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Psychopathology of Perception - Dr.Yasser Abdelrazek.pptx
- 1. Psychopathology of perception YasserAbdel Razek Professor of Psychiatry Ain Shams University
- 2. Definition OF PERCEPTION •A mental process by which we transfer sensory information to psychological information ( interpretation into meaning ) • It is an active process • A meaningful percept : I recognize the meaning of my sensation • It is the psychological meaning of information coming to the brain by sensory organs and tracts.
- 3. DEFINITION OF SENSATION •Sensation Is The Act of receiving stimulus by any sensory organ • It is a First stage and By itself can not form a meaning • Sensory percept : A sensory configuration without recognition what is perceived
- 4. Differences Perception Sensation Definition Interpretationof + Receiving + Brain area 2ndry association area 1ry association area University Variable Universal Basis Psychological Physiological
- 5. Requirements of perception •In order to perceive it must – Hold myself distinct from the object – Me and the object are held together by movement of me towards it – The object must hold a challenge to be explored. •
- 6. Perception depends on •Past experience • Present stimulus • Future expectation • Change of stimulus is essential for perception • Emotions affect our capacity for perception eg. Effect of enthusiasm and suggestion • Motivation • Physical condition
- 7. Disturbance of perception •1-Distortion of perception • 2-Deception of perception • 3-Splitting of perception • 4-Loss of perception
- 8. SENSORY DISTORTION • Theperception changes in only one parameter could be
- 9. • Intensity eg.Increased in Hyperacusis in depression and migraine. Lowered in depression E.g. Sounds are muffled All foods have the ‑ same taste, etc. • Color eg. black white vision in depression • Brightness eg. Manic patient sees everything bright (visual hyperaesthesia) • Size eg. Micropsia, macropsia • Rate eg. Auditory perception may be accelerated in temporal lobe fits • Shape eg. Change of shape may occur with parietal lobe lesion • NB. All perceptual distortions may occur in parietal lobe lesions, temporal lobe lesions, acute organic states and epilepsy
- 10. FALSE PERCEPTION (DECEPTION) •1- Illusion • 2- Hallucinations
- 11. Illusion • Stimuli fromperceived object are combined with a mental image to produce a false perception • Types: – Completion illusion – Affect illusion – Pareidolic illusion
- 12. Completion illusion • Allincomplete perception that is meaningless of itself is filled in from previous experiences (Gestalt school of psychology) – Disappear by attention
- 13. Affect illusion • Lastsa short time and disappear with attention and disappearance of the affect
- 14. Pareidolic illusion • Itis formed by admixture of imagination into the perceived stimulus by effortless e.g. seeing vivid picture in the clouds – Occurs in children – Increased by attention – Normal (set, lack of perceptual clarity, intense emotions) – Delirium (perceptual threshold is raised)
- 15. Fantastic illusion • Patientssee extraordinary modification of his environment • e.g. Person looking to the mirror instead of seeing his head he saw a head of a pig
- 16. DD of Pareidolicillusion • 1- Perceptual misinterpretation • 2- Functional hallucination • 3- Fantastic interpretation
- 17. HALLUCINATION • Perception withouta stimulus • Has the full force and impact of a real experience • Unwilled, intrusive, occurs spontaneously and can not be controlled • Occur in the form of images • Derived from internal sources of information • Appraised incorrectly as if from external sources of information • Not disappear with attention • Occur simultaneously with normal perception • Experienced as sensation and not as fantasy or imagination • Relevant to emotions, needs and actions
- 18. • Tubal hallucination:Experiences of those who has cardiac arrest after recovery from arrest • Negative hallucinations : the patient sees no thing in mirror
- 19. Auditory hallucination • Elementaryor completely organized (well defined) • Vary in quality from clear to whispering voices • Ascribed to individuals or not • Chronic patient usually is undisturbed by his lack of ability to describe or determine direction, sex, or interpret why he hears this voices • Patients may have slight lip, tongue and laryngeal movements with hallucination • Occupation with physical or mental tasks may diminish hallucinations
