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Visual Hallucinations and Schizophrenia

Schizophr Res; ePub 2019 Mar 3; Chouinard, et al

Findings from a recent cross-sectional study showed the clinical and disease relevance of visual hallucinations (VH) as they were associated with severe morbidity of illness, including suicide attempts and catatonic behavior. These findings also suggest a phenotype associated with hallucinations in other modalities and specific types of delusions. Researchers examined clinical risk factors for VH in a well-characterized sample of patients with adult psychotic disorders across diagnostic categories of schizophrenia (n=227) and schizoaffective disorder (n=210). The Structured Clinical Interview for DSM-IV-TR was used for diagnosis and symptom measurements. They found:

  • The prevalence of VH was 26.1% (200/766).
  • Multivariate logistic regression showed that VH were independently associated with the presence of hallucinations in other modalities, including auditory, tactile, olfactory, and gustatory hallucinations.
  • History of a suicide attempt and catatonic behavior were also associated with VH.
  • In addition, specific delusions were associated with VH, in particular, delusions of control, and religious, erotomanic, and jealousy delusions.
  • Diagnosis, negative symptoms, and family history of psychosis were not independent predictors of VH.

Chouinard V-A, Shinn AK, Valeri L, et al. Visual hallucinations associated with multimodal hallucinations, suicide attempts and morbidity of illness in psychotic disorders. [Published online ahead of print March 3, 2019]. Schizophr Res. doi:10.1016/j.schres.2019.02.022.


Schizophrenia is a highly heterogeneous disorder that, in some individuals, may present with perceptual disturbances, notably hallucinations that can occur in various modalities including visual, auditory, olfactory and tactile domains. This report by Chouinard and colleagues explored the association between multimodal hallucinations, symptoms and selected other clinical elements indicative of more severe illness. The constellation of visual and other modality hallucinations combined with specific delusional content and history of suicide attempt and catatonia represents a potential distinct phenotype that deserves further study. With respect to potential clinical implications, patients with visual hallucinations may require particularly close monitoring for suicidal ideation. —Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.