Monday, July 13, 2020

ILLUSION

Dr. Debjani Datta, Principal

Edited by: Anis Ahmed

 

Illusion, a misrepresentation of a “real” sensory stimulus—that is, an interpretation that contradicts objective “reality” as defined by general agreement. An illusion is a distortion of the senses, which can reveal how the human brain normally organizes and interprets sensory stimulation. Illusion refers to a specific form of sensory distortion. An illusion is distinguished from a hallucination, an experience that seems to originate without an external source of stimulation. Illusions are special perceptual experiences in which information arising from “real” external stimuli leads to an incorrect perception, or false impression, of the object or event from which the stimulation comes.

Some of these false impressions may arise from factors beyond an individual’s control , from inadequate information, or from the functional and structural characteristics of the sensory apparatus.

Types of illusion: Different types of illusion are described below:-

Optical: An optical illusion or visual illusion is characterized by visually perceived images that are deceptive or misleading. Optical Illusions can use color, light and patterns to create images that can be deceptive or misleading to brains. The information gathered by the eye is processed by the brain, creating a perception that in reality, does not match the true image. Perception refers to the interpretation of what we take in through our eyes. Numerous optical illusions are produced by the refraction (bending) of light as it passes through one substance to another in which the speed of light is significantly different. A ray of light passing from one transparent medium (air) to another (water) is bent as it emerges. Thus, the pencil standing in water seems broken at the surface where the air and water meet; in the same way, a partially submerged log in the water of a swamp gives the illusion of being bent.

Another illusion that depends on atmospheric conditions is a mirage, in which, for example, the vision of a pool of water is created by light passing through layers of air above the heated surface of a highway. In effect, cooler layers of air refract the sun’s rays at different angles than do less-dense strata of heated air, giving the appearance of water where there is none; nearby objects may even appear to be reflected in it.

Some illusions are related to characteristics of the perceiver, namely the functioning of the brain and the senses, rather than to physical phenomena that distort a stimulus. Many common visual illusions are perceptual: they result from the brain’s processing of ambiguous or unusual visual information. Other illusions result from the aftereffects of sensory stimulation or from conflicting sensory information.

When an observer is confronted with a visual assortment of dots, the brain may group the dots that “belong together.” These groupings are made on the basis of such things as observed similarity (e.g., red versus black dots), proximity, common direction of movement, perceptual set (the way one is expecting to see things grouped), and extrapolation (one’s estimate of what will happen based on an extension of what is now happening).

Some of the examples of such illusion are:

 

Hermann Grid Illusion

In the Hermann Grid Illusion, the white dots at the center of each square seem to shift from white to gray.

Figure-ground illusion

 The “figure-ground” illusion is commonly experienced when one gazes at the illustration of a white vase, the outline of which is created by two black profiles. At any moment, one will be able to see either the white vase (in the centre area) as “figure” or the black profiles on each side (in which case the white is seen as “ground”). The fluctuations of figure and ground may occur even without conscious effort. Seeing one aspect usually excludes seeing the other.

 


Auditory : An auditory illusion is an illusion of hearing, the listener hears either sound which are not present in the stimulus, or "impossible" sounds. In short, audio illusions highlight areas where the human ear and brain, as organic, makeshift tools, differ from perfect audio receptors (for better or for worse). In auditory illusions, the human brain thinks that it can hear something that is either not “there” or exists in a very different form to how it is perceived. Normally, we rely on being able to translate the world around us into accurate sense perceptions. But in certain circumstances, the relationship between stimuli and senses breaks down, leading to some interesting results.

The way we visualize the world has an important impact on the things that we hear. This is neatly illustrated by one of the most famous auditory illusions: the McGurk Effect. Named after one of its discoverers (the British psychologist Harry McGurk), the effect is particularly common in conversation. It turns out that the way words are formed by the speaker is as important in how they are perceived as the sound that they make. So, if you shape your mouth in two different ways, but say the same word, viewers may well hear two separate sounds.

 

Another  example of an auditory illusion is a Shepard tone.

 

Tactile: A tactile illusion is an illusion that affects the sense of touch. Tactile illusions are found when the perception of a quality of an object through the sense of touch does not seem to be in agreement with the physical stimulus. They can arise in numerous circumstances and can provide insights into the mechanisms subserving haptic sensations. Examples of tactile illusions include phantom limb, the thermal grill illusion, the cutaneous rabbit illusion and a curious illusion.

One of the oldest tactile illusions is the Aristotle illusion. It is easy to perform. Cross your fingers, then touch a small spherical object such as a dried pea, and it feels like you are touching two peas. This also works if you touch your nose. This is an example of what is called “perceptual disjunction”.

