Month: June 2019

Symptoms of Disorders of Perception

According to the levels of complexity of the perception, the symptoms of his disorder can be divided into three groups: a) disorders of sensations; b) disorders of perception itself and C) disorders of representation (or hallucinations). Now on counts.

Disorders of sensations

Hypersensitivity (from the Greek. hyper — excessively and aesthesis — sensation, feeling) — hypersensitivity under the action of ordinary or even weak stimuli, while the sensations are bright, up to discomfort and even soreness. On what senses are involved, allocate hyperesthesia optic, acoustic, gustatory, olfactory and tactile (or cutaneous hypersensitivity of the senses). Accordingly, the first in the eye with a flashlight to Shine on the second not to scream, the third and fourth do not give garlic, fifth not to tickle. And not mistake!

Gipostezii (from the Greek. hypo- — and aesthesis — feeling, feeling) — decrease in susceptibility to external stimuli, when the colors of the surrounding world fade and the sharpness of sensations is dulled. It’s like sex in a wetsuit: the meaning of all these physical exercises is unclear…

Hyperalgesia (from Greek. hyper — excessively and algos — pain) — increasing pain sensitivity. Inquisitor’s dream.

Anesthesia (from Greek. an— negative particle and aesthesis — feeling) — loss of sensitivity. Here it is necessary to allocate separately hysterical neurotic symptoms: mental amblyopia (blindness), mental anosmia (insensitivity to smells; from the point of view of the passenger of public transport in the summer it is already rather good), mental ageisia (loss of sense of taste), mental deafness, mental analgesia (loss of pain and tactile sensitivity, respectively — the nightmare of the Inquisitor). Do not confuse them with neurological symptoms when anesthesia is caused by nerve damage or the corresponding area of the cerebral cortex.

Senestopatii (from lat. sensus — feeling, Greek. pathos — ailment, suffering) — extremely painful and unpleasant, indefinite bodily sensations despite the fact that in reality there is no bodily injury or pathology, that is, the sensations that the patient projects into his own bodily “I”: pain is, suffering is very much there, and there is no organ damage. At the same time, descriptions of suffering are vivid, imaginative and colorful, unusual and pretentious. So, the patient can complain of tightening, tearing, gurgling, clogging, pulsation, drilling, chaining and even biting! Most often, these feelings do not have a clear localization, blurred or migrate through the body. As a rule, with such complaints go anywhere, but not to a psychiatrist, to whom they get already with a plump from the analyzes of an outpatient card and a refrain of mass dance of doctors of other specialties: “NOT OURS, NOT OURS!»

Perception disorders: a) psychosensory disorders; b) illusions.

Psychosensory disorders — when the surrounding objects, your own body or the flow of time are perceived distorted in size, shape, volume, weight or flow rate (for time). At the same time, a person knows for sure that this is the same object (say, a teapot — he is also a teapot in Africa) or that the body is his own, which distinguishes them from illusions. Highlight:

Metamorphosis (from Greek. meta — beyond, after; morphe — form, shape; opsis — vision) distorted in appearance, the perception of magnitude: micro – and macropsia (little people around the small and cockroach in the apartment — just elephant-like); forms: of dysmorphobia (skaloobraznuju uncle with Contrabassoon Auntie); the increase in the number of polyopia (how many moons? and in what number?) and the spatial arrangement of objects.

Derealization is a distorted perception of the world as a whole or its individual objects according to more generalized characteristics. At the same time, the surrounding world can appear dead, lifeless, flat, as if painted, unnatural, unreal. May be extraordinary contrast (Galerija), painting everything around in yellow (xanthopsia) or red (Eritrea, not to be confused with “All red” by I. khmelevskiy [14]). This also includes the phenomenon of “already seen”, or déjà vu, when an unfamiliar place or situation is perceived as having happened before; “never seen”, or jamais vu, when a familiar situation is perceived as completely new and unknown; “already heard”, as well as false recognition of others — a symptom of a positive double (what the hell our brother-in-law does an alcoholic in the state Duma?); symptom of a negative double, when familiar faces are not identified as such (can fill the face, if you have them something borrowed).

