Visual hallucinations

Research into visual hallucinations has accelerated over the last decade from around 350 publications per year in 2000 to over 500 in 2010. Increased recognition of the frequent occurrence of visual hallucinations in a number of common disorders, coupled with improvements in the measurement of phenomenology, and more sophisticated imaging techniques have allowed the development and initial testing of sophisticated models. However, key questions remain unanswered. Amongst these are: whether there is a satisfactory definition of hallucinations in a constructive visual system; whether there are one, two or several core varieties of hallucinations; what are the underlying brain mechanisms for hallucinations; and what, if anything, can be done to treat them when they lead to distress? Looking across research in several clinical areas suggests a tentative integrative model that allows the possibility of answering these questions, but much work remains to be done.

Identifying specific interpretations and use of safety behaviours in people with distressing visual hallucinations: an exploratory study

Visual hallucinations (VH) are a common experience and can be distressing and disabling, particularly for people suffering from psychotic illness. However, not everyone with visual hallucinations reports the experience to be distressing. Models of VH propose that appraisals of VH as a threat to wellbeing and the use of safety seeking behaviours help maintain the distress.

Does bladder wall thickness decrease when obstruction is resolved?

The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery.

A semi-structured interview to assess visual hallucinations in older people

OBJECTIVE: Visual hallucinations are under-reported by patients and are often undiscovered by health professionals. There is no gold standard available to assess hallucinations. Our objective was to develop a reliable, valid, semi-structured interview for identifying and assessing visual hallucinations in older people with eye disease and cognitive impairment. METHODS: We piloted the North-East Visual Hallucinations Interview (NEVHI) in 80 older people with visual and/or cognitive impairment (patient group) and 34 older people without known risks of hallucinations (control group). The informants of 11 patients were interviewed separately. We established face validity, content validity, criterion validity, inter-rater agreement and the internal consistency of the NEVHI, and assessed the factor structure for questions evaluating emotions, cognitions, and behaviours associated with hallucinations. RESULTS: Recurrent visual hallucinations were common in the patient group (68.8%) and absent in controls (0%). The criterion, face and content validities were good and the internal consistency of screening questions for hallucinations was high (Cronbach alpha: 0.71). The inter-rater agreements for simple and complex hallucinations were good (Kappa 0.72 and 0.83, respectively). Four factors associated with experiencing hallucinations (perceived control, pleasantness, distress and awareness) were identified and explained a total variance of 73%. Informants gave more 'don't know answers' than patients throughout the interview (p = 0.008), especially to questions evaluating cognitions and emotions associated with hallucinations (p = 0.02). CONCLUSIONS: NEVHI is a comprehensive assessment tool, helpful to identify the presence of visual hallucinations and to quantify cognitions, emotions and behaviours associated with hallucinations.

Elevated serum triiodothyronine and intellectual and motor disability with paroxysmal dyskinesia caused by a monocarboxylate transporter 8 gene mutation

Monocarboxylate transporter 8 (MCT8 or SLC16A2) is important for the neuronal uptake of triiodothyronine (T3) in its function as a specific and active transporter of thyroid hormones across the cell membrane, thus being essential for human brain development. We report on a German male with Allan-Herndon-Dudley syndrome presenting with severe intellectual and motor disability, paroxysmal dyskinesia combined with truncal muscular hypotonia, and peripheral muscular hypertonia at his current age of 9 years. Additionally, the patient has a lesion in the left putamen region revealed by magnetic resonance imaging and elevated serum T3 levels. The male appeared to have a hemizygous mutation (R271H) in the MCT8 gene that was sequenced directly from genomic DNA and occurred de novo in the maternal germline, as both his mother and his sister were not carriers of the mutation. Ruling out a common polymorphism, 50 normal individuals of the same ethnic background did not harbour the mutation. The identified MCT8 gene mutation (R271H) is very likely to be the genetic cause for neuronal hypothyroidism despite elevated serum T3 levels.

