Disorder of perception in psychology. Perceptual disturbance

- this is a group of pathopsychological symptoms, including various violations of the integral reflection of objects projected into real space. Manifested by unrecognition of objects and sounds (agnosia), derealization, depersonalization, distortion of the properties of surrounding objects and one's own body, erroneous perception of existing and absent in reality phenomena, objects (hallucinations, illusions). For diagnostics, the method of clinical conversation is used, a set of specific experimental psychological techniques. Treatment is aimed at eliminating the underlying disease that provoked perception disorders.

ICD-10

R48.1 R44

General information

Perception is a mental function responsible for the processing of sensory information coming from receptors of different modalities. Thanks to the ability to perceive information from the surrounding world, from parts and organs of the body, a person learns reality and successfully orients himself in it. General data on the prevalence of perceptual disorders are not available. According to various studies, hallucinations (from episodic on the background of overwork to deployed in mental illness) are observed in 10-30% of the population, depersonalization-derealization syndrome - in 1-2%. Pathological illusions of varying degrees of persistence and duration are experienced by about 60% of people. This type of disorder is determined not only by the state of health of a particular person, but also by living conditions. So, for example, small peoples whose life is organized in small settlements with traditional dwellings (low, round) do not have the illusions of perceiving the depth of space that are characteristic of residents of cities with dense multi-storey buildings.

The reasons

Factors in the occurrence of this group of pathologies are often changes in the structure and functions of the brain - biochemical changes (impaired activity of neurotransmitters), traumatic, vascular, intoxication and infectious damage to the brain substrate. In addition, the processing of objective sensory information may change as a result of psychological experiences, influences of the motivational sphere of the personality. The most common causes of perceptual disorders include:

• Organic lesions of the central nervous system. Perceptual disturbances can develop with stroke, brain tumors, traumatic brain injuries, encephalitis, degenerative diseases (Alzheimer's disease, Pick's disease, and others). The nature of the symptoms is determined by the location and depth of damage to the nervous tissue.
• Mental disorders. Distortions and deceptions of perception are characteristic of schizophrenia, manic-depressive psychosis, delusional disorders of various origins, and intoxication psychoses. The intensity of manifestations increases with exacerbation of diseases.
• drug intoxication. Hallucinations and complex illusions can be triggered by some drugs. There have been cases of perceptual disturbances when taking analgesics, antibiotics, antidepressants, tranquilizers, antihistamines, antiviral and anticonvulsant drugs.
• Addiction. Even a single use of narcotic drugs causes changes in perception. Compounds such as LSD, beta-carbolines, amphetamines, dissociative anesthetics and anticholinergics, marijuana and some other drugs have hallucinogenic properties.
• Psychic trauma. Perhaps a distorted perception of situations, objects after experiencing shock, intense fright, fear. Neutral stimuli appear threatening to patients.

Pathogenesis

At the heart of perceptual disorders is a violation of the connection between the sense organs, which are in direct contact with the outside world, and brain analyzers - areas of the cortex that form ideas based on sensory experienced information. The cortical sections of the analyzers are represented by three zones hierarchically built on top of each other. The first, the simplest, is formed by the projection fields into which the fibers of the analyzers come. The excitation of these areas does not spread and causes only simple sensations. Secondary fields have a more complex structure and are called projection-associative. In them, the fragmentation and synthesis of incoming information takes place - simple images of perception are formed, and when these zones are affected, agnosias develop - stimulus recognition disorders.

The tertiary zones of the cortex are located mainly in the parietal-temporal-occipital region and consist entirely of complex associative neurons of the second and third layers. They combine information from analyzers of different modalities coming from the underlying zones. Thanks to their functioning, a person is able to perceive objects and phenomena in a complex way - to form an image based on visual, auditory, skin-kinesthetic and vestibular signals. In case of damage or dysfunction of the tertiary zones, patients experience difficulties in orientation, assessment of spatial relationships, and simultaneous perception of multimodal information. Illusions, psychosensory symptoms develop. Defects are found in operations with abstract categories, the internal organization of elements into a system in “quasi-space” - counting, writing, construction and understanding of logical and grammatical structures are violated.

Classification

In clinical practice, the division of perceptual disorders into agnosias, psychosensory disorders, illusions, hallucinations is common. In scientific research, a classification is often used based on the nature of the symptoms - their direction, depth, content. According to her, four types of pathologically altered perception are distinguished:

1. Lack of perception. It is represented by agnosia - the inability to recognize phenomena and objects while maintaining a clear consciousness and the normal functioning of receptors, analyzers. There are acoustic, optical, spatial and tactile agnosia.
2. Change in the intensity of perception. With an increase in function, they speak of hyperpathy (sensitive perception of stimuli), with a decrease, hypopathy (inadequate perception of weak and moderate stimuli). In both cases, a change in sensory perception entails emotional disturbances.
3. Perceptual distortion. Psychosensory disturbances are included - an altered display of the shape, number of objects, perspective; optic-vestibular disorders - the perceived movement of stationary objects (walls, furniture). The feeling of alienation of one's body or personality is called depersonalization, and the feeling of remoteness, unnaturalness of the environment is called derealization.
4. Perception errors. This group consists of illusions and hallucinations. With illusions, real-life phenomena, objects are incorrectly displayed (some illusions are explained by the peculiarities of life experience and are a variant of the norm, for example, the Ebbinghaus illusion). Hallucinations are an erroneous perception of something that doesn't exist. They are divided into true and pseudo hallucinations.

Symptoms of Perceptual Disorders

Agnosias are manifestations of neurological diseases. With the visual form of the disorder, the patient is unable to name the object, explain its purpose; with auditory - to determine the source of the sound, the meaning of the spoken phrase or word; with tactile - assess the nature of the impact, describe it. In psychiatric practice, there is the phenomenon of anosognosia - misrecognition, denial of one's own illness.

Illusions can be a variant of the normal functioning of the psyche. For example, the physical illusion of distortion of an object half-immersed in water, or the physiological illusion of hot water (actually warm) after a person has been in the cold for a long time. Perceptual disorders include affective and pareidolic illusions. The first are accompanied by anxiety, fear, expectation of trouble. Patients perceive neutral stimuli as threatening if they are somehow related to previous traumatic experiences. With pareidolic illusions, visual images are erroneously displayed. In carelessly thrown clothes, folds of curtains, wallpaper patterns, patients see changing faces, moving figures of animals and people, scenes of quarrels and battles.

Hallucinating patients perceive non-existent objects, events, phenomena. There is no critical attitude to the symptom, the emerging images, sounds and other influences are taken for real, not imaginary. Persuasion attempts are ineffective. The composition of hallucinations are simple and complex. Simple visual hallucinations are called photopsies, they are represented by shapeless spots, glare, unclear contours. Auditory phenomena - acoasma - unintelligible hails, knocks, rustles, noises. Complex forms of hallucinations arise on the basis of the synthesis of information from different analyzers and appear in the form of images. Patients see people, aliens, animals, mythical creatures, distinguish between individual words and phrases, complex sounds, tactile effects with an accurate definition of the source - wind noise, bee buzzing, insects crawling on the skin. Often a visible object says something, smells in a certain way, causes sensations of tingling, pain.

With psychosensory disorders, the patient recognizes the real object correctly, but in a distorted form - the shape, size, weight, color, ratio of perceived objects is perceived as altered. Pieces of furniture appear small, doorways appear crooked, trees appear tilted, table legs appear deformed. Derealization is typical for exogenous psychoses, manifested by a distorted perception of the environment. It is indefinite, it is difficult for patients to describe their condition. Often they report a feeling of change, implausibility of situations and events - "everything has become gray / too fast / slow / lifeless."

Distorted perception of time is typical for depressive (slowdown) and manic (acceleration) patients. Narcotic intoxication when using marijuana is accompanied by a distortion of the perception of space - nearby objects seem distant. With somatopsychic depersonalization, the body scheme is violated - the idea of ​​body parts, the functioning of organs. The autopsychic form is characteristic of endogenous psychoses, it is experienced as a feeling of a change in the “I” (“I became worse, angrier or more stupid”).

Complications

With the preservation of the critical attitude of patients, perceptual disorders become an obstacle to orientation in space, planning time, performing professional and domestic duties, and maintaining social activity. Patients are in a state of confusion. Violation of the functions of perception provokes the development of fears, phobias, limits behavior. The greatest danger for patients and their environment is imperative hallucinations - calls and orders to perform one or another action that can lead to serious consequences - self-harm, suicide, violence against children, the murder of acquaintances or bystanders. If left untreated, the hallucinations get worse and occur several times a day.

