Perception disorders. Disorders of sensation and perception - general information The main form of pathology of perception is

PSYCHOPHYSIOLOGY OF COGNITIVE MENTAL PROCESSES.

PSYCHOPHISIOLOGY OF PERCEPTION. PATHOLOGY OF PERCEPTION.

Perception is the second stage of any cognitive process and is characterized by an integral generalized reflection of objects and phenomena.

tions in the totality of all properties obtained through sensations (that is, irritation of the corresponding receptors).

The concept of perception is related with the phenomenon of a holistic reflection of the surrounding reality. According to the ideas of P.K. Anokhin, the physiological basis of perception (image formation) is the coordinated work of many psychophysiological systems united in the process workinto a singlefunctional systemsat, which includes as part the scheme for the formation of conditioned reflex connections.

Perception is associated with the coordinated activity of several or all senses and the comprehension of holistic information. For example, by “summing up” many sensations: hard, heavy, cold, characteristic color and shape, and correlating these sensations with existing experience, we can make a general conclusion that this is some kind of mineral or metal.

In the modern understanding, perception is an active cognitive process with motor components, the process of transforming physical stimulation into mentally assessed information, with the help of which sensory stimuli are transformed and translated to a conscious level.

At the same time, the so-called “subthreshold perception” of information is also possible, when signals are processed in a subthreshold zone: the gap between the “perception threshold” (threshold of conscious recognition) and the “physiological threshold” (receptor level), when conscious processing and assessment of the corresponding signals.

As it develops, human perception becomes less concrete, sensual and more and more rational, observant: sequential (successive) perception of the contour of an external object gives way to simultaneous (simultaneous) perception of the generalized properties of the external stimulus.

In the process of cognition, the dominant place is occupied by voluntary, intentional perception, replacing the involuntary and naturally turning into observation. It is observation, as the most developed form of intentional perception, as a purposeful, systematic perception of objects and situations in the knowledge of which a person is interested, that contributes to the active assimilation of material in the process of learning and knowledge of the world as a whole.

There are individual types of perception and observation, such as:

synthetic;

analytical;

analytical-synthetic;

and emotional.

Types of perception differ according to the leading analyzer:

visual;

auditory;

tactile, etc.)

The types of perception differ depending on the object that is reflected in the perception; in this case, perception reflects the spatiotemporal relationship between the object and phenomena (shape, size, volume, distance of external objects, reflection of the duration and sequence of events, etc.).

There are several general properties of perception:

selectivity (the ability to isolate only a few from a huge number of influences on a person, with greater clarity and meaningfulness);

structure (the presence in the field of perception of “background” and “figure”, which, by the way, reveal possible interchangeability and mutual transitions);

constancy (relative constancy, stability of the perceived object with changes in angle, illumination, distance);

awareness (generalized designation of perceived stimuli with the corresponding concept, word);

objectivity (attribution of a visual image of perception to a specific object of the external world), and integrity (each component part included in the image of perception acquires meaning only when it is correlated with the whole and is determined by it).

Perception is characterized by speed, accuracy and volume. Perceptual characteristics are determined, as a rule, using a tachistoscope, which allows subtests to be presented for short periods of time. For example, flashing on the screen for tenths of a second Yu t image I objects that the subject must recognize.

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 associated with 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 a wallpaper pattern - millions of small animals, in the patterns of a carpet - his own 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, tested the sick in the head atomic bombs, which made her “roll her eyes.” The patient mentally talked to them all the time, either in Russian or in English.

To distinguish true hallucinations from false ones that have great value 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 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.
So, for example, a patient long time heard voices
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 confined 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 attached to the theme 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), grasping 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 is in effect. 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 ceases to apply to them universal gravity, as a result of which they can be carried into space (on the street) or they can fly up 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 is reduced to the size 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.

Smirnova Olga Leonidovna

Neurologist, education: First Moscow State Medical University named after I.M. Sechenov. Work experience 20 years.

Articles written

Perception disorders are accompanied by a disruption in the process of cognition of the surrounding world. The main variants of pathology are illusions and problems with psychogenic synthesis. The patient cannot do without qualified help from a psychiatrist. In most cases, such phenomena indicate the development of mental disorders. They bring a lot of problems to the patient and his loved ones and require treatment.

Perception is characterized by a mental process that contributes to the formation of images of objects and phenomena of the external world.

Without the presence of primary sensations, perception of the surrounding world is impossible. A person makes conclusions based on knowledge, desires, his own imagination, and mood.

There are many types of perceptions. Each person perceives the world differently. If something seems obvious, it does not mean that the other person also thinks so. Therefore, in order to avoid disputes, all the nuances should be discussed.

Perception has a direct connection with emotional response. It determines emotions and at the same time emotions determine perception. Congenital characteristics play an important role in its development. Since childhood, a person receives a lot of information about the world. But what the perception will be in the future depends on the baby’s activity level. Therefore, children’s development should be promoted in every possible way.