Disorders of body scheme (somatopsychic derealization) — when there is an unpleasant, painful sensation changes in the shape, size, quantity, texture, spatial location of body parts: the head is abnormally large, fingers longer than expected, the subject of male pride size and consistency is not satisfied — but you never know!

Deceptions of orientation in space — when the surrounding is seen rotated 90 or 180 degrees in a particular plane. Perhaps even more impressive has got to look the highway, going up into the sky. Or the sea.

Disorders of perception of time — when it begins to flow faster or slower, and loses smoothness and moves in leaps or jerks.

Illusions — perverted sensations and perception realistically (!) of existing objects and phenomena, when the understanding of these objects and phenomena is not true and has distorted the meaning (in contrast to hallucinations, there object, sound, feeling really exist, but are perceived differently). Distinguish the illusion of the physical, physiological, mental.

Mental illusions: auditory — when human voices are heard instead of noise (the same “white noise” of the radio, if you listen to it for a long time) or human speech is distorted (what-what did you call me?); visual and others. There are affective illusions that arise in affective States (fear, anxiety, depression, ecstasy) — then their content is consistent with the current mood; pareidolic illusions in which the play of light and shadow, spots, frosty patterns, cracks, cracks, plexus branches of trees are replaced by fantastic, bizarre images.

Any moron who claimed the Lord God was talking to him actually heard my voice… or his imagination.

K/f “Dogma»
Disorders of representation are, in fact, hallucinations.

Hallucinations are representations that have reached the sensual power and brightness of real objects and phenomena, it is “perception without an object.” That is — entirely the creation of the patient. Not a breakthrough into another reality, like the vents in an alternate Europe, not the machinations of angels and demons (in shifts, according to the approved schedule), not a local materialization of the astral plane (demonstrasi, beta, copyright is missing). Of course, we cannot exclude that at this moment the inhabitants of other realities and plans, coupled with Angelo-demonic community resent or, on the contrary, ugly chuckle — say, wait a minute, let’s see what you say after a century or two… But prevailing in the present opinion of the official science on the nature of the hallucinations I have outlined.

According to the analyzers, hallucinations are divided into auditory, visual, olfactory, tactile, gustatory, visceral (from lat. viscera — insides), kinesthetic.

On complexity — the simplest, ordinary and complex.

The simplest, or elementary, hallucinations are located a little apart. They are United by the incompleteness of what a person sees. Visual — photopsias (from Greek. phōs, phōtos light and opsis — vision) in the form of circles, spots, sparks, balls, etc.; auditory — acousma (footsteps, noises, squeaks) and phoneme (from the Greek. phonema — sound) (inarticulate sounds, calls, syllables, pronouns). That is, separate the fragments, the details of which do not stack in any particular way.

Simple — when hallucinations are born in one analyzer [15]: only auditory, only visual — and not a step aside.

Complex — multiple analyzers connected to the overall plot (see in the courtyard of the assassins, hearing their voices is heard behind the wall that the neighbors are plotting to poison him while smelling poisonous gas).

It is also possible to separate one-sided, or unilateral, hallucinations (visual and auditory), when a person sees or hears them only from one side. They happen when the cerebral cortex is affected in the form of a focus from any of the sides.

Hallucinations with complete objectivity (as opposed to the simplest):

Verbal (verbal) — by belonging: familiar, unfamiliar, male, female, child, belonging to other beings; by volume: quiet, loud, deafening, natural, whispering; by content: threatening, accusing (not to be confused with the voice of conscience), blaspheming (usually with a predominance of profanity), commenting (look — got up; here he went; Opanki — fell; and you — again got up; well, you see — now we swear…), contrast (one voice praise and promise medal, the other a mother and threaten to shoot like a mad dog), stereotypical (every day the same), imperative (those that ordered, the indication for immediate hospitalization, the patient wants that or not); in the form of: monologues, dialogues, conversations in their native and foreign languages; duration: episodic, persistent, SAG; focus — from any direction and distance.

Interesting auditory hallucinations of Allenstyle — when people are tensely waiting for the knock on the door or a phone call and then starts to hear them. Found in healthy people and is regarded as a variant of the “acoustic memory”.