Diagnostics

Examination of patients with disorders of perception is carried out in a complex manner. The set of diagnostic procedures is determined by the most likely underlying disease. With neurological pathology, agnosias and simple types of hallucinations are formed, an examination and anamnesis is carried out by a neurologist, instrumental studies are prescribed to determine the cause of the symptom and establish an accurate diagnosis (CT, MRI of the brain, ultrasound of the vessels of the brain). Specific diagnosis is performed by a psychiatrist, a clinical psychologist. Includes:

• conversation. The doctor asks the patient about disturbing symptoms, collects an anamnesis, specifying hereditary burden, the presence of mental and neurological diseases, drug addiction, alcoholism. With a pronounced violation of the function of perception, patients are scattered, they hardly keep the topic of conversation, they are distracted, and they do not always adequately answer questions. In most cases, additional information is required from relatives.
• observation. Assessing the features of behavior, motor and emotional reactions, the doctor determines the presence of perceptual disorders. Patients with hyperpathy have overreactions to minor stimuli: startling at loud noises, soft speech, half-whispers, the desire to protect themselves from sunlight. Patients with auditory hallucinations plug their ears, cover their heads with a blanket, conduct a dialogue with voices, utter words that do not fit with the topic of the conversation. With visual hallucinations, patients look away with concentration, follow the images with their eyes, and emotionally react to their content.
• Experimental psychological research. These methods are used in the diagnosis of complex auditory and visual functions. Visual agnosias are detected by the "Classification of objects" test, Poppelreiter's tables (recognition of contour, crossed out, noisy and superimposed images). Illusions are determined using Raven's tables, M.F. Lukyanova's test (wavy background, moving figures). The study of auditory perception is performed by the tachistoscope method (listening and identifying sounds).

Treatment of Perceptual Disorders

Specific therapy for this group of disorders has not been developed, since they are always a symptom. Methods of treatment are determined by the leading disease - organic pathology of the central nervous system, mental disorder, acute emotional reaction, drug addiction. As a rule, drug therapy is prescribed, which may include taking vascular drugs, nootropics, tranquilizers, sedatives. Hallucinations are stopped by antipsychotic drugs. To increase the effectiveness of the main treatment, the patient and relatives must adhere to a number of rules:

• Compliance with the daily routine. Symptoms are aggravated by fatigue, lack of sleep, excessive mental or physical fatigue. Therefore, patients need to avoid stress and emotional stress, alternate periods of activity with rest, sleep at least 8 hours at night and allocate time for sleep during the day.
• Additional lighting. At dusk, deceptions and distortions of perception occur more often. Indoors, it is necessary to create additional sources of soft light. You should organize the space so that there are no shadows in the room.
• The color and brightness of objects. The best option for walls, ceiling and floor is plain pastel colors. Furniture, doors and windows should be bright and also plain. It is recommended to avoid the use of patterns, ornaments, plot paintings, glossy surfaces in the interior.

Forecast and prevention

Subject to medical recommendations and active rehabilitation measures, the prognosis of perceptual disorders is positive: severe symptoms stop, the patient successfully adapts to normal life. Prevention includes refusal to use alcohol and drugs, preventive diagnostic procedures in the presence of hereditary burden for mental disorders or degenerative diseases of the central nervous system, comprehensive examinations after head injuries, neuroinfections, and intoxications.

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

Disorder of perception from time to time visits more than 70% of people around the world. It seems to them that their consciousness is divided into two parts, and one of them, having lost control over their mind and body, panics, and the second is watching this from the side indifferently. It is like a nightmare and therefore very frightening. A person sees everything in a fog, in muted colors, he cannot move his hand or foot. He feels the strongest discomfort and it seems to him that he is going crazy.

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

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

It is necessary to know that depersonalization can also accompany clinical depression, panic attacks, anxiety and bipolar disorders, schizophrenia. Narcotic drugs, sedatives and antihistamines and a number of other drugs, as well as caffeine and alcohol, cause similar sensations.

Causes of Perceptual Disorder

Depersonalization occurs in people of all ages and genders, but most often it affects young women. As already mentioned, it is caused by a stressful situation. The psyche that resists it reduces the strong emotional load of a person, switching his attention to third-party observation. Thus, the individual turns his consciousness on himself, his senses are dulled, but at the same time logical thinking remains the same.

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

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

• stroke;
• hypertension;
• brain tumor;
• neurological disease;
• head injury;
• epileptic attack;
• neurosurgical operation;
• severe infectious disease in childhood;
• birth injury.

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

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

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

Symptoms

There are 3 conditional groups of signs that characterize the syndrome of depersonalization:

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

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

Fear is experienced only from the loss of control of one's body and loss of orientation in space. Depresses the feeling of confusion from a lack of understanding of the location, the history of getting here and further actions.

2. Violation of physical sensations:

• loss of sensitivity to hot and cold;
• colors become dull, color blindness may appear;
• taste sensations change;
• objects seem blurry, without borders;
• sounds seem muffled, as in water;
• pain with minor injuries is absent;
• impaired coordination of movements;
• there is no feeling of hunger, and with it the appetite disappears.

3. Mental Immunity:

• a person forgets his preferences - what he likes and dislikes;
• lack of incentives and motives - unwillingness to take care of oneself, cook food, do laundry, work, go shopping;
• temporary disorientation - an individual can sit, doing nothing, for several hours and not understand how much time has passed;
• the feeling of participating as an actor in a boring dragging play;
• contemplation from the side of your life, as if it were a dream.

The main sign of a perceptual disorder is considered to be a deep immersion of a person in himself. At first, he understands that he perceives his personality incorrectly, this depresses him and causes great emotional unrest.

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

In general, the clinical picture of depersonalization can be described as follows:

1. The perception of the world is disturbed - it seems unreal, fantastic.
2. Complete detachment from what is happening around.
3. Loss of satisfaction from natural physiological needs - sleep, food, defects, sex, etc.
4. Closure.
5. Disturbances in the perception of the structure of one's body - arms and legs seem artificial, incomprehensible configuration or size.
6. Inability to control your body.
7. Decreased intellectual abilities.
8. Feeling of loneliness, abandoned by everyone.
9. Absence of any emotional manifestations.
10. Change in physiological sensations.
11. Split personality.
12. The feeling of watching yourself from the outside.

These symptoms of a perceptual disorder can have different degrees of severity with different types of depersonalization, which will be discussed below.

Varieties

Modern psychology shares several forms of the depersonalization syndrome, which differ from each other in their unique perception of the world around them and themselves:

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

Diagnostics

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

Blood tests and examination of the patient will not give anything - he does not look sick, he does not have chronic and hidden somatic diseases, his immunity is not satisfactory, his physical condition is quite normal. But on the other hand, MRI will show changes in certain areas of the brain. There are also special laboratory studies confirming changes in protein receptors and disturbances in the work of the endocrine gland - the pituitary gland.

Now there are clear criteria to confirm the diagnosis:

1. The critical thinking of the patient, who is aware of his problem.
2. Preservation of clarity of consciousness, the absence of so-called twilight episodes, confusion of thought.
3. Complaints that the mind exists separately from the body, the latter exists independently and its perception is disturbed.
4. Sensation of terrain change, unreality, unrecognition of familiar objects.

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

Therapy for depersonalization disorder

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

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

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

Depersonalization on the background of depression, panic attacks, schizophrenia, the psychiatrist prescribes a complex of tranquilizers, antidepressants, antipsychotics. The following drugs are shown:

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

Some patients have to take psychotropic drugs for life, as the syndrome cannot be completely cured. Medicines allow them to pay off the severity of the experiences caused by the disorder.

When symptomatic manifestations are removed, the time of psychotherapy comes. The specialist conducts a series of sessions with the patient, in which he reveals the causes of the perceptual disorder, switches the patient's attention to other people, and teaches him how to cope with the attacks of splitting in the future.

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

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

Additional measures may include:

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

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

It happens that people with a severe degree of depersonalization have a negative attitude towards the rehabilitation program, they are passive. In this case, they resort to the help of the patient's relatives, who literally pull the relative "into the light".

Smirnova Olga Leonidovna

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

Articles written

Disorders of perception are accompanied by a violation of the process of cognition of the surrounding world. The main variants of pathology are illusions and malfunctions of psychogenic synthesis. The patient can not do without the qualified help of a psychiatrist. In most cases, such phenomena indicate the development of mental disorders. They bring a lot of problems to the patient and his relatives 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 draws conclusions on the basis of knowledge, desires, his own imagination, 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. Therefore, in order to avoid disputes, all the nuances should be discussed.

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

How do receptors and sense organs affect

The sense organs help a person to compose a picture of the environment, taking into account all its diversity and versatility.

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

Sensations are distinguished by objectivity, since external stimuli are reflected in them. The subjectivity of sensations depends on the state of the nervous system.

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

In the human body there is 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 an external stimulus into an external signal.
2. Conducting nerve pathways. Through them, signals are sent to the brain, and from it to the overlying sections, and then again to the brain and low-lying sections.
3. Cortical projection zones. This think tank, located in the region.

Individual receptors have the ability to receive certain manipulations. Different sensations arise with a distinctive speed. 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 a distinctive clinical picture, duration and treatment methods. At the first manifestations, you need to consult a doctor, since the problem will not be solved on its own.

