Perception, unlike sensations, gives a complete picture of an object or phenomenon. Its physiological basis is the sense organs. The end product of perception is a figurative, sensory representation of a particular object.
Perceptual disorders are represented by several disorders: illusions, agnosias, hallucinations and psychosensory disorders.
Agnosia- unrecognition of the object, the inability of the patient to explain the meaning and name of the perceived object Visual, auditory
and other agnosias are similarly treated and studied in the course of nervous diseases. In psychiatry, anosognosias (not recognizing one's illness) are of particular interest, occurring in many mental and somatic diseases (hysterical disorders, alcoholism, tumors, tuberculosis, etc.) and having a different pathogenetic nature.
Illusions- such a violation of perception, in which a real-life object is perceived as completely different (for example, a shiny object on the road that looks like a coin, upon closer examination, turns out to be a piece of glass, a dressing gown hanging in a dark corner - for the figure of a lurking person).
Distinguish illusions physical, physiological and mental.
Physical illusions are due to the peculiarities of the environment in which the perceived object is located. For example, a mountain range is perceived as colored in different colors in the rays of the setting sun, as we see it in R. Roerich's paintings. An object in a transparent vessel half-filled with liquid seems to be broken at the boundary between liquid and air.
Physiological illusions arise in connection with the conditions for the functioning of receptors. Cold water after being in the cold is perceived as warm, a light load after prolonged physical exertion is perceived as heavy.
Mental illusions, more often they are called affective in connection with the emotional state of fear, anxiety, expectation. An anxious and suspicious person walking late hears the steps of the pursuer behind him. Being in a state of alcohol withdrawal, he sees various faces or figures in spots on the wall.
Pareidolic illusions are mental, they are a kind of visual with a changing content of erroneous images. They often occur in the initial period of psychotic states, in particular alcoholic delirium. Patients in the drawings of wallpaper, carpets see changing faces, moving figures of people, even pictures of a battle.
The remaining illusions are often not a symptom of a mental illness, they are often found in mentally healthy individuals under the above conditions.
Another existing classification of illusions is based on their differentiation by analyzers: visual, auditory, tactile, olfactory, gustatory. The first two varieties are most common, and the last two cause great difficulty in distinguishing from hallucinations of smell and taste.
hallucinations.
Hallucinations is such a violation of perception, in which an object or phenomenon that does not exist at a given time and place is perceived in the absence of a critical attitude towards them .. Hallucinating patients perceive them as really existing, and not something imaginary. Therefore, any reasonable arguments of the interlocutor that the sensations they experience are only manifestations of the disease are denied and can only irritate the patient.
All hallucinatory experiences are classified according to a number of characteristics: complexity, content, time of occurrence, interest of one or another analyzer, and some others.
According to the complexity of hallucinations are divided into elementary, simple and complex. The former include photopsias (visual images devoid of a specific form in the form of spots, contours, glare), acoasma (calls, obscure noises) and other simple phenomena. Only one analyzer is involved in the formation of simple hallucinations. When complex hallucinations appear, several analyzers are involved. Thus, the patient can not only see an imaginary person, but also hear his voice, feel his touch, smell his cologne, etc.
Most often in clinical practice there are visual or auditory hallucinations.
Visual hallucinations can be represented by single or multiple images, previously encountered or mythical creatures, moving and stationary figures, harmless or attacking the patient, with natural or unnatural coloring.
If the visual image is perceived not in the usual field of view, but somewhere on the side or behind, then such hallucinations are called extracampal. The experience of seeing one's doubles is called autoscopic hallucinations.
Auditory hallucinations can be experienced by patients as the sound of the wind, the howling of animals, the buzzing of insects, etc., but most often in the form of verbal hallucinations. These can be the voices of familiar or unfamiliar people, one person or a group of people (polyphonic hallucinations), who are nearby or at a far distance.
According to the content, "voices" can be neutral, indifferent to the patient or threatening, insulting. They can address the patient with questions, messages, award him orders or remove him from office, comment on his actions (commenting on hallucinations) and give advice. Sometimes the “voices” talk about the patient without addressing him, while some scold him, threaten him with punishments, others defend him, offer to give him time to correct himself (antagonistic hallucinations).
The greatest danger for the patient and his environment are imperative hallucinations, which are in the form of orders to perform a particular action. These orders may be harmless (cook food, change clothes, visit, etc.), but often lead to dire consequences (self-harm or suicide, injure or kill a familiar person or a bystander).
As a rule, the patient cannot oppose these orders, he carries them out, at best he asks to restrict his actions in some way so as not to cause trouble.
Tactile hallucinations are most often represented by the feeling of crawling on the skin or under it of various kinds of insects. Moreover, even if the feeling of crawling is not confirmed by visual hallucinations, the patient can tell about their size, number, direction of movement, color, etc.
Olfactory and gustatory hallucinations are rare. Olfactory consists in the sensation of non-existent pleasant, often unpleasant odors (hydrogen sulfide, rot, sewage, etc.) Taste - the experience of some kind of taste in the mouth, regardless of the nature of the food taken.
With visceral hallucinations, patients claim that there are some creatures in their body (worms, frogs, snakes, etc.) that cause them pain, eat food taken, disturb sleep, etc.).
Visceral hallucinations, unlike senestopathies, have the appearance of an image with the corresponding characteristics of size and color. movement features.
Functional, dominant, hypnagogic and hypnopompic hallucinations are considered separately from others.
Functional hallucinations arise against the background of the action of an external stimulus, and are perceived simultaneously with it, but without merging, as is the case with illusions. For example, in the noise of rain, the ticking of a clock, the patient begins to hear the voices of people.
Dominant hallucinations reflect the content of the mental trauma that caused the disease. For example, a person who has lost a close relative hears his voice or sees his figure.
Hypnagogic hallucinations of any kind occur during the transition from wakefulness to sleep, hypnopampampic hallucinations - upon awakening.
Of particular importance for the diagnosis of a mental disorder is the division of hallucinations into true and false (pseudohallucinations).
For true hallucinations a projection into the environment is characteristic, they naturally fit into it, wear the same signs of reality as the surrounding objects. Patients are convinced that others are experiencing the same experiences, but for unknown reasons they hide it. True perceptual delusions usually influence the behavior of the patient, which becomes consistent with the content of hallucinatory images. True hallucinations are more common in exogenous psychoses.
Pseudo-hallucinations have a number of distinctive properties from the true:
1. They are devoid of signs of reality, do not fit into the environment, are perceived as something alien, strange, different from previous sensations. Through the man sitting on a chair, the back of the chair is visible, a nearby tiger with a grin of teeth, according to V.Kh. Kandinsky, does not cause a feeling of fear, but rather curiosity.
2. Projection of hallucinations inside the body. The patient hears voices not with the ear, but inside the head, sees images located in the abdomen or chest.
3. Experience the feeling of having hallucinations. The patient does not see the image himself, but it is shown to him, he hears a voice inside his head because someone did this, perhaps by inserting a microphone into his head. If a visual hallucination is projected outside, but has the above listed signs, it can be classified as a pseudo hallucination.
4. Often, pseudohallucinations, if they are not imperative, do not affect the patient's behavior. Even close relatives may not realize for months that there is a hallucinating person next to them.
Pseudohallucinations are more common in endogenous disorders, namely in schizophrenia, are included in the Kandinsky-Clerambault syndrome.
The presence of hallucinatory experiences can be learned not only from the words of the patient and his relatives, but also from the objective signs of hallucinations that are reflected in the patient's behavior.
Hallucinations belong to the psychotic level of disorders, their treatment is best carried out in a hospital, and imperative hallucinations are a prerequisite for involuntary hospitalization.
