verbal illusions. Visceral hallucinations are characterized by all of the following except: Anterograde amnesia is characterized
The emergence of verbal illusions (from Latin verbalis - oral, verbal) is based on the conversations that actually take place around a person, the sound of speech, and the sound stimuli acting on a sick person are perceived by him in a completely different form, as a rule, in threatening tones.
In other words, illusions of an auditory nature that contain individual words that were accidentally spoken by someone close to a sick person, or spoken phrases, are called verbal.
Psychiatrists designate the phenomenon of bright, obsessive, constantly arising verbal illusions as "illusory hallucinosis". Their appearance is possible against the background of a painful, altered affective state, when anxiety or fear arises, and quite often they are accompanied by a delusional interpretation of the content.
Due to the fact that these phenomena are based on fear and affect, the meaning of the overheard conversation by a sick person is usually perceived as a threat, accusation, abuse, aimed exclusively at him.
For example, auditory illusions are characteristic of patients suffering from delusions of persecution or mania of jealousy. A patient with chronic alcoholism can eavesdrop on his wife's conversation with strangers, and being internally afraid of confirmation of punishment or betrayal, "hears" exactly this in a conversation.
Auditory (verbal) illusions can arise not only with speech sounds, but also in the form of non-verbal deceptions, such as hissing, noises (cranes, for example), individual sounds (shots, surf noises). If a person hears one voice, then we are talking about monovocal auditory illusions, if two voices - about a dialogue, three or more - they talk about polyvocal illusions.
The origins of the mechanism of illusions, including verbal ones (as well as hallucinations), have not been fully studied to date, therefore, the reasons that cause these phenomena, manifested in illusions, that is, a violation of the active, but very selective nature of a person’s perception of certain sounds are not yet clear enough.
In order to perceive a defect (with negative symptoms), it is necessary to realize that perception for a person is the primary source of information (for all his mental activity), and at the slightest violation, the perception signal is distorted.
Perceptions in positive symptoms are an illusion (in this case, a verbal phenomenon) - an incorrect assessment of the signal-information received from the hearing organ, and a hallucination - a violation of perception. At the same time, in the organs of hearing (analyzers), the interpretation of a false (imaginary) perception of a non-existent, incomprehensible (unheard) information message by the organs of hearing is considered to be a real event.
At the initial stage of a person's perception of any phenomenon lies a sensation, during which individual qualities, properties of an object, images or phenomena are revealed. Sensation has power, quality, a certain place and sensual coloring.
The combination of several types of sensations is the perception of something. As a result, an associative series of representations arises in the brain, which are imprinted in the memory and can be restored to consciousness at any moment.
Representations arise on their own without the presence of a stimulus, and perception is a process of reflecting images or phenomena of reality when they act on sensory receptors. The correctness or fallacy of the process of perception is directly dependent on the state of physical functions (consciousness, hearing, attention, the possibility of analysis, etc.).
Perception disturbances, the occurrence of verbal illusions are classified by experts according to the sense organ to which this particular distorted information belongs - in this case, as auditory hallucinations (there are visual hallucinations, tactile hallucinations or senestopathies, etc.).
Some healthy people experiencing such phenomena as verbal illusions are subject to the so-called set, in other words, they have a distortion of perception under the influence of the previous perceptions immediately before the moment of the appearance of the illusion. This phenomenon in healthy people was studied by the psychologist D.N. Uznadze, who created his own school on this issue.
The well-known Canadian neurosurgeon V. Penfield supported the same point of view, causing visual and auditory hallucinations and illusions during operations related to epilepsy, using electrical stimulation of the occipital and temporal lobes of the cerebral cortex.
Doctors and psychologists believe that the manifestations of verbal illusions are a much more complex process than affective (mental) visual illusions. This is due to the fact that this process consists in the fact that the patient in the noise of sounds and voices, in extraneous neutral speech, hears words or whole phrases directed at him, that is, directly related to him. And, most importantly, they, as a rule, coincide in the plot of what is happening or in their content with the affective and delusional torments and experiences of the patient.
