Menon G Jayakrishna
Royal Eye Infirmary, Plymouth, England.
Arch Ophthalmol. 2005 Mar;123(3):349-55. doi: 10.1001/archopht.123.3.349.
To study complex visual hallucinations in visually impaired individuals.
A prospective comparative study involving structured history taking and cognitive assessment in 48 consecutive visually impaired individuals with best-corrected visual acuity of 20/200 or worse and an age-matched cohort of 48 consecutive patients with visual acuity of 20/40 or better in at least 1 eye.
Thirty visually impaired subjects (63%) experienced hallucinations, unrelated to specific ocular pathology. None volunteered the symptom; 2 admitted hallucinations on nonleading questioning and 28 on direct questioning. All displayed insight into the unreality of their hallucinations, although 18 (60%) achieved this after initial deception. Seventeen (57%) expressed concern; 7 (23%) experienced disturbing images. Nineteen (63%) feared being labeled as insane were they to admit to hallucinations, while 10 (33%) were fearful of impending insanity. Sixteen (94%) of 17 concerned patients derived comfort from sympathetic reassurance that their hallucinations did not represent sinister pathology. In contrast, none of the individuals with normal vision experienced any hallucinations (P<.001). Cognition was intact in all groups.
Complex visual hallucinations with insight commonly occur in visually impaired, cognitively intact individuals due to acquired visual impairment and are unrelated to chronological age. Hallucinatory experiences are almost invariably admitted to only on direct questioning, due to fears of being considered insane. Although generally pleasant, hallucinations may cause distress, because of content or implications of the hallucinatory activity. Sympathetic explanation affords significant emotional relief.
研究视力受损个体的复杂视幻觉。
一项前瞻性对照研究，对48例最佳矫正视力为20/200或更差的连续视力受损个体进行结构化病史采集和认知评估，并与48例年龄匹配、至少一只眼睛视力为20/40或更好的连续患者组成的队列进行比较。
30例视力受损受试者（63%）出现幻觉，与特定眼部病变无关。无人主动提及该症状；2例在非引导性询问时承认有幻觉，28例在直接询问时承认有幻觉。尽管18例（60%）在最初受骗后才认识到幻觉的不真实性，但所有患者都能洞察到其幻觉的非真实性。17例（57%）表示担忧；7例（23%）经历了令人不安的图像。19例（63%）担心若承认有幻觉会被贴上精神错乱的标签，而10例（33%）担心即将精神错乱。17例担忧患者中有16例（94%）因得到同情性保证，即其幻觉不代表严重病变而感到宽慰。相比之下，视力正常的个体均未出现任何幻觉（P<0.001）。所有组的认知功能均正常。
有洞察力的复杂视幻觉常见于因后天视力受损而视力下降、认知功能正常的个体，与实际年龄无关。由于担心被视为精神错乱，幻觉经历几乎总是仅在直接询问时才被承认。尽管幻觉通常令人愉悦，但由于幻觉活动的内容或暗示，可能会造成困扰。同情性解释能显著缓解情绪。
