Pathology of perception: clinical and psychological phenomenology. Pathologies of perception Loss of perception function includes

The text is taken from the website of the Department of Psychiatry and Narcology of St. Petersburg State Medical Academy named after. I.I. Mechnikov http://psychiatry.spsma.spb.ru
Pathology of perception.

Theoretical material.

Perception is defined as the ability to objectively reflect the surrounding world. Sensation and perception represent the first stage of a person’s cognition of the surrounding world and himself at the level of sensory cognition.

Sensation is the simplest mental process, consisting in the reflection of individual properties of objects and phenomena of the objective world, arising as a result 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.

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

Association is a connection of ideas.

The sensations are extremely diverse and emotionally colored; they integrate the cognitive, emotional and regulatory aspects of the psyche. In evolutionary terms, ancient and new reception are distinguished, according to the characteristics of contact - distant and contact, according to the location of receptors - extero-, proprio- and interoception. A special place is occupied by gravitational sensitivity, reflecting vibrations of the elastic medium (“contact hearing”). Kinesthetic sensations are distinguished - sensations of movement and position of individual parts of the body, organic - arising from the action of interoceptors and forming the so-called. “organic feeling” (hunger, pain, etc.); in a broad sense, a distinction is made between protopathic and phylogenetically younger, epicritic sensitivity. There is also a distinction between “modality” - belonging to a specific type (optical, gustatory, etc.), and “submodality” of sensations - differentiation within a specific type (red, black or sour, sweet, etc.).

^ The pathology of sensations (sensopathy) is often the object of neurological research, although a number of phenomena are also related to psychopathology.

Hyperesthesia is increased sensitivity to common stimuli that affect the senses. Hyperesthesia associated with hearing and vision is more common. Sounds begin to be perceived as unnaturally loud, the usual lighting is perceived as excessively bright. Less commonly, hyperesthesia extends to smells, thermal and tactile sensations. Smells are either unpleasant or irritating. Various touches (the patient is accidentally touched in transport, bed linen, clothes) cause a feeling of mental and physical discomfort. It is observed in asthenia (receptive G.), traumatic and intoxication lesions of the nervous system, and in the form of hyperalgesia (up to “algic melancholy”) - in the initial and final stages of depression, during abstinence (affective G.). Hyperpathy is characterized by the fact that any, even the slightest irritation is accompanied by extremely unpleasant sensations of pain and a long aftereffect.

Hypoesthesia is a more or less sharp weakening of ordinary sensations, a decrease in sensitivity. Characteristic of asthenic, depressive states, in states of impaired consciousness, primarily in the initial periods of stunning.

Anesthesia is a loss of sensitivity, or more precisely, a loss of the receptive component of sensations. In the form of analgesia (loss of pain sensitivity) it occurs in acute psychoses, deep depression, conversion disorders, progressive paralysis, somatopsychic depersonalization.

Paresthesia - sensations of tingling, numbness, crawling.

Senestopathies are painful, often extremely painful sensations localized in various superficial areas of the body (in the skin, under the skin), or in internal organs in the absence of objective signs of organic pathology. Their occurrence is not associated with local disorders that can be determined by somatoneurological studies. Due to their intensity and unpleasant nature, they are extremely painful for patients; various internal sensations of constriction, burning, pressure, bursting, turning over, peeling, bursting, twisting, tightening, etc. The experiences are painful, unbearable, they are difficult to express in concrete words, since they were not previously familiar to the patient, and they are difficult to compare with any well-known sensations. When describing senestopathies, patients often give unusual definitions and use a variety of comparisons, including figurative ones, in order to convey the characteristics of the pathological sensations they experience.

Senestopathies can occur in the form of a monosymptom. In such patients, along with senestopathies, mild subdepressive, neurotic, and depersonalization disorders can often be identified. In other cases, senestopathies are accompanied by pronounced psychopathological syndromes, primarily depression, as well as intense depersonalization disorders, delusions, mental automatisms, and psychoorganic syndrome. Very often, senestopathies are a persistent disorder and can exist for many years. In elderly and senile people, senestopathies are more common and are often more diverse and intense.

Perception, in contrast to sensations, is the result of complex analytical-synthetic activity, which involves identifying the most general, essential features and combining them into one meaningful whole - into the image of an object.

^ Pathology of perception includes psychosensory disorders, illusions and hallucinations.

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

This kind of pathology arises as a result of a disruption in the process of sensory synthesis of multiple stimuli emanating from the outside world and one’s own body. As a rule, the awareness of the painfulness and inadequacy of the corresponding experiences remains. The following symptoms of psychosensory disorders are distinguished: autometamorphopsia, metamorphopsia, disturbances in time perception and derealization.

Autometamorphopsia (disorder of the “body diagram”) is a distortion of the shape or size of one’s body, the experience of a discrepancy between the sensation received from a particular organ and the way this organ was previously reflected in consciousness. With total autometamorphopsia, the whole body is perceived as clearly enlarged or reduced (macrosomia and microsomia) until its complete disappearance; with partial, we are talking about changes in the weight, shape, volume and relative position of individual parts of the body; the perception of the position of individual parts of the body in space may be impaired (the head seems to be turned with the back of the head forward, etc.).

There are sensations of separation, displacement, disappearance of certain parts of the body, a violation of the perception of the unity of the body, a feeling of weightlessness and lightness; with pronounced disturbances, the body is perceived as distorted beyond recognition, completely losing its previous physical individual form. Autometamorphopsia can be constant or periodic, they occur more often with eyes closed, when falling asleep (with open eyes the body can be perceived normally), they are characterized by a desire for correction and negative affective experiences. This can occur with organic brain lesions.

Metamorphopsia is a violation of the perception of the size and shape of objects and space in general. Objects seem enlarged or reduced (macro- and micropsia), elongated, twisted around an axis, beveled (dysmegalopsia), the perception of the structure of space changes, it lengthens, shortens, objects move away, etc. (porropsia). Metamorphopsia occurs, as a rule, paroxysmally, with a critical attitude towards painful experiences and is caused mainly by organic damage to the parietotemporal parts of the brain.

^ Disturbances in the perception of time, in addition to the feeling of its acceleration or deceleration, also manifest themselves in the loss of distinction between the past, present and future, in a change in the pace of real processes, in a feeling of discontinuity, discreteness of the time process, i.e. in disrupting the smooth flow of time.

The state of depersonalization is a feeling of change in one’s own “I”, with the loss of the emotional component of mental processes.

There is a distinction between allopsychic depersonalization (derealization), which includes loss or dulling of emotional perception of the surrounding world. Patients complain that the surroundings have become “dull”, “colorless”, perceived as “through a film”, or “cloudy glass”. They say that they distinguish colors, but they are not aware of their differences; everything seems equally colorless. Autopsychic depersonalization is a feeling of “emptiness in the head,” a complete absence of thoughts and memories, but there is no feeling of taking away thoughts. The feeling of familiarity is lost, the familiar environment is perceived as alien. It is impossible to mentally recreate the image of a loved one. The perception of one’s own “I” is disrupted, “as if the soul had disappeared,” “became a robot, an automaton,” a feeling of complete loss of feelings arises, accompanied by a feeling of the torment of such a state. This is “mournful insensibility” - anesthesia phsychica dolorosa. At the same time, there is an absence of feelings of melancholy, anger, and pity. Sometimes there is an alienation of the processes of thinking and memory - a feeling of absence of thoughts and memories. An important component of depersonalization is a violation of the perception of time: real time flows unbearably long for patients and even stops, since images and thoughts are not accompanied by emotional coloring. The past time seems to leave no traces and is therefore perceived as a short moment.

