Phantom vision, or hallucinosis of Charles Bonnet

This disease belongs to the category of severe mental disorders. With this pathological condition, the patient experiences uncontrollable visual and sound illusions. Patients may see non-existent pictures, blurry figures, images. The appearance of images is not associated with any external reasons or provocations in the form of external stimuli.

At the same time, the patient’s consciousness remains completely intact, without changes. Timely treatment of hallucinosis ensures a reduction in the manifestations of the diagnosis.

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Hallucinosis is a painful condition characterized by the constant presence of hallucinations (deceptions of perception) with clear consciousness.

In the presence of the phenomenon of pseudohallucinations, they speak of pseudohallucinosis. Pseudohallucinations are false perceptions localized within the body (in the head, in the body), characterized by a feeling of being made by someone from the outside. For example, a voice sounding in the head is perceived as “induced by someone and purposefully influencing.”

What happens if you refuse treatment?

Some patients gradually get used to hallucinosis, but refusing treatment can have serious consequences. Hallucinatory syndrome is only a consequence of other more serious diseases. If left untreated, the patient may develop paranoia, depression, or delusions. Each of these pathologies can make a person dangerous to himself and others, and this can happen at any time.

For example, depression that is accompanied by threats from imaginary voices in the head often leads to suicide. If hallucinations are perceived as a threat, a person may harm relatives, friends, neighbors and strangers, anyone within reach. The type of delusion may change and develop into a paranoid state. In this case, the patient will contact government authorities and services with a statement of persecution and attempt.

Symptoms of hallucinatory syndrome usually worsen in the evening: the patient at this time may be in a stupor, show suspicion, and blame others for something. Relatives should pay attention to the unusual behavior of a person suffering from hallucinosis. If you suspect a mental disorder, you should immediately contact a psychiatrist.

Symptoms

Hallucinosis is manifested by the presence of deceptions of perception, relatively constant and homogeneous. For example, this can occur in the form of the presence of “voices” (auditory deceptions), pictures and images (visual deceptions), unpleasant odors (olfactory deceptions), tastes (gustatory deceptions), sensations of touch or pressure (tactile hallucinosis). The difference between hallucinosis is complete clarity of consciousness: orientation in time, place and one’s own personality is completely preserved, all events are fully preserved in memory.

With hallucinosis, delusional ideas may arise, but they are usually unstable and fully correspond to the content of hallucinations. For example, a patient experiencing olfactory hallucinations in the form of unpleasant odors concludes that there is a corpse in the next room. Or, if there are auditory deceptions in the form of voices, he begins to believe that there are people behind the wall who are emitting these voices.

Acute hallucinosis with mental automatisms

Mainly ideational mental automatisms are recorded. The patient may claim that the voices know their thoughts in advance and pronounce them. Further, the symptoms intensify, and auditory pseudohallucinations appear. Then violently arising thoughts may appear. Rare cases are characterized by so-called sensory automatisms.

The appearance of mental automatisms is associated with the progression of true verbal hallucinosis to polyvocal. Hallucinations become comments and commands to do something.

Course and prognosis

There are two types of hallucinosis: acute and chronic.

Acute hallucinosis develops suddenly and lasts from several hours to several days. Accompanied by a feeling of fear, restlessness, sleep disturbance and impulsive actions. The patient’s critical attitude is often observed; he understands that the deceptions of perception are a mistake of the brain. With adequate treatment, it has a good prognosis and can stop completely.

Chronic hallucinosis is characterized by a long course and is difficult to treat. Relatively orderly and calmer behavior is observed without anxiety or fussiness. Over time, a critical attitude may be lost. It has a poor prognosis and is difficult to treat.

Types of hallucinosis

Illusions that appear in patients in the form of hallucinations can be caused by different types of pathologies.

Alcoholic hallucinosis

It is the second most common alcohol psychosis after delirium tremens. It develops in about 10% of patients suffering from chronic alcoholism. It can occur in chronic, acute and subacute forms.