Yet another example of vision influencing touch occurs in patients with phantom limbs. After amputation of an arm, the vast majority of patients continue to feel vividly the presence of the missing arm, a phenomenon termed phantom limb in the late 1800s by physician and author Silas Weir Mitchell. Many people report that their phantom limb is frozen, paralyzed in a constant or fixed position, and that this experience is sometimes painful.

Temporal: A temporal illusion is a distortion in the perception of time that occurs for various reasons, such as due to different kinds of stress. In such cases, a person may momentarily perceive time as slowing down, stopping, speeding up, or even running backwards, as the timing and temporal order of events are misperceived.

In a wonderful book, Brain Bugs”, the author, Dean Buonomano, writes on temporal illusions.  

“On the much shorter scale of hundredths of a second (tens of million seconds) to a few seconds, the brain needs to keep track of time effectively to understand speech, appreciate music, or perform the highly coordinated movements necessary for catching a ball or playing the violin. Although timing on this scale is often automatic, it is critical to our ability to communicate with and navigate the world.

One example is the stopped clock illusion. If you have an analog clock with a second hand (one that “ticks,” not one with smooth and continuous motion), on occasion you may have shifted your gaze to the second hand, and for a brief moment thought to yourself “damn, the clock stopped,” but by the time you finished your thought you realized you were mistaken. As we first look at the second hand it seems to remain motionless for longer than we expect a second to last; it is as if time dilated or stood still for a moment, and for this reason is sometimes referred to as chronostasis. The illusion is related to shifts in attention, motion, and our internal expectations. Additionally, the physical characteristics of what we are looking at influence our estimates of duration, and generally the more the physical characteristics of an object engage our attention, the longer it seems to last. For example, when people are asked to judge the duration that pictures of faces are shown on a computer screen, people judge faces of angry people to have lasted longer than pictures of smiling people.

 

Illusions of psychiatric significance

Illusions called pseudohallucinations occur at times when feelings of anxiety or fear are projected on external objects, as when a child perceives threatening faces or monsters in shadows at night or sees goblins in trees.

 

 

 

 

 

 

 

 



 

 

Thursday, July 2, 2020


Hallucination

Dr. Debjani Datta, Principal

Edited by: Anis Ahmed

The word "hallucination" was introduced into the English language by the 17th-century physician Sir Thomas Browne in 1646 from the derivation of the Latin word alucinari meaning to wander in the mind. For Browne, hallucination means a sort of vision that is "depraved and receive[s] its objects erroneously".

A hallucination is a perception in the absence of external stimulus that has qualities of real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and imagery (imagination), which does not mimic real perception and is under voluntary control.Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus (i.e., a real perception) is given some additional (and typically absurd) significance.

Hallucinations can occur in any sensory modality—visual, auditory, olfactory, gustatory, tactile, proprioceptive, equilibrioceptive, nociceptive, thermoceptive and chronoceptive.

Types of hallucination

There are many different types of hallucinations, including:

Visual

Visual hallucinations involve seeing things that aren’t there. The hallucination may be of objects, visual patterns, people, or lights. It is "the perception of an external visual stimulus where none exists".

Visual hallucinations are classified as simple or complex:

  • Simple visual hallucinations (SVH) are also referred to as non-formed visual hallucinations and elementary visual hallucinations. These terms refer to lights, colors, geometric shapes, and indiscrete objects. These can be further subdivided into phosphenes which are SVH without structure, and photopsias which are SVH with geometric structures.
  • Complex visual hallucinations (CVH) are also referred to as formed visual hallucinations. CVHs are clear, lifelike images or scenes such as people, animals, objects, places, etc.

Numerous hypotheses have been suggested to explain the genesis of visual hallucinations. These have been summarized and categorized by Asaad and Shapiro: psychophysiologic (i.e., as a disturbance of brain structure), psychobiochemical (as a disturbance of neurotransmitters), and psychodynamic (as an emergence of the unconscious into consciousness). Visual hallucinations can be the result of all 3 processes, given the interplay among disturbances of brain anatomy, brain chemistry, prior experiences, and psychodynamic meaning.

Olfactory

Olfactory hallucinations involve sense of smell. Phantosmia (olfactory hallucinations), smelling an odor that is not actually there,and parosmia (olfactory illusions), inhaling a real odor but perceiving it as different scent than remembered,are distortions to the sense of smell (olfactory system) that, in most cases, are not caused by anything serious and usually go away on their own in time.

