Disorders of time and perception psychiatry

1. Dr.SuneeL Kr. MoonD
1ST Yr PG ResidenT
Dept. Of Psychiatry
JLN MC,AJMER

2.  Time is an dimension within which everything
moves and happens.In conjuction with space
it is a universal framework.We can’t move
through space without time and vice versa.
 Time involves rhythm with variation, a
dynamic structure of framing ,timing
,synchronization , duration ,sequence ,
tempo and intensity. (BARBARA ADAM)

3. D/O OF OBJECTIVE TIME D/O OF SUBJECTIVE TIME
 D/O KNOWLEDGE OF
TIME
 D/O DURATION OF
TIME
 D/O OF
CHRONOLOGY(tempor
al order)
 D/O OF SUBJECTIVE
TIME
 D/O FLOW OF TIME
 D/O DIRECTION OF
TIME
 D/O UNIQUENESS OF
TIME
 D/O QUALITY OF TIME

4.  Objective time is quantitative and
independent of the self,depends upon
accurate measurement and is objective
and verifiable.
 Objective time may be altered so that
knowledge of time and chronology is
affected.
 Subjective time is inner,subjective
experience of time
 Subjective time altered so that
experience of time duration,flow of
time,meaning of time,uniqueness of time
may be affected.

5. 1)Disorientation in time
 Unable to correctly tell time without clock.
 Closely associated with impairment of
attention ,concentration , consciousness and
memory.
 Feature of delirium and dementia.
 Impaired ability to assess duration of time.

6. 2)Age disorientation
 Term 1st used by zangwill in relation to
korsakov’s syndrome.
 Defined as 5 yr discrepancy btwn pt’s actual
age and what pt states.
 Pt. with age disorientation are less able to
answer questions about date and time
duration.

7.  In depression,patient tends to underestimate
passage of 30 seconds on average ny 6
seconds whereas normal control
overestimate same duration by 10
seconds.(Kuhs et. Al 1991)
 This time is momentary.
 Other investigations found overestimatin of
time in depressive patients.(kitamura and
kumar,1984 munzal et. Al 1988)

8.  Pts with diencephalic lesions have deficit in
learning temporal orders of memory tasks or
events as compared to medial temporal lobe
lesions.
 Frontal lobe lesions are also asso with
temporal order of tasks.
 Frequency estimation (how many times an
event occurred) is impaired in left frontal
lesions and not on temporal lesion.

9.  d/o flow of time
 In depression flow of time is felt by patient
as slow or at some instance time seems to be
stand still.
 Feeling of time standing still is also observed
in ecstasy state in which patient feels that
he is existing in past,present and future at
same time.
 In mania, time passes rapidly but in
schizophrenia it remains unclear.

10.  Zeitraffer phenomenon – its literally an
time lapse phenomemon
 Features are
 1)speeding up or slowing down of events
 2)associations with increased speed ,pitch
and volume of auditory perceptions.
 3)alterations in the fluency of observed
movements.
 Occurs in setting of acute organic brain
disease like cerebrovascular accident.

11.  Normal past- present- future
 In some patients there is events are on
‘rewind mode’.

12.  Déjà vu –experience of feeling of familiarity
to the events and time that have not been
encountered previously.
 Jamais vu – absence of feeling of familiarity
to the events and time that have been
encountered previously.
 Reduplication of time– in this patient’s
central symptom was the belief that he has
lived through life before.

13.  In these disorder, normal experience of
quality of time is either lost or distorted.
time became salient , unreal.
 Person can assess time span accurately and
memory is intact but he has no feeling that
things are happening or time is passing.

14.  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 data to represent reality is
called PERCEPTION.

21.  Complete absence of color

27.  PORROPSIA: Experience of retreat of objects
into the distance without change in space.
 Edema of retina.
 Partial paralysis of accomodation.
 Disease affecting nerves controlling
accomodation.

