Descriptive Psychopathology: The Signs and Symptoms of ...

257 Chapter 10: Perceptual disturbancesbut without stereotyped spells. 13 In patients with complex partial seizures,specific psychosensory features facilitate the identification of the seizure focus.In manic-depressive illness psychosensory phenomena are signs of severity andemerging chronicity, 14 but do not predict response to anticonvulsant rather thanlithium therapy. 15 Psychosensory phenomena include sensory (autonomic perturbations,dissociation), emotion (incontinence), memory (false familiarity andunfamiliarit y), and perceptual distor tions and hallucinations ( Table 10.1).HallucinationsEsquirol defined hallucinations as perceptions without an object. Jaspers definedhallucinations as false perceptions which are not sensory distortions or misinterpretations,but which occur at the same time as real perceptions.Pseudo-hallucinationsPseudo-hallucination is a misnomer. It is a hallucination that is experienced asunreal. It is vivid but circumscribed from other accurate perceptions. Pseudohallucinationstend to localize to a part of the body or a point in near-by space.They differ from “mental images”, which are recognized as subjective and notvivid. Pseudo-hallucinations are associated with identifiable neurologic diseasemore than with the primary psychotic disorders. 16 Patient 10.1 illustrates.Patient 10.1An 85-year-old man with long-standing cardiovascular disease had a flu-likesyndrome that lasted about a week. Toward the end of this discomfort, heawoke one morning to the sound of a radio playing popular music from hisyouth. The music was clear and fully recognizable, but the patient knew that theradio was not “on” and that he was “hearing things”. He had no other psychopathology.Brain imaging identified a new right-sided temporal–parietal ischemiclesion. Over the next several weeks the hallucination gradually resolvedwithout psychotropic medication.Hypnogogic and hypnopompic hallucinationsHypnogogic hallucinations occur as the person is falling asleep. Hypnopompichallucinations occur as the patient is awakening. These phenomena are not vividand are experienced as distinct from dreams. Visual experiences are the mostcommon and include seeing shapes, figures, and scenes. Auditory experiencesinclude music, brief voices (e.g. one’s name being called) and environmentalsounds (e.g. a dog barking). In non-ill persons they are associated with periodsof sleep deprivation. When frequent, they suggest narcolepsy. 17