The document discusses various types of perceptual disturbances and disorders. It describes sensory distortions like constant distortions of real objects. It also discusses sensory deceptions like new perceptions that may or may not be in response to external stimuli. It outlines various changes in intensity of sensations seen in conditions like anxiety, depression, and migraine. It also describes increased or decreased sensitivity to noise. The document outlines various visual perceptual disturbances caused by toxic drugs. It discusses changes in perceived shape, size, and distance of objects seen in various neurological and psychiatric conditions. It also discusses illusions, hallucinations, and other false perceptions seen across organic, neurological, and psychiatric conditions.

2.  Individuals capable of receiving information
on sensation. Data is then organized to make
it meaningful and comprehensible. The
organized entities are called percepts. This
processing of the data to represent reality is
called PERCEPTION.

3.  Sensory Distortion- Constant 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

4.  Changes in Intensity - Increased intensity of
sensation- hyperesthesia seen in increasing
sensations or lowering of physiological
threshold.
Seen in
 anxiety
 depressive disorder,
 Hangover from alcohol
 Migraine
 hypochondria cal personalities

5.  Increased sensitivity to noise – Hyperacusis
 Decreased sensitivity to noise – Hypoacusis
 Delirious
 Depression
 Attention deficit disorder

6.  Visual perception – affected by this are
brought about by toxic drugs
Xanthopsia- Coloring of Yellow
Chloropsia - Coloring of green
Erythropsia- Coloring of red
Derealization- Everything looks unreal and
strange
Mania- looks perfect and beautiful

7. Change in percieved shape of an object
 Retinal disease
 Disorders of accommodation
 Temporal and Parietal Lobe Lesions
 Poisoning with Atropine and Hyoscine
 SCHIZOPHRENIA

8.  Micropsia – a visual disorder in which the
patient sees objects
o Smaller than they really are
o Farther away than they really are
 Macropsia – opposite to micropsia

9.  Experience of retreat of subjects into the
distance without any change in space -
porropsia
 Edema of the retina
 Partial Paralysis of accomdation
 Diseases affecting the nerves controlling
accommodation

10.  MACROPSIA : Scarring of retina with
retraction
and complete paralysis of accommodation.
 DYSMEGALOPSIA: Objects are perceived
larger in one side and smaller in the other.
 Atropine, Hyoscine poisoning
 Chronic arachnoiditis
 METAMORPHOSIA: Irregular in shape.

11.  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)
disorders of time is seen in milder form there
may be over estimation of time.

12.  Illusions- Misinterpretation of a single stimuli
arising from a single stimuli
 Stimuli from a perceived object are combined
with a mental image to produce a false
perception.
Derived from set and lack of perceptual
clarity
 Delirium
 Severe depression with delusions of guilt

13.  Complete Illusion – These depends on
misreading words in newspapers or missing
misprints because we read the word as if it
were capable
 Affect Illusion- These arise in the context of
particular mood state
 Paradolia – vivid illusions occur without the
patient making any effort ; are the result of
excessive fantasy thinking and a vivid visual
imagery.

14.  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.

15.  Intense emotions
 Suggestion
 Disorders of sense organs
 Sensory deprivation
 Disorders of CNS
 Psychiatric disorders

16.  depressed patients with delusions of guilt;
hallucination tends to be disjointed or short
phases
 Occurrence of continuous persistent
hallucinatory voices in severe depression
should arouse the suspicion of schizophrenia
or some intercurrent physical disease.

17.  Normal subjects can be made to hallucinate
 Hypnotic hallucinations do not produce
objective effects similar to those produced by
ordinary perceptions such as complimentary
after images and so on

18.  Hallucinatory voices may be heard in ear
disease
 Visual hallucination is seen in eye diseases
but usually there is disorder of the CNS as
well.
 Peripheral lesions of sense organs may play a
part in hallucinations in organic states

19.  If all incoming stimuli are related to minimum
in a normal subject they will begin to
hallucinate after few hours
 Usually these are changing visual
hallucinations and repetitive phrases
 BLACK PATCH DISEASE delirium following
cataract extraction in the aged result of
sensory deprivation and mild senile brain
changes

20.  Lesions of diencephalons and cortex can
produce hallucination that are not only visual
but can be auditory.

21.  Hearing
 Vision
 Smell
 Taste
 Touch
 Pain and deep sensation
 Vestibular sensations
 The sense of presence

22.  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 also ‘voices’ can be heard
but less well formed than schizophrenia

23. 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

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

25.  Elementary- flashes of light
 Partly organized- patterns
 Completely organized- visions of people
animals or objects.
Scenic hallucinations- whole scenes are
hallucinated like a cinema film
More commonly seen in delirium
seen in psychiatric disorders associated with
epilepsy.

