Moderator-Dr.Ravichandra Karkal

DISORDERSOF

Dr.Samin Sameed

Post-graduate

Department of Psychiatry

Yenepoya University

PERCEPTION The process of transferring physical

stimulation into psychological information; mental process by which sensory stimuli are brought to awareness.

ABNORMAL PERCEPTIONAbnormalperceptio

n

Sensory deception

s

Sensory distortions

TYPES Sensory Distortion- real perceptual

object which is perceived in a distorted way

Sensory Deception- new perception that may occur that may or may not be in response to external stimuli

Disorders in the experience of time

DISTORTION

Color,intensity

Shape and size

Motion/general quality

location

uniqueness

SENSORY DISTORTIONS Changes in Intensity - hyperesthesia

- lowering of physiological threshold. Eg.Hyperacusis Seen in anxiety depressive disorder, Hangover from alcohol Migraine hypochondria cal personalities

Hypoaesthesia Eg - Hypoacusis

Seen in

Delirium Depression Attention deficit disorder

•Hyperaesthesia

ACHROMATOPSIA

•Complete absence of color

CHANGES IN QUALITY Visual perception – toxic drugs

XanthopsiaChloropsia Erythropsia

Derealization- Everything looks unreal and strange

Mania- looks perfect and beautiful

CHANGES IN SPATIAL FORM Change in perceived shape of an object Retinal disease Disorders of accommodation Temporal and Parietal Lobe Lesions Poisoning with Atropine and Hyoscine SCHIZOPHRENIA

Micropsia – a visual disorder in which the patient sees objects

o Smaller than they really areo Farther away than they really are

Macropsia – Seeing objects larger than they really

are

MACROPSIA

MICROPSIA

Experience of retreat of subjects into the distance without any change in space - porropsia

Edema of the retina Partial Paralysis of accomodation Diseases affecting the nerves controlling

accommodation

METAMORPHOPSIA

teleopsia •Object appearing far away

pelopsia •Object appearing nearer than it should

DISORDERS IN THE EXPERIENCE OF TIME Psychopathological point of view Physical- Determined by physical

events Personal- Personal judgement of

passage of timeMania- Time passes quicklyDepression- Time passes slowlyAcute Schizophrenia- personal time goes

in fits and startsAcute organic states (temporal

disorientation)

SENSORY DECEPTIONS

illusionhallucination

Misinterpretations of

stimuli from

external object

Perceptions without external stimulus

ILLUSIONS

Stimuli from perceived

objectMental image

False perception

TYPES OF ILLUSIONS Completion Illusion – These depends

on inattention,misreading words in newspapers

Affect Illusion- These arise in the context of particular mood state

Pareidolia – vivid illusions without the patient making any effort ; result of excessive fantasy thinking and a vivid visual imagery.

PAREIDOLIA

HALLUCINATIONS False perception which is not a sensory

distortion or misinterpretation but which occurs at the same time as real perception.

Essential criteria for an operational definition1. Percept like experience in the absence of

an external stimuli2. Percept like stimuli which has full force and

impact of real perception3. Percept like experience which is unwilled,

occurs spontaneously and cannot be readily controlled by percipient.

CAUSES Intense emotions Suggestion Disorders of sense organs Sensory deprivation Disorders of CNS Psychiatric disorders

EMOTIONS depressed patients -delusions of guilt;

hallucination - disjointed or short phrases

continuous persistent hallucinatory voices in severe depression ? Schizophrenia /physical disease.

SUGGESTION Normal subjects can be persuaded to

hallucinate . By hypnosis or brief task motivation

instructions.

DISORDERS OF SENSE ORGANS Hallucinatory voices -in ear disease Visual hallucination - eye

diseases ,disorders of the CNS Peripheral lesions -sense organs -

hallucinations in organic states

SENSORY DEPRIVATION incoming stimuli reduced to minimum -

normal subject -hallucinate after few hours

changing visual hallucinations ,repetitive phrases

BLACK PATCH DISEASE delirium following cataract extraction in the aged result of sensory deprivation and mild senile brain changes

DISORDERS OF CNS Lesions of diencephalons and cortex can

produce hallucination that are not only visual but can be auditory.

HALLUCINATIONS OF INDIVIDUAL SENSES Hearing Vision Smell Taste Touch Pain and deep sensation Vestibular sensations The sense of presence

HEARING Hearing (auditors) may be elementary

or unformed. Elementary – noises, bells or

undifferentiated whispers ; in organic states

Partly organized- music Completely organized- hallucinatory

voices- schizophrenia- persecutory in nature

Severe depression ‘voices’ heard , less well formed than schizophrenia

Imperative hallucination Voices sometimes act upon individuals

and give instructions. may or may not act upon themAuditory hallucinations Adverse Neutral Helpful Incomprehensible nonsense Neologism

Thought echo - hearing one’s own thoughts being spoken loud, voice may come from inside or outside the head.

i. GEDANKENLAUTWERDEN- thoughts spoken at the same time or before they are occurring.

ii. ECHO DE LA PENSES- thoughts are spoken just after they occurred.

Running commentary hallucinations are usually abusive.

VISION Elementary- flashes of light Partly organized- patterns Completely organized- people,

animals,objects.Scenic hallucinations- like a cinema common in delirium in psychiatric disorders with epilepsy.

Patients with visual and auditory hallucinations co occur as a whole

Temporal lobe epilepsy Late onset of schizophrenia (protracted)

Visual Hallucinations - organic states +clouding of consciousness >functional psychoses

Small animals –delirium rare -schizophrenia Occasionally without any

psychopathology CHARLES BONNET SYNDROME

SMELLSeen in Schizophrenia Organic states like temporal lobe

epilepsy Depression (uncommon)PADRE PIO PHENOMENON- religious

people can smell around certain saints

TASTE

Seen in Schizophrenia Organic states

Depressed patient often describes loss of taste.

