Chronic Hallucinatory Disorder
Chronic hallucinatory disorder or chronic hallucinatory psychosis is a sub-type of psychosis and is classified in the International Statistical Classification of disease and health related problems (WHO) 10th Revision in chapter V under the Mental and Behavioral disorders. This disorder comes in the classification of “Other non-Organic Psychosis.” What makes this condition distinct from other mental illnesses is that other symptoms of psychosis are generally absent. Usually the patient is otherwise normal.
People who suffer from chronic hallucinatory psychosis also don’t exhibit confusion and memory lapses that are usually seen in psychosis. Some people may exhibit positive signs of depression, paranoia and melancholia. This disease is primarily a disease of hallucinations.
Causes
The causes are varied and range from those which have been classified as psycho-physiologic, in which case there is an actual disturbance of brain structure, to psycho-biochemical, in which neurotransmitters are disturbed. Actual psychological causes are also explored and these are usually the most common causes of the disorder. If there is a history of drug or alcohol abuse, this then becomes the most obvious cause. Visual hallucinations are the ones that are most commonly associated with actual organic disorders that are primarily of the brain tissue, and also seen in alcohol and drug related illnesses.
Symptoms
In Chronic Hallucinatory Disorder hallucinations are usually the main symptom. Although other types of hallucinations may be present, the most prominent are auditory hallucinations. Patients may hear a single or multiple voices speaking to them, although no one may be present in reality. This symptom on its own is frightening and depressing for the patient as most of the times they are aware of the fact that there is no one speaking, even when they can hear voices. The disorder may last for years and can even become life-long but this is rare.
Hallucinations
Hallucinations are sensory perceptions that are present, in the absence of any stimuli. These perceptions can be of objects, people and other things. These are different from dreams as they are experienced while a person is awake and are very vivid and seemingly real for the person perceiving them. They are different from illusions as well which is actually a distorted view of reality and imagery which is actually under voluntary control. These are also different from “delusional perceptions” which are actually real sensory perceptions that are interpreted in a bizarre manner.
Types of Hallucinations in Chronic Hallucinatory Disorder
Visual and auditory hallucinations can occur with Chronic Hallucinatory Disorder.
Hallucinations can be of many forms. Different types of hallucinations actually effect different senses, and can also occur simultaneously in this disorder. These are then experienced as multiple sensory hallucinations.
Visual Hallucinations
This is one of the most common types of hallucinations experienced by people suffering from hallucinatory diseases and come second to only “auditory” hallucinations. In this type of hallucination people claim to see things that are actually not present.
Auditory Hallucinations
Auditory hallucinations are the main types of hallucinations that are perceived in hallucinatory disorder. These are also known as paracusia and are defined as the actual perception of sound in the absence of any external stimuli. Hallucinations of these types involve usually one or more voices heard taking. Such hallucinations are especially associated with mental illnesses like schizophrenia, and may be the key symptoms when a diagnosis of this condition is being made. In Chronic Hallucinatory Disorder however, auditory hallucinations are present without the presence of other psychotic symptoms this is why a diagnosis of schizophrenia is not possible to make.
Command Hallucinations
These hallucinations are experienced in the form of a person or persons giving commands. Hallucinations of these types can be dangerous as the commands may range from random actions to actual self harm commands to commands that dictate the harm of others. These hallucinations are also most commonly associated with schizophrenia and the person experiencing them may comply, or may not comply with the commands.
Olfactory Hallucinations
These are also called Phantosmia. These involve smelling odors that are actually not present. Most commonly a person may smell unpleasant odors such as, vomit, feces, rotting flesh, urine, a burning smell or others.
Tactile Hallucinations
These hallucinations are sensations of feeling something on the flesh in the absence of all stimuli. Most common sensation is of insects crawling.
Gustatory Hallucinations
Gustatory hallucinations involve the perception of taste in the absence of any stimulus.
General Somatic Sensations
These are experienced when a person feels as if his body is getting mutilated in the literal sense. The person may experience as if their body is getting twisted, torn and even disemboweled.
Treatments
The treatment of this disorder is done with the help of medications and psychotherapy. When treating this condition it should be noted that this can actually be the first stage of an illness which may develop later in more definite lines. When hallucinations are first experienced a person becomes confused and seeks an explanation for them. When no other psychotic symptoms are present he or she may develop delusions, most commonly persecutory delusions. These are also most commonly seen with hallucinations in psychiatric illness.
Medications
Anti-psychotic medicines and atypical anti-psychotic medicines may help treat severe symptoms that are causing significant distress to the patient. Since Chronic Hallucinatory Disorder is rare without the presence of other psychotic symptoms, it can also be treated without the use of anti-psychotic drugs.
Lifestyle Changes
Managing levels of stress, encouraging a healthy lifestyle, incorporating exercise in daily life and getting plenty of rest and adequate sleep may help reduce the occurrence of hallucinations.
Psychotherapy
Psychotherapy may be deemed necessary in order to alleviate any depression that may occur as a result of experiencing hallucinations.
References:
The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10 (WHO)
Blueprints Psychiatry Michael J Murphy, Ronald L. Cowan, Lloyd I Sederer