 

Auditory

Auditory hallucinations are among the most common type of hallucination. Auditory hallucinations or paracusia are the perception of sound without outside stimulus.

Other examples of this type of hallucination include hearing sounds, like someone walking in the attic or repeated clicking or tapping noises.

Auditory hallucinations can be divided into two categories: elementary and complex.

Elementary hallucinations are the perception of sounds such as hissing, whistling, an extended tone, and more. In many cases, tinnitus is an elementary auditory hallucination. However, some people who experience certain types of tinnitus, especially pulsatile tinnitus, are actually hearing the blood rushing through vessels near the ear. Because the auditory stimulus is present in this situation, it does not qualify it as a hallucination.

Complex hallucinations are those of voices, music, or other sounds that may or may not be clear, may be familiar or completely unfamiliar, and friendly or aggressive, among other possibilities. A hallucination of a single individual person of one or more talking voices is particularly associated with psychotic disorders such as schizophrenia, and hold special significance in diagnosing these conditions.

Musical hallucinations are also relatively common in terms of complex auditory hallucinations and may be the result of a wide range of causes ranging from hearing-loss (such as in musical ear syndrome, the auditory version of Charles Bonnet syndrome), lateral temporal lobe epilepsy, arteriovenous malformation, stroke, lesion, abscess, or tumor.

Auditory hallucinations are one of the most important symptoms for the diagnosis of psychosis, especially schizophrenia. Auditory hallucinations are commonly associated with psychiatric disorders such as schizophrenia, psychotic depression, mania, and posttraumatic stress disorder.

High caffeine consumption has been linked to an increase in likelihood of one experiencing auditory hallucinations.

Command

Command hallucinations are hallucinations in the form of commands; they can be auditory or inside of the person's mind or consciousness. The contents of the hallucinations can range from the innocuous to life threatening. People experiencing command hallucinations may or may not comply with the hallucinated commands, depending on the circumstances. Patients with command hallucinations (voices ordering particular acts, often violent or destructive ones) are commonly assumed to be at high risk for dangerous behavior. Command hallucinations are often associated with schizophrenia.

Tactile

Tactile hallucinations involve an abnormal or false sensation of touch or perception of movement on the skin or inside the body. Usually, the condition causes unpleasant, uncomfortable, disturbing sensations. Some people may feel that bugs are crawling over their body or something is inside them trying to get out. One subtype of tactile hallucination, formication, is the sensation of insects crawling underneath the skin and is frequently associated with prolonged cocaine use.However, formication may also be the result of normal hormonal changes such as menopause, or disorders such as peripheral neuropathy, high fevers, Lyme disease, skin cancer etc.

Gustatory

A gustatory hallucination is a sensation of taste without having tasted or eaten something.It is the perception of taste without a stimulus. These hallucinations, which are typically strange or unpleasant, are relatively common among individuals who have certain types of focal epilepsy, Gustatory hallucinations can also be a symptom of schizophrenia. Typically the tastes experienced are unusual and not pleasant.

For example, a person experiencing a gustatory hallucination may perceive they are eating spoiled food even when they are not.

General somatic sensations

General somatic sensations of a hallucinatory nature are experienced when an individual feels that their body is being mutilated, i.e. twisted, torn, or disemboweled. Other reported cases are invasion by animals in the person's internal organs.

Reason of Hallucinations

There are different reasons or causes for Hallucinations. Some of the reasons are discussed below:-

Delirium tremens

One of the more enigmatic forms of visual hallucination is the highly variable, possibly polymodal delirium tremens. Individuals suffering from delirium tremens may be agitated and confused, especially in the later stages of this disease. Insight is gradually reduced with the progression of this disorder. Sleep is disturbed and occurs for a shorter period of time, with rapid eye movement sleep.

Hypnagogic hallucination

These hallucinations occur just before falling asleep, and affect a high proportion of the population The hallucinations can last from seconds to minutes; all the while, the subject usually remains aware of the true nature of the images. These may be associated with narcolepsy. Hypnagogic hallucinations are sometimes associated with brainstem abnormalities.

Peduncular hallucinosis

Peduncular means pertaining to the peduncle, which is a neural tract running to and from the pons on the brain stem. These hallucinations usually occur in the evenings, but not during drowsiness, as in the case of hypnagogic hallucination. The subject is usually fully conscious and then can interact with the hallucinatory characters for extended periods of time.

