Individuals are capable of receiving information and
organizing it into meaningful entities. This processing
of the information to represent reality is called
PERCEPTION.
Perception is derived from Latin term, perceptio,
which means organization, identification, and
interpretation of sensory information.
It refers to the way world looks, sounds, feels, tastes
and smells, i.e. whatever is experienced by the person.
Sensory Distortions:-
perception of the
constant real object in a
distorted manner.
Sensory Deceptions:-
new perception in
response to external
stimuli.
Sensory Distortion:-
Change in intensity
Change in quality
Change in spatial form
Distortions of experience of time
Changes in Intensity (hyperaesthesia and
hypoaesthesia):-
Hyperaesthesia:- increased intensity of sensations.
intense emotions
lowering of physiological threshold
Anxiety and depressive disorder as well as hangover from
headache or migraine,- increased sensitivity to noise
(hyperacusis)
Hypomanic under influence of LSD (lysergic acid
diethylamide), seeing colours as bright and intense.
A true hypoacusis occurs in delirium, threshold for all
sensations are raised, associated with depression and ADD
(attention-deficit disorder).
Changes in Quality:- are mainly visual distortions
which colour all perceptions, because of toxic
substances.
Xanthopsia- colouring of yellow; by santonin
Chloropsia- colouring of green
Erythropsia- colouring of red
In derealisation, everything appears to unreal, while in
mania object looks perfect and beautiful.
Changes in Spatial Form (dysmegalopsia):- is
change in perceived shape of object, caused due to-
retinal disease
disorders of accommodation
disorders of convergence
temporal lobe lesions (mainly affecting posterior lobe)
Micropsia, seeing objects as smaller; macropsia
(meagalopsia) seeing objects as bigger.
Macropsia and micropsia have been used for changes
in perception of size in dreams and hallucination.
Micropsia:- is a visual disorder
in which patient sees object;
smaller than they really are
farther away than they really
are
experience of retreat of objects
into distance, without any
change in size (porropsia)
Oedema of retina image falls on
functionally smaller part of
retina
Partial paralysis of
accommodation
Macropsia:-
Scarring of retina with retraction
(distortion produced by scarring is
usually irregular, metamorphopsia
is more likely to occur)
Complete paralysis or
over-reactivity of accommodation
during near vision causes
macropsia.
If accommodation is normal but
convergence is weakened,
macropsia occurs and vice versa.
Although hypoxia and rapid
acceleration of body can affect
accommodation and convergence,
dysmegalopsia is rare among high
altitude pilots.
Disorders of Experience of Time:- There are two
varieties of time, physical and personal.
The psychiatric disorders are affected by personal
time.
Time flies when one is happy (in case of mania) and
time stops when one is sad (in case of de
The presentation describes what id perception; differences between sensation, perception and imagery; disorders of perception and how to assess perception using mental status examination.
Individuals are capable of receiving information and
organizing it into meaningful entities. This processing
of the information to represent reality is called
PERCEPTION.
Perception is derived from Latin term, perceptio,
which means organization, identification, and
interpretation of sensory information.
It refers to the way world looks, sounds, feels, tastes
and smells, i.e. whatever is experienced by the person.
Sensory Distortions:-
perception of the
constant real object in a
distorted manner.
Sensory Deceptions:-
new perception in
response to external
stimuli.
Sensory Distortion:-
Change in intensity
Change in quality
Change in spatial form
Distortions of experience of time
Changes in Intensity (hyperaesthesia and
hypoaesthesia):-
Hyperaesthesia:- increased intensity of sensations.
intense emotions
lowering of physiological threshold
Anxiety and depressive disorder as well as hangover from
headache or migraine,- increased sensitivity to noise
(hyperacusis)
Hypomanic under influence of LSD (lysergic acid
diethylamide), seeing colours as bright and intense.
A true hypoacusis occurs in delirium, threshold for all
sensations are raised, associated with depression and ADD
(attention-deficit disorder).
Changes in Quality:- are mainly visual distortions
which colour all perceptions, because of toxic
substances.
Xanthopsia- colouring of yellow; by santonin
Chloropsia- colouring of green
Erythropsia- colouring of red
In derealisation, everything appears to unreal, while in
mania object looks perfect and beautiful.
