Transcript LYSERGIC PSYCHOMA

400 patients recruited in New York and surroundings
characterized by:
1) at least one psychotic symptom
2) no psychiatric history (since the 6 months before
recruitment)
3) alcohol and/or substance abuses in the last 30 days
44% received a diagnosis of substance-induced
psychosis
56% received a diagnosis of primary psychotic
disorder
NB: Based on PRISM
(Psychiatric Research Interview for Substances and Mental
disorders)
Caton et al. Arch. Gen Psy, 2005
Caton et al. Arch. Gen Psy, 2005
Caton et al. Arch. Gen Psy, 2005
Statistically significant clinical characteristics
1) Primary psychosis group: younger age,
higher score in positive symptoms scales;
mostly auditory hallucinations, less insight in
negative symptoms and higher scores at
PANSS general psychopatologic scale.
Caton et al. Arch. Gen Psy, 2005
Statistically significant clinical characteristics :
2) Substance-induced psychosis group: more
common visual hallucinations and higher
prevalence of suicidal thought during previous
year. More violence. Family history of substance
abuse.
More insight.
Caton et al. Arch. Gen Psy, 2005
Main differences
Type of hallucination
Insight
The hallucinatory phenomena
• The hallucinatory phenomena were firstly defined in
1574 by JF. Fernel, who used the term
“hallucination” in regard to eyes disease.
• Esquirol, in 1817, described the phenomenon as “a
perception without an object”, while Jaspers
proposed the definition of “false perception”, which
is not a sensory distortion or a misinterpretation, but
“occurs at the same time as real perceptions”.
The hallucinatory phenomena
• Hallucination
• Pseudo-hallucination
• Hallucinosis
The hallucinatory phenomena
• According to Jaspers, what clearly distinguishes
hallucinations from real perceptions is that they are
images coming from the inner space, although the
subject reacts as if they were true perceptions
coming from outside.
• This characteristic trait allows to set them apart from
vivid mental images (pseudohallucinations), which
also derive from the inner world but are recognized
as such.
Hallucinosis
• hallucinations determined by drug of abuse, mainly
hallucinogens, stimulants and designer drugs.
• These phenomena typically consist of diffuse
distortions of the existing world, which can often be
seen even when eyes are closed.
Hallucinations and Dopamine
• In schizophrenia has been evidenced that very high levels
of dopamine in limbic system play a major role in
determining hallucinations and delusions.
• Antipsychotic medications, which block central
dopaminergic activity, determine a reduction of
hallucinatory symptoms in psychosis.
• On the other hand, drugs with strong dopaminergic
effect, such as L-dopa, methylphenidate, bromocriptine,
pramipexole and piribedil, and direct dopamine agonists,
like D-amphetamine, may induce hallucinations.
Hallucinations and Glutamate
• A possible role of glutamate in hallucinations has
instead been suggested by the finding that glutamate
antagonists like phencyclidine and ketamine can
induce hallucinations.
• This has led to the hypothesis that psychotic
symptoms may in part be attributed to an
hypofunction of NMDA receptors.
Hallucinatory visions
• Marsh et al. (1979), proposed the distinction of three
types of visual hallucinations in schizophrenics:
• 1) superimposed hallucinations;
• 2) spatial and depth distortion;
• 3) animations.
Hallucinatory visions
Superimposed
hallucinations
• spatially separated from
objective reality
• relatively abstract
geometric shapes, and
there is some agreement
among subjects about
their common
characteristics
Animations
• spatially integrated with
reality
• highly individualized, with
interference in visual
perception and probably
greatly influenced by
specific psychodynamic
factors
Hallucinatory visions in Schizophrenia
• As regard to hallucinatory topics, animals and
figures may be prominent; a delusional or hyperreligious character is often present, with a
“personal significance” and an emotional
impression (Small et al., 1966). This is probably
the main characteristic of visual hallucinatory
phenomenon in schizophrenia, in which the
“personal significance” is usually terrific,
persecutory, with a feeling of catastrophe
(Katastrophale Stimmungstönung des Erlebens of
Müller-Suur) and “end of the world”
(Weltuntergangserlebnis of Wetzel, 1922).
Hallucinatory visions in Schizophrenia
• Hallucinatory visions in schizophrenia may be
characterized by the presence of tiny people, imaginary
objects, persons or animals of diminutive size,
sometimes considered pleasant and amusing, in the
so-called Lilliputian hallucination.
• Other specific alterations of the perception of relative
size of the body or external world without other visual
disturbances is usually associated with ‘Alice in
Wonderland’ syndrome, micro- or macrosomatognosia,
which is relatively more common in children, usually
linked to migraine or epilepsy, and quite rare in
schizophrenia (Todd, 1955; Evans & Rolak, 2004).