Hallucinations form the basis of the hallucinatory syndrome. Long-term, non-stop hallucinations, most often verbal, are referred to as hallucinosis.
Psychosensory disorders.
(impaired sensory synthesis)
Sensory synthesis disorders are called such a disorder of perception, in which a real (as opposed to hallucinations) perceived object is recognized correctly (as opposed to illusions), but in an altered, distorted form.
There are two groups of psychosensory disorders - derealization and depersonalization.
Derealization is a distorted perception of the world around. It in the statements of patients can be indefinite, difficult to verbalize. There is a feeling of change in the surrounding world, it has become somehow different, not the same as before. Houses don't stand that way, people don't move that way, the city looks camouflaged, and so on. For patients who are depressed, statements are characteristic that the world has lost its colors, has become dull, blurry, lifeless.
In other cases, experiences of derealization are expressed in quite definite terms. This concerns, first of all, the distortion of the shape, size, weight and color of the perceived object.
Micropsia - perception of an object in a reduced size, macropsia - in an enlarged size, metamorphopsia - in a distorted form (broken, bent, deformed, etc.) One of the patients periodically ran out of the ward with a loud cry of "fire", as he perceived everything around him in bright red color.
Derealization can also be manifested by the phenomena déjà vu, eprouve vu, entendu vu, as well as jamais vu, jamais eprouve vu, jamais entendu. In the first case, we are talking about the fact that the individual experiences the situation that has arisen as it has already been seen, heard or experienced. In the second, already previously known - as never seen, heard or experienced.
Derealization also includes a violation of the perception of time and space.
Patients in a manic state perceive time faster than in reality, in a depressive state - as slowed down.
Those who are in a state of intoxication as a result of smoking marijuana experience the feeling that nearby objects are at a distance of tens of meters from them.
Derealization is more common in mental disorders of exogenous etiology.
Symptoms of depersonalization can be presented in spirit variants: somatopsychic and autopsychic.
Somatopsychic depersonalization, or a violation of the body schema, is represented by experiences of changes in the size of the body or its parts, weight and configuration. Patients may claim that they are so grown that they do not fit in their bed, their head cannot be torn off the pillow due to weight, etc. These disorders are also more common with exogenies.
Autopsychic depersonalization is expressed in the experience of a feeling of change in one's "I". In such cases, patients declare that their personality traits have changed, that they have become worse than before, they have ceased to be warm to relatives and friends, etc. (in a state of depression). Autopsychic depersonalization is more characteristic of patients with endogenous diseases.
Depersonalization-derealization syndrome can be complicated by delirium, depression, mental automatisms and other disorders of mental activity.
Definitions
Perception - a holistic subjective mental reflection of objects and phenomena of the surrounding world when they affect our senses. It consists of sensations, the formation of an image, its addition to representation and imagination.
Feeling- a type of mental activity that, arising from the direct impact of objects and phenomena of the surrounding world on our sense organs, reflects only individual properties of these objects and phenomena.
Performance- the result of the revival of images or phenomena perceived earlier, in the past.
Clinical manifestations.
Hyperesthesia- violation of sensitivity, which is expressed in the super-strong perception of light, sound, smell. It is typical for conditions after somatic diseases, traumatic brain injury. Patients may perceive the rustling of leaves in the wind as rumbling iron, and natural light as very bright.
hypothesia- decreased sensitivity to sensory stimuli. The environment is perceived as faded, dull, indistinguishable. This phenomenon is typical of depressive disorders.
Anesthesia- most often loss of tactile sensitivity, or functional loss of the ability to perceive taste, smell, individual objects, is typical for dissociative (hysterical) disorders.
Paresthesia- sensation of tingling, burning, crawling. Usually in zones corresponding to the zones of Zakharyin - Ged. Typical for somatoform mental disorders and somatic diseases. Paresthesias are due to the peculiarities of blood supply and innervation, which differ from senestopathies.
Senestopathy- unpleasantly experienced sensations of varying intensity and duration from the internal organs in the absence of an established somatic pathology. They, like paresthesia, are difficult to verbalize by patients, and when describing them, the latter most often use comparisons. For example: as if the intestines are moving, air is blowing through the brain, the liver has increased in size and presses on the bladder, etc.
The main perceptual disturbances are illusions and hallucinations. Patients may be reluctant to talk about these phenomena or hide them.
Indirect signs of perceptual disorders are:
A person's conversation with himself (alone or in the presence of others),
Unreasonable and sudden change in attitude towards others,
The emergence of new words (neologisms) in speech,
mimic grimaces,
The tendency to solitude, change of mood,
Contraction of masticatory muscles and sternocleidomastoid muscles,
Tension of the orbital region with a half-open mouth,
Sudden glance to the side when talking
Dissociation of facial expressions, posture and gesture,
Non-purposeful unexpected gestures with relatively motionless facial expressions.
Illusions- erroneous perception of real-life objects and phenomena.
The main characteristics of illusions are:
The presence of an object or phenomenon that is subject to distortion, such as a visual, auditory or other sensory image,
The sensory nature of the phenomenon, that is, its connection with a specific modality of perception,
Distorted assessment of the object,
Evaluation of the distorted sensation as real,
Psychopathological delusions are:
Illusions affective(i. affectivae) - illusions arising under the influence of fear, anxiety. An anxious and suspicious person walking at a late time hears the steps of the pursuer behind him.
Illusions are verbal(i. verbales) - auditory illusions, the content of which is individual words or phrases.
Illusions are pareidolic(i. pareidolicae; couple + Greek eidōlon image) - visual illusions of fantastic content, usually arising on the basis of a wallpaper or carpet pattern, cracks and spots on the ceiling and walls, etc. Unfold on a plane, for example, when viewing a pattern of wallpaper on On the wall, the patient sees changeable, fantastic landscapes, faces of people, unusual animals, etc. The basis of illusory images are the details of the actual drawing. Often occur in the initial period of alcoholic delirium.
hallucinations- the perception of an object or sensory image that occurs without the presence of a real object, but is accompanied by confidence that this object exists. The term "hallucination" was introduced for the first time by J.-E.D. Esquirol in 1838.
True hallucinations:
Endowed with all the properties of real objects (corporality, weight, bright sound).
projected into real space immediately surrounding the patient.
There is confidence in the natural way of obtaining information about imaginary objects and phenomena through analyzers.
The patient is sure that everyone around perceives the same objects in exactly the same way as he does.
The patient treats imaginary objects as if they were real: he tries to pick them up, runs away from pursuers, attacks enemies.
Pseudo-hallucinations:
Deprived of sensual liveliness, natural timbre, incorporeal, transparent, non-voluminous.
They are projected into an imaginary space, come either from the patient's body or from areas inaccessible to his analyzers, do not come into contact with objects of the real situation.
They can give the impression of being forcibly evoked, made, put into the head with the help of special devices or psychological influence.
The patient believes that the images are transmitted to him on purpose and are inaccessible to the senses of others.
The patient cannot run away from hallucinations, because he is sure that they will reach him at any distance, but sometimes he tries to "shield" his body from exposure.
They are perceived as an attempt of mental violence, the desire to enslave the will, to force them to act against desires, to drive them crazy.
They often occur in chronic psychoses, are quite resistant to therapy, do not depend on the time of day, and may disappear completely at night during sleep.
