Commentary Hallucination in the Elderly: Three Case Reports

T. Kobayashi, S. Kato, T. Osawa, and K. Shioda, Psychogeriatrics, September 2004, 4, 3, 96–101.

Abstract: Three elderly females with commentary hallucinations are presented. Here, the term ‘commentary hallucination’ is used as a comprehensive term describing a condition where the subject hears voices that comment on, command, or describe the subject’s actions or behavior. According to the DSM-IV, the three cases presented here met the criteria for a psychotic disorder not otherwise specified, a schizoaffective disorder, and schizophrenia, respectively. All three cases showed no evidence of abnormalities when examined using neuroimaging techniques but might have had some senile brain changes that were under the threshold of the neuroimaging studies. Although the commentary hallucinations in the three patients were not distinctively different from the hallucinations that are characteristic of schizophrenia, the subjects were able to keep some distance from the hallucinations; in other words, the hallucinations were not ego-invasive. The commentary hallucinations in the present patients might be explained as resulting from exhaustion caused by stressful life events, subtle senile organic brain changes, and a subsequent decline in psychological tension. These hallucinations may have originated from the pathological appearance of a background-inner speech accompanying the patients’ behavior.