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Visual Hallucinations in the Psychosis Spectrum and Comparative Information From Neurodegenerative Disorders and Eye Disease
Open accessAbstract
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.
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“Although the conventional view focuses preferentially on auditory hallucinations in psychosis, epidemiological evidence indicates that hallucinations in the visual domain are very common in, for example, schizophrenia (13).”
From Shift toward prior knowledge confers a perceptual advantage in early psychosis and psychosis-prone healthy individuals (2015) · cites this paper as [13]
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“The authors reported visual hallucinations with a substantial point prevalence of 27% (Waters et al., 2014).”
From What visual illusions teach us about schizophrenia (2014) · cites this paper as Waters et al., 2014
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Multimethod Assessment of Psychosis and Psychotic Phenomena
Mihura, J. L., Kleiger, J. H., & Khadivi, A. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190092689.013.19
Nerland, S., Slapø, N. B., Barth, C., Mørch-Johnsen, L. E., Jørgensen, K. N., Beck, D., Wortinger, L. A., Westlye, L. T., Jönsson, E. G., Andreassen, O. A., et al. (2023) · medRxiv · doi:10.1101/2023.04.18.23288743
“AH has a lifetime prevalence of 60-80% in SCZ (Waters et al., 2014) and can significantly affect quality of life (Chiang, Beckstead, Lo, & Yang, 2018; Choi et al., 2021).”
BackgroundUreste, P. J., Gunther, M. G., Artz, J. D., & Wang, K. (2023) · Springer eBooks · doi:10.1007/978-3-031-14372-4_9
Firdaus, R., Hernawaty, T., & Suryani, S. (2023) · SENTRI Jurnal Riset Ilmiah · doi:10.55681/sentri.v2i8.1407
A systematic review and meta-analysis on contrast sensitivity in schizophreniaPreprint
Linares, D., Joostens, A., & de la Malla, C. (2023) · doi:10.31234/osf.io/k6rf3
Bosacki, S. L. (2016) · doi:10.1002/9781394259212.oth1
Hallucinations, Visual and Auditory
Pelak, V. S. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95702-1.00092-0
The role of sleep health and cognitive control in the occurrence of hallucinatory experiencesPreprint
Punton, G., Smailes, D., McCarty, K., Ellis, J. G., & Moseley, P. (2024) · doi:10.31234/osf.io/erqh4
Aideyan, B. (2023) · Digital Repository Service (Northeastern University) · doi:10.17760/d20652988
Marian apparitions: A multidisciplinary approach. The case of Île Bouchard
Drouin, E., Fénelon, G., & Hendrickx, M. (2024) · Revue Neurologique · doi:10.1016/j.neurol.2024.04.008
Núñez, D. E., de Almeida, E. R., Smit, A. C., Snippe, E., Muller, M. K., van den Berg, D. P. G., Wang, Y., Veling, W., Booij, S. H., & Wigman, J. T. W. (2025) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2025.100251
Marian apparitions: A multidisciplinary approach. The case of Ile Bouchard
Drouin, E., Fénelon, G., & Hendrickx, M. (2025) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2025.02.014
Otte, M., & Wolf, R. C. (2024) · Springer eBooks · doi:10.1007/978-3-031-32035-4_108-1
Neural Dynamics in Extrastriate Cortex Underlying False Alarms
Sahoo, B., & Snyder, A. C. (2025) · Journal of Neuroscience · doi:10.1523/jneurosci.1733-24.2025
Avila, A., Coentre, R. M., Mendes, T., Levy, P., Cella, M., & Novais, F. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14103308
“Impairments in visual processing have been related to overall clinical severity in patients with schizophrenia and have been associated with the emergence of positive symptoms via a disruption in fronto-subcortical pathways [58].”
Chen, Q., Ma, Y., Li, Z., Yu, C., Wang, X., & Miao, A. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13302-x
“Consequently, dysfunction within this region has been linked to visual perception disorders, including hallucinations and distortions [79, 80].”
Otte, M., & Wolf, R. C. (2025) · Springer eBooks · doi:10.1007/978-3-031-73368-0_108
Khoe, H. C., Chang, C. W., & Ho, C. S. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009458634.0111
Garg, N., Jain, A., Garg, S., & Dhyani, M. (2025) · Archives of Biological Psychiatry · doi:10.25259/abp_18_2025
The Time Machine revisited: An updated account of time-shifting in Alzheimer’s Disease
Lee, K., & James, I. A. (2025) · FPOP Bulletin Psychology of Older People · doi:10.53841/bpsfpop.2025.1.172.62
The Hitchhiker’s guide to hallucination research
Abalo‐Rodríguez, I., & Pinheiro, A. P. (2025) · Consciousness and Cognition · doi:10.1016/j.concog.2025.103941
Believing in simulated virtual scents produces reported olfactory sensations
Berg, A., & Henttonen, P. (2025) · Scientific Reports · doi:10.1038/s41598-025-25418-1
“Visual hallucinations (VH), or visions, have been defined as visual percepts that are experienced when fully conscious but in the absence of the corresponding external stimulus 56 .”
Making Sense of Visual Hallucinations in Lewy Body Dementia for Informal Caregivers
Hutchinson, J. G., Knox, A., Collerton, D., & Prout, A. (2025) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000705
Self-citation
Metadata
- Authors
- Waters, F., Collerton, D., ffytche, D. H., Jardri, R., Pins, D., Dudley, R., Blom, J. D., Mosimann, U. P., Eperjesi, F., Ford, S., & Larøi, F.
- Affiliations
- The University of Western Australia (AU)
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
- King's College London (GB)
- Centre Hospitalier Universitaire de Lille (FR)
- University of Groningen (NL)
- University of Bern (CH)
- Aston University (GB)
- Sir Charles Gairdner Hospital (AU)
- University of Liège (BE)
- Corresponding author
- Waters, Flavie
- ORCID
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-06-13
- Volume
- 40
- Issue
- Suppl_4
- Pages
- S233-S245
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC4141306
- OpenAlex
- W2146834289
- Cited by
- 325
- References
- 123
- Citations by year
- 2026: 21 · 2025: 33 · 2024: 23 · 2023: 33 · 2022: 33 · 2021: 31 · 2020: 37 · 2019: 29 · 2018: 19 · 2017: 20 · 2016: 26 · 2015: 12 · 2014: 8
- FWCI
- 12.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Schizophrenia Bulletin (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- UWA Profiles and Research Repository (UWA) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- HAL (submittedVersion, other-oa)
- Aston Publications Explorer (Aston University) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, other-oa)
- ORBi (University of Liège) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Open Access CRIS of the University of Bern
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Visual perception and processing mechanisms
- Keywords
- visual hallucinations, psychosis spectrum
- MeSH terms
- Affective Disorders, Psychotic, Brain, Eye Diseases, Hallucinations, Humans, Schizophrenia, Schizophrenic Psychology, Severity of Illness Index, Visual Cortex, Neurodegenerative Diseases
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