Hallucinations are classified:
1. by the senses:
Auditory (imperative, threatening, commentary, antagonistic)
Visual (photopsies, zoopsies; autoscopic, extracampal, hypnagogic, hypnopompic)
Tactile (thermal, haptic, hygric)
Flavoring
Olfactory (imaginary perception of unpleasant odors)
Visceral, general feeling (presence in the body of some objects, animals)
2. according to the degree of difficulty:
Elementary (acoasma, photopsia)
Simple (linked to 1 analyzer)
Complex (deceptions by several analyzers at once)
scene-like
Functional hallucinations - occur against the background of a real stimulus acting on the senses, and only during its action.
Suggested and induced hallucinations:
Lipman's symptom - causing visual hallucinations by lightly pressing on the patient's eyeballs.
Symptom of a blank sheet (Reichardt) - the patient is invited to carefully examine a blank sheet of white paper and tell what he sees there.
Aschaffenburg's symptom - the patient is offered to talk on the switched off phone, the readiness for the occurrence of auditory hallucinations is checked.
Clinical example:
Patient S., aged 32, suffered from psychosis with severe perceptual disturbances in the form of illusions and hallucinations. This patient, who had been abusing alcohol for a long time, fell into insomnia during a train ride, began to experience fear and severe anxiety. On the third day of such a state, I heard how the wheels of the car “began to clearly pronounce”: “Be afraid, be afraid,” and after some time, and in the noise of the fan in the roof of the car, I began to distinguish the words: “do not expect mercy.” By the evening of the same day, he began to see how the cobweb was flying around the compartment, felt how it landed on his face and hands, felt its unpleasant, sticky touch.
In the middle of the night, I suddenly distinctly heard how several male voices behind the wall were talking about how to destroy him, but they could not come to an agreement that it would be better to use a knife or a rope for this. I realized that intruders had gathered in the next compartment, who would now kill him. In great fear, he ran out into the vestibule and at the very first stop, jumped out of the car. I calmed down for a while, then suddenly I saw that the lantern on the pole was not a lantern, but some kind of searchlight or “electronic gas”.
Psychosensory disorders sometimes considered intermediate between disorders of consciousness and perception. These include experiences of depersonalization and derealization, as well as special syndromes described in the corresponding section.
Depersonalization expressed in the following symptoms:
Mental:
Changes in the "I", peculiar sensations of transformation, often negative, of one's own personality, accompanied by the fear of going crazy, experiencing one's own uselessness, the emptiness of the meaning of life and the loss of desires. This condition is characteristic of affective disorders and some neuroses.
The splitting of the "I", typical for schizophrenia and dissociative disorders, is expressed in the feeling of having two or more personalities, each of which has its own intentions, desires.
- alienation of the self.
Physical:
A change in the body scheme is expressed in an abnormal perception of the length of the limbs, shortening or stretching of the arms and legs, changes in the shape of the face and head. A condition observed as a result of organic disorders.
Derealization expressed in a change:
Colors, for example, during depression, the world may appear gray or with a predominance of blue tones, which is especially noticeable in the work of artists such as E. Munch, who during periods of depression used mainly black, blue and green colors. The predominance of bright colors in the environment is noted by patients with manic states. The perception of red and yellow tones or fire is typical of twilight epileptic conditions.
Shapes and sizes: the environment can increase or decrease (Alice in Wonderland syndrome), approach and recede, constantly transform. The patient can perceive the right side as the left and vice versa (Alice in the Looking Glass syndrome). Conditions of this kind are characteristic of intoxication with psychoactive substances and organic brain lesions.
Tempo and time: the environment may seem to change extremely quickly, like old movie frames (cinema syndrome), or, on the contrary, it seems to be drawn out. In some cases, it seems that the months run like moments, in others - there is no end to the night. Patients may report that they notice the same stereotypically repeated plot. All of these experiences are associated with emotionality, for example, in a good mood, it seems that time flows faster, and in a bad mood - more slowly.
Thus, the following syndromes can be distinguished.
Hallucinosis- a condition characterized by an abundance of hallucinations within one analyzer and not accompanied by clouding of consciousness, lasting from 1-2 weeks (acute hallucinosis), up to 6 months (subacute), up to several years (chronic hallucinosis).
The patient is anxious, restless or, conversely, inhibited. The severity of the condition is reflected in the behavior and attitude of the patient to hallucinations. By severity, acute and chronic hallucinosis are distinguished, and by content - auditory, tactile, visual. auditory hallucinosis it is usually verbal: voices are heard talking among themselves, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis is determined by the clinical picture of the alcoholic psychosis of the same name; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain. Patients with tactile hallucinosis feel the crawling of insects, worms, microbes on the skin and under the skin, touching the genitals; criticism of what is experienced is usually absent. It is noted in psychoses of late age, with organic damage to the central nervous system. Visual hallucinosis - a frequent form of hallucinosis in the elderly and people who have suddenly lost their sight, it also happens with somatogenic, vascular, intoxication and infectious psychoses. With the hallucinations of Charles Bonnet, patients suddenly begin to see bright landscapes on the wall, in the room, sunlit lawns, flower beds, playing children, they are surprised at this, although the awareness of the pain of experiences and the understanding that vision is impossible due to loss of vision remain intact. Usually, with hallucinosis, the patient's orientation in place, time and his own personality is not disturbed, there is no amnesia of painful experiences, i.e. there are no signs of confusion. However, in acute hallucinosis with life-threatening content, the level of anxiety rises sharply, and in these cases consciousness can be affectively narrowed.
hallucinatory syndrome- an influx of copious hallucinations from various analyzers (verbal, visual, tactile) against the background of a clear consciousness. May be accompanied by affective disorders (anxiety, fear), as well as delusional ideas. Hallucinatory syndrome can occur in schizophrenia, epilepsy, organic brain lesions, including syphilitic etiology.
Kandinsky-Clerambault Syndrome- is a special case of hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - mental automatisms and delusions of influence. Mental automatisms - alienation to the patient of his own mental acts, the feeling that some processes in his psyche occur automatically, against his will. There are 3 types of automatism:
Ideatory (thinking) - a feeling of insertion and withdrawal of thoughts, outside interference in their course, a symptom of "openness of thoughts", breaks (sperrung) and influxes of thoughts (mentism).
Sensory (sensual) - a state in which many unpleasant sensations in the body seem to be “made”, specially caused.
Motor (motor) - the feeling that the patient's movements are performed against his will, caused by influence from the side, "puppet movements".
The presence of all 3 variants of automatism is mental panautomatism.
Clinical example: The patient reports that for several years now he has been under the constant influence of some kind of apparatus that directs "rays of atomic energy" at him. He understands that the influence comes from some scientists setting up an experiment. "They chose me because I always had good health." The experimenters "take away his thoughts", "show some images" that he sees inside his head, while in his head "a voice sounds" - "also their work." Suddenly, during a conversation, the patient begins to grimace, twist his mouth, twitch his cheek. When asked why he does this, he replies: “It’s not me at all, but they burn with rays, direct them to different organs and tissues.”
It is also possible to develop the so-called inverse variant of the Kandinsky-Clerambault syndrome, the essence of which is that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings, and actions. These phenomena are usually combined with ideas of overestimation of one's personality or delusional ideas of grandeur and are observed in the picture of paraphrenia.
Definitions
Perception is a holistic subjective mental reflection of objects and phenomena of the surrounding world when they affect our senses. It consists of sensations, the formation of an image, its addition to representation and imagination.
Sensation is a kind of mental activity that, arising from the direct impact of objects and phenomena of the surrounding world on our sense organs, reflects only individual properties of these objects and phenomena.
Representation is the result of the revival of images or phenomena perceived earlier, in the past.
Clinical manifestations.
Hyperesthesia is a violation of sensitivity, which is expressed in the super-strong perception of light, sound, smell. It is typical for conditions after somatic diseases, traumatic brain injury. Patients may perceive the rustling of leaves in the wind as rumbling iron, and natural light as very bright.
