DISORDERS OF SENSATION AND PERCEPTION. Theory

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

The basis of sensory cognition is obtaining objective information about the world around and the internal state of the human body through the work of analyzers - visual, auditory, gustatory, olfactory, tactile and proprioceptive. However, analyzers allow us to obtain the sensations available to us (heat, cold, color, shape, size, surface quality, severity, taste and smell) information only about certain qualities of an object. The final conclusion about the essence of perceived objects and phenomena is not just the result of the summation of sensations, but a complex process of analyzing features, highlighting the main (meaning-forming) qualities and secondary (random) phenomena, comparing the information received with ideas that reflect our previous life experience in memory. For example, we have an idea of what a "chair", "dress", "purse" is, and we recognize these objects regardless of their color, size, intricate shape. Doctors, having an idea of the symptoms of diseases, recognize them in the stream of insignificant information about the patient's condition. Lack of experience makes perception incomplete: for example, without the necessary training, it is impossible to detect auscultatory signs of pneumonia, even in the presence of subtle hearing.

Impaired thinking also significantly affects the result of perception: for example, a mentally retarded patient may well examine the doctor's white coat, the environment of the ward, but is unable to answer the question of where he is, what is the profession of his interlocutor. The psyche of a healthy person recreates a complete picture of the phenomenon even if disturbances in the functioning of the sense organs do not allow him to receive complete information. So, a person with a hearing impairment can guess the meaning of what was said without even hearing one of the words said. With dementia, a person with good hearing often gives the impression of hearing impairment, because he does not understand the meaning of the words he heard, he can confuse words that are similar in sound, despite their inappropriateness, inappropriateness to the situation. The process of sensory cognition of the world described above, which is the result of the integral work of the entire psyche, can be defined as perception.

Disorders of sensations

Disorders of sensations are associated with damage to the peripheral and central parts of the analyzers, with a violation of the pathways of the central nervous system. So, the sensation of pain usually indicates irritation of pain receptors by a painful process, and can also represent a lesion of the conducting nerve trunks (phantom pain).

In mental illness, sensations can be formed in the brain independently of the information coming from the analyzers. This is the nature of psychogenic hysterical pains, which are based on the mechanism of self-hypnosis. Painful sensations in depressive syndrome (pain in the heart, in the abdomen, headache, etc.) are very diverse. All these disorders are the cause of prolonged and ineffective examination and treatment by a therapist or even a surgeon (see Chapter 12).

Features of the mental state largely determine the threshold of sensitivity, examples of changes in which in mental disorders are symptoms of general hyperesthesia, general hypesthesia and the phenomenon of hysterical anesthesia.

Hyperesthesia is a general decrease in the threshold of sensitivity, perceived by the patient as an emotionally unpleasant feeling with a touch of irritation

This leads to a sharp increase in the susceptibility of even extremely weak or indifferent stimuli. Patients complain that they cannot fall asleep because "the alarm clock ticks right in the ear", "the starched sheet rattles like a tram", "the moon shines right in the eyes."Discontent is caused by phenomena that were previously simply not noticed by the patient (the sound of water dripping from the tap, the beat of his own heart).

Hyperesthesia is one of the most characteristic manifestations of asthenic syndrome, in which it is observed in many mental and somatic diseases. This is a nosologically nonspecific symptom, indicating a general state of depletion of mental activity. As the main disorder, hyperesthesia appears in the mildest neurotic diseases (neurasthenia)

Hypesthesia is a general decrease in sensitivity, manifested by an unpleasant feeling of change, fading, dullness of the surrounding world. Patients note that they cease to distinguish shades of color, taste of food; sounds seem to them muffled, uninteresting, as if coming from afar

Hypesthesia is characteristic of a state of depression. In this syndrome, it reflects the general pessimistic background of the mood of patients, suppression of drives and a general decrease in interest in life

- A 32-year-old patient with a diagnosis of manic-depressive psychosis, describing the symptoms typical of the onset of a depressive attack, notes that the first sign of the onset of the disease, as a rule, is the feeling that he does not feel the taste of cigarettes, smokes without pleasure. At the same time, appetite decreases sharply. Even the dishes that have always been eaten with great pleasure seem to be devoid of distinct taste, "like grass." Music does not evoke the usual emotional response in the patient, it seems deaf and colorless.