Phenomena of somatopsychic depersonalization are often observed. This is the absence of a feeling of hunger, satiety, a decrease in temperature, pain, tactile and proprioceptive sensitivity. In some cases, massive somatopsychic depersonalization, developing against a background of anxiety, leads to a delusional interpretation, hypochondriacal nihilistic ideas, reaching the level of Cotard's delusion.

Illusions are an erroneous perception of objects and phenomena that actually exist at the moment. Illusory perception can be classified as a deception of perception that borders on hallucinations, although some illusions also occur in healthy people.

Physical and physiological illusions in mentally healthy individuals and mental (pathological) illusions in psychopathological disorders are distinguished. The first group includes phenomena associated with the deceptive manifestation of the physical properties of an object or action (the perception of a stick lowered into water) or due to the physiological characteristics of normally functioning analyzers (Dellof's test: the feeling of greater heaviness of a 3-kilogram metal ball compared to a plastic ball of the same weight) . True illusions are divided into affective, verbal and pareidolic; by analyzers - visual, auditory, olfactory, etc.

Affective illusions arise during pathological changes in the affective sphere, under the influence of strong fear, excessive nervous tension, and less often during manic states. A robe hanging in the corner is perceived as an ominous figure, a neurological hammer is mistaken for a gun, etc. Young, unexamined soldiers may experience the “illusion of forward posts,” when in the dark, various sounds and objects are perceived as the steps of strangers, the silhouettes of external objects as a creeping enemy, and then the person takes self-defense measures.

Verbal illusions consist of a distorted perception of various types of sound stimuli. Neutral speech is perceived as threats, hostile statements, reproaches, and the true content of the conversations of others does not reach the patient’s consciousness. When the TV or radio is on, you may get the impression that all programs on a verbal level are addressed to the patient. Such illusions that arise in a state of anxiety and suspicion can be considered as a verbal version of affective illusions.

Pareidolic illusions are visual illusions of fantastic content. The content is characterized by colorfulness and imagery: instead of carpet patterns, wallpaper patterns, parquet floors, unusual figures, fairy-tale characters, landscapes, etc. are seen in the outlines of clouds, in the crowns of trees.

Illusions mainly occur in acute exogenous mental disorders, for example, in a state of intoxication with certain narcotic substances (opium, hashish) and in febrile states.

Hallucinations are imaginary perceptions, perceptions without an object. Due to disturbances in mental activity, the “hallucinant” (a person experiencing a hallucination) “sees,” “hears,” “feels” something that does not exist in reality. The occurrence of hallucinations is associated with a general mental disorder; their specific manifestations depend on the state of consciousness, thinking, intelligence, emotional sphere and attention, and on the characteristics of the relationship between hallucinations and the patient’s personality. There are many approaches to the classification of hallucinations (etiological, phenomenological, dynamic, etc.); in practice, the topical, receptor-localization principle is more often used, according to which hallucinations are divided, like illusions, according to the senses, as well as into true and pseudohallucinations.

True hallucinations are characterized by an external projection of a hallucinatory image (projection into the surrounding space, “outside”), they are associated with a real, concrete situation, sensually - extremely alive, vivid and have such a degree of objective reliability that the hallucinant completely identifies them with reality: hallucinations are so are as natural to the patient as real things. Also characteristic is a focus on the physical “I”, corporeality, objectivity and behavioral reactions (their division, characteristics)

Pseudohallucinations, first described by V.Kh. Kandinsky (1890), are projected, in contrast to the true ones, into subjective space (inside the head, in the body, “inside”). Beyond the capabilities of the analyzer. They lack the character of objective reality and have little connection with the environment; they are perceived by patients as something alien to their consciousness and mental activity. Pseudohallucinations are not characterized by sensory brightness and liveliness; on the contrary, they are accompanied by a feeling of violence, “doneness,” influence from the outside; they are distinguished by a special character in comparison with the images of perception of really existing objects and phenomena, “monotony and melancholy” (Kandinsky), there is no sense of one’s own activity; P. are aimed at the psychic “I”, they reveal closeness to the “I”, to the inner world. The patient is usually inactive.

As a rule, hallucinations are a symptom of a mental disorder, although in some cases they can occur in healthy people (suggested in hypnosis, induced) or with pathologies of the organs of vision (cataracts, retinal detachment, etc.) and hearing. A critical attitude during hallucinations is usually absent; it is very important to take into account the objective signs of hallucinations (changes in facial expressions, gestures, behavior). The content of hallucinations is extremely varied.

^ Auditory hallucinations are divided into acoasms (individual sounds, rustles, noises - non-speech) and phonemes or “voices” - pathological perception of some words, phrases, conversations, speech. Verbal pseudohallucinations are “thoughts in a sensory shell.” The content can be neutral towards the patient, commentary (statemental), indifferent (informational), threatening or laudatory. Of particular danger to the condition of the patient and those around him are imperative, “commandative”, “imperative” hallucinations, when orders are “heard” to remain silent, to hit or kill someone, to cause self-harm, etc. With antagonistic (contrasting) hallucinations, the patient is at the mercy of two “voices” or two groups of “voices” with contradictory meanings; these “voices” seem to argue among themselves and fight for the patient (in schizophrenia). Musical – alcoholic psychosis, epilepsy.

^ Visual hallucinations can be elementary (so-called photopsia - in the form of flies, sparks, zigzags) or objective (“vision” of various animals that do not exist in reality (zoopsia), people (anthropomorphic), cinematic and demonomaniacal (during intoxication), micro-, macropsis (with organic lesions of the central nervous system) or entire scenes (plot), panoramas of fantastic content) can cause curiosity, or anxiety, fear. Sometimes the patient “sees” something behind him, out of sight (extracampal hallucinations - in schizophrenia) or observes his own image (autoscopic hallucinations - in severe brain pathology). They indicate a deeper defeat than verbal ones.

^ Tactile hallucinations are expressed in the sensation of an unpleasant touch on the body (thermal hallucinations), the appearance of moisture, liquid on the body (hygric hallucinations), and a sensation of grasping (haptic hallucinations). Visceral hallucinations are also a type of tactile hallucinations - a feeling of the presence of animals, some objects, or foreign organs in one’s own body. Erotic tactile hallucinations.

^ Olfactory and gustatory hallucinations are sometimes difficult to distinguish from illusions and delusions. Hallucinatory experiences of this kind are characterized by extremely unpleasant content (“cadaverous, putrid smell”, “disgusting taste”), they are persistently retained in various real situations. Dysmorphomania - body odor, delusions of poisoning - from the outside, Cotard's delusions - from the inside. Taste - can be inside the body.

^ Hallucinations of the general sense (interoceptive) - foreign bodies, living beings, devices. The difference from senestopathies is physicality, objectivity. Delirium of obsession.

Prognostic unfavorability increases from true - to pseudo - and from visual - to olfactory and gustatory hallucinations. The category of rare hallucinations includes reflex hallucinations, which arise in the sphere of one analyzer when an objective stimulus acts on another, kinesthetic, motor and speech motor (in addition to the will, the tongue pronounces words, individual phrases), hypnagogic and hypnopompic - visual perceptions with eyes closed before falling asleep and, accordingly, final awakening, functional hallucinations appearing against the background and simultaneously with the action of a real external stimulus (“voices” heard only during the murmur of water from a switched on tap). There may also be complex, combined (combined) hallucinations, when a hallucinatory image is simultaneously “heard”, “seen”, “touched”, “smelled”, etc. Hallucinations that occur in conditions of information deficiency, sensory isolation (bathyscaphe, sound chamber, spaceship), i.e. in a closed system they are designated as reactive-insulating. Caused by G. - pathological suggestibility (Lipman, Reichardt, etc.). Induced - collective G.

