Receptor disorders include the most elementary symptoms of mental illness :

1) hyperesthesia - increased susceptibility to external irritations that are neutrally perceived by a person in a normal state; then the light seems too bright, the sounds are deafeningly loud, the touches are rough, although in fact the intensity of the stimulus does not exceed the usual thresholds familiar to the body, hypoesthesia, when sensitivity, on the contrary, decreases, objects seem shapeless, dull, sounds lose their intonation;

2) senestopathies - unpleasant, painful vague sensations emanating from various parts body - burning, tickling, tightening, pressure that has no real reason;

3) metamorphopsia - a change in the perception of the size and shape of objects and space, for example, the ceiling in a room seems tilted, or the street looks infinitely long, the size of parts of one’s body may also change;

4) derealization is a symptom that is complex in nature, consisting in a feeling of the illusory nature of the environment, when the world is seen “as if through a net”, “as if in a dream”, the sense of reality is lost; the concepts of “already seen” and “never seen” are close to this state, when an object seen for the first time seems painfully familiar, or vice versa;

5) personified awareness - the feeling that someone is present in the room where the patient is alone, with a simultaneous feeling that this feeling is wrong;

6) disorder of time awareness (acceleration, deceleration, complete absence);

7) apperception disorder - the inability to establish connections between phenomena and understand the meaning of what is happening.

Disorders of orientation in time, in a given situation, in a place, in one’s own personality:

1) confusion (affect of bewilderment) - an unpleasant lack of understanding of one’s condition, which is recognized as unusual (in this state the patient asks, “What happened? What happened to me?”);

2) depersonalization - a disorder of awareness of one’s own personality, a feeling of alienness of one’s thoughts, feelings, actions, up to the feeling of their being “made,” artificially introduced from the outside, as a product of someone’s will, and up to the loss of self-awareness.

Perceptual disorders

Cognition- This is a person’s reflection of the surrounding external world. There is a distinction between sensual, direct cognition, which constitutes our sensations, perceptions, ideas, and abstract cognition, when the world is cognized with the help of thinking in verbally formulated concepts and judgments. At mental illness Predominant impairments of each of these types of cognition may be observed. Of various, highly variable disorders and disorders cognitive activity We will focus on the main ones, the most common in mental patients, and those that are of greatest importance in the clinic of mental illness.

A person perceives the world around him and navigates it with the help of analyzers. Irritation of analyzers by certain objects and phenomena of the external world causes the emergence of perceptions - reflections in our consciousness of the object as a whole.

Types of perception disorders:

1) illusions are distorted perceptions of really existing objects. Illusions are not always the result of painful perceptions. There are physiological illusions characteristic of mentally healthy people and determined by the laws of living and inanimate nature.

Hallucinations are false perceptions. This is perception without an object. Essentially, hallucinations are an involuntary, intensely sensory idea that is projected into the real world and acquires the properties of objective reality. Hallucinations practically do not occur in healthy people and usually indicate the presence of mental disorder;

2) true hallucinations differentiated by sense organs:

Auditory hallucinations more often occur in the form of “voices” (verbal hallucinations). The patient hears words related to his actions and thoughts. The voices either threaten, or reproach him for something, or guide his actions. He hears whispers, enters into conversation with the voices, argues with them, covers his ears with his hands, the patient’s facial expressions reflect the nature of his experiences. In some cases, hallucinations appear at the moment of falling asleep and are accompanied by fear. Of particular note are the so-called imperative (imperative) hallucinations, under the influence of which the patient can commit sudden and incomprehensible actions to others. He obeys a decisive order automatically. Auditory hallucinations are most often observed in schizophrenia and in some alcoholic psychoses.

Visual hallucinations They are less common than others, they are not as long-lasting as auditory ones, which can last for years. Visual hallucinations in alcoholics with so-called delirium tremens can be very vivid. They see animals, monsters, devils, things are transformed, one picture quickly gives way to another.

Tactile hallucinations-- unpleasant sensations arising in the skin or under the skin (tickling, crawling, pressure), correlated with certain inanimate objects (crystals, pieces of foreign bodies), or living creatures (insects, small animals, etc.), the external signs of which accurately described by patients (hard, small with long legs, etc.).

Olfactory and gustatory hallucinations are less common. At the same time, patients can feel the effects of poisonous gases, disgusting odors, as if specially released into the room. The special taste of food convinces the patient that poison has been mixed into it. In this regard, there is a refusal to eat, distrust of others, and all sorts of precautions. Olfactory hallucinations also manifest themselves in the fact that patients perceive a smell as if emanating from themselves, from which they conclude that they are decomposing alive.

Pseudohallucinations- involuntary, usually with a feeling of being done or violent, perceptions that arise without the presence of a real object, perceived as really existing, but still “special” images, introduced from the point of view of the patient by the “external influence on him” of someone’s will, like usually localized beyond the reach of the senses, for example, a visual image behind the back, inside the head.

They can be sensually bright and concrete, projected outward, although more often there is an introprojection of images (localized by patients not in objective, but in subjective space - seen or heard “mentally”, “mind”, “inner eye”, etc.) .

