Visual Perceptual Abnormalities: Hallucinations and Illusions John W
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12 Retina Gabriele K
299 12 Retina Gabriele K. Lang and Gerhard K. Lang 12.1 Basic Knowledge The retina is the innermost of three successive layers of the globe. It comprises two parts: ❖ A photoreceptive part (pars optica retinae), comprising the first nine of the 10 layers listed below. ❖ A nonreceptive part (pars caeca retinae) forming the epithelium of the cil- iary body and iris. The pars optica retinae merges with the pars ceca retinae at the ora serrata. Embryology: The retina develops from a diverticulum of the forebrain (proen- cephalon). Optic vesicles develop which then invaginate to form a double- walled bowl, the optic cup. The outer wall becomes the pigment epithelium, and the inner wall later differentiates into the nine layers of the retina. The retina remains linked to the forebrain throughout life through a structure known as the retinohypothalamic tract. Thickness of the retina (Fig. 12.1) Layers of the retina: Moving inward along the path of incident light, the individual layers of the retina are as follows (Fig. 12.2): 1. Inner limiting membrane (glial cell fibers separating the retina from the vitreous body). 2. Layer of optic nerve fibers (axons of the third neuron). 3. Layer of ganglion cells (cell nuclei of the multipolar ganglion cells of the third neuron; “data acquisition system”). 4. Inner plexiform layer (synapses between the axons of the second neuron and dendrites of the third neuron). 5. Inner nuclear layer (cell nuclei of the bipolar nerve cells of the second neuron, horizontal cells, and amacrine cells). 6. Outer plexiform layer (synapses between the axons of the first neuron and dendrites of the second neuron). -
The Influence of Religious Activity and Polygenic Schizophrenia Risk On
Schizophrenia Research 210 (2019) 255–261 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres The influence of religious activity and polygenic schizophrenia risk on religious delusions in schizophrenia Heike Anderson-Schmidt a,b,⁎,1,KatrinGadea,b,1,DörtheMalzahnc,1,2, Sergi Papiol a,d, Monika Budde a, Urs Heilbronner a, Daniela Reich-Erkelenz a, Kristina Adorjan a,d, Janos L. Kalman a,d,e,FannySennera,d, Ashley L. Comes a,e,LauraFlataua,AnnaGryaznovaa, Maria Hake a,MarkusReittb,MaxSchmaußf, Georg Juckel g,JensReimerh, Jörg Zimmermann h,i, Christian Figge i, Eva Reininghaus j, Ion-George Anghelescu k, Carsten Konrad l, Andreas Thiel l, Martin von Hagen m, Manfred Koller n, Sebastian Stierl o, Harald Scherk p, Carsten Spitzer q, Here Folkerts r, Thomas Becker s,DetlefE.Dietricht,u,3, Till F.M. Andlauer v, Franziska Degenhardt w,x,MarkusM.Nöthenw,x, Stephanie H. Witt y, Marcella Rietschel y, Jens Wiltfang b,z,aa,PeterFalkaid,ThomasG.Schulzea,b a Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich 80336, Germany b Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen 37075, Germany c Department of Genetic Epidemiology, University Medical Center Göttingen, Georg-August-University, Göttingen 37099, Germany d Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich 80336, Germany e International Max Planck Research School for Translational Psychiatry, Max Planck Institute of -
Advice for Floaters and Flashing Lights for Primary Care
UK Vision Strategy RCGP – Royal College of General Practitioners Advice for Floaters and Flashing Lights for primary care Key learning points • Floaters and flashing lights usually signify age-related liquefaction of the vitreous gel and its separation from the retina. • Although most people sometimes see floaters in their vision, abrupt onset of floaters and / or flashing lights usually indicates acute vitreous gel detachment from the posterior retina (PVD). • Posterior vitreous detachment is associated with retinal tear in a minority of cases. Untreated retinal tear may lead to retinal detachment (RD) which may result in permanent vision loss. • All sudden onset floaters and / or flashing lights should be referred for retinal examination. • The differential diagnosis of floaters and flashing lights includes vitreous haemorrhage, inflammatory eye disease and very rarely, malignancy. Vitreous anatomy, ageing and retinal tears • The vitreous is a water-based gel containing collagen that fills the space behind the crystalline lens. • Degeneration of the collagen gel scaffold occurs throughout life and attachment to the retina loosens. The collagen fibrils coalesce, the vitreous becomes increasingly liquefied and gel opacities and fluid vitreous pockets throw shadows on to the retina resulting in perception of floaters. • As the gel collapses and shrinks, it exerts traction on peripheral retina. This may cause flashing lights to be seen (‘photopsia’ is the sensation of light in the absence of an external light stimulus). • Eventually, the vitreous separates from the posterior retina. Supported by Why is this important? • Acute PVD may cause retinal tear in some patients because of traction on the retina especially at the equator of the eye where the retina is thinner. -