26.  Patients with visual and auditory
hallucinations co occur as a whole
 Temporal lobe epilepsy
 Late onset of schizophrenia (protracted)

27.  Visual Hallucinations are more common in
organic states with clouding of consciousness
than in the functional psychoses
 Small animals are often hallucinated in
delirium
 Extremely rare in schizophrenia
 Occasionally without any psychopathology
CHARLES BONNET SYNDROME
 Produced by drugs of abuse typically consist
of diffuse distortions of existing visual world.

28. Seen in
 Schizophrenia
 Organic states like temporal lobe epilepsy
 Depression (uncommon)
PADRE PIO PHENOMENON- religious people
can smell around certain saints

29. Seen in
 Schizophrenia
 Organic states
Depressed patient often describes loss of taste.

30.  Formication- a feeling that animals are
crawling over the body; not uncommon in
organic states
 Cocaine bug – formication occurring with
delusion of persecution in cocaine psychosis
 Sexual Hallucinations- seen in acute and
chronic schizophrenia

31.  Classified into 3 types
1. Superficial
2. Kinesthetic
3. Visceral

32.  Thermic – a cold wind blowing across the face
 Haptic- feeling a hand brushing against the
skin
 Hygic- feeling fluid such as water running
from the head into the stomach
 Paraesthetic- pins and needles. Mostly
organic.

33.  affects muscles and joints
 Patient feels their limbs are being twisted
pulled or moved
 Seen in schizophrenics
 Organic states such as alcohol intoxication
and benzodiazepine withdrawal

34.  Visceral hallucinations (SIMS 2003).
 Twisting and tearing pains
 Very bizarre complaints- organs being ripped
out and flesh ripped from his body
 Seen in chronic schizophrenia

35.  Organic states
 Schizophrenia
 Hysteria
 Normal people – feverently religious

36.  Type of mental image that although clear and
vivid lack the substantiality of perceptions
 Full consciousness
 Located in subjective space
 Definite outlines, compete sound
 Constancy retained
 Relevant to emotions, needs and actions
 Depends on the observer for existence
Hysterical
Attention seeking personalities

37.  Functional hallucinations : a auditory
stimulus causes the hallucination, but it is
experienced as well as the hallucination.
 Chronic schizophrenia
 Reflex Hallucination : a stimulus in one
sensory field produces a hallucination in one
another. Morbid variety of synaesthesia.

38.  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

39.  Autoscopy (phantom mirror image) -The
patient sees himself and knows that it is he.
Not just visual hallucination , because even
kinesthetic and somatic sensations are
present
 Normal subjects- emotionally disturbed, tired
and exhausted
 depressed
 Hysteria
 Schizophrenia

40.  Acute and sub acute delirious states
 Epilepsy
 Focal lesions in parieto occipital region
 Toxic infective states whose effect is greatest
in basal regions of the brain
 Drug addiction
 Chronic alcoholism
NEGATIVE AUTOSCOPY
INTERNAL AUTOSCOPY

41.  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. His name being called
 May be geometrical designs , abstract shapes ,
faces , figures or scenes from nature
 EEG shows alpha rhythm

42.  Occurs when the subject is waking up
 Hallucinations persisting from sleep when the
eyes are open
 More in narcolepsy.

43.  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

44.  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.

45. 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.

46.  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.

47.  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

48.  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.

49.  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.

50. 1) Confusional hallucinosis:
i. consciousness is clouded
ii. Visual hallucinosis are prominent
iii. Auditory hall are mainly music , noises or odd words
but connected sentences are already heard.
2) Self reference hallucinosis:
i. Pt hears people talking about him
ii. Rough idea about what the voices are saying but
unable to reproduce them

51. 3) Verbal Hallucinosis
Pt hears clear voices which talk about him and
he can reproduce their content accurately
4) Fantastic hallucinosis
i. Hallucinosis of all kinds seem to occur
ii. Pt describes fantastic experiences based on
auditory and visual hallucination
iii. Sometimes the patient describes dream
experiences as if they were real
iv. These pts usually have mass hallucinations

52.  Hyperschemazia –  ORGANIC CAUSES
percieved o Brown Sequard
magnifications of body Syndrome
parts o PVD, MS, thrombosis
 When part of the body of PICA
feels larger than the  NON ORGANIC
normal CAUSES
o Hypochondriasis
o Conversion disorder
o Depersonalization

53.  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

54.  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.

55. THE END
Fish Psychopharmacology
Andrew Sims- Symptoms in the
mind
Comprehensive text book of
Psychiatry- Kaplan and
Saddock