Unlike true hallucinations, pseudohallucinations are not identified with real objects, that is, they lack the character of objective reality. However, there is no critical attitude towards pseudohallucinations. Pseudohallucinations can be auditory, visual, olfactory, gustatory, tactile, general feeling, with all their inherent features (for example, visual pseudohallucinations can be elementary and complex, colorless and colored).

Functional hallucinations according to the mechanism of occurrence, they occupy an intermediate position between hallucinations themselves and illusions. They appear only in the presence of a real external stimulus and continue, without merging with it, separately, as long as this stimulus is active. The patient actually hears the sound of train wheels and at the same time the words “pig, pig, pig” appear; when the train stops, these words disappear.

Hypnagogic hallucinations-- visions or auditory deceptions that occur when closed eyes before falling asleep or in a drowsy state.

Hypnopompic hallucinations- visions, less often auditory deceptions that occur during the period of awakening.

The forensic psychiatric significance of perception disorders is that they disrupt the correct attitude towards the outside world and can lead to actions that pose a social danger. True, in almost all cases this is associated with a delusional interpretation of reality. Imperative hallucinations have a more independent meaning. They lead to actions devoid of any motives, even delusional ones.

6.1. Perceptual disorders

Perception is the initial stage of higher nervous activity. Thanks to perception, external and internal stimuli become facts of consciousness, reflecting individual properties of objects and events.

Stimulus? feeling? perception? performance.

Sensation is the simplest mental process, consisting in the reflection of individual properties of objects and phenomena, arising in the process of their impact on the senses.

Perception is the mental process of reflecting objects and phenomena as a whole, in the totality of their properties. Does not depend on the will of the individual.

Representation is an image of an object or phenomenon, reproduced in the mind based on past impressions. Depends on the will of the individual.

Symptoms of Perceptual Disorders

Hyperesthesia – increased sensitivity to stimuli of normal strength. Often occurs with exogenous organic lesions of the central nervous system (intoxication, trauma, infection), manic states.

Hypesthesia(hypoesthesia) – decreased sensitivity to stimuli. Often observed in disorders of consciousness, organic disorders of the central nervous system, depressive states. Anesthesia is an extreme degree of hypoesthesia. Painful mental anesthesia is a subjectively seemingly very painful weakening of any type of sensitivity due to a decrease in emotional tone ( anesthesia psychica dolorosa). Observed in depression.

Agnosia– failure to recognize the stimulus, occurs with organic lesions of the central nervous system, hysterical sensitivity disorders.

Paresthesia– subjective sensations that arise without an irritant (tingling sensation, crawling sensations, numbness, etc.). The disorders have a localization clearly limited to innervation zones. They are a symptom of a neurological disorder.

Senestopathies(illusions of general feeling) - vague, difficult to localize, unpleasant, painful bodily sensations. They have peculiar descriptions by patients (pulling, spilling, delamination, turning over, drilling, etc.). The sensations have no real basis, are “non-objective”, and do not correspond to the zones of innervation. Often found in the structure of senesto-hypochondriasis syndrome (senestopathies + ideas of an “imaginary” illness + affective disorders), with schizophrenia, depression.

Illusions– erroneous perception of real-life objects and events.

Affectogenic illusions occur with fear, anxiety, depression, ecstasy. Their occurrence is facilitated by unclear perception of the environment (poor lighting, slurred speech, noise, distance of the object). The content of illusions is associated with affective experiences. For example, when there is expressed fear for one’s life, a person hears threats in the conversation of people far away.

Physical- associated with features physical phenomena(a spoon in a glass of water seems crooked).

Pareidolic illusions– visual illusions in which patterns, cracks, tree branches, clouds are replaced by images of fantastic content. Observed in delirium, intoxication with psychomimetics.

With illusions, there is always a real object (as opposed to hallucinations) or a phenomenon of the surrounding world, which is reflected incorrectly in the patient’s consciousness. In some cases, illusions are difficult to differentiate from the patient’s delusional interpretation of the environment, in which objects and phenomena are correctly perceived, but are interpreted absurdly.

Edeitism– a sensually vivid representation of an immediately preceding sensation (especially a vivid memory).

Phantasm– sensually vivid, distinctly fantastic daydreams.

Hallucinations– a disorder of perception in the form of images and ideas that arise without a real object.

Simple hallucinatory images arise in one analyzer (for example, only visual ones).

Complex(complex) – two or more analyzers are involved in the formation of images. The content of hallucinations is connected by a common plot. For example, with alcoholic delirium, the patient “sees” the devil, “feels” his touch and “hears” speech addressed to him.

According to analyzers (by modality), the following types of hallucinations are distinguished.

Visual hallucinations. Elementary (photopsia) lack a clear form - smoke, sparks, spots, stripes. Completed - in the form individuals, objects and phenomena.

Depending on the subjective assessment of size, the following are distinguished:

1) normoptic - the hallucinatory image corresponds to the real size of objects;

2) microptic hallucinations – reduced in size (cocaineism, alcoholic delirium);

3) macroptic hallucinations – gigantic.

Types of visual hallucinations:

1) extracampal hallucinations – visual images appear outside the field of vision (from the side, from behind);

2) autoscopic hallucinations – the patient’s vision of his own double.