Changes in Spatial Form (dysmegalopsia):- is
change in perceived shape of object, caused due to-
retinal disease
disorders of accommodation
disorders of convergence
temporal lobe lesions (mainly affecting posterior lobe)
Micropsia, seeing objects as smaller; macropsia
(meagalopsia) seeing objects as bigger.
Macropsia and micropsia have been used for changes
in perception of size in dreams and hallucination.
Micropsia:- is a visual disorder
in which patient sees object;
smaller than they really are
farther away than they really
are
experience of retreat of objects
into distance, without any
change in size (porropsia)
Oedema of retina image falls on
functionally smaller part of
retina
Partial paralysis of
accommodation
Macropsia:-
Scarring of retina with retraction
(distortion produced by scarring is
usually irregular, metamorphopsia
is more likely to occur)
Complete paralysis or
over-reactivity of accommodation
during near vision causes
macropsia.
If accommodation is normal but
convergence is weakened,
macropsia occurs and vice versa.
Although hypoxia and rapid
acceleration of body can affect
accommodation and convergence,
dysmegalopsia is rare among high
altitude pilots.
Disorders of Experience of Time:- There are two
varieties of time, physical and personal.
The psychiatric disorders are affected by personal
time.
Time flies when one is happy (in case of mania) and
time stops when one is sad (in case of de
The presentation describes what id perception; differences between sensation, perception and imagery; disorders of perception and how to assess perception using mental status examination.
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Disorders of Perception.pptx
1. DISORDERS OF PERCEPTION
T. Aladashvili
Perception - (from the Latin perceptio, percipio) is
the organization, identification, and interpretation
of sensory information in order to represent and
understand the environment
3. 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
4. Sensory Distortion
Changes in perception that are the result of :
1. Change in the intensity
2. Quality of the stimulus
3. Spatial form of the perception
4. Distortions of the experience of time
5. Splitting of perception
5. 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
Increased sensitivity to noise – Hyperacusis is associated with
Anxiety and depressive disorders as well as hangover from
alcohol and migraine.
Decreased sensitivity to noise – Hypoacusis, occurs in
delirium, where the threshold for all sensations is raised.
Hypoacusis feature of other disorders associated with
attentional deficits such as depression and attention- deficit
disorder
7. Changes in quality
Visual perception
• Xanthopsia- Coloring of yellow
• Chloropsia - Coloring of green
• Erythropsia- Coloring of red
•which is result of drugs (poisoning with
mescaline or digitalis)
9. Changes in spatial form
• Change in percieved shape of an object, can
result from
Retinal disease
Disorders of accommodation
Temporal and Parietal Lobe Lesions
Poisoning with Atropine and Hyoscine
Schizophrenia
10. Micropsia - a visual disorder in which the
patient sees objects
Smaller than they really are
Farther away than they really are
Macropsia or Megalopsia - opposite to
micropsia
Porropsia : Experience of retreat of subjects
into the distance without any change in space
Dysmegalopsia: Objects are perceived larger
in one side and smaller in the other.
Metamorphosia: Irregular in shape
13. Distortions in the experience of time
• Mania- Time passes quickly
• Depression- Time passes slowly
• Temporal lobe lesions- feels time either passes
slowly or quickly
• Schizophrenia- have abnormalities of time
judgment, estimating intervals to be less than
they are
14. Splitting of perception
Seen sometimes with organic states and with
schizophrenia
Unable to form usual assumed link between
two or more perceptions
While watching TV experiencing a feeling of
competition between the visual and auditory
perception and not coming out of the same
source
17. Illusions - Stimuli from a perceived object are
combined with a mental image to produce a
false perception
Types of Illusion
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
18.