Hysterical anesthesia is a functional disorder that occurs in Persons with demonstrative character traits immediately after the action of psychotrauma

With hysteria, both loss of skin (pain, tactile) sensitivity and loss of hearing or vision are possible. The fact that information enters the brain can be judged by the presence of evoked potentials on the EEG. However, the patient himself is quite sure that there is a gross sensory disorder. Since this condition is formed by the mechanism of self-hypnosis, the specific manifestations of anesthesia can be very different from the symptoms in organic neurological lesions and in diseases of the sense organs. Thus, areas of skin anesthesia do not always correspond to typical areas of innervation. Instead of a smoothed transition from a healthy area of the skin to an insensitive distal part of the limb, which is characteristic of polyneuropathy, a sharp border is possible (by the amputation type). An important sign of the functional hysterical nature of the disorders is the presence of unconditioned reflexes, for example, the "gaze tracking" reflex (while maintaining vision, the eyes are fixed on objects and cannot move simultaneously with head turns). With hysterical skin anesthesia, atypical persistence of reaction to cold objects is possible in the absence of pain sensitivity.

In hysterical neurosis, anesthesia can be observed for a relatively long time, but more often it occurs in a demonstrative personality as a transient reaction to a specific traumatic event.

In addition to a general decrease or increase in sensitivity, a manifestation of a mental disorder is the occurrence of atypical or pathologically perverted sensations.

Paresthesia is a common neurological symptom that occurs when peripheral nerve trunks are affected (for example, in alcoholic polyneuropathy)

It is expressed in the familiar to many feeling of numbness, tingling, "creeping creeps." Paresthesias are often associated with a transient disturbance of the blood supply to the organ (for example, during sleep in an uncomfortable position, with strenuous walking in patients with Raynaud's disease), are usually projected onto the surface of the skin and are perceived by the patients themselves as a psychologically understandable phenomenon.

Senestonation is a symptom of mental disorders that manifests itself in an extremely diverse, always extremely subjective, unusual sensations in the body, an indefinite, undifferentiated nature of which causes serious difficulties in patients when trying to accurately describe the feeling experienced

For each patient, it is completely unique, not similar to the sensations of other patients: some compare it with stirring, trembling, seething, stretching, squeezing; others do not find words in the language that adequately reflect their feelings, and invent their own definitions (“gagging in the spleen,” “shurundite in the back of the head,” “twisting under the ribs”). Sometimes senestopathies resemble somatic complaints, however, when clarifying, the patients themselves often emphasize the psychological, inorganic nature of the disorders ("I feel that the anus is sticking together", "it seems that the head is coming off"). When compared with the physical feeling of pain, patients clearly indicate a significant difference (“it’s better that it just hurts, otherwise it turns right inside out”).

Often, senestopathies are accompanied by thoughts of the presence of some kind of somatic illness. In this case, the condition is referred to as senestopathic-hypochondriac syndrome.

Senestopathies are not a nosologically specific symptom: they can occur in mild neurosis-like forms of schizophrenia and various organic brain lesions, accompanied by mild neurosis-like symptoms. In schizophrenia, attention is drawn to the dissociation between the mild, seemingly insignificant nature of the symptom and the pronounced maladjustment of patients.

So, one of our patients could not continue to work as a turner, because he constantly felt "a chill in his mouth", another dropped out of college, because he constantly felt "a soft warm substance, like dough, flowing down the surface of the brain." With organic lesions of the brain, senestopathies acquire a particularly pretentious, complex character.

