Talk:Macropsia

Comment 1

While reviewing your topic, I became interested in the physiology behind how the Epstein-Barr virus may contribute to AIWS. This research article may provide additional information, particulary clinical observations, about the manifestation of macropsia. Specifically, MRIs of Epstein-Barr Virus patients possessing AIWS symptoms demonstrated "transient T2 prolongation and swelling of the cerebral cortex".

Atsushi Kamei, Makoto Sasaki, Manami Akasaka, Shoichi Chida. Abnormal magnetic resonance imaging in a child with Alice in Wonderland syndrome following Epstein-Barr virus infection No to hattatsu. Brain and development. 2002 Jul;34(4): 348-52

Patrick Raab 01:32, 28 November 2009 (UTC)

Response

Thanks for your input Mr Raab. Information from your helpful article has been included under the section which discusses macropsia caused by viruses.I tried to keep to keep it general however, since I could only access the abstract.Sunderv (talk) 17:36, 5 December 2009 (UTC)

Comment 2

I found your article very interesting and thorough. I am curious if there are any outward signs an observer can look for to confirm that a macropsia sufferer is having an episode. Is there a noticeable change in behavior on the part of the sufferer? Does the sufferer's pupils dilate/constrict? In the study you mentioned with the anorexic woman's Zolpidem-induced macropsia episodes, did the researchers have to go by the patient's word alone concerning the severity of her episodes when the dosage was of Zolpidem was decreased? Aside from my curiosities, I thought this article was very well organized. You may want to link to the micropsia page in the second sentence of your opening. CafeDelMar (talk) 05:00, 28 November 2009 (UTC)

Response

I addressed your questions as best I could under the "Prescription Drugs" subsection. While only the woman's accounts of her episodes were used in the study presented, we are going to add a new section that discusses the more objective ways to diagnose macropsia. The only external sign of the macropsia episode was nervousness, but this happened only during the first episode and was not related to macropsia, but instead by the shock of what was going on. During the later episodes, the patient knew what was happening and remained calm. No information was found concerning the dilation/constriction of pupils with regard macropsia.

Philades (talk) 18:07, 5 December 2009 (UTC)

Comment 3

After reviewing your article I did some research to see what information I could find that related macropsia to the brain. Your thorough explanation of what goes on in the eye was very well written and described. However, I found while browsing some connections with the brain. As one of the comments above mentions, I found specific effects in the different parts of the brain that have been observed with patients affected by macropsia. This website may be of some assistance to lead you in further research: http://www.redorbit.com/news/health/433627/medical_conditions_with_psychiatric_manifestations/index.htmlMacropsia Another article I came across that involved a brain mechanism for macropsia is titled "Macropsia caused by Acute Posterior Cerebral Artery Infarction." I did not have access to the article but thought this may be of interest to your group and can enhance your article. I also agree with the comment that a diagram of the eye may be useless to the reader. Another suggestion I have that may or may not be of use to you is that it may be helpful to move the Physiology Behind the Disease to a section earlier in the article, perhaps after Symptomology. Personally as I was reading the article I found myself wondering early on how the disease was being caused physiologically. Just a suggestion though. Otherwise, the article was well written and very detailed. Good job! —Preceding unsigned comment added by Nalvarez (talk • contribs) 23:36, 29 November 2009 (UTC)

Nalvarez (talk) 18:37, 29 November 2009 (UTC)

Response

Thanks for your input Nalvarez. I browsed the link you posted and I fond some info about macropsia as a symptom of Epstein Barr Virus, but we do have a section about that in your article as is. The physiology section has been moved so thank you for your suggestion. The article "Macropsia caused by Acute Posterior Cerebral Artery Infarction" is in Korean, and we do not have access to it either. We did, however, add a brief discussion about how lesions specifically in the occipital lobe may be tied to macropsia. This addition relates to the abstract of the article you suggested so thanks for your input.Sunderv (talk) 19:09, 5 December 2009 (UTC)

Comment 4

Under “Psychologicacl Effects” you mention biophysiological contraction. Define this more clearly, as it is an incomplete explanation as is.