Hypothesia is a decrease in sensitivity to sensory stimuli. The environment is perceived as faded, dull, indistinguishable. This phenomenon is typical of depressive disorders.
Anesthesia - the loss of most often tactile sensitivity, or a functional loss of the ability to perceive taste, smell, individual objects, is typical for dissociative (hysterical) disorders.
Paresthesia - a sensation of tingling, burning, crawling. Usually in zones corresponding to the zones of Zakharyin - Ged. Typical for somatoform mental disorders and somatic diseases. Paresthesias are due to the peculiarities of blood supply and innervation, which differ from senestopathies.
Senestopathy - unpleasantly experienced sensations of varying intensity and duration from the internal organs in the absence of an established somatic pathology. They, like paresthesia, are difficult to verbalize by patients, and when describing them, the latter most often use comparisons. For example: as if the intestines are moving, air is blowing through the brain, the liver has increased in size and presses on the bladder, etc.
The main perceptual disturbances are illusions and hallucinations. Patients may be reluctant to talk about these phenomena or hide them.
Indirect signs of perceptual disorders are:
- - a person's conversation with himself (alone or in the presence of others),
- - unreasonable and sudden change in attitude towards others,
- - the emergence of new words (neologisms) in speech,
- - mimic grimaces,
- - tendency to solitude, change of mood,
- - contraction of masticatory muscles and sternocleidomastoid muscles,
- - tension of the orbital region with a half-open mouth,
- - a sudden glance to the side when talking,
- - dissociation of facial expressions, posture and gesture,
- - non-purposeful unexpected gestures with relatively motionless facial expressions.
Illusions are an erroneous perception of real-life objects and phenomena.
The main characteristics of illusions are:
- - the presence of an object or phenomenon that is subject to distortion, for example, a visual, auditory or other sensory image,
- - the sensory nature of the phenomenon, that is, its connection with a specific modality of perception,
- - a distorted assessment of the object,
- - assessment of the distorted sensation as real,
Psychopathological illusions include:
- · Illusions affective (i. affectivae) - illusions that arise under the influence of fear, anxiety. An anxious and suspicious person walking at a late time hears the steps of the pursuer behind him.
- · Verbal illusions (i. verbales) - auditory illusions, the content of which are individual words or phrases.
- Illusions of pareidolims (i. pareidolicae; pair + Greek eidflon image) - visual illusions of fantastic content, usually arising on the basis of a wallpaper or carpet pattern, cracks and spots on the ceiling and walls, etc. Unfold on a plane, for example, when looking at the pattern of wallpaper on the wall, the patient sees changeable, fantastic landscapes, faces of people, unusual animals, etc. The basis of illusory images are the details of the actual drawing. Often occur in the initial period of alcoholic delirium.
Hallucinations are the perception of an object or sensory image that occurs without the presence of a real object, but is accompanied by the belief that this object exists. The term "hallucination" was introduced for the first time by J.-E.D. Esquirol in 1838.
True hallucinations:
Endowed with all the properties of real objects (corporality, weight, bright sound).
They are projected into the real space directly surrounding the patient.
There is confidence in the natural way of obtaining information about imaginary objects and phenomena through analyzers.
The patient is sure that everyone around perceives the same objects in exactly the same way as he does.
The patient treats imaginary objects as if they were real: he tries to pick them up, runs away from pursuers, attacks enemies.
Pseudo-hallucinations:
Deprived of sensual liveliness, natural timbre, incorporeal, transparent, non-voluminous.
They are projected into an imaginary space, come either from the patient's body or from areas inaccessible to his analyzers, do not come into contact with objects of the real situation.
They can give the impression of being forcibly evoked, made, put into the head with the help of special devices or psychological influence.
The patient believes that the images are transmitted to him on purpose and are inaccessible to the senses of others.
The patient cannot run away from hallucinations, because he is sure that they will reach him at any distance, but sometimes he tries to "shield" his body from exposure.
They are perceived as an attempt of mental violence, the desire to enslave the will, to force them to act against desires, to drive them crazy.
They often occur in chronic psychoses, are quite resistant to therapy, do not depend on the time of day, and may disappear completely at night during sleep.
Hallucinations are classified:
- 1. by sense organs:
- Auditory (imperative, threatening, commenting, antagonistic)
- Visual (photopsies, zoopsies; autoscopic, extracampal, hypnagogic, hypnopompic)
- Tactile (thermal, haptic, hygric)
- Taste
- Olfactory (imaginary perception of unpleasant odors)
- Visceral, general feeling (presence in the body of some objects, animals)
- 2. by degree of difficulty:
- Elementary (acoasma, photopsia)
- Simple (associated with 1 analyzer)
- Complex (deceptions by several analyzers at once)
- Scene-like
Functional hallucinations - occur against the background of a real stimulus acting on the senses, and only during its action.
Suggested and induced hallucinations:
Lipman's symptom - causing visual hallucinations by lightly pressing on the patient's eyeballs.
Symptom of a blank sheet (Reichardt) - the patient is invited to carefully examine a blank sheet of white paper and tell what he sees there.
Aschaffenburg's symptom - the patient is offered to talk on the switched off phone, readiness for the occurrence of auditory hallucinations is checked.
Clinical example:
Patient S., aged 32, suffered from psychosis with severe perceptual disturbances in the form of illusions and hallucinations. This patient, who had been abusing alcohol for a long time, fell into insomnia during a train ride, began to experience fear and severe anxiety. On the third day of such a state, I heard how the wheels of the car “began to clearly pronounce”: “Be afraid, be afraid,” and after some time, and in the noise of the fan in the roof of the car, I began to distinguish the words: “do not expect mercy.” By the evening of the same day, he began to see how the cobweb was flying around the compartment, felt how it landed on his face and hands, felt its unpleasant, sticky touch.
In the middle of the night, I suddenly distinctly heard how several male voices were talking behind the wall about how to destroy it, but they could not come to an agreement on what would be better to use for this - a knife or a rope. I realized that intruders had gathered in the next compartment, who would now kill him. In great fear, he ran out into the vestibule and at the very first stop, jumped out of the car. I calmed down for a while, then suddenly I saw that the lantern on the pole was not a lantern, but some kind of searchlight or “electronic gas”.
Psychosensory disorders are sometimes considered intermediate between disorders of consciousness and perception. These include experiences of depersonalization and derealization, as well as special syndromes described in the corresponding section.
Depersonalization is expressed in the following symptoms:
Mental:
- - changes in the "I", peculiar sensations of transformation, often negative, of one's own personality, accompanied by the fear of going crazy, experiencing one's own uselessness, the emptiness of the meaning of life and the loss of desires. This condition is characteristic of affective disorders and some neuroses.
- -- the splitting of the "I", typical for schizophrenia and dissociative disorders, is expressed in the feeling of having two or more personalities, each of which has its own intentions, desires.
- - Alienation of one's own "I".
Physical:
A change in the body scheme is expressed in an abnormal perception of the length of the limbs, shortening or stretching of the arms and legs, changes in the shape of the face and head. A condition observed as a result of organic disorders.
Derealization is expressed in a change:
- - colors, for example, during depressions, the world may seem gray or with a predominance of blue tones, which is especially noticeable in the work of artists such as E. Munch, who during periods of depression used mainly black, blue and green colors. The predominance of bright colors in the environment is noted by patients with manic states. The perception of red and yellow tones or fire is typical of twilight epileptic conditions.
- - shapes and sizes: the environment can increase or decrease (Alice in Wonderland syndrome), approach and recede, constantly transform. The patient can perceive the right side as the left and vice versa (Alice in the Looking Glass syndrome). Conditions of this kind are characteristic of intoxication with psychoactive substances and organic brain lesions.
