functional ,reflex ,autoscopy ,extracampine ,pseudohallucinations ,induced hallucinations ,phantom limb pain as described in fish psychopathology and SIMS(symptoms of mind) for m.phil clinical psychology

2. REFLEX
AUTOS
COPY
FUNCT
IONAL
ORGA
NIC

3. FUNCTIONAL
 a rare phenomenon, where in hallucinations are triggered by a
stimulus in the same modality, and co-occur with it.
 The hallucination requires the presence of another real sensation
 Patient can distinguish between both features from each other
and crucially,the hallucination does not occur without the
stimulus

4. examples
 A patient with schizophrenia first heard the voice of God as her clock ticked
Later, she heard voices coming from a running tap and from chirping of the
birds(auditory)
 One patient described that she saw the mouths of her collection of dolls
moving. the perception of dolls was necessary to produce the hallucination
but the movements of their mouths was distinct and separate and did not
represent a transformation of that perception ,thus making it a functional
hallucination and not illusion (visual)
 A patient told –”jaise jaise bike chalti hai ,usme se bike ki bhi awaz aati hai
and bhagwan ki bhi awaz aati hai” (auditory)

5.  A case report from Functional Hallucinations in Schizophrenia Responding to Adjunctive Sodium Valproate research paper :
 A single man, aged 30, employed in a factory, presented to our Outpatient Department, in 2007,
with two years’ continuous illness, characterized by persistent auditory hallucinations, secondary
delusions of reference, social withdrawal, and impaired occupational functioning. He also reported
obsessive doubts about routine activities, such as closing doors or taps, and a compulsion to check
whether he had done these properly, despite knowing that this was unnecessary. There were no
mood disturbances or history of substance use. Physical examination and routine laboratory
investigations were unremarkable. He was diagnosed to have paranoid schizophrenia and
obsessive-compulsive disorder, and was treated with risperidone (titrated up to 8 mg/day) and
fluoxetine (titrated up to 80 mg/day). On the above-mentioned medications, he improved
significantly, and was able to return to his job.
 However, he was still troubled by a single symptom. His job involved frequent contact with
machinery and motors. Whenever he heard these machines running, he would hear several
unknown male voices abusing or criticizing him. He found these distressing, and this led him to
frequently avoid his work or leave it incomplete. He did not hear these voices at any other time, and
did not report any recurrence of his other symptoms. There was no evidence of other
hallucinations, delusions or obsessional phenomena on interview.

6. REFLEX
 Experience of a stimulus in one sense
modality producing a sensory experience
in another k/as SYNAESTHESIA.
 Reflex hallucination are morbid form of
synaesthesia
 Sometimes occurs under the influence of
hallucinogenic drugs

8. Examples
Feeling of cold in one’s spine on hearing a fingernail
scratch on blackboard
One patient described hearing his own reflection and said
that when attempting to carry out some action he could
hear himself doing so
Patient felt a pain in her head(somatic hallucination) when
she heard other people sneeze(stimulus) and was
convinced that sneezing caused the pain

10. A 41 year old Iranian woman with 3 sisters and 5 brothers is the 7th child of the
family. She has got married 18 years ago and now has 2 daughters. At the first year
of marriage, her family relation with her husband was very good, but a little after
that, problems developed. Although she had a great reliance on her husband, but
always felt lack of affection by her husband and it bothered her. One year ago, she
involved in conditions of depression including: extreme physical exhaustion, crying,
fear of taking responsibility for daily living such as cooking and …, disinterested and
disenjoyment. She always thought suicide by cutting a vessel, but because of
religious beliefs, she never did this.
She visited a psychiatrist and used drugs about 9-10 months. She remained on
nortriptyline . By using drugs, her condition became better, but stopped taking
them, because she did not have a good belief on psychiatric drugs. Some symptoms
emerged 3 months after stopping using medicine. She says: One day, I was sitting
near our garden. I saw a bird sitting on a tree’s leaves and it’s beak was open
because of the hot weather. Suddenly, I sensed bird’s feathers on my body and it’s
feeling because of the heat. Another one, when a child was taking milk from
mother’s breast, I exactly felt flavor of milk, touching breast tissue and even
differences of it between young mother and older one. When my daughter’s finger
cut, I felt the sense of irritation and weakness she had at that time. When our house
hold “Love bird” was cleaning it’s feathers with its back, I felt as if something was
touching my body.