Complex visual hallucinations and attentional performance in eye disease and dementia: a test of the Perception and Attention Deficit model

OBJECTIVE This study aimed to test the prediction from the Perception and Attention Deficit model of complex visual hallucinations (CVH) that impairments in visual attention and perception are key risk factors for complex hallucinations in eye disease and dementia. METHODS Two studies ran concurrently to investigate the relationship between CVH and impairments in perception (picture naming using the Graded Naming Test) and attention (Stroop task plus a novel Imagery task). The studies were in two populations-older patients with dementia (n = 28) and older people with eye disease (n = 50) with a shared control group (n = 37). The same methodology was used in both studies, and the North East Visual Hallucinations Inventory was used to identify CVH. RESULTS A reliable relationship was found for older patients with dementia between impaired perceptual and attentional performance and CVH. A reliable relationship was not found in the population of people with eye disease. CONCLUSIONS The results add to previous research that object perception and attentional deficits are associated with CVH in dementia, but that risk factors for CVH in eye disease are inconsistent, suggesting that dynamic rather than static impairments in attentional processes may be key in this population.

Factors Affecting Post-Capture Survivability of Lobster Homarus Americanus

Technological advances in gear and fishing practices have driven the global expansion of the American lobster live seafood market. These changes have had a positive effect on the lobster industry by increasing capture efficiency. However, it is unknown what effect these improved methods will have on the post-capture fitness and survival of lobsters. This project utilized a repeated measures design to compare the physiological changes that occur in lobsters over time as the result of differences in depth, hauling rate, and storage methodology. The results indicate that lobsters destined for long distance transport or temporary storage in pounds undergo physiological disturbance as part of the capture process. These changes are significant over time for total hemocyte counts, crustacean hyperglycemic hormone, L-lactate, ammonia, and glucose. Repeated measures multivariate analysis of variance (MANOVA) for glucose indicates a significant interaction between depth and storage methodology over time for non-survivors. A Gram-negative bacterium, Photobacterium indicum, was identified in pure culture from hemolymph samples of 100% of weak lobsters. Histopathology revealed the presence of Gram-negative bacteria throughout the tissues with evidence of antemortem edema and necrosis suggestive of septicemia. On the basis of these findings, we recommend to the lobster industry that if a reduction in depth and hauling rate is not economically feasible, fishermen should take particular care in handling lobsters and provide them with a recovery period in recirculating seawater prior to land transport. The ecological role of P. indicum is not fully defined at this time. However, it may be an emerging opportunistic pathogen of stressed lobsters. Judicious preemptive antibiotic therapy may be necessary to reduce mortality in susceptible lobsters destined for high-density holding facilities.

Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease

Much of the research on visual hallucinations (VHs) has been conducted in the context of eye disease and neurodegenerative conditions, but little is known about these phenomena in psychiatric and nonclinical populations. The purpose of this article is to bring together current knowledge regarding VHs in the psychosis phenotype and contrast this data with the literature drawn from neurodegenerative disorders and eye disease. The evidence challenges the traditional views that VHs are atypical or uncommon in psychosis. The weighted mean for VHs is 27% in schizophrenia, 15% in affective psychosis, and 7.3% in the general community. VHs are linked to a more severe psychopathological profile and less favorable outcome in psychosis and neurodegenerative conditions. VHs typically co-occur with auditory hallucinations, suggesting a common etiological cause. VHs in psychosis are also remarkably complex, negative in content, and are interpreted to have personal relevance. The cognitive mechanisms of VHs in psychosis have rarely been investigated, but existing studies point to source-monitoring deficits and distortions in top-down mechanisms, although evidence for visual processing deficits, which feature strongly in the organic literature, is lacking. Brain imaging studies point to the activation of visual cortex during hallucinations on a background of structural and connectivity changes within wider brain networks. The relationship between VHs in psychosis, eye disease, and neurodegeneration remains unclear, although the pattern of similarities and differences described in this review suggests that comparative studies may have potentially important clinical and theoretical implications.

The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients.