- - pace and time: the environment may seem to change extremely rapidly, like frames of an old movie (cinema syndrome), or, on the contrary, it seems drawn out. In some cases, it seems that the months run like moments, in others - there is no end to the night. Patients may report that they notice the same stereotypically repeated plot. All of these experiences are associated with emotionality, for example, in a good mood, it seems that time flows faster, and in a bad mood - more slowly.
Thus, the following syndromes can be distinguished
Hallucinosis is a condition characterized by an abundance of hallucinations within one analyzer and not accompanied by confusion, lasting from 1-2 weeks (acute hallucinosis), up to 6 months (subacute), up to several years (chronic hallucinosis).
The patient is anxious, restless or, conversely, inhibited. The severity of the condition is reflected in the behavior and attitude of the patient to hallucinations. By severity, acute and chronic hallucinosis are distinguished, and by content - auditory, tactile, visual.
Auditory hallucinosis is usually verbal: voices are heard talking among themselves, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis is determined by the clinical picture of the alcoholic psychosis of the same name; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain.
Patients with tactile hallucinosis feel the crawling of insects, worms, microbes on the skin and under the skin, touching the genitals; criticism of what is experienced is usually absent. It is noted in psychoses of late age, with organic damage to the central nervous system. Visual hallucinosis - a common form of hallucinosis in the elderly and people who have suddenly lost their sight, it also happens with somatogenic, vascular, intoxication and infectious psychoses. With the hallucinations of Charles Bonnet, patients suddenly begin to see bright landscapes on the wall, in the room, sunlit lawns, flower beds, playing children, they are surprised at this, although the awareness of the pain of experiences and the understanding that vision is impossible due to loss of vision remain intact.
Usually, with hallucinosis, the patient's orientation in place, time and his own personality is not disturbed, there is no amnesia of painful experiences, i.e. there are no signs of confusion. However, in acute hallucinosis with life-threatening content, the level of anxiety rises sharply, and in these cases consciousness can be affectively narrowed.
Hallucinatory syndrome - an influx of profuse hallucinations from different analyzers (verbal, visual, tactile) against the background of a clear consciousness. May be accompanied by affective disorders (anxiety, fear), as well as delusional ideas. Hallucinatory syndrome can occur in schizophrenia, epilepsy, organic brain lesions, including syphilitic etiology.
The Kandinsky-Clerambault syndrome is a special case of the hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - mental automatisms and delusions of influence. Mental automatisms - alienation to the patient of his own mental acts, the feeling that some processes in his psyche occur automatically, against his will. There are 3 types of automatism:
- Ideatory (thinking) - a feeling of insertion and withdrawal of thoughts, outside interference in their course, a symptom of "openness of thoughts", breaks (sperrung) and influxes of thoughts (mentism).
- · Sensory (sensual) - a state in which many unpleasant sensations in the body seem to be “made”, specially caused.
- Motor (motor) - the feeling that the patient's movements are made against his will, caused by influence from the side, "puppet movements".
The presence of all 3 variants of automatism - mental panautomatism.
Clinical example: The patient reports that for several years now he has been under the constant influence of some kind of apparatus that directs "rays of atomic energy" at him. He understands that the influence comes from some scientists setting up an experiment. "They chose me because I always had good health." The experimenters "take away his thoughts", "show some images" that he sees inside his head, while in his head "a voice sounds" - "also their work." Suddenly, during a conversation, the patient begins to grimace, twist his mouth, twitch his cheek. When asked why he does this, he replies: “It’s not me at all, but they burn with rays, direct them to different organs and tissues.”
It is also possible to develop the so-called inverse version of the Kandinsky-Clerambault syndrome, the essence of which is that the patient himself supposedly has the ability to influence others, recognize their thoughts, influence their mood, feelings, actions. These phenomena are usually combined with ideas of overestimation of one's personality or delusional ideas of grandeur and are observed in the picture of paraphrenia.
Perception - the mental process of reflecting an object or phenomenon as a whole, in the aggregate of its properties and parts.
In some pathological conditions, especially in mental and nervous diseases, perceptual processes may be disturbed. However, there are also such deviations of perception that can be observed in quite healthy people (for example, illusions). Perceptual disorders can be conditionally divided into three main groups: illusions, hallucinations, and sensory synthesis disorders (psychosensory disorders).
Illusions. An illusion is a distorted perception of a real-life object or phenomenon. Illusions are classified according to the sense organs - visual, auditory, tactile and others. Depending on the main causes underlying the distortion of perception, all illusions can also be divided into physical, physiological and mental.
physical illusions are explained by objective physical laws and do not depend on the person himself. An example of a physical illusion that is also captured by a camera is the perception of a spoon in a glass of water. The spoon seems to be broken due to the different light-refracting properties of water and air.
Physiological illusions find their explanation in the features of the structure and activity of our sense organs. For example, try to press on the eyeball from the side, and immediately the object we are looking at will split in two. Bifurcation of an object occurs due to an increase in the disparity of its image on the retinas of the eyes. Another example of this type of illusion is found in Aristotle: cross two fingers and start rolling a small ball between them, and it will appear double. When an object first comes into contact with the index finger and then with the middle finger, both contacts occur at different points in space familiar to us. Touching the index finger seems to be higher, although the finger is actually lower; touching the middle is lower, although the finger is actually higher. There are many such illusions on the part of the vestibular apparatus - illusions of rolls, counter-rotations, and others.
Psychic illusions are associated both with various mental states of a person, and with some psychological features of our perception.
In diseases, mental illusions are observed most often in states of disturbed consciousness, with excitement (exaltation, ecstasy) in manic patients, or states of fear and anxiety in depression. Their illusions are almost not corrected, and the patient is inclined to consider these errors of perception as a reality. Verbal illusions, when the patient hears abuse, threats and insults instead of neutral speech, often occur in the early stages of the formation of auditory verbal (speech) hallucinations in some psychoses. They differ from the so-called functional auditory hallucinations by the fact that during illusions a pathologically arisen image absorbs the image of a real object (the patient "hears instead of ..."), with hallucinations - the pathological image does not merge with the real one ("hears along with ...").
In healthy people, against the background of various mental states (expectation, anxiety or fear), mental illusions also often arise. For example, when entering a room, a child will be frightened by a figure at the window, but after that he will laugh, as he will see that he was frightened by a coat and a hat hanging on a hanger. And if in every tree standing by the road we see the person we are waiting for, then we are also talking about mental illusions.
In order for the process of interpreting sensory information to reach the level of consciousness, special techniques are needed, and some of them have already been mentioned earlier (image simplification, grouping principles, contrasts, and others). Illusions are often caused by the ambiguity of perception that arises due to a lack of essential information or an excess of irrelevant information in the image. The ambiguity of perception also arises in cases where several significant images can be extracted from the same image.
In the experiment, illusions are used to study various aspects of the organization of the properties of the analyzer system. Visual illusions were often used to feed ambiguous sensory information to the input of the visual system in order to identify the errors that the system makes and thereby reveal some of its hidden properties. Numerous facts and conditions of errors in perception are described - the illusion of an "arrow", railway tracks, overestimation of vertical lines, intersections, concentric circles, "impossible figures" and others.
hallucinations. Hallucinations are disorders of perception, when a person, due to mental disorders, sees, hears, feels something that does not exist in reality. It is a perception which is said not to be based on an external object, otherwise it is an "imaginary, false perception".
We can observe hallucinations in mental illnesses, as well as in healthy people in experiments with sensory isolation or with the use of certain drugs (hallucinogens); hallucinations can also be suggested to a person in deep hypnotic sleep.
