Descriptive Psychopathology: The Signs and Symptoms of ...

286 Section 3: Examination domainsMemory hallucinationsChronically ill patients may recall hallucinatory experiences as if they were realevents. Bleuler used the term retroactive. 55 Patients describe nightly rapes in theirhospital room, persons yelling at them from outside their homes, and FBI agentsransacking their apartment.Déjà vu, jamais vu, and similar phenomenaThese phenomena reflect an error in matching what is being experienced withrecollections. Each is a false memory. Déjà vu is the experience of false familiarity:“I have been here before” or “I have seen this before”. Many non-ill personshave fleeting and vague déjà vu experiences. Frequent, intrusive, and intenseexperiences of false familiarity reflect illness. Jamais vu is the experience of falseunfamiliarity: “I have never done this” or “I have never been here before”. It is notcommonly reported in non-ill persons. Déjà vécu is the feeling that a novelexperiencing has been experienced before. Déjà entendu is the experience ofhearing familiar sounds and voices as novel. These phenomena, when chronicand persistent, are associated with limbic system disease or seizure disorder, useof hallucinogenic agents, and in manic-depressive illness. When jamais vu isfrequently experienced, it is a harbinger of dementia. 56Confabulation and fantastic confabulationIn most instances, confabulation is an attempt to cover memory gaps. The falseinformation is mundane. The patient who confabulates is influenced by suggestionsof what transpired earlier in the day or the night before. Although classicallyassociated with Korsakoff’s syndrome, confabulation need not be present in thatdementia. It also occurs in other amnestic states, and its presence may be influencedby personality traits. 57Fantastic confabulation is a sign of substantial frontal lobe disease. Suchpatients animatedly engage in the telling of clearly false tales that can go beyondnature’s rules. Patients relate their experiences in outer space, flying like a bird,and inside machinery that fills the center of the earth or surrounds it. Thesefantastic confabulations are often intermingled with other false grandiose memoriesof great accomplishment. 58Pseudologia fantasticaLike fantastic confabulation, these are clearly false statements. Vorbeireden andtalking-past-the-point are other terms. The phenomenon was initially considereda sign of hysteria and the Ganser syndrome, but it is mostly associated withcatatonia. 59 Such patients believe the false statements, despite their obvioussilliness. For example, to the question, “What color was George Washington’s