Illusions

In this case, a person sees in a distorted form an object that really exists. The patient may misperceive the shape, color, size, texture, and other characteristic features. In the presence of illusions, the visual image is distorted. For example, there is a coat hanging in the closet, and he was taken for a real person due to similar outlines. With auditory illusions, the perception of existing sounds is disturbed. For example, when someone shouts on the street, and it seems to the person that his name is. There are even taste illusions. At the same time, the taste or smell familiar to the dish is modified. There are cases of tactile illusions. 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, distortedly. He mistakenly recognizes objects, instead of one he sees a completely different one.

Illusory perception is often indistinguishable from sensory perception. Therefore, there is no criticism of illusory deception. A person is completely sure of 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 lower a stick into water, it will seem that it is broken in half. While traveling in a train, it seems that the landscape also moves along with the vehicle.

In psychiatry, illusions are most often referred to 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.

The most common are affective illusions. 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 images, fantastic paintings. For example, when a patient examines a drawing on a carpet, he sees people, animals, 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-term, fuzzy 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 made about a change in consciousness.

Such a 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 sensory pathologies, is characterized by excessive impressionability and dreaminess, a tendency to fantasies, is too tired or little sleep.

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 sure of 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 induce action.

The occurrence of hallucinations does not depend on whether the object exists or not. Patients are fully convinced of the reality of visible images. Hallucinations may be true. At the same time, a person indicates exactly where the image is located, which he perceives as real.

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

eidetism

This is a special kind 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.

Senestopathy

This is a mental disorder that is accompanied by unusual sensations. A person suffers from vague, painful, unpleasant, obsessive, difficult to localize sensations.

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

At the same time, it seems to the patient 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 are changing rapidly.

A person constantly focuses his attention on these sensations. They interfere with his normal life.

Agnosia

Translated into Greek, "gnosis" means "knowledge". This nervous function allows a person to recognize objects, phenomena, his own body.

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

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

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

The problem is manifested by a lack of understanding of speech, the inability to determine the object by touch. Inability to consider the subject, to paint it.

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

Derealization disorders

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

1. macropsia. At the same time, it seems to the person that the surrounding objects are decreasing in size. It is characterized by an increase in the size of surrounding objects.
2. Dysmegalopsia. In this case, the surrounding objects lengthen, expand, bevel, pervert around the axis.
3. Porropsia. The person has the impression that the object is moving away from him.

Such disorders of sensation and perception are characterized by an incorrect attitude towards one's personality, individual qualities or parts of the body.

A good example of a problem is the 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, space is distorted.

With such a disorder, a person has the impression that his limbs are lengthening, shortening, tearing off.

Temporal Perception Disorders

In this case, it feels like:

1. Time stopped. In this case, dullness and flatness of objects are observed. It seems to the patient that he has no connection with the outside world and loved ones.
2. The timer is stretched. The patient thinks that time is longer than usual. He relaxes and is in a euphoric state. The impression of a plane and three-dimensionality of objects, their mobility is created.
3. Lost sense of time. Man thinks that he is completely freed from time. At the same time, the perception of the world always changes. Increases the contrast of objects and people.
4. Time has slowed down. People move at a calm pace with grim expressions.
5. The timer has sped up. The world and your own body seem fleeting, and people are fussy. Feeling of your body worsens. It is difficult to determine the time of day and the duration of events.
6. Time flows backwards. If the event happened a few minutes ago, then it seems that it happened a very long time ago.

Violations of 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 have certain information. How its development will proceed in the future depends on how active the child is.

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

During this period, it is important to be screened for possible perceptual disturbances. The problem can arise in diseases of the brain that break the connection with the sense organs and centers of the brain. Trauma and morphological changes in the body contribute to the development of disorders.

Young children perceive the world vaguely and indistinctly. If, for example, the mother changes into a fancy dress, then it will be difficult for the baby to recognize her.

The development of perception of the world is an important process, how the child perceives the world, reality, and adapts to environmental conditions depends on how successful it is.

Perception, unlike sensations, gives a complete picture of an object or phenomenon. Its physiological basis is the sense organs. The end product of perception is a figurative, sensory representation of a particular object.

Perceptual disorders are represented by several disorders: illusions, agnosias, hallucinations and psychosensory disorders.

Agnosia- unrecognition of the object, the inability of the patient to explain the meaning and name of the perceived object Visual, auditory

and other agnosias are similarly treated and studied in the course of nervous diseases. In psychiatry, anosognosias (not recognizing one's illness) are of particular interest, occurring in many mental and somatic diseases (hysterical disorders, alcoholism, tumors, tuberculosis, etc.) and having a different pathogenetic nature.

Illusions- such a violation of perception, in which a real-life object is perceived as completely different (for example, a shiny object on the road that looks like a coin, upon closer examination, turns out to be a piece of glass, a dressing gown hanging in a dark corner - for the figure of a lurking person).

Distinguish illusions physical, physiological and mental.

Physical illusions are due to the peculiarities of the environment in which the perceived object is located. For example, a mountain range is perceived as colored in different colors in the rays of the setting sun, as we see it in R. Roerich's paintings. An object in a transparent vessel half-filled with liquid seems to be broken at the boundary between liquid and air.

Physiological illusions arise in connection with the conditions for the functioning of receptors. Cold water after being in the cold is perceived as warm, a light load after prolonged physical exertion is perceived as heavy.

Mental illusions, more often they are called affective in connection with the emotional state of fear, anxiety, expectation. An anxious and suspicious person walking late hears the steps of the pursuer behind him. Being in a state of alcohol withdrawal, he sees various faces or figures in spots on the wall.

Pareidolic illusions are mental, they are a kind of visual with a changing content of erroneous images. They often occur in the initial period of psychotic states, in particular alcoholic delirium. Patients in the drawings of wallpaper, carpets see changing faces, moving figures of people, even pictures of a battle.

The remaining illusions are often not a symptom of a mental illness, they are often found in mentally healthy individuals under the above conditions.

Another existing classification of illusions is based on their differentiation by analyzers: visual, auditory, tactile, olfactory, gustatory. The first two varieties are most common, and the last two cause great difficulty in distinguishing from hallucinations of smell and taste.

hallucinations.

Hallucinations is such a violation of perception, in which an object or phenomenon that does not exist at a given time and in a given place is perceived in the complete absence of a critical attitude towards them .. Hallucinating patients perceive them as really existing, and not something imaginary. Therefore, any reasonable arguments of the interlocutor that the sensations they experience are only manifestations of the disease are denied and can only irritate the patient.

All hallucinatory experiences are classified according to a number of characteristics: complexity, content, time of occurrence, interest of one or another analyzer, and some others.

According to the complexity of hallucinations are divided into elementary, simple and complex. The former include photopsias (visual images devoid of a specific form in the form of spots, contours, glare), acoasma (calls, obscure noises) and other simple phenomena. Only one analyzer is involved in the formation of simple hallucinations. When complex hallucinations appear, several analyzers are involved. Thus, the patient can not only see an imaginary person, but also hear his voice, feel his touch, smell his cologne, etc.

Most often in clinical practice there are visual or auditory hallucinations.

Visual hallucinations can be represented by single or multiple images, previously encountered or mythical creatures, moving and stationary figures, harmless or attacking the patient, with natural or unnatural coloring.

If the visual image is perceived not in the usual field of view, but somewhere on the side or behind, then such hallucinations are called extracampal. The experience of seeing one's doubles is called autoscopic hallucinations.

Auditory hallucinations can be experienced by patients as the sound of the wind, the howling of animals, the buzzing of insects, etc., but most often in the form of verbal hallucinations. These may be the voices of familiar or unfamiliar people, one person or a group of people (polyphonic hallucinations), who are nearby or at a far distance.

According to the content, "voices" can be neutral, indifferent to the patient or threatening, insulting. They can address the patient with questions, messages, award him orders or remove him from office, comment on his actions (commenting on hallucinations) and give advice. Sometimes the “voices” talk about the patient without addressing him, while some scold him, threaten him with punishments, others defend him, offer to give him time to correct himself (antagonistic hallucinations).

The greatest danger for the patient and his environment are imperative hallucinations, which are in the form of orders to perform a particular action. These orders may be harmless (cook food, change clothes, visit, etc.), but often lead to dire consequences (self-harm or suicide, injure or kill a familiar person or a bystander).

As a rule, the patient cannot oppose these orders, he carries them out, at best he asks to restrict his actions in some way so as not to cause trouble.

Tactile hallucinations are most often represented by the feeling of crawling on the skin or under it of various kinds of insects. Moreover, even if the feeling of crawling is not confirmed by visual hallucinations, the patient can tell about their size, number, direction of movement, color, etc.

