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Psychosis as a Personal Crisis seeks to challenge the way people who hear voices are both viewed and treated. This book emphasises the individual variation between people who suffer from psychosis and puts forward the idea that hearing voices is not in itself a sign of mental illness. In this book the editors bring together an international range of expert contributors, who in their daily work, their research or their personal acquaintance, focus on the personal experience of psychosis. Further topics of discussion include: accepting and making sense of hearing voices the relation between trauma and paranoia the limitations of contemporary psychiatry the process of recovery. This book will be essential reading for all mental health professionals, in particular those wanting to learn more about the development of the hearing voices movement and applying these ideas to better understanding those in the voice hearing community.

Scientific and philosophical perspectives on hallucination: essays that draw on empirical evidence from psychology, neuroscience, and cutting-edge philosophical theory. Reflection on the nature of hallucination has relevance for many traditional philosophical debates concerning the nature of the mind, perception, and our knowledge of the world. In recent years, neuroimaging techniques and scientific findings on the nature of hallucination, combined with interest in new philosophical theories of perception such as disjunctivism, have brought the topic of hallucination once more to the forefront of philosophical thinking. Scientific evidence from psychology, neuroscience, and psychiatry sheds light on the functional role and physiology of actual hallucinations; some disjunctivist theories offer a radically new and different philosophical conception of hallucination. This volume offers interdisciplinary perspectives on the nature of hallucination, offering essays by both scientists and philosophers. Contributors first consider topics from psychology and neuroscience, including neurobiological mechanisms of hallucination and the nature and phenomenology of auditory-verbal hallucinations. Philosophical discussions follow, with contributors first considering disjunctivism and then, more generally, the relation between hallucination and the nature of experience. Contributors István Aranyosi, Richard P. Bentall, Paul Coates, Fabian Dorsch, Katalin Farkas, Charles Fernyhough, Dominic H. ffytche, Benj Hellie, Matthew Kennedy, Fiona Macpherson, Ksenija Maravic da Silva, Peter Naish, Simon McCarthy-Jones, Matthew Nudds, Costas Pagondiotis, Ian Phillips, Dimitris Platchias, Howard Robinson, Susanna Schellenberg, Filippo Varese

Background Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is increasingly recognized as a clinicoradiological syndrome. Its etiology is diverse, encompassing a variety of triggers, including infections and metabolic abnormalities. Uniquely, MERS may present with psychiatric symptoms, such as delirium, visual hallucinations, and catatonia, posing diagnostic challenges. The variability of these neuropsychiatric symptoms necessitates early diagnosis through magnetic resonance imaging (MRI) to avoid prolonged antipsychotic treatment. Case Presentation This report details a case of MERS in a 39‐year‐old male. The patient initially presented with headache, sore throat, and abnormal laboratory results: leukocytosis, neutrophilia with a left shift, elevated C‐reactive protein (CRP) levels, and hyponatremia. On the fourth day of admission, he developed severe anxiety and restlessness, exhibited thoughts of death, and reported experiencing vivid hallucinations upon closing his eyes. MRI revealed a hyperintense lesion in the corpus callosum. A lumbar puncture showed no increase in cell count or protein. The patient showed a positive response to treatment with antibiotics and olanzapine, demonstrating rapid symptomatic improvement. A follow‐up MRI on the 11th day showed complete resolution of the brain lesions. Six months later, no neurological or psychiatric sequelae were noted. The patient's clinical progression and imaging findings led to a definitive diagnosis of MERS. Conclusion The early presentation of symptoms such as restlessness, hallucinations, and death ideation played a critical role in diagnosing MERS, with early MRI examination being instrumental in both diagnosis and preventing prolonged antipsychotic medication use. This report elucidates a rare presentation of MERS in a 39‐year‐old male, triggered by an episode of tonsillitis, with significant psychiatric manifestations. Although the early psychiatric manifestations of this case, particularly restlessness, hallucinations, and death ideation, were considered psychotic, timely MRI testing played an important role in the diagnosis and avoidance of long‐term use of antipsychotic medications. This case is noteworthy for its atypical presentation and the fact that a multidisciplinary approach to diagnosis and treatment resulted in a favorable outcome.

