Knowledge of the surrounding world and oneself begins with the perception by our senses of everything that surrounds a person and is himself. We look out the window of our house at the yellowing foliage. And instantly an image arises in the mind, and then a judgment that autumn is in the yard. We see our unshaven face in the mirror, and immediately the thought arises that we need to put ourselves in order.

Perception is the sum of sensations + representation. Perception is a mental process of reflecting objects as a whole and forming a holistic image. Perception ends with recognition.
Feeling- this is a reflection of the individual properties of objects of the surrounding world when exposed to the senses (cold, wet, hard, etc.).
Representation is a mental image of an object based on memories.

Sensory disturbance

Quantitative changes in sensations:
anesthesia(lack of sensitivity);
hypoesthesia(decrease in sensitivity);
hyperesthesia(increased sensitivity).

Qualitative changes in sensations:
paresthesia(sensitivity distortion);
senestopathies(complex violations).

Hyperesthesia occurs in asthenic syndrome, anxiety states, delirious state, in pregnant women (to odors).
Hypesthesia and anesthesia are found in depression, states of unconsciousness, catatonic syndrome, hysterical (conversion) disorders, deep hypnosis, a state of strong affect.

Senestopathy

Senestopathy- complex perceptual disorders characterized by:
1. Painful sensations inside the body.
2. Painful character.
3. Difficult to describe: spasm, pressure, heat, burning, cold, bursting, pulsation, detachment, tears, bursting, stretching, twisting, tightening, friction, trembling, etc.
4. With migration throughout the body or indeterminate localization.
5. Appeal to therapists, low curability.

“It’s as if a bubble is bursting in the head”, “the intestines seem to be twisted”, “there is a feeling in the stomach, as if the kitten is scratching.”

Senestopathies are found in depression, neurotic disorders, schizophrenia, organic diseases of the brain.

Illusions

Illusions- this is a distorted perception, in which real phenomena or objects are perceived by a person in an altered, erroneous form.
"A coat on a hanger looks like a scary tramp."

Illusions differ depending on the sense organs: visual, auditory (including verbal), olfactory, gustatory, tactile, hallucinations of the general sense (visceral and muscular).

Illusions differ in the mechanism of formation:
Physiological illusions arise in all people due to the peculiarities of the activity of the senses and perception. For example, illusionists “saw” a girl in half, a spoon in water seems broken, etc.
Illusions of inattention arise with a lack of attention or in conditions that impede perception (noise, lack of lighting, etc.). For example, instead of one word, another is heard that is close in sound (for example, at a party, when loud music is playing nearby).
Affective illusions (affectogenic) arise against the background of affect (pronounced emotional reaction) of fear, anxiety. An anxious and suspicious person, walking late in an unfamiliar place, hears the steps of a pursuer behind him, sees people hiding in the shadows of trees, etc.
Pareidolic illusions- visual illusions of bizarre-fantastic content, arising from the perception of complex configurations of lines, patterns on various surfaces.

“Kovrin stopped in amazement. On the horizon, like a whirlwind or a whirlwind, a tall black column rose from the earth to the sky. Its contours were unclear, but at the very first moment one could understand that he was not standing still, but moving with terrible speed, moving right here, right on Kovrin ... A monk in black clothes, with a gray head and black eyebrows, crossed on chest of the hand, swept past ... ". A.P. Chekhov, the story "The Black Monk".

Illusions of inattention and affective illusions may be normal.
Pareidolic illusions are found in delirious states, organic psychosis, drug addiction, psychomimetic poisoning.

hallucinations

hallucinations- perception without an object, perception of what is not really there.

There are many classifications of hallucinations.
A. By degree of difficulty:
. Elementary - the simplest phenomena (flashes of light, clicks, knocks, "calls", etc.)
. Simple - occur only in one of the analyzers (for example, an imaginary smell of lavender is only felt)
. Complex (complex) - occur in several analyzers at once (for example, the patient sees a "line", hears his words, feels his touch)
. Scene-like - the whole environment changes, for example, it seems to the patient that he is in a completely different place. Indicates the development of clouding of consciousness.

B. By analyzers:
. visual
elementary - photopsies (visual images devoid of a specific form in the form of spots, flashes, "sparks", contours, glare)
macro- and microoptical - hallucinatory images of small or large size;
. Auditory
elementary - acoasms (hails, obscure noises, clicks, knocks);
in the form of speech - verbal:
mono- and polyvocal - one or more voices, respectively;
by content: condemning, threatening, praising, commenting, imperative.
. Visceral- a feeling of the presence in one's own body of some objects, animals, worms, etc.
. Tactile- perception of any objects on the surface of the body (on the skin or mucous membranes, inside or under them).
. Flavoring- the appearance of a taste (usually unpleasant) in the oral cavity without any real stimulus, food intake.
. Olfactory- the appearance of a smell without a real stimulus.