Olfactory and gustatory hallucinations are rare. Olfactory consists in the sensation of non-existent pleasant, often unpleasant odors (hydrogen sulfide, rot, sewage, etc.) Taste - the experience of some kind of taste in the mouth, regardless of the nature of the food taken.

With visceral hallucinations, patients claim that there are some creatures in their body (worms, frogs, snakes, etc.) that cause them pain, eat food taken, disturb sleep, etc.).

Visceral hallucinations, unlike senestopathies, have the appearance of an image with the corresponding characteristics of size and color. movement features.

Functional, dominant, hypnagogic and hypnopompic hallucinations are considered separately from others.

Functional hallucinations arise against the background of the action of an external stimulus, and are perceived simultaneously with it, but without merging, as is the case with illusions. For example, in the noise of rain, the ticking of a clock, the patient begins to hear the voices of people.

Dominant hallucinations reflect the content of the mental trauma that caused the disease. For example, a person who has lost a close relative hears his voice or sees his figure.

Hypnagogic hallucinations of any kind occur during the transition from wakefulness to sleep, hypnopampampic hallucinations - upon awakening.

Of particular importance for the diagnosis of a mental disorder is the division of hallucinations into true and false (pseudohallucinations).

For true hallucinations a projection into the environment is characteristic, they naturally fit into it, wear the same signs of reality as the surrounding objects. Patients are convinced that others are experiencing the same experiences, but for unknown reasons they hide it. True perceptual delusions usually influence the behavior of the patient, which becomes consistent with the content of hallucinatory images. True hallucinations are more common in exogenous psychoses.

Pseudo-hallucinations have a number of distinctive properties from the true:

1. They are devoid of signs of reality, do not fit into the environment, are perceived as something alien, strange, different from previous sensations. Through the man sitting on a chair, the back of the chair is visible, a nearby tiger with a bared teeth, according to V.Kh.Kandinsky, does not cause a feeling of fear, but rather curiosity.

2. Projection of hallucinations inside the body. The patient hears voices not with the ear, but inside the head, sees images located in the abdomen or chest.

3. Experience the feeling of having hallucinations. The patient does not see the image himself, but it is shown to him, he hears a voice inside his head because someone did this, perhaps by inserting a microphone into his head. If a visual hallucination is projected outside, but has the above listed signs, it can be classified as a pseudo hallucination.

4. Often, pseudohallucinations, if they are not imperative, do not affect the patient's behavior. Even close relatives may not realize for months that there is a hallucinating person next to them.

Pseudohallucinations are more common in endogenous disorders, namely in schizophrenia, are included in the Kandinsky-Clerambault syndrome.

The presence of hallucinatory experiences can be learned not only from the words of the patient and his relatives, but also from the objective signs of hallucinations that are reflected in the patient's behavior.

Hallucinations belong to the psychotic level of disorders, their treatment is best done in a hospital, and imperative hallucinations are a prerequisite for involuntary hospitalization.

Hallucinations form the basis of the hallucinatory syndrome. Long-term, non-stop hallucinations, most often verbal, are referred to as hallucinosis.

Psychosensory disorders.

(impaired sensory synthesis)

Sensory synthesis disorders are called such a perceptual disorder, in which a real (as opposed to hallucinations) perceived object is recognized correctly (as opposed to illusions), but in an altered, distorted form.

There are two groups of psychosensory disorders - derealization and depersonalization.

Derealization is a distorted perception of the world around. It in the statements of patients can be indefinite, difficult to verbalize. There is a feeling of change in the surrounding world, it has become somehow different, not the same as before. Houses don't stand that way, people don't move that way, the city looks camouflaged, and so on. For patients who are depressed, statements are characteristic that the world has lost its colors, has become dull, blurry, lifeless.

In other cases, experiences of derealization are expressed in quite definite terms. This concerns, first of all, the distortion of the shape, size, weight and color of the perceived object.

Micropsia - perception of an object in a reduced size, macropsia - in an enlarged size, metamorphopsia - in a distorted form (broken, bent, deformed, etc.) One of the patients periodically ran out of the ward with a loud cry of "fire", as he perceived everything around him in bright red color.

Derealization can also be manifested by the phenomena déjà vu, eprouve vu, entendu vu, as well as jamais vu, jamais eprouve vu, jamais entendu. In the first case, we are talking about the fact that the individual experiences the situation that has arisen as it has already been seen, heard or experienced. In the second, already previously known - as never seen, heard or experienced.

Derealization also includes a violation of the perception of time and space.

Patients in a manic state perceive time faster than in reality, in a depressive state - as slowed down.

Those who are in a state of intoxication as a result of smoking marijuana experience the feeling that nearby objects are at a distance of tens of meters from them.

Derealization is more common in mental disorders of exogenous etiology.

Symptoms of depersonalization can be presented in spirit variants: somatopsychic and autopsychic.

Somatopsychic depersonalization, or a violation of the body schema, is represented by experiences of changes in the size of the body or its parts, weight and configuration. Patients may claim that they are so grown that they do not fit in their bed, their head cannot be torn off the pillow due to weight, etc. These disorders are also more common with exogenies.

Autopsychic depersonalization is expressed in the experience of a feeling of change in one's "I". In such cases, patients declare that their personality traits have changed, that they have become worse than before, they have ceased to be warm to relatives and friends, etc. (in a state of depression). Autopsychic depersonalization is more characteristic of patients with endogenous diseases.

Depersonalization-derealization syndrome can be complicated by delirium, depression, mental automatisms and other disorders of mental activity.

Perception disorders are manifested in difficulty in recognition, in distortions of the perceived material, in deceptions of the senses, false recognitions, violation of generalization in the restructuring of perceptual activity.

Types of Perceptual Disorders

The concept of illusions. Illusions are called erroneous, changes in the perception of real-life objects and phenomena. Illusions can be both mentally ill and perfectly 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 terrible, bearded forest king, in the second, swirling figures of demons are seen in a blizzard, and their voices are heard in the noise of the wind.

Illusions in healthy people. Healthy people may have physical, physiological illusions, as well as illusions of inattention.

Physical illusions are based on the laws of physics. For example, the perception of the refraction of an object at the boundary of various transparent media: for example, a spoon in a glass of water seems to be refracted, on this occasion R. Descartes said: "My eye refracts it, and my mind straightens it." A similar illusion is a mirage.

Physiological illusions are associated with the functioning of the analyzers. If a person looks at a moving train for a long time, he gets the feeling that the train is standing still, as if he is rushing in the opposite direction. When the rotating carousel suddenly stops, the people sitting in it for several seconds retain the feeling of a circular rotation of the surroundings. For the same reason, a small room, pasted over with light wallpaper, seems to be larger in volume than in reality. Or a fat person dressed in black seems to be more slender than in reality.

Illusions of inattention are noted, for example, in cases where, with 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 the pathology of the psyche. Illusions associated with the pathology of the mental sphere are usually divided into affective (affectogenic), verbal and pareidolic.

Affective illusions arise in a situation of affect or an unusual emotional state (strong fear, excessive desire, intense expectation, etc.), in a situation of insufficient illumination of the surrounding space. For example, hanging a tie in the twilight can be perceived as a cobra ready to jump. Affective illusions are sometimes noted in healthy people, because this distorted perception is associated with an unusual emotional state. Almost anyone can experience affective illusions if they visit a cemetery alone 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 also appear against the background of some kind of affect and are expressed in an erroneous perception of the meaning of the conversations of people around, 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) against the backdrop of the TV turned on, how he was invited to divide the company "into three" by "hairy people with tails" completely unfamiliar to him, freely passing through the wall of the house.

Pareidolic (near-shaped) illusions associated with the activity of the imagination when fixing the gaze on objects that have a fuzzy configuration. In this disorder, perception is bizarre-fantastic in 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 carpet patterns - his life path. Pareidolic illusions always occur with a reduced tone of consciousness against the background of various intoxications.

Sick N. saw in the patterns of shabby wallpaper all the same, but significantly reduced in size, hairy people with tails, who hospitably opened the gates to hell in front of him, holding a bottle of vodka in each hand to meet him.

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 an isolated form is not a symptom of a 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.

The main feature of deceptions of the senses in mental illness is the lack of their direct identification with real objects and their qualities.

The concept of agnosia. Agnosia (from the Greek gnosis - "knowledge") is a disorder of recognition of the characteristics of objects and sounds. Allocate visual, tactile and auditory agnosia.

Visual agnosia manifests itself in the fact that a person, while maintaining sufficient visual acuity, cannot recognize objects and their images. Visual agnosias are subdivided into subject, color, symbolic and spatial.

Tactile agnosia consists in a disorder in the recognition of objects by touch (astereognosis) or in a violation of the recognition of parts of one's own body, in a violation of ideas about the body scheme (somatognosia).

Auditory agnosia manifests itself in violations of phonemic hearing, which determines a person's ability to distinguish speech sounds.

