Psychose, mélancolie et hallucinations négatives chez le sujet âgé

Abstract

Negative hallucinations are an apparent abnormal inability to perceive an object or a person that is right before one's eyes. To erase the reality hallucinate as well to about nothing is a paradoxical phenomenon. Negative hallucinations are characterized by a defect in perception of an object or a person, and a denial of their existence. This term highlights a specific defense mechanism, clumsy and ineffective attempt to represent an absence. Psychological trauma and negative hallucinations have a close relationship with Cotard's syndrome, delusional theme of organ denial, observed in melancholic syndromes in geriatric psychiatry. Negative hallucinations require a phenomenological approach to identify their sense. A deficiency in symbolization is supposed in connection with neuropsychological deficits. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. The prevalence of this symptom is without doubt underestimated, although its presence often underlines thymic suffering that is more striking. These hallucinatory symptoms have an important impact on the patients’ daily life, and they appear to be prisoners of a suffering, that they cannot communicate. We propose in this article to review the clinical symptoms of negative hallucinations in the elderly and the way to manage them. The medicinal approaches are not always effective. A greater place must be given to non-pharmacological approaches, such as somatic ones, which can be either invasive (electroconvulsive therapy) or (transcranial magnetic stimulation).