A 49-year-old patient who suffered a head injury about 10 years ago, along with complaints of fatigue and memory loss, notes extremely unpleasant sensations for him in the face and upper half of the body, which are not constantly observed, but occur periodically. First, a tingling appears, and then on the face, as it were, areas of "bending and twisting" in the shape of the letter "G" are formed. At this moment, a suffering expression is visible on the patient's face. However, after 1-2 minutes, the unpleasant sensations disappear and the patient calmly continues the conversation with the doctor.

Deceptions of perception

Deceptions of perception include illusions and hallucinations. These are rather complex mental disorders, involving the perversion of many mechanisms of the perception process, an extraordinary revival of the ideas stored in the patient's memory, supplemented by imagination.

Perceptual delusions are productive (positive) symptoms.

Illusions

Illusions are disorders in which real-life objects are perceived as completely different objects and objects

From pathological illusions, one should distinguish between errors of perception in mentally healthy people with difficulties in obtaining objective information about the external world. So, errors are quite natural in a darkened room or with significant noise, especially in people with hearing and vision impairments. A hearing aid wearer may feel that people are talking to each other, calling his name, discussing or condemning his actions

The occurrence of errors in a healthy person is often associated with the presence of an attitude toward the perception of a certain object, with a state of expectation. So, a mushroom picker in the forest easily takes a bright autumn leaf for a mushroom cap.

Illusions in mental illness are of a fantastic, unexpected nature; they arise when there are no obstacles to obtaining reliable information. Often the basis for the formation of such illusions is a darkened or affectively narrowed consciousness.

Affectogenic illusions appear under the influence of extreme anxiety and feelings of fear, most clearly seen in patients with an acute attack of delirium, when it seems to them that the persecutors are surrounding them from all sides

In the conversation of a random group of people, patients hear their name, insults, threats. In the unexpected exclamations of those around them, they see the words "war", "shooting", "spy". The patient escapes from pursuit by flight, but in different parts of the city he picks up new phrases in the speech of passers-by, consistent with the fear he is experiencing.

Pareidolic illusions (pareidolias) are complex fantastic images that forcibly arise when examining real objects

In this case, against the will of the patient, the fuzzy, indefinite pattern of the wallpaper turns into a "plexus of worms"; the flowers depicted on the teacup are perceived as "evil eyes of an owl"; stains on the tablecloth are mistaken for a "bunch of cockroaches." Pareidolic illusions are a rather gross mental disorder that usually precedes the appearance of hallucinations and is most often observed in the initial period of delirious stupefaction (for example, with delirium tremens or infections with severe intoxication and fever).

A 42-year-old patient, who abused alcohol for many years, felt extremely anxious in a state of hangover, could not fall asleep, constantly walked around the rooms, as it seemed that there was someone in the house. Opening the bathroom door, I clearly saw a man with a gray beard in a turban and a long oriental dress standing at the door. Grabbed him, but found himself holding a bathrobe. Angrily, he threw him to the floor and went to the bedroom. At the window I saw the same oriental man again, rushed to him, but realized that it was a curtain. I went to bed, but I could not sleep. I noticed that the flowers on the wallpaper became convex, they began to grow out of the wall.

One should distinguish from paraidolic illusions the natural desire of healthy people to “dream up” by looking at clouds or a frosty pattern on glass. Artistically gifted people develop the ability to eideticism - the ability to sensually, vividly represent imaginary objects (for example, a conductor, when reading a score, can clearly hear the sound of an entire orchestra in his head). However, great

an even person always clearly distinguishes between real and imaginary objects, is capable of stopping the flow of ideas at any time at will.

Hallucinations

Hallucinations are perceptual disorders in which objects or phenomena are found where there is really nothing

Hallucinations indicate the presence of a gross mental disorder (psychosis) and, unlike illusions, cannot be observed in healthy people in their natural state, although with altered consciousness (under the influence of hypnosis, drugs) they also appear for a short time in a person without a chronic mental illness. In general, hallucinations are not a specific diagnostic feature of any disease. They are extremely rare as an isolated disorder (see section 4.5) and are usually accompanied by other psychotic symptoms (clouding of consciousness, delirium, psychomotor agitation), therefore, in order to establish a diagnosis and form the appropriate therapeutic tactics, the features of the manifestation of this symptom in a particular patient should be carefully analyzed.

