms.
Asunto(s)
Trastorno Bipolar/fisiopatología , Sustancia Gris/patología , Alucinaciones/fisiopatología , Adulto , Trastorno Bipolar/complicaciones , Trastorno Bipolar/diagnóstico por imagen , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/fisiopatología , Estudios Transversales , Femenino , Sustancia Gris/diagnóstico por imagen , Alucinaciones/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Adulto JovenRESUMEN
This study evaluated parasitological and molecular techniques for the diagnosis and assessment of cure of schistosomiasis mansoni. A population-based study was performed in 201 inhabitants from a low transmission locality named Pedra Preta, municipality of Montes Claros, state of Minas Gerais, Brazil. Four stool samples were analysed using two techniques, the Kato-Katz® (KK) technique (18 slides) and the TF-Test®, to establish the infection rate. The positivity rate of 18 KK slides of four stool samples was 28.9% (58/201) and the combined parasitological techniques (KK+TF-Test®) produced a 35.8% positivity rate (72/201). Furthermore, a polymerase chain reaction (PCR)-ELISA assay produced a positivity rate of 23.4% (47/201) using the first sample. All 72 patients with positive parasitological exams were treated with a single dose of Praziquantel® and these patients were followed-up 30, 90 and 180 days after treatment to establish the cure rate. Cure rates obtained by the analysis of 12 KK slides were 100%, 100% and 98.4% at 30, 90 and 180 days after treatment, respectively. PCR-ELISA revealed cure rates of 98.5%, 95.5% and 96.5%, respectively. The diagnostic and assessment of cure for schistosomiasis may require an increased number of KK slides or a test with higher sensitivity, such as PCR-ELISA, in situations of very low parasite load, such as after therapeutic interventions.
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Humanos , Delirio/fisiopatología , Alucinaciones/complicaciones , Trastornos de la Visión/complicaciones , Relaciones Enfermero-Paciente , SíndromeRESUMEN
In the Caribbean island of Guadeloupe, patients with atypical parkinsonism develop a progressive supranuclear palsy-like syndrome, named Guadeloupean parkinsonism. Unlike the classical forms of progressive supranuclear palsy, they develop hallucinations and myoclonus. As lesions associated with Guadeloupean parkinsonism are poorly characterized, it is not known to what extent they differ from progressive supranuclear palsy. The aim of the present study was to determine the structural and metabolic profiles of Guadeloupean parkinsonism compared with progressive supranuclear palsy and controls using combined structural and diffusion magnetic resonance imaging and magnetic resonance spectroscopy. We included 9 patients with Guadeloupean parkinsonism, 10 with progressive supranuclear palsy and 9 age-matched controls. Magnetic resonance imaging examination was performed at 1.5 T and included 3D T(1)-weighted and fluid-attenuated inversion recovery images, diffusion tensor imaging and single voxel magnetic resonance spectroscopy in the lenticular nucleus. Images were analysed using voxel-based morphometry, voxel-based diffusion tensor imaging and brainstem region of interest measurements. In patients with Guadeloupean parkinsonism, structural and diffusion changes predominated in the temporal and occipital lobes, the limbic areas (medial temporal, orbitofrontal and cingulate cortices) and the cerebellum. In contrast to patients with progressive supranuclear palsy, structural changes predominated in the midbrain and the basal ganglia and diffusion abnormalities predominated in the frontocentral white matter, the basal ganglia and the brainstem. Compared with controls, the N-acetylaspartate to creatinine ratio was decreased in patients with progressive supranuclear palsy and to a lesser extent in patients with Guadeloupean parkinsonism. The pattern of structural and diffusion abnormalities differed between progressive supranuclear palsy and Guadeloupean parkinsonism. Widespread cortical atrophy was observed in patients with Guadeloupean parkinsonism who presented marked cognitive changes and hallucinations, whereas midbrain lesions were less severe than in progressive supranuclear palsy. Midbrain (progressive supranuclear palsy) or cortical (Guadeloupean parkinsonism) atrophy was a distinctive neuroimaging feature for differential diagnosis.