The presence of hallucinations is judged not only by what the patient himself talks about them, but also by his appearance and behavior. For auditory hallucinations, especially those that occur acutely. The patient listens to the plague, his facial expressions and pantomime are changeable and expressive. In some psychoses, for example, alcoholic, when a doctor speaks verbally to a patient, he can use a gesture or a short phrase not to interfere with his listening. The presence of auditory hallucinations can be indicated by the fact that sick people around them communicate any unusual facts, for example, about the start of a war. Very often, with auditory hallucinations, patients try to find out the source (place) from which the “voices” are heard. With hallucinations of threatening content, patients can flee by committing impulsive acts - jumping out of a window, jumping off a train, etc., or, on the contrary, go on the defensive, for example, barricading themselves in the room in which they are currently located (a state of siege situation), providing stubborn resistance, sometimes associated with aggression, directed against imaginary enemies or themselves. Some patients, usually with long-term auditory hallucinations, plug their ears with cotton and hide under a blanket. However, many patients with long-term auditory hallucinations behave, especially in public, absolutely correctly. In some cases, some of these patients are able to perform professional duties for years, requiring significant mental and emotional effort to acquire new specialized knowledge. Usually we are talking about mature patients suffering from schizophrenia.

With visual hallucinations, especially those accompanied by confusion, the patient’s behavior is always disorganized to one degree or another. More often, the patient becomes restless, suddenly turns around, begins to back away, brushes off something, shakes something off. Motor immobility appears much less frequently, or motor reactions are limited only to variable facial expressions: fear, amazement, curiosity, concentration, admiration, despair, etc., appearing either separately or replacing one another.

The behavior of patients with intense tactile hallucinations changes especially dramatically. In acute cases, they feel themselves, throw something off or shake it off their body or clothes, try to crush it, take off their clothes. In some cases, patients begin to disinfect the objects around them: they wash and iron their underwear or bed linen, disinfect the floor and walls of the room in which they live in various ways, etc. They often undertake repairs to their premises.

With olfactory hallucinations, patients pinch or plug their nose with something.

With taste hallucinations, refusal to eat is common.

^ RESTRICTION CRITERIA
Hallucinations

Projection
pathological
images

Sensual brightness
vividness of hallucinatory images

Feeling of violence, being “done,” influence from outside

True

Into the environment
space
("outside")

Saved

Absent

False (pseudohallucinations)

Into subjective space (“inside”)

Absent

Perception is a holistic reflection of an object or phenomenon by our “I”.

Illusions.

Illusions are the erroneous, altered perception of really existing objects or phenomena, “perversion of perception” (J. Esquirol), “delusion of imagination” (F. Pinel), “imaginary sensation” (V. P. Serbsky). Illusions can occur in both mentally ill and completely healthy people.

Descriptions of illusions are given in “The Forest King” by I. Goethe and in “Demons” by A. S. Pushkin. In the first case, instead of a tree, the boy’s painful imagination sees the image of a scary, bearded forest king; in the second, in a raging snowstorm, the swirling figures of demons are seen, and their voices are heard in the noise of the wind.

Healthy people may experience physical, physiological illusions, as well as illusions of inattention.

Physical illusions based on the laws of physics. For example, the perception of the refraction of an object at the boundary of various transparent media (a spoon in a glass of water seems to be refracted; in this regard, Descartes even said: “My eye refracts it, but my mind straightens it”). A similar illusion is a mirage.

Physiological illusions are associated with the peculiarities of the functioning of analyzers. If a person looks at a moving train for a long time, he gets the feeling that the train is standing still, and it seems to be rushing in the opposite direction. When a rotating swing suddenly stops, the people sitting in it retain the feeling of a circular rotation of the surrounding environment for several seconds. For the same reason, a small room covered with light wallpaper seems larger in volume. Or a plump person dressed in a black dress seems slimmer than in reality.

Illusions of inattention are noted in cases where, due to excessive interest in the plot of a literary work, a mentally healthy person does not notice obvious grammatical errors and typos in the text.

Illusions associated with pathology of the mental sphere are usually divided into affective (affectogenic), verbal and pareidolic.

Affective illusions arise in a situation of passion or an unusual emotional state (strong fear, excessive desire, tense anticipation, etc.), in a situation of insufficient illumination of the surrounding space. For example, a tie hanging on a chair in the twilight can be perceived as a cobra ready to jump. Affective illusions are sometimes observed in healthy people, because this distorted perception is associated with an unusual emotional state. Almost anyone can experience affective illusions if they alone visit a cemetery at midnight.

A lonely religious patient was afraid to walk past the balcony of her apartment at night, because she constantly saw the “tempter” in the household utensils stored on the balcony.

Verbal, or auditory, illusions They also appear against the background of some kind of affect and are expressed in an erroneous perception of the meaning of the conversations of surrounding people, when neutral speech is perceived by the patient as a threat to his life, curses, insults, accusations.

Patient N., who suffered from alcoholism, often heard (and saw) with the TV on, how he was invited to share a company “into three” by “hairy people with tails”, completely unfamiliar to him, freely passing through the wall of the house.

Pareidolic (periform) illusions associated with the activity of the imagination when fixing the gaze on objects that have an unclear configuration. In this disorder, the perception is of a bizarre and fantastic nature. For example, in a kaleidoscope of ever-moving clouds a person can see divine pictures, in wallpaper patterns - millions of small animals, in carpet patterns - his life path. Pareidolic illusions always occur with a decreased tone of consciousness against the background of various intoxications and are an important diagnostic sign. In particular, this version of illusions may be one of the first symptoms of incipient alcoholic delirium.

Sometimes illusions are divided according to the senses: visual, auditory, olfactory, gustatory And tactile. It should be emphasized that the presence of only affective, verbal and pareidolic illusions in isolated form is not a symptom of mental illness, but only indicates a person’s affective tension or overwork. Only in combination with other mental disorders do they become symptoms of certain mental disorders.

Hallucinations.

Hallucinations are perception disorders when the patient sees, hears and feels something that does not actually exist in a given situation. This is the so-called perception without an object. According to Lasègue’s figurative expression, illusions are to hallucinations as slander is to slander (that is, slander is always based on a real fact, distorted or distorted, while in slander there is not even a hint of the truth).

Hallucinations are classified according to the sense organs: visual, auditory, olfactory, gustatory, general senses (visceral And muscular).

Hallucinations can be simple or complex. Simple hallucinations are usually localized within one analyzer (for example, only auditory or only olfactory, etc.). Complex (combined, complex) hallucinations are a combination of two or more simple hallucinations.

For example, the patient sees a huge boa constrictor lying on his chest (visual illusions of perception), which “hisses threateningly” (auditory), feels his cold body and enormous heaviness (tactile hallucinations).

In addition, hallucinations can be true, more characteristic of exogenous mental illnesses, in which the patient sees pictures that are currently absent or hears non-existent sounds, and false (pseudohallucinations), more often noted in endogenous disorders, in particular schizophrenia. Essentially, pseudohallucinations include not only disturbances of perception, but also the pathology of the associative process, i.e., thinking.

Patient M., a teacher at one of the Moscow universities, “with her inner eye” constantly saw in her head two groups of physicists, American and Soviet. These groups stole “atomic secrets” from each other and tested atomic bombs in the patient’s head, which made her “eyes roll back.” The patient mentally talked to them all the time, either in Russian or in English.

To distinguish true hallucinations from false ones, which are of great importance for the nosological presumability of the disease, differential diagnostic criteria are distinguished:

1. Projection criterion. With true hallucinations, there is a projection of the hallucinatory image to the outside, i.e. the patient hears a voice with his ears, sees with his eyes, smells with his nose, etc.

With pseudohallucinations, there is a projection of an image inside the body
patient, i.e. he hears the voice not with his ears, but with his head, and the voice is located inside the head or another part of the body. In the same way, he sees visual images inside his head, chest or other parts of the body. At the same time, the patient says that inside the body there is a kind of small TV. Pseudohallucinations are quite widely represented in fiction. For example, Prince Hamlet saw the ghost of his father “in the eye of his mind.”