12. AUTOSCOPY/PHANTOM MIRROR IMAGE
 Experience of seeing oneself and knowing that it is oneself
 It is not just visual hallucination because kinesthetic and somatic
sensation must also be present to give the subject the impression
that the hallucinations is oneself (he-autoscopy)
 Can occur in healthy subjects when they are emotionally upset or
when exhausted
 In these cases there is some change in the consciousness state

13. AN UNUSUAL CASE OF AUTOSCOPIC HALLUCINATION:
A CASE REPORT AND REVIEW OF LITERATURE
 A 27-year young single female belongs to urban nuclear family from upper socio-economic status presented with
insidious onset of symptoms since last five years characterised by auditory hallucination; voices were
discussing and threatening type. In addition to hearing voices, the delusion of persecution, delusion of reference,
poor self-care, and poor social interaction were also present. Gradually her condition deteriorated, stopped going
out of the home, and would remain fearful, not participating in household chores. For these symptoms, was taken
to various faith healers and local quake but had no relief. Since the last two and half years, she started crying on
and off the pattern for about 5-10 minutes about 3-4 times in a day. While crying, she would point out her figures
toward the wall. Later on, she revealed that “she would see herself, i.e. almost the photocopy of her, i.e. “double”
in front of her about 2-3 feet away from her body. She would describe her double with the similar facial features,
colour and style of hair, complexion in fact “it was another me”. She would say that her double would appear
naked to her; it was like her “mirror image” or “self”. She would say that a man would come and would rape with
the “self”. She would have guilt that she could not save the “self” being raped by someone. As her “self” would ask
for help in a loud volume and would cry. She denied having any sensation to hers’ original body. It would occur at
any point in time. She visited various psychiatrists, started on antipsychotic but had not much relief. Compliance
was not so good, citing the reason of no improvement with the drug

15.  Occasionally ,autoscopy is a hysterical symptom
 Schizophrenic patients have them ,but more common in
acute and sub acute delirious states
 Generally associated with lesions of parieto-occipital
region and toxic infective states whose effect is greatest
in basal region

16.  A few patients suffering from
organic states look in mirror
and see no image k/as
negative
autoscopy/heautoscopy
 Some subjects see their own
internal organs ,psychiatrists
calling it internal
autoscopy/heautoscopy

17.  Patient has hallucination that is outside the limits of the sensory field
 Jasper called it the phenomenon of "vivid physical awareness" (leibhaftige
Bewusstheit), i.e. an awareness of an external object independent from any
feeling that it related to a sensory perception ("There are patients who have a
certain feeling-in the mental sense-or awareness that someone is close by,
behind them or above them, someone that they can in no way perceive with
the external senses, yet whose actual/concrete presence is directly/clearly
experienced"

18.  Patient sees somebody standing
behind them when they are looking
straight ahead
 Hears voices talking in kanpur when
they are in gwalior
 [can occur in healthy people as
hypnagogic hallucinations]

19. HYPNOGOGIC/HYPNPOMPIC
• Hallucinations occur when the subject is falling asleep or waking
up,respectively
• Hypnogogic occurs just as person is entering Stage 1 sleep
• Hypnopompic occur during REM sleep state
• It has been suggested that hypnopompic hallucinations are often
hypnagogic experiences that occur in morning when the subject is
waking and dosing off again, so that they actually happen when the
subject is falling asleep

20. • Term “hypnopompic” should be reserved
for those hallucinatory experiences that
persist from sleep when the eyes are open
• Hypnagogic hallucinations occur during
drowsiness ,are discontinuous ,appear to
force themselves on the subject and do not
form part of an experience in which the
subject participates as they do in a dream.
They are 3 times more common than
hypnopompic hallucinations