There are several approaches to classifying hallucinations. The oldest and most traditional method is the division according to the senses. Thus, visual, auditory, tactile, olfactory and gustatory hallucinations are distinguished. In addition, hallucinations of the general feeling (visceral) arising from the internal organs are often found. They can be accompanied by hypochondriacal ideas and sometimes resemble senestopathies, from which they differ in distinct objectivity and clarity. So, one patient with schizophrenia quite clearly felt a dragon inside her, the head of which stretched through her neck, and the tail crawled out through the anus. The distinction between hallucinations by sense organs is not essential for diagnosis. It should only be noted that visual hallucinations are much more common in acute psychoses and are usually unstable; auditory, on the contrary, often indicate chronic persistent psychosis (for example, in schizophrenia).

The occurrence of gustatory and especially olfactory hallucinations in schizophrenia usually indicates a malignant, therapy-resistant variant of psychosis.

There are several special variants of hallucinations, the appearance of which requires the presence of certain conditions, for example, the patient's sleepiness. Hallucinations that occur when falling asleep are called hypnagogic, when awakening, hypnopompic. Although these symptoms do not belong to extremely gross mental disorders and rarely occur in healthy people with fatigue, however, with severe somatic diseases and alcohol withdrawal syndrome, they serve as an early sign of onset delirium and indicate the need to start specific treatment.

A 38-year-old patient, who abused alcohol for a long time, could not fall asleep against the background of severe abstinence, tossed and turned in bed. When trying to fall asleep, nightmares immediately arose (the patient dreamed that he was lying among many snakes), forcing him to wake up immediately. In one of the awakenings in the dark, I clearly saw a mouse on the headboard. He reached out and touched. The mouse was warm, covered with soft fur, sat quite solidly and did not run anywhere. The patient jerked his hand back, jumped out of bed, hit the imaginary animal with a pillow with all his might. Turning on the chandelier, I could not find a mouse. There were no other visions at that moment. I went to bed and tried to sleep. Later I woke up again and saw on the blanket a small creature with thin sharp horns, thin legs with hooves and a long tail. I asked "besik" what he needed. He laughed, but did not run away. The patient tried to grab him, but did not catch him. With the lights on, all visions disappeared. The next night, the patient with signs of acute alcoholic delirium was hospitalized in a psychiatric hospital.

Especially vivid and profuse hypnagogic and hypnopompic hallucinations are noted with narcolepsy (see section 12.2).

Functional (reflex) hallucinations occur only in the presence of a specific stimulus. These include the speech that a person hears under the sound of wheels; voices in your head when you turn on the TV; auditory hallucinations that occur under the shower. With the termination of the action of the stimulus, the deceptions of perception can disappear. These states differ from illusions in that imaginary images are perceived simultaneously with the stimulus, and do not replace it.

Psychogenic and suggested hallucinations are more often observed in persons suggested, with demonstrative character traits and are especially pronounced in hysterical reactive psychoses. In this case, they arise immediately after the traumatic situation, reflect the most important experiences of the person (a woman who has lost her husband talks to his photograph, hears her husband walking, sings a lullaby to her).

Charles Bonnet described the occurrence of hallucinations in people with a sharp decrease in vision (senile cataract). Similar conditions were later noticed with hearing loss. It is possible that the mechanism of sensory deprivation plays a role in the genesis of such hallucinations (for example, during a long stay of a person in a dark cave).

According to the degree of complexity, hallucinations can be divided into elementary, simple, complex and scene-like.

Examples of elementary hallucinations are acoasms (knocking, clicks, rustling, whistling, crackling) and photopsies (lightning, flashes, mice, flickering, points in front of the eyes). Elementary hallucinations often indicate a neurological disease, damage to the primary areas of the cerebral cortex (with brain tumors, vascular lesions, in the area of an epileptogenic sclerotic focus).