Hallucinations are usually classified according to the sense organs: visual, auditory, olfactory, and others. Great importance in psychiatric diagnosis is given to the division of hallucinations into true and false (pseudohallucinations).
true hallucinations characterized by sensual clarity, they unfold in real spatial or another analyzer and "patients not only think they see and hear, but actually see and hear" (E. Krepelin, 1909). The behavior of patients usually corresponds to the content of hallucinatory experiences, and they are convinced that the people around them see and hear the same thing as they do.
Pseudo-hallucinations differ from true hallucinations in that they do not have complete sensual-bodily clarity of images, and this brings them closer to ideas. Patients talk about what they see and hear, adding "as if", although they insist on the reality of their hallucinations. The pseudo-hallucinatory image unfolds in the imagined, or rather - intrapsychic (subjective) space this or that analyzer, so patients can report the ability to "see" beyond the horizon line or through opaque barriers, and also report sounds and human voices that occur "inside the head". Since false hallucinations are perceived as something subjective and very different from real images, the behavior of patients is almost always dissociated from the content of hallucinations. Pseudohallucinations indicate a more unfavorable course of a mental illness, often become protracted and chronic, and are accompanied by impaired thinking.
In healthy people, against the background of fatigue or exhaustion, sometimes when falling asleep, visual or auditory hallucinations similar to pseudohallucinations, which are called hypnogogic due to their proximity to dreams (hypnopompic- the same, but are noted at the moment of awakening).
Visual and auditory hallucinations are often divided into simple(photopsia - perception of flashes of light, stars, sparks; acoasma - perception of sounds, noise, cod, whistle, crying) and complex(verbal - perception of articulate speech).
At reflex hallucinations the perceived real image is immediately accompanied by the appearance of a hallucinatory image similar to it (the patient hears a phrase - and immediately a phrase similar to it begins to sound in his head).
Apperceptive hallucinations(auditory or visual) appear after the corresponding volitional effort of the patient who wants to experience them.
Hallucinations of Charles Bonnet(visual, less often auditory) are observed when the peripheral part of the analyzer is damaged (in the blind, deaf), as well as during sensory deprivation or isolation (in prison, in a foreign language environment) in the field of the affected or information-limited analyzer. They should be distinguished from hemianoptic hallucinations in the field of hemianopsia with damage to the cortical end of the analyzer (tumor, trauma, vascular lesion).
Hallucinations that occur as a result of mental trauma are called psychogenic. They are divided into the following varieties:
dominant(auditory and visual) with psychologically understandable content, reflecting mental trauma, and emotionally saturated;
eidetic(usually auditory), which tend to be cliché-like (for example, the constant hallucinatory playback of funeral music and sobs at funerals);
hallucinations of Dupree's imagination, where the plot follows from hysterical dreams and fantasies;
induced hallucinations arise by the type of mutual suggestion and self-hypnosis against the background of emotional stress;
suggested hallucinations often occur with alcoholic delirium during the "lucid window" (daytime clarification of consciousness): Reichardt's symptom (suggested reading on a blank sheet of paper), Aschaffenburg's symptom (suggested imaginary conversation on a switched off phone), Lipmann's symptom (suggested visual hallucinations after ten seconds of pressure on the eye apples), etc.
Sensory synthesis disorders. Perception is a complex process of integration, synthesis of the image of a perceived object from sensory signals coming through the senses from the external environment and one's own body. In some conditions and diseases, we encounter various violations of the synthesis process, the integration of sensory information in the course of perception. Usually psychosensory disorders include two groups of disorders - derealization and "body schema" disorders.
Derealization - violation of sensory synthesis of information that comes from the outside world. From the association of sensory signals that take part in the formation of the image of external reality, something can "fall out", change, and ultimately the world around us loses its sensory reality - it is distorted.
A person can lose the perception of the depth of space, and then everything around him is seen in a flat, two-dimensional image. Distortions of perception may also concern certain features of an object - shape (metamorphopsia), size (increase - macropsia, decrease - micropsia) or others. With porropsy, the distance estimate is violated - it seems to a person that objects are further away than they are in reality; in dysmegalopsia, the perceptual disturbance concerns elongation, expansion, obliqueness, or twisting around the axis of surrounding objects.
Disorders close to derealization are when the usual, familiar environment is perceived as completely new (phenomenon "never seen" jamais vu), or, conversely, a new environment (area, street, house) is perceived as well known and well-known (phenomenon "already seen" - deja vu). Patients are especially concerned about the distortion of time - its slowdown (bradychronia) or acceleration (tachychronia), as well as the loss of the emotional components of the perception of the environment - "everything is frozen, glassy", and "the world has become like a scenery." Patients almost always retain a critical attitude towards these disorders, they are alien to the personality and subjectively extremely unpleasant.
Body schema disorders characterized by various symptoms of disturbances in the perception of one's own body, peculiar sensations of an increase or decrease in weight, the size of the whole body or its parts (arms, legs, head). Occur when the sensory systems of the upper parietal region of the cerebral cortex are damaged. Body schema disorders also include disturbances in the perception of the relationship between body parts: patients talk about the wrong position of the ears, "twisting" of the body. The patient feels these changes only with his eyes closed, since under the control of vision all misconceptions about his body disappear.
agnosia – non-recognition of the visible or audible with the complete preservation of the elementary functions of perception, which occurs with focal lesions of the brain .
Visual agnosia arise with local lesions of various parts of the visual cortex (mainly secondary and tertiary fields) and are related to violations of the higher organization of visual processes. In this case, the patient does not recognize objects by their visual images. There are six main types of visual gnosis disorders: object, facial, optical-spatial, letter, color and simultaneous agnosia.
Object agnosia is a left hemispheric symptom, but in a more rough form it is associated with a bilateral lesion of the lower part of the "wide visual sphere". With gross impairment of recognition, patients do not stumble upon objects, but constantly feel them and navigate by sounds.
Facial agnosia is associated with damage to the lower-posterior parts of the "broad visual sphere" of the right hemisphere (in right-handers). At the same time, the patient does not distinguish between human faces and recognizes even close people only by voice. The degree of severity can be different: from impaired memory of faces in special experimental tasks to not recognizing relatives and even oneself in the mirror.
Opto-spatial agnosia - associated with a bilateral lesion of the upper part of the "wide visual sphere". In this case, the patient is poorly oriented in the spatial features of the object (left-right orientation suffers especially). If the right hemisphere predominantly suffers, then the pattern is disturbed to a greater extent in patients (they cannot depict further-closer, more-less, left-right, top-bottom in the drawing), and the “posture praxis” is also disturbed - the patient cannot copy the pose (Head's test), and this is associated with difficulties in everyday motor acts (for example, dressing apraxia). The combination of visuo-spatial and movement disorders is called apractoagnosia. Optical-spatial agnosia can impair reading skills, as there are difficulties in reading letters with left-right signs (E-E).
Letter (symbolic) agnosia - occurs with a unilateral lesion of the lower part of the "wide visual sphere" on the border of the occipital and temporal cortex of the left hemisphere (in right-handers). In this case, the patient correctly copies the letters, but cannot read them. The breakdown of the reading skill in this case is called primary alexia.
Color agnosia - possible with damage to the 17th and other fields of the visual cortex, especially the right hemisphere. At the same time, the patient distinguishes colors (there is no color blindness as such, distinguishes colors on cards), but does not know which objects are painted in a given color, cannot remember the colors of even well-known real objects, cannot select the same colors and shades. Thus, in patients with color agnosia, the categorization of color sensations is difficult.
