Disorders Of Perception
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Disorders Of Perception






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Disorders Of Perception Disorders Of Perception Presentation Transcript

  • Moderator-Dr.Ravichandra Karkal Dr.Samin Sameed Post-graduate Department of Psychiatry Yenepoya University
  •  The process of transferring physical stimulation into psychological information; mental process by which sensory stimuli are brought to awareness.
  • Abnormal perception Sensory deceptions Sensory distortions
  •  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
  • Color,intensity Shape and size Motion/general quality location uniqueness
  •  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
  • •Complete absence of color
  •  Visual perception – toxic drugs Xanthopsia Chloropsia Erythropsia Derealization- Everything looks unreal and strange Mania- looks perfect and beautiful
  •  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 are o Farther away than they really are  Macropsia –  Seeing objects larger than they really are
  •  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
  • teleopsia •Object appearing far away pelopsia •Object appearing nearer than it should
  •  Psychopathological point of view  Physical- Determined by physical events  Personal- Personal judgement of passage of time Mania- Time passes quickly Depression- Time passes slowly Acute Schizophrenia- personal time goes in fits and starts Acute organic states (temporal disorientation)
  • illusion hallucination Misinterpre tations of stimuli from external object Perceptions without external stimulus
  • Stimuli from perceived object Mental image False perception
  •  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.
  •  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 definition 1. Percept like experience in the absence of an external stimuli 2. Percept like stimuli which has full force and impact of real perception 3. Percept like experience which is unwilled, occurs spontaneously and cannot be readily controlled by percipient.
  •  Intense emotions  Suggestion  Disorders of sense organs  Sensory deprivation  Disorders of CNS  Psychiatric disorders
  •  depressed patients -delusions of guilt; hallucination - disjointed or short phrases  continuous persistent hallucinatory voices in severe depression ? Schizophrenia /physical disease.
  •  Normal subjects can be persuaded to hallucinate .  By hypnosis or brief task motivation instructions.
  •  Hallucinatory voices -in ear disease  Visual hallucination - eye diseases ,disorders of the CNS  Peripheral lesions -sense organs - hallucinations in organic states
  •  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
  •  Lesions of diencephalons and cortex can produce hallucination that are not only visual but can be auditory.
  •  Hearing  Vision  Smell  Taste  Touch  Pain and deep sensation  Vestibular sensations  The sense of presence
  •  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 them Auditory 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.
  •  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
  • Seen in  Schizophrenia  Organic states like temporal lobe epilepsy  Depression (uncommon) PADRE PIO PHENOMENON- religious people can smell around certain saints
  • Seen in  Schizophrenia  Organic states Depressed patient often describes loss of taste.
  •  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 types 1. Superficial 2. Kinesthetic 3. Visceral
  •  Thermic  Haptic  Hygric  Paraesthetic
  •  affects muscles and joints  Patient feels limbs twisted pulled or moved  schizophrenia  Organic states - alcohol intoxication benzodiazepine withdrawal
  •  Visceral hallucinations (SIMS 2003).  Twisting and tearing pains  Very bizarre complaints- organs ripped out , flesh ripped from his body  chronic schizophrenia
  •  Organic states  Schizophrenia  Conversion disorder  Normal people – fervently religious
  •  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 Hysterical Attention seeking personalities
  •  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 Schizophrenia o Organic conditions- epilepsy
  •  Autoscopy (phantom mirror image) – experience of seeing oneself and knowing that it is oneself VH+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 alcoholism NEGATIVE AUTOSCOPY INTERNAL AUTOSCOPY
  •  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
  •  Occurs when the subject is waking up  Hallucinations persisting from sleep when the eyes are open  More in narcolepsy.
  •  Occurs in any sensory modality and may occur in various neurological or psychiatric disorders  Depends on i. General condition of the brain ii. Recent experiences iii. Psychodynamic factors iv. Effect of local lesion
  •  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.
  • Almost exclusively the result of lesion which produces sensory defect PHANTOM 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.
  •  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
  •  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.
  •  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.
  •  Hyperschemazia – percieved magnifications of body parts  When part of the body feels larger than the normal  ORGANIC CAUSES o Brown Sequard Syndrome o PVD, MS, thrombosis of PICA  NON ORGANIC CAUSES o Hypochondriasis o Conversion disorder o 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.
  •  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