Simple hallucinations are associated with only one analyzer, but they differ in a formalized structure and objectivity. An example is verbal hallucinations, in which a person hears non-existent speech of very different content. The following variants of verbal hallucinations are distinguished: commenting (remarks about a person's actions, thoughts that arise in his head), threatening (insulting, intending to kill, rape, rob), antagonistic (the patient, as it were, witnesses a dispute between a group of his enemies and his defenders), imperative (commands, orders, requirements to the patient). Verbal hallucinations are more often perceived by a person as an interference with his personal life. Even with a benevolent character, they often irritate the patient. Patients internally resist observing themselves, refuse to obey the commands of the voices, however, with a sharp exacerbation of the disease, they are unable to overcome the insistent demands of the voice, under the influence of imperative hallucinations, they can commit murder, jump out the window, burn themselves with a cigarette, and try to pierce their eyes. All this allows us to consider imperative hallucinations as an indication for involuntary hospitalization.

Complex hallucinations involve deceptions by several analyzers at once. When consciousness is clouded (for example, with delirium), the entire environment can be completely transformed by hallucinatory images, so that it seems to the patient that he is not at home, but in the forest (at the dacha, in the morgue); he attacks visual images, hears their speech, feels their touch. In this case, one should speak of oscene-like hallucinations.

It is very important for conducting a diagnostic search to separate the deceptions of perception into true hallucinations and pseudo-hallucinations. The latter were described by V. Kh. Kandinsky (1880), who noticed that in a number of cases hallucinations differ significantly from the natural process of perception of the surrounding world. If in true hallucinations painful phantoms are identical to real objects: they are endowed with sensual liveliness, volume, are directly related to the objects of the situation, are perceived naturally, as if through the senses, then with pseudo-hallucinations one or more of these properties may be absent. Therefore, pseudo-hallucinations are regarded by the patient not as real objects and physical phenomena, but as their images. This means that during pseudo-hallucinations, a person sees not objects, but "images of objects", he catches not sounds, but "images of sounds." Unlike genuine objects, pseudo-hallucinatory visual images are devoid of corporeality, weight, they are not among existing objects, but in the ether, in another imaginary space, in the patient's mind. Sound images lack the usual characteristics of sound - timbre, pitch, direction. Pseudohallucinations are often perceived, according to patients, not by the senses, but by the “inner gaze”, “inner hearing”. The unusual, unnatural nature of what they are experiencing forces patients to believe that they are being influenced, that images are specially inserted into their heads with the help of technical devices (lasers, tape recorders, magnetic fields, radars, radio receivers) or through telepathy, hypnosis, witchcraft, extrasensory influence. Sometimes patients compare verbal pseudo-hallucinations with sounding thoughts, without distinguishing by timbre to whom the voice belongs: a child or an adult, a man or a woman. If, in true hallucinations, sounds and imaginary objects, like real objects, are outside of the patient (extraprojection), then with pseudohallucinations they can emanate from the patient's body, his head (intraprojection) or be taken from areas inaccessible to our sense organs (projection outside the boundaries sensory horizon), for example from Mars, from another city, from the basement of a house. The behavior of patients with pseudo-hallucinations is adequate to their idea of the essence of the phenomena they observe: they do not flee, do not attack imaginary persecutors, for the most part they are sure that others cannot perceive the same images, since they are supposedly transmitted specifically for the patient. You can list many signs that distinguish pseudo-hallucinations from true ones (Table 4.1), however, it should be borne in mind that one patient does not have all of the listed signs at the same time, therefore, any hallucination should be attributed to pseudo-hallucinations, one or a number of signs significantly different from the usual, natural perception of the surrounding world.