In all these cases, a person is sure that he "hears" something that was not actually said. This interpretation of it is a verbal illusion, which is directly related to the fact that individual sounds that are auditory stimuli are "constructed" by his consciousness into meaningful words, sometimes into a whole speech, which creates a holistic (erroneously recognized) auditory image for a person, while , its content depends entirely on the specific state of the person at that moment. Psychiatrists take it as an axiom that verbal illusions, as a rule, become the basis for the formation of the patient's delusional mood.
In some cases of verbal phenomena, these may be hails that are distinguishable in the actual noise and sound of voices (it is necessary to distinguish them from hallucinatory hails), and in others, they are directly verbal illusions, which are often very difficult to distinguish from the so-called delusions of the patient's delusions. person.
It is very difficult to differentiate three fundamentally different phenomena in these cases. Doctors refer to these phenomena:
Delusional or overvalued (erroneous interpretation of the patient) interpretation of words, fragments of phrases and full sentences actually heard in a crowd of people, and incorrectly attributed to them by a sick person at his own expense;
Illusory processing (interpretation) of really really heard words, sounds with their perception by the patient in the form of other words and phrases corresponding to his specific mood at a given period of time;
A verbal hallucination (not an illusion) due to sounds arising in the noise of the crowd, (true, real or functional).
Experiences of this type (illusions) can arise not only of a verbal nature, but also in the form of visual, gustatory, and olfactory deviations. Sometimes the role of an affect (psychogenic state) that causes verbal illusions is played by the concept of delusion, leading to affectation. After that, indirectly, through it, it leads to verbal illusions that arise, now, on the basis of delirium.
With the onset of darkness (evening, night), the intensity of illusions of a different nature increases, while verbal illusions can persist during the day (almost always). Some phases of psychotic states are characterized by the fact that patients independently clearly determine their position - with their eyes closed they feel the phenomena of visual deceptions, and with their eyes open they "hear" the conversations and voices of people outside the window, negotiating aimed at the upcoming reprisal against them.
At the same time, doctors accurately distinguish between verbal illusions and delusional ideas of relationships. With the appearance of delirium, the patient really hears the speech of the people around him correctly, but at the same time he is completely convinced that it contains threats and hints directed at him.
Verbal illusions can also arise in healthy people, under the influence of an excited mood, inattention, and under certain conditions (vague music coming from afar, the sound of rain, etc.). However, the difference between such phenomena in a healthy person and a patient is that they do not violate the moment of correct recognition of sound stimuli, because a healthy person has enough opportunities to check the correctness of the sensation (auditory illusion) and clarify the first erroneous impression.
An interesting example of such a phenomenon is given by the American scientist William James in his book "Psychiatry": "One day, late at night, I was sitting and reading; suddenly a terrible noise was heard from the upper part of the house, it stopped and then, after a minute, the words resumed, I went out into the hall, to listen to the noise, but it did not repeat itself. As soon as I had time to return to my room and sit down at the book, an alarming, loud noise arose again, as if before the start of a storm. It came from everywhere. Extremely alarmed, I again went out into the hall, and again the noise ceased. Returning a second time to my room, I suddenly discovered that the noise was being made by its snoring of a small dog sleeping on the floor. efforts to renew the former illusion".
That is, by his observation, he confirmed that if the consciousness of a healthy person for some reason took for reality that the sound source is located far away, then it seems much louder, but when the real source is established, the illusion goes away.
An illusion is an erroneous perception of a real-life object. Regarding the sense organs, there are: visual, auditory, olfactory, tactile and taste illusions, as well as illusions of a general sense (position in space).
Illusions can occur in any sensory modality. Illusions are not necessarily associated with any pathology: most people are familiar; very many, walking alone late in the evening along a dark street, tend to “hear” behind their backs, as it were, steps pursuing them. Certain emotional states, such as anxiety, are often accompanied by similar phenomena.
The most common types of illusions are:
"normal"- can occur in completely healthy people
- physical,
- physiological,
- affective,
pathological- Occur in psychiatric disorders
- verbal
- pareidolic.
Physical illusions are caused by certain physical properties of an object. For example, it can be the northern lights or a mirage in the desert.
Physiological illusions are those illusions, the appearance of which in most cases is associated with the peculiarities of the work of the analyzers. For example, when a train suddenly stops, it seems that the surrounding objects are still moving. Sometimes mentally ill people may have thoughts about the special significance of such phenomena.