How do receptors and sense organs affect

The senses help a person put together a picture of the environment, taking into account all its diversity and versatility.

The world is known through sensations. With their help, you can recognize individual signs of an object or their combination, using vegetative reactions for these purposes.

Sensations are characterized by objectivity, since they reflect external stimuli. The subjectivity of sensations depends on the state of the nervous system.

Sensations allow you to send information about the human body and environment into the brain.

The human body has a sensory system, under the influence of which sensations arise. The analyzer analyzes and synthesizes external and internal stimuli, which includes:

1. A receptor responsible for converting external stimulation into an external signal.
2. Conducting nerve pathways. Through them, signals travel to the brain, and from it to the overlying sections, and then again to the brain and lower sections.
3. Cortical projection zones. This think tank, located in the .

Individual receptors have the ability to receive certain manipulations. Different sensations arise at distinctive rates. A person feels the impact, and then perceives it depending on the threshold of sensitivity.

Types of disorders

There are different types of perceptual disorders in psychiatry. They have distinctive clinical presentations, durations, and treatment modalities. At the first manifestations, you need to consult a doctor, since the problem will not be solved on your own.

Illusions

In this case, a person sees in a distorted form an object that actually exists. The patient may incorrectly perceive shape, color, size, consistency, etc. characteristic features. In the presence of illusions, the visual image is distorted. For example, there is a coat hanging in the closet, but it was perceived as a real person due to its similar outline. With auditory illusions, the perception of existing sounds is disrupted. For example, when someone is shouting on the street, and it seems to the person that his name is being called. There are even taste illusions. At the same time, the taste or smell familiar to the dish is modified. Cases of tactile illusions have been observed. Their formation is influenced by real sensations. Illusions develop under the influence of physiological and psychological characteristics.

A disorder of perception, which is called an illusion, manifests itself in the fact that a person perceives reality incorrectly and distortedly. He mistakenly recognizes objects, instead of one he sees something completely different.

Illusory perception often cannot be distinguished from sensory perception. Therefore, there is no criticism of illusory deception. A person is completely confident in what he saw or heard, even if it is something unusual, implausible, fantastic.

Illusions can also be optical, physiological and others. For example, if you put a stick in water, it will appear as if it is broken in half. While traveling on the train, it seems that the landscape also moves with the vehicle.

In psychiatry, illusions are most often classified as pathological conditions that do not arise under the influence of physiological and optical laws.

Most often, the appearance of auditory, visual and affective illusions is observed. Deception of smell and touch is rare.

Affective illusions are considered the most common. They appear if a person suffers from stress, anxiety, fear or prolonged depression.

There are illusions of the pareidolic type. They are distinguished by the complexity of their images and fantastic paintings. For example, when a patient examines a drawing on a carpet, he sees people, animals, and various scenes from their lives there. Sometimes illusions can follow each other like a movie.

In some cases, patients are completely sure that the images are real. If they are short-lived, unclear or vague, then the person understands that this is not a real picture.

Illusions are considered a psychotic or subpsychotic symptom. With abundant visual illusions, a conclusion is drawn about a change in consciousness.

Such deception of hearing and vision often occurs if a person is in an anxious state, experiences fear, suffers from stress, is in a room in which there is not enough light or noise, suffers from pathologies of the sensory organs, is overly impressionable and daydreaming, prone to fantasies, or is too tired or sleeps little.

Hallucinations

Major perceptual disturbances include hallucinations.

They are characterized by the perception of objects that do not exist in reality, but at the same time the person is completely confident in the existence of the object at the moment.

This is the most striking manifestation of a perceptual disorder, which has a serious impact on a person, his behavior and can motivate him to take action.

The occurrence of hallucinations does not depend on whether the object exists or not. Patients are completely convinced of the reality of visible images. Hallucinations can be real. In this case, the person indicates exactly where the image is located, which he perceives as real.

It is important to remember that a disorder of perception, when the patient sees something that is not there, is called a hallucination. Such problems require treatment.

Eidetism

This is a special type of memory that allows you to retain and later reproduce a visual image. People with this feature quickly remember what they see and can return to memories at any time. A person is able to save an image for a long time and scroll through it with the smallest details.

Senestopathies

This mental disorder, which is accompanied by unusual sensations. A person suffers from vague, painful, unpleasant, intrusive, difficult-to-localize sensations.

The deviation is associated with hysteria, manic psychosis, schizophrenia, general neurosis, neurasthenia, and chronic poisoning.

At the same time, the patient feels that he is sipping, tingling or burning in a certain place. But these sensations are not associated with organ pathologies and their nature and localization quickly change.

A person constantly focuses his attention on these sensations. They prevent him from living a normal life.

Agnosia

Translated into Greek, “gnosis” means “knowledge.” This nerve function allows a person to recognize objects, phenomena, and his own body.