Table 4.1. The main signs of true hallucinations and pseudo-hallucinations

In their main manifestations, pseudo-hallucinations are quite consistent with the concept of "hallucinations": they are a sign of psychosis, patients usually cannot treat them critically, since they perceive them as a completely objective phenomenon, despite their difference from ordinary, real objects. In connection with the above, we note that some psychiatrists, considering the term "pseudo-hallucinations" not entirely successful, use instead the more cautious name "hallucinoids" [Osipov VP, 1923; Popov A. E., 1941].

True hallucinations are not a nosologically specific phenomenon; they can be observed in a wide range of exogenous, somatogenic and organic psychoses.

In principle, their appearance is also possible in an acute attack of schizophrenia (especially with additional exposure to intoxication factors or somatic illness). However, they are most clearly manifested in delirious confusion.

Pseudo-hallucinations differ from true ones in greater specificity. Although they are not considered a pathognomonic symptom, they are much more common in clinical practice than in any other disease in paranoid schizophrenia (see section 19.1.1). Pseudohallucinations are an important part of the Kandinsky-Clerambo mental automatism syndrome characteristic of schizophrenia (see section 5.3). Let's give an example.

A 44-year-old patient, an engineer, has been observed by psychiatrists for the last 8 years in connection with complaints of threatening voices and the impression of physical remote influence. The disease began with the feeling that the patient's performance in his own apartment was reduced. After examining various rooms, I discovered that my well-being in the kitchen was deteriorating, and a prolonged stay in which gave rise to the feeling that "the ray is penetrating the brain." I tried to find out who lives in the neighboring apartments. Soon, simultaneously with the action of the beam, I began to hear in my head shouts by name, which were sometimes joined by insults and short threats ("we will kill …", "We will get you …", "got caught …"). I could not understand who was pursuing him, because the voices were low, with an unnatural "metallic" timbre. The police refused to help him. I "understood" that the persecution was organized by a group of police officers who invented some kind of special device. Despite the objection of his relatives, he changed his apartment to one located in another district of Moscow. At first I felt uneasy there, but the “voices” did not arise, and after about 2 weeks they reappeared. He tried to leave them in the forest, where he felt calmer. At home, I made a wire mesh to shield my head from exposure, but was disappointed to find that it did not help.

Identifying hallucinations is usually not difficult because in a psychotic state patients cannot hide from the doctor significant experiences for them … After treatment, as well as in patients in a subacute state, a critical attitude towards hallucinations is gradually formed. Aware of the strangeness of their experiences, patients may hide the fact that hallucinations continue to bother them. In this case, behavioral features will be indicated to the doctor for the presence of hallucinations. So, a person with auditory hallucinations is often distracted from the conversation, becomes silent, goes deep into himself; sometimes, walking around the department, he covers his ears with his hands so that sounds in the department do not drown out inner voices.

It should be borne in mind that with the help of psychological suggestion it is possible to induce hallucinations in a healthy person (for example, during hypnosis), therefore, in difficult expert cases, it is necessary to be especially careful to build a conversation with the patient, without provoking him to excessive suspicion. If a patient who does not give the impression of being mentally ill mentions that he is experiencing hallucinations, you need to ask him independently, without leading questions, to tell in detail about the experience. As a rule, a patient who fakes hallucinations cannot describe them in detail, since he has no sensory experience. However, a doctor who is confident that the patient has hallucinations (for example, with the next exacerbation of chronic psychosis) can overcome the interlocutor's unwillingness to talk about what he has experienced with categorical questions: “What do the voices tell you?”, “What did the voices say to you last night?”, “What are you talking about? see? Individual symptoms are also based on the method of suggestion, which make it possible to timely identify the patient's readiness for the occurrence of hallucinations (for example, in the onset of alcoholic delirium). If, during the interview, the doctor suspects the onset of acute psychosis, and there are no hallucinations, then their occurrence can be provoked if you lightly press on the eyeballs over the closed eyelids and ask to tell what the patient sees (Lipmann's symptom). Other possible techniques are to invite the patient to talk to the CR on the phone, disconnected from the network, while the patient is talking with an imaginary interlocutor (Aschaffenburg symptom), you can ask the patient to “read” what is “written” on a blank sheet of paper (Reichardt symptom).