B. According to special conditions of occurrence
In some cases, hallucinations occur only under certain conditions.
. Hypnagogic- when falling asleep, hypnopompic - when waking up. The states of transition from sleep to wakefulness and vice versa facilitate the occurrence of hallucinations in conditions predisposing to their development (in the initial stages of delirium tremens, against the background of emotional stress).
. Functional (reflex)- arise against the background of another stimulus, but unlike illusions, they do not replace it and do not mix with it (he hears the stereotypical repetition of one curse against the background of the noise of the refrigerator, the noise of the refrigerator is perceived separately, but when the refrigerator stops, the curses disappear).
. With sensory deprivation(Hallucinations of Charles Bonnet - occur in those who have lost their sight).
. Psychogenic (caused)- after a traumatic situation, during hypnosis or during tests for readiness for hallucinations (symptoms of a blank slate, switched off phone, etc.).

D. According to the characteristics of perception

There are true hallucinations and pseudo hallucinations.

Hallucinations occur in psychosis (alcoholism, schizophrenia, epilepsy, organic brain damage, drug addiction) , the use of psychotomimetics and cataracts (Charles-Bonnet hallucinations).

Hallucinosis(hallucinatory syndrome) is an influx of profuse hallucinations against the background of a clear consciousness, lasting from 1-2 weeks to several years. Hallucinosis can be accompanied by affective disorders (anxiety, fear), as well as delusional ideas.

Psychosensory disorders

Psychosensory disorders- this is a distorted perception of phenomena and objects.
Psychosensory disorders differ from illusions in the adequacy of perception: the patient knows that he sees a chair, although with crooked legs. With an illusion, one is taken for another (instead of a chair - a huge spider).
Metamorphopsia, macropsia, micropsia.
Autometamorphopsia - change and distortion of various parts of one's own body.

A patient suffering from cerebral vasculitis saw cars moving along the street on which she lived, the size of a ladybug, and houses standing on the same street, the size of a matchbox. At the same time, she clearly understood that this could not be, but she experienced a feeling of great surprise and anxiety at these phenomena.

Psychosensory disorders are found in temporal lobe epilepsy, encephalitis, encephalopathies, intoxications, eye diseases.

Depersonalization-derealization syndrome

Depersonalization- Violation of the reality of self-perception.
It happens:
1. Vital - the very feeling of life disappears in the patient.
2. Autopsychic - alienation of the mental functions of one's Self (thoughts are not mine, I hear my speech as if from the outside, my past - no matter how mine, I don’t understand - I want to sleep or don’t want to, painful mental anesthesia also belongs to the range of these disorders) .
3. Somatopsychic - alienation or disappearance of one's body or its parts. But at the same time, there are no changes in the proportions or dimensions of the body, the patients simply do not feel it or its parts - “I don’t seem to have legs”, the patients cannot understand whether they are hungry or not, there is an urge to urinate or not, etc. .
Derealization- Violation of the reality of perception of the environment.
"The world is like a picture."
Related derealization phenomena are such symptoms as already seen (deja vu), already experienced (deja veku), already experienced, already heard (deja entendu), never seen.
Depersonalization-derealization syndrome occurs in psychoses (for example, schizophrenia) and in healthy people, with lack of sleep, prolonged stress, fatigue, overstrain.

In mental illness, disorders are a common symptom and often play a significant role in the emergence of false ideas about the outside world and one's own personality.

Perceptual disorders include illusions, hallucinations, distorted perceptions own body and the outside world

Hallucinations are one of the most common symptoms of a mental disorder. Sometimes it is difficult to distinguish them from illusions. Both are deceptions of the senses, as a result of which the patient's correct perception of the outside world (sometimes himself) is disturbed. Yet in most cases the following distinction can be made between illusions and hallucinations.

At the core illusions there is always a real, valid source of perception, however, objects, phenomena are perceived in a distorted form. So, for example, a wallpaper pattern, a crack in the wall can acquire special outlines for the patient, frightening him.

Illusions are often found in healthy people. Fear, expectation, fatigue, etc., can contribute to their occurrence. So, it may seem that a person is hiding behind a bush on the road; in a darkened room, clothes on a hanger may look like a person hanging in a noose. Expectation, alertness, fatigue can create conditions under which an extraneous sound is perceived as a call by name, etc.