Two Cases of Intractable Auditory Hallucination Successfully Treated with Sound Therapy
ORIGINAL ARTICLE International Tinnitus Journal. 2010;16(1):29-31. Two cases of intractable auditory hallucination successfully treated with sound therapy Yutaka Kaneko, M.D. 1 Yasuhiko Oda, M.D. 2 Fumiyuki Goto, M.D. 3 Abstract We report two cases of patients with schizoaffective disorder with treatment-refractory auditory verbal hallucinations (AVHs) who were successfully treated with sound therapy, which is effective to treat tinnitus. AVHs in both patients were alleviated within about one month, and no recurrence was reported for 31 and 17 months after the sound the- rapy together with medication. Further studies may confirm the therapeutic value of sound therapy in patients with intractable AVHs. Keywords: auditory hallucinations, sound therapy. 1 Kaneko Otorhinolaryngology Clinic, Sendai, Miyagi, 2 Kunimidai Hospital (Psychiatry), Sendai, Miyagi, and 3 Department of Otorhinolaryngology, Hino Municipal Hospital, Tokyo, Japan Corresponding Author: Yutaka Kaneko, M.D. Kaneko Otorhinolaryngology Clinic 2-9-14 Kunimi,Aoba-ku,Sendai 981-0943,Japan Tel & Fax: +81-22-233-7722 E-mail: [email protected] International Tinnitus Journal, Vol. 16, No 1 (2010) www.tinnitusjournal.com 29 INTRODUCTION levomepromazine and olanzapine, together with fluvo- xamine maleate and sodium valproate during her hos- Auditory hallucinations (AHs) are generally defined pitalization for 3 years. She then received a psychiatric as false perceptions manifesting as “voices commenting” referral to our ear clinic for audiological evaluation and or “voices conversing” in patients with schizophrenia and treatment in August 2006. Her hearing level, calculated schizoaffective disorder. Auditory verbal hallucinations as the average across the frequencies 250, 500, 1000, (AVHs) are one of the major symptoms for the diagnosis and 2000 Hz, was 13.8 dB in the right ear and 18.8 dB of these disorders as well as the evaluation of psychotic in the left ear. -
Localisation of Visual Hallucinations
BRITISH MEDICAL JOURNAL 16 JULY 1977 147 of hypothermia; the duration of cardiac arrest; and the disturbances of sleep or consciousness.4 Hallucinations may be promptness and correctness of treatment. Peterson's pessi- evoked by sensory deprivation, but other factors are usually mistic report from California,8 in which all 15 near-drowned present; thus the "black-patch" delirium that may follow children who had fits, fixed dilated pupils, flaccidity, and loss cataract extraction in the elderly probably results from sensory Br Med J: first published as 10.1136/bmj.2.6080.147 on 16 July 1977. Downloaded from of pain sensation suffered severe anoxic encephalopathy, deprivation and mild senile brain changes and is more frequent may be explained by the high water temperatures there. In when hearing is also impaired.5 warm water the protective effect of hypothermia against brain Hallucinations may be due to focal lesions. Past experiences, damage would be missing. In contrast was the case described the quality of eidetic imagery, and psychodynamic "actors in Trondheim, Norway,9 in which a 5-year-old fell through influence the content of organic hallucinosis,6 and it would be ice in fresh water with an outside temperature of 10° below unwise to lean too heavily on the occurrence and nature of zero centigrade. He was in the water for 22 minutes and was hallucinosis in localising intracranial lesions. Visual hallucina- brought out apparently dead, with widely dilated pupils and tions are a relatively infrequent accompaniment oflesions ofthe bluish white skin. He was warmed up (the method was not calcarine cortex (Brodmann's area 17), which has few thalamo- described) and-despite the risks noted above-was given cortical connections; yet they may occur as a false-localising external cardiac massage without suffering ventricular symptom of frontal or subtentorial lesions. -
