The Phenomenology and Neurobiology of Visual Distortions and Hallucinations in Schizophrenia: An Update.
Steven M. Silverstein, Adriann Lai
Frontiers in Psychiatry June 11, 2021 DOI: 10.3389/fpsyt.2021.684720 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Philosophy of mind |
| Keywords | Retina Schizophrenia Mechanisms Psychosis Self Visual hallucinations Visual distortions |
| Key findings | Argues that visual hallucinations and distortions in schizophrenia are under-studied and proposes an updated model in which they arise from alterations at multiple points in the visual pathway, including retinal changes and multiple neurotransmitters, together with disinhibited default mode network activity and enhanced state-related apical/contextual drive, possibly reflecting vulnerabilities in maintaining a sense of self. |
Abstract
Schizophrenia is characterized by visual distortions in ~60% of cases, and visual hallucinations (VH) in ~25-50% of cases, depending on the sample. These symptoms have received relatively little attention in the literature, perhaps due to the higher rate of auditory vs. visual hallucinations in psychotic disorders, which is the reverse of what is found in other neuropsychiatric conditions. Given the clinical significance of these perceptual disturbances, our aim is to help address this gap by updating and expanding upon prior reviews. Specifically, we: (1) present findings on the nature and frequency of VH and distortions in schizophrenia; (2) review proposed syndromes of VH in neuro-ophthalmology and neuropsychiatry, and discuss the extent to which these characterize VH in schizophrenia; (3) review potential cortical mechanisms of VH in schizophrenia; (4) review retinal changes that could contribute to VH in schizophrenia; (5) discuss relationships between findings from laboratory measures of visual processing and VH in schizophrenia; and (6) integrate findings across biological and psychological levels to propose an updated model of VH mechanisms, including how their content is determined, and how they may reflect vulnerabilities in the maintenance of a sense of self. In particular, we emphasize the potential role of alterations at multiple points in the visual pathway, including the retina, the roles of multiple neurotransmitters, and the role of a combination of disinhibited default mode network activity and enhanced state-related apical/contextual drive in determining the onset and content of VH. In short, our goal is to cast a fresh light on the under-studied symptoms of VH and visual distortions in schizophrenia for the purposes of informing future work on mechanisms and the development of targeted therapeutic interventions.
Comparable studies
Other narrative reviews on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Body Consciousness: A Philosophy of Mindfulness and Somaesthetics | 2008 | Review article | |
| Phenomenology, Structure, and Dynamic of Psychedelic States | 2016 | Review | |
| Classic Hallucinogens and Mystical Experiences: Phenomenology and Neural Correlates. | 2018 | Review | |
| The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. Individuals with lived experience of psychosis, family members, and carers | 2022 | Co-written bottom-up review | |
| From autopoiesis to neurophenomenology: Francisco Varela's exploration of the biophysics of being. | 2003 | Review |
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