Unlike illusions, hallucinations are completely imaginary perceptions that are not associated with any external irritation.

hallucinations usually indicate the presence of a mental disorder.

There are hallucinations according to the sense organs: auditory, visual, olfactory, gustatory, etc. Considering them in isolation, it must be borne in mind that in reality they usually occur in various combinations.

auditory hallucinations most often found in the form of calls by name, by surname. Sometimes at the same time the patient hears a few words relating to his actions, to his thoughts. These remarks lead the patient into a state of anxiety. He hears: “You won’t leave, you won’t leave”, “today there will be misfortune”, etc. The voices either threaten, or reproach him for something, or order him and guide his actions. As soon as the patient thinks about something, an objection is immediately heard. With the long-term existence of hallucinations, the patient can get used to them, come to terms with them. Patients hear voices that are loud or quiet; legible or incomprehensible; expressed in connected phrases or in fragmentary words, sometimes in fragments of words. Verbal (verbal) hallucinations are most often observed in schizophrenia and with prolonged alcoholic hallucinosis.

Auditory hallucinations can be imperative. Under the influence of such a verbal or mental-hallucinatory order, patients can perform sudden and incomprehensible actions for others.

visual hallucinations they are less common and usually not as long as the auditory ones, which can last for years. Very bright are visual hallucinations in alcoholics with the so-called delirium tremens. They see animals, monsters, things change, everything changes quickly, one picture follows another. Visual hallucinations are observed mainly in various forms of disorders of consciousness, in acute psychoses.

In a state of altered consciousness, patients may be presented with vivid, majestic pictures, sometimes leading them into a state of painful ecstasy, inspiration or fear.

Hallucinations with closed eyes are of a special nature, usually before falling asleep, which is observed, for example, in alcoholics. Sometimes this is a kind of stage, sometimes preceding a vivid visual hallucinosis, sometimes occurring during the recovery period. These hallucinations are called hypnagogic.

Olfactory and gustatory hallucinations are even less common. They manifest themselves mainly in the sensation of poisonous gases, unpleasant odors. Patients often interpret these deceptions of the senses in a delusional way. The special taste of food convinces them that poison is mixed with it. In this regard, there is a refusal to eat, distrust of others.

Olfactory hallucinations are also manifested in the fact that patients perceive a bad smell, as if coming from themselves. They sometimes conclude that they are decomposing alive. One sick student complained that a bad smell spread from him to the whole ward. Out of delicacy and pity for him, those around him allegedly do not notice this, but he sees that the nurses turn pale at night, they feel sick, they open the windows, but this does not help them much either.

Olfactory hallucinations are not always a sign of severe mental illness. With psychogenic reactions, especially in a depressive state, these sensations are frequent. They mostly come down to the fact that in food or in the air there is a smell of rot, carrion.

Hallucinations of the skin and general sense are expressed in peculiar disturbances of physical well-being. Patients, trying to explain these sensations, declare that worms are crawling under their skin, that a spider is sitting in their head, that snakes are tossing and turning in the stomach, that an electric current is passed through the body. Experiencing unusual sensations, patients sometimes believe that during their sleep, those around them perform some kind of manipulation on them, for example, pour fetid substances into their mouths, perform unnatural sexual actions, thereby causing exhaustion of the body, etc.

A special place is occupied by the so-called pseudohallucinations described by Kandinsky. Patients experience the sound of their own thoughts, note "nested", slightly sounding thoughts of others. Visual pseudohallucinations are less often observed. Patients claim that they are "mentally" shown "images". With pseudohallucinations, there is no physicality, distinctness, projection outward, characteristic of true hallucinations.

In mental illness, sometimes there are distorted perceptions of one's own body and the outside world which should be distinguished from hallucinations. They are called body schema disorders. The simplest example of this kind of phenomena is the following: a legless invalid experiences itching in his toes. An erroneous perception of the boundaries of the body is created. In other cases, patients lose the ability to correctly localize their sensations. A frequent symptom is a feeling of enlargement, swelling of the head, thickening, lengthening of the limbs. Sometimes the head and arm appear to be separated from the body. All these sensations can occur not only in a particular organism, but also touch the whole body. Perhaps a similar distorted perception of the external world (everything seems to be displaced, reduced, enlarged, elongated, beveled, distant, etc.).

Definitions

Perception - a holistic subjective mental reflection of objects and phenomena of the surrounding world when they affect our senses. It consists of sensations, the formation of an image, its addition to representation and imagination.