21. • Hypnopompic hallucinations are better
indicator of narcolepsy
• The subject believes that the hallucinations has
woken them up(for eg,hearing the telephone
ring even though it has not).
• Subjects describing hypnogogic hallucinations
often assert that they are fully awake. But, EEG
records show that there is low alpha rhythm at
the time of hallucinations

22. examples
Hypnagogic visual hallucinations can be geometrical
designs ,abstract shapes,faces etc
One of the most common is that of hearing one’s name
called
Voice saying a sentence or phrase that has no discoverable
meaning

23.  Can occur in any sense modality
and occur in variety of neurological
and psychiatric conditions
 Occur in eye disorders ,CNS
,lesions of optic tract
 Complex scenic hallucinations
occur in temporal lobe lesions

24.  Charles bonnet syndrome
consists of VHs in absence of
any other psychopathology,
although impaired vision is
present
 All dementias , deliriums
,substance abuse are
associated with VHs

25.  Phantom limb is most common organic
somatic hallucination (patient believes
he has a limb from which he is not
receiving any sensation either because it
has been amputated or sensory
pathways have been destroyed
 In rare cases with thalamo-parietal
lesions the pt. describes a 3rd limb .
 Usually occurs after lesions of peripheral
nerve or medulla or spinal cord

27. PSEUDOHALLUCINATIONS
 Patients with pseudohallucinations (typically of auditory or
visual nature) usually present to emergency departments or
psychiatric clinics and their symptoms are often associated
with emotional distress and dissociative behavioural
disturbance.
 Usually experienced by grieving people , BPD ,people who
have live psychological trauma

28.  Pseudohallucinations are often qualitatively
distinguishable from hallucinations caused by brain
disorders such as schizophrenia, Parkinson's disease,
and acute delirium in that they are internally
inconsistent, usually contexual and symbolic, convey
messages that reflect the patient's psychological
distress, and are more likely than hallucinations to be
perceived as internal.

29. INDUCED HALLUCINATIONS
• Happens in case of induced psychotic disorders where the
influence of a patient with psychosis is such that the
relatives and the associates sharing secluded life with the
patient become convinced of patient’s beliefs.
• As patient they may taste peculiar flavour of water
suspecting poisoning or smell the gas from the window
they have been made to inhale

30. REFERENCES
1. Rajkumar R. P. (2012). Functional hallucinations in schizophrenia responding to adjunctive sodium valproate. Indian journal
of psychological medicine, 34(1), 76–78. https://doi.org/10.4103/0253-7176.96165
2. Feras Ali Mustafa , Pseudohallucinations as functional cognitive disorders , VOLUME 7, ISSUE 3, P230, MARCH 01, 2020
3. Ehsan Farhadi Shurbalaghi, Mahdie Bahri, Maryam Fazli Ahmadabadi and Reza Bidak Clinical Image - International Journal of
Clinical & Medical Images (2016) Volume 3, Issue 4
4. Confusing and Interesting Feature of Hallucination as Reflex Hallucination in Multiple Modalities; a Clinical Image
5. Fish clinical psychopathology
6. Textbook of descriptive psychopathology(1st edition)
7. Aseem Mehra1, Sandeep Grover2, Manoj Kumar3 ,An unusual Case of Autoscopic Hallucination: A Case Report and Review of
Literature ; Matthew journal of psychiatry and mental health , volume 1 ,issue 1-2019
8. Anzellotti, F., Onofrj, V., Maruotti, V., Ricciardi, L., Franciotti, R., Bonanni, L., Thomas, A., & Onofrj, M. (2011). Autoscopic
phenomena: case report and review of literature. Behavioral and brain functions : BBF, 7(1), 2.
https://doi.org/10.1186/1744-9081-7-2
9. Symptoms in mind(SIMS)
10. Waters, F., Blom, J. D., Dang-Vu, T. T., Cheyne, A. J., Alderson-Day, B., Woodruff, P., & Collerton, D. (2016). What Is the Link
Between Hallucinations, Dreams, and Hypnagogic-Hypnopompic Experiences?. Schizophrenia bulletin, 42(5), 1098–1109.
https://doi.org/10.1093/schbul/sbw076