The Psychiatric Mental Status Examination by Trzepacz Paula T.;Baker Robert W.; & Robert W. Baker

Author:Trzepacz, Paula T.;Baker, Robert W.; & Robert W. Baker
Language: eng
Format: epub
Publisher: Oxford University Press, Incorporated
Published: 1993-08-15T00:00:00+00:00

Perception

Perceptual disturbances can take the form of hallucinations, illusions, derealization, depersonalization, autoscopy, déjà vu, or jamais vu. Hallucinations are unprovoked perceptual experiences that occur in the mind of the patient. They occur in any sensory modality (sight, hearing, smell, taste, touch) in the absence of any external physical stimulation, and may be simple or complex. Patients with chronic psychotic conditions may hallucinate continually. Other patients may have episodic or single-episode hallucinations, such as those induced by psychoactive drugs or those that accompany delirium.

In contrast to hallucinations, illusions are the exaggeration, distortion, or misinterpretation of an actual physical stimulus. Mirages of desert oases are visual illusions; hearing one’s name in the noise of the wind blowing through trees is an auditory illusion. Metamorphosia is a visual illusion in which images of actual objects or persons are distorted in size (micropsia or macropsia) or shape, as experienced by Alice in Wonderland. Micropsia is the illusory perception of everything in the environment being unduly small, whereas in macropsia objects seem quite large. Visual perseveration or palinopsia is the persistence or repeated recurrence of something that was previously seen but is no longer within the field of vision. Patients with cortical blindness due to bilateral occipital lesions confabulate descriptions of what they cannot see (Anton’s syndrome). Although illusions are not infrequent in psychosis, delirium, dementia, and neurologic disorders such as temporal lobe epilepsy, they also may occur in normal individuals.

Depersonalization is a feeling that one’s self or one’s body is unreal or unfamiliar. This includes a sense of being outside of one’s self, that one’s goals or mores are wrongheaded or meaningless; it is generally accompanied by anxiety or dysphoria. Derealization, the feeling that the world is unreal or has abruptly taken on unreal characteristics, is to the external environment what depersonalization is to the internal one. Patients describe feeling as though they are in a play or in outer space. Except in the most extreme cases, patients with depersonalization or derealization have the feelings of unreality, yet intellectually recognize what is or is not real. Thus, depersonalization and derealization are usually not delusional. Depersonalization and derealization are most commonly encountered in borderline personality disorder, partial complex seizure disorders, conversion or hysterical disorders, early or mild psychotic states, and normal adolescence. These experiences are usually transient, lasting minutes to hours, but may recur. Some patients experience both derealization and depersonalization.

Déjà vu is the perception of having previously seen or lived the current (novel) setting or situation. Jamais vu is more or less the converse: the sense that something familiar is strange, as though it is being seen or experienced for the first time. Both symptoms have been associated with complex partial epilepsy, but can occur in a variety of psychiatric and neurologic disorders, and, if of moderate or less degree, can be experienced by otherwise healthy persons.

Hallucinations occur in every sensory modality. Auditory hallucinations are characteristic of schizophrenia and mood disorders. Other forms of hallucinations frequently coexist with auditory hallucinations in primary psychiatric disorders;

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