A necessary condition for reliably identifying hallucinations is the patient's trust in the interlocutor. Sometimes he shares with his family or, conversely, random people experiences that he does not tell the doctor about. The patient may conceal erotic experiences, cynical insults, cruel images in a conversation with a group of doctors, but will willingly entrust them to his attending physician.

Psychosensory Disorders (Sensory Synthesis Disorders)

Along with deceptions of perception, there are disorders in which the recognition of objects is not disturbed, but their individual qualities are painfully transformed - size, shape, color, position in space, angle of inclination to the horizon, heaviness. Such phenomena are called psychosensory disorders, or sensory synthesis disorders, examples of which can be changes in the color of all surrounding objects (red coloration - erythropsia, yellow coloration - xanthopsia), their size (increase - macropsia, decrease - micropsia), shape and surface (metamorphopsia), doubling, a feeling of their instability, falling;

rotation of the environment by 90 ° or 180 °; feeling that the ceiling is descending and threatens to crush the patient with it.

One of the variants of psychosensory disorders is a disorder of the body scheme, which manifests itself extremely diversely in different patients (the feeling that the hands are "swollen and do not fit under the pillow"; the head has become so heavy that "is about to fall off the shoulders"; the arms have lengthened and "hang down to the floor "; the body" became lighter than air "or" cracked in half "). With all the brightness of the feelings experienced, the patients immediately notice, when controlled by their gaze, that internal sensations deceive them: in the mirror they do not see either a "doubled head" or a "nose sliding from the face."

More often, manifestations of such psychosensory disorders occur suddenly and do not exist for long in the form of separate paroxysmal attacks. Like other paroxysms, they can appear in many organic brain diseases in the form of independent psychosensory seizures or as part of the aura preceding a large convulsive seizure (see section 11.1). M. O. Gurevich (1936) pointed out the peculiar disorders of consciousness accompanying psychosensory disorders, when the environment is perceived incompletely, fragmentarily. This allowed him to designate such seizures as special states of consciousness.

Psychosensory disorders also include a violation of the perception of time, accompanied by the feeling that time drags on for an infinitely long time or has stopped altogether. Such disorders are often observed in depressed patients and are combined with a feeling of hopelessness. In some variants of special states of consciousness, on the contrary, there is an impression of a leap, flickering, incredible speed of the events taking place.

Derealization and depersonalization

The phenomena of derealization and depersonalization are very close to psychosensory disorders and are sometimes combined with them.

Derealization is the feeling of a change in the surrounding world, which gives the impression of "unreal", "alien", "artificial", "adjusted".

Depersonalization is a painful experience of the patient's own change, the loss of his own identity, the loss of his own self

Unlike psychosensory disorders, impaired perception does not affect the physical properties of surrounding objects, but concerns their inner essence. Patients with derealization emphasize that, like the interlocutor, they see objects of the same color and size, but perceive the environment as something unnatural: “people look like robots”, “houses and trees are like theatrical scenery”, “the environment does not immediately reach consciousness, as if through a glass wall. Patients with depersonalization describe themselves as “having lost their own face”, “having lost the fullness of their feelings,” “stupid,” despite the fact that they perfectly cope with complex logical problems.

Derealization and depersonalization rarely occur as separate symptoms - they are usually included in a syndrome. The diagnostic value of these phenomena largely depends on the combination with what symptoms they are observed.

So, in the syndrome of acute sensory delirium, derealization and depersonalization act as a transient productive symptomatology, reflecting the extremely pronounced feelings of fear and anxiety inherent in this state. The patients see the reasons for the change in the environment in the fact that, "perhaps a war has begun"; they are amazed that “all people have become so serious, tense”; are sure that "something happened, but no one wants" to "tell them about it." Their own change is perceived by them as a catastrophe (“maybe I'm losing my mind ?!”). Let's give an example.