Hallucinatory visions in Schizophrenia
• Autoscopy, also called phantom mirror-image, is
the experience of seeing one’s own body and
knowing it as self. It is not just a visual
hallucination because cenestethic and somatic
sensations must be present to give the subject
the impression that the hallucination is himself.
• Negative Autoscopy is instead the phenomenon
of looking in the mirror and seeing no image.
Internal Autoscopy is the possibility for the
subject to see his internal organs.
Hallucinosis (induced states)
• Small animals and insects are most often
hallucinated in delirium tremens induce by
alcohol. Sometimes, hallucinatory phenomena
induced by drug of abuse are really bizarre,
and “impossible” in their representation. The
“personal significance” could be absent.
Hallucinosis (induced states)
• These phenomena typically consist of diffuse
distortions of the existing world, which can
often be seen even when eyes are closed.
Geometric patterns, grids and lines, often
described as ‘form constants’ (Kluver, 1966)
are forms of hallucinatory experience in which
the subject typically retains good insight, and
are quite uncommon in schizophrenia.
Visual Effects (superimposed
hallucinations and illusions)
Color Enhancement
Higher pattern perception
Visual drifting
Tracers
Texture repetition
Scenery slicing
Geometria visiva (Visuals)
Hallucinosis (induced states)
• More insight, with less paranoia and thought
disorders, and hallucinations carry less “personal
significance” than in schizophrenia (Frieske and
Wilson, 1966).
• After substance abuse, visual hallucinations often
occur without auditory voices, whereas
schizophrenics rarely suffer visual hallucination
alone, though they may accompany more
common auditory hallucinations, especially in
acute diseases and in certain culture.
HALLUCINATORY DELUSION (HENRY EY)
• Psychoactive substances induce hallucinations;
• Hallucinations alert the subject;
• In a first phase hallucinations are referred to be caused by the
substance;
• Twilight, transitional states and delirium complicate the
relationship with reality;
• Flash-back phenomenon convinces the patient that something
has changed;
• The subjects start to interprete and make connections among
hallucinations and relationships between them and the world;
• Paranoid development, pseudoschizophrenia.
The hallucinatory phenomena
Type of hallucination
Insight
LYSERGIC PSYCHOMA:
A FOREIGN BODY IN YOUR MIND
CRITICAL
EGO
Something new from a
psychopathological point of
view.
(Hellpach, Cargnello)
PSYCHE
PSYCHOME
PSYCHOPATHOLOGICAL SYNDROME CHARACTERIZED BY PERCEPTION OF
EXTRANEOUS BODY IN ONE’S OWN MIND :
THE RESIDUAL CRITICAL EGO TAKES POSITION AGANIST THE INTOXICATED
PART OF ONE’S OWN SELF (CALLIERI, 1968)
LSD AFFECTS PERCEPTIONS AND UNDERLINES HOW IMPORTANT
PERCEPTION IS IN OUR CONSTRUCTION OF REALITY
• FLOATING
• FLIP OUT
• FLATTENED
• HORROR
TRIP/BAD TRIP
• FLASHBACK
DANILO CARGNELLO
(1911-1998)
“PSICOMA LISERGICO”
LYSERGIC PSYCHOMA:
Consciousness
modifications
Affective swings
(excitation, depression, rapid cycling of
mood; laughing explosion)
Chromatic perception statess
(dyschromatopsies)
Visual perception disorders
(macropsia, megalopsia, micropsia,
metamorphopsia, dysmegalopsia,
dysopsia, pareidolia, hallucinosis);
LYSERGIC PSYCHOMA:
Depersonalization;
Temporal experience
modifications;
(duation, temporal insularity)
Thought disorders;
Traumatic flashbacks of
childhood experiences.
HALLUCINOGENS: BODY BOUNDARIES PERCEPTIONS
• To confuse himself with
nature or enviroment;
(floating)
• Loss of Body boundaries
(floating);
• Unawareness of own
body, limbs and
propioception (floating)
Psychedelic Experiences
G. ENRICO MORSELLI
(1900-1973)
PEYOTE/ MESCALINA
“The impression of losing one’s own personality is not
related so much to coenesthesics or neurotics as to a real
dissociative alteration of the Ego. At a certain point
saying my own name meant almost nothing to me:
“Morselli!” I shouted, - “Who is he?” I had to have a
tremendous willpower in order to remember that Enrico
Morselli was me and not somebody else”
Contributo allo studio delle turbe da mescalina,
II International Congress Of Neurology
London, 29-07/02-08 1935
Two different ways of being psychotic
To have a psychosis
(induced psychosis)
To be psychotic
(psychotic onset)
• Body as the place of the
battle between the subject
and the “psychoma”;
• Ego experience as the place
of the battle between the
subject and his
tranformation;
• The “Body I Have””
• The ”Body I am”
• Korper
• Leib