Feeling- a type of mental activity that, arising from the direct impact of objects and phenomena of the surrounding world on our sense organs, reflects only individual properties of these objects and phenomena.

Representation- the result of the revival of images or phenomena perceived earlier, in the past.

Clinical manifestations.

Hyperesthesia- violation of sensitivity, which is expressed in the super-strong perception of light, sound, smell. It is typical for conditions after somatic diseases, traumatic brain injury. Patients may perceive the rustling of leaves in the wind as rumbling iron, and natural light as very bright.

hypothesia- decreased sensitivity to sensory stimuli. The environment is perceived as faded, dull, indistinguishable. This phenomenon is typical of depressive disorders.

Anesthesia- most often loss of tactile sensitivity, or functional loss of the ability to perceive taste, smell, individual objects, typical for dissociative (hysterical) disorders.

Paresthesia- sensation of tingling, burning, crawling. Usually in zones corresponding to the zones of Zakharyin - Ged. Typical for somatoform mental disorders and somatic diseases. Paresthesias are due to the peculiarities of blood supply and innervation, which differ from senestopathies.

Senestopathy- unpleasantly experienced sensations of varying intensity and duration from the internal organs in the absence of an established somatic pathology. They, like paresthesia, are difficult to verbalize by patients, and when describing them, the latter most often use comparisons. For example: as if the intestines are moving, air is blowing through the brain, the liver has increased in size and presses on the bladder, etc.

The main perceptual disturbances are illusions and hallucinations. Patients may be reluctant to talk about these phenomena or hide them.

Indirect signs of perceptual disorders are:

A person's conversation with himself (alone or in the presence of others),

Unreasonable and sudden change in attitude towards others,

The emergence of new words (neologisms) in speech,

mimic grimaces,

The tendency to solitude, change of mood,

Contraction of masticatory muscles and sternocleidomastoid muscles,

Tension of the orbital region with a half-open mouth,

Sudden glance to the side when talking

Dissociation of facial expressions, posture and gesture,

Non-purposeful unexpected gestures with relatively motionless facial expressions.

Illusions- erroneous perception of real-life objects and phenomena.

The main characteristics of illusions are:

The presence of an object or phenomenon that is subject to distortion, such as a visual, auditory or other sensory image,

The sensory nature of the phenomenon, that is, its connection with a specific modality of perception,

Distorted assessment of the object,

Evaluation of the distorted sensation as real,

Psychopathological delusions are:

Illusions affective(i. affectivae) - illusions arising under the influence of fear, anxiety. An anxious and suspicious person walking at a late time hears the steps of the pursuer behind him.

Illusions are verbal(i. verbales) - auditory illusions, the content of which is individual words or phrases.

Illusions are pareidolic(i. pareidolicae; couple + Greek eidōlon image) - visual illusions of fantastic content, usually arising on the basis of a wallpaper or carpet pattern, cracks and spots on the ceiling and walls, etc. Unfold on a plane, for example, when viewing a pattern of wallpaper on On the wall, the patient sees changeable, fantastic landscapes, faces of people, unusual animals, etc. The basis of illusory images are the details of the actual drawing. Often occur in the initial period of alcoholic delirium.

hallucinations- the perception of an object or sensory image that occurs without the presence of a real object, but is accompanied by confidence that this object exists. The term "hallucination" was introduced for the first time by J.-E.D. Esquirol in 1838.

True hallucinations:

Endowed with all the properties of real objects (corporality, weight, bright sound).

projected into real space immediately surrounding the patient.

There is confidence in the natural way of obtaining information about imaginary objects and phenomena through analyzers.

The patient is sure that everyone around perceives the same objects in exactly the same way as he does.

The patient treats imaginary objects as if they were real: he tries to pick them up, runs away from pursuers, attacks enemies.

Pseudo-hallucinations:

Deprived of sensual liveliness, natural timbre, incorporeal, transparent, non-voluminous.

They are projected into an imaginary space, come either from the patient's body or from areas inaccessible to his analyzers, do not come into contact with objects of the real situation.

They can give the impression of being forcibly evoked, made, put into the head with the help of special devices or psychological influence.

The patient believes that the images are transmitted to him on purpose and are inaccessible to the senses of others.

The patient cannot run away from hallucinations, because he is sure that they will reach him at any distance, but sometimes he tries to "shield" his body from exposure.

They are perceived as an attempt of mental violence, the desire to enslave the will, to force them to act against desires, to drive them crazy.

They often occur in chronic psychoses, are quite resistant to therapy, do not depend on the time of day, and may disappear completely at night during sleep.