Agnosia is a complex concept that combines disorders of gnostic functions.

The pathological condition is usually observed during degenerative processes in the Central nervous system, after injuries, infections, etc.

Clinical agnosia is usually diagnosed in children at a young age, since they have not yet completed the process of formation nervous activity. The problem is often identified in children as young as seven years old.

The problem is manifested by a lack of understanding of speech and the inability to identify an object by touch. Inability to examine an object or paint it.

One type of such a perception disorder is somatoagnosia, in which a person does not recognize parts of his own body.

Derealization disorders

This perception disorder is a psychogenic disorder that manifests itself in the form of:

1. Macropsia. At the same time, it seems to a person that surrounding objects are decreasing in size. It is characterized by an increase in the size of surrounding objects.
2. Dysmegalopsia. At the same time, surrounding objects lengthen, expand, bevel, and become distorted around their axis.
3. Porropsia. A person gets the impression that the object is moving away from him.

Such disorders of sensations and perceptions are characterized by an incorrect attitude towards one’s personality, individual qualities or parts of the body.

A good example of a problem is Alice in Wonderland syndrome. This disease is rare. With it, patients feel that their body is too big or small, time slows down or speeds up, and space is distorted.

With this disorder, a person has the impression that his limbs are lengthening, shortening, or being torn off.

Impaired temporal perception

In this case, it feels like:

1. Time stopped. In this case, dullness and flatness of objects are observed. The patient feels that he has no connection with the outside world and loved ones.
2. The timer is stretching. The patient thinks that time lasts longer than usual. He relaxes and is in a euphoric state. The impression of flatness and three-dimensionality of objects and their mobility is created.
3. Lost sense of time. A person thinks that he has completely freed himself from time. At the same time, the perception of the world always changes. The contrast between objects and people increases.
4. Time has slowed down. People move at a calm pace with gloomy facial expressions.
5. The timer has sped up. The world and your own body seem fleeting, and people seem fussy. The feeling of your body deteriorates. It is difficult to determine the time of day and duration of events.
6. Time passes in reverse order. If an event happened a few minutes ago, it seems like it happened a long time ago.

Impaired temporal perception occurs if the right hemisphere of the brain has been affected.

Perception in children

The process of its development depends on specific features. From birth, children possess certain information. How its development will proceed in the future depends on how active the child is.

The process of perception formation should be under the control of parents. It continues from birth and as the child develops. In infancy, a person learns to recognize people, distinguish between objects, and control his body. The completion of this process occurs at primary school age.

During this period, it is important to undergo examination for possible perception disorders. The problem can arise with diseases of the brain that break the connection with the senses and centers of the brain. The development of disorders is facilitated by injuries and morphological changes in the body.

Young children perceive the world vaguely and unclearly. If, for example, a mother dresses up in a fancy dress, it will be difficult for the baby to recognize her.

The development of perception of the world is an important process; how successful it is will determine how the child will perceive the world, reality, and adapt to environmental conditions.

Perception is a more complex process of reflecting objects and phenomena in general, in the totality of their properties. Perceptions are objective, holistic, categorical, constant, projected into the so-called real (objective) space and fill it, which is associated with the field of activity of analyzers.

Representation - traces of perceived images that arise in consciousness voluntarily or involuntarily in the absence of a given object within the reach of the corresponding analyzer.

Sensations, perceptions and ideas are divided by sense organs: visual, auditory, olfactory, gustatory, tactile (including temperature, etc.), visceral (intero- and proprioceptive).

Sensations and perceptions have a number of properties: sensory liveliness, extra-projection, brightness, speed, completeness and the absence of arbitrary variability of images. It is important to take into account that their properties depend on age, gender, health status, life experience, individual personality characteristics, focus of attention, degree of preservation and training of the analyzer and all functional systems that serve them,

In contrast to perception, representation is characterized by dullness, fragmentation, arbitrary variability, intraprojection (projection in subjective space with belonging to the mental “I”).

5.1.1. Pathology of sensation. Pathological changes in sensitivity thresholds include a decrease in sensitivity thresholds hyperesthesia, an increase hypoesthesia, complete loss anesthesia and perversion senesthopathy.

Hyperesthesia increased sensitivity when exposed to ordinary or even weak stimuli; mild mental vulnerability with hypersensitivity in any analyzer. Text from the site Big Abstract RU Occurs in intoxications, somatic and infectious diseases, acute psychotic states (acute hallucinosis, paranoid, etc.), initial manifestations of non-paroxysmal clouding of consciousness (delirium, oneiroid, amentia).

Hypesthesia decreased susceptibility to external irritations when the world, individual objects and properties lose their brightness, colorfulness, richness, distinctness and individuality. Occurs in cases of stupor, depressive states, hysterical syndromes, alcohol and drug intoxication.