Background: Confusion and hallucinations in geriatric patients are frequent symptoms and typically associated with delirium, late-life psychosis or dementia syndromes. A far rarer but well-established differential in patients with rapid cognitive deterioration, acute psychosis, abnormal movements and seizures is autoimmune encephalitis. Exemplified by our case we highlight clinical and economic problems arising in management of geriatric patients with cognitive decline and psychotic symptoms. Case Presentation: A 77-year-old female caucasian patient with an unremarkable medical history was hospitalized after a fall in association with diarrhea and hyponatremia. Upon adequate therapy, disorientation and troubled short-term memory persisted. Within a week the patient developed visual hallucinations. Basic blood and urine samples and imaging (cranial computed tomography and magnetic resonance imaging) were unremarkable. With progressive cognitive decline, amnestic impairment, word finding difficulty and general apathy, psychiatric and neurologic expertise was introduced. Advanced diagnostics did not resolve a final diagnosis; an electroencephalogram showed unspecific generalized slowing. Extended clinical observation revealed visual hallucinations and faciobrachial dystonic seizures. A treatment with anticonvulsants was initiated. Cerebrospinal fluid ultimately tested positive for voltage-gated potassium channel LGl1 (leucine-rich-inactivated-1) antibodies confirming diagnosis of autoimmune anti-LGI1 encephalitis. Immediate immunotherapy (high-dose glucocorticoids and administration of intravenous immunoglobulin G) led to a rapid improvement of the patient's condition. After immunotherapy was tapered, the patient had one relapse and completely recovered with reintroduction of glucocorticoids and initiation of therapy with rituximab. Conclusion: Rapidly progressive dementia in geriatric patients demands a structured and multidisciplinary diagnostic approach. Accurate management and financially supportable care is a major issue in rare diseases such as anti-LGI1-encephalitis. Education and awareness about autoimmune encephalitis of all physicians treating a geriatric population is important in order to involve expertise and establish treatment within reasonable time. Keywords: neurocognitive decline, visual hallucinations, rapid progressive dementia, autoimmune encephalitis, anti-LGI1-encephalitis, psychogeriatry, case report

Non-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood. Systematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods. Searches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3-14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates. AH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.

Visual hallucinations (VH) in Lewy body disease (LBD) have a heterogenous phenomenology classified into minor phenomena (MVH) and complex hallucinations (CVH). Mechanisms underpinning VH and their temporal aspects are largely unknown. According to the hodotopic model, we investigated whether changes in distinct cognitive domains and neural networks in the hallucination trait underpin temporal aspects of MVH and CVH in the hallucination state. 35 LBD patients with VH underwent a complete neuropsychological evaluation and resting-state fMRI. North-East-Visual-Hallucinations-Interview was used to assess their typical VH content, duration, and frequency. We found that MVH was not associated with cognitive impairment, while CVH was associated with impairments in visuoperceptual processes, attention and visual abstract reasoning. In seed-to-seed functional connectivity (FC) analysis we identified functional couplings associated with MVH and CVH temporal severity (duration x frequency), duration and frequency. MVH severity was negatively associated with FC between early visual areas (EVA) and ventral-visual-stream regions, and negatively associated with FC between brainstem and EVA, which may be linked to LBD brainstem neuropathology. CVH duration was positively associated with FC between ventral-visual stream and salience network (SN). CVH frequency was negatively associated with FC between DMN and SN. Functional alterations in distinct visual and attentional networks and their dynamic interaction in trait LBD hallucinators are linked to both the phenomenology of state content and its temporal characteristics. Within a network, VH frequency and duration may be linked to different types of functional alterations: increased connectivity leading to sustained activity prolonging VH (duration) and decreased connectivity increasing dysregulated, spontaneous activity (frequency). These findings support the hodotopic hypothesis of VH and may reflect a link between VH phenomenology, LBD neuropathological progression and the involvement of specific neurotransmitter systems.