19. Hallucination
A perception without an object
A false perception which is not a sensory
distortion or a misinterpretation but which occurs
at the same time as real perceptions
Causes:
• Intense emotions
• Suggestion
• Disorders of sense organs
• Sensory deprivation
• Disorders of CNS
20. Disorders of a peripheral sense organ
Hallucinatory voices may occur in ear disease
and visual hallucinations in diseases of the eye
Charles Bonnet syndrome (phantom visual
images) is a condition in which complex visual
hallucinations occur in the absence of any
psychopathology and in clear consciousness
It is associated with either central or
peripheral reduction in vision
21. Charles Bonnet syndrome
Features of delirium, dementia, organic affective or
delusional syndromes, psychosis, intoxication or
neurological disorders with lesion of central visual
cortex are absent
Hallucinations are located in external space, much more
vivid than the patient’s impaired vision would otherwise
permit
May be modifiable by voluntary control
Usually insight is there concerning their unreality
Can be either elementary or complex
22. Sensory Deprivation
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
24. Hearing
Hearing may be elementary or unformed
• Elementary – noises, bells or undifferentiated
whispers ; in organic states
• Partly organized- music
• Completely organized –”Voices” are
characteristic of schizophrenia (also
occurring in organic states: delirium,
dementia and sometimes in severe
depression or mania)
26. Hearing
Imperative/Command hallucination:
• Voices sometimes act upon individuals and
give instructions.
• may or may not act upon them
• Voices speak about the person in the third person
and may give a running commentary on their
actions, although this was one thought to be
diagnostic of schizophrenia, this is no longer the
case since these symptoms have also been
described in mania
• This kind of hallucinations are usually
abusive
27. Vision
• 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
Also seen in psychiatric disorders associated with
epilepsy
28. Vision
• Visual hallucinations are more common in
acute organic states with clouding of
consciousness than in functional psychosis
• Patients with temporal-lobe epilepsy may
have combined auditory and visual
hallucinations
• Some patients with schizophrenia may see
and hear people being tortured, murdered and
mutilated
29. Smell (olfactory)
Seen in
• Schizophrenia
• Organic states like temporal lobe epilepsy are
often ushered in by an aura involving an
unpleasant odour such as burning paint or
rubber with or without fit
• Depression (uncommon)
• PADRE PIO PHENOMENON- religious
people can smell roses around certain saints
30. Taste (gustatory)
• Seen in
• Schizophrenia
• Organic states
• Depressed patient often describes loss of taste
31. Touch (Tactile)
• Formication- a feeling that animals are
crawling over the body (organic states)
• Cocaine bug – formication occurring with
delusion of persecution in cocaine psychosis
• Sexual Hallucinations- seen in acute and
chronic schizophrenia
• Types of tactile hallucination
1. Superficial,
2. Kinaesthetic,
3. Visceral
32. Superficial
Thermic (cold wind blowing across the face)
Haptic (feeling a hand brushing against the skin)
Hygric (feeling fluid )
Paraesthetic (feeling pins and needles)
Kinaesthetic
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
33. Pain and deep sensation
• Visceral hallucinations
• Twisting and tearing pains
• Very bizarre complaints- organs being ripped
out and flesh ripped from his body
• Seen in chronic schizophrenia
• Delusional zoopathy in which delusional
belief that there is an animal crawling about in
the body and also a hallucinatory component
since the patient feels it & can describe it
34. Sense of presence
• vivid sensation that somebody
(distinct from oneself) is present
nearby
• Organic states
• Schizophrenia
• Hysteria
• Normal people – Reverently religious
35. Special kinds of hallucination
• Reflex hallucinations
• Synaesthesia is the experience of a stimulus in
one sense modality producing a sensory
experience in another
• Can occur under the influence of
hallucinogenic drugs such as LSD or
mescaline when the subject might describe
feeling, tasting and hearing colours
simultaneously
36. Special kinds of hallucination
• Autoscopy is the experience in which an
individual perceives the surrounding
environment from a different perspective, from
a position outside of their own body.
• Autoscopy comes from the ancient Greek
αὐτός ("self") and σκοπός ("watcher")
Internal Autoscopy – Experience of seeing or
vividly describing one’s internal organs
External Autoscopy - Person sees an image of
himself outside his own body
Negative Autoscopy: patients look in the
mirror and see no image
37. Hypnagogic and hypnopompic
hallucinations
• Hallucinations occur when the person is
falling asleep or waking up
• Hypnagogic hallucinations is about three
times more common than hypnopompic
hallucinations.
• Hypnopompic a better indicator of narcolepsy.
• Commonest is auditory. His name being called
• May be geometrical designs , abstract shapes ,
faces, figures or scenes from nature
38. Phantom Limb
• Most common organic somatic hallucination.