BACKGROUND Kidney recipients maintaining a prolonged allograft survival in the absence of immunosuppressive drugs and without evidence of rejection are supposed to be exceptional. The ERA-EDTA-DESCARTES working group together with Nantes University launched a European-wide survey to identify new patients, describe them and estimate their frequency for the first time. METHODS Seventeen coordinators distributed a questionnaire in 256 transplant centres and 28 countries in order to report as many 'operationally tolerant' patients (TOL; defined as having a serum creatinine <1.7 mg/dL and proteinuria <1 g/day or g/g creatinine despite at least 1 year without any immunosuppressive drug) and 'almost tolerant' patients (minimally immunosuppressed patients (MIS) receiving low-dose steroids) as possible. We reported their number and the total number of kidney transplants performed at each centre to calculate their frequency. RESULTS One hundred and forty-seven questionnaires were returned and we identified 66 TOL (61 with complete data) and 34 MIS patients. Of the 61 TOL patients, 26 were previously described by the Nantes group and 35 new patients are presented here. Most of them were noncompliant patients. At data collection, 31/35 patients were alive and 22/31 still TOL. For the remaining 9/31, 2 were restarted on immunosuppressive drugs and 7 had rising creatinine of whom 3 resumed dialysis. Considering all patients, 10-year death-censored graft survival post-immunosuppression weaning reached 85% in TOL patients and 100% in MIS patients. With 218 913 kidney recipients surveyed, cumulative incidences of operational tolerance and almost tolerance were estimated at 3 and 1.5 per 10 000 kidney recipients, respectively. CONCLUSIONS In kidney transplantation, operational tolerance and almost tolerance are infrequent findings associated with excellent long-term death-censored graft survival.

National debts : partly read before the British Association, at Liverpool, Sept. 1870

by R. Dudley Baxter

Mid-Pleistocene benthic foraminiferal record in the Southwest Pacific

Benthic foraminiferal faunas from three bathyal sequences provide a proxy record of oceanographic changes through the mid-Pleistocene transition (MPT) on either side of the Subtropical Front (STF), east of New Zealand. Canonical correspondence analyses show that factors related to water depth, latitude and climate cycles were more significant than oceanographic factors in determining changes in faunal assemblage composition over the last 1 Ma. Even so, mid-Pleistocene faunal changes are recognizable and can be linked to inferred palaeoceanographic causes. North of the largely stationary STF the faunas were less variable than to the south, perhaps reflecting the less extreme glacial-interglacial fluctuations in the overlying Subtropical Surface Water. Prior to Marine Isotope Stage (MIS) 21 and after MIS 15, the northern faunas had fairly constant composition, but during most of the MPT faunal composition fluctuated in response to climate-related food-supply variations. Faunal changes through the MPT suggest increasing food supply and decreasing dissolved bottom oxygen. South of the STF, beneath Subantarctic Surface Water, mid-Pleistocene faunas exhibited strong glacial-interglacial fluctuations, inferred to be due to higher interglacial nutrient supply and lower oxygen levels. The most dramatic faunal change in the south occurred at the end of the MPT (MIS 17- 12). with an acme of Abditodentrix pseudothalmanni, possibly reflecting higher carbon flux and lower bottom oxygen. This study suggests that the mid-Pleistocene decline and extinction of a group of elongate, cylindrical deep-sea foraminifera may have been related to decreased bottom oxygen concentrations as aresult of slower deep-water currents.

The CMCC Eddy-permitting Global Ocean Physical Reanalysis (C-GLORS v5, 1980-2014), links to NetCDF files

The CMCC Global Ocean Physical Reanalysis System (C-GLORS) is used to simulate the state of the ocean in the last decades. It consists of a variational data assimilation system (OceanVar), capable of assimilating all in-situ observations along with altimetry data, and a forecast step performed by the ocean model NEMO coupled with the LIM2 sea-ice model. KEY STRENGTHS: - Data are available for a large number of ocean parameters - An extensive validation has been conducted and is freely available - The reanalysis is performed at high resolution (1/4 degree) and spans the last 30 years KEY LIMITATIONS: - Quality may be discontinuos and depend on observation coverage - Uncertainty estimates are simply derived through verification skill scores