Reread the entire article for typos (there were quite a few). Pay particular attention to the Migraine section- it could be written so that it is more fluid and not so choppy.

How can macropsia help with diagnosis of epilepsy? Explain this.

You mention several times that it is usually females who experience symptoms. Did you find any information talking about why this is? Are there statistics that say that females are more likely to show these symptoms than males?

“Patients have reported significantly improved visual comfort associated with a correction of 5-10% of the aniseikonia” Are there any treatments besides this, since it only helps in 5-10% of the cases. I tried researching, but could not find any answers (only ones for micropsia) but it would be worthwhile for you to look into it.

The section “Physiology Behind The disease” should be moved to the beginning of the article right after symptomology, as this section would provide a good background for the causes. You state a lot of the same information in this section as you do in the Symptomology section, so I would suggest editing these sections to cut down on repeating information. Tothje (talk) 00:33, 30 November 2009 (UTC)

Response

Hi thanks for your comments Tothje. the concepts of biophysiological contraction and macropsia were uniquely presented in only one of our sources. The author of the quite old article argued that all lifeforms are governed by pulsatory contractions and expansions, and that when the psyche is affected by stimuli it responds with a contraction or expansion. Thus, macropsia is essentially a mental construct. I found the article amusing yet in conflict with our other numerous sources. That is why I made brief mention of the concept yet did not dwell on it as a vital cause of macropsia. Here is a link containing an excerpt from the article.http://ajp.psychiatryonline.org/cgi/pdf_extract/122/1/111. Sunderv (talk) 18:04, 5 December 2009 (UTC)

We only mentioned once that women experience more symptoms, and that was with regard to zolpidem use. I addressed this in the "Prescription Drugs" subsection, where I stated how the article explains that they believe this is the case because plasma zolpidem concentration is 40% higher in women, and this concentration is increased in anorexic women. Thanks for bringing up that point. As for your inquiry into treatments, you misread the last sentence of the "Treatment" section. It does not say that 5-10% of patients experience alleviation of macropsia, but that patients experience alleviation with a 5-10% decrease in the extent of their aniseikonia. We did not come across any other treatments in our research, but I added a little note about the treatment of macropsia with regard to drug use or viral infection; once these underlying problems are treated, the induced-macropsia ceases.

Philades (talk) 18:15, 5 December 2009 (UTC)

I added a small section explaining how macropsia aids in epilepsy diagnosis by virtue of it being a preliminary symptom which catches the attention of the patient. Sunderv (talk) 18:23, 5 December 2009 (UTC)

Comment 5 - image appearance question

I found your article to be very interesting but I had some questions while I was reading. First, I think you should clarify exactly what a person sees when they suffer from macropsia. Do all objects, including people, around them look enlarged? Is it just selected objects? Only objects are not people? I think clarifying this right in the introduction would be beneficial to the reader. I agree with one of the above comments that you should move the physiology section higher up in the article. I think it is important to know how the eye is affected before you go into the causes and such. Additionally, I think that you should include in the causes section maybe the biological connection between the causes and macropsia? For example, how does the drug affect the cones of the eye to cause macropsia? Also, I do not believe you mentioned this in your article but in which case is macropsia permanent? It seems to me that many of the causes of macropsia are temporary, so in which cases does the patient undergo the treatment that you outlined in the paper? Also I found one of your symptoms in particular to be a little confusing to understand from a reader’s perspective. It seems as though you are contradicting yourself in the psychological effects subsection. When I first started reading it states that macropsia might be a psychological phenomenon and then a few sentences later you say that macropsia is not caused by psychosis. It seems as though most of your information for that section is good but perhaps stating it in a different way would make it easier for the reader to understand. Lastly, there were quite a few typos and grammatical errors so I would just read over it again and look out for those. Overall, good job and I hope these suggestions help.Msprockel (talk) 20:39, 30 November 2009 (UTC)