Anesthesia manifested by anatomical and functional damage to the analyzer, starting from the receptor section and ending with the cortical representation, which is clinically accompanied by skin sensitivity, loss of taste, smell, blindness, deafness

IN neurology They distinguish visual agnosia (failure to recognize visual images, letters, words), auditory (failure to recognize an object when palpating), autotopognosia (failure to recognize parts of one’s body), anosognosia (non-recognition of illness, injury), and facial agnosia. In hysterical neurotic syndromes, mental amblyopia (blindness), mental anosmia (insensitivity to smells), mental ageism (loss of the sense of taste), mental deafness, mental tactile and pain anesthesia (analgesia) are observed.

Senestopathies vague, difficult to localize, migrating, diffuse, unpleasant, extremely painful, pointless sensations projected inside the bodily “I”. Patients often resort to the “luxury of figurative comparisons” and designate them as “tightening”, “tearing”, “fettering”, “tickling”, “gurgling”, etc. According to the content, senestopathies are divided into pathological thermal sensations (“burning”, “scorching”) ”, “chilling”), pathological sensations of fluid movement (“pulsation”, “transfusion”, “filling”, “clogging”, etc.), circumscriptive (“drilling”, “tearing”, burning pain), sensations of movement, tissue displacement, sensation of tension.

Somatic pathology is characterized by localization, stereotypy, connection with the anatomical boundaries and topography of organs, determined by a certain clinical picture of the disease. It is important to understand that paresthesia, which is a sign of a neurological or vascular lesion, is also characterized by the above-mentioned signs of a specific neurological pathology with a projection onto the surface of the skin (pathology of sensory nerves or dorsal roots) in accordance with the zones of innervation.

Senestopathies found in neurotic and depressive syndromes, included in delusional (paranoid, paranoid, paraphrenic, affective-delusional), oneiric and psychoorganic syndromes.

5.1.2. Pathology of perception. There are two main types of pathology of perception: psychosensory disorders and illusions. According to the degree of severity, there are four main types of psychosensory disorders: metamorphopsia (micro-, macro- and dysmorphopsia), disturbances of the “body scheme” (autometamorphopsia or somatic depersonalization), derealization and distortion of the perception of the passage of time.

Metamorphopsia distorted in appearance (as opposed to an illusion, when there is a distortion of perception in essence) visual perception of size (micro- and macropsia), shape (dysmorphopsia curvature of the shape of an object), an increase in the number (polyopsia) and spatial arrangement of real objects.

Derealization(allopsychic depersonalization) - distorted perception of objective reality or individual objects, phenomena of the surrounding world in shape, size, color, relative location, in time, space, etc. The real world appears as if “dead”, “flat”, “lifeless” ”, “unnatural”, “as if drawn”, “unreal”. There is unusual illumination or contrast (galeropia), the coloring of everything around is yellow (xanthopsia), red (erythropsia). Derealization also includes the phenomena of “already seen,” when an unfamiliar environment or situation is perceived as already seen or familiar; “never seen”, when a familiar environment is perceived as unfamiliar; “already heard”, “never experienced” (by analogy with the above); false recognition of surrounding persons (positive double symptom or Capgras symptom), when strangers are perceived as familiar; negative double symptom or Fregoli symptom (by analogy). May distort perceptions of left or right and vice versa; the flow of time, the sequence of events when the flow of time accelerates, slows down or is distorted. These experiences are often reflected by patients in drawings.

Body schema disorders(somatopsychic derealization, somatic depersonalization) includes various, painful sensations of changes in shape, size, consistency, quantity, spatial arrangement of limbs and individual parts body (for example, increasing the size of the head, lengthening the limb, dividing the body into parts, etc.). Many patients depict violations of the “body diagram” in drawings, paintings, and diagrams.

Psychosensory disorders occur with organic lesions of the brain and can be accompanied by confusion, bewilderment, a state of helplessness, anxiety and fear; at the same time, a correct assessment of the environment and a critical attitude towards painful symptoms are maintained. They can be included in severe delusional syndromes and clouding of consciousness syndromes (oneiroid), then the critical assessment of experiences is completely lost.

Illusions perverted sensations and perceptions of really existing objects and phenomena, in which the understanding of the latter (images) does not always correspond to reality and may have a different meaning. There are physical, physiological and mental illusions.

Physical illusions appear as a result of the peculiarities of the physical properties of objects and substances (for example, refraction of an object at the boundary of two environments, mirages, etc.).

Physiological illusions are associated with the peculiarities of the physiological functioning of the analyzer (for example, the sensation of movement of surrounding objects after the train stops).

Mental illusions distorted perception of a really existing object with an inadequate, unrealistic understanding of its true essence

Taking into account the dependence on the disorder of the activity of a particular analyzer, auditory (hearing human voices instead of noise, distorted perception of the meaning of real speech, etc.), visual and other illusions are distinguished. There are also affective illusions that appear during pronounced affective states (fear, anxiety, depression, ecstasy), pareidolic illusions, in which the play of chiaroscuro, spots, frosty patterns, crevices, intertwining tree branches and foliage, etc. are replaced by fantastic images. Illusions occur in the initial stages of clouding syndromes (delirium, oneiroid), acute delusional and affective-delusional syndromes, and in some states of drug intoxication.