Quaternary isotope stratigraphy of DSDP Hole 90-593 from the Challenegr Plateau, South Tasman Sea

A moderate-resolution isotope stratigraphy (with an average of one sample per 17,500 yr.) derived from the benthic foraminifer Uvigerina (or Cibicides), the planktonic foraminifer Globigerina bulloides, and calcareous nannofossil concentrates is presented for the entire Quaternary (and latest Pliocene) section of mid-upper bathyal calcareous oozes from DSDP Site 593, western Challenger Plateau, south Tasman Sea. Superimposed on a trend of gradually increasing average delta18O values through the Pleistocene, reflecting the progressive buildup of polar ice sheets, is a record of highfrequency but generally low amplitude (0.5-1?) isotope fluctuations in the early Quaternary (1.9-1.0 m.y.), followed by a greatly increased intensity (1.5-2.0 ?) of glacial-interglacial fluctuations during the late Quaternary (< 1.0 m.y.). The standard late Quaternary isotope stages 1 to 24 are mainly resolvable. Significant excursions in both delta18O and delta13C values at various times during the Quaternary are suggested to be due to periodic, fundamental changes in ocean circulation properties over the plateau. For example, intensified upwelling of Antarctic Intermediate Waters during several glacial periods is indicated by the convergence of benthic and planktonic foraminiferal delta18O data, and productivity variations may account for certain delta13C spikes in the record. With increasingly higher resolution analysis this core will provide a useful Quaternary isotope reference section for southern temperate waters in the southwest Pacific, centered on New Zealand.

Late Quaternary benthic foraminiferal record of the Bounty Trough, east of New Zealand

The Bounty Trough, east of New Zealand, lies along the southeastern edge of the present-day Subtropical Front (STF), and is a major conduit via the Bounty Channel, for terrigenous sediment supply from the uplifted Southern Alps to the abyssal Bounty Fan. Census data on 65 benthic foraminiferal faunas (>63 µm) from upper bathyal (ODP 1119), lower bathyal (DSDP 594) and abyssal (ODP 1122) sequences, test and refine existing models for the paleoceanographic and sedimentary history of the trough through the last 150 ka (marine isotope stages, MIS 6-1). Cluster analysis allows recognition of six species groups, whose distribution patterns coincide with bathymetry, the climate cycles and displaced turbidite beds. Detrended canonical correspondence analysis and comparisons with modern faunal patterns suggest that the groups are most strongly influenced by food supply (organic carbon flux), and to a lesser extent by bottom water oxygen and factors relating to sediment type. Major faunal changes at upper bathyal depths (1119) probably resulted from cycles of counter-intuitive seaward-landward migrations of the Southland Front (SF) (north-south sector of the STF). Benthic foraminiferal changes suggest that lower nutrient, cool Subantarctic Surface Water (SAW) was overhead in warm intervals, and higher nutrient-bearing, warm neritic Subtropical Surface Water (STW) was overhead in cold intervals. At lower bathyal depths (594), foraminiferal changes indicate increased glacial productivity and lowered bottom oxygen, attributed to increased upwelling and inflow of cold, nutrient-rich, Antarctic Intermediate Water (AAIW) and shallowing of the oxygen-minimum zone (upper Circum Polar Deep Water, CPDW). The observed cyclical benthic foraminiferal changes are not a result of associations migrating up and down the slope, as glacial faunas (dominated by Globocassidulina canalisuturata and Eilohedra levicula at upper and lower bathyal depths, respectively) are markedly different from those currently living in the Bounty Trough. On the abyssal Bounty Fan (1122), faunal changes correlate most strongly with grain size, and are attributed to varying amounts of mixing of displaced and in-situ faunas. Most of the displaced foraminifera in turbiditic sand beds are sourced from mid-outer shelf depths at the head of the Bounty Channel. Turbidity currents were more prevalent during, but not restricted to, glacial intervals.