Visual hallucinations usually occur against a background of clouded consciousness.

Hallucinatory images can be painted in one color (with epilepsy they are often monochrome, red), they can be moving and motionless, scene-like (with oneiroid), persistent and fragmentary.

Auditory (verbal) hallucinations. Elementary (acoasms) - noise, crackling, calling by name. Phonemes are individual words and phrases. Hallucinatory experiences are most often represented in the form of voices. This may be one specific voice or several (a choir of voices).

1) imperative, or commanding, hallucinations (are an indication for hospitalization in a psychiatric hospital);

2) commentators (the imaginary interlocutor comments on the patient’s actions and thoughts); threatening, insulting;

3) antagonistic (content opposite in meaning - sometimes accusing, sometimes defending).

Tactile (tactile) hallucinations Unlike senestopathies, they are objective in nature, the patient clearly describes his sensations: “cobwebs on the face,” “insects crawling.” A characteristic symptom for some intoxications, in particular cyclodol, is the “disappearing cigarette symptom,” in which the patient clearly feels the presence of a cigarette pressed between his fingers, but when he brings his hand to his face, the cigarette disappears. For non-smokers, this may be an imaginary glass of water.

Thermal- feeling of warmth or cold.

Hygric– feeling of moisture on the surface of the body.

Haptic- a sudden sensation of touching, grabbing.

Kinesthetic hallucinations- sensation of imaginary movement.

Speech motor hallucinations– a feeling that the speech apparatus makes movements and pronounces words against the will of the patient. In fact, it is a variant of ideational and motor automatisms.

Hallucinations of general feeling(visceral, bodily, interoceptive, enteroceptive) are manifested by sensations of presence inside the body foreign objects or living beings.

For the patient, sensations have precise localization and “objectivity”. Patients clearly describe their sensations (“snakes in the head,” “nails in the stomach,” “worms in the pleural cavity”).

Taste hallucinations– a feeling of unusual taste sensations in the oral cavity, usually unpleasant, not related to food intake. They are often the reason for the patient’s refusal to eat.

Olfactory hallucinations- imaginary perception of odors emanating from objects or from own body, often of an unpleasant nature. Often coexist with taste.

They can be observed as a monosymptom (Bonner's hallucinosis - an unpleasant odor from one's own body).

It is clinically important to distinguish between true and false hallucinations.

True hallucinations– the patient perceives hallucinatory images as part of the real world, the content of hallucinations is reflected in the patient’s behavior. Patients “shake off” imaginary insects, flee from monsters, talk with imaginary interlocutors, plug their ears, which may be objective sign their availability. Extraprojection is characteristic, that is, images are projected outward or into real space within reach. The course is usually acute. Characteristic of exogenous psychoses (poisoning, trauma, infection, psychogenicity). There is no criticism of the patient's experiences.

False hallucinations (pseudohallucinations)– patients lack a sense of objective reality. The patient perceives images with the inner “I”. He clearly distinguishes between reality and a hallucinatory image. Interoprojection is characteristic, voices sound “inside the head”, images appear before the inner gaze, or the source is out of reach of the senses (voices from space, telepathic communication, astral plane, etc.). There is almost always a feeling of being done, of violence. The patient “understands” that the images are transmitted only to him. The course is usually chronic. There may be a critical attitude towards experiences, but at the height of psychosis there is no criticism. Observed in endogenous psychoses.

Hypnagogic hallucinations– most often visual hallucinations. They appear when closing the eyes at rest, often precede falling asleep, and are projected onto a dark background.

Hypnapompic hallucinations- the same thing, but upon awakening. These two types of hallucinations are often classified as types of pseudohallucinations. Among this type of hallucination, the following types of pathological ideas are observed: visual (most often), verbal, tactile and combined. These disorders are not yet a symptom of psychosis; they often indicate a prepsychotic state or occur during exacerbation of severe somatic diseases. In some cases, they require correction if they cause sleep disturbances.

Additionally, according to the characteristics of their occurrence, the following types of hallucinations are distinguished.

Functional hallucinations always auditory, appear only with a real sound stimulus. But unlike illusions, the real stimulus does not merge (is not replaced) with the pathological image, but coexists with it.

Reflex hallucinations lie in the fact that correctly perceived real images are immediately accompanied by the appearance of a hallucinatory similar to them. For example, a patient hears a real phrase - and immediately a similar phrase begins to sound in his head.

Apperceptive hallucinations appear after the patient’s volitional effort. For example, patients with schizophrenia often “cause” voices in themselves.

Hallucinations of Charles Bonnet observed when damaged peripheral part analyzer (blindness, deafness), as well as in conditions of sensory deprivation. Hallucinations always occur in the field of a damaged or informationally limited analyzer.

Psychogenic hallucinations arise under the influence mental trauma or suggestions. Their content reflects a traumatic situation or the essence of the suggestion.

Psychosensory disorders– disturbance of the perception of size, shape, relative position of objects in space and (or) size, weight of one’s own body (body diagram disorder).

Micropsia– reduction in the size of visible objects.

Macropsia– increase in the size of visible objects.