In most cases, patients suffer from auditory hallucinations. Delirium often develops. Unlike delirium, in alcoholic hallucinosis the patient remains oriented in the world around him, his consciousness is not impaired. As this delusional state develops, the patient may enter a stage of harming himself and others. The illness can last from several days to a year or more.

The disease occurs against the background of long-term constant intake of alcoholic liquids. Women are more susceptible to developing hallucinosis. Complex therapy includes taking B vitamins, antipsychotics, and drugs that improve metabolic processes in the brain.

Organic hallucinosis

Occurs under the influence of a provoking organic factor. This pathology is a condition accompanied by constant hallucinations. They arise in clear consciousness during the waking period. Illusions can be of any type, including all types of disturbances from visual to tactile. They can be auditory and belong to the olfactory type. This condition is provoked by:

• taking certain medications;
• brain injuries;
• impaired blood supply to the brain in cardiovascular pathologies;
• for diseases of the sensory organs, including deafness and blindness;
• migraine with aura;
• epilepsy.

Currently, research has suggested that the cause of the pathology is changes in the vessels supplying the brain with blood, nerve tissue, damage to the temporal and frontal lobes of the brain and other diagnoses.

Acute hallucinosis

They are distinguished by the most striking external manifestations. In most cases, it is associated with acute alcohol dependence during insanity or hallucinogenic delusions of people suffering from alcohol dependence. Most often it manifests itself in the form of delirium during the period of falling asleep.

The pathological condition can last up to several weeks. With timely treatment, the condition is reversible.

Verbal hallucinosis

Is an auditory hallucination. It can manifest itself in the form of communication between several voices entering into dialogue. The patient may hear a “monologue.” Two voices or a large number of them take part in the conversation. Accompanied by figurative anxiety, motor delirium, anxiety and fear. With vascular psychoses it can become chronic. The pathology intensifies at night and in the evening. Requires urgent medical attention. The patient is capable of harming himself and others.

Chronic hallucinosis

Occurs in schizophrenia and alcoholism. It is a rare form of hallucinogenic psychosis, observed in 4-5% of patients suffering from hallucinations. It is diagnosed when hallucinations do not stop 6 months after the first manifestation of the pathology and continue continuously.

As a rule, patients are tormented by similar illusions. Hallucinations are most often verbal.

Acute alcoholic hallucinosis

Lasts no more than 4 weeks. Associated with excessive and long-term alcohol intake. May manifest as auditory and visual hallucinations. It goes away suddenly and can stop at the first manifestation without additional specialized therapy.

Visual hallucinosis

Depending on the location of the affected area in the brain, it may be associated with damage to its peduncles (Lhermitte hallucinosis) or other areas (Van Bogart hallucinosis). Associated with vascular damage. May be a reaction to injury or infectious disease. In most situations it manifests itself in the form of the appearance of small images. In most situations, visual illusions appear in the dark and in rooms with low light levels.

Causes

The development of hallucinosis has many causes. From the consequences of mechanical damage to brain tissue during vascular disorders to endogenous diseases (schizophrenia, psychosis). Damage leads to disruption of the analyzers (brain structures responsible for the perception and processing of information). The German psychiatrist and scientist Wernicke explained the development of hallucinations by irritation of certain areas of the cerebral cortex. Diseases in which hallucinosis may develop:

• Organic brain damage: encephalopathy, consequences of injuries, poisoning, strokes and heart attacks, neoplasms and atrophy of brain tissue.
• Epilepsy.
• Schizophrenia and schizophrenia spectrum disorders.
• Alcoholism, drug addiction.
• Oligophrenia.
• For diseases accompanied by decreased vision and hearing.