Simultaneous agnosia (eng. Simultaneous - “simultaneous”) was first described by P. Balint (1909) and occurs with bilateral or right-sided lesions of the occipito-parietal cortex. At the same time, a patient with intact visual fields finds it difficult to perceive the image as a whole and sees only its individual fragments, since he cannot shift his gaze and examine the entire image sequentially. It is especially difficult for him to perceive two images in one drawing at the same time.
auditory agnosia - violation of the musical abilities that the patient had in the past - is divided into motor amuseia, in which the ability to reproduce familiar melodies is primarily impaired, and sensory amuseia, characterized by impaired recognition of familiar melodies. In addition, a patient with auditory agnosia may not identify the voices of animals and birds, and may not distinguish between various noises familiar to him.
At tactile agnosia (astereognosis) the ability to recognize presented objects by touch is lost in the absence of distinct defects in elementary types of sensitivity (superficial and deep). Disorders are observed with local lesions of the sensory zones of the lower parietal region of the cerebral cortex. The following disorders are distinguished:
tactile object agnosia, manifested by a violation of recognition by touch with closed eyes of the size and shape of an object and the definition of its functional purpose;
tactile texture agnosia the object is characterized by the inability to determine by feeling the quality of the material, the surface features of the object and its density;
finger agnosia - the patient does not recognize the fingers of his hand with his eyes closed when touched
test questions
List the 3 main types of perceptual impairments.
Describe the difference between an illusion and a hallucination.
What are the characteristics of pseudo hallucinations.
What types of sensory synthesis disorder do you know?
What types of brain damage are associated with different types of agnosia?
The human body is an amazing combination of many organs, tissues, functions, chemical reactions, electrical impulses that allow a person to live, learn and learn about the world around him. Cognition occurs with the help of influences on the human senses - light, sound, taste, smell, tactile and spatial perceptions. All this is the basis of knowledge and existence of a person in the world around him. And perceptual disturbances, whatever they may be and for whatever reasons, are a serious problem.
Perception: reality plus imagination
In the fact that a person can perceive the world around him, the sense organs and imagination are involved. Those knowledge that is obtained with the help of vision, hearing, taste, tactile impact, smell and determining the position of the body in space, are processed by special parts of the brain and, with the help of imagination and previous experience, become ideas about the world around. Disorders of perception in any area do not allow a person to get a complete picture.
far and near
And the perceptions of the received data are closely interconnected. Receptors that receive information about the surrounding reality transmit nerve impulses to the brain, where the analysis and processing of the received information takes place and a response occurs in the form of an idea of an object or phenomenon that affects the receptors. Moreover, some of the receptors should receive such an impact during direct contact with the object, and some - through space. So, for example, taste sensations arise when food enters the oral cavity and on the tongue. But vision allows you to see objects at a distance. The perception of the received information through various sense organs and receptors is the main mechanism of human cognition of the world. Perceptual disorders are a complex physiological and psychological problem.
Sense organs and receptors
In addition to the six sense organs known to everyone from school, the human body perceives much more stimuli. So, there are receptors responsible for the perception of heat - cold, pain, as well as the sensations of your body. So science distinguishes not six, but 9 types of sensations:
- vision;
- hearing;
- smell;
- touch;
- equiprioception - a sense of balance;
- taste;
- nociception - perception of pain;
- thermoception - feeling of warmth;
- proprioception - the spatial sensation of one's body.
Receiving information about the world around us with the help of various receptors, the brain processes them into perceptions of the surrounding reality.
Perceptions and medical practice
If any disturbances occur in the human body, a big problem can arise - perception disorders. Psychiatry, as a scientific and practical field of medicine, studies these disorders and, to the extent possible, helps to correct them. Psychiatrists have been studying perceptual disorders for centuries, helping not only the patients themselves, but also the people around them, to live with such problems. Violations of the work of one or more sense organs are not always disorders of a complex analysis of the surrounding world. A person who has lost his sight knows how objects and colors look in reality, and with the help of the work of other senses, he can present a real picture of the world around him. In psychiatry, disorders of the perception process are a whole complex of disorders caused not so much by problems in the work of receptors, but by changes in the processes of processing the information received and obtaining the final result.
How do perceptual disturbances manifest themselves?
The field of psychiatry is a special field of medicine that studies various mental disorders and their manifestations. This is a very specific area of human knowledge, which operates with the concepts of "disease", "health", "norm" and "pathology" in relation to the mental state. One of the areas of work of a psychiatrist is perceptual disorders. Psychiatry considers such problems to be mental pathologies. Disorders of sensation and perception are manifested by several conditions:
- Anesthesia is manifested by the inability to perceive tactile sensations, taste and smell. In its manifestations, it is similar to medical anesthesia, which is called to turn off the sensitivity of pain receptors in patients during medical interventions.
- Hyperesthesia is a disorder of sensitivity caused by an apparent increase in smell, light, sound. Very often, hyperesthesia manifests itself in patients who have suffered a traumatic brain injury.
- Hypothesia is the opposite of hyperesthesia, a change in sensitivity. Sensory perception reduces natural stimuli. Patients with depressive disorders suffer from hypoesthesia, to whom the world seems dull, boring.
- Paresthesias are expressed in sensations of itching, burning, tingling, "goosebumps" due to impaired blood supply and innervation. Often, paresthesias occur in the Zakharyin-Ged zones: problems of internal organs manifest themselves in the form of unpleasant, painful sensations in certain areas of the surface of the human body.
- Senestopathies are unpleasant sensations that occur inside the human body, they are difficult to describe in words, most often the patient uses vivid comparative images to talk about these sensations.
"Wrong" sensations sometimes coincide with the clinical manifestations of some disease, and not only from psychiatric practice. Competent or condition - this is the basis of quality treatment.
Major Perceptual Disorders
Psychiatry as a field of clinical medicine operates with the concepts of methodology, diagnosis, treatment and prevention. To make a diagnosis, it is necessary to clearly know the manifestations of the disease, this is helped by clinical tests, history taking, laboratory and instrumental studies. Categorical judgments allow correctly interpreting the data obtained in order to make an adequate diagnosis. To refer to certain mental health problems in psychiatry, two main categories of perceptual disorder are distinguished:
- illusions;
- hallucinations.
Both concepts cause quite negative feelings in most people, but the patient himself has no power over them, although in many cases such disorders occur due to conditions in which a person drives himself, for example, drug or alcohol poisoning. Some types of perceptual disorders can occur in perfectly healthy people in terms of psychiatry.
Blue Caterpillar from Wonderland
"What you see, but what is not really" - that's it, a hallucination. Problems in the perception of reality as it really is are manifested by the appearance of pseudo-real images. Psychiatry, studying perceptual disorders, defines hallucinations as an image that has appeared in the mind and is defined as really existing, but without an external stimulus that affects human receptors. These images appear from scratch, so to speak, due to a perceptual disorder. Hallucinations by psychiatrists are divided into several varieties:
- - are vivid images, for the patient having certain shapes, color, smell, emitting specific sounds. True hallucinations are perceived by the patient as a manifestation of reality through his senses, he tries to manipulate them, as if the phenomena or objects he sees exist in reality. In addition, according to the patient experiencing true hallucinations, all the people around him should perceive them in exactly the same way as he does.
- Pseudo-hallucinations are perceived by the patient as something unnatural, but really existing, it is devoid of brightness, often incorporeal, it can occur either from the body of the patient himself, or from areas that are not subject to his receptors. Often, false hallucinations are considered by the patient to be forcibly inserted into his body with the help of special devices, apparatus, machines, or because of the mental impact exerted on him.