• Patient feels that they have a limb from which
in fact they are not receiving any sensations
either because it has been amputated or
because the sensory pathways from it have
been destroyed.
• In rare cases with thalamo−parietal lesions
the patient describes a third limb
39. Thought disorder
A thought disorder is any disturbance in cognition that
adversely affects language and thought content, and
thereby communication
Content-thought disorder
thought disturbance in which a person experiences
multiple, fragmented delusions, typically a feature
of schizophrenia
Formal thought disorder
also known as disorganized speech – evident
from disorganized thinking, and is one of the
hallmark features of schizophrenia
40. Types
• Alogia – A poverty of speech, either in amount or content
• Blocking or thought blocking – An abrupt stop in the
middle of a train of thought
• Circumstantial speech - An inability to answer a question
without giving excessive, unnecessary detail.
• Clanging – A severe form of flight of ideas whereby ideas
are related only by similar or rhyming sounds rather than
actual meaning.
• Derailment -Thought frequently moves from one idea to
another which is obliquely related or unrelated, often
appearing in speech but also in writing
• Echolalia– Echoing of another's speech that may only be
committed once, or may be continuous in repetition
• Flight of ideas - a form of formal thought disorder marked
by abrupt leaps from one topic to another
41. Types
• Illogicality– Conclusions are reached that do not follow
logically
• Incoherence (word salad)– Speech that is unintelligible
because, though the individual words are real words, the
manner in which they are strung together results in incoherent
gibberish
• Neologisms – forms completely new words or phrases whose
origins and meanings are usually unrecognizable
• Perseveration– Persistent repetition of words or ideas even
when another person attempts to change the topic
• Pressured speech - Rapid speech without pauses, difficult to
interrupt.
• Self reference – Patient repeatedly and inappropriately refers
back to self
• Tangential speech – Wandering from the topic and never
returning to it or providing the information requested
42. Delusions
Fixed, false beliefs that conflict with reality. Despite contrary evidence, a
person can’t let go of their convictions
Delusions are categorized into four different groups:
• Bizarre delusion: Delusions which are clearly not understandable to same-
culture peers and do not derive from ordinary life experiences
Example: a belief that someone replaced all of one's internal organs with
someone else's without leaving a scar
• Non-bizarre delusion: A delusion that, though false, is at least technically
possible
Example: the affected person mistakenly believes that they are under
constant police surveillance
• Mood-congruent delusion: Any delusion with content consistent with
either a depressive or manic state
Example: a depressed person believes that news anchors on television
highly disapprove of them, or a person in a manic state might believe they are
a powerful deity
• Mood-neutral delusion: A delusion that does not relate to the sufferer's
emotional state
Example: a belief that an extra limb is growing out of the back of one's
head is neutral to either depression or mania
43. Themes
• Delusion of control: False belief that another person, group of
people, or external force controls one's general thoughts, feelings,
impulses, or behaviors
• Cotard delusion: False belief that one does not exist or that one
has died
• Delusional jealousy: False belief that a spouse or lover is having an
affair, with no proof to back up
• Delusion of guilt or sin (self-accusation): Ungrounded feeling of
remorse or guilt
• Delusion of mind being read: False belief that other people can
know one's thoughts
• Delusion of thought insertion: Belief that another thinks through
the mind of the person
• Delusion of reference: False belief that insignificant remarks,
events, or objects in one's environment have personal meaning or
significance. Usually the meaning assigned to these events is
negative
44. Themes
• Erotomania: False belief that another person is in love with them (usually
famous one)
• Religious delusion: Belief that the affected person is a god or chosen to act
as a god
• Somatic delusion: False belief is that the body is somehow diseased,
abnormal or changed.
A specific example of this delusion is delusional parasitosis: Delusion in
which one feels infested with insects, bacteria, spiders, lice, fleas, worms, or
other organisms
• Delusion of poverty: Person strongly believes they are financially
incapacitated
• Grandiose delusions: False beliefs that one is famous, omnipotent or
otherwise very powerful
• Persecutory delusions: In which the affected person wrongly believes that
they are being persecuted, spied on, attacked, poisoned or drugged
The individual thinks that the persecutors have the intention to cause harm