5.1.3. Pathology of presentation. Hallucinations are severe and serious disorders of perception and representation.

Hallucinations representations that achieve sensory strength and brightness of perception of real objects and phenomena; “perception without object.”

Classification of hallucinations by analyzers: auditory, visual, olfactory, tactile, gustatory, visceral, kinesthetic, including speech motor.

The simplest (elementary) hallucinations are characterized by the incompleteness of the object: visual photopsia (circles, spots, sparks, balls, etc.); auditory acoasms (steps, rustles, creaks, etc.) and phonemes (inarticulate sounds, calls, syllables, pronouns, etc.).

Simple hallucinatory images appear in one analyzer. Text from the Big Abstract RU website

Complex (complex) in the formation of hallucinatory images two or more analyzers are involved, connected by a common plot (for example, the patient “sees” murderers in the yard and hears their speech).

Hallucinations with complete objectivity:

a) verbal (verbal): by affiliation familiar, unfamiliar, male, female, childish; by volume quiet, loud, deafening, natural, whispering; by content threatening, accusing, slanderous, narrative, contrasting, stereotypical, imperative (imperative, posing a social threat); in form monologues, dialogues, conversations in native or foreign languages; by duration episodic, constant, intermittent; by sound: indistinct, clear, singing; by direction one- and two-sided, from above, from below, near, from afar;

b) visual: by color black and white, one-color, colored, colorless and transparent; movable and immobile; scene-like, landscape, portrait, kaleidoscopic; in terms of content: threatening, indifferent, accusing, autoscopic (the appearance of a hallucinatory image of a double) and negative autoscopic (the disappearance of one’s reflection in the mirror); by size normal, midget, giant; integral and partial, hemianopic, mono- and polyopic; extracampal (perception outside the field of vision during pseudohallucinations);

c) tactile - on the skin and under the skin (dermatozooid) perception of objects, insects, animals, cobwebs, ropes, etc.; temperature heat, cold; haptic sensation of grasping, touching; hygric feeling of moisture;

d) olfactory. perception of extremely unpleasant, suffocating odors of carrion, rotting, most often emanating from the patient himself;

e) visceral endoscopic (“vision” of one’s internal organs); hallucinations of transformation (changes in internal organs, their elongation, movement); genital (feeling of manipulation of the genitals, violence, masturbation, etc.), “appearance” of animate and inanimate objects inside the body;

f) kinesthetic perception of the absence of a limb or the presence of extra limbs, violent movements, speech motor (feeling the movement of the tongue, pronouncing words, sounding them outside the vocal cords during pseudohallucinations).

There are so-called objective signs of hallucinations: when. visual - the patient looks closely, follows, observes invisible hallucinatory images; for auditory hearing: listens, covers ears, talks; with tactile shake off, collect imaginary insects, objects, etc.

Variants of hallucinations according to the conditions of occurrence: functional (usually auditory, arising from a real sound stimulus); reflex (with real irritation in the co-analyzer); hypnagogic (when falling asleep), hypnopompic (when waking up), Charles Bonnet type (when the peripheral part of the analyzer is damaged, for example, “vision” with severe cataracts); apperceptive (caused by volitional effort); psychogenic dominant (during affectively rich experiences, for example, the “voice” of a deceased husband), imagination of Dupre (during dreams and fantasies), induced (suggested to a hallucinating patient), suggested (imposed by a doctor during a study, for example, in a patient with alcoholic delirium Lipman's symptom, when visual images are suggested; Aschaffenburg's symptom, suggested “voices”, sounds. Many patients strive to depict hallucinatory experiences in paintings, drawings, and less often in literary works. They are part of the structure of such syndromes as hallucinosis, paranoid, mental automatism, paraphrenic.

Pseudohallucinations (false hallucinations) differ from true hallucinations in the nature of violence, imposition, artificiality; insufficient stability, volume, lack of sensual vividness of the image, lack of objectivity, physicality and extra-projection; a sense of subjectivity, alienation from the individual. Pseudohallucinations are distinguished by analyzers, projection, content, and affiliation. They are part of pseudohallucinosis, KandinskyClerambault syndrome of mental automatism, paraphrenic.

Symptoms of memory pathology

Memory mental process reflection, the ability to fix (memorize), preserve (retention) and reproduce (reproduce) past experience.

There are short-term (short-term), long-term (long-term) and working memory. There are types of memory based on the participation of analyzers: visual, auditory, motor, mixed; on the participation of signaling systems: visual-figurative and verbal-logical; by memory mechanism: mechanical, semantic; according to the degree of involvement of attention and volitional effort: involuntary and voluntary memorization.