Visual Perception in Migraine: a Narrative Review
vision Review Visual Perception in Migraine: A Narrative Review Nouchine Hadjikhani 1,2,* and Maurice Vincent 3 1 Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA 2 Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, 41119 Gothenburg, Sweden 3 Eli Lilly and Company, Indianapolis, IN 46285, USA; [email protected] * Correspondence: [email protected]; Tel.: +1-617-724-5625 Abstract: Migraine, the most frequent neurological ailment, affects visual processing during and between attacks. Most visual disturbances associated with migraine can be explained by increased neural hyperexcitability, as suggested by clinical, physiological and neuroimaging evidence. Here, we review how simple (e.g., patterns, color) visual functions can be affected in patients with migraine, describe the different complex manifestations of the so-called Alice in Wonderland Syndrome, and discuss how visual stimuli can trigger migraine attacks. We also reinforce the importance of a thorough, proactive examination of visual function in people with migraine. Keywords: migraine aura; vision; Alice in Wonderland Syndrome 1. Introduction Vision consumes a substantial portion of brain processing in humans. Migraine, the most frequent neurological ailment, affects vision more than any other cerebral function, both during and between attacks. Visual experiences in patients with migraine vary vastly in nature, extent and intensity, suggesting that migraine affects the central nervous system (CNS) anatomically and functionally in many different ways, thereby disrupting Citation: Hadjikhani, N.; Vincent, M. several components of visual processing. Migraine visual symptoms are simple (positive or Visual Perception in Migraine: A Narrative Review. Vision 2021, 5, 20. negative), or complex, which involve larger and more elaborate vision disturbances, such https://doi.org/10.3390/vision5020020 as the perception of fortification spectra and other illusions [1]. -
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REVIEW OF OPTOMETRY EARN 2 CE CREDITS: Positive Visual Phenomena—Etiologies Beyond the Eye, PAGE 58 ■ VOL. 155 NO. 1 January 15, 2018 www.reviewofoptometry.comwww.reviewofoptometry.com ■ ANNUAL CORNEA REPORT JANUARY 15, 2018 ■ CXL ■ EPITHELIAL DEFECTS How to Heal Persistent Epithelial Defects PAGE 38 ■ TRANSPLANTS Corneal Transplants: The OD’s Role PAGE 44 ■ INFILTRATES Diagnosing Corneal Infiltrative Disease PAGE 50 ■ POSITIVE VISUAL PHENOMENA CXL: Your Top 12 Questions —Answered! PAGE 30 001_ro0118_fc.indd 1 1/5/18 4:34 PM ĊčĞĉėĆęĊĉĆĒēĎĔęĎĈĒĊĒćėĆēĊċĔėĎēǦĔċċĎĈĊĕėĔĈĊĉĚėĊĘ ĊđĎĊċĎēĘĎČčę ċċĊĈęĎěĊ Ȉ 1 Ȉ 1 ĊđđǦęĔđĊėĆęĊĉ Ȉ Ȉ ĎĒĕđĊĎēǦĔċċĎĈĊĕėĔĈĊĉĚėĊ Ȉ Ȉ ĔēěĊēĎĊēę Ȉ͝ Ȉ Ȉ Ƭ 1 ǡ ǡǡǤ͚͙͘͜Ǥ Ȁ Ǥ ͚͙͘͜ǣ͘͘ǣ͘͘͘Ǧ͘͘͘ ĕĕđĎĈĆęĎĔēĘ Ȉ Ȉ Ȉ Ȉ Ȉ čĊĚėĎĔē̾ėĔĈĊĘĘ Ȉ Ȉ Katena — Your completecomplete resource forfor amniotic membrane pprocedurerocedure pproducts:roducts: Single use speculums Single use spears ͙͘͘ǡ͘͘͘ήĊĞĊĘęėĊĆęĊĉ Forceps ® ,#"EWB3FW XXXLBUFOBDPNr RO0118_Katena.indd 1 1/2/18 10:34 AM News Review VOL. 155 NO. 1 ■ JANUARY 15, 2018 IN THE NEWS Accelerated CXL Shows The FDA recently approved Luxturna (voretigene neparvovec-rzyl, Spark Promise—and Caution Therapeutics), a directly administered gene therapy that targets biallelic This new technology is already advancing, but not without RPE65 mutation-associated retinal dystrophy. The therapy is designed to some bumps in the road. deliver a normal copy of the gene to By Rebecca Hepp, Managing Editor retinal cells to restore vision loss. While the approval provides hope for patients, wo new studies highlight the resulted in infection—while tradi- the $425,000 per eye price tag stands as pros and cons of accelerated tional C-CXL has a reported inci- a signifi cant hurdle. -
Migraine Triggered Seizures and Epilepsy Triggered Headache and Migraine Attacks: a Need for Re-Assessment
