Hallucinations in Psychoses and Affective Disorders: A Clinical and Biological Approach

210 Pages·2018·3.7 MB·English

by  Paolo Brambilla

Hallucinations in
Psychoses and
Affective Disorders
A Clinical and Biological
Approach
Paolo Brambilla
Massimo Carlo Mauri
Alfredo Carlo Altamura
Editors
123
Hallucinations in Psychoses
and Affective Disorders
Paolo Brambilla • Massimo Carlo Mauri
Alfredo Carlo Altamura
Editors
Hallucinations in
Psychoses and Affective
Disorders
A Clinical and Biological Approach
Editors
Paolo Brambilla Massimo Carlo Mauri
Fondazione IRCCS Ca’ Granda Ospedale Fondazione IRCCS Ca’ Granda Ospedale
Maggiore Policlinico Maggiore Policlinico
University of Milan University of Milan
Milan Milan
Italy Italy
Alfredo Carlo Altamura
Fondazione IRCCS Ca’ Granda Ospedale
Maggiore Policlinico
University of Milan
Milan
Italy
ISBN 978-3-319-75123-8 ISBN 978-3-319-75124-5 (eBook)
https://doi.org/10.1007/978-3-319-75124-5
Library of Congress Control Number: 2018947582
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Presentation
Of all patients diagnosed with schizophrenia or related psychotic disorders, 60–80%
experience auditory hallucinations and a smaller proportion visual or other unimodal hal-
lucinations. Hallucinations can be dramatic and may have severe impact in affected indi-
viduals, and it might be associated with suicidality, violence, and sometimes homicide.
Currently, the abuse of substances with psychotomimetic properties, such as
cocaine, amphetamines, hallucinogens, ketamine and cannabis, represents one of
the main causes of hallucinogen perception disorders. Indeed, the use or the abuse
of these substances can result in psychotic reactions, including hallucinations, and
can therefore resemble a primary psychotic disorder. In general, the use of drugs has
increased during early adolescence, when the developing brain might be especially
sensitive to environmental exposures. In particular, the escalating use of metham-
phetamine and derivative substances throughout the world and their association
with psychotic symptoms in regular users has fuelled concerns. Specifically, the use
of cannabis and cocaine by young people has been increasing during these years,
and age at first use has dramatically decreased. Cannabis, is indeed the most com-
mon illegal substance used in most of the western countries. Indeed, nowadays,
about 20% of young people report heavy cannabis consumption (which means a use
in more than one hundred occasions) or at least one consumption per week.
Several studies suggest a high comorbidity of substance abuse and schizophrenia, asso-
ciated with higher relapse rates and higher frequency of hallucinations, unusual thought
content, depressive symptoms, cognitive impairment, poorer outcome and reduced treat-
ment response. A high incidence of substance abuse and related symptoms, particularly
verbal and visual hallucinations, is also observed immediately in first episode psychosis
patients. Among substance abusers, in most cases the onset of hallucinations precedes the
onset of a structured psychotic episode by several years. Accordingly, hallucinations have
traditionally been one of the main treatment targets for antipsychotic drugs and indeed the
positive psychotic symptoms of schizophrenia collectively are far more responsive to these
drugs than negative or other cognitive symptoms, although it is not always true. It is impor-
tant to outline that psychotic symptoms, such as delusions and hallucinations, may occur
in both major (affective and schizophrenic) psychoses and in substance-induced psycho-
sis, which are different diseases with diverse clinical trajectory and outcome.
The book starts with Part I (Neurotransmission and Psychopathology) by focus-
ing on the specific molecular mechanisms involved in substance-induced hallucina-
tions. Indeed, there are at least three different pharmacological ways to induce
v
vi Presentation
hallucinations: activation of dopamine D2 receptors (D2Rs) with cocaine and amphet-
amine-type stimulants, activation of serotonin 5HT2A receptors (HT2ARs) with psy-
chedelics, and blockage of glutamate NMDA receptors with dissociative anesthetics.
Moreover, it discusses verbal hallucinations as a specific diagnostic symptom charac-
terizing the psychopathological picture defined by French literature as “Chronic
Hallucinatory Disorder. Finally, it describes hallucinatory symptomatology among
substance-induced disorders, major psychoses and neurological diseases.”
In Part II (Genetics and Neuroimaging) references to recent genetic, neurochem-
ical, and neuroimaging data outlining hallucinations will be discussed. In schizo-
phrenia, the relative importance of NMDAR and DRs in the occurrence of
2
hallucinations is still debated. Slight clinical differences are observed for each etiol-
ogy. Auditory-verbal hallucinations (AVHs) are associated with an impaired con-
nectivity of large-scale networks and have a potential genetic basis. To examine the
relationship between white matter integrity and AVHs, it has been conducted a
meta-analysis of diffusion tensor imaging studies that compared patients with
schizophrenia and AVHs with matched healthy controls (HCs). The meta- analysis
demonstrated a reduced fractional anisotropy in the left arcuate fasciculus (AF) of