2. The criterion of doneness. Characteristic of pseudohallucinations.
The patient is sure that the demonstration of pictures in the head, the installation of a television and tape recorder in the head, recording his secret thoughts, was specially arranged by powerful organizations or individuals. With true hallucinations there is never a feeling of being done or being arranged.

3. The criterion of objective reality and sensory brightness.
True hallucinations are always closely related to the real environment and are interpreted by patients as existing in reality. The patient sees a small King Kong sitting on a real chair, in a real room, surrounded by real students, commentating on a real television program and drinking
vodka from a real glass. Pseudohallucinations are devoid of objective reality and sensory vividness. Thus, auditory pseudohallucinations are quiet, indistinct, as if distant. This is neither a voice nor a whisper, and not a woman’s, nor a man’s, nor
for children, and not for adults. Sometimes patients doubt whether their voice
this or the sound of your own thoughts. Visual pseudohallucinations, often bright, are never associated with the real environment; more often they are translucent, icon-like, flat and lacking shape and volume,

4. Criterion of relevance of behavior. True hallucinations
are always accompanied by actual behavior, because patients
are convinced of the reality of hallucinatory images and behave
adequate to their content. In the face of frightening images, they experience panic fear, in the presence of threatening voices coming from a neighboring apartment, they seek help from the police and prepare for defense or hide with friends, and sometimes just
cover their ears. For pseudohallucinations, the relevance of behavior is not characteristic. Patients with voices of unpleasant content inside their heads continue to lie indifferently in bed. It is extremely rare that actions “adequate” to pseudohallucinations are possible.
For example, a patient who has been hearing voices for a long time
coming from the big toe of his left foot, he tried to cut off the last one.

5. Social confidence criterion. True hallucinations
always accompanied by a feeling of social confidence. So,
a patient experiencing commentary hallucinations of unpleasant content is convinced that statements about his behavior are heard by all residents of the house. With pseudohallucinations, patients are sure that such phenomena are of a purely personal nature and are experienced exclusively by them.

6. Criterion for mental or physical focus
"I". True hallucinations are directed at the physical “I” of the patient, while pseudohallucinations are always addressed to the mental “I”. In other words, in the first case the body suffers, and in the second the soul suffers.

7. Criterion for dependence on time of day. The intensity of true hallucinations increases in the evening and at night.
As a rule, such a pattern is not observed with pseudohallucinations.

In psychiatric practice, auditory (verbal) hallucinations are most often encountered.

Auditory hallucinations can be elementary in the form of noises, individual sounds (acoasms), as well as in the form of words, speeches, conversations (phonemes). In addition, auditory hallucinations are divided into so-called hails(the patient constantly hears his name being called), imperative, commenting, threatening, contrasting (contrasting), speech motor, etc.

Imperative (commanding, imperative) verbal hallucinations are expressed in the fact that the patient hears orders that he is almost unable to resist. These hallucinations pose a significant threat to others and the patient himself, since they are usually “ordered” to kill, hit, destroy, blow up, throw a child from a balcony, cut off one’s leg, etc.

Commenting verbal hallucinations are also very unpleasant for the patient and are expressed in the fact that voices constantly seem to discuss all the actions of the patient, his thoughts and desires. Sometimes they are so painful that the patient finds the only way to get rid of them is suicide.

Threatening verbal hallucinations are expressed in the fact that patients constantly hear verbal threats addressed to them: they are going to be hacked to death, quartered, castrated, forced to drink a slow-acting poison, etc.

Contrasting (antagonistic) verbal hallucinations have the character of a group dialogue - one group of voices angrily condemns the patient, demands sophisticated torture and death, and the other timidly, uncertainly defends him, asks for a postponement of execution, assures that the patient will improve, stop drinking, become better, kinder . It is characteristic that the voices do not address the patient directly, but debate among themselves. Sometimes, however, they give him exactly the opposite orders, for example, to fall asleep and at the same time sing and do dance steps. This version of auditory deceptions of perception is an imperative type of antagonistic hallucinations. Contrasting disorders also include clinical cases when a patient hears threatening, hostile voices in one ear, and benevolent voices in the other, approving of his actions.

Speech motor Segla's hallucinations are characterized by the patient's confidence that someone is speaking with his speech apparatus, affecting the muscles of the mouth and tongue. Sometimes the speech motor apparatus pronounces voices that are not audible to others. Many researchers classify Segla's hallucinations as a type of pseudohallucinatory disorder.

Visual hallucinations In terms of their representation in psychopathology, they occupy second place after auditory ones. They range from elementary (photopsies) in the form of smoke, fog, sparks to panoramic, when the patient sees dynamic battle scenes with many people. Highlight zoopsy, or zoological visual illusions in the form of various aggressive wild animals attacking the patient (they are more often observed with delirium tremens).

Demonomaniacal hallucinations - the patient sees images of mystical and mythological creatures (devils, angels, mermaids, werewolves, vampires, etc.).

Autoscopic (deuteroscopic), or double hallucinations - the patient observes one or more doubles that completely copy his behavior and manners. Negative autoscopic hallucinations are distinguished when the patient does not see his reflection in the mirror. Autoscopies have been described in cases of alcoholism, organic lesions of the temporal and parietal parts of the brain, hypoxia after heart surgery, as well as against the background of a severe psychotraumatic situation. Heine and Goethe apparently experienced autoscopic hallucinations.

Microscopic (Lilliputian) hallucinations - deceptions of perception are of reduced size (many gnomes dressed in extremely bright clothes, like in a puppet theater). These hallucinations are more common in infectious psychoses, alcoholism and intoxication with chloroform and ether.

Patient M. saw many small, but extremely angry and aggressive rats that chased him throughout the apartment.

Macroscopic deceptions of perception - giants, giraffe-like animals, huge fantastic birds appear before the patient.

Polyopic hallucinations - many identical hallucinatory images, as if created as a carbon copy, are observed in some forms of alcoholic psychosis, for example, delirium tremens.

Adelamorphic hallucinations are visual illusions, devoid of clarity of shape, volume and brightness of colors, disembodied contours of people flying in a specific enclosed space. Many researchers classify adelomorphic hallucinations as a special form of pseudohallucinations; characteristic of the schizophrenic process.

Extracampal hallucinations - the patient sees out of the corner of his eye behind him, outside the field of normal vision, some phenomena or people. When he turns his head, these visions instantly disappear. Hallucinations occur in schizophrenia.

Hemianopsic hallucinations - loss of one half of vision, occur with organic damage to the central nervous system.

Hallucinations Charles Bonnet type - always true deceptions of perception, noted when any analyzer is damaged. So, with glaucoma or retinal detachment, a visual version of these hallucinations is noted, and with otitis media - an auditory version.

Negative, those. suggested visual hallucinations. A patient in a state of hypnosis is told that after leaving the hypnotic state, for example, he will see absolutely nothing on a table littered with books and notepads. Indeed, after emerging from hypnosis, a person sees a completely clean and empty table within a few seconds. These hallucinations are usually short-lived. They are not a pathology, but rather indicate the degree of hypnotizability of a person.

In the diagnosis of mental illness, great importance is attached to the topic of visual hallucinations (as well as auditory ones). Thus, religious themes of hallucinations are characteristic of epilepsy, images of dead relatives and loved ones - for reactive states, visions of alcoholic scenes - for delirium tremens.

Olfactory hallucinations represent an imaginary perception of extremely unpleasant, sometimes disgusting odors of a decomposing corpse, decay, a burnt human body, feces, stench, unusual poison with a suffocating odor. Often, olfactory hallucinations cannot be distinguished from olfactory illusions. Sometimes both disorders exist simultaneously in the same patient. Such patients often persistently refuse to eat.

