Download “Hallucinations” Extra Credit Hallucinations don`t belong wholly to

“Hallucinations” Extra Credit
Hallucinations don’t belong wholly to the insane. Much more commonly, they are linked to
sensory deprivation, intoxication, illness, or injury. People with migraines may see
shimmering arcs of light or tiny, Lilliputian figures of animals and people. People with failing
eyesight, paradoxically, may become immersed in a hallucinatory visual world.
Hallucinations can be brought on by a simple fever or even the act of waking or falling
asleep, when people have visions ranging from luminous blobs of color to beautifully detailed
faces or terrifying ogres. Those who are bereaved may receive comforting “visits” from the
departed. In some conditions, hallucinations can lead to religious epiphanies or even the
feeling of leaving one’s own body. Humans have always sought such life-changing visions,
and for thousands of years have used hallucinogenic compounds to achieve them. As a young
doctor in California in the 1960s, Oliver Sacks had both a personal and a professional
interest in psychedelics. These, along with his early migraine experiences, launched a lifelong
investigation into the varieties of hallucinatory experience.
From the book review of “Hallucinations” by Oliver Sacks, on Amazon.com
Listen to Flora Lichtman’s Science Friday interview with neurologist Oliver Sacks to answer
the following questions. 34 minutes.
1. Charles Bonnet was a Swiss naturalist in the 1700’s. He described a syndrome that now
bares his name and is actually quite common in the elderly who have lost their eyesight.
Dr. Sacks explains that many blind people have vivid visual hallucinations, but won’t
spontaneously tell you for fear of ______________________________________________________________.
Towards the end of the interview, Dr. Sacks states that ________% of visually impaired
people have elaborate hallucinations, while ________% have simple hallucinations
(geometric patterns and such).
2. Dr. Sacks relates a story about an LSD experience he had in the 1960’s involving a visual
hallucination of a pear-shaped, internally glowing, blob of indigo. He later relates that LSD
and DMT (N,N-dimethyltryptamine, a hallucinogen common in many plant families)
impact serotonin systems in the CNS, while amphetamines and cocaine mainly impact
______________________________. He explains that while each type of hallucination is related to
inappropriate activity in a particular part of the brain, the same region of the brain will be
activated by actual stimuli (that is, if you hallucinate a vision of your mom and actually see
your mom, the same regions of the brain light up in functional magnetic resonance
imagining {fMRI}). The parts of your brain affected by hallucinogenic drugs in reward
pathways and those attributed to mystical consciousness, can be stimulated by
___________________________________________________________________________________________________
3. Temporal lobe epilepsy (TLE) is associated with olfactory hallucinations. TLE patients
also have lots of déjà vu experiences and it may be the first sign/symptom of their
epilepsy. In general, as people get older, déjà vu occurs more often. As you fall asleep it is
common for people to hallucinate. Migraine sufferers often have hallucinations grouped
under the term “auras.” What, according to Dr. Sacks, is different about all of these
hallucinations and those of a schizophrenic? ________________________________________________
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“Hallucinations” Extra Credit
Go to this article: Hallucinations in Parkinson’s Disease Prevalence, phenomenology and
risk factors. Gilles Fenelon et.al. Brain 2000 123(4):733-745. In this article, the authors
discuss explanations for the relatively high prevalence of hallucinations in patients with
Parkinson’s Disease.
4. Approximately 25% of outpatients diagnosed with Parkinson’s disease experience
hallucinations, most of which are visual. This article was published in 2000, since then the
FDA has added boxed warnings to the drug they recommend using to treat hallucinations
in Parkinson’s patients. First, what is the drug? And second, what are the boxed warnings
(use your notes or drugs.com/pro/)?
a. Drug? ___________________________________________________________________________________________
b. Boxed warnings? ______________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
5. They present a case study of “a 68-year-old-woman had received a diagnosis of Parkinson's
disease 18 years previously. She had moderate cognitive disorders (MMP score 25) and felt
depressed. She had experienced presence hallucinations (of an unindentified person) for the
last 6 months. In one instance she saw her deceased son with another person. Her son
distinctly said to her: “take care of yourself.” “ She was taking three drugs we covered in
class and one that is only available overseas. What were the three drugs we covered that
are indicated to treat PD? __________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
6. Patients with visual hallucinations differed in a number of respects: they were older, had a
longer duration of disease, had a more severe motor state, had more depressive
symptoms, and were more likely to have cognitive impairment, day-time somnolence and
a history of ocular pathology. They were less likely to receive ___________________________ or
____________________________ and received a higher daily dose of levodopa, but the levodopaequivalent dose did not differ significantly between the two groups.
7. First, they present evidence to support the explanation that the hallucinations are a result
of dopaminergic therapy. What are the three points they make that support the
hallucinations being caused by the dopamine agonists used to treat the disease?
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
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8. Then they present evidence that appears to refute this idea. Fill in key words in the
following quoted text:
 First, in early reports the frequency of acute psychic adverse reactions may have been
overestimated as larger doses of _______________________ were used. Moreover, as stressed
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“Hallucinations” Extra Credit
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by Factor and colleagues, “it is difficult to determine the incidence with which these
problems occurred because the early studies varied with regard to the inclusion
criteria, the dosages of _______________________ employed, and the classification of the
psychiatric effects reported”. In fact, hallucinations in the course of Parkinson's disease
usually occur in a normal state of consciousness without delirium, and have a chronic
course.
Secondly, hallucinations were recorded before the use of _______________________, but the
data are difficult to interpret because most studies were not prospective, patients with
postencephalitic syndromes were often included, and anticholinergic medications
were used widely.
Thirdly, there is no simple dose–effect relationship between dopaminergic treatment
and the development of hallucinations. In the present study, the daily dose of levodopa
but not the daily levodopa-equivalent dose was significantly higher in patients with
visual hallucinations. However, this variable did not emerge as an independent
predictive factor in the multivariate analysis. Moreover, in two prospective studies and
one retrospective study, hallucinations were not associated with the dosage of
_______________________ medication (levodopa or dopaminergic agonists). Recently, Goetz
and colleagues showed that there was not a simple relationship between visual
hallucinations and high plasma levels of _______________________ or sudden changes in
plasma levels (Goetz et al., 1998). This does not preclude a facilitating or triggering
action of dopaminergic treatment on hallucinations, but eliminates a simple doserelated side-effect.
Fourthly, non-dopaminergic pharmacological agents (mainly _______________________) may
elicit hallucinations in Parkinson's disease patients.
Fifthly, in a series of patients treated with _______________________ for pituitary tumours,
hallucinations (mainly auditory) occurred in only 1% of cases.
Finally, hallucinations may occur spontaneously (i.e. in the absence of
_______________________ or other treatment), sometimes at presentation, in the course of
DLB (dementia with Lewy bodies)
In the present study, non-hallucinators were more likely to be on _______________________
or _______________________ than patients with hallucinations.
9. Fill in the blanks in this quoted text:
The more frequent involvement of the visual cortex in Parkinson's disease
dementia and DLB than in Alzheimer's disease could explain the higher
prevalence of visual hallucinations in the first two conditions. Another
possibility is that the prevalence of hallucinations is modified in different
ways by pharmacological factors, i.e. it may be enhanced by ____________________
_______________________ in Parkinson's disease and reduced by _____________________
in Alzheimer's disease.
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