Literature:

1. Clinical features of acute alcoholic hallucinosis. Alikulov B.A.
2. Teshabayeva G.D. Magazine “Health is the basis of human potential: problems and ways to solve them”, 2014
3. Alcoholic psychoses: clinical picture, classification. Gofman Alexander Genrikhovich, Orlova Maria Alekseevna, Meliksetyan Anait Sergeevna / Journal “Social and Clinical Psychiatry” 2010
4. Features of the pathomorphosis of alcoholic psychoses. Umanskaya P.S. / Magazine "Tyumen Medical Journal" 2010

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The most common types of hallucinosis:

Alcoholic hallucinosis

Develops in individuals who abuse alcohol and have a predisposition to endogenous diseases. Most often it occurs in the form of verbal hallucinations (in the form of words, phrases, dialogues, songs).

Visual hallucinosis

It can develop in people who have completely or partially lost their vision.

Gabek's olfactory hallucinosis

The patient begins to feel unpleasant odors, which, as it seems to him, come from himself. Characteristic is a decrease in criticism and the appearance of delusional ideas of the attitude: “those around you smell these smells and therefore behave differently.”

Tactile hallucinosis: Ekbom's dermatozoal hallucinosis

The patient feels crawling and moving on his skin. This causes scratching, itching and general anxiety. The sensations are so believable that patients often refuse to accept the true nature of their complaints and spend a lot of energy on unnecessary tests and consultations to search for imaginary parasites.

Prevention of relapse

Intensive treatment in a hospital does not mean that alcoholic hallucinosis will not happen again. To prevent a repeat episode, comprehensive therapy for alcoholism is necessary. The best option is to undergo a course of physiotherapy, hardware cleansing, and psychotherapy in a clinical setting.

After normalization of health, comprehensive diagnostics and consultations with highly specialized specialists are necessary. As a rule, with such a long period of alcohol abuse, chronic diseases of the liver, pancreas, and heart failure are diagnosed. And it is not only alcoholism that requires treatment, but also associated pathologies.

The final stage of therapy is rehabilitation. Modern drug treatment clinics offer various readaptation schemes. The most common is the 12-step system and one of its variations (Minnesota model), excellent results are noted after rehabilitation using the Shichko method.

Treatment

Therapy for hallucinosis is carried out by a psychiatrist. In case of a mild condition, treatment can be carried out at home, in case of a severe condition - in a 24-hour specialized hospital. Treatment of hallucinosis begins with clarifying the causes and mechanisms of development of this disease. The doctor also establishes all the individual characteristics of the patient: physical and mental state, social factors.

Treatment consists of two stages: the first is active therapy, the purpose of which is to restore normal perception and remove hallucinations, the second is rehabilitation, during which the achieved result is consolidated and measures are taken to prevent relapse of the disease.

The most commonly used treatments for hallucinosis are:

• Drug therapy: neuroleptics, neurometabolic therapy, normothimics and restoratives.
• Physiotherapy: electroanalgesia and electro-sleep.
• Isolation from external stimuli.
• Psychotherapy.
• Therapeutic exercise, general massage.

An important result of treatment is not only the complete cessation of perceptual deceptions (hallucinations), but also the complete restoration of the patient’s critical attitude towards the symptoms he has experienced.

Treatment of hallucinosis at the ROSA clinic:

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• Consultation with our specialist at home or in the clinic.
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• Assistance in case of forced hospitalization.
• Psychological support for relatives.
• We are one of the few clinics in Moscow that are licensed and certified to provide qualified care for mental disorders in a hospital setting.

Content:

1. Main forms and symptoms of the disease:

1.1. Acute (“classic”) hallucinosis. 1.2. Chronic alcoholic hallucinosis.

2. Treatment.
3. Prevention of relapse.

In addition to the negative impact on health, alcohol causes serious mental disorders that are difficult to treat. One of the most common is alcoholic hallucinosis (in specialized literature, such a disorder is also called hallucinatory insanity or hallucinatory delusions of alcoholics). This syndrome is a form of alcoholic psychosis, usually occurs after 10–15 years of addiction, is more common in women, and lasts from 4–5 weeks to six months or more.