For patients with organic lesions of the brain, the phenomena of agnosia consist in the selection in objects of one sign, then another, but to recognize it by combining all the signs, i.e. to synthesize, they cannot. Thus, the process of perception in mental illness acquires the character of guessing and gradual recognition of objects. For example, when examining patient V., she interprets a picture of a rake presented to her as follows: “This is a brush, maybe a floor brush, or maybe a toothbrush. But why does she have such rare villi? No, this is not a brush. Maybe it’s a rake "But why is there a rake here? Why? I don't know what it is." The patient calls the mushroom drawn in the picture either a haystack or a lamp.

Pathopsychological studies indicate that patients with neuropsychiatric disorders demonstrate, albeit gradually, a tendency to recognize specific images, but it is especially difficult for them to correlate schematic drawings with a certain category of objects. For example, when presented with a dotted image of a paperweight, patient N. calls this object "some dots." When shown a silhouette image of a paperweight, she says that it is "a strange thing, like a ship or a boat." And only when she is shown a specific image of a given object, she names it correctly. Some patients have other features: it is difficult for them to recognize the object in the picture, but they can easily and in detail describe its shape. At the same time, it should be noted that in the answers of the majority of patients there is doubt and uncertainty about the correctness of their conclusions.

In patients described by B. V. Zeigarnik, agnostic phenomena were of the following character. They recognized the shape and configuration even when the latter were presented tachyscopically. Without recognizing objects, they could describe them. So, for example, during tachyscopic presentation of a garden watering can, the patient says: "A barrel-shaped body, something round, in the middle it moves away like a stick on one side," another patient, with a tachyscopic presentation of a comb, says: "Some kind of horizontal line, small , thin sticks. Sometimes patients could draw an object without recognizing it.

As an illustration, we present the data of a pathopsychological study and the medical history of patient V., which was described by B. V. Zeigarnik together with G. V. Birenbaum in 1935.

Patient V., aged 43, is a bibliographer by profession. Diagnosis: epidemic encephalitis (from the case history of Dr. E. G. Kaganovskaya).

She fell ill in 1932. There was a sharp drowsiness, which lasted about a week and was replaced by insomnia. There was salivation, left-sided paresis of the leg and pain in the area of ​​the outer part of the left shoulder, fever. There were illusions and hallucinations. On the wall around the fan, "mice were running", figures were jumping on the floor, "dancing faces" were spinning. With these phenomena, the patient was admitted to the Botkin hospital.

A few days later, short-term disturbances of consciousness appeared, the patient could not find her ward, bed. In 1933, she was transferred to the VIEM psychiatric clinic.

By the time of our study, the mental status of the patient had changed. The patient is in a clear consciousness, correctly oriented in the environment. Somewhat amimic. Quiet, slightly modulating voice. Many lies, complaining of fatigue and headaches.

With difficulty and not immediately gives anamnestic information, while dwelling on details that are not related to the essence of the issues. She reads little, "there is not enough, - the patient notes, - a lively imagination." Outwardly good-natured, emotional. This state, however, is quickly replaced by irritability, malice, reaching affective explosiveness. Along with emotional lability, there is a generally poor and rather uniform affective life with a very narrow circle of attachments, an indifferent attitude to people, to work, to social life, to literature, which was previously very beloved.

Against this background of general emotional monotony, there is an interest in recovery.

An experimental psychological study does not reveal any gross changes in the mental activity of the patient. The patient correctly assimilated the instructions, conveyed well the content, subtext of the read book, understood the conventional meaning of proverbs and metaphors. Only some passivity and lack of interest in the experimental situation were revealed.

At the same time, a pathopsychological study revealed gross impairments in object recognition. The patient often did not recognize (40%) the images presented to her. So, she calls the painted mushroom "haystack", matches - "crystals". The patient does not catch the plot of the picture immediately, but only after prolonged fixations on individual details. The process of perception is in the nature of guessing: "What could the ego be - a comb? What does it sit on - on an armchair, a chair? What could it be - a stove, a trough?" When showing the well-known painting "The suicide bomber", the patient says: "What kind of woman is this, thinking about something? What is she sitting on? On the bed? What are these shadows?"

We present the data of the study protocol.

The protocol of the experimental psychological study of the patient V.

Even with the correct name, the patient always noted doubt and uncertainty, she is looking for strong points in the drawing in order to confirm the correctness of her conclusion with them. So, the patient recognized the image of the book, but the usual doubts for the patient immediately set in: "Is it a book, is it some kind of square. No, the square has no protrusions and something is written here. Yes, this is a book."

With such a pronounced disturbance in the recognition of drawings, the patient perfectly recognized geometric shapes, supplemented unfinished drawings in accordance with structural laws. Moreover, without recognizing the object in the drawing, the patient perfectly described its shape. For example, not recognizing the drawing of the drum and cabinet, she described their shape extremely accurately and even copied them well.

In the course of the study, it turned out that the patient always recognized real objects well and found it difficult to recognize modules from papier-mâché (for example, the patient did not recognize an airplane, hardly recognized a dog, furniture).

Thus, a kind of gradation of her disorders was created. The patient recognized objects well, recognized models worse, and drawings of objects were even worse. She was especially bad at recognizing those images that were schematically drawn in the form of contours. Therefore, the assumption arose that the reason for the difficulty of recognition, obviously, is caused by the generalization, formalization that is inherent in the drawing. To verify the following series of experiments was carried out: the patient was presented with images of the same objects in different versions: in the form of a dotted outline, in the form of a black silhouette and in the form of an accurate photographic image, sometimes against the background of specific details, for example, next to the paperweight was drawn pen and inkwell. The experimental data confirmed our assumption. The patient did not recognize dotted images at all, somewhat better, but still very poorly recognized silhouette images and better concrete ones.

For illustration, we present several extracts from the protocols of her research.

Thus, the experiment revealed the peculiar gradation of recognition indicated above; the latter improved as the object was included in the background, characterized by specific details, coloring. We can say that, capturing the structural design of the drawing, the patient does not seem to comprehend what she sees, she is not able to attribute the schematic drawing to a certain category of things. This is also evidenced by the guessing nature of her recognitions, the search for supporting details (“what are these dots, what do they mean?”), the interrogative form of her statements (“was it really a fence?”, “Is it really a comb?”).

As A. R. Luria points out, "the process of visual analysis turned into a series of verbal attempts to decipher the meaning of perceived signs and synthesize them into a visual image." The patient could not perceive the drawing "from the eye", the process of perception acquired the character of a disjointed, disautomated action.

This is evidenced by the following fact: having recognized the photographic image, the patient could not transfer this recognition to the silhouette image. After the patient recognizes the scissors in the colored image, the experimenter asks: "Did I show you this object before?" The patient ponders and says with surprise: "No, I see him for the first time; oh, do you think those sticks that you showed me? No, these are not scissors." (The patient draws them from memory.) "What could it be? I don't know." Even when she manages to make the transfer, she remains insecure. Recognizing the painted hat, she says to the contour one: "What is this, also a hat?" In response to the experimenter's affirmative answer, she remarks: "What does this line have to do with it?" (points to the shadow). When she is presented with this drawing again in a subsequent experiment, she remarks: "You then said that it was a hat."

The given data showed that perception is disturbed in its specifically human characteristic as a process that has the function of generalization and convention; therefore, it seemed legitimate to us to speak of a violation of the generalizing function of perception. This is also supported by the ways in which this defect could be compensated. So, if the experimenter asked to indicate a certain object ("indicate where the hat is or where the scissors are"), then the patients correctly recognized. Thus, the inclusion of the presented object in a certain circle of meaning helped recognition. The name of the approximate circle of objects to which this object belongs (show furniture, vegetables) helped less. Therefore, it was to be expected that such agnostic disorders should be especially clearly identified in dementia patients.

The concept of hallucinations. Hallucinations are perceptual disorders in which the patient sees, hears and feels something that does not actually exist in this situation. According to Lasegue's figurative expression, illusions are related to hallucinations, as slander is to slander (i.e., slander is always based on a real fact, inverted or perverted, while in slander there is not even a hint of the truth).

Hallucinations have common and distinctive features when compared with representations received from real objects. Hallucinations are characterized by:

• o hallucinatory images are projected outward. Patients treat hallucinations as real perceived objects;
• o a hallucinatory image, as a rule, is colored sensually. The brightness of impressions, the sensuality of the image convince patients of the reality of hallucinations;
• o the appearance of a hallucinatory image is accompanied by a lack of control. The patient cannot be convinced that the hallucinatory image does not really exist.

Hallucinations are distinguished by the sense organs: visual, auditory, olfactory, gustatory, general sense (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 deceptions of perception), which hisses menacingly (auditory), the patient feels his cold body and enormous heaviness (tactile hallucinations).

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

Patient M., a lecturer 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 atomic bombs in the patient's head, from which she rolled her eyes. The patient kept talking to them mentally, now in Russian, now in English.