Memory disorders can affect all its main components (fixation, retention, reproduction) and manifest themselves in dysmnesia (increase, decrease and loss of memory areas) and paramnesia (distortion or perversion of memory).

Hypermnesia short-term painful increase in involuntary reproduction, less often memory; occurs in febrile states, hypnotic and manic states.

Hyponesia painful weakening of remembering the present or reproducing past events. The so-called “perforated memory” occurs when the patient does not remember everything that he should remember, but the most powerful and vivid impressions. A mild degree of hypomnesia is manifested by weakness in reproducing dates, names, terms, numbers, etc. It occurs in neurotic, drug addiction, psychoorganic syndromes, paralytic and dementia.

Amnesia absence of memories of experiences, limited to a particular period of time, a particular situation.

Amnesia is distinguished according to the relationship between the period undergoing amnesia and the period of illness (disorder of consciousness); by impaired memory function, by dynamics, by the object of amnesia.

The first type of amnesia includes retrograde loss from memory of events preceding the acute period of the disease; anterograde loss of memories for a particular period of the disease; anteroretrograde (total) and congrade loss of memories, complete or partial, during a period of impaired consciousness. Occurs in brain injuries, encephalitis, and in quantitative and qualitative disorders of consciousness of various origins.

Amnesia due to predominantly impaired memory function: fixation sharp weakening or absence of the ability to memorize new information, current events, is one of the main signs of Korsakoff amnestic syndrome anekphoria inability to voluntarily remember without prompting.

According to the dynamics, amnesia is divided into: progressive decay of memory in accordance with Ribot’s law, from the current to an increasingly distant past; stationary, regressive the assimilation of current events and reproduction of the past gradually improves: retarded delayed, delayed, when events do not fall out of memory immediately, but some time after the pathological condition,

Variants of amnesia by object: affectogenic (catathymic) amnesia memory gaps after pronounced affective, unpleasant and unacceptable impressions and events for the individual; close to it is hysterical amnesia, when only events unacceptable to the individual are fragmentarily lost from memory; scotomization, also very close to the disorders described above, loss of areas of memories in persons without hysterical symptoms. Most often observed in neurotic reactions, hysteria and other psychogenic diseases.

Paramnesia distorted, perverted memories.

Pseudoremocence is the movement of memories in time, events that took place in another period are transferred to the current period of time. Most often they are of a replacement nature, filling memory gaps caused by fixation amnesia. They are part of Korsakoff's syndrome, partial and total dementia, pseudodementia and puerilism.

Cryptomnesia - a distortion of memory in which the differences between events in personal life and events in public life, seen in a dream, read, etc. are weakened or disappeared.

Echomnesia (reduplicating Pick paramnesia) is a deception of memory in which events, facts, and experiences that took place in the patient’s life appear doubled or tripled in the patient’s memories, often scattered over time.

Confabulations are fictions, distorted memories of events that did not occur either in the period of time that the patient is talking about or in his past life.

There are substitute confabulations - fictions that fill memory gaps, mainly caused by fixation amnesia; fantastic confabulations - distorted memories of incredible fantastic events that allegedly took place in the distant and recent past, caused by delusional experiences, confabulation; paralytic confabulations, also associated with megalomanic delirium in combination with increasing dementia; Kahlbaum's hallucinatory memories (specific phantoremia) distorted memories caused by hallucinatory experiences and transferred to the patient's past experiences; pseudohallucinatory pseudo-memories of V. X. Kandinsky the fact created by the imagination immediately becomes the content of auditory or visual pseudo-hallucinations, which are presented in the patient’s mind as memories of a real event.

Pathology of attention

Attention the ability to concentrate on any external or internal events, objects or activities. Attention contributes to a sustainable increase in the level of sensory, intellectual and motor activity, ensuring the productivity of mental activity. Attention does not have its own, separate and specific product.

Its result is the improvement of any mental activity to which it is connected.

There are active (voluntary) and passive (involuntary), post-voluntary attention. The properties of attention include stability, volume, switchability, and direction.

Attention disorders include:

• absent-mindedness attention impaired ability to maintain focus for a long time;
• exhaustibility weakening of the intensity of attention, rapid transition of active attention to passive;
• distractibility increased mobility, rapid change in direction, concentration, intensity of attention;
• stiffness inertia, fixed attention, with difficulty switching from one object to another;
• contraction of volume attention pathological concentration caused by the weakness of its distribution between objects.

Attention disorders are part of all positive and negative syndromes.

39. Pathologies of perception. Agnosia, pseudoagnosia, violation of the semantic aspect of perception. Pathology of perception as an indicator of abnormal mental activity.

Perception is an active process of analysis and synthesis of sensations by comparing them with previous experience.

Depending on the analyzers, the following types of perception are distinguished: vision, touch, hearing, smell, taste, kinesthesia (perception of one’s body in space). Each of these types of perception involves motor sensations.