hallucinators. The current meta-analysis confirmed disruptions of white matter
integrity in the left AF bundle of schizophrenia patients with AVHs.
The book concludes with Part III (Treatment) on the pharmacology and treat-
ment of hallucinations including electric and magnetic stimulation. In fact dysregu-
lated cortical plasticity has been demonstrated to underlie the pathogenesis of
positive symptoms like auditory hallucinations in schizophrenia. Transcranial direct
current stimulation (tDCS), a noninvasive brain stimulation technique, can modu-
late neuroplasticity. Add-on tDCS has also been shown to ameliorate auditory ver-
bal hallucinations in schizophrenia that are nonresponsive to antipsychotic treatment.
Preliminary evidence suggests a neuroplasticity modulation effect of tDCS to
improve treatment-resistant auditory hallucinations in schizophrenia.
Internationally recognized clinical scientists have contributed to this book which,
in our opinion, represents a novel and comprehensive contribution to the role of hal-
lucinations in major psychoses delineating the state of the art in this area from clini-
cal, neurobiological, and therapeutic perspectives.
Milan, Italy Alfredo Carlo Altamura
Milan, Italy Massimo Carlo Mauri
Milan, Italy Paolo Brambilla
February 2018
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Contents
Part I N eurotransmission and Psychopathology
1 Substances of Abuse and Hallucinogenic Activity:
The Dopaminergic Pathway - Focus on Cocaine
and Amphetamine-type Stimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Matteo Lazzaretti, Gian Mario Mandolini, Alfredo Carlo Altamura,
and Paolo Brambilla
2 Substances of Abuse and Hallucinogenic Activity:
The Serotoninergic Pathway - Focus on Classical
Hallucinogens and Entactogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Matteo Lazzaretti, Gian Mario Mandolini, Alfredo Carlo Altamura,
and Paolo Brambilla
3 Substances of Abuse and Hallucinogenic Activity:
The Glutamatergic Pathway - Focus on Ketamine . . . . . . . . . . . . . . . 33
Gian Mario Mandolini, Matteo Lazzaretti, Alfredo Carlo Altamura,
and Paolo Brambilla
4 Chronic Hallucinatory Disorder “an Equivalent”
of Delusional Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Massimo Carlo Mauri, Silvia Paletta, Chiara Di Pace, Chiara
Rovera, Giorgio Marotta, and Alfredo Carlo Altamura
5 Hallucinations in the Substance-Induced Psychosis . . . . . . . . . . . . . . 57
Massimo Carlo Mauri, Silvia Paletta, and Chiara Di Pace
6 Hallucinatory Symptomatology in  Major Psychoses
(Schizophrenia and Bipolar Disorders) . . . . . . . . . . . . . . . . . . . . . . . . 85
Andrea Raballo, Michele Poletti, and Mads Gram Henriksen
7 Hallucinations in Neurological Disorders . . . . . . . . . . . . . . . . . . . . . . . 99
Alessio Di Fonzo, Edoardo Monfrini, Paola Basilico,
and Andrea Arighi
ix
x Contents
Part II G enetics and Neuroimaging
8 Genetic Basis of Auditory Verbal Hallucinations
in Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Anushree Bose, Venkataram Shivakumar, and Ganesan
Venkatasubramanian
9 Imaging Genetics of Hallucinations . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Jacqueline Mayoral-van Son, Julio Sanjuan, and Benedicto
Crespo-Facorro
10 Dysconnectivity in Hallucinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Branislava Ćurčić-Blake, Josselin Houenou, and Renaud Jardri
Part III Treatment
11 Translating Neurocognitive Models of Auditory
Verbal Hallucinations in Schizophrenia into Novel
Therapeutic Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Natasza Orlov, Jane Garisson, and Paul Allen
12 Innovative Approaches to Hallucinations in Psychosis
and Affective Disorders: A Focus on Noninvasive Brain
Stimulation Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Bernardo Dell’Osso, M. Carlotta Palazzo,
and Alfredo Carlo Altamura
Contributors
Paul Allen Department of Psychology, University of Roehampton, London, UK
Department of Psychosis Studies, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London, London, UK
Alfredo  Carlo  Altamura Department of Neurosciences and Mental Health,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of
Milan, Milan, Italy
Andrea Arighi Neurodegenerative Disease Unit, Department of Pathophysiology
and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Paola Basilico Neurodegenerative Disease Unit, Department of Pathophysiology
and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione IRCCS
Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Anushree Bose InSTAR Program, Schizophrenia Clinic, Department of Psychiatry,
National Institute of Mental Health and Neurosciences, Bengaluru, India
Paolo Brambilla Department of Neurosciences and Mental Health, Fondazione
IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan,
Italy
Department of Psychiatry and Behavioural Neurosciences, University of Texas at
Houston, Houston, TX, USA
M. Carlotta Palazzo Department of Psychiatry, Fondazione IRCCS Ca’Granda,
Ospedale Maggiore Policlinico, Milano, Italy
Centro S. Ambrogio, Ordine Ospedaliero San Giovanni di Dio Fatebenefratelli,
Milan, Italy
Benedicto Crespo-Facorro University Hospital Marqués de Valdecilla, IDIVAL,
Santander, Spain
CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
Department of Psychiatry, School of Medicine, University of Cantabria, Santander,
Spain
xi