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by PubMed Central J Headache Pain (2011) 12:287–288 DOI 10.1007/s10194-011-0344-2 COMMENTARY Migraine triggered seizures and epilepsy triggered headache and migraine attacks: a need for re-assessment Paul T. G. Davies • C. P. Panayiotopoulos Received: 5 April 2011 / Accepted: 8 April 2011 / Published online: 24 April 2011 Ó The Author(s) 2011. This article is published with open access at Springerlink.com In this issue of the Journal, Belcastro and associates review Migralepsy terminology and classification issues for migralepsy, hem- icrania epileptica, post-ictal and ictal headache [1]. They According to the ICHD-II 1.5.5, ‘‘migraine-triggered sei- raise key points such as ictal headache and visual seizures zure (sometimes referred to as migralepsy)’’ denotes an are often misdiagnosed as migraine, ‘‘migralepsy’’ is unli- epileptic seizure that occurs ‘‘during or within one hour kely to exist and an ‘‘epilepsy-migraine sequence’’ is much after a migraine aura’’ [3]. However, the evidence of this more common and well documented than the dominant ‘‘migraine-seizure’’ sequence is weak and the proposed view of a ‘‘migraine-epilepsy sequence’’. Their relevant criterion of 1 h gap between the end of the ‘‘aura’’ and the proposals need appropriate attention by the committee of start of an epileptic seizure is entirely arbitrary the international classification of headache disorders Migralepsy is an old term derived from migra(ine) and (ICHD) as well as the physicians in their clinical practice (epi)lepsy, coined by Dr Douglas Davidson, but mainly because of the consequences that misdiagnosis may have on attributed to Lennox and Lennox, which we quote, ‘‘a patients. -
Federal Air Surgeon's
Federal Air Surgeon’s Medical Bulletin Aviation Safety Through Aerospace Medicine 02-4 For FAA Aviation Medical Examiners, Office of Aerospace Medicine U.S. Department of Transportation Winter 2002 Personnel, Flight Standards Inspectors, and Other Aviation Professionals. Federal Aviation Administration Best Practices This article launches Best Practices, a new series of HEADS UP profiles highlighting the shared wisdom of the most A Dean Among Doctors senior of our senior aviation medical examiners. 2 Editorial: Research By Mark Grady Written by one of Dr. Moore’s pilot medical and Aviation Safety General Aviation News certification applicants, this article appeared in the November 22, 2002, issue of General Avia- 3 Certification Issues OCTOR W. DONALD MOORE of tion News. —Ed. and Answers Coats, N.C., knows a lot of pilots 6 Bariatric D— many quite intimately. After Surgery: all, as an Federal Administra- morning just to give medical exams for pilots in the area. How Long tion Aviation Administration- approved medical examiner, He estimates he’s given more to Wait? he’s poked and prodded quite than 12,000 flight physicals a few of them during his more over the past 41 years. 7 Checklist for than 40 years of making sure “I’ve given an average of Pilot they meet the FAA’s physical 300 flight physicals a year since Physical requirements for flying. 1960,” he says, noting those He also knows what it’s like exams have been in addition to fly, because he flew for 40 to running a busy general 8 Palinopsia Case years. medical and obstetrics Report Moore began giving FAA Dr. -
Elementary Visual Hallucinations, Blindness, and Headache in Idiopathic Occipital Epilepsy: Diverentiation from Migraine
536 J Neurol Neurosurg Psychiatry 1999;66:536–540 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.66.4.536 on 1 April 1999. Downloaded from SHORT REPORT Elementary visual hallucinations, blindness, and headache in idiopathic occipital epilepsy: diVerentiation from migraine C P Panayiotopoulos Abstract also fundamental symptoms often with the This is a qualitative and chronological same sequence of events in occipital seizures.1−9 analysis of ictal and postictal symptoms, This is a systematic prospective qualitative frequency of seizures, family history, study of the characteristics of elementary visual response to treatment, and prognosis in hallucinations, blindness, and headache in nine patients with idiopathic occipital epi- idiopathic occipital epilepsy. lepsy and visual seizures. Ictal elementary visual hallucinations are stereotyped for Methods each patient, usually lasting for seconds. These are detailed elsewhere.910 Patients with They consist of mainly multiple, bright occipital seizures were prospectively evaluated coloured, small circular spots, circles, or and followed up from 1973. Nine patients with balls. Mostly, they appear in a temporal idiopathic occipital epilepsy with visual halluci- hemifield often moving contralaterally or nations (IOEVH) had: in the centre where they may be flashing. (a) Incontrovertible clinical evidence of oc- They may multiply and increase in size in cipital seizures with or without secondarily the course of the seizure and may progress generalisation. to other non-visual occipital seizure (b) Normal physical, neurological, and men- symptoms and more rarely to extra- tal states and high resolution MRI. They all had detailed interviews, seven com- occipital manifestations and convulsions. 9 Blindness occurs usually from the begin- pleted a purposely designed questionnaire, ning and postictal headache, often indis- and eight provided drawings of their visual hal- tinguishable from migraine, is common. -