In addition to these two types of hallucinations, they are also divided according to the sense organs with which they can be caused:
- visceral;
- taste;
- visual;
- olfactory;
- auditory;
- tactile.
Each such type of hallucination has its own scientific definition and can be decomposed into several subspecies, which is important for clinical psychiatry.
By the way, hallucinations can be inspired and caused. One of the methods of psychiatry uses the Aschaffenburg symptom, when the patient is allowed to listen to a previously turned off telephone, thus checking his readiness for auditory hallucinations. Or the symptom of Reichardt is a symptom of a blank slate: the patient is given a completely white sheet of paper and is invited to talk about what is depicted on it. Hallucinations can also be functional, arising against the background of irritation of certain receptors and disappearing after the removal of the stimulus. By the way, the image of the Blue Caterpillar smoking a hookah on a mushroom cap from Lewis Carroll's fairy tale "Alice in Wonderland" is regarded by many as a classic hallucination.
Such a beautiful illusion
In psychiatry, another type of perceptual disorder stands out - illusions. Everyone is familiar with this concept, even those who do not suffer from psychiatric perception disorders. People often use the expression "beautiful illusion, terrible illusion". So what is it? The scientific definition of one type of perceptual disorder sounds like an incorrect, erroneous perception of objects that exist in reality. Deception of the senses - that's what an illusion is. For example, an illusion can occur when the level of stimulus is insufficient - in the dark it is very easy to mistake the outline of a bush for a human figure. So the emergence of illusions is not always the area of psychiatry. The hallmarks of an illusion are:
- an object or phenomenon subject to sensory distortion: a figure, voice, tactile or spatial sensation;
- distortion, misperception and evaluation of a real object;
- the illusion is based on sensory perception, that is, the human receptors are actually affected, but it is perceived somewhat differently than it actually is;
- the feeling of the false as real.
Disorder of visual perception is one of the frequent illusions of healthy people. Moreover, such an error can be physical or physiological in nature. The physical nature of illusions has nothing to do with psychiatry; the same mirage in the desert has a rationale, albeit not too simple, but proven by the exact science of physics. Clinical psychiatry considers psychopathological illusions:
- affective, arising against the background of fear or nervous excitability about imminent danger;
- verbal, that is, verbal, illusions - individual words or phrases that are heard by a person;
- pareidolic illusions - visual illusions that arise against the background of a real image by conjecturing images, for example, a drawing on a wallpaper can become an illusion of the frightening content of a picture; most often, such illusions are observed in creative personalities, for example, scientists have found that Leonardo da Vinci suffered from pareidolia.
The basis of illusions is a disorder of perceptions and ideas about the world around. They are not always pathological. Often they are caused by a distortion of perception against the background of an incorrect assessment of the work of receptors.
Thinking and memory in perceptual disorders
What distinguishes Homo sapiens from all other living beings? The ability to think. Thinking is the main cognitive process that combines the world around a person into a logical picture. Thinking is inextricably linked with perception and memory. All the processes that characterize man as a rational being have changed, developed and transformed for thousands of years. And if for a start it was only necessary to apply physical force in order to satisfy their natural needs (food, reproduction and self-preservation), then over time a person learned to build logical chains - to think in order to get the necessary result with less physical effort and harm to one's health and life. To consolidate the favorable result obtained, memory began to develop - short-term, long-term, as well as other mental functions characteristic of people - imagination, the ability to see the future, self-awareness. Symbiosis of disorders of perception and thinking - psychosensory disorders. In psychiatry, these disorders are divided into two main types:
- depersonalization can also be manifested by incorrect sensations of one's body, the so-called mental depersonalization, and distorted concepts of one's own "I" - mental depersonalization;
- derealization is manifested in a distorted perception of the surrounding world - space, time, dimensions, forms of the surrounding reality are perceived by the patient as distorted, although he is absolutely sure that his vision is correct.
Thinking is a feature of a person. Reasonable thinking is subjected to refutation with perceptual disturbances. Psychiatry, as a field of clinical medicine, seeks to find ways to resolve the controversy caused by perceptual disturbances in mental patients. With disorders of perception, patients also show a disorder of thinking - delusions, obsessions, or which become the meaning of the life of such a person.
Psychiatry is a complex science of human mental illness, the area of \u200b\u200bwhich includes disorders of perception, memory, and thinking, as well as other mental functions. Moreover, any problems with mental health are most often associated with a whole range of mental functions - from the work of the senses to short-term or long-term memory.
Why is the perception of reality disturbed?
When faced with problems of a psychiatric nature, the question arises: what are the causes of perceptual disorders? There can be a whole complex of them: from alcohol and drug poisoning to a pathological state of the human psyche. Mental illnesses are quite difficult to diagnose, often due to the fact that a person cannot accurately describe his feelings, events that have happened or are happening to him, and the initial stages of the disease are not always noticeable to others. Perception disorders can develop as a result of any diseases of the internal organs or systems, as well as due to a violation of the processing of the received information, its analysis and obtaining a specific result. Psychiatric practice at the moment cannot absolutely accurately determine the causes of the development of a perceptual disorder, except for intoxications, when the pathology mechanism is precisely determined by a poisonous substance. Disturbances in the perception of reality can and should cause alertness among people around, since often the patients themselves are in no hurry to turn to specialists, not considering these violations to be something pathological. A timely identified problem with the perception of the surrounding reality can help the patient avoid serious problems. Distorted reality is a huge problem both for the patient and for the people around him, both mentally and physically.
Childhood Fantasies and Perceptual Disorders
Child psychiatry and psychology is a special kind of medicine. Children are great dreamers and inventors, and the increased reactivity of the child's psyche and little life experience do not give the child the opportunity to independently correct false sensations in time. That is why perceptual disorders in children are a special area of pedagogy, psychology and psychiatry. Visual and auditory illusions are one of the components of the childhood of every person. A scary tale told at night becomes a real nightmare for the baby, hiding under the bed or in the closet. Most often, such disorders occur in the evening, the child's fatigue and drowsiness affect. Terrible tales and stories, especially told to the baby at night, can become the basis for the development of a neurotic state. Hallucinations occur in children most often against the background of somatic and infectious diseases as a result of an increase in body temperature. The age of the most frequent manifestation of such disorders is 5-7 years. Hallucinations of this nature are elementary - sparks, contours or images of people, animals, and from the sounds children hear shouts, knocking, voices of birds or animals. All these visions are perceived by the child as a fairy tale.
Children of all ages can also suffer from manifestations of schizophrenia. In this case, all hallucinations acquire a complex, often sinister character. The plot of hallucinations is complex, often carrying a danger to the health or even the life of the baby. For children of older adolescence, and this is 12-14 years old, the development of taste and tactile hallucinations is characteristic, the child begins to refuse previously favorite food, his character and behavior change.
Pediatrics and child psychiatry distinguishes children with congenital disorders of perception into a special group. In these cases, the child grows and learns to compensate for the lack of some sensations by enhancing the development of other sensory abilities. A classic example - a child with congenital hearing loss has excellent vision, notices the smallest details, pays more attention to minor details of the surrounding reality.
Perception is the basis of knowledge of the surrounding world in all its manifestations. In order to feel, a person is given six sense organs and nine varieties of receptors. But in addition to sensations, the information received must be transmitted to the appropriate parts of the brain, where it must go through the process of processing and analysis, drawing up a general picture of reality based on a complex of sensations and life experience. The result of perception is a picture of the surrounding reality. Violations in at least one link in the chain of obtaining a picture of the world lead to a distortion of reality. Psychiatry as a field of clinical medicine studies the causes of occurrence, stages of development, signs and symptoms, methods of treatment and prevention of perceptual disorders of both individual phenomena and components of general human health problems.
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