Disorders Of Perception

1. Moderator- Dr.Ravichandra Karkal Disorders of Dr.Samin Sameed Post-graduate Department of Psychiatry Yenepoya University

2. Perception The process of transferring physical stimulation into psychological information; mental process by which sensory stimuli are brought to awareness.

3. Abnormal perception

4. 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

5. Distortion

6. SENSORY DISTORTIONS Changes in Intensity - hyperesthesia - lowering of physiological threshold. Eg.Hyperacusis Seen in anxiety depressive disorder, Hangover from alcohol Migraine hypochondria cal personalities

7. Hypoaesthesia Eg - Hypoacusis Seen in Delirium Depression Attention deficit disorder

8. Achromatopsia

9. CHANGES IN QUALITY Visual perception – toxic drugs Xanthopsia Chloropsia Erythropsia Derealization - Everything looks unreal and strange Mania- looks perfect and beautiful

10. CHANGES IN SPATIAL FORM Change in perceived shape of an object Retinal disease Disorders of accommodation Temporal and Parietal Lobe Lesions Poisoning with Atropine and Hyoscine SCHIZOPHRENIA

11. Micropsia – a visual disorder in which the patient sees objects Smaller than they really are Farther away than they really are Macropsia – Seeing objects larger than they really are

12. MACROPSIA

13. micropsia

14. 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

15. metamorphopsia

16. Disorders in the experience of time 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 )

17. Sensory deceptions Misinterpretations of stimuli from external object Perceptions without external stimulus

18. illusions

19. Types of illusions 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.

20. Pareidolia

21. Hallucinations 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 Percept like experience in the absence of an external stimuli Percept like stimuli which has full force and impact of real perception Percept like experience which is unwilled , occurs spontaneously and cannot be readily controlled by percipient.

22. causes Intense emotions Suggestion Disorders of sense organs Sensory deprivation Disorders of CNS Psychiatric disorders

23. emotions depressed patients -delusions of guilt; hallucination - disjointed or short phrases continuous persistent hallucinatory voices in severe depression ? Schizophrenia /physical disease.

24. suggestion Normal subjects can be persuaded to hallucinate . By hypnosis or brief task motivation instructions.

25. Disorders of sense organs Hallucinatory voices -in ear disease Visual hallucination - eye diseases ,disorders of the CNS Peripheral lesions -sense organs - hallucinations in organic states

26. Sensory deprivation 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

27. Disorders of cns Lesions of diencephalons and cortex can produce hallucination that are not only visual but can be auditory.

28. Hallucinations of individual senses Hearing Vision Smell Taste Touch Pain and deep sensation Vestibular sensations The sense of presence

29. Hearing 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

30. 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

31. Thought echo - hearing one’s own thoughts being spoken loud, voice may come from inside or outside the head. GEDANKENLAUTWERDEN - thoughts spoken at the same time or before they are occurring. ECHO DE LA PENSES - thoughts are spoken just after they occurred. Running commentary hallucinations are usually abusive.

32. VISION Elementary- flashes of light Partly organized- patterns Completely organized- people, animals,objects . Scenic hallucinations- like a cinema common in delirium in psychiatric disorders with e pilepsy .

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

34. Visual Hallucinations - organic states +clouding of consciousness >functional psychoses Small animals –delirium rare -schizophrenia Occasionally without any psychopathology CHARLES BONNET SYNDROME

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

36. Taste Seen in Schizophrenia Organic states Depressed patient often describes loss of taste.

37. Touch Formication - animals crawling over the body; in organic states Cocaine bug – formication + delusion of persecution - cocaine psychosis Sexual Hallucinations - acute and chronic schizophrenia

38. Classified into 3 types Superficial Kinesthetic Visceral

39. Superficial Thermic Haptic Hygric Paraesthetic

40. Kinesthetic Hallucination affects muscles and joints Patient feels limbs twisted pulled or moved schizophrenia Organic states - alcohol intoxication benzodiazepine withdrawal

41. Pain and deep sensation Visceral hallucinations (SIMS 2003). Twisting and tearing pains Very bizarre complaints- organs ripped out , flesh ripped from his body chronic schizophrenia

42. The sense of presence Organic states Schizophrenia Conversion disorder Normal people – fervently religious

43. PSEUDOHALLUCINATION 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

44. SPECIAL KINDS OF HALLUCINATIONS 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 .

45. Extracampine hallucination : Hallucinations that is outside the limits of the sensory field. Seen in healthy people as hypnagogic hallucination Schizophrenia Organic conditions- epilepsy

46. 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

47. Acute and sub acute delirious states Epilepsy Focal lesions in parieto occipital region Drug addiction Chronic alcoholism NEGATIVE AUTOSCOPY INTERNAL AUTOSCOPY

48. Hypnagogic Hallucination 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

49. Hypnopompic Hallucination Occurs when the subject is waking up Hallucinations persisting from sleep when the eyes are open More in narcolepsy.

50. Organic Hallucinations Occurs in any sensory modality and may occur in various neurological or psychiatric disorders Depends on General condition of the brain Recent experiences Psychodynamic factors Effect of local lesion

51. ( i )Visual hallucinations 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.

52. (ii)Tactile hallucinations 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.

53. 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.

54. (iv) Auditory hallucinations 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

55. HALLUCINATION OF TASTE 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.

56. TEMPORAL LOBE HALUCINATIONS 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.

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

58. 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

59. 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.

60. References 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

61. Compared to the brilliance of the evening sun, reflecting on the beautiful sea, we humans are NOTHING, but SHADOWS…

62. “You see, but you do not observe. The distinction is clear.” – Sherlock Holmes