Hallucinations transdiagnostic

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Hallucinations transdiagnostic

  1. 1. A transdiagnostic approach to Mikhail A.Vrubel, 1890
  2. 2. OUTLINE Mikhail A.Vrubel, 1890 Prevalences Subtypes Cognition & Perception Imaging Treatment
  3. 3. I. Levitan, 1899 Prevalences of hallucinations and delusions PATIENT GROUP PREVALENCE SOURCE schizophrenia 59% hallucinations 73% delusions Lecrubier et al. 2007 bipolar disorder 76% psychotic symptoms Tillman et al. 2008 delirium 86% hallucinations 43% delusions Perälä et al. 2010 borderline personality disorder 50% psychotic symptoms Kingdon et al. 2010 narcolepsy 40% hallucinations 2% delusions Leu-Semenescu et a. 2011 Lewy body dementia 78% hallucinations 25% delusions Nagahama et al. 2007 anxiety disorder 27% psychotic symptoms Wigman et al. 2012 Parkinson's disease 30% hallucinations 5% delusions Friedman et al. 2013 Alzheimer's disease 21% hallucinations 10% delusions Burghaus et al. 2012 multiple sclerosis 10% hallucinations 7% delusions Diaz-Olavarietta et al. 1999 epilepsy 25% psychotic symptoms Matsuura et al. 2003 post traumatic stress disorder 12% psychotic symptoms Soosay et al. 2012 visual acuity < 0.3 11% hallucinations Teunisse et al. 1995 unipolar depression 10% psychotic symptoms Quinlan et al. 1997 systemic lupus erythematosus 6% psychotic symptoms Beltrao et al. 2013 mild-moderate hearing loss 4% hallucinations Teunisse et al. 2012
  4. 4. Diagnosis? • Diagnosis: schizophrenia Mr. A hears voices that forbid him to eat. He doesn't trust many people. • Diagnosis: borderline personality disorder Ms. B hears voices that forbid her to eat. She doesn't trust many people. • Diagnosis: schizophrenia Ms. C is an eccentric lady. She sees visitors no one else sees and has tea with them. • Diagnosis: Parkinson's disease Mr. D sees visitors that no one else sees and has tea with them. • Diagnosis: Charles Bonnet syndrome Mrs. E has vision loss, yet she sees visitors no one else sees and has tea with them.
  5. 5. Formele denkstoornissenFour subtypes that present across diagnoses 1. Highly salient psychotic symptoms (the hyperdopaminergic subtype) • Highly emotional content. • Hallucinations of threatening voices, blood and amputated body parts. • Delusions: bizarre or non-bizarre, abundant and frightening. 2. Trauma related psychotic symptoms (the re-experiencing subtype) • Hallucinations related to traumatic events. • Delusions mild or absent, except for a general distrust. 3. Dreamlike psychotic symptoms (the inattentive subtype) • Non-emotional hallucinations, mainly visual, of persons/ animals. • Delusions: non- bizarre: misidentification, spousal infidelity, theft, Capgras syndrome. 4. Isolated psychotic symptoms (the de- afferentiation subtype) • Hallucinations in one modality, non- emotional without personal meaning. • Auditory hallucinations may be musical • Visual hallucinations: figures at walls, persons, sceneries. • Delusions absent or only explanations for hallucinations.
  6. 6. Hyperdopaminergic subtype: F-DOPA PET SPECT Inattentive subtype: slowing on EEG, fMRI:increased DMN Re-experience subtype: ERP increased startle De-afferentiation subtype: fMRI: increased excitability sensory cortex
  7. 7. Subtype Perception Attention Reality Testing Social Isolation Trauma Excitability Sensory Cortex Striatal Dopamine Optimal Treatment Hyper- dopaminergic = =/  =/ =/ =  Anti-psychotic medication re-experiencing =  = =  = =/  EMDR inattentive =/  =/ = = = =/  cholinesterase inhibitors de- afferentiation  = =  =  = TMS Working with Domains Instead of Diagnoses
  8. 8. BENEFITS Find similarities and differences across diagnoses Create homogenous groups Link phenomenology to pathophysiology Link pathophysiology to treatment More accurate description Treatment better tailored to symptoms

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