Response

Macropsia does not cause a person to see sporadic random items increased in size, but rather the certain field of vision affected by macropsia distorts all items, be them people or not, to be seen as larger than normal. I added that to the information like you suggested. Through our research, we did not come across any biological pathways that explain the connections between drugs and macropsia. As you acknowledged, most cases of macropsia are indeed temporary, lasting only as long as the underlying cause lasts. However, surgically-induced macropsia can be permanent. The confusion surrounding the psychological affects has been fixed so as to eliminate confusion.

Philades (talk) 19:55, 5 December 2009 (UTC)

Response - a perception description

The article and the studies are not distinguishing enough between different processes that result in perception, what can, in all cases, be called macropsia. This is unfortunate, because it puts eye retina deformation and brain visual processing on the same level, which it is not. Also, it thus mixes visual distortion types with non-distorted images, permanent vs. object-based, migraine type vs. common...

I will focus on one macropsia effect type here. Most people wouldn't even have time to notice, those who do only realize it when pausing for a while, that the object of their focus of interest (a computer monitor, a book they are reading or a person they are talking to) seems to be "zoomed in" in a way a telephoto lens does it, the object simply seems closer than the actual distance would allow it to, taking more field of vision than it should have been. This perceived zoom can be anywhere from 20% to 300% and the interesting part is the amount of perceived detail in the picture. This could be explained by brain and retina neurons image processing; as the center of vision contains vastly more information as the edges of vision, if you gave adequate image representation based on the amount of information being collected, it would make sense to make the objects appearing in the center to be larger. But that is not completely what is happening: the objects the macropsia sufferer notices that are larger are not the random surroundings around her/him, but the face of a person he/she has a strong bond to. That would point to a stronger processing of information and details the person has interest in, which, by a manner of much more detailed information as usual, would stand out and be perceived as filling a much larger field of vision.

This seems supported by the other macropsia sources, such as the serotonergic drugs mentioned or the euphoric state at the time the macropsia is perceived. In this way macropsia may be far more common, just affected persons don't realize they have seen things from a slightly greater distance than it really happened. That would mean that only cases when a person comes to a sudden realization that a center of his/her interest stands out, magnified to supersize come to be noticed. (And recall how many times people have recollection of events from a much closer distance than was the reality, no manner how short time ago the event happened... or the Gorilla effect, where a surgeon does not see a gorilla walk by on an X-ray image he is focusing on.)

Returning back to younger children: what adults may disregard as a fantasy may be in reality also a macropsia effect, the excitement and overactive developing brain are representing objects of interest over a much wider perceived field of vision than would a computer camera do. It should be noticed how many times is is this type of harmless macropsia connected with exctitement of the person perceiving objects as larger and how vivid, detailed and full of information the recollections are. We should not disregard how easy it can be for brain to disregard events at the periphery of our vision and compensate by bringing the more central parts up front. If the whole field of human vision had the same sharpness and detail resolution as the most focused parts, we would be looking at appoximately a 200Mpix to 1Gpix stereo image to be processed...

When a person notices macropsia effect, usual reaction is "wow", the question is whether some amazement precedes the macropsia, and in many cases it does, that too leads to an explanation of it being a harmless natural effect of temporarily enhanced abilities.

The problem is still, the past literature, nor anything does have a more precice classification system for the different sources that manifest as macropsia, or the mechanism, even. Our understanding of the brain is still small.

I think a description of macropsia could mention "enlarged perceived field of vision with enhanced perceived detail as in a zoomed-in picture", as it is an exhaustive explanation.

