Descriptive Psychopathology: The Signs and Symptoms of ...

254 Section 3: Examination domainsmultimodal the distortions, the more likely the patient will have an identifiableneurologic disease.Hyperesthesia and hypoesthesiaThese phenomena are distortions of stimulus intensity. In hyperesthesia thestimulus appears more intense (e.g. a dim light appears “glaring”). In hypoesthesia,the stimulus appears diminished. Hyperesthesia is associated with disordersof emotion, drug intoxications, migraine, and histrionic personality traits. 3In somatosensory hypoesthesia the patient experiences “numbness”. In visualand auditory hypoesthesia, colors appear “washed-out” and sounds are dulled,muffled or perceived as coming from a distance. Hypoesthesia occurs in severedepressive illness and many neurologic disorders. 4SynesthesiaSynesthesia is the stimulation of one sensory modality eliciting a perception in adifferent sensory modality, as in “seeing a sound”. It is associated with toxic states,and is considered the classic perceptual disturbance of LSD intoxication.DysmegalopsiaDysmegalopsia is a distortion of the size of objects and body parts. In micropsiaobjects appear smaller, farther away or retreating into the distance. In macropsiaor megalopsia, objects appear larger or closer. Images are perceived to fluctuatefrom large (like a zoom lens) to small (as if looking through the wrong end of atelescope). Dysmegalopsia occurs in seizure disorders, chronic manic-depressiveillness, retinal disease, and disorders of accommodation and convergence. Whenassociated with left-sided spatial neglect of the left side of the body and environment,it indicates right parietal lobe disease. 5 Memory for shapes, the location ofobjects and direction are also impaired in such patients. 6In retinal swelling the image falls on a smaller part of the retina than usual,eliciting micropsia. Retinal scarring with retraction elicits macropsia, but alsovisual distortions or metamorphopsia. Dysmegalopsia also occurs in anticholinergicdelirium and degenerative brain disease affecting the visual associational cortex. 7DysmorphopsiaDysmorphopsia is the visual distortion of shape and is associated with dysmegalopsia.Objects or body parts appear twisted and bent as if viewed through a glassof water, or as distorted in Fun House mirrors. 8Color spectrum distortionsToxic states and degenerative disease of the visual associational cortex are associatedwith change in color perception. In degenerative brain disease objects and