Which one of the following is an elementary hallucination?
A. Elementary hallucinations are unstructured hallucinations that are seen in acute organic states. They are composed of sounds or fl ashes without being fully formed. Elementary hallucinations can precede development of fully formed hallucinations, especially in alcoholic hallucinosis. The fl ashes of lights are also called phosphenes. Words such as ‘go’ are meaningful and so cannot be a part of elementary hallucination.
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Which of the following is NOT a common feature of schizophrenic auditory hallucinations?
D. Phonemes are any auditory hallucinations that occur as human voices. Schizophrenic phonemes are usually multiple voices. The voices may or may not be recognizable. These voices are usually male with a different accent but speaking in one’s mother tongue. Schizophrenic hallucinations are usually episodic – almost never continuous. Continuous, non-stop hallucinations should make one suspect the veracity of the reported experience.
Which of the following can cause visual hallucinations?
E. Occipital lobe tumours, postconcussional states, epileptic twilight state, hepatic failure (any toxic delirium), and dementia are some of the known causes of visual hallucinations. In fact, nearly 30% of old-age psychiatric referrals have visual hallucinations. Solvent sniffing and hallucinogens can cause elementary visual hallucinations such as light fl ashes. In dementia of Lewy body type visual hallucinations are a prominent feature.
An 80-year-old lady with normal consciousness experiences vivid, distinct, colourful images of Mickey Mouse in her living room.
On physical examination one must look for which of the following signs?
A. Elderly patients having normal consciousness and no brain pathology but with reduced visual acuity due to ocular problems experience vivid, distinct, usually well-coloured hallucinations. This is known by the eponym Charles Bonnet syndrome. Paradoxically these perceptions are clear and colourful in contrast to real sensation, which is blurred due to eye disease. These hallucinations are mostly in the form of humans, or at times animals and cartoons. These objects usually show movement, and can be voluntarily controlled to an extent as they disappear on closing the eyes. Insight about unreality is usually preserved – though they may evoke emotions, including fear and joy. About one-third of Charles Bonnet hallucinations are elementary, unformed hallucinations. Usually these hallucinations are located in external space.
A patient withdrawing from alcohol sees small Chinese soldiers marching on his carpet.
This phenomenon is called:
C. Lilliputian hallucinations can occur in visual or haptic mode – they usually involve seeing tiny people or animals (or feeling diminutive insects crawling if haptic) and are seen in delirium tremens. Unlike other organic visual hallucinations, lilliputian hallucinations can be accompanied by pleasure (though this is often intermingled with terror). These are not the same as micropsia. Micropsia is a perceptual distortion but not a hallucination as there is a stimulus which is perceived to be erroneously small. Perception of small objects in the absence of such stimuli is a lilliputian hallucination.
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