Sign in to follow this  
Followers 0
manjupanatt

visual hallucinations v/s psedudo v/s imagery

16 posts in this topic

Hi,

Talking about basic psychopathology has anybody come across good tabular forms showing the differences between all these :-/. The usual explanations that i get on individual patient is- he has a schizo feel so is probably hallucinating....... >:(

Share this post


Link to post
Share on other sites

For the purpose of understanding read Sims; it's beautifully given.

But you've got to be imaginative as well.

For the purpose of exam do something else, make your own tables or columns....hehe.

Share this post


Link to post
Share on other sites

Read Sims' book. It will make it clearer.

You need first to understand the definitions of these phenomena, and then you can start to more accurately diagnose patients. However it is important to bear in mind that there is a spectrum of intensity of experience of these things, and the patients' experiences do not always fall into a categorical definition.

In essence, a hallucination in any modality is a perception in the absence of an external stimulus. I.e. the patient's awareness of what is internally generated imagery and what is externally percieved reality has broken down. For this reason a true hallucination will be percieved as real by the patient.

In pseudohallucinations, there is either the awareness in the patient that the object is not real (it may be 2D or black and white for example), or there is the awareness that the image is internally generated - that is to say that they know it is coming from within their own mind and is not a real object.

In illusions and misrepresentations the sensory organs are tricked by real objects in the world and the patient is aware that these are externally caused. For example figure ground illusions like Rubins vase, or pareidolic illusions such as seeing faces in the clouds.

Sims says it all a lot better than I can!

Share this post


Link to post
Share on other sites

thanks for that chris. i had gone through sims a bit.  the real life is not as simple as the textbook as u said.....

i can give you the clinical details...

a lady treated for post partum psychosis but noncompliant now 4months postpartum has visions about the tv falling over her child while the child was playing near it. says she sees it vividly and has no control over it feels she sees it outside not in her mind's eye.  but when i ask how she manages this or what she does about it- says she immediately removes the child from there and knows it is unreal when the child is not harmed.  she recognises these visions as having the same quality as the previous perception abnormality when she was diagnosed with psychosis.  at that time these visions lasted for minutes (now only seconds)- it would be about strangers coming into a shop trying to harm the child-sort of predicting the future-but not in a grandiose fashion.  

with the limited info i have at the moment do i go on treating it as psychosis (ask her to go back on antipsychotics) or treat it as probable postpartum depression with imagery (start on antidepressants)at the moment.  My impression is it is imagery because there was an external stimulus-tv but unsure how u explain the immediate postpartum perception abnormalities.

My idea for this question what are the tick boxes that i have to fill to justify my decision and what additional info should i gather in an op clinic/ osce station.........

Share this post


Link to post
Share on other sites

From the limited information I think you are right to consider the possibility of intrusive imagery as part of an OCD type spectrum disorder. As you say there is not going to be the possibility to fit everybody into a categorical model as the symptoms people get are not all or nothing ones. There is a blurring of the boundaries between these illnesses and a spectrum of the ways they manifest. I always like to think of obsessional thought as bordering on psychosis. The main thing is to be able to acurately describe in psychopathological terms the symptoms that your patients present with. That will help to guide your communication with other colleagues and give you important information about the type of illness you are dealing with, with all the implications that holds for treatment and prognosis. These are some of the unique skills of a psychiatrist, and what make us invaluable members of the CMHT.

Share this post


Link to post
Share on other sites
thanks for that chris. i had gone through sims a bit.  the real life is not as simple as the textbook as u said.....

i can give you the clinical details...

a lady treated for post partum psychosis but noncompliant now 4months postpartum has visions about the tv falling over her child while the child was playing near it. says she sees it vividly and has no control over it feels she sees it outside not in her mind's eye.  but when i ask how she manages this or what she does about it- says she immediately removes the child from there and knows it is unreal when the child is not harmed.  she recognises these visions as having the same quality as the previous perception abnormality when she was diagnosed with psychosis.  at that time these visions lasted for minutes (now only seconds)- it would be about strangers coming into a shop trying to harm the child-sort of predicting the future-but not in a grandiose fashion.  

with the limited info i have at the moment do i go on treating it as psychosis (ask her to go back on antipsychotics) or treat it as probable postpartum depression with imagery (start on antidepressants)at the moment.  My impression is it is imagery because there was an external stimulus-tv but unsure how u explain the immediate postpartum perception abnormalities.