Visual hallucinations (VH) and pareidolia, a type of minor hallucination, share common underlying mechanisms. However, the similarities and differences in their brain regions remain poorly understood in Parkinson’s disease (PD). A total of 104 drug-naïve PD patients underwent structural MRI and were assessed for pareidolia using the Noise Pareidolia Test (NPT) were enrolled. Subcortical gray matter volume and cortical surface volume were analyzed using the FreeSurfer software. Structural analyses revealed associations between NPT scores and atrophy in the right thalamus, right hippocampus, right temporal cortex, and right orbitofrontal cortex in all PD participants. These results were almost the same after adjusting for right-handed 97 patients with PD. It is considered that hallucinations in patients with PD are related to altered integration of sensory input (bottom-up) and prior knowledge (top-down) within the visual system. Our findings indicate that pareidolia in PD involves both bottom-up (thalamus and temporal cortex) and top-down (orbitofrontal cortex) processing disturbances; in contrast, VH predominantly involves bottom-up but not top-down regions. Understanding these distinctions could aid in the development of targeted interventions for hallucinations in patients with PD.

Visual hallucinations (VH) are common in Parkinson’s disease (PD), yet their mechanisms remain poorly understood. Several studies have investigated structural brain correlates of Parkinsonian VH, but critical gaps in knowledge persist. An inverse relationship between auditory hallucinations and paracingulate sulcus (PCS) length, associated with reality-monitoring mechanisms, has been reported. This study examines the relationship between PCS length and VH in PD patients. Sixty-five PD patients (aged 48–81 years) meeting diagnostic criteria were included. The University of Miami Parkinson’s Disease Hallucinations Questionnaire was used to classify patients into PD with VH (PDVH, n = 32) or PD without VH (PDnonVH, n = 33) groups. PCS length was measured using sagittal T1-weighted MRI scans, and total intracranial volume was calculated. Clinical and neuropsychometric assessments were also performed. No significant demographic or clinical differences were found between groups. Total PCS length was significantly shorter in the PDVH group (68.56 ± 38.03 mm) compared to the PDnonVH group (106.36 ± 48.77 mm; p < .01). Right and left PCS lengths were also shorter in the PDVH group (p < .01). Visual immediate and long-term memory scores were significantly lower in the PDVH group (p < .01, p < .05, respectively), while Spatial Boundaries Subtest recognition scores were higher (p < .05). In the PDVH group, semantic fluency scores positively correlated with PCS length (p < .05). Reduced PCS length increased the likelihood of VH (β =−0.020, Odds Ratio = 0.980, p < .01). PCS length may serve as a biomarker indicative of anatomical structures associated with reality-monitoring mechanisms and biological predisposition to hallucinations in patients with PD.

There is a growing recognition in psychosis research of the importance of hallucinations in modalities other than the auditory. This has focused attention on cognitive and neural processes that might be shared by, and which might contribute distinctly to, hallucinations in different modalities. In this article, I address some issues around the modality-generality of cognitive and neural processes in hallucinations, including the role of perceptual and reality-monitoring systems, top-down and bottom-up processes in relation to the psychological and neural substrates of hallucinations, and the phenomenon of simultaneous multimodal hallucinations of the same entity. I suggest that a functional systems approach, inspired by some neglected aspects of the writings of A. R. Luria, can help us to understand patterns of hallucinatory experience across modalities and across clinical and non-clinical groups. Understanding the interplay between modality-general and modality-specific processes may bear fruit for improved diagnosis and therapeutic approaches to dealing with distressing hallucinations.

Background: The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and ocularpathology causing visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. Antipsychotic medications are often prescribed. However, their efficacy in CBS has been based on sketchy evidence. The use of serotonin selective reuptake inhibitor (SSRI) for CBS was anecdotally reported. We herein describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment. Methods: Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after eight weeks of treatment. All had undergone brain CT and cognitive assessment. Brain CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had Mini-Mental Status Examination scores of ≥ 27/30. Results: There were four men and four women, with a mean age of 81.7 ± 7.3 years. Previous antipsychotic treatment was mostly with risperidone, 1.0 to 3.0 mg/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after eight weeks of escitalopram treatment (mean dose: 11.8 mg/daily). There were no side effects, nor any adverse events were reported. Conclusions: This is the first case-series to show that SSRI is an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in CBS.