Metamorphopsia– impaired perception of space, shape and size of objects.

Poropsia– violation of the perception of space in perspective (elongated or compressed).

Polyopsia– with the formal preservation of the organ of vision, instead of one object, several are seen.

Optical allesthesia– the patient feels that objects are supposedly out of place.

Dysmegalopsia– changes in the perception of objects, in which the latter seem to be twisted around their axis.

Autometamorphopsia– distorted perception of the shape and size of one’s own body. Disorders occur in the absence of visual control.

Impaired perception of the passage of time(tachychrony is a subjective feeling of time speeding up, bradychrony is a slowing down). Often observed in depression and manic states.

Impaired perception of the sequence of temporal events.

This includes phenomena “already seen” - deja vu, “already heard” - deja entendu, “already tested” – deja vecu and “never seen” - jamais vu, “not heard” - jamais entendu, “previously not experienced” – jamais vecu. In the first case, patients in a new, unfamiliar environment have the feeling that this environment is already familiar to them. In the second, a well-known setting seems as if seen for the first time.

Psychosensory disorders occur separately rarely. Typically, individual symptoms of psychosensory disorders are considered within the framework of two main syndromes: derealization syndrome And depersonalization syndrome.

These disorders most often occur in exogenous-organic psychoses, withdrawal states, epilepsy, and neurorheumatism.

Perceptual disorder syndromes

Hallucinosis– a psychopathological syndrome, the leading disorder of which is hallucinations. Hallucinations, as a rule, occur in one analyzer, less often in several. The resulting affective disorders, delusions, and psychomotor agitation are secondary in nature and reflect the content of hallucinatory experiences. Hallucinosis occurs against the background of clear consciousness.

Disorders can be acute, characterized by vivid hallucinatory symptoms, hallucinatory arousal, the affective component of psychosis is pronounced, the formation of delusions is possible, and psychotically narrowed consciousness may be noted.

In the chronic course of hallucinosis, the affective component fades away, hallucinations become a familiar monosymptom for the patient, and a critical attitude towards the disorders often appears.

Acute auditory (verbal) hallucinosis. The leading symptom is auditory (verbal) hallucinations. In the prodromal period, elementary auditory hallucinations(acoasmas, phonemes), hyperacusis. At the height of psychosis, true hallucinations are characteristic (sounds come from outside - from behind the wall, from another room, from behind). Patients talk about what they hear with an abundance of detail, and it seems as if they see it (scene-like hallucinosis).

There is always an affective component – fear, anxiety, anger, depression. Often a hallucinatory variant of psychomotor agitation occurs, in which the patient’s behavior reflects the content of hallucinations (patients talk with imaginary interlocutors, cover their ears, make suicidal attempts, refuse food). The formation of secondary delusions (hallucinatory delusions) is possible; delusional ideas reflect the content of hallucinations and affective experiences.

There is no criticism of what is happening. Consciousness is formally clear, psychotically narrowed, patients are focused on their experiences.

Chronic verbal hallucinosis– manifestation, as a rule, is limited to hallucinatory symptoms.

Can be observed as unfavorable outcome acute verbal hallucinosis. In this case, the intensity of affect first decreases, then behavior is streamlined, and delirium disappears. Criticism of experiences appears. Hallucinations lose their brightness, their content becomes monotonous and indifferent to the patient (encapsulation).

Chronic verbal hallucinosis without a stage of acute psychotic state begins with rare hallucinatory episodes that become more frequent and intensified. Sometimes it is possible to form less relevant interpretive delusions.

Occurs in infectious, intoxication, traumatic and vascular lesions of the brain. May be initial sign schizophrenia, while it becomes more complicated and transforms into Kandinsky-Clerambault syndrome.

Peduncular visual hallucinosis (Lhermitte hallucinosis)

occurs when the cerebral peduncles are damaged (tumors, injuries, toxoplasmosis, vascular disorders). The leading symptom is visual hallucinations with extraprojection at a short distance from the eyes, usually from the side. As a rule, hallucinations are mobile, silent, and emotionally neutral. The attitude towards experiences is critical.

Visual hallucinosis of Charles Bonnet occurs with complete or partial blindness. Initially, individual incomplete visual hallucinations appear. Then their number grows, they become three-dimensional, stage-like. At the height of experience, criticism of hallucinations may disappear.

Van Bogart's hallucinosis characterized by persistent true visual hallucinations. More often these are zooptic hallucinations in the form of beautiful butterflies, small animals, and flowers. At first, hallucinations occur against an emotionally neutral background, but over time, the following appear in the structure of the syndrome: affective tension, psychomotor agitation, and delusions. Hallucinosis gives way to delirium. It is characteristic that this hallucinosis is preceded by a stage of somnolence and narcoleptic attacks.

Kandinsky-Clerambault syndrome is a kind of first-rank syndrome in the diagnosis of schizophrenia. The structure of the syndrome includes auditory pseudohallucinations and mental automatisms.

At hallucinatory form syndrome is dominated by auditory pseudohallucinations.

At delusional version the clinical picture is dominated by delusions of influence (telepathic, hypnotic, physical). Usually all types of automatisms are present.