Olfactory hallucinations can occur in various mental illnesses, but primarily they are characteristic of organic brain damage with temporal localization (so-called uncinate seizures in temporal lobe epilepsy).

Taste hallucinations often combined with olfactory sensations and are expressed in the sensation of rot, “dead matter,” pus, feces, etc. in the oral cavity. These disorders occur with equal frequency in both exogenous and endogenous mental illnesses. The combination of olfactory and gustatory hallucinations and illusions, for example in schizophrenia, indicates the malignancy of the latter and a poor prognosis.

Tactile hallucinations represent a sensation of something hot or cold touching the body (thermal hallucinations), the appearance of some liquid on the body (hygric), grabbing the body from the back (haptic), crawling on the skin of insects and small animals (external zoopathy), the presence of skin “like insects and small animals” (internal zoopathy).

Some researchers also include the symptom of a foreign body in the mouth in the form of threads, hair, thin wire, described in tetraethyl lead delirium, as tactile hallucinations. This symptom is essentially a manifestation of the so-called oropharyngeal hallucinations.

Tactile hallucinations are very characteristic of cocaine psychoses, delirious stupefaction of various etiologies, and schizophrenia. With the latter, tactile hallucinations are often localized in the genital area, which is an unfavorable prognostic sign.

Visceral hallucinations are expressed in the sensation of some small animals or objects in the body cavities (green frogs live in the stomach, they breed tadpoles in the bladder).

Functional hallucinations arise against the background of a real stimulus and exist as long as this stimulus acts. For example, against the background of a violin melody, the patient hears both the violin and the “voice” at the same time. As soon as the music stops, the auditory hallucination also stops. In other words, the patient simultaneously perceives both a real stimulus (violin) and a voice of an imperative nature (which distinguishes functional hallucinations from illusions, since there is no transformation of music into voices). There are visual, olfactory-gustatory, verbal, tactile and other variants of functional hallucinations.

Close to functional reflex hallucinations , which are expressed in the fact that when one analyzer is influenced, they arise from others, but exist only during stimulation of the first analyzer.

For example, when looking at a certain picture, the patient experiences the touch of something cold and wet on the heels (reflex hygric and thermal hallucinations). But as soon as he takes his eyes off this picture, these sensations instantly disappear.

Kinesthetic (psychomotor) hallucinations manifest themselves in the fact that patients have a feeling of movement of some parts of the body against their will, although in fact there is no movement. Occurs in schizophrenia as part of the syndrome of mental automatism.

Hypnogogic and hapnopompic hallucinations appear in the patient before falling asleep: against the background of closed eyes, various visions and pictures of action appear with the inclusion of other analyzers (auditory, olfactory, etc.). As soon as the eyes are opened, the visions instantly disappear. The same pictures can appear at the moment of awakening, also against the background of closed eyes. These are the so-called drowsy, or hypnopompic, hallucinations.

Ecstatic hallucinations are noted in a state of ecstasy, are distinguished by their brightness, imagery, and impact on the emotional sphere of the patient. They often have religious, mystical content. They can be visual, auditory, complex. They last a long time and are observed in epileptic and hysterical psychoses.

Hallucinosis - a psychopathological syndrome, which is characterized by severe, abundant hallucinations against the background of clear consciousness. In acute hallucinosis, patients do not have a critical attitude towards the disease. In the chronic course of hallucinosis, criticism of hallucinatory experiences may appear. If periods of hallucinosis alternate with light intervals (when hallucinations are completely absent), they speak of mental diplopia.

At alcoholic hallucinosis, there is an abundance of auditory hallucinations, sometimes accompanied by secondary delusional ideas of persecution. Occurs with chronic alcoholism and can manifest itself in acute and chronic forms.

Hallucinosis pedicellate occurs with local damage to the brain stem in the area of ​​the third ventricle and cerebral peduncles due to hemorrhage, tumor, as well as during the inflammatory process of these areas. Manifests itself in the form of moving colored, microscopic visual hallucinations, constantly changing shape, size and position in space. They usually appear in the evening and do not cause fear or anxiety in patients. Criticism remains for hallucinations.

Hallucinosis Plauta - a combination of verbal (much less often visual and olfactory) hallucinations with delusions of persecution or influence with unchanged consciousness and partial criticism. This form of hallucinosis has been described in cerebral syphilis.

Hallucinosis atherosclerotic occurs more often in women. In this case, hallucinations are initially isolated; as atherosclerosis deepens, an increase in characteristic symptoms is noted: weakening of memory, intellectual decline, indifference to the environment. The critical attitude toward hallucinations in the early stages of the disease is lost. The content of hallucinations is often neutral and concerns simple everyday matters. As atherosclerosis progresses, hallucinations can take on a fantastic character. It is noted, as the name suggests, in cerebral atherosclerosis and in some forms of senile dementia.

Hallucinosis olfactory - an abundance of olfactory, often unpleasant hallucinations. Often combined with delusions of poisoning and material damage. It is noted in organic cerebral pathology and in psychoses of late age.

Sensory synthesis disorders.

This group includes disturbances in the perception of one’s own body, spatial relationships and the shape of the surrounding reality. They are very close to illusions, but differ from the latter in the presence of criticism.

The group of sensory synthesis disorders includes depersonalization, derealization, disturbances in the body diagram, a symptom of something already seen (experienced) or never seen, etc.

Depersonalization - this is the patient’s belief that his physical and mental “I” have somehow changed, but he cannot explain specifically what and how has changed. There are types of depersonalization.

Somatopsychic depersonalization - the patient claims that his bodily shell, his physical body has changed (the skin is somehow stale, the muscles have become jelly-like, the legs have lost their former energy, etc.). This type of depersonalization is more common with organic brain lesions, as well as with some somatic diseases.

Autopsychic depersonalization - the patient feels a change in the mental “I”: he has become callous, indifferent, indifferent or, conversely, hypersensitive, “the soul cries for an insignificant reason.” Often he cannot even verbally explain his condition, he simply states that “the soul has become completely different.” Autopsychic depersonalization is very characteristic of schizophrenia.

Allopsychic Depersonalization is a consequence of autopsychic depersonalization, a change in the attitude toward the surrounding reality of an “already changed soul.” The patient feels like a different person, his worldview and attitude towards loved ones have changed, he has lost the feeling of love, compassion, empathy, duty, the ability to participate in previously beloved friends. Very often, allopsychic depersonalization is combined with autopsychic depersonalization, forming a single symptom complex characteristic of the schizophrenic spectrum of diseases.

A special variant of depersonalization is the so-called weight loss. Patients feel how their body weight is steadily approaching zero, the law of universal gravitation ceases to apply to them, as a result of which they can be carried into space (on the street) or they can soar to the ceiling (in a building). Understanding with their minds the absurdity of such experiences, patients nevertheless, “for peace of mind,” constantly carry some kind of weight with them in their pockets or briefcase, not parting with them even in the toilet.

Derealization - this is a distorted perception of the surrounding world, a feeling of its alienation, unnaturalness, lifelessness, unreality. The surroundings are seen as painted, devoid of vital colors, monotonously gray and one-dimensional. The size of objects changes, they become small (micropsia) or huge (macropsia), extremely brightly lit (galeropia) until a halo appears around, the surroundings are colored yellow (xanthopsia) or purplish-red (erythropsia), the sense of perspective changes (porropsia) , shape and proportions of objects, they seem to be reflected in a distorted mirror (metamorphopsia), twisted around their axis (dysmegalopsia), objects double (polyopia), while one object is perceived as many of its photocopies. Sometimes there is a rapid movement of surrounding objects around the patient (optical storm).