40.  Incoming stimuli reduced to minimum in
normal subject,they begin to hallucinate
after few hours.
 Usually these are changing visual
hallucinations and repetitive phrases.
 BLACK PATCH DISEASE- Delirium following
cataract extraction in aged is result of
sensory deprivation and senile brain changes.

41.  Lesions of diencepehelon and cortex can
produce hallucinations that are not only
visual but auditory also.

46.  THOUGHT ECHO-Hearing one’s own thoughts
being spoken loud,voices may come from
inside or outside of head.
 1)GEDANKENLAUTWERDEN- Thoughts spoken
at same time or before they are occuring.
 2)ECHO DE LA PENSES- Thoughts are spoken
just after they occurred.
 Running commentry hallucinations are
usually abusive.

50.  VISUAL HALLUCINATIONS – Organic states +
clouding of consiousness > functional
psychoses.
 Small animals – delirium.
 Rarely in schizophrenia.
 Occasionaly without any psychopathology –
CHARLES BONNET SYNDROME.

52.  SEEN IN
 1)Schizophrenia.
 2)Organic states like temporal lobe epilepsy
 3)rarely in depression.
 PADRE PIO PHENOMENON –Religious people
can smell around certain saints.

54.  SEEN IN
 1)Schizophrenia
 2)organic states
 Depressed patients often describes loss of
taste.

56.  Formication – crawling of animals over
body,in organic states.
 Cocaine bugs – Formication + delusion of
persecution, in cocaine psychosis.
 Sexual hallucinations – acute and chronic
schizophrenia.

57.  Classified into 3 types
 1)superficial
 2)kinesthetic
 3)Visceral

58.  Thermic – Cold wind blowing across face.
 Haptic –hand brushing against skin.
 Hygric –feeling fluid like water running from
head to stomach.
 Paraesthetic-pins and needles ,mostly
organic.

59.  Affects muscle and joints
 Patient feels limbs twisted,pulled or moved.
 Schizophrenia
 Organic states – Alcohol intoxication,
Benzodiazepine withdrawal

60.  Visceral hallucinations
 Twisting and tearing pains
 Very bizarre complaints – organs ripped out,
flesh ripped out of body.
 Chronic schizophrenia.

61.  Organic states
 Schizophrenia
 Conversion disorder
 Normal people – fervently religious.

63.  Functional Hallucinations- Auditory stimulus
causes the hallucination, both experienced.
 Reflex Hallucinations – stimulus in one
sense modality produces hallucination in
another modality. Morbid variety of
synesthesia.

64.  Extracampine hallucinations
 Hallucinations outside the limit of sensory
modality.
 Seen in healthy people like hypnagogic
hallucination.
 Schizophrenia
 Organic states - Epilepsy

69.  Occurs when subject is waking up.
 Hallucintions persists even when eyes are
open.
 More common in narcolepsy.

76.  Whistling,buzzing,drumming
 In patients with middle ear disease or
internal disease
 Due to epileptic foci or temporal lobe lesions

77.  Seen in temporal lobe epilepsy asso. With
salivation,chewing and sniffing.
 Stimulating depth of sylvian fissure around
transverse temporal gyri.
 Olfactory hallucination
 Seen in temporal lobe epilepsy.

78.  Are multisensory hallucinations but doesn’t
include somatic sensations as temporal lobe
is separated by somatosensory area by
sylvian fissure

79.  HYPERSCHEMAZIA- perceived magnification
of body parts.
 Part of body feels larger than normal.
 Causes
 1)ORGANIC
 Brown sequerd syndrome
 PVD,Thrombosis of PICA
 2)NON ORGANIC
 Hypochondriasis
 Conversion disorder derealization.

80.  Aschemazia
 Hyposchemazia
 Paraschemazia-distortion of body part from
rest of body
 Hemisomatognosia-unilateral lack of body
image
 Anosgnosia- “denial of illness”
rt.hemisphere stroke denied their knowledge
early after stroke and refused to admit any
weakness in left arm.
 Somatoparaphrenia-delusional belief about
body either distorted ,severed or any
abnormality.