Sensory modalities

Hallucinations can affect every sense modality. The most common in the idiopathic psychoses are auditory hallucinations, usually in the form of voices, although other kinds of sound may be associated with delusional contents. Voices talking to each other about the patient, and voices commenting about the patient's ongoing acting or thinking, are considered to be typical of but not specific to schizophrenia. (!3) Voices calling the patient's name or talking without comments to the patient are considered to be nosologically non-specific.

Visual hallucinations are most frequently found in organic psychoses, particularly deliria, in which they may occur for only a couple of hours during the night if the syndrome is not full blown. Visual hallucinations, more often than those in other sensory modalities, depict animals and scenes with several persons. In alcoholic delirium in particular, optical hallucinations of fine structures (such as hairs, threads, or spider webs) occur, and are especially likely to apear if the patient stares at a white wall. A typical, although not specific, combination of hallucinations and delusions in organic psychoses is the 'siege experience', in which patients believe they are besieged by enemies and have to bar their doors and windows.

Bodily, tactile, or coenaesthetic hallucinations are associated more often with schizophrenia than with affective or organic psychoses. The phenomenology includes simple tactile sensations of the skin, sexual sensations, sensations of the contraction, expansion, or rotation of inner organs, or atypical pain. Usually these sensations are associated with delusional explanations. Tactile hallucinations localized in the skin can underlie the delusion of parasitosis. Elderly patients in the early stages of organic cerebral alterations are at highest risk.

Coenaesthesia is a form of misperception which may be considered as an abortive hallucination. (14> These bodily misperceptions last for minutes to days, are fluctuating (sometimes in relation to stress), and usually are not attributed to external agents or explained by delusional ideas. Patients seldom report them spontaneously. They are categorized as basic symptoms. Klosterk6tter(19 suggests that when coenaesthesia is attibuted strongly to external influences, it is likely to be followed by schizophrenia.

Hallucinations may be of gustatory or olfactory sensations, for example a smell of gas (perhaps thought to have been infused in the flat by neighbours to kill the patient). Blunting of gustatory sensations or misperception of food as oversalted or overspiced is occasionally reported by melancholic patients.

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