Asunto(s)
Encéfalo/metabolismo , Encéfalo/patología , Trastornos Parkinsonianos/metabolismo , Trastornos Parkinsonianos/patología , Parálisis Supranuclear Progresiva/metabolismo , Parálisis Supranuclear Progresiva/patología , Anciano , Ácido Aspártico/análogos & derivados , Ácido Aspártico/metabolismo , Estudios de Casos y Controles , Trastornos del Conocimiento/complicaciones , Trastornos del Conocimiento/metabolismo , Trastornos del Conocimiento/patología , Creatinina/metabolismo , Diagnóstico Diferencial , Imagen de Difusión por Resonancia Magnética/instrumentación , Imagen de Difusión por Resonancia Magnética/métodos , Imagen de Difusión Tensora/instrumentación , Imagen de Difusión Tensora/métodos , Femenino , Guadalupe , Alucinaciones/complicaciones , Alucinaciones/metabolismo , Alucinaciones/patología , Humanos , Procesamiento de Imagen Asistido por Computador , Espectroscopía de Resonancia Magnética/instrumentación , Espectroscopía de Resonancia Magnética/métodos , Masculino , Trastornos Parkinsonianos/complicacionesAsunto(s)
Insuficiencia de la Válvula Aórtica/patología , Válvula Aórtica/patología , Adulto , Disección Aórtica/patología , Aneurisma de la Aorta Torácica/patología , Insuficiencia de la Válvula Aórtica/etiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/patología , Resultado Fatal , Alucinaciones/complicaciones , Humanos , Masculino , Rigidez Muscular/complicaciones , Convulsiones/complicacionesAsunto(s)
Adulto , Humanos , Masculino , Insuficiencia de la Válvula Aórtica/patología , Válvula Aórtica/patología , Disección Aórtica/patología , Aneurisma de la Aorta Torácica/patología , Insuficiencia de la Válvula Aórtica/etiología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/patología , Resultado Fatal , Alucinaciones/complicaciones , Rigidez Muscular/complicaciones , Convulsiones/complicacionesRESUMEN
Although much attention has been paid to patients who lack insight into their obsessional beliefs, less importance has been given to individuals with obsessive-compulsive disorder (OCD) who display perceptual disturbances typically found in psychotic disorders, including schizophrenia, schizoaffective disorders, or mood disorders with psychotic features. We would like to call the attention to a phenomenon that has been neglected in the psychiatric literature: the occurrence of hallucinations and related phenomena in patients with OCD. In this case report, we describe five clinical vignettes of patients with OCD with hallucinations in several different sensory modalities, including the auditory, the visual, the tactile, the olfactory, and the cenesthetic ones. Further psychopathological research should clarify the clinical significance of hallucinations among patients with OCD.
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Alucinaciones/complicaciones , Trastorno Obsesivo Compulsivo/complicaciones , Trastorno Obsesivo Compulsivo/psicología , Adulto , Femenino , Humanos , Masculino , Trastorno Obsesivo Compulsivo/diagnóstico , Escalas de Valoración Psiquiátrica , Índice de Severidad de la EnfermedadRESUMEN
In this article the authors report two cases of Charles Bonnet syndrome, defined as complex visual hallucinations in patients with low vision, and the patient is aware of the unreal nature of the phenomenon. A great number of cases is misdiagnosed due to lack of direct questioning by the physician. Since the emotional distress caused by this disease, the knowledge of its symptoms is essential in the management of these patients.
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Alucinaciones/complicaciones , Trastornos de la Visión/complicaciones , Anciano , Femenino , Humanos , SíndromeRESUMEN
Se presentan 2 pacientes con diagnóstico de delirio dermatozoo, al realizar una revisión de dicha entidad a propósito de la presentación, en ambos casos aparece una asociación causal con la afección orgánica. El tratamiento indicado con fluspirileno resultó novedoso y de buena evolución, y no había sido reportado con anterioridad (AU)
Asunto(s)
INFORME DE CASO , Masculino , Femenino , Adulto , Delirio/complicaciones , Delirio/diagnóstico , Delirio/tratamiento farmacológico , Discapacidad Intelectual/complicaciones , Otosclerosis/complicaciones , Alucinaciones/complicaciones , Fluspirileno/uso terapéuticoRESUMEN
Se presentan 2 pacientes con diagnostico de delirio dermatozoo, al realizar una revision de dicha entidad a proposito de la presentacion, en ambos casos aparece una asociacion causal con la afeccion organica. El tratamiento indicado con fluspirileno resulto novedoso y de buena evolucion, y no habia sido reportado con anterioridad
Asunto(s)
Masculino , Femenino , Adulto , Delirio/complicaciones , Delirio/diagnóstico , Delirio/tratamiento farmacológico , Fluspirileno/uso terapéutico , Alucinaciones/complicaciones , Discapacidad Intelectual/complicaciones , Otosclerosis/complicacionesRESUMEN
La punción accidental de duramadre como complicación en la instalación del bloqueo epidural, trae consigo en el postanestésico una serie de síntomas principales, como son la cefalea mareo, náuseas, vómito, acúfenos, fosfenos. En este caso, una paciente presenta alucinaciones visuales complejas además de los síntomas antes mencionados. Se discuten otras causas que pudieran haber ocasionado las alucinaciones y se hace una correlación entre la mejoría de la sintomatología y la terapéutica empleada
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Humanos , Femenino , Persona de Mediana Edad , Alucinaciones/complicaciones , Anestesia Epidural/efectos adversos , Anestesia Epidural/psicología , Punción Espinal/efectos adversos , Punción Espinal/psicologíaRESUMEN
We longitudinally evaluated the neuropsychological functions, rate of progression, and waking EEG findings in 17 patients with probable Alzheimer's disease (AD) with delusions and hallucinations, and compared them with those of matched AD patients without delusions and hallucinations. AD patients with delusions and hallucinations had a more rapid rate of decline, as measured by the Mini-Mental State Examination, a specific defect in receptive language, and a greater frequency of aggression and hostility. Visual EEG analysis showed that these patients had a significantly greater proportion of moderately abnormal EEGs, and spectral analysis confirmed the increased amount of delta and theta activity. These data demonstrate that AD patients with delusions and hallucinations have a greater degree of cerebral dysfunction and a relatively focal neuropsychological defect, which may indicate a localized pathologic abnormality.