Derealization disorders differ from hallucinations in that there is a real object, and from illusions in that, despite the distortion of shape, color and size, the patient perceives this object as this particular object, and not any other. Derealization is often combined with depersonalization, forming a single depersonalization-derealization syndrome.

With a certain degree of convention, symptoms can be attributed to a special form of derealization-depersonalization "already seen" (deja vu), “already experienced” (deja vecu), “already heard” (deja entendu), “already experienced” (deja eprouve), “never seen” (jamais vu). The symptom of “already seen”, “already experienced” is that the patient, who finds himself for the first time in an unfamiliar environment, an unfamiliar city, is absolutely sure that he has already experienced exactly this situation in the same place, although with his mind he understands: in fact, he is here for the first time and never seen this before. The “never seen before” symptom is expressed in the fact that in a completely familiar environment, for example in his apartment, the patient experiences the feeling that he is here for the first time and has never seen this before.

Symptoms of the “already seen” or “never seen” type are short-term, lasting a few seconds and often occur in healthy people due to overwork, lack of sleep, and mental stress.

Close to the "never seen before" symptom "object rotation" relatively rare. It manifests itself in the fact that a well-known area seems to be turned upside down by 180 degrees or more, and the patient may experience short-term disorientation in the surrounding reality.

Symptom "impaired sense of time" is expressed in a feeling of acceleration or deceleration of time. It is not pure derealization, since it also includes elements of depersonalization.

Derealization disorders, as a rule, are observed with organic brain damage with localization of the pathological process in the region of the left interparietal groove. In short-term variants, they are also observed in healthy people, especially those who suffered in childhood "minimal brain dysfunction"- minimal brain damage. In some cases, derealization disorders are paroxysmal in nature and indicate an epileptic process of organic genesis. Derealization can also be observed during intoxication with psychotropic drugs and narcotic drugs.

Violation of the body diagram (Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of one’s body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head increases to the size of a room, his torso either shortens or lengthens. Sometimes there is a feeling of pronounced disproportion between body parts. For example, the head shrinks to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Sensations of changes in the body diagram can appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of body diagram disorders is their correction by vision. Looking at his legs, the patient is convinced that they are of normal size, and not multi-meter; Having looked at himself in the mirror, he discovers the normal parameters of his Head, although he experiences the feeling that his head reaches 10 m in diameter. Vision correction ensures that patients have a critical attitude towards these disorders. However, when vision control ceases, the patient again begins to experience a painful feeling of changes in the parameters of his body.

Violation of the body diagram is often observed in organic pathologies of the brain.

The human body is an amazing combination of many organs, tissues, functions, chemical reactions, electrical impulses that allow a person to live, recognize and experience the world around him. Cognition occurs through influences on the human senses - light, sound, taste, smell, tactile and spatial perceptions. All this is the basis of human knowledge and existence in the world around him. And perceptual disorders, whatever they may be and for whatever reasons they occur, are a serious problem.

Perception: reality plus imagination

The fact that a person can perceive the world around him involves the senses and imagination. The knowledge that is obtained through vision, hearing, taste, tactile influence, smell and determining the position of the body in space is processed by special parts of the brain and, with the help of imagination and previously gained experience, become ideas about the world around us. Perception disorders in any area do not allow a person to obtain a holistic picture.

Far and near

And the perceptions of the data obtained are closely interrelated. Receptors that receive information about the surrounding reality transmit nerve impulses to the brain, where analysis and processing of the received information occurs 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 effect through direct contact with the object, and some through space. So, for example, taste sensations arise when food enters the mouth and tongue. But vision allows you to see objects at a distance. The perception of received information through various senses and receptors is the main mechanism for human cognition of the world. Perceptual disorders are a complex physiological and psychological problem.

Sense organs and receptors

In addition to the six senses known to everyone from school, the human body perceives many more stimuli. So, there are receptors responsible for the perception of heat - cold, pain, as well as sensations of your body. So science identifies not six, but 9 types of sensations:

• vision;
• hearing;
• sense of smell;
• touch;
• equibryoception - sense of balance;
• taste;
• nociception - perception of pain;
• thermoception - feeling of heat;
• proprioception - spatial awareness of your body.

Receiving information about the world around us with the help of various receptors, the brain processes it into perceptions of the surrounding reality.

Perceptions and medical practice

If any disturbances occur in the human body, a big problem may arise - perception disorders. Psychiatry, as a scientific and practical field of medicine, studies these disorders and, as far as possible, helps correct them. Psychiatrists have been studying perception disorders for centuries, helping not only the patients themselves, but also the people around them, to live with such problems. Disturbances in the functioning 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 what objects and colors really look like and, with the help of the other senses, can imagine 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 functioning of receptors, but by changes in the processes of processing received information and obtaining the final result.

How do perceptual disorders 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”, “normal” and “pathology” in relation to 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 an inability to perceive tactile sensations, taste and smell. Its manifestations are similar to medical anesthesia, which is caused to turn off the sensitivity of pain receptors in patients during medical interventions.
• Hyperesthesia is a sensitivity disorder caused by a seeming increase in smell, light, and sound. Very often, hyperesthesia occurs in patients who have suffered a traumatic brain injury.
• Hypoesthesia is the opposite of hyperesthesia, a change in sensitivity. Sensory perception reduces natural stimuli. Patients with depressive disorders suffer from hyposthesia, for whom the world seems dull and boring.
• Paresthesia is expressed in sensations of itching, burning, tingling, and “goosebumps” caused by impaired blood supply and innervation. Often, paresthesia occurs 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 arise 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 any disease, and not only from psychiatric practice. Competent or condition is the basis of quality treatment.

Major Perceptual Disorders

Psychiatry as a field of clinical medicine operates in terms of methodology, diagnosis, treatment and prevention. To make a diagnosis, it is necessary to clearly know the manifestations of the disease; clinical tests, medical history, laboratory and instrumental studies help with this. The categorical nature of judgments allows one to correctly interpret the data obtained in order to make an adequate diagnosis. In psychiatry, there are two main categories of perceptual disorder to refer to certain mental health problems:

• illusions;
• hallucinations.

Both concepts evoke quite negative feelings in most people, but the patient himself has no control over them, although in many cases such disorders occur due to conditions into which a person has driven himself, for example, drug or alcohol poisoning. Some types of perception disorders can occur in completely healthy people in terms of psychiatry.

Blue Caterpillar from Wonderland

“What you see, but which is not really there” - that’s it, a hallucination. Problems in perceiving reality as it really is are manifested by the emergence of pseudo-real images. Psychiatry, studying perception disorders, defines hallucinations as an image that appears in the mind and is defined as really existing, but without an external stimulus affecting human receptors. These images appear out of nowhere, so to speak, due to a disorder of perception. Psychiatrists divide hallucinations into several types:

• - represent vivid images that for the patient have certain shapes, colors, smells, and produce 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 a patient experiencing true hallucinations, all people around him should perceive them exactly the same way as he does.
• Pseudohallucinations are perceived by the patient as something unnatural, but really existing; it is devoid of brightness, often incorporeal, and can originate either from the body of the patient himself, or from areas 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, devices, machines, or due to mental influence exerted on him.

In addition to these two types, hallucinations are also divided according to the sense organs by which they can be caused:

• visceral;
• taste;
• visual;
• olfactory;
• auditory;
• tactile.

Each type of hallucination has its own scientific definition and can be divided into several subtypes, which is important for clinical psychiatry.

By the way, hallucinations can be suggested or caused. One of the methods of psychiatry uses the Aschaffenburg symptom, when the patient is allowed to listen to a previously switched off telephone, thus checking his readiness for auditory hallucinations. Or Reichardt's symptom is a symptom of a blank sheet: the patient is given a completely white sheet of paper and asked to talk about what is depicted on it. Hallucinations can also be functional, occurring against the background of stimulation of certain receptors and disappearing after the stimulus is removed. 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 considered by many to be a classic hallucination.

