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Visual Hallucinations in Serotonergic Psychedelics and Lewy Body Diseases
Nathan H. Heller, Frederick Streeter Barrett, Tobias Buchborn, Daniel Collerton, David Dupuis, Adam L. Halberstadt, Renaud Jardri, Tehseen N. Noorani et al.. Schizophrenia Bulletin, 2025-04-17
Topic: Brain proteins, microglia and lab models
Both LBDs and SPs exhibit distinct visual aberrations, ranging from minor metamorphopsias to complex hallucinations. Some features in LBDs resemble those induced by SPs (eg, illusory motion and entity encounters), suggesting shared neural mechanisms. Neuroimaging studies indicate a common pattern of hyperactive associative cortex and hypoactive sensory cortex. At the neuromodulator level, SP-induced VH involves serotonin 2A and 1A receptor (5-HT2AR and 5-HT1AR) modulation, while in LBDs, 5-HT2A receptor upregulation correlates with increased VH, and its inhibition (eg, with pimavanserin) reduces VH. Two shared cortical signatures are highlighted: reduced visual evoked responses and shifts toward visual excitation. Examining cortical and neuromodulatory similarities between LBD- and SP-induced VH may elucidate the link between sensory degradation, excitation, and hallucinogenesis. Future research should employ real-time neuroimaging of discrete hallucinatory episodes to identify shared mechanisms and develop targeted interventions for LBD hallucinations.
Key findings
- Both LBDs and SPs exhibit distinct visual aberrations, ranging from minor metamorphopsias to complex hallucinations.
- Some features in LBDs resemble those induced by SPs (eg, illusory motion and entity encounters), suggesting shared neural mechanisms.
- Neuroimaging studies indicate a common pattern of hyperactive associative cortex and hypoactive sensory cortex.
- At the neuromodulator level, SP-induced VH involves serotonin 2A and 1A receptor (5-HT2AR and 5-HT1AR) modulation, while in LBDs, 5-HT2A receptor upregulation correlates with increased VH, and its inhibition (eg, with pimavanserin) reduces VH.
- Two shared cortical signatures are highlighted: reduced visual evoked responses and shifts toward visual excitation.
Why it matters
This narrative review compares visual hallucinations in serotonergic psychedelics and Lewy body diseases and suggests they may share neural mechanisms, including serotonin receptor involvement. It proposes future research directions but reports no treatment, cure or prevention tested in patients.
Study details
- Study designnarrative review
- Evidence strengthLow
How this study scored 40/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Schizophrenia Bulletin) |
| Journal's citation record | 3 / 4 | Schizophrenia Bulletin: journal h-index 298 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | Design recorded as “narrative review”, which our rubric does not rank (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 3 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 3 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Pantelis Leptourgos: h-index 16 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 16 institution(s) in 7 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41051875) |
| Free to read | 2 / 2 | Free to read |
| Total | 40 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1093/schbul/sbaf068
- PubMed: 41051875
- Original source →
- Free full text: Schizophrenia Bulletin →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Heller, N. H., Barrett, F. S., Buchborn, T., Collerton, D., Dupuis, D., Halberstadt, A. L., et al. (2025). Visual Hallucinations in Serotonergic Psychedelics and Lewy Body Diseases. Schizophrenia Bulletin. https://doi.org/10.1093/schbul/sbaf068
Vancouver
Heller NH, Barrett FS, Buchborn T, Collerton D, Dupuis D, Halberstadt AL, et al. Visual Hallucinations in Serotonergic Psychedelics and Lewy Body Diseases. Schizophrenia Bulletin. 2025. doi:10.1093/schbul/sbaf068. PMID: 41051875.
BibTeX
@article{heller2025-41051875,
author = {Heller, Nathan H. and Barrett, Frederick Streeter and Buchborn, Tobias and Collerton, Daniel and Dupuis, David and Halberstadt, Adam L. and Jardri, Renaud and Noorani, Tehseen N. and others},
title = {{Visual Hallucinations in Serotonergic Psychedelics and Lewy Body Diseases}},
journal = {Schizophrenia Bulletin},
year = {2025},
doi = {10.1093/schbul/sbaf068},
pmid = {41051875},
url = {https://doi.org/10.1093/schbul/sbaf068}
}
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