TOUCH Formication- animals crawling over the

body; in organic states

Cocaine bug – formication + delusion of persecution - cocaine psychosis

Sexual Hallucinations- acute and chronic schizophrenia

Classified into 3 types1. Superficial2. Kinesthetic3. Visceral

SUPERFICIAL

Thermic Haptic Hygric Paraesthetic

KINESTHETIC HALLUCINATION affects muscles and joints Patient feels limbs twisted pulled or

moved schizophrenia Organic states - alcohol intoxication

benzodiazepine withdrawal

PAIN AND DEEP SENSATION Visceral hallucinations (SIMS 2003). Twisting and tearing pains Very bizarre complaints- organs ripped

out , flesh ripped from his body chronic schizophrenia

THE SENSE OF PRESENCE

Organic states Schizophrenia Conversion disorder Normal people – fervently religious

PSEUDOHALLUCINATION mental image ,clear and vivid,lack the

substantiality of perceptions Full consciousness subjective space Definite outlines Constancy retained,insight preserved Relevant to emotions, needs and actions Depends on the observer for existence

HystericalAttention seeking personalities

SPECIAL KINDS OF HALLUCINATIONS

Functional hallucinations : auditory stimulus causes the hallucination, both experienced

Chronic schizophrenia Reflex Hallucination : a stimulus in

one sense modality produces hallucination in another. Morbid variety of synaesthesia.

Extracampine hallucination : Hallucinations that is outside the limits of the sensory field.

o Seen in healthy people as hypnagogic hallucination

o Schizophreniao Organic conditions- epilepsy

Autoscopy (phantom mirror image) –experience of seeing oneself and knowing that it is oneselfVH+Kinesthetic +somatic sensation.

Normal subjects- emotionally disturbed, tired and exhausted

depressed Hysteria Schizophrenia

Acute and sub acute delirious states Epilepsy Focal lesions in parieto occipital region Drug addiction Chronic alcoholismNEGATIVE AUTOSCOPYINTERNAL AUTOSCOPY

HYPNAGOGIC HALLUCINATION Occur when the subject is falling asleep

during drowsiness Are discontinuous Appears to force themselves on the

subject Do not form part of an experience in which

the subject participates unlike DREAM Commonest is auditory. geometrical designs , abstract shapes ,

faces , figures or scenes from nature EEG shows alpha rhythm

HYPNOPOMPIC HALLUCINATION Occurs when the subject is waking up Hallucinations persisting from sleep

when the eyes are open More in narcolepsy.

ORGANIC HALLUCINATIONS Occurs in any sensory modality and may

occur in various neurological or psychiatric disorders

Depends oni. General condition of the brainii. Recent experiencesiii. Psychodynamic factorsiv. Effect of local lesion

(I)VISUAL HALLUCINATIONS Stimulation of visual projection areas in

the walls of the calacrine fissure causes perception of flashes of light as does stimulation or irritation of optic radiation.

Lesions of optic tract and lateral geniculate bodies.

Spontaneous V H – sensory defect Complex scene hallucination –

stimulation of posterior part of temporal lobe.

(II)TACTILE HALLUCINATIONSAlmost exclusively the result of lesion

which produces sensory defectPHANTOM LIMB Most common organic somatic

hallucination 95% of amputation after 6 yrs of age Pt feels he sees the limb from which in

fact he is not receiving any sensations either because limb has been amputated or sensory pathway destroyed.

Most phantom limbs are produced by peripheral and central disorders.

Occasionally it develops from lesion of peripheral nerve or the medulla or spinal cord.

Thalamoparietal lesions have phantom third arm or leg.

Correspond to the previous image of the limb.

(IV) AUDITORY HALLUCINATIONS Whistling , buzzing, drumming and even

bells heard by patients with middle ear disease or internal disease

Caused by epileptic foci and space occupying lesions in the temporal lobes

HALLUCINATION OF TASTE Occurs most often in temporal lobe

epilepsy ass with salivation and chewing and sniffing

Stimulating the depths of the sylvian fissure around the transverse temporal gyri.

OLFACTORY HALLUCINATIONS temporal lobe epilepsy.

TEMPORAL LOBE HALUCINATIONS These are multisensory hallucinations

but they do not include somatic sensations, which is to be expected because the somatic sensory area is separated from the temporal lobe by sylvian fissure.

BODY IMAGE DISTORTIONS Hyperschemazia

– percieved magnifications of body parts

When part of the body feels larger than the normal

ORGANIC CAUSESo Brown Sequard

Syndromeo PVD, MS,

thrombosis of PICA NON ORGANIC

CAUSESo Hypochondriasiso Conversion

disordero Depersonalization

Aschemazia- perception of body parts as absent

Hyposchemazia – Body parts as diminished

Paraschemazia – distorted of body image as a feeling that body parts are distorted or twisted from rest of the body.

Hemisomatognosia- Unilateral lack of body image in which the person behaves as if one side of body is missing

Anosgnosia- ‘denial of illness’ –Rt hemisphere strokes denied their knowledge early after stroke and refused to admit to any weakness in their left arm

Somatoparaphrenia- delusional beliefs about the body, distorted, inanimate , severed, or in any other ways abnormal.

REFERENCES Fish’s Clinical Psychopathology- Patricia

Casey and Brendan Kelly SIMS’ Symptoms in the Mind- Femi

Oyebode Synopsis Of Psychiatry-Benjamin James

Sadock, Virginia Alcott Saddock

Compared to the brilliance of the evening sun, reflecting on the beautiful sea, we humans are NOTHING, but

SHADOWS…

“You see, but you do not observe. The distinction is clear.” – Sherlock Holmes