Such a beautiful illusion

In psychiatry, there is another type of perception disorder - illusion. 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 of the types of perception disorder sounds like an incorrect, erroneous perception of objects that exist in reality. Deception of feelings - that is what 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. Characteristic signs of illusion are:

• object or phenomenon subject to sensory distortion: figure, voice, tactile or spatial sensation;
• distortion, incorrect perception and evaluation of a real object;
• the illusion is based on sensory perception, that is, a person’s receptors are actually affected, but it is perceived somewhat differently than it actually is;
• the feeling of the false as really existing.

Visual perception disorder is one of the common illusions of healthy people. Moreover, such an error may be of a physical or physiological nature. The physical nature of illusions has nothing to do with psychiatry; the same mirage in the desert has a logical basis, albeit not too simple, but proven by the exact science of physics. Clinical psychiatry considers psychopathological illusions:

• affective, arising against a background of fear or nervous excitability about impending danger;
• verbal, i.e. 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 pattern on wallpaper can become an illusion of the frightening content of the picture; Most often, such illusions are observed in creative individuals; for example, scientists have found that Leonardo da Vinci suffered from pareidolia.

The basis of illusions is disorders of perceptions and ideas about the world around us. They are not always pathological in nature. They are often caused by a distortion of perception due to an incorrect assessment of the functioning of the receptors.

Thinking and memory in perceptual disorders

What distinguishes Homo sapiens from all other living beings? Ability to think. Thinking is the main cognitive process that unites 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 over thousands of years. And if at first it was only necessary to exert physical force to satisfy one’s natural needs (food, reproduction and self-preservation), then over time a person learned to build logical chains - to think in order to get the desired 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 perception and thinking disorders - psychosensory disorders. In psychiatry, these disorders are divided into two main types:

• depersonalization can be manifested by both incorrect sensations of one’s body, the so-called mental depersonalization, and distorted concepts of one’s own “I” - mental depersonalization;
• Derealization manifests itself 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 of the correctness of his vision.

Thinking is a human characteristic. Reasonable thinking is challenged by perceptual disturbances. Psychiatry, as a field of clinical medicine, is trying to find ways to resolve the disagreements caused by perceptual disturbances in mental patients. With perceptual disorders, patients also exhibit a thinking disorder - delusions, obsessive thoughts, or which become the meaning of such a person’s life.

Psychiatry is a complex science about human mental illnesses, the area of ​​which includes disorders of perception, memory, and thinking, as well as other mental functions. Moreover, any mental health problems are most often associated with a whole range of mental functions - from the functioning of the senses to short-term or long-term memory.

Why is the perception of reality disrupted?

When faced with psychiatric problems, the question arises: what are the causes of perception disorders? There can be a whole range 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, the events that 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 consequence of any diseases of internal organs or systems, as well as due to disruption of the processes of processing received information, analyzing it and obtaining a specific result. Psychiatric practice at the moment cannot absolutely accurately determine the causes of the development of perception disorders, except for intoxication, when the mechanism of pathology is precisely determined by the toxic substance. Disturbances in the perception of reality can and should cause caution among people around them, since often the patients themselves are in no hurry to turn to specialists, not considering these disturbances as something pathological. A timely identified problem with the perception of 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.

Children's fantasies and perceptual disorders

Child psychiatry and psychology is a special type of medicine. Children are great dreamers and inventors, and the increased reactivity of the child’s psyche and insignificant life experience do not give the child the opportunity to independently correct unreal sensations in time. That is why perception disorders in children are a special area of ​​pedagogy, psychology and psychiatry. Visual and auditory illusions are one of the components of every person’s childhood. A scary fairy tale told at night becomes a real nightmare for the baby, hiding under the crib or in the closet. Most often, such disorders occur in the evening, affecting the child’s fatigue and drowsiness. Scary tales and stories, especially those told to a 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 increased body temperature. The age at which such disorders most often manifest 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 different ages can also suffer from manifestations of schizophrenia. In this case, all hallucinations acquire a complex, often ominous character. The plot of hallucinations is complex, often endangering the health or even the life of the baby. Children of older adolescence, which is 12-14 years old, are characterized by the development of taste and tactile hallucinations, the child begins to refuse previously loved foods, and his character and behavior change.

Pediatrics and child psychiatry classifies children with congenital disturbances 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 is that a child with congenital hearing loss has excellent vision, notices the smallest details, and 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 types of receptors. But in addition to sensations, the information received must be transmitted to the appropriate parts of the brain, where it must undergo a process of processing and analysis, drawing up an overall picture of reality based on a complex of sensations and life experiences. 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 appearance, stages of development, signs and symptoms, methods of treatment and prevention of perception disorders, both individual phenomena and components of general human health problems.

INTRODUCTION

In the formation of a professional doctor, the role of general psychopathology can hardly be overestimated. It creates the basis for the successful study of special branches of psychiatry. Moreover, its assimilation contributes to the development of medical thinking, and especially that part of it that is called clinical thinking. In many textbooks, issues of general psychopathology are characterized by complexity of presentation, and sometimes by contradictory interpretations of individual disorders. In this regard, in this manual an attempt is made to present materials on the main (basic) sections of general psychopathology in a systematized and understandable form, which contributes to the quality and strength of their assimilation.

The subject of general psychopathology is the semiotics of mental disorders, i.e. description of symptoms and syndromes of mental illness. Symptoms, as clinical criteria for the pathological state of the body, are divided into general and local, functional and organic, favorable and unfavorable, positive, negative, “core” and transient, etc. Each individual symptom does not allow us to judge a specific mental illness. At the same time, their characteristic combination (syndrome), as a typical set of pathogenetically related symptoms, reflects the pathogenesis of mental illness. The clinical picture of the disease is formed from the syndromes and their successive changes. Therefore, the diagnosis of mental illness begins with an analysis of symptoms, which teach us to see the picture of mental illness and answer questions about what and how is happening to the patient.

Normal human mental activity is a unity of various processes: sensations, perception, thinking, attention, memory, intelligence, emotions and will, which was the basis for describing mental activity in pathology. When analyzing the patient's mental state (status), disturbances in each of these processes are examined and described.

Lesson 1

PATHOLOGY OF SENSATIONS AND PERCEPTION

FEEL– reflection of individual properties and qualities of objects and phenomena. This is the initial stage and the simplest type of cognitive activity.

Classification of sensations:

1. By modality: visual, auditory, tactile, tactile

2. According to the location of the receptors: e xteroceptive, proprioceptive, interoceptive.

There are also protopathic (primitive) sensations - sensations characterized by undifferentiation, lack of specific localization, external projection and direct connection with cognitive processes. They inform about the vital functions of the body and are inseparable from emotional states.

SENSATION DISORDERS:

ANESTHESIA - loss of sensitivity, HYPESTHESIA - its decrease, HYPERESTHESIA - increase in one or more types of sensitivity.

ANALGESIA – loss of pain sensitivity.

PAINFUL MENTAL ANESTHESIA is a painful weakening of any type of sensitivity associated with a loss of the emotional tone of sensations.

HYPERALGESIA – increased pain sensitivity (with mild depression).

PARESTHESIA – unpleasant sensations of burning, tingling, skin tightening, crawling insects (occurs when nerve conductors are disrupted, in particular vascular innervation).

SENESTOPATHIES - unpleasant, painful sensations without a clear localization, which are described by patients with difficulty, using “as if”, “as if ...” there is a fire inside, something is shimmering, gurgling in the stomach... Senestopathies are localized on the surface of the skin, under the skin, in internal organs and body cavities (heart, stomach, abdominal cavity, etc.).

