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The prevalence of visual hallucinations in non-affective psychosis, and the role of perception and attention

Published online by Cambridge University Press:  17 March 2016

M. M. van Ommen ,
M. van Beilen ,
F. W. Cornelissen ,
H. G. O. M. Smid ,
H. Knegtering ,
A. Aleman ,
T. van Laar  and
GROUP Investigators
M. M. van Ommen
Affiliation:
Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands
M. van Beilen
Affiliation:
Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands University of Groningen, University Medical Center Groningen, School of Behavioral and Cognitive Neurosciences, The Netherlands Department of Psychiatry, University of Groningen, University Medical Center Groningen, Department of Hearing Voices, the Netherlands University of Groningen, University Medical Center Groningen, BCN NeuroImaging Center, The Netherlands
F. W. Cornelissen
Affiliation:
University of Groningen, University Medical Center Groningen, BCN NeuroImaging Center, The Netherlands Laboratory for Experimental Ophthalmology, University of Groningen, University Medical Center Groningen, The Netherlands
H. G. O. M. Smid
Affiliation:
University of Groningen, University Medical Center Groningen, BCN NeuroImaging Center, The Netherlands
H. Knegtering
Affiliation:
University of Groningen, University Medical Center Groningen, BCN NeuroImaging Center, The Netherlands Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, The Netherlands Lentis Center for Mental Health, Groningen, The Netherlands
A. Aleman
Affiliation:
University of Groningen, University Medical Center Groningen, BCN NeuroImaging Center, The Netherlands Department of Psychology, University of Groningen, The Netherlands
T. van Laar
Affiliation:
Department of Neurology, University of Groningen, University Medical Center Groningen, The Netherlands University of Groningen, University Medical Center Groningen, School of Behavioral and Cognitive Neurosciences, The Netherlands
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Abstract

Background

Little is known about visual hallucinations (VH) in psychosis. We investigated the prevalence and the role of bottom-up and top-down processing in VH. The prevailing view is that VH are probably related to altered top-down processing, rather than to distorted bottom-up processing. Conversely, VH in Parkinson's disease are associated with impaired visual perception and attention, as proposed by the Perception and Attention Deficit (PAD) model. Auditory hallucinations (AH) in psychosis, however, are thought to be related to increased attention.

Method

Our retrospective database study included 1119 patients with non-affective psychosis and 586 controls. The Community Assessment of Psychic Experiences established the VH rate. Scores on visual perception tests [Degraded Facial Affect Recognition (DFAR), Benton Facial Recognition Task] and attention tests [Response Set-shifting Task, Continuous Performance Test-HQ (CPT-HQ)] were compared between 75 VH patients, 706 non-VH patients and 485 non-VH controls.

Results

The lifetime VH rate was 37%. The patient groups performed similarly on cognitive tasks; both groups showed worse perception (DFAR) than controls. Non-VH patients showed worse attention (CPT-HQ) than controls, whereas VH patients did not perform differently.

Conclusions

We did not find significant VH-related impairments in bottom-up processing or direct top-down alterations. However, the results suggest a relatively spared attentional performance in VH patients, whereas face perception and processing speed were equally impaired in both patient groups relative to controls. This would match better with the increased attention hypothesis than with the PAD model. Our finding that VH frequently co-occur with AH may support an increased attention-induced ‘hallucination proneness’.

Keywords

CognitionPAD modelprevalencepsychotic disordersvisual hallucinations
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 8 , June 2016 , pp. 1735 - 1747
Copyright
Copyright © Cambridge University Press 2016 

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