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Comments & Controversies p Coming to Ask more questions APA? suspected to be at risk for workplace MAY 2009 Visit us at booth The list of interview questions Dr. #1624 violence and for fi tness for duty. Mob- Henry Nasrallah suggested in “The bing seems to be more prevalent and hallucination portrait of psychosis: the consequences more dire for a vic- Probing the voices within” (From the A DOWDEN PUBLICATION • VOL. 8, NO. 5 Beyond threats tim who is feeling pressured to leave Editor, Current Psychiatry, May Risk factors for suicide his or her job when there is little hope in borderline personality 2009, p. 10-12) is a much-needed re- disorder of getting another one or is taking on ] SPECIAL REPORT minder of the clinical importance of Economic anxiety: First aid responsibilities previously held by oth- for the recession’s casualties patients’ verbal auditory hallucina- What is your patient’s ers who have been laid off. predicament? Knowing can tions. In 15 years of practice—much Mr. S experiences recurrent hypothermia inform clinical practice This brings to the forefront a very during treatment for multiple medical PLUS Editorial: Dr. Nasrallah problems and psychotic symptoms. of that inpatient psychiatry—I have Hallucination portrait of psychosis: important consideration for individu- Could antipsychotics be the cause? Probing the voices within Malpractice Rx cared for many patients with hallu- Smoking allowed: als who confront such assessment Is hospital policy a liability risk? Pearls cinations, and until recently I confess \DRiNK TWO 6 PACK challenges. Gathering collateral infor- clarifi es substance use ONLINE ONLY my interview was not as thorough as SEE PAGE 9 mation is critical for diagnostic accura- Dr. -
The Effect of Delusion and Hallucination Types on Treatment
Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2016;29:29-35 Research / Araştırma DOI: 10.5350/DAJPN2016290103 The Effect of Delusion and Esin Evren Kilicaslan1, Guler Acar2, Sevgin Eksioglu2, Sermin Kesebir3, Hallucination Types on Ertan Tezcan4 1Izmir Katip Celebi University, Ataturk Training and Treatment Response in Research Hospital, Department of Psychiatry, Izmir - Turkey 2Istanbul Erenkoy Mental Health Training and Research Schizophrenia and Hospital, Istanbul - Turkey 3Uskudar University, Istanbul Neuropsychiatry Hospital, Istanbul - Turkey Schizoaffective Disorder 4Istanbul Beykent University, Department of Psychology, Istanbul - Turkey ABSTRACT The effect of delusion and hallucination types on treatment response in schizophrenia and schizoaffective disorder Objective: While there are numerous studies investigating what kind of variables, including socio- demographic and cultural ones, affect the delusion types, not many studies can be found that investigate the impact of delusion types on treatment response. Our study aimed at researching the effect of delusion and hallucination types on treatment response in inpatients admitted with a diagnosis of schizophrenia or schizoaffective disorder. Method: The patient group included 116 consecutive inpatients diagnosed with schizophrenia and schizoaffective disorder according to DSM-IV-TR in a clinical interview. Delusions types were determined using the classification system developed by Gross and colleagues. The hallucinations were recorded as auditory, visual and auditory-visual. Response to treatment was assessed according to the difference in the Positive and Negative Syndrome Scale (PANSS) scores at admission and discharge and the duration of hospitalization. Results: Studying the effect of delusion types on response to treatment, it has been found that for patients with religious and grandiose delusions, statistically the duration of hospitalization is significantly longer than for other patients.