A 27-year-old patient, a student, after successfully defending his diploma, felt tense, uncollected, slept badly. I readily agreed with the advice of my parents to spend a few days on the Black Sea coast. Together with 2 fellow students went by plane to Adler, where they settled in a tent right on the seashore. However, over the next 3 days, the young man hardly slept, was anxious, quarreled with friends and decided to return to Moscow alone. Already on the plane, he noticed that the passengers were significantly different from those who flew with him from Moscow: he did not understand what had happened. On the way from the airport, I noticed fundamental changes that had taken place over the last 3 days: everywhere there was devastation and desolation. I was scared, I wanted to get home faster, but in the metro I could not recognize familiar stations, I got confused in the designations, I was afraid to ask the passengers for directions, because they seemed somehow suspicious. I was forced to call my parents and asked them to help him get home. On the initiative of his parents, he turned to a psychiatric hospital, where he received treatment for an acute attack of schizophrenia for a month. Against the background of the treatment, the feeling of fear quickly decreased, the feeling of adjustment and unnaturalness of everything that was happening disappeared.

Psychosensory disorders, derealization and depersonalization can be a manifestation of epileptiform paroxysms. Examples of such symptoms are seizures with a feeling of already seen (deja vu) or never seen (jamais vu) (Similar symptoms are also described, deja entendu (already heard), dqa eprouve (already experienced), deja fait (already done), etc.). During such an attack, a person at home may suddenly feel that he is in a completely unfamiliar environment. This feeling is accompanied by pronounced fear, confusion, sometimes psychomotor agitation, but after a few minutes it just as suddenly disappears, leaving only painful memories of the experience.

Finally, depersonalization is often a manifestation of the negative symptoms inherent in schizophrenia. With a mild, low-progressive course of the disease, irreversible personality changes first of all become noticeable to the patient himself and cause him a painful feeling of his own change, inferiority, loss of fullness of feelings. With the further progression of the disease, these changes, expressed by increasing passivity and indifference, are also noticed by those around.

Hallucinosis syndrome

In the first 4 sections of this chapter, individual symptoms of perception disorders were considered, however, as we have already seen, syndromic assessment is more important for accurate diagnosis and formation of correct patient management tactics.

Hallucinosis is a relatively rare syndrome, expressed in the fact that numerous hallucinations (as a rule, simple, i.e. within the same analyzer) constitute the main and practically the only manifestation of psychosis. At the same time, there are no other common psychotic phenomena, delusions and disturbances of consciousness

Since in hallucinosis, perceptual deceptions affect only one of the analyzers, such types of it as visual, auditory (verbal), tactile, olfactory are distinguished. In addition, depending on the course, hallucinosis can be recognized as acute (lasting several weeks) or chronic (lasting for years, sometimes all life).

The most typical causes of hallucinosis are exogenous harm (intoxication, infection, injury) or somatic diseases (atherosclerosis of the cerebral vessels). In most cases, these conditions are accompanied by true hallucinations. Some intoxications are distinguished by special types of hallucinosis. So, alcoholic hallucinosis is more often expressed by verbal hallucinations, while the voices, as a rule, do not address the patient directly, but discuss him among themselves (antagonistic hallucinations), speaking about him in the 3rd person (“he is a scoundrel,” “completely lost shame "," I drank all my brains out "). In case of poisoning with tetraethyl lead (a component of leaded gasoline), sometimes there is a feeling of the presence of hair in the mouth, and the patient tries unsuccessfully to clear his mouth all the time. In case of cocaine intoxication (as well as in case of poisoning with other psychostimulants, for example, phenamine), a tactile hallucinosis with a sensation of insects and worms crawling under the skin (Maniac's symptom) is described as extremely unpleasant for its wearer. In this case, the patient often scratches the skin and tries to extract imaginary creatures.

In schizophrenia, the syndrome of hallucinosis is extremely rare and is presented exclusively in the form of pseudo-hallucinosis (the dominance of pseudo-hallucinations in the picture of psychosis).