Perception disorders in various mental illnesses have various reasons And various shapes manifestations. With local brain lesions, one can distinguish:

1. Elementary and sensory disorders (impaired sense of height, color perception, etc.). These disorders are associated with lesions at the subcortical levels of the analytical systems.

2. Complex gnostic disorders, reflecting disturbances of different types of perception (perception of objects, spatial relationships). These disorders are associated with damage to the cortical areas of the brain.

psychosensory disorders

Psychosensory disorders- distorted perception of objects or their individual characteristics (properties, signs) with preservation (identification) of recognition of the perceived object and the patient’s critical attitude towards it; subjectively they are extremely unpleasant. Based on the type of distortedly perceived object, two groups of symptoms are distinguished:
- Derealization- distortion of the surrounding world. If they are quite definite in nature and can be described, then this is metamorphopsia. If the object is so changed that it is impossible to talk about it, then the term dysmorphopsia is used.
- Depersonalization- distorted perception of the location of its parts, their relationship, weight, volume, etc.

Psychosensory disorders are mainly found in psychosensory, psychoorganic and withdrawal syndromes.

There are two groups of psychosensory disorders - derealization and depersonalization. Derealization is a distorted perception of the surrounding world. In the statements of patients, it can be vague and difficult to verbalize. There is a feeling that the world around us has changed; it has become somehow different, not the same as before. Derealization also includes a violation of the perception of time and space.

Symptoms of depersonalization can be presented in two variants: somatopsychic and autopsychic. Somatopsychic depersonalization, or a violation of the body diagram, is represented by experiences of changes in the size of the body or its parts, weight and configuration. Autopsychic depersonalization is expressed in the experience of a feeling of change in one’s “I”. In such cases, patients declare that their personal characteristics have changed, that they have become worse than before, have ceased to treat relatives and friends warmly, etc.

Gnostic disorders vary depending on the damage to the analyzer, and are divided into visual, auditory and tactile agnosia.

Agnosia- disorder of recognition of objects, phenomena, parts of one’s own body, their defects while maintaining consciousness of the external world and self-awareness. Agnosia is associated with damage to the secondary (projection-association) parts of the cerebral cortex, which are part of the cortical level of the analytical systems. There are several main types of agnosia: visual; tactile; auditory.

Visual agnosia occurs when the secondary parts of the occipital cortex are damaged and are divided into:

1) object agnosia - impairment of recognition various items while maintaining vision function. At the same time, patients can describe their individual signs, but cannot say what kind of object is in front of them. Occurs when the convexital surface of the left occipital region is affected;

2) agnosia for colors and fonts - the inability to select the same colors or shades, as well as to determine whether a particular color belongs to a specific object. Develops with damage to the occipital region of the left dominant hemisphere;

3) optical-spatial agnosia (the understanding of the symbolism of the drawing, reflecting the spatial qualities of the drawing, is impaired, the ability to convey the spatial characteristics of the object in the drawing is lost: further, closer, more-less, top-bottom, etc.).

4) simultaneous agnosia - a disorder associated with a functional narrowing of the visual field and limiting it to only one object. Develops when the anterior part of the dominant occipital lobe is affected;

In gnostic hearing disorders, there is a decrease in the ability to differentiate sounds and understand speech. Auditory hallucinations may occur. Possible defects in auditory memory (patients cannot remember two or more sound standards), arrhythmia (they cannot correctly assess rhythmic structures, the number of sounds and the order of alternations), a violation of the intonation aspect of speech (patients do not distinguish between intonations and have inexpressive speech).

Tactile agnosia occurs when the secondary cortical fields of the parietal lobe of the left or right hemisphere are damaged and manifest themselves in the form of a disorder in the recognition of objects by touch (astereoagnosia) or in a violation of the recognition of parts of one’s own body, a violation of the body diagram (somatoagnosia).

Auditory agnosia occur when the secondary cortical fields of the temporal lobe are damaged. When the temporal cortex of the left hemisphere is damaged, auditory or auditory-verbal agnosia manifests itself in the form of a violation of phonemic hearing, i.e. impaired ability to distinguish speech sounds, which leads to speech disorder; when the temporal cortex of the right hemisphere is damaged (in right-handed people), auditory agnosia proper occurs - the inability to recognize familiar non-musical sounds and noises (for example, barking dogs, creaking steps, the sound of rain, etc.) or amusia - the inability to recognize familiar melodies, musical hearing disorder .

Dementia is dementia as a consequence of underdevelopment or atrophy of higher mental functions. Pseudoagnosia is a violation of the motivational component of perception.

With visual pseudoagnosia in dementia, patients do not recognize silhouette and dotted patterns. Their perception is diffuse and undifferentiated. Dementia patients do not grasp the plot; they often describe individual objects without seeing their plot connection.