ITCHING is a perverted feeling of pain.

PAIN (describe how it is tolerated in various diseases).

PERCEPTION– reflection of objects and phenomena as a whole (in all the diversity of their properties and qualities). Perception is not reduced to a mechanical summation of individual sensations; it is not the result of simple associations of individual features. Complete perception of an object is the result of complex analytical-synthetic activity, which involves identifying essential features and combining them into one meaningful whole - into the image of an object.

Types of perception – perception of time, space, movement.

PATHOLOGY OF PERCEPTION:

	HALLUCINATIONS (imaginary perceptions)		PSYCHOSENSORY DISORDERS (distorted perception of an object)

1. Illusions- distorted perception of really existing objects and phenomena. They occur in healthy people.

TYPES of illusory perception:

Physical - incorrect perception of an object due to the physical properties of the environment (a spoon refracted in a glass, a mirage...)

Psychological – illusions associated with the psychological characteristics of the perception process (changes in attention, affective state, attitude).

Physiological - illusions associated with the functioning of analyzers.

Classification of illusions:

1. By analyzers: visual, auditory, olfactory, gustatory, tactile.

2. Affective illusions arise in connection with the affects of fear, anxiety, horror (in the frosty patterns of the window he sees the face of a robber, in the folds of the blanket he sees a hidden killer, instead of the usual knock - the clicking of a gun bolt, shots).

3. Pareidolic – are visual illusions with fantastic content and occur against the background of slight clouding of consciousness (at high temperatures, the child sees heroes from fairy tales in the carpet patterns, sees faces and people in cracks on the ceiling; portraits come to life).

2.HALLUCINATIONS – imaginary perception (perception without an object). The definition contains the following main features: the appearance of hallucinations is not associated with the perception of really existing objects (the exception is functional and reflex hallucinations), the patient simultaneously perceives real phenomena and a hallucinatory image.

Types of hallucinations:

1. By the senses: visual, auditory, olfactory, tactile, hallucinations of the general sense.

Visual:

Colored,

Black and white,

Mobile, stationary, multiple, single,

Zoological,

Scene-like

Elementary (photopsies: stripes, dots, spots, sparkles, flies).

Auditory:

Imperative (imperative),

Commenting,

Antagonistic (sometimes praised, sometimes hated),

Threatening,

Accusing, insulting.

Acoasmas (elementary non-speech hallucinations): individual sounds, steps, breathing, knocking, ringing, creaking floorboards.

Phonemes (calling names, screams, groans, crying, sighs).

4. Depending on the conditions under which hallucinations occur, the following types are distinguished:

- Hypnagogic hallucinations – with eyes closed, before falling asleep or at dusk.

- Hypnopompic hallucinations – when waking up from sleep (usually visual, less often auditory).

- Reflex hallucinations - localized in one of the analyzers when stimuli act on the other.

- Functional hallucinations - develop at the moment of action of a real stimulus and within the same analyzer.

- Hallucinations of Charles Bonnet - occur when the function of the analyzer is impaired, first described in patients suffering from senile cataracts and hearing loss (single or multiple, scene-like, colored, mobile).

There are also hallucinations:

MOTOR (kinesthetic) - a feeling that they are moving their arms, shaking their heads, bending their body down.

VISCERAL (hallucinations of general feeling) - false sensations of the presence of something foreign inside the body or in some organ (living beings, foreign bodies, objects).

Hallucinations are divided into TRUE and FALSE (pseudogallucinations).

True and pseudohallucinations

3. PSYCHOSENSORY DISORDERS – disturbance of sensory synthesis.

Types of psychosensory disorders:

- Violation of the body diagram: distorted perception of the shape or size of one’s body (reduction or enlargement of individual parts of the body).

- Derealization– disruption of the perception of the real world, i.e. shape, size of an object. Macro- and micropsies; twisted objects, polyopsia (instead of one - several objects).

- Color perception disorders(with depression everything is black and gray.)

- Symptoms of something already seen or never seen.

- Depersonalization– violation of the perception of one’s own personality (split of one’s self into physical and mental).

Methods for studying sensations and perception: observation, conversation, for perception disorders - sensory excitability, Aschaffenburg, Reichard, Litman tests.

Test questions for self-study

1. Sensation: concept, types of sensations and their features.

2. Characteristics of the pathology of sensations (hyper(hyper)esthesia, anesthesia, paresthesia, senestopathy).

3. Perception, types of perceptions.

4. General characteristics of perception disorders: illusions, hallucinations, psychosensory disorders.

5. Distinguishing between illusions and hallucinations.

6. Illusions, their types.

7. Hallucinations, classification of hallucinations.

8. The concept of pseudohallucinations, differential diagnosis of true and pseudohallucinations.

9. Violations of sensory synthesis (derealization, depersonalization, schema violation).

10. Methods for studying sensations and perception.

Topics for abstracts:

1. The meaning of sensations and perceptions in human life.

2. Illusions: types, mechanisms, clinical significance.

3. Illusions and hallucinations of states of darkened consciousness.

PATHOLOGY OF PERCEPTION

Perception is a complex system of processes for receiving and transforming information, which allows the body to realize the functions of reflecting objective reality and orientation in the surrounding world. Together with sensation, perception synthesizes the starting path of the cognition process, supplying the body with suitable sensory material. Perception in the process is somehow mediated by the activity of thinking and verified by practice.

Of the numerous stimuli acting on the body, only a part is perceived. This depends both on the physiological characteristics of the brain structure and on previous experience. A person does not passively perceive everything that affects his senses. He perceives everything that corresponds to his attitude, interest, leaving in the background or excluding everything else. Perception, in contrast to sensation, undoubtedly includes a centrifugal (fugal) component and is active, which is confirmed by the semantics of this term. The basis of perception really lies, as we know, on a set of isolated sensations. However, such a process refers only to the analysis of objects and phenomena that have no connections with previous experience, completely new to the subject, alien to him, requiring research. In the same way, such a process of perception is linked to socio-historical and individual experience, it represents a holistic process of recognition and assimilation of objects and phenomena, and this determines the further perception of details, individual parts of the object. The concept of structure in relation to the process of perception should be spoken of not only with reference to the specific anatomical structure of the brain apparatus, but also as a special functional principle.

Here, in particular, one has to take into account the damage or pathological interest of the area of ​​the interparietal sulcus, which is important for the synthesis of sensations that relate to various sense organs. A number of researchers have shown that when this zone is damaged, pathological phenomena are observed that are included in the concept of “metamorphopsia”, when the shape of perceived objects is distorted; in addition, disorders of the “body scheme” may be observed, when the patient, for example, seems that his head or body is enlarging and occupying the entire room, etc. M. O. Gurevich showed (1949) that these disorders of the cerebral apparatus studied neurologists, are also important in the psychiatry clinic.

From the point of view of representatives of “Gestalt psychology”, the environment is always perceived as a kind of unity that has a foreground and a background. In line with this psychology, the idea of ​​K. Goldstein (1880) is developed, linking the activity of the frontal lobes with the ability to highlight the essential, to delimit the “figure from the main background.” Although the methods of “Gestalt psychology” do not fully meet all the requirements of a universal method for explaining mental phenomena, this structural principle in itself deserves attention.

The mechanism of perception depends on the correct function of receptors (sense organs) and analyzers (central organs), consisting of a number of transformers (nerve nodes), through which the energy received from the external world is converted into a substrate for the mental function of perception; this mechanism also depends on the state of consciousness and attention and, in addition, on social experience. Of particular importance are dysfunctions of the central mechanisms of perception, especially if there is not a complete loss of functions, but only pathological changes leading to a distortion of sensory experience and to the so-called deceptions of the senses, which are the main psychopathological disorders associated with disturbances in this area.