Hallucinations are classified:

1. by the senses:

Auditory (imperative, threatening, commentary, antagonistic)

Visual (photopsies, zoopsies; autoscopic, extracampal, hypnagogic, hypnopompic)

Tactile (thermal, haptic, hygric)

Flavoring

Olfactory (imaginary perception of unpleasant odors)

Visceral, general feeling (presence in the body of some objects, animals)

2. according to the degree of difficulty:

Elementary (acoasma, photopsia)

Simple (linked to 1 analyzer)

Complex (deceptions by several analyzers at once)

scene-like

Functional hallucinations - occur against the background of a real stimulus acting on the senses, and only during its action.

Suggested and induced hallucinations:

Lipman's symptom - causing visual hallucinations by lightly pressing on the patient's eyeballs.

Symptom of a blank sheet (Reichardt) - the patient is invited to carefully examine a blank sheet of white paper and tell what he sees there.

Aschaffenburg's symptom - the patient is offered to talk on the switched off phone, the readiness for the occurrence of auditory hallucinations is checked.

Clinical example:

Patient S., aged 32, suffered from psychosis with severe perceptual disturbances in the form of illusions and hallucinations. This patient, who had been abusing alcohol for a long time, fell into insomnia during a train ride, began to experience fear and severe anxiety. On the third day of such a state, I heard how the wheels of the car “began to clearly pronounce”: “Be afraid, be afraid,” and after some time, in the noise of the fan in the roof of the car, he began to distinguish the words: “do not expect mercy.” By the evening of the same day, he began to see how the cobweb was flying around the compartment, felt how it landed on his face and hands, felt its unpleasant, sticky touch.

In the middle of the night, I suddenly distinctly heard how several male voices behind the wall were talking about how to destroy him, but they could not come to an agreement that it would be better to use a knife or a rope for this. I realized that intruders had gathered in the next compartment, who would now kill him. In great fear, he ran out into the vestibule and at the very first stop, jumped out of the car. I calmed down for a while, then suddenly I saw that the lantern on the pole was not a lantern, but some kind of searchlight or “electronic gas”.

Psychosensory disorders sometimes considered intermediate between disorders of consciousness and perception. These include experiences of depersonalization and derealization, as well as special syndromes described in the corresponding section.

Depersonalization expressed in the following symptoms:

Mental:

Changes in the "I", peculiar sensations of transformation, often negative, of one's own personality, accompanied by the fear of going crazy, experiencing one's own uselessness, the emptiness of the meaning of life and the loss of desires. This condition is characteristic of affective disorders and some neuroses.

The splitting of the "I", typical for schizophrenia and dissociative disorders, is expressed in the feeling of having two or more personalities, each of which has its own intentions, desires.

- alienation of the self.

Physical:

A change in the body scheme is expressed in an abnormal perception of the length of the limbs, shortening or stretching of the arms and legs, changes in the shape of the face and head. A condition observed as a result of organic disorders.

Derealization expressed in a change:

Colors, for example, during depressions, the world may appear gray or with a predominance of blue tones, which is especially noticeable in the work of artists such as E. Munch, who during periods of depression used mainly black, blue and green colors. The predominance of bright colors in the environment is noted by patients with manic states. The perception of red and yellow tones or fire is typical of twilight epileptic conditions.

Shapes and sizes: the environment can increase or decrease (Alice in Wonderland syndrome), approach and recede, constantly transform. The patient can perceive the right side as the left and vice versa (Alice in the Looking Glass syndrome). Conditions of this kind are characteristic of intoxication with psychoactive substances and organic brain lesions.

Tempo and time: the environment may seem to change extremely quickly, like old movie frames (cinema syndrome), or, on the contrary, it seems to be drawn out. In some cases, it seems that the months run like moments, in others - there is no end to the night. Patients may report that they notice the same stereotypically repeated plot. All of these experiences are associated with emotionality, for example, in a good mood, it seems that time flows faster, and in a bad mood - more slowly.

Thus, the following syndromes can be distinguished.

Hallucinosis- a condition characterized by an abundance of hallucinations within one analyzer and not accompanied by clouding of consciousness, lasting from 1-2 weeks (acute hallucinosis), up to 6 months (subacute), up to several years (chronic hallucinosis).