Comment 6

Overall, I found your page to be very informative, detailed, and well-written. My suggestions mainly deal with points of clarification and/or elaboration:

In the SYMPTOMOLOGY section, you may want to highlight the typical age at which this condition arises… and if one does not exist, perhaps indicate how the time of onset varies according to the specific cause that aggravated the condition. Also, it would be helpful to include more information about the frequency and/or duration of the hallucinations that classify macropsia, specifically with respect to cases that arise without a connection to drug usage: how often to hallucinations occur? Do incidences of hallucination increase over time? Lastly, the term “intolerable rivalry” is used in the last sentence of the second paragraph – it would be helpful to define or clarify this terminology for the reader.

In the PSYCHOLOGICAL EFFECTS section, it would be helpful to clarify whether or not psychological conditions actually cause macropsia, because the way the information is presented is a bit unclear. At first, it is stated that: “It has even been stated that macropsia may be an entirely psychological pathological phenomenon without any structural defect or definite cause.” But a few sentences later, it is stated that: “Psychological conditions are often caused by macropsia, but do not cause macropsia.” These viewpoints appear contradictory, so I would either reword this section so that one clearly emerges as the “correct” position, or clearly state that opposing positions exist.

In the PHYSIOLOGY SECTION, you may want to include a basic diagram of the anatomy of the eye, so that the reader can physically orient their understanding of the physiology behind the disease within the body.

Haworthk (talk) 16:39, 29 November 2009 (UTC)

Response

Hi thanks for your comments. We found no evidence in our sources that any specific age group is more likely to have macropsia. The duration of the episodes does depend on the specific cause. Once a drug leaves, drug induced macropsia usually fades. If the cause is migraine, the macropsia is usually associated with the aura before the migraine which can last 15 minutes or so. Some of our sources specifically stated that the duration of episodes varies. Therefore, it is probably best not to generalize the duration of macropsia outside of relating it to a specific condition. There is an apparent contradiction in the article when it is stated that macropsia may be entirely a psychological manifestation. This was the argument of only one author of our sources. It is mentioned that the theory has been scrutinized. Thanks Sunderv (talk) 19:39, 5 December 2009 (UTC). Other comments have stated that a diagram of the eye would be unnecessary and we feel the same way- that macropsia would be outside the scope of a simple anatomical diagram of the eye. With respect to your question regarding the term "intolerable rivalry", the preceding lines in that section discuss the disturbances of perceiving image of different sizes between the two eyes can cause the multitude of symptoms listed in the section. Among these were the term "intolerable rivalry", which was found in a paper that offered no further description of the phenomenon. It can be inferred that the intolerable rivalry refers to the problems of consolidating the different perceived images from each eye but further search of the term in other literature did not elucidate the particular phenomenon so further detail cannot be included.--Hassan.zayn (talk) 19:59, 5 December 2009 (UTC)

Comment 7

• You may want to place the Physiology Behind the Disease section earlier in your article.

• Are there any diagnostic tests available for macropsia? I found one test that can be used called the Amsler Grid Test. A patient’s diagnosis is dependent upon what he or she sees when looking at the series of grids.

• Since macropsia is often times a symptom of other conditions and disorders, is it common for physicians to treat the primary condition? Does this then rid the patient of the macropsia?

• Some research suggests that carotenoids may be a possible treatment in restoring retinal function and morphology conditions such as macropsia. One carotenoid in particular is astaxanthin that may have the ability to protect the photoreceptor cells of the retina. This treatment may be helpful with age related macular degeneration, which has the symptom of macropsia. There is not a lot of information on the Internet concerning carotenoids as a possible

Katie1341 (talk) 16:57, 29 November 2009 (UTC)

Response

Thank you for your comments and suggestions. The "Physiology Behind The Disease" section has been moved and we created a "Diagnosis" section that discusses the Amsler Grid test. The "Diagnosis" section also talks about getting rid of macropsia by treating underlying problems/conditions. While carotenoids can help prevent macular degeneration, there is no direct role between them and macropsia, and there is no specific information explaining how carotenoids can be used to treat macropsia directly, so we are not going to include that.

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