- 20. Types of voices •Ordering (2n person) • Calling • Threatening • Praising • Commentary • third voice • Abusive • Reassuring • Neoligism • Thought echo or echo de ponsees (his thought s are spoken aloud and he heard them from inside or outside head)
- 21. Patient’s response tohallucinations (Attitude of patient to hallucination) • Patient’s response to hallucinations – Verbal response : self talk – Behavioral response • May be disturbing to patient's function • Denial is common • Hallucinations may be not disturbing at all (friendly attitude) • May decreased when block ears?? by cottons or preoccupation with a physical or mental task
- 22. • Emotional response –May be terrified – Suspicious – Incongruent • Rationalization by the patient or origin of the hallucination – May be not concerned – Coming from surrounding people – Witchcraft – Telepathy – Gene – Part of the body
- 23. Auditory hallucinations Inorganic • Unstructured sounds (elementary) • If words it is simple short sentences • Frightening • Fluctuant • Talking to the patient in the second person (orders insults) ‑
- 24. Auditory hallucinations Inschizophrenia • Structured • Persistent • Commentary • Own thoughts out loud • Arguing and discussing the patient between themselves • Single or multiple voices • Recognized as from outside the head or his self • Ascribed to known people or strangers • Some schizophrenic patients may vocalize their hallucinations at the same time as they experience them • Schizophrenic hallucinations decreased by Changes in behavior (accompanying others, changing the posture, relaxation, exertion, blocking ears) • Changes in cognition (control of attention and active suppression)
- 25. Visual hallucinations • OccursIn • *Organic states with or without clouding of consciousness • Occipital temporal, and parietal lobe tumor. • Delirium (mall animals are most common) • Epileptic twilight states • Hepatic failure • Dementia • *Substance induced (LSD Glue) ‑ • *Rare in schizophrenia and usually associated with all other types of hallucinations
- 26. Content of visualhallucinations • Ill defined = elementary • Well defined = completely organized • Scenes like cinema film ( background) more common in epilepsy
- 27. • Synaesthesia :Sensory Stimulus in one modality is perceived as a sensation in another modality eg e.g. seeing music tones, hearing a picture
- 28. Lilliputian hallucinations • Visualhallucinations which is characteristrically in the form of micropsia usually pleasureable occur in organic cases
- 29. • Onerioid states •Occurs in schizophrenia • Characterized by disturbed consciousness • Vivid elaborate scenic hallucinations
- 30. • Charles Bonnetsyndrome – Complex visual hallucination – No other symptoms or signs – Normal consciousness – Patient is insightful – Commonly in elderly – Episodic (days months or years) ‑ – Associated with reduction of vision
- 31. • Delirium Tremenshallucination – It is called Lilliputian hallucinations – In the form of little animals or diminutive men – Change rapidly so patient may not be able to describe them – Associated with hallucination and illusions
- 32. Autoscopic hallucinations • Itis Abnormal visual perception involves seeing oneself in external space • Sometimes called Phantom mirror image • May occur in the form of hallucination or pseudohallucination • More in males • Episodic lasts for about 30 minutes • It is a mixture of visual, kinesthetic and somatic hallucination • Associated with provoked distress, fear, anxiety and depression • Occur In – Decreased Consciousness – Delirium – Epilepsy especially (TLE) – Parietal lobe lesions – Depression – Mixed neurological and psychiatric disorders is common
- 33. • Negative autoscopy: Patients looks in the mirror and sees nothing at all • Internal autoscopy : Subject see his internal organs • Hallucination of Body Sensation • Hearing and vision are called distant sense
- 34. Tactile hallucinations • Oftenassociated with Delusions • 1- Superficial sensations as • Associated also with delusions especially somatic type • *Haptic (touch) e.g. • a- Genital stimulation (sexual sensations) i.e Females may say that they are raped by external agency. Males may complain of forced erections and orgasm • b- Formication = infestation (little animal or insect crawling on or under the skin as in cocaine addiction (cocaine bug) and delusional infestation)