Differential diagnostic criteria for hallucinations. To distinguish between true hallucinations and false ones, which are important for the nosological presumptiveness of the disease, differential diagnostic criteria are distinguished.

• 1. Projection criterion . With true hallucinations, a projection of the hallucinatory image outward is noted, i.e. the patient hears a voice with his ears, sees with his eyes, smells with his nose, etc. With pseudohallucinations, an image is projected inside the patient's body, 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 part of the body. At the same time, the patient says that inside the body there is, as it were, a small TV set. Pseudohallucinations are widely represented in fiction as well. So, for example, Prince Hamlet saw the ghost of his father "in the eye of his mind."
• 2. Done criterion . characteristic of pseudohallucinations. The patient is sure that the demonstration of pictures in his head, the installation of a TV and a tape recorder in his head that records his secret thoughts, is specially arranged by powerful organizations or individuals. With true hallucinations, there is never a sense of being done, of being attuned.
• 3. Criterion of objective reality and sensual brightness . True hallucinations are always closely related to the real environment and are interpreted by patients as existing in reality. The patient sees a small King Kong sitting on a real chair, in a real room, surrounded by real students, commenting on a real TV program and drinking vodka from a real glass. Pseudo-hallucinations are devoid of objective reality and sensual liveliness. So, auditory pseudohallucinations are quiet, indistinct, as if distant. This is not a voice, not a whisper, and not a woman's, and not a man's, and not a child's, and not an adult. Sometimes patients doubt whether it is a voice or the sound of their own thoughts. Visual pseudo-hallucinations, often bright, are never associated with the real environment, more often they are translucent, icon-like, flat and devoid of shape and volume.
• 4. Behavior Relevance Criterion . True hallucinations are always accompanied by actual behavior, because patients are convinced of the reality of hallucinatory images and behave adequately to their content. With frightening images, they experience panic fear, with threatening voices coming from a neighboring apartment, they seek help from the police and prepare for defense or hide with friends, and sometimes they just shut themselves up

ears. For pseudohallucinations, the relevance of behavior is not typical. Patients with voices of unpleasant content inside the head continue to lie indifferently in bed. It is extremely rare that actions "adequate" to pseudo-hallucinations are possible. So, for example, a patient, who for a long time heard voices emanating from the big toe of his left foot, tried to cut off the latter.

• 1. Criterion of social confidence . True hallucinations are always accompanied by a sense of social security. So, a patient experiencing commenting hallucinations of unpleasant content is convinced that all residents of the house hear statements about his behavior. With pseudohallucinations, patients are sure that such phenomena are purely personal in nature and are experienced exclusively by them.
• 2. The criterion of focus on the mental or physical "I" . True hallucinations are directed to the physical "I" of the patient, while pseudo-hallucinations are always addressed to the mental "I". In other words, in the first case, the body suffers, and in the second, the soul.
• 3. Criterion depending on the time of day . The intensity of true hallucinations intensifies in the evening and at night. Such patterns in pseudohallucinations, as a rule, are not observed.

Types of hallucinations. In psychiatric practice, auditory (verbal) hallucinations are most common.

auditory hallucinations can be elementary in the form of noises, individual sounds (acoasma), 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), motor speech, etc.

Patient S., who suffers from coat-like schizophrenia, described her auditory hallucinations as follows: “On the night of March 4-5, I slept very badly from fear, as I heard different voices all night. The most unpleasant voice belonged to the devil. He said, that he came for me, because at my birth he cast a spell on me - a curse. When I turn 36 years old, I will have to go to another world - to hell. And then this day came - March 5. The terrible voice of the devil roared, that it’s time for me to get ready, that now he will turn all my insides inside out - this is a pass to hell. And in hell he will gouge out my blue eyes, pierce through my back, tear off all my nails. He added that they do this with all newcomers to hell "Another voice, soft and gentle, appeared so that I could atone for all my sins and save the world from filthy devils. This voice said that if at the moment I can overcome this evil spirit, my life will change and I will become in five years of world healer".

imperative (ordering, imperative) verbal hallucinations are expressed in the fact that the patient hears orders, which he almost cannot resist. These hallucinations pose a significant threat to others and the patient himself, as they are usually "ordered" to kill, hit, destroy, blow up, throw a child out of a balcony, cut off yoga, etc.

On the day of his mother's death, sick X. heard an "order from heaven" forbidding her to be buried, because "she, like Jesus Christ, will rise again in three days." To prevent smoldering, the patient wrapped the mother's corpse with a film and placed it in the refrigerator, where she lay not for three days, but for three years.

The patient, under the influence of imperative voices, jumped out of the sixth floor and, having landed in a snowdrift, miraculously survived. Subsequently, the fact that she remained alive was regarded by her mother as a fact of mental health (“if she were sick, she would have crashed, and since she was able to plan into a snowdrift, it means she is mentally healthy”). This once again confirms the wisdom of the popular proverb - "The apple does not fall far from the tree."

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

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

Patient K., who abuses alcohol, late at night heard from a nearby polyclinic the voice of the attending physician, threatening to "take him apart for spare parts," in particular, "to take the heart for transplantation to the president." Frightened, he ran to the police station, but on the way he heard the voices of other people from the side who threatened to burn him alive if he dared to complain.

Contrasting (antagonistic) verbal hallucinations are in the nature 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 respite 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 discuss 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 variant of auditory perceptual delusions is an imperative variety of antagonistic hallucinations. Contrasting disorders also include clinical cases when a patient hears threatening, hostile voices with one ear, and friendly, approving his actions with the other.

The same sick K., who was alone in the apartment, late in the evening heard a group of voices, of which the majority very actively and persistently demanded that he be quartered or drowned in a bath of vodka as an unworthy person who ruined his family, lost his job due to alcohol, drank all things including baby clothes. Another group of voices - like his lawyers - very timidly and with great doubts suggested giving the patient one last chance to improve, to code, to return the family. K. heard "this meeting" all night, tried to justify himself, but no one listened to him, the voices were busy discussing among themselves about his "unhappy life or already predetermined death."

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 heard by others. Many researchers attribute Segle's hallucinations to a variety of pseudohallucinatory disorders.

Patient G., during a conversation with a doctor, suddenly suddenly began to speak Tatar, to the doctor’s surprised question he answered that it was not he who spoke, his mouth was controlled by the headman of the village, who poorly understands and speaks Russian.

visual hallucinations in terms of their representation in psychopathology, they are second only to auditory ones. They range from elementary (photopsy) in the form of smoke, fog, sparks to panoramic, when the patient sees dynamic battle scenes with many people. There are zoopsias, or zoological visual deceptions in the form of various aggressive wild animals attacking the patient (they are more often noted in alcoholic delirium).

Sick Ya saw a lot of fetid little crocodiles, which, with their mouths open, crawled under the covers to him and bit off his genitals and scrotum little by little.

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

Sick S. was convinced that his mother-in-law was a relative of Viy, he periodically saw how she turns into a vampire and sucks out his blood. Sometimes she arranged "bloody feasts" with Dracula himself, while the patient was always left for dessert, because his blood is "both a drink and an appetizer at the same time."

Autoscopic (deuteroscopic), or double hallucinations - the patient observes one or more doubles that completely copy his behavior and mannerisms. Allocate negative autoscopic hallucinations, when the patient does not see his reflection in the mirror. Autoscopies are described for alcoholism, for organic lesions of the temporal and parietal parts of the brain, for hypoxia after heart surgery, and also against the background of a severe psychotraumatic situation. Autoscopic hallucinations seem to have been experienced by Heine and Goethe.

microscopic (Lilliputian) hallucinations, in which perceptual delusions are reduced in size (many gnomes dressed in extremely bright clothes, as in a puppet theater), are more common in infectious psychoses, alcoholism, and in chloroform and ether intoxication.

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

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

Sick C. suddenly saw herself surrounded by huge flying, crawling and swimming, but equally frightening lizards that were hunting her. The patient realized with horror that she had been "transferred to Jurassic Park".

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

Patient N., in delirium tremens, saw in his room late at night many identical naked girls with exactly the same bottles of vodka and exactly the same pickles (appetizer).

Adelomorphic hallucinations are visual deceptions, devoid of clarity of form, volume and brightness of colors, incorporeal contours of people flying in a specific enclosed space. Many researchers refer adelomorphic hallucinations to a special form of pseudo-hallucinations; 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.

Sick S. saw out of the corner of his eye how a man standing behind him raises his hand with a hammer to hit his head. To avoid a blow, the patient constantly turns around, but never once did he see the attacker.

Hemianopsia hallucinations - loss of one half of the vision, occur with organic damage to the central nervous system (CNS).

Hallucinations such as Charles Bonnet - always true delusions of perception - are noted when an analyzer is damaged. So, with glaucoma or retinal detachment, a visual version of these hallucinations is noted, with otitis media - auditory.

Patient F. with complete hearing loss constantly hears threatening voices of employees at work, accusing him of simulation, dishonest attitude to work, "to say the least."