The patient is anxious, restless or, conversely, inhibited. The severity of the condition is reflected in the behavior and attitude of the patient to hallucinations. By severity, acute and chronic hallucinosis are distinguished, and by content - auditory, tactile, visual. auditory hallucinosis it is usually verbal: voices are heard talking among themselves, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis is determined by the clinical picture of the alcoholic psychosis of the same name; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain. Patients with tactile hallucinosis feel the crawling of insects, worms, microbes on the skin and under the skin, touching the genitals; criticism of what is experienced is usually absent. It is noted in psychoses of late age, with organic damage to the central nervous system. Visual hallucinosis - a frequent form of hallucinosis in the elderly and people who have suddenly lost their sight, it also happens with somatogenic, vascular, intoxication and infectious psychoses. With the hallucinations of Charles Bonnet, patients suddenly begin to see bright landscapes on the wall, in the room, lawns lit by the sun, flower beds, playing children, they are surprised at this, although the awareness of the pain of experiences and the understanding that vision due to loss of vision is impossible remain intact. Usually, with hallucinosis, the patient's orientation in place, time and his own personality is not disturbed, there is no amnesia of painful experiences, i.e. there are no signs of confusion. However, in acute hallucinosis with life-threatening content, the level of anxiety rises sharply, and in these cases consciousness can be affectively narrowed.

hallucinatory syndrome- an influx of copious hallucinations from various analyzers (verbal, visual, tactile) against the background of a clear consciousness. May be accompanied by affective disorders (anxiety, fear), as well as delusional ideas. Hallucinatory syndrome can occur in schizophrenia, epilepsy, organic brain lesions, including syphilitic etiology.

Kandinsky-Clerambault Syndrome- is a special case of hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - mental automatisms and delusions of influence. Mental automatisms - alienation to the patient of his own mental acts, the feeling that some processes in his psyche occur automatically, against his will. There are 3 types of automatism:

Ideatory (thinking) - a feeling of insertion and withdrawal of thoughts, outside interference in their course, a symptom of "openness of thoughts", breaks (sperrung) and influxes of thoughts (mentism).

Sensory (sensual) - a state in which many unpleasant sensations in the body seem to be “made”, specially caused.

Motor (motor) - the feeling that the patient's movements are performed against his will, caused by influence from the side, "puppet movements".

The presence of all 3 variants of automatism is mental panautomatism.

Clinical example: The patient reports that for several years now he has been under the constant influence of some kind of apparatus that directs "rays of atomic energy" at him. He understands that the influence comes from some scientists setting up an experiment. "They chose me because I always had good health." The experimenters "take away his thoughts", "show some images" that he sees inside his head, while in his head "a voice sounds" - "also their work." Suddenly, during a conversation, the patient begins to grimace, twist his mouth, twitch his cheek. When asked why he does this, he replies: “It’s not me at all, but they burn with rays, direct them to different organs and tissues.”

It is also possible to develop the so-called inverse variant of the Kandinsky-Clerambault syndrome, the essence of which is that the patient himself allegedly has the ability to influence others, recognize their thoughts, influence their mood, feelings, and actions. These phenomena are usually combined with ideas of overestimation of one's personality or delusional ideas of grandeur and are observed in the picture of paraphrenia.

The physiological basis of perception is the sense organs. The end product of perception is a figurative, sensory representation of a particular object. Perceptual disorders are represented by such disorders as hallucinations, allusions and psychosensory disorders.

Illusions

Such perception disorder, as an illusion is a violation in which a really existing object is perceived as something else. Psychologists distinguish physical, physiological and mental illusions. physical illusion determined by the environment in which it is located. For example, a mountain range can be perceived as painted in different colors, etc. Physiological illusion arises in connection with the conditions of functioning of receptors. Disturbances in their functioning can cause misperceptions. For example x Cold water after being in the cold is perceived as warm. and last, mental illusions are affective due to the emotional state of fear and anxiety. For example, an anxious person may hear non-existent footsteps or sounds. Also, pareidolic illusions are mental, they are a kind of visual erroneous images.

Verbal illusions appear against the background of some 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, swearing, insults, accusations.

hallucinations

Hallucinations are a violation of perception in which a non-existent object or phenomenon is not perceived critically by the patient. Denials of hallucinations are not perceived or are perceived aggressively. All hallucinations are classified by complexity, content, time of occurrence of interest. According to the complexity of hallucinations are divided into elementary, simple, complex. Simple hallucinations:

• photopsies (spots, contours, glare of visual images);
• acoasma (hails, indistinct noise).