My idea for this question what are the tick boxes that i have to fill to justify my decision and what additional info should i gather in an op clinic/ osce station.........

Yo cant call it any diagnosis based just on these symptoms. The rest of the symptoms whether depressed, or any other signs of psychosis also need to be explored, I would also think EEG if their is any suggestion of visual halls/prior history of symptoms or signs of TLE like syndromes.

Share this post


Link to post
Share on other sites

i agree with flakjak about no particular diagnosis on the basis of what you have said and the need to explore other depressice/psychotic symptoms before diagnosis. i'd also suggest dicussing with your consultant in more detail rather than posting incomplete details here and asking for advice.

Share this post


Link to post
Share on other sites

recurrent and persistent images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

this most fits what you described... she knows it is not real... and she acts upon it (removes the child)...

Like flak said, you would have to take it in context of the bigger picture...

the few questions I wuld like some answers are

1. Are these 'visions' as real as she sees you

2. Are there any other situations she experiences this

3. What would happen if she does not respond?

4. What does she think is causing this?

Are there any other symptoms suggestive of psychosis (e.g. delusions)

Is there a depressive element???

Share this post


Link to post
Share on other sites

thanks for your opinion,

she does not have any depressive symptoms at the moment, fully functional and going back to part time work in a weeks time.  has reasonable plans for that.  no other psychotic symptoms.  i have not asked her for other situations, apart from  when she has these symptoms immediate postpartum in the supermarket. initially se said it was very clear but now its so fast in a split second that she would respond instantaneously but earlier it was prolonged and was clear.  she was not sure if her worry for the baby was causing this(premorbidly anxious person and would do anything to please other people; unplanned preg).

I had discussed it with my consultant and his opinion was we would treat it as previous depression and advice prophylactic antidepressants.  i had posted it here to know the different viewpoints

Share this post


Link to post
Share on other sites

very interesting discussion, please keep us up todate regarding the outcome

Share this post


Link to post
Share on other sites
From the limited information I think you are right to consider the possibility of intrusive imagery as part of an OCD type spectrum disorder. As you say there is not going to be the possibility to fit everybody into a categorical model as the symptoms people get are not all or nothing ones. There is a blurring of the boundaries between these illnesses and a spectrum of the ways they manifest.[highlight] I always like to think of obsessional thought as bordering on psychosis.[/highlight] The main thing is to be able to acurately describe in psychopathological terms the symptoms that your patients present with. That will help to guide your communication with other colleagues and give you important information about the type of illness you are dealing with, with all the implications that holds for treatment and prognosis. These are some of the unique skills of a psychiatrist, and what make us invaluable members of the CMHT.

well only in extreme cases chris.otherwise obsessions whether cognitive or imagery need not have a psychotic touch to it :)

Share this post


Link to post
Share on other sites

Obsessive ruminations and imagery which are mood congruent  are not uncommon during the course of a depressive episode. I clearly remember a lady who I had seen with a long history of bipolar disorder presenting with obsessive thoughts and compulsive behaviour only during her depressive episodes. It was complex, extremely distressing but responded well to treatment of depressive episode (Sertraline 150 mg) along with Olanzapine.

Regarding Obsessions bordering on Psychosis. I can't quote any evidence but I have noticed the more complex the nature of obsessions are and the more varied they are( imagery, ruminations,thoughts) occuring over a short period of time especially in a young person the more chance there is for this being a part of Psychosis.

Share this post


Link to post
Share on other sites

Balmu I agree with the first paragraph but sorry I will have to disagree with para2 cos having varied imagery, ruminations and obsessions can happen without any psychotic element to it. But again in extreme cases i agree it very much borders psychosis and even tend to overlap. :)

Share this post


Link to post
Share on other sites

I think the most difficult part is identifying magical thinking from delusions.

Delusions if at all it happens in OCD would never be systematised so should never be complex. I think if they are complex then there is a valid reason to reconsider the diagnosis of psychosis. But it is surely an interesting symptom complex.

Can I check what people feel about this-Can a person have obsessive thinking about not going to toilet and actually pee in their dress. I have heard of ASD children doing things like going to the loo exactly at 09:10. but this is extreme. I dont have much more info because she is not one of my patient. I did think it was extreme but unsure if it can be explained solely on obsessive thinking.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
Sign in to follow this  
Followers 0