- 35. Animals crawling hallucinations •External delusional zoophathy on the skin • Internal delusional zoophathy inside the body
- 36. • *Thermic (heator cold) • *Hygric (fluid) • *Pain may be associated with somatic hallucinations • *Electric sensations • All these sensation if occurred in absence of coarse brain disease considered hallucinations
- 37. 2 - Kinaesthetic sensation asvibration • Linked with bizarre somatic delusions • May occur in – Organic states – Withdrawal of BDZ – Alcohol intoxication
- 38. 3 - Visceral sensation • Falseperception of inner organs • Common in schizophrenia • Associated also with delusions especially control
- 39. 4 - Vestibular sensations • Flyingthrough the air, sinking through the bed • Most commonly in delirium tremens
- 40. 5 - Sense of thepresence • Some patients know that someone else is present but they don't see. May or may not known to them • Occur in organic schizophrenia and hysteria ‑
- 41. Olfactory and gustatoryhallucination • Frequently occur together • Olfactory – Invested with strong affective component – May be related to himself (foul smell arise from him self in depression) – Those patients may killed themselves – Occur in • Schizophrenia • Epilepsy especially temporal lobe epilepsy (burning rubber) • It is difficult to know is it an illusion or hallucinations
- 42. • Gustatory – UsuallyAssociated with poisoning delusions – Occur in • Epilepsy (esp TLE) • Schizophrenia • Depression (Smells may disappear or became unpleasant) • Psychotropic drugs as lithium
- 43. Differential Diagnosis ofHallucinations • 1 Illusion ‑ • 2 Pseudohallucination ‑ • 3 Hypnagogic and Hypnopompic ‑ • 4 Mental images ‑ • 5 Normal perception ‑
- 44. Pseudohallucinations • Occur ininner subjective space (seen by inner eyes) • More like true perception or hallucination than like mental imagery • Figurative • Definite outline • Vivid details • Colored • Not voluntarily created or evoked • Recognized by the patient as has no external relation • There is gradation from the fully formed pseudohallucination to imagery • Both pseudohallucination and hallucination may occur together • Sometimes occur in the form of true hallucination with good insight • May occur in attention seeking and hysterical persons
- 45. Hallucinations Normal perception Comesfrom within Comes front outside React to them as if they are true coming from outside React to them Not shared by others Shared by others
- 46. Hallucination Pseudohallucian tio (Typeof mental image by Fish) Fantasy =imagery = Mental image Apperceptive or pale hallucinations Objective space Subjective space Subjective space Insightless Insightless Insighful Vivid colored detailed Vivid colored detailed Incomplete, indefinite, dim Out of control Out of control Voluntarily created
- 47. True Perception Mentalimage Objective space Subjective Space Clearly delineated Not Constant and independent of will Changeable & Voluntarily created Full and fresh sensory elements Not complete
- 48. Extracampine hallucinations • Hallucinationsare experienced behind the limits of sensory organs • e.g. hearing people at another country
- 49. Hypnagoic and HypnopompicHallucination • Occur in many people with good health • Discontinuous, ill defined, and calling • May be visual, auditory or tactile • Pathological in: • Narcolepsy, cataplexy and sleep paralysis • Glue sniffing • Post infective depressive states • Acute fevers • Phobic anxiety •
- 50. Functional hallucination • Externalstimulus is necessary to evoke tile hallucination. • Both the stimulus and the hallucination are perceived in the same modality of sensation so it is not an illusion. • The hallucination never occurred apart from the stimulus • Not highly diagnostic for any thing but may occur in schizophrenia •
- 51. Reflex hallucination • Astimulus in one sensory modality is producing hallucination in another sensory modality • e.g. Pain when certain word is heard • Not highly diagnostic for any thing
- 52. Sensory deprivation • Continuingperceptions is important for consciousness It leads to: • Visual hallucination • Abnormal perception in other modalities than vision • Altered affective states(panicky, restless, irritable, apathy)
- 53.