Verbal illusions are a distorted, false perception of the content of a real conversation of others. At the same time, the question of one of the outside interlocutors, as well as the answers of the other, are perceived by the patient as completely different. In these conversations, the patient hears derogatory and insulting remarks addressed to him, threats of reprisal, which cause him fear and anxiety.
Affective illusions - illusions that arise in a state of intense expectation, fear, anxious and depressed mood. Under such circumstances, instead of a stethoscope in the hands of a doctor, the patient may see a knife or a pistol, and in the noise of the wind the breath of his pursuers overtaking him.
Pareidolic illusions are associated with distorted perception, when the patient, looking, for example, at wallpaper, carpets, spots on the ceiling or cracks on the wall, perceives them as bright, dynamically changing pictures, in which fantastic landscapes, monsters, fairy-tale heroes and similar visions replace each other. . Such illusions mainly arise in the initial stages of acute psychosis and require urgent psychiatric help.
Psychologists also describe the illusion of attitude that occurs when pairs of objects are repeatedly compared. As a result, their weight is perceived as lighter or heavier, depending on the sequence in which they alternate.
Perhaps the most common pathological cause of delusions is sensory deficiency (as, for example, with impaired vision or hearing); a similar effect can occur with extremely limited input of sensory signals of one modality or another, for example, in the dark. A similar effect has a decrease in the level of consciousness. Delusions are especially likely to occur in delirium. For example, in this state, the play of shadows can be distortedly perceived, say, as the movement of some dangerous animals, and the touch of bed linen on the skin as crawling insects. Not surprisingly, patients who experience such delusions often appear frightened.
Illusions should be distinguished from other delusions, conclusions (for example, glass well-cut by a jeweler is perceived as a diamond) and functional
No. 1. sensations of the obvious presence of foreign objects in the body cavity,
No. 2. sensations of presence in the body of living beings,
Number 3. the presence of pointless, unusual, painful sensations in different places,
No. 4. the ability to accurately describe their feelings,
No. 5. sensations, one hundred these objects are motionless or moving.
Hypnagogic hallucinations are manifested by visions:
No. 1. spontaneously occurring before falling asleep
No. 2. occurring with closed eyes
Number 3. occurring in the dark field of vision
No. 4. all of the above
No. 5. none of the above.
Hallucinations of muscle feeling are manifested by sensations:
No. 1. special lightness of the body
No. 2. special lightness of the members of the body
Number 3. gravity of the body or its members,
No. 4. movements of the tongue or other organs,
No. 5. all of the above.
Affective illusions are characterized by:
No. 1. distorted perception associated with an unusual emotional state,
No. 2. the occurrence of pathological changes in affect,
Number 3. more common with fear, anxiety,
No. 4. strengthening against the background of fatigue,
No. 5. all of the above.
Peduncular hallucinosis is characterized by:
No. 1. the presence of moving microscopic visual hallucinations,
No. 2. lack of fear and painful sensations,
Number 3. more common in the evening,
No. 4. occurrence more often with lesions of the midbrain, legs of the brain,
No. 5. all of the above.
All of the following are characteristic of pseudohallucination except:
No. 1. lack of concreteness, reality,
No. 2. the presence of signs of impaired consciousness,
Number 3. lifelessness, soundlessness, incorporeality,
No. 4. intraprojections inside the body,
No. 5. feeling of "done".
Visual hallucinations are characterized by all of the following except:
No. 1. feelings of "doneness"
No. 2. the presence of invoked, "showed visions", pictures,
Number 3. occurring in disorders of consciousness,
No. 4. shapeless or distinct form,
No. 5. simplicity or sceneness.
Auditory pseudohallucinations are defined by all of the following except:
No. 1. the emergence of "internal", "made", "mental" voices,
No. 2. the sound of thoughts
Number 3. loud thoughts,
No. 5. sensations that words, phrases are pronounced by the patient's language.
Verbal illusions are characterized by:
No. 1. false perception of the content of the real conversation of others,
No. 2. perception of accusations, reproaches, scolding, threats in neutral conversations,
Number 3. occurrence, often against the background of anxious suspicion, fear,
No. 4. all of the above,
No. 5. none of the above.