Visual — different colors or without them, moving and motionless, scenic (they are scene-like, where everything that sees the patient, linked to one theme, the scene with a clear plot), landscape, portrait, kaleidoscopic, demonomanic (characters all entirely folklore and mythological orientation); content: threatening (and what is it in a hoodie and with a scythe here is?), apathetic (well worth and worth — maybe waiting for the tram…), accusing (scenes of the court, including Scary); autoscopia (the appearance of hallucinating your DoppelgangeR), negative autoscopia (the disappearance of the reflection in the mirror, may cause the appropriate treatment); largest: normal, midget, giant and other, other, other…

Separately, we can distinguish peduncular hallucinations of lermitt, arising from the defeat of the brain stem (or to be precise, in the area of the legs and the third ventricle): in the evening see moving medium-sized pictures, quickly replacing each other (insects, animals, etc.), while patients are not afraid of what they see, and clearly realize that this is a hallucination; hallucination van Bogart, characteristic of leukoencephalitis [16]: see animals painted in different colors, fish, butterflies, all this is brightly colored with emotions And interspersed with bouts of drowsiness; hallucinations Tibia: on the wall seen the glowing letters written by someone’s invisible hand; hallucinations Peak (if it affects the bottom of the IV ventricle): patients say they can see through the wall: “there is one through it has passed, there he is behind the wall goes, there’s a cat too, through the wall slipped — a nest there, or what?”Tactile: the skin and under the skin; dermatotropnye: the perception of objects, insects, animals, spider webs, ropes; temperature: heat, cold; haptic: the sense of grasping, touching, bumps and shocks from the outside; gigacheck: the feeling of moisture.

Olfactory — often the perception of unpleasant, sharp, stinking odors of decay, decomposition, often as if emanating from the patient (there are two oddities: first, I almost did not meet the description of pleasant olfactory hallucinations-in the form of smells, for example, “Chanel № 5”, and, judging by personal observations, the mass of people have negative olfactory hallucinations on the actual smell coming from them; in any case, with the benefits of civilization in the form of soul and soul deodorant they are in no hurry to get acquainted). Visceral — endoscopic — vision of their internal organs (a dream or nightmare of an endoscopist); hallucinations of transformation — changes in the internal organs, their movement, elongation, shortening (also a dream or a nightmare, depending on the location and character); genital (feeling as if with the genitals do something shameless and obscene).

Kinesthetic — perception, or lack of limbs, or the presence of additional (to the volume of Confucius and the cell phone when you drive), violent movements, including recidivating (feeling the movement of the tongue, uttering words).

Hallucinations often have objective signs, when the occurrence of hallucinations can be determined by the behavior of the patient: when the visual patient looks closely, monitors the hallucinatory way; when hearing listens, closes his ears or talks (you should make sure that the person does not use at this moment a headset for a cell phone or mp3-player); when tactile something shakes off.

One day, walking with his wife in the city, we saw this picture: to meet us, actively gesticulating and enthusiastically talking with an invisible interlocutor, was a lady. As she came up to us, she nodded, pointing at us.:

You know who that is? Doctors, psychiatrists, so behave yourself! she continued her exercise.

Under the conditions under which they occur, hallucinations are divided into:

Functional — often auditory, which occur in the real sound stimulus (in the noise of water — whisper poisoners in the stop of the wheels — the conspiracy of neighbors in the compartment on the theme of “kill-kill”, etc.).

Reflex or reflected — when the action of a real stimulus for the analyzer gives impetus to the beginning of the hallucinations (it is a push, not a constant background, as in functional). Can occur under the action of canalizador: auditory hallucinations, while irritation of the visual, visual hallucinations at acoustic stimulus, etc.

Hypnagogic (from Greek. hypnos — sleep, agogos — causing) — when falling asleep (found normally).

Hypnopompic (from Greek. hypnos — sleep, pompos — accompanying) — upon awakening, as well as in the interval between sleep and wakefulness (can also occur in a healthy person).

Type Charles Bonet — with damage to the peripheral part of the analyzer, for example, “vision” with severe cataracts.

Apperceptive — caused by strong-willed effort (“I said — squirrels! Three lines! On the windowsill!”).

