Secondary Schizophrenia (15 page)

ological Catchment Area (ECA) study conducted in
the United States, and the rates of hallucinations in
Delirium

various modalities has been analysed by Tien
[207].

The ECA study noted that tactile (“somatic”) hal-Tactile hallucinations are often associated with delir-lucinations were perhaps the most common, albeit
ium, although studies are lacking that clearly out-most benign, form of hallucinations, occurring in rates
line their prevalence as most studies focus on visual
slightly higher than auditory and significantly higher
and auditory phenomena associated with the deliri-than visual and olfactory hallucinations across the
ous state. One descriptive series of consecutive patients
lifespan. For both genders, this declined until the mid-suggests the prevalence in an unselected delirious pop-dle of the seventh decade
[207].

ulation is less than 5%
[148]
, although these symptoms
may be more characteristic of and common in alcohol-withdrawal delirium (discussed later).

Tactile hallucinations in psychiatric

disorders

Tactile hallucinations in neurological

Tactile hallucinations have been described in a num-Tactile hallucinations have only been occasionally
ber of organic states including dementia, diabetes, and
described in schizophrenia
[208,
209,
210],
usually
brain injury
[21,
220].
Their most frequent associ-in the setting of complex hallucinatory phenom-ation has been with the synucleinopathies, in par-ena whereby the tactile hallucination is associated
ticular Parkinson’s disease (PD). In the early twenti-with hallucinations in other modalities (particularly
eth century, postencephalitic Parkinsonian states were
visual). One study used functional magnetic resonance
described as frequently featuring tactile hallucina-imaging (fMRI) in a patient with schizophrenia and
tions
[221].
Goetz found 7% of PD patients treated
painful tactile hallucinations, and noted an increased
for at least one year with dopaminergic medication
activation in hallucinations compared to the non-experienced tactile hallucinations
[59],
and features
hallucinating state in the precuneus and supplemen-associated with abnormal tactile experiences in PD

tary motor area region
[211].
Shergill and colleagues
include cognitive impairment and daytime somno-also used fMRI in a schizophrenia patient experi-lence
[222].
Fenelon described tactile hallucinations,
encing both tactile and auditory hallucinations, and
generally intimately associated with visual hallucina-noted increased activation in the primary somatosen-tions, in a series of eight patients with Parkinson’s dis-sory and posterior parietal cortex – regions mediating
ease
[223],
which were frequently of animals, insects,
somatic perception – whereas auditory hallucinations
or human figures. Tactile hallucinations have also
were associated with activation in areas associated with
been described in association with midline tumors,

processing external speech
[212].

although the mechanism remains unclear
[224].

Chapter 3 – Secondary hallucinations

Tactile hallucinations in substance

the underpinning models described in this chapter,
abuse/withdrawal

drawn from a range of different disorders such as delirium, dementia, and substance-induced states, bear sig-Tactile hallucinations are relatively frequent in alco-nificant homology to some of the emergent neurobiol-hol withdrawal states
[225],
and are markers of a pro-ogy of schizophrenia-spectrum disorders.

longed and severe withdrawal
[226].
Visual halluci-There are a number of common threads that can be
nations are often associated with alcohol withdrawal
drawn from the preceding sections describing hallu-states and as alterations in the dopamine transporter
cinations in organic states. The strongest evidence for
have been associated with VHs in alcohol with-neurochemical disturbance in secondary hallucina-drawal
[227],
this is suggestive of a dopaminergic
tory states revolves around abnormalities in dopamin-role in withdrawal-related THs. Supporting the role of
ergic transmission, and disregulation of dopamin-dopaminergic systems, up to 15% of cocaine users may
ergic systems may be the “final common pathway”

report tactile hallucinations
[206].
Tactile hallucina-for psychotic symptoms in schizophrenia
[162,
230].

tions in cocaine users tend to commence after a num-However the role of cholinergic pathology in the
ber of months of heavy use and are often preceded by
attentional, memory, and perceptual disturbances in
migratory itching experiences
[220].
They have sim-dementia has also been suggestive of cholinergic
ilarly been associated with chronic use of another
pathology underlying positive, negative, and cogni-dopaminergic compound, amphetamine
[228, 229].

tive symptoms in schizophrenia, and this has been
supported by a range of studies suggestive of mus-carinic cholinergic pathology in primary psychotic ill-

ness
[231, 232].
The involvement of frontal and tem-Understanding the biological basis of hallucinatory
poral cortical zones in a number of hallucination-experience can shed significant light on the underlying
prone organic disorders also suggests that frontotem-pathophysiology of major mental disorders in which
poral pathology is implicated in schizophrenia, and
hallucinations are common, most particularly the psy-again this is borne out by a range of imaging and neu-chotic disorders such as schizophrenia. A number of
ropathological studies
[233, 234].

Introduction – Section 1

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Chapter 3 – Secondary hallucinations