Only one analyzer is involved in the formation of simple hallucinations. When complex hallucinations appear, several analyzers are involved. For example, a patient can not only see an imaginary person, but also hear his voice, feel his touch, smell aromas. But the most common are visual or auditory hallucinations. visual hallucinations as a rule, they are represented by single or multiple images, mythical creatures, moving and stationary figures, safe or attacking the patient. There are also visions of their doubles, which doctors call autoscopic hallucination.

auditory hallucinations are experienced by patients as the sound of the wind or the howling of animals. But most often they are expressed in the form of verbal hallucinations (voices of strangers). Voices can talk about the patient, scold or threaten. But the greatest danger is the so-called imperative hallucinations, which are in the form of orders and can often lead to serious consequences (suicide, harm to oneself and others). As a rule, it is difficult for the patient to control orders. There are also the following types of hallucinations:

• olfactory (sensation of unpleasant odors);
• taste;
• visceral (sensation of worms, frogs, snakes in the body).

Separately from others, the following are also considered types of hallucinations:

• Functional. Hallucinations that occur as a result of an external stimulus, perceived simultaneously with it. For example, in the sound of rain, the patient hears the voices of people.
• Dominant. Reflect mental trauma. The patient can see the figure of the deceased relative.
• Hypnogogic. Occur during the transition from wakefulness to sleep.
• Pseudo-hallucinations. The disorder may be true or false. A true hallucination is characterized by a projection into the environment. 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 are devoid of signs of reality, do not fit into the environment, are perceived as something alien, strange, different from previous sensations. Pseudohallucinations are more common in endogenous disorders, namely schizophrenia. The presence of hallucinatory experiences can be learned not only from the words of the patient and his relatives, but also by objective signs that are reflected in the behavior of the patient.

Psychosensory disorders

Psychosensory disorders are also a violation of perception, when a real-life object is perceived by the patient in an altered form. There are also derealization and depersonalization. With derealization, the patient's perception of the world is disturbed, this concerns the distortion of the shapes and weight of objects, objects, the mismatch of color with the real one. Microscopy may also be present, when the object is perceived in a reduced size or vice versa (metamorphopsia). Derealization can be attributed to a violation of the perception of time and space. Patients in a manic state perceive time faster than in reality, in depressive - like slow.

Depersonalization can be symptoms:

• somatopsychic;
• autopsychic.

Somatopsychic depersonalization represented by experiences of changes in the size or weight of the body. Patients may assure the physician that they cannot fit in their bed, and so on. Autopsychic depersonalization expressed in the patient through the experience of a sense of change in his "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.

Prevention and treatment

Prevention of diseases includes avoiding excessive alcohol consumption, avoidance of narcotic and toxic substances. It is also important to monitor your health and mental state, avoid stress whenever possible. Good rest and sleep is also important. Diagnostics perceptual disturbances consists in a thorough medical examination, checking the patient's complaints, assessing and identifying violations through simple tests. A psychiatrist should be aware of the signs of the disease. The relatives of the patient also bear a certain responsibility, who should be aware of possible potentially dangerous situations with an existing impairment of perception.

Receptor disorders include the most elementary symptoms of mental illness :

1) hyperesthesia - increased susceptibility to external stimuli, neutrally perceived by a person in a normal state; then the light seems too bright, sounds - deafeningly loud, touches - rude, although in fact the intensity of the stimulus does not exceed the usual thresholds for the body, hypesthesia, when sensitivity, on the contrary, decreases, objects seem shapeless, dull, sounds lose their intonation;

2) senestopathies - unpleasant, painful vague sensations emanating from various parts of the body - burning, tickling, tightening, pressure, which have no real reasons;

3) metamorphopsia - a change in the perception of the size and shape of objects and space, for example, the ceiling in a room seems to be tilted, or the street looks infinitely long, the size of parts of one's body can also change;

4) derealization is a symptom that is complex in nature, consisting in a sense of the illusory nature of the environment, when the world is seen "as if through a grid", "as if in a dream", the sense of reality is lost; the concepts of "already seen" and "never seen" are close to this state, when the object seen for the first time seems painfully familiar, or vice versa;

5) personified awareness - the feeling that someone is present in the room where the patient is alone, with a simultaneous feeling of the fallacy of this feeling;

6) disorder of awareness of time (acceleration, deceleration, complete absence);

7) disorder of apperception - the inability to establish connections between phenomena and understand the meaning of what is happening.

Disorders of orientation in time, in a given situation, in a place, in one's own personality:

1) confusion (affect of bewilderment) - an unpleasant misunderstanding of one's condition, which is recognized as unusual (in this state, the patient inquires, "What happened? What happened to me?");

2) depersonalization - a disorder of awareness of one's own personality, a feeling of alienation of one's thoughts, feelings, actions, up to the feeling of their "done", artificial introduction from the outside, as a product of someone's will, and up to the loss of self-consciousness.