Negative , i.e. suggested visual hallucinations. A patient in a state of hypnosis is told that after leaving the hypnotic state, for example, he will not see absolutely nothing on a table littered with books and notebooks. Indeed, after leaving hypnosis, a person sees a completely clean and empty table within a few seconds. These hallucinations are usually

short-lived. They are not a pathology, but rather indicate the degree of hypnotizability of a person.

In the diagnosis of mental illness, great importance is attached to the subject of visual hallucinations (as well as auditory ones). Thus, the religious themes of hallucinations are typical for 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 smells of a decaying corpse, decay, a burnt human body, excrement, stench, an unusual poison with a suffocating smell. Often, olfactory hallucinations cannot be distinguished from olfactory illusions. Sometimes in the same patient both disorders exist synchronously. Such patients often staunchly refuse to eat.

Patient S. refused breakfast for a long time, since it was the morning portion of food that had the smell of a sick woman, discharged earlier, who "was turned into cutlets for the whole department in the basement."

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

Taste hallucinations often combined with olfactory and expressed in the sensation of the presence of rot, "dead meat", 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 course of the latter and a poor prognosis.

Patient X. refused to eat for a long time, since the food that got into her mouth was always "with the taste of stale cadaverous human meat."

Tactile hallucinations are a sensation of touching the body with something hot or cold (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 under the skin "like insects and small animals" (internal zoopathy).

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

Tactile hallucinations are very characteristic of cocaine psychosis, 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.

Patient U., who suffered from alcoholism, woke up unexpectedly at night from severe back pain and to his horror realized that his drinking companions were torturing him with an electric iron plugged into the network, demanding recognition of where he had hidden a bottle of vodka that had not been drunk the day before.

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

Patient C, who lived in the countryside, was convinced that she swallowed a frog egg along with swamp water, the egg turned into a tadpole, and then into an adult frog. For about a year, the patient went to the only doctor in the village with a request to remove the frog by surgery In the end, an inexperienced doctor, tired of her visits, simulated an operation: the patient was given anesthesia, a skin incision was made along the midline of the abdomen. While the patient was under anesthesia, a real frog was put in a jar and presented to the patient who came to her senses. The patient was happy for several days , but a week later she came to the same doctor with a statement that the frog that had previously lived in it had time to spawn before the operation, and now the patient is all "stuffed" with tadpoles.

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

Patient Zh., with the noise of falling water in the bathroom or with an open tap in the kitchen, heard the selective obscenity of a neighbor from the apartment on the floor above, directed at the patient. This "conversation" instantly stopped when the water was turned off. The patient, a very narrow-minded person, decided that the physicist neighbor had learned to transmit his thoughts through water.

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

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

Kinesthetic (psychomotor) hallucinations manifested in the fact that patients have a feeling of movement of some parts of the body against their will, although in fact there are no movements. They occur in schizophrenia as part of the syndrome of mental automatism.

Patient N. felt how, on his first date in his life, his hips, against his will, began to frivolously rotate.

Hypnogogic and hypnopompic hallucinations appear in the patient before falling asleep: against the background of closed eyes, various visions appear, pictures of action 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 pro-sleep, or hypnopompic, hallucinations.

Patient M. against the background of closed eyes in a waking state saw a motionless portrait of her deceased son and deceased uncle, who twisted their fingers at the temple, hinting to the patient at her mental illness.

Hypnogogic and hypnopompic hallucinations are often the first sign of an incipient intoxication psychosis, in particular delirium tremens.

Ecstatic hallucinations are noted in a state of ecstasy, differ in brightness, imagery, impact on the emotional sphere of the patient. Often have a religious, mystical content. They can be visual, auditory, complex. They keep for a long time, are noted in epileptic and hysterical psychoses.

Hallucinosis - psychopathological syndrome, which is characterized by pronounced profuse hallucinations against the background of clear consciousness. In acute hallucinosis, patients do not have a critical attitude to 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. It occurs with chronic alcoholism, can manifest itself in acute and chronic form.

Hallucinosis pedicellate occurs with a local lesion of the brain stem in the region of the third ventricle and legs of the brain due to hemorrhage, tumor, as well as in the inflammatory process of these areas. It manifests itself in the form of moving color, 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 about 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 brain syphilis.

Hallucinosis atherosclerotic occurs more often in women. At the same time, hallucinations are isolated at first, as atherosclerosis deepens, there is an increase in characteristic signs: memory loss, intellectual decline, indifference to the environment. The attitude towards hallucinations, which is critical in the early stages of the disease, is lost. The content of hallucinations is often neutral, it concerns simple everyday affairs. With the course of atherosclerosis, hallucinations can take on a fantastic character. It is noted, as the name implies, in cerebral atherosclerosis and in some forms of senile dementia.

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

The concept of sensory synthesis disorders. This group includes violations of the perception of one's own body, spatial relations and the form of the surrounding reality, they are very close to illusions, but differ from the latter in the presence of criticism. Among such violations, one can name depersonalization - a violation of the body scheme, a symptom of what has already been seen (experienced) or never seen, etc.

Depersonalization - this is the patient's conviction that his physical and mental "I" have somehow changed, but he cannot explain specifically what and how has changed.

There are different types of depersonalization.

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

autopsychic depersonalization - the patient feels the lowness of the mental "I": he became 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 characteristic of schizophrenia.

Allopsychic depersonalization is a consequence of autopsychic depersonalization, a change in the attitude towards the surrounding reality of an already changed soul. The patient feels like a different person, his attitude to the world has changed, he has lost the feeling of love, compassion, empathy, duty, the ability to participate in previously beloved friends. Very often, alopsychic depersonalization is combined with autopsychic depersonalization for the schizophrenic spectrum of diseases.

A special type of depersonalization is the so-called weight loss . Patients feel how their body mass is steadily approaching zero, the law of universal gravitation ceases to act on them, as a result of which they can be carried away into space (on the street) or they can soar up to the ceiling (in a building). Understanding by reason the absurdity of such experiences, the sick, however, "for peace of mind" constantly carry with them in their pockets or briefcase any weights, not parting with them even in the toilet.

Derealization - this is a distortion of the perception of the surrounding world, a feeling of its alienation, unnaturalness, lifelessness, unreality. The environment is seen as drawn, devoid of vital colors, monotonous gray and one-dimensional. The sizes of objects change, they become small (micropsia) or huge (macropsia), extremely illuminated (galeropsia), up to the reddening of the halo around, the surroundings are colored yellow (xanthopsia) or crimson red (erythropsia). The sense of perspective (porropsia), the shape and proportions of objects change, they seem to be reflected in a crooked mirror (megamorphopsia), twisted around their axis (dysmegalopsia), objects double (polyopsia), while one object is perceived as many of its photocopies. Sometimes there is a rapid movement of surrounding objects around the patient (optical storm).

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

Symptom " already seen ", "already experienced "is expressed in the fact that in a familiar environment, for example in his apartment, the patient feels that he has not seen this for the first time here. These symptoms are short-lived, last a few seconds and are often found in healthy people due to overwork, lack of sleep, mental stress .

Symptom object rotation manifests itself in the fact that a well-known area seems to be turned upside down by 180 or more degrees, while the patient may experience short-term disorientation in the surrounding reality.

Symptom " time disturbances "is expressed in a feeling of acceleration or deceleration of the passage of time. It is not pure derealization, as it also includes elements of depersonalization.

Derealization disorders, as a rule, are observed with organic brain damage. In short-term variants, they are also noted in healthy people, especially those who have undergone "minimal brain dysfunction" in childhood.

Body schema disorders (Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of your body and its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head grows to the size of a room, his torso shortens, then lengthens. For example, the head is reduced to the size of a small apple, while the body reaches 100 m, and the legs extend from the center of the Earth. Sensations of the body scheme can appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of violations of the body scheme is their correction by vision. Looking at his legs, the patient claims that they are of normal size, and not many meters; looking at himself in the mirror, he discovers the normal parameters of his head, although he feels that the head in diameter reaches 10 m. Correction by vision provides a critical attitude of patients to these disorders, however, when visual control is stopped, the patient again begins to experience a painful feeling of the lowness of his parameters. body.

Violation of the body scheme is often noted in organic pathology of the brain.

Violation of the motivational component of perception. Back in 1946, S. L. Rubinshtein wrote that perception reflects the entire diverse life of the individual, and when personal attitudes change, perceptual activity also changes.

The process of perception depends on what motives stimulate and direct the activity of the subjects. At the same time, differences in the perceptual activity of healthy and sick people are revealed. The significance of the personality factor in perceptual activity is evidenced by the data obtained in the study of patients with frontal syndrome. They have pronounced violations of controllability, arbitrariness, their behavior is distinguished by spontaneous behavior. Such faces hardly recognize object, silhouette, dotted or shaded drawings. They cannot convey the meaning of paintings depicting successive events.