Mental automatism– alienation of patients’ own mental processes and motor acts - one’s own thoughts, feelings, movements are felt suggested, violent, subject to outside influence.

There are several types of mental automatism.

1. Ideatorial (associative) is manifested by the presence of a feeling of investing other people’s thoughts, phenomena of openness of thoughts are noted (the feeling that one’s own thoughts become known to others, they sound, a feeling of theft of thoughts).

2. Sensory (sensory) mental automatism consists in the emergence of sensations and feelings as if under the influence of external ones. Alienation of one's own emotions is characteristic; the patient has the feeling that emotions arise under the influence of an outside force.

3. Motor (kinesthetic, motor) mental automatism is characterized by the patient’s feeling that any movements are carried out under the influence of external influences.

The presence of this syndrome in the clinical picture of the disease indicates the severity of the psychotic process and requires massive complex therapy.

The syndrome is characteristic of schizophrenia, but some authors rarely describe it in cases of intoxication, trauma, or vascular disorders.

It is also possible to develop the so-called inverted version of Kandinsky-Clerambault syndrome, in which the patient himself supposedly has the ability to influence others. These phenomena are usually combined with delusional ideas of greatness and special power.

Derealization syndrome. The leading symptom is an alienated and distorted perception of the surrounding world as a whole. In this case, disturbances in the perception of the tempo of time (time flows faster or slower), colors (everything is in gray tones or, on the contrary, bright), and a distorted perception of the surrounding space are possible. Déjà vu-like symptoms may also occur.

When you are depressed, the world may seem gray and time moves slowly. The predominance of bright colors in the surrounding world is noted by patients when using certain psychoactive drugs.

Perception of the environment in red and yellow tones is typical for twilight epileptic states.

A change in the perception of the shape and size of the surrounding space is characteristic of intoxication with psychoactive substances and for organic lesions brain.

Depersonalization syndrome is expressed in a violation of self-awareness, a distorted perception of one’s own personality and alienation of individual physiological or mental manifestations. Unlike mental automatism, with these disorders there are no sensations of external influence. There are several options for depersonalization.

Allopsychic depersonalization. A feeling of change in one’s own “I”, duality, the appearance of an alien personality that reacts differently to the environment.

Anesthetic depersonalization. Loss of higher emotions, the ability to feel and experience. Complaints of painful insensibility are typical. Patients lose the ability to feel pleasure or displeasure, joy, love, hatred or sadness.

Neurotic depersonalization. Typically, patients complain of inhibition of all mental processes, changes in emotional response. Patients are focused on their experiences, an abundance of complaints about difficulty is revealed mental activity, difficulty concentrating. Characterized by obsessive “soul-searching” and introspection.

Somato-physical depersonalization. Characteristic changes in perception internal organs, alienation of the perception of individual processes with the loss of their sensory brightness. Lack of satisfaction from urination, defecation, eating, sexual intercourse.

Violation of the layout and size of the body and its individual parts. Feelings of disproportion of the body and limbs, “improper placement” of arms or legs. Under visual control, the phenomena disappear. For example, a patient constantly has a feeling of the enormity of his fingers, but when looking at his hands, these sensations disappear.

Dysmorphophobia. The conviction of the existence of a non-existent shortcoming in oneself proceeds without severe disorders mental activity. It manifests itself mainly in adolescents as a transient age-related phenomenon.

Senesto-hypochondriacal syndrome. The basis of the syndrome is senestopathy, which occurs first. Subsequently, overvalued ideas of hypochondriacal content are added. Patients turn to doctors, the mental nature of the disease is rejected, so they constantly insist on more in-depth examination and treatment. Subsequently, hypochondriacal delusions may develop, which is accompanied by one’s own interpretation of disorders, often of anti-scientific content; there is no trust in health workers at this stage (reaches the level of open confrontation).

Perception- This visual-figurative reflection existing V this moment to the sense organs of things, objects, and not their individual properties and signs.

Basic properties of perception:

1.) objectivity - the ability to perceive the world in the form of separate objects that have certain properties;

2) integrity- the ability to mentally complete a perceived object to a complete form if it is represented by an incomplete set of elements;

3) constancy- the ability to perceive objects as constant in shape, color, consistency and size, regardless of the conditions of perception;

Basic types of perception are distinguished depending on the sense organ (as well as sensations):

1) visual;

2) auditory;

3) taste;

4) tactile;

5) olfactory.

One of the most significant types of perception in clinical psychology is a person’s perception of time (it can change significantly under the influence various diseases). Great importance is also attributed to disturbances in the perception of one’s own body and its parts.

Basic principles of perception:

Principle of proximity ( the closer they are to each other elements are located in the visual field, the more likely they are to be combined into a single image).

Principle of similarity ( similar elements strive to unification).

The principle of “natural continuation” (elements acting as parts of familiar figures more likely to unite exactly in these figures).

The principle of closure - elements of the visual field tend to create a closed image).

MAIN TYPES OF PERCEPTION DISORDERS

The main perception disorders include:

I) Illusions - this is a distorted perception of a real object.

1. Physical (mirage).

2. Physiological (passenger’s feeling of movement on the train).

3. Mental (pareidolic illusions - a scream on the street is like a call by name; noise outside the door is like a doorbell ringing).