Perceptual disorders

Cognition It is a reflection of the outside world around. Distinguish sensual, direct knowledge, which makes up our sensations, perceptions, ideas and abstract knowledge, when the world is known with the help of thinking in verbally formulated concepts and judgments. In mental illness, there may be predominant violations of each of these types of cognition. Of the various, highly variable impairments and disorders of cognitive activity, we will focus on the main ones that are most common in mentally ill people and are of the greatest importance in the clinic of mental illness.

A person perceives the world around him and orients himself in it with the help of analyzers. Irritation of analyzers by certain objects and phenomena of the external world causes the emergence of perceptions - reflections in our consciousness of the object as a whole.

Types of perception disorders:

1) illusions are distorted perceptions of real objects. Illusions are not always the result of painful perception. There are physiological illusions that are characteristic of mentally healthy people and are determined by the laws of animate and inanimate nature.

Hallucinations are imaginary perceptions. It is perception without an object. Essentially, hallucinations are an involuntary, intensely sensory representation that is projected into the real world and acquires the properties of objective reality. Hallucinations practically do not occur in healthy people and usually indicate the presence of a mental disorder;

2) true hallucinations are distinguished by the sense organs:

auditory hallucinations more common in the form of "voices" (verbal hallucinations). The patient hears words related to his actions, thoughts. Voices either threaten, or reproach him for something, or direct his actions. He hears whispers, enters into conversation with voices, argues with them, covers his ears with his hands, the patient's facial expressions reflect the nature of the experiences. In some cases, hallucinations appear at the time of falling asleep and are accompanied by fear. Of particular note are the so-called imperative (imperious) hallucinations, under the influence of which the patient can commit sudden and incomprehensible actions for others. He obeys the decisive order automatically. Auditory hallucinations are most often observed in schizophrenia and in some alcoholic psychoses.

visual hallucinations are less common than others, they are not as long as auditory ones, which can last for years. Very bright are visual hallucinations in alcoholics with the so-called delirium tremens. They see animals, monsters, devils, things change, one picture is quickly replaced by another.

Tactile hallucinations- unpleasant sensations that occur in the skin or under the skin (tickling, crawling, pressure), correlated with certain inanimate objects (crystals, pieces of foreign bodies), or living beings (insects, small animals, etc.), whose external signs accurately described by patients (hard, small with long legs, etc.).

Olfactory and gustatory hallucinations are less common. At the same time, patients can feel the effects of poisonous gases, disgusting, as if smells were specially allowed into the room. The special taste of food convinces the patient that poison is mixed with it. In this regard, there is a refusal of food, distrust of others, all sorts of precautions. Olfactory hallucinations are also manifested in the fact that patients perceive the smell, as if coming from themselves, from which they conclude that they are decomposing alive.

Pseudo-hallucinations- involuntary, usually with a feeling of being made or forced, perceptions that arise without the presence of a real object, perceived as really existing, but still "special" images, introduced from the patient's point of view by "influencing him from the outside" of someone's will, as as a rule, localized beyond the reach of the senses, for example, a visual image behind the back, inside the head.

They can be sensually bright and concrete, projected outward, although more often there is an intro-projection of images (they are localized by patients not in the objective, but in the subjective space - seen or heard "mentally", "mind", "inner eye", etc.) .

Unlike true hallucinations, pseudohallucinations are not identified with real objects, that is, they are devoid of the nature of objective reality. However, there is no critical attitude towards pseudo-hallucinations. Pseudohallucinations can be auditory, visual, olfactory, gustatory, tactile, general sense, with all their inherent features (for example, visual pseudohallucinations can be elementary and complex, colorless and colored).

functional hallucinations according to the mechanism of occurrence, they occupy an intermediate position between the actual hallucinations and illusions. They appear only in the presence of a real external stimulus and continue, without merging with it, separately, as long as this stimulus acts. The patient really hears the sound of train wheels and at the same time the words "pig, pig, pig" appear, when the train stops, these words disappear.

Hypnagogic hallucinations- visions or auditory deceptions that occur when eyes are closed before falling asleep or in a drowsy state.

Hypnopompic hallucinations- visions, less often auditory deceptions that occur during the period of awakening.

The forensic psychiatric significance of perceptual disorders lies in the fact that they violate the correct attitude towards the outside world and can lead to actions that pose a social danger. True, in almost all cases this is associated with a delusional interpretation of reality. Imperative (imperative) hallucinations have a more independent meaning. They lead to actions devoid of any motives, even delusional ones.