Pseudohallucinations as functional cognitive disorders

Abstract

In their Review of functional cognitive disorders, Laura McWhirter and colleagues1McWhirter L Ritchie C Stone J Carson A Functional cognitive disorders: a systematic review.Lancet Psychiatry. 2019; (published online Nov 12.)http://dx.doi.org/10.1016/S2215-0366(19)30405-5Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar predominantly focused on functional memory impairment, which is prevalent and potentially associated with iatrogenic harm. I suggest that pseudohallucinations, which are heterogeneous perceptual phenomena that are commonly experienced by people that are grieving2Castelnovo A Cavallotti S Gambini O D'Agostino A Post-bereavement hallucinatory experiences: a critical overview of population and clinical studies.J Affect Disord. 2015; 186: 226-274Crossref Scopus (47) Google Scholar or have lived through psychological trauma,3Clifford G Dalgleish T Hitchcock C Prevalence of auditory pseudohallucinations in adult survivors of physical and sexual trauma with chronic post-traumatic stress disorder (PTSD).Behav Res Ther. 2018; 111: 113-118Crossref Scopus (11) Google Scholar and patients with borderline personality disorder,4Yee L Korner AJ McSwiggan S Meares RA Stevenson J Persistent hallucinosis in borderline personality disorder.Compr Psychiatry. 2005; 46: 147-154Crossref PubMed Scopus (83) Google Scholar have the hallmarks of functional cognitive disorders and therefore should be considered a subtype of functional neurological disorders. 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. 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.5Telles-Correia D Moreira AL Goncalves JS Hallucinations and related concepts—their conceptual background.Front Psychol. 2015; 6: 991Crossref Scopus (27) Google Scholar Yet, pseudohallucinations might still be misdiagnosed as psychotic phenomena, increasing the risk of iatrogenic harm from unnecessary investigations, treatment with antipsychotic drugs, or employment and occupational restrictions. The term pseudohallucination is potentially pejorative and misleading to both the public and clinicians, who might then view pseudohallucinations as feigned symptoms, resulting in the alienation and stigmatisation of genuinely distressed patients. Thus, I propose the alternative terminology of functional perceptual disorders. I declare no competing interests. Functional cognitive disorders: a systematic reviewCognitive symptoms are common, and yet many who seek help for cognitive symptoms neither have, nor go on to develop, dementia. A proportion of these people are likely to have functional cognitive disorders, a subtype of functional neurological disorders, in which cognitive symptoms are present, associated with distress or disability, but caused by functional alterations rather than degenerative brain disease or another structural lesion. In this Review, we have systematically examined the prevalence and clinical associations of functional cognitive disorders, and related phenotypes, within the wider cognitive disorder literature. Full-Text PDF Pseudohallucinations as functional cognitive disorders – Authors' replyWe thank Feras Ali Mustafa for his interest in our Review.1 We also welcome the suggestion that more thought is needed into how we conceptualise and thereafter describe poorly understood symptoms. In our view, curiosity about the nature of the subjective experience of cognitive symptoms—a phenomenological approach—will be important in helping us to better delineate primarily functional cognitive symptoms from those caused by degenerative brain disease. Full-Text PDF