The first 2 types also occur in healthy people. There are illusions visual(distortion of the visual image - “the patient perceives a coat hanging in the closet as a person based on the similarity of contours”), taste(modification of taste, appearance of “taste”), olfactory(change in smell) and auditory.

There is also a special type of visual illusion in which the perception of objects changes significantly.

· Metamorphopsia:

· macropsia - a disorder of perception, which is characterized by an increase in the size of surrounding objects;

· micropsia - ... reducing the size of surrounding objects;

· dysmegalopsia - a disorder that is characterized by expansion, elongation or twisting of surrounding objects around their own axis;

· porropsia - a disorder characterized by a change in distance (the object seems to move away from the patient while the size of the object itself remains unchanged).

II) Hallucinations - disturbances of perception arising without the presence of a real object and accompanied by confidence that this object is in given time and in this place it really exists.

Visual and auditory galls are usually divided into two groups: simple and complex.

Simple: A) photopsia- perception of bright flashes of light, circles, stars; b) acoasms- perception of sounds, noise, crackling, whistling, crying.

Complex hallucinations- auditory hallucinations that have the appearance of articulate phrasal speech and are usually of a commanding or threatening nature.

In addition, according to the mechanism of occurrence, hallucinations are divided into 2 groups: true and pseudohallucinations(can be differentiated only with visual and auditory illusions of perception):

· true hallucinations(images are projected outward; they are bright, loud, intense, resonant);

· false hallucinations or pseudohallucinations(the images are “inside the patient’s head”; they are “made”, imposed, dull, blurry, muffled; you can “shield yourself” from them for a while; the image has an imperative or commentary character; patients are aware of their false nature, they are in the imagination of the patients themselves) .

III) Eidetism - a disorder of perception in which the “trace” of the just ended excitation in some analyzer remains in the form of a clear and vivid image. This is the reproduction in all details of the images of objects that are not currently acting on the analyzers (a person continues to perceive the object in its absence). From a physiological point of view, this is residual excitation of the analyzer.

IV) Depersonalization disturbances of perception .

Under the term "recognition" imply recognition of the perceived object as already known from past experience.

Depersonalization- this is a distorted perception of how self(the perception of one’s own personality is distorted, which is manifested by a feeling of loss, splitting of the “I”, alienation of the “I”), and individual qualities and parts of the body(there are no crazy ideas and criticism is fully or partially preserved). There are partial (part of the body) and total (the whole body).

Disorders of perception (recognition) of one's own body include somatoagnosia- recognition disorder own body (with lesions of the brain, neurological diseases). This is the inability to recognize and show fingers on the hand (digital autotopagnosia), posture (autotopagnosia of posture), half the body (autotopagnosia of half the body), disorientation in “right” and “left”; body diagram disturbances- enlargement or reduction of the body, individual parts, painful perception of the location of individual parts of the body - “ears on the back of the head”).

V) Derealization - distorted perception of the surrounding world, “everything is frozen, glazed over,” “the world is like a stage set”). In the context of derealization, one should consider time perception disorders: a person has a feeling of stopping, stretching, slowing down, accelerating, “reverse” flow, loss of the sense of time (if the right hemisphere of the brain is damaged).

VI) Agnosia - impaired recognition of objects, as well as parts of one’s own body, while maintaining consciousness and self-awareness. These are disturbances of visual, auditory and kinesthetic perceptions during local lesions CGM of various origins (for example, tumor, inflammation, vascular damage). There may be a violation of the generalized perception of objects (they do not recognize a table, a chair), they do not recognize familiar, previously seen, space - they can’t find their room, the doctor’s office, or the toilet.

The following types of agnosia are distinguished:

· Visual agnosia- disorders of recognition of objects and their images with sufficient acuity. They occur with lesions of the occipital and inferior posterior parts of the parietal lobes of the brain.

· Tactile (tactile) agnosia- failure to recognize an object by feeling it while maintaining tactile sensitivity. appear astereognosis - With their eyes closed, when feeling an object (a comb, a pencil), patients do not recognize, do not feel the shape and size, but when they see an object, they recognize it.

· Auditory agnosia- impaired ability to recognize speech sounds in the absence of hearing impairment. Characteristic of damage temporal lobes GM (patients do not recognize the sound of an airplane, wind, car).

An abnormal perception of the surrounding world and oneself, when everything seems unreal, and one’s own thoughts, emotions, sensations seem to be observed from the outside, is called depersonalization in psychiatry. Often it occurs along with derealization, characterized by the remoteness of everything around, the absence of colors in it, and memory impairment. Due to the similarity of symptoms, in the 10th revision International classification diseases, depersonalization-derealization syndrome is indicated by one code F 48.1.

Perception disorder affects more than 70% of people worldwide from time to time. It seems to them that their consciousness is divided into two parts and one of them, having lost control over their mind and body, panics, and the second indifferently watches this from the side. It looks like horrible dream and that's why it's very scary. A person sees everything in a fog, in muted colors, and cannot move either an arm or a leg. He feels extreme discomfort and feels like he is going crazy.