Psychogenic: dominant — saturated with affective experiences, for example, the “voice” of the deceased spouse; the imagination Dupree — when dreams and fantasies, especially easily arise in children and in individuals with painful a keen imagination; induced — inspired hallucinary patients (that is, from one patient to another patient); suggestion (not to be confused with induced) imposed by the physician in the study, for example, in a patient with alcoholic delirium — a symptom of the set, when instigated visual images (“Oh, look, a Goblin!»); a symptom of Aschaffenburg — when a patient in delirium tremens talking on a pre-disconnected phone.

It is characteristic that in childhood there are more visual hallucinations, and if there are auditory, they are often simple or elementary.

Pseudohallucinations differ from the true character of artifice, perceptions, lack of properties of objectivity: if “voices” are sounding inside the head, if the “vision” — something like a movie or cartoon.

Although hallucinations as an isolated symptom can not allow to accurately determine what kind of disease the patient has, nevertheless, their presence (except for hypnagogic, hypnopompic and auditory Alenshtil — these may be normal) is serious and not good. In addition, we can say, for example, that auditory pseudohallucinations are more characteristic of schizophrenia (although can also occur in many other psychotic disorders), and visual hallucinations for the intoxication process, or vascular catastrophes. This sets the direction for further diagnostic search.

Symptoms of disorders of consciousness

Symptoms of impaired consciousness (be patient, such Goodies as, for example, coma or delirium, will be considered in the section syndromes). They are still in 1911, was clearly described by Karl Jaspers:

Violation of orientation in time, situation, space, surrounding persons and self. Let’s try to reveal a little the essence of each of the points of disorientation.

In time. Of course, to forget what today is the day or day of the week, happened to each of us, especially if the work or the situation (vacation, for example) does not imply the need to clearly monitor them. Another thing, if you struggle to understand what in the yard a season or a year. Or why it’s evening, but only that it was morning, although there may also be options…

In a situation. At once the fool to whom participants of a funeral procession hung for a wish “to drag to you — not to drag”is remembered. In other words, it is alarming if a person is not able to assess what kind of situation and relationships (at least in General terms) develop around him: anniversary or Wake.

In space. Of course, no one requires you to know the exact longitude, latitude, altitude and serial number of the galaxy, but the city, the area, and the way home — should.

In the surrounding seats. The General rule of loving people: if you do not remember the name of the partner, call a Bunny, sun or lapulya — you will live longer. Worse, if you are not able to identify people from the surrounding brother, sister, mother, father (the intricacies of the plot lines Express the hero of the Indian cinema), raises many questions.

In self. Unlike Hu em AI, played perfectly by Jackie Chan, a patient who is truly disoriented in his own personality is unlikely to molest you with self-identification problems. And generally hardly understand a word of speech addressed to him — will react as the sound, but no more. Usually this happens with a gross disorder of consciousness.

It should be added that the above paragraphs are given in such a sequence is not accidental. They are a kind of scale of increasing depth and severity of the disorder of consciousness: from disorientation in time, as the easiest (if not a miss in half a century), to disorientation in his own personality, when everything is very, very bad and the patient’s life is in question.

  1. Detachment from the surrounding reality. This is a situation where the reality itself, the patient itself. Events, facts and external stimuli are perceived as fragments of conversations from the street — fragmentary, on the very verge of perception, a person is not able to seriously and permanently attract attention, not to mention a clear and holistic awareness of them. Confusion, indecision prevail — how to behave in a situation when the reality waves the handle? Confusion, surprise: Oh, what is it? Where is it? Oh my gosh!
  2. Violations of understanding. Since consciousness and the process of thinking are inextricably linked with each other, any violations of consciousness will certainly be reflected in the harmony of thinking. This simplification of the associative process (to complex series, when everything is bad!), and problems with abstraction, and violation of sequence — in one way or another least, in dependence from depth disorder.
  3. Memory disorders relating to the period of the disorder of consciousness, amnesia or congrega. Can be full, when memory falls all the painful period, and partial, when some of the memories still remains. For this reason, many alcoholics who have suffered delirium, swear that more — no-no! And we pretend to believe.

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