Parkinson's disease and Lewy body dementia

Parkinson's disease is linked with Lewy body dementia for their similar hallucinatory symptoms. The symptoms strike during the evening in any part of the visual field, and are rarely polymodal. Hallucination may begin with illusions. where sensory perception is greatly distorted, but no novel sensory information is present. These typically last for several minutes, during which time the subject may be either conscious and normal or drowsy/inaccessible.

Charles Bonnet syndrome

Charles Bonnet syndrome causes a person whose vision has started to deteriorate to see things that aren't real. It is visual hallucinations experienced by a partially or severely sight impaired person. The hallucinations can occur at any time and can distress people of any age. The hallucinations may be simple patterns, or detailed images of events, people or places. They're only visual and don't involve hearing things or any other sensations. There are 2 main types of hallucination that people with Charles Bonnet syndrome tend to experience.

They are :

·         simple repeated patterns

·         complex images of people, objects or landscapes.

Migraine coma

This type of hallucination is usually experienced during the recovery from a comatose state. The migraine coma can last for up to two days, and a state of depression is sometimes comorbid.

Focal epilepsy

Visual hallucinations due to focal seizures differ depending on the region of the brain where the seizure occurs. For example, visual hallucinations during occipital lobe seizures are typically visions of brightly colored, geometric shapes that may move across the visual field, multiply, or form concentric rings and generally persist from a few seconds to a few minutes.

Temporal lobe seizures, can produce complex visual hallucinations of people, scenes, animals, and more as well as distortions of visual perception. Complex hallucinations may appear to be real or unreal, may or may not be distorted with respect to size, and may seem disturbing or affable, among other variables.

Schizophrenia

Psychiatric illnesses, in particular schizophrenia, are probably one of the conditions most commonly associated with hallucinations in general. The hallucinations of schizophrenia tend to be of the auditory type, although visual hallucinations can certainly occur.

Drug-induced hallucination

Drug-induced hallucinations are caused by hallucinogens, dissociatives, and deliriants, including many drugs with anticholinergic actions and certain stimulants, which are known to cause visual and auditory hallucinations. Some psychedelics such as lysergic acid diethylamide (LSD) and psilocybin can cause hallucinations that range in the spectrum of mild to intense. In addition, many drugs that are available in the market have side effects that include hallucinations. 

Sensory deprivation hallucination

Hallucinations can be caused by sensory deprivation when it occurs for prolonged periods of time, and almost always occur in the modality being deprived (visual for blindfolded/darkness, auditory for muffled conditions, etc.). Sensory deprivation or perceptual isolation is the deliberate reduction or removal of stimuli from one or more of the senses.

Experimentally-induced hallucinations

Anomalous experiences, such as so-called benign hallucinations, may occur in a person in a state of good mental and physical health, even in the apparent absence of a transient trigger factor such as fatigue, intoxication or sensory deprivation.

Treatments

There are few treatments for many types of hallucinations. However, for those hallucinations caused by mental disease, a psychologist or psychiatrist should be consulted, and treatment will be based on the observations of those doctors. Antipsychotic and atypical antipsychotic medication may also be utilized to treat the illness if the symptoms are severe and cause significant distress.

Some of the approaches used to treat hallucination are described below:

  • General measures that can be taken to reduce the frequency or severity of hallucinations include stress management, healthy living, regular exercise and sleeping well.
  • The use of illicit drugs such as cocaine, LSD, amphetamines or ecstasy can cause hallucinations. Excessive alcohol consumption is another cause. These hallucinations can occur during periods of withdrawal from drugs or alcohol if the substances are stopped too suddenly. People experiencing hallucinations due to drugs or alcohol withdrawal can be given medication to help prevent the hallucinations occurring. Rehabilitation programs are also available to help the patient recover from their addiction.
  • Psychosocial strategies used to help manage hallucination include education and counselling to help the patient and their family cope with the hallucinations and understand the importance of medication compliance.
  • Examples of antipsychotic medications used to treat hallucinations include haloperidol, olanzapine and risperidone.
  • Hallucinations can occur as a side effect of the treatment for Parkinson’s disease. If this occurs, the patient’s medication may require adjustment. Usually, amantadine and anticholinergics are stopped first. Thereafter, dopamine agonists may be withdrawn. Clozapine and quetiapine are examples of neuroleptic drugs that may help treat hallucinations in Parkinson’s disease.
  • Other problems that occur as a result of hallucination such as memory disturbance, sleep disorder, depression, anxiety and associated panic attacks may also need to be managed with treatment.

 

 

References

1) Chen E, Berrios GE (1996). "Recognition of hallucinations: a multidimensional model and methodology".

2) Johnson FH (1978). The Anatomy of Hallucinations.

3) www.nhs.uk