Experts do not consider this disorder a serious mental pathology. The human psyche can react this way to stress, fear, severe emotional shock, and even overwork in the physical sense. The brain “turns on” the defense, reducing a person’s sensory sensitivity and emotionality, so objects seem strange, unusual to the touch, and colors seem faded. That is, the perception of the world becomes unusual and strange, unfamiliar. This condition usually goes away on its own and quickly, without treatment.

But, if such a syndrome manifests itself frequently and lasts for a long time, and the symptoms intensify, then it is already dangerous: the individual can cause harm to himself and others with his inappropriate behavior, or commit suicide. Therefore, in this case, the help of doctors is necessary.

You need to know that depersonalization can also accompany clinical depression, panic attacks, anxiety and bipolar disorder, schizophrenia. Similar sensations are caused by narcotic drugs, sedatives and antihistamines and a number of other medications, as well as caffeine and alcohol.

Causes of perception disorder

Depersonalization occurs in people of different ages and gender, but most often it affects young women. As already mentioned, it is caused by a stressful situation. The psyche that resists it reduces the strong emotional load of a person, switching his attention to outside observation. Thus, the individual turns his consciousness inward, his senses become dulled, but logical thinking remains the same.

The process of development of the syndrome in the body looks like this: under the influence of stress, a large amount of endorphins begins to be produced. As a result of their large-scale chaotic attack on the receptors responsible for emotions limbic system unable to cope with such pressure and forced to partially switch off.

But the above mechanism can also be triggered by other physical factors:

stroke;
hypertension;
brain tumor;
neurological disease;
head injury;
epileptic seizure;
neurosurgical operation;
heavy infectious disease in childhood;
birth injury.

Very rarely, depersonalization is inherited or is a consequence of negative changes in the nervous system.

It has already been said that taking drugs or other intoxication of the body can also cause a disorder of perception, as this provokes increased production of “hormones of happiness” - endorphins. Therefore, in the United States, an organization on drug addiction issues is studying depersonalization at the state level.

It should be noted that in schizophrenia, split personality has other causes and this is a symptom of a serious mental disorder, the approach to which is special and requires complex treatment.

Symptoms

There are 3 conditional groups of signs characterizing depersonalization syndrome:

1. Emotional coldness, indifference in the perception of the world around us, detachment, indifference to people::

indifference to the suffering of others;
lack of joy when communicating with family and friends;
insensitivity to music;
loss of sense of humor;
maintaining equanimity in situations that previously aroused any feelings, both negative and positive.

Fear is experienced only from the loss of control of one's body and loss of orientation in space. The feeling of confusion from not understanding the location, the history of getting here and further actions is depressing.

2. Violation of physical sensations:

Loss of sensitivity to hot and cold;
colors become dull, color blindness may appear;
taste sensations change;
objects seem blurry and have no boundaries;
sounds seem muffled, as in water;
There is no pain with minor wounds;
coordination of movements is impaired;
There is no feeling of hunger, and with it the appetite disappears.

3. Mental immunity:

a person forgets his preferences - what he likes and dislikes;
lack of incentives and motives - reluctance to take care of yourself, cook food, do laundry, work, go shopping;
temporary disorientation - an individual can sit without doing anything for several hours and not understand how much time has passed;
the feeling of participating as an actor in a boring, drawn-out play;
contemplation from the outside of your life, as if it were a dream.

The main sign of a perception disorder is a person’s deep self-absorption. At first he realizes that he perceives his personality incorrectly, this depresses him and causes strong emotional disturbance.

When trying to understand what is happening, the feeling of unreality becomes stronger, and the absurdity of the situation forces the individual to avoid communication with other people. The individual, however, is aware of the painfulness of his condition.

All in all clinical picture Depersonalization can be described as follows:

The perception of the world is disrupted - it seems unreal, fantastic.
Complete detachment from what is happening around.
Loss of satisfaction from natural physiological needs– sleep, food, defects, sex, etc.
Closedness.
Impaired perception of the structure of one's body - arms and legs seem artificial, of unknown configuration or size.
Inability to control your body.
Decreased intellectual abilities.
Feeling of loneliness, abandoned by everyone.
Absence of any emotional manifestations.
Changes in physiological sensations.
Split personality.
The feeling of watching yourself from the outside.

These symptoms of perceptual disorder may have varying degrees severity at different types depersonalization, which will be discussed below.

Varieties

Modern psychology shares several forms of depersonalization syndrome, differing in the uniqueness of their perception of the world around them and themselves:

Autopsychic depersonalization is a heightened sense of one’s “I”, an increase in the feeling of its loss. It seems to a person that some stranger lives in him, feels at ease and acts in his own way. Such a split makes you suffer and experience discomfort, and reject yourself. Social contacts are difficult.
Allopsychic depersonalization – derealization. The surroundings are perceived as a dream, the world is seen as through a cloudy glass. Everything seems alien and hostile: sounds are booming, objects are fuzzy, people look the same. Automatic thoughts and movements, disorientation, deja vu.
Anesthetic depersonalization - increased internal vulnerability with complete external insensitivity.
Somatopsychic depersonalization, characterized by a pathological perception of one’s body and its functions. It is the most unusual: it seems to a person that he has no hair or clothes, parts of the body have changed and live their own separate lives. Eating is difficult - the throat “does not want” to push food through, there is no desire to eat. Taste sensations change, sensitivity to air and water temperature decreases.

