Source : FISH ’S Clinical psychopathology

Taste (gustatory)

Hallucinations of taste occur in schizophrenia and acute organic states but it is not always easy to know whether the patient actually tastes something odd or if it is a delusional explanation of the effect of feeling strangely changed. Depressed patients often describe a loss of taste or state that all food tastes the same.

Touch (tactile)

This may take the form of small animals crawling over the body, so-called formication. This is not uncommon in acute organic states. In cocaine psychosis this type of hallucination commonly occurs together with delusions of persecution and is known as the ‘cocaine bug’. Some patients experience the feeling of cold winds blowing on them, sensations of heat, electrical shocks and sexual sensations, and the patient is convinced that these are produced by outside agencies. In the absence of coarse brain disease, the most likely diagnosis is schizophrenia. Indeed, Sims (2003) points out that there is almost always a concomitant delusional elaboration of tactile hallucinatory experiences. Sexual hallucinations can occur in both acute and chronic schizophrenia, for example, one patient complained that she could feel the penis of her son’s employer in her vagina no matter what she did and although she could not see the man she was certain of this.

Sims (2003) classifies tactile hallucinations into three main types:

superficial, kinaestethic and visceral (see below). Sims further divides superficial hallucinations, which affect the skin, into four types: thermic (e.g. a cold wind blowing across the face), haptic (e.g. feeling a hand brushing against the skin), hygric (e.g. feeling fluid such as water running from the

head into the stomach) and paraestethic (pins and needles), although the latter most often have an organic origin. Kinaestethic hallucinations affect the muscles and joints and the patient feels that their limbs are being twisted, pulled or moved. They occur in schizophrenia, where they can be distinguished from delusions of passivity by the presence of definite sensations. Vestibular sensations such as sinking in the bed or flying through the air can also be hallucinated and are best regarded as a variant of kinaestethic hallucinations and occur in organic states, most commonly delirium tremens. Kinaestethic or vestibular perceptions occur in organic states such as alcohol intoxication and during benzodiazepine withdrawal and may also occur in the absence of any abnormality, for example after a week’s sailing an undulating feeling may persist for a few days.