Perception, freed from the organizing role of thinking, becomes diffuse, structural decay easily occurs, unimportant elements of the picture become the center of attention and lead to incorrect recognition.

Thus, impaired perception in dementia confirms the leading role of the factor of meaningfulness and generalization in any act of perceptual activity.

Violations of the semantic aspect of perception

Hallucinations are one of the types of perception disorders in which images and ideas that arise and are externalized have no basis in a real external stimulus.

Visual hallucinations are characterized by the fact that the image is located in the perceived space, assimilating with it. Visual hallucinations also often contain elements of symbolism.

Simple auditory hallucinations are represented by non-speech individual sounds - rustles, noises, sighs, steps, or more meaningful sounds such as a running engine, the sound of the surf, a mosquito squeak, etc., or musical or rhythmic images.

Verbal hallucinations are a type of auditory hallucinations and contain a phonemic component. Sometimes they relate to the behavior of other persons and are in the nature of a dialogue. True auditory hallucinations, due to their connection with mental processes, reflect more high level lesions than all other hallucinations.

Tactile hallucinations are imaginary sensations of touching, touching, crawling, pressure, localized on the surface of the body, inside the skin or under it.

Olfactory hallucinations are usually characterized by extremely unpleasant, painful content of imaginary odors. The same smell is consistently repeated in various real situations. Smells can come from others or the patient himself, from internal organs.

Gustatory hallucinations usually coexist with olfactory hallucinations or appear later than them: food acquires a disgusting taste or difficulties arise in describing the taste deception.

Visceral hallucinations are disturbances of interoreception that are formed into delineated objective perceptions, experienced as living beings or some other inanimate objects, usually located inside the body. Such hallucinations are often combined with ideas of possession, influence, persecution, and other types of delusions.

In contrast to the true hallucinations described above, when the patient does not distinguish them from real objects, there are pseudohallucinations that resemble ideas that the patient considers special, unnatural, “made” by someone. The patient says with conviction that he is “showed” pictures, sounding thoughts enter his head “with the help of transistors,” etc. Because of this, pseudohallucinations are often combined with delusions of influence.

In most cases, pseudohallucinatory images are projected inside the patient’s body, mainly in the head, but even if in rare cases they arise outside it, they lack the character of objective reality characteristic of true hallucinations and are completely unrelated to the real situation. According to one criterion, patients with true hallucinations are confident that others are experiencing the same experiences, while patients with pseudohallucinations consider their experiences to be purely personal.

The study of perception can be carried out using clinical and experimental psychological methods.

Clinical method used in cases where it is necessary to study pain, tactile, temperature, vibration or auditory sensitivity, it is carried out with the help of specially selected hairs, bristles, needles, anamaloscopes, audiometers, etc. Such diagnostics are usually carried out by doctors.

To study more complex auditory and visual functions, experimental psychological methods, for example, a set of techniques.

Superimposed Popelreuter figures

This test allows you to study visual-object perception, the formation of visual images and representations and recognition of objects in the external world in conditions of a “noisy” object picture. Recognition presupposes the identification of essential features of objects, which is already a function of thinking.

Experimental material - a standardized drawing with a schematic representation of the contours of animals superimposed on each other.

Criteria for assessing the success of the task: accuracy and differentiation of showing/outlining the figure (presence or absence of “slips” onto elements of another figure); identification of the animal, smooth movements when tracing figures; execution/recognition time of figures; the presence of pauses and the need for stimulation from an adult; refusal to complete a task.

Methodology “Koos Cubes”

Target: the study of visual-figurative forms of thinking, violations of spatial orientation, the ability to carry out constructive praxis, the ability to analyze and synthesize.

Material: a set of cubes, colored identically; a set of cards with patterns of increasing complexity; a transparent overlay (mesh) on the patterns, which divides it into parts corresponding to the number of cubes.

Completing test tasks requires the manifestation of a complex of qualities of perception, motor skills, hand-eye coordination, spatial concepts and heuristic abilities. This complex nature of the tasks allows us to assess the ability to perform basic mental operations - comparison, analysis, synthesis, obtain an integral characteristic of practical, visual and effective thinking, and identify the level of development of non-verbal intelligence.

Methodology " Graphic dictation Elkonin"

Designed to study orientation in space. It also helps determine the ability to listen carefully and accurately follow an adult’s instructions, correctly reproduce the given direction of a line, and independently act as directed by an adult. To carry out the technique, the child is given a notebook sheet in a box with four dots marked on it one below the other. First, the child is given a preliminary explanation: “Now you and I will draw different patterns. We must try to make them beautiful and neat. To do this, you need to listen carefully to me, I will tell you how many cells and in which direction you should draw the line. Only the line that I say is drawn. The next line must begin where the previous one ends, without lifting the pencil from the paper.” After this, the researcher and the child find out where his right hand is and where his left hand is, and show on a sample how to draw lines to the right and left. Then the drawing of the training pattern begins.