Diagnostics

To identify a perceptual disorder, a thorough interview of the patient and his relatives is required - they will describe the patient’s behavior. Special testing is also carried out.

Blood tests and examination of the patient will not yield anything - he does not look sick, he has no chronic or hidden somatic diseases, his immunity is not satisfactory, and his physical condition is quite normal. But an MRI will show changes in certain areas of the brain. There are also special laboratory research, confirming changes in protein receptors and disturbances in the functioning of the gland internal secretion- pituitary gland.

Now there are clear criteria to confirm the diagnosis:

Critical thinking of a patient who is aware of his problem.
Maintaining clarity of consciousness, the absence of so-called twilight episodes, confusion of thought.
Complaints that the mind exists separately from the body, the latter exists independently and its perception is impaired.
A feeling of changing terrain, unreality, misrecognition of familiar objects.

The specialist should distinguish depersonalization from schizophrenia, which has similar symptoms. These pathologies are distinguished as follows: schizophrenia manifests itself with the same symptoms of the same intensity every day, and with a perceptual disorder they are much more varied.

Therapy for depersonalization disorder

Since this disorder is individual for each patient, treatment is selected for each patient separately.

As already mentioned, short-term cases of depersonalization do not require treatment, but psychoanalysis will help eliminate the discomfort.

If the culprit of depersonalization is the use of narcotic substances, then detoxification of the body is carried out. Hormonal treatment will be needed if the cause of the disorder is endocrine pathology.

Depersonalization due to depression, panic attacks, schizophrenia, the psychiatrist prescribes a complex of tranquilizers, antidepressants, and antipsychotics. The following drugs are indicated:

"Decorten";
Seroquel in combination with Anafranil;
"Cytoflamin";
"Cavinton";
"Naloxone";
vitamin C with drugs such as Amitriptyline, Sonapax, Clopiramine, Quetiapine.

Some patients have to take psychotropic drugs lifelong, as the syndrome cannot be completely cured. Medicines allow them to relieve the severity of the feelings caused by the disorder.

When symptomatic manifestations are removed, it’s time for psychotherapy. The specialist conducts a series of sessions with the patient, during which he identifies the causes of the perception disorder, switches the patient’s attention to other people, and teaches him to subsequently cope with emerging attacks of duality.

An effective method for getting rid of depersonalization is to remember strange feelings and then tell them to a psychologist. The latter, in turn, teaches the patient not to be afraid of such cases, and they gradually fade away.

Auto-training and hypnosis are also successfully used; they are most effective together with explanatory therapy.

As additional measures may be prescribed:

acupuncture;
soothing massage;
phytotherapy;
taking antidepressants;
physiotherapy;
homeopathy.

Psychotherapeutic techniques are reinforced social rehabilitation: the patient is advised to be in public more often, go to museums, theaters, etc. This gives tangible results in treatment and recovery.

It happens that people with severe depersonalization have a negative attitude towards rehabilitation program, passive. In this case, they resort to the help of the patient’s relatives, who literally drag the relative “out into the world.”

27. Basic perception disorders

The main perception disorders include:

1. Illusions are a distorted perception of a real object. For example, illusions can be auditory, visual, olfactory, etc.

Based on the nature of their occurrence, there are three types of illusions:

1) physical;

2) physiological;

3) mental.

2. Hallucinations are disturbances of perception that occur without the presence of a real object and are accompanied by the belief that this object really exists at a given time and place.

Visual and auditory hallucinations are usually divided into two groups:

1. Simple. These include:

a) photopsia - perception of bright flashes of light, circles, stars;

b) acoasms - perception of sounds, noise, crackling, whistling, crying.

2. Complex. These include, for example, auditory hallucinations, which have the appearance of articulate phrasal speech and are usually of a commanding or threatening nature.

3. Eidetism is a disorder of perception in which a trace of just ended excitation in some analyzer remains in the form of a clear and vivid image.

4. Depersonalization is a distorted perception of both one’s own personality as a whole and individual qualities and parts of the body. Based on this, two types of depersonalization are distinguished:

1) partial (impaired perception of individual parts of the body); 2) total (impaired perception of the whole body).

5. Derealization is a distorted perception of the surrounding world. An example of derealization is the symptom of “already seen” (de ja vu).

6. Agnosia refers to impaired recognition of objects, as well as parts of one’s own body, but at the same time consciousness and self-awareness are preserved.

Highlight the following types agnosia:

1. Visual agnosia – disorders of recognition of objects and their images while maintaining sufficient visual acuity. Are divided into:

a) object agnosia;

b) agnosia for colors and fonts;

c) optical-spatial agnosia (patients cannot convey the spatial characteristics of an object in a drawing: further - closer, more - less, higher - lower, etc.).

2. Auditory agnosia – impaired ability to distinguish speech sounds in the absence of hearing impairment;

3. Tactile agnosia - disorders characterized by failure to recognize objects by feeling them while maintaining tactile sensitivity.

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