Patients with Pick's disease (with atrophic brain damage) are not able to combine the objects presented to them into one whole. Similar disorders are observed in patients with progressive paralysis (with damage to the frontal lobes). Such patients cannot correctly distribute a series of plot pictures and are limited only to describing their individual fragments. The examples given show that a significant role in gnostic disorders in these individuals is played by a violation of control, the impossibility of comparing one's actions with the proposed result.

Λ. N. Leontiev emphasized that the activity of perception includes the main characteristic of the human psyche - partiality. From this it follows that the process of perception is built differently depending on what motives will induce and direct the activity of the subjects. It can be expected that perceptual activity in sick and healthy people will have a different structure.

Pathopsychological studies show that the activity of the subjects can be determined by the influence of two motives - the motive of expertise and their own motive of perception. Own motive of perception plays the role of an additional stimulus. The combined action of both motifs can provide a meaningful interpretation of the pictures.

An experimental study conducted by E. T. Sokolova proves that perception essentially depends on the structure of the activity implemented by the subject. A special role belongs to its motivational component, which determines the direction, content and meaning of the perceptual process. In the case of the normal development of the psyche, a change in motivation leads to a restructuring of human activity, and the nature of perception is determined by the leading, meaning-forming motive.

In the pathological process of meaning formation, a number of features arise. So, in schizophrenics, the meaning-forming process is so difficult that the experiment does not allow one to form their activity. Patients with epilepsy, on the contrary, demonstrate the extraordinary ease with which an experimentally created motif becomes meaningful. These features of the process of meaning formation also affect perception. Persons suffering from schizophrenia, in conditions of differently motivated activity, only formally describe the structure of pictures, without putting forward hypotheses regarding the plot or the object of the image. Patients with epilepsy are characterized by hyperbolization of semantic formations, leading to the emergence of dramatization hypotheses. There is an aggravation of the content of the plot. So, the facts prove that a change in the motivational component changes the structure of perception.

In patients with epilepsy, the change in instructions led to a complete restructuring of activities. Patients enthusiastically begin the task, describe the pictures with pleasure for a long time. The number of formal statements has sharply decreased. Hypotheses become much more emotional, often accompanied by lengthy reasoning. In their responses, patients do not so much give an interpretation of the pictures as they strive to demonstrate their attitude to events or characters. Often this is achieved by assigning certain roles to the characters. Long ornate monologues of the characters are commented on by the "author", along with an assumption about the plot, an assessment is given to the characters or events. Hypotheses turn into "dramatic scenes". The use of direct speech, melodious intonation, sometimes rhythmization and an attempt to rhyme give the answers exceptional emotionality. For illustration, we present an extract from the protocol of the patient G.

Patient G., born in 1939, livestock specialist by education. Diagnosis: epilepsy with personality changes. Sick since 1953, when the first convulsive seizures appeared. In recent years, memory impairment, dysphoria, and irritability have been noted. The patient's thinking is characterized by concreteness, a tendency to detail. He is contact, he is interested in research, reports that he "always liked to fantasize."

Upon presentation of cards with a fuzzy image of the reflection of the headlights on the pavement, he says: "Evening is coming, I'm going to walk and just waiting to meet my sweetheart, we go to the park to dance. And I meet her and - to my favorite place where we met, not far from the park, where the chandeliers reflected."

Some changes were outlined in the activities of patients with schizophrenia. Compared with the previous version, the number of formal responses has halved, in some patients it was possible to create a focus on revealing the content side of the pictures. Nevertheless, 30% of patients retained formal statements and refusals. Patients with schizophrenia did not show that pronounced complex of emotional reactions that characterizes activity.

The results obtained during the experiment showed that the activity of healthy subjects takes the form of a detailed solution of a perceptual problem. There is a search for informative elements of the image, their comparison, construction and testing of hypotheses. Formal descriptions, inadequate hypotheses are found only when it is difficult to determine the content of the pictures and constitute an intermediate stage in interpretation. Here is a description of one of the healthy subjects of the card, which depicts a group of excited women.

“The first thing that catches your eye is the face of a woman, possibly a mother. A boy is reaching for her, his face is similar to the expression on the face of a woman, a mother. On the right is an elderly woman, possibly a mother. She says something, calms ... The spot on the boy's back... blood? Then you can explain why people are looking so desperately... Why are women with children in the foreground, and men aside? If this was a collision, then why with women and children? at the same time, the boy’s head rests very naturally on the woman’s shoulder, so this version is no longer relevant... Most likely, this is the moment when something very expensive is taken away from people. "They don't suffer like that at home. Perhaps something happened to the men... Yes, it seems to me that this is a train station, and the men are being taken away somewhere, that's why women have such faces."

The hypothesis formulated by the subject is thus the result of a long, step-by-step process of reasoning. It is of interest to compare these data with the results of a study of patients with epilepsy. Patients attached great importance to experimental research, treated the task as a kind of examination of the mind. The presentation of pictures causes a detailed, detailed description of the images. At the same time, along with informative elements, on the basis of which a hypothesis can be built, details are involved that do not carry any semantic load.

Patient O., born in 1930, education seven classes. Diagnosis: epilepsy of traumatic genesis with personality change according to the epileptic type. Mental status: viscous, inert, long-winded, thorough, prone to reasoning.

Here are the statements of the patient upon presentation of the already mentioned picture.

“Several people are depicted in this picture. A woman is standing on the left, another is near her. Her hair is dark. She folded her arms over her chest and cries. he is sitting on something, clinging to her, embracing her with his right arm... In the left corner, two more women are standing..." and so on.

This example shows how the activity, initially aimed at a meaningful interpretation of the picture, turns into a scrupulous description of its individual fragments. In some cases, this slows down the process of hypotheses, leading to the emergence of formal answers.

The activity of patients with schizophrenia has a different look. Despite the "intellectual" orientation of the study, the patients showed no interest in the task, did not respond to the experimenter's assessment, and did not correct their mistakes. The activity of patients is characterized by extreme curtailment, lack of search activity, which is so pronounced in the norm. The statements of the patients are extremely laconic, a little emotional, and basically only generally state some plot or subject content of the pictures: "Some kind of misfortune", "The man is thinking."

Analysis of the results of the study made it possible to establish that a change in motivation causes a different structure of activity, in accordance with which the place and content of the perception process changes. With the introduction of meaning-forming motives, a new motivational structure is formed, which is different in normal and pathological conditions.

Terminological dictionary

agnosia is a disorder of recognition of the characteristics of objects and sounds.

Amnesia- lack of memory.

Aprosexia is a complete lack of attention.

Rave- an incorrect, false conclusion, which is of tremendous importance for the patient, penetrating his whole life, always developing on pathological grounds (against the background of a mental illness) and not subject to psychological correction from the outside.

Attention- a mental process characterized by the concentration of the subject's activity at a certain point in time on some real or ideal object (object, event, image, reasoning, etc.).

Perception- a holistic reflection of objects, phenomena, situations and events in their sensually accessible temporal and spatial connections and relationships.

hallucinations- perceptual disorders, when the patient sees, hears and feels something that does not actually exist in this situation.

Hypermnesia- short-term amplification, sharpening of memory.

Hypomnesia- memory loss.

Depersonalization- the patient's conviction that his physical and mental "I" has somehow changed, but he cannot explain specifically what and how has changed.

Derealization- distortion of the perception of the surrounding world, a sense of its alienation, unnaturalness, lifelessness, unreality.

Illusions- an erroneous, altered perception of real-life objects and phenomena.

Inertia of attention(small mobility of attention) - characterized by a violation of the switching of attention, it is, as it were, a pathological fixation of attention.

Korsakov's syndrome- violation of memory associated with current events.

Lability of thinking- this is an alternation of adequate and inadequate solutions.

Memory- a mental process, which consists in consolidating, preserving and subsequently reproducing a person's experience.

paramnesia- this is a deception, a failure of memory, which is filled with various information that determines the type of paramnesia.

Increased distractibility- excessive mobility of attention, continuous transition from one type of activity to another.

progressive amnesia- memory impairment, when the disorder extends not only to current events, but also to past ones.

Diversity of thinking- the flow of judgments in different channels.

Distracted attention- impaired ability to concentrate attention for a long time, concentration with constant transitions from one phenomenon to another, without dwelling on anything.

Reasoning (intellectualization of thinking, tangential thinking)- a tendency to empty, fruitless reasoning with a lack of concrete ideas.

Thinking- a cognitive process associated with the solution of various problems and the creative transformation of reality.

Violation of the motivational component of memory- a violation in which the patient remembers only what he considers necessary and important.

Attention switch disorder- this is a violation of the labile transition from one stereotype of the performance of an activity to another, a violation of the ability to inhibit previous methods of activity.

Obsessions (obsessions)- various thoughts, inclinations, fears, doubts, ideas, involuntarily invading the mind of the patient, who perfectly understands all their absurdity and at the same time cannot fight them.