Functional hallucinations are characterized by:
No. 1. appearance against the background of perception of a real external object,
No. 2. coexistence with an external stimulus without merging with it,
Number 3. disappearance with the cessation of the action of stimuli,
No. 4. all of the above,
No. 5. none of the above.
Hallucinatory-paranoid syndrome is characterized by:
No. 1. a combination of delusions of persecution and hallucinations,
No. 2. mental automatisms and pseudohallucinations,
Number 3. variety of content (from the idea of witchcraft and hypnosis to the most modern methods of persecution),
No. 4. all of the above,
No. 5. none of the above.
Ideatory (associative) automatisms are manifested by all of the following, except:
No. 1. imaginary impact on the processes of thinking and other forms of mental activity,
No. 2. mentism, a symptom of openness, the sound of thoughts,
Number 3. feelings of "doneness" of unpleasant sensations,
No. 4. feelings of “taking away” thoughts, feelings of their “doneness”, unwinding of memories,
Senestopathic (sensory) automatisms are manifested by all of the following except:
No. 1. extremely unpleasant sensations arising from the imaginary influence of extraneous forces,
No. 2. varied nature of "made" sensations,
Number 3. "done" mood, "done" feeling,
No. 4. feelings of “made” heat or cold, painful sensations in different parts of the body,
No. 5. unusual, bizarre sensations.
Kinesthetic (motor) automatisms are manifested by all of the following except:
No. 1. beliefs that movements are made against the will, under the influence from outside,
No. 2. the patient's beliefs that his actions are directed, move his limbs,
Number 3. "taking away thoughts", unwinding memories,
No. 4. manifestations of a feeling of immobility, numbness,
No. 5. speech motor automatisms.
Acute hallucinatory-paranoid syndrome is characterized by:
No. 1. sensual delusion,
No. 2. lack of a tendency to systematize delusional disorders,
Number 3. affect of fear, anxiety, confusion, transient catatonic disorders,
No. 4. all of the above.
Chronic hallucinatory-paranoid syndrome is characterized by:
No. 1. tendency to systematize delusional disorders,
No. 2. frequent occurrence at the height of development of the phenomena of delusional depersonalization,
Number 3. lack of confusion, brightness of affect,
No. 4. all of the above,
No. 5. none of the above.
The hallucinatory variant of the hallucinatory-paranoid syndrome is characterized by:
No. 1. the predominance of pseudohallucinations,
No. 2. a small proportion of mental automatisms,
Number 3. an insignificant proportion of delusions of persecution and influence,
No. 4. all of the above,
No. 5. none of the above.
The delusional variant of the hallucinatory-paranoid syndrome is characterized by:
No. 1. the predominance of delusional ideas of influence and persecution,
No. 2. a large proportion of mental automatisms,
Number 3. relative weakness of the severity of pseudohallucinatory disorders,
No. 4. all of the above,
No. 5. none of the above.
Paraphrenic syndrome is manifested by all of the following, except:
No. 1. combinations of fantastic delusions of grandeur, persecution, influence, phenomena of mental automatism, changes in affect,
No. 2. plausibility of statements
Number 3. evidence for patients, the indisputability of their statements,
No. 4. propensity to expand delusions, enrichment with new "facts",
No. 5. antagonistic nonsense.
Acute paraphrenia is manifested by all of the following except:
No. 1. the development of acute sensual delusions with pseudohallucinations and unstable confabulations, instability, variability of delusional ideas,
No. 2. propensity to develop at the height of twilight clouding of consciousness,
Number 3. intensity of affect
No. 4. the emergence of acute fantastic and antagonistic delirium,
No. 5. propensity to develop oneiroid at her height.
Chronic paraphrenia manifests itself:
No. 1. delirium stability,
No. 2. monotonous affect,
Number 3. relatively small proportion of sensual delirium,
No. 4. all of the above,
No. 5. none of the above.
Systematized paraphrenia is characterized by:
No. 1. systematized fantastic delusions of grandeur,
No. 2. combined with antagonistic delusions,
Number 3. combination with delusions of persecution,
No. 4. all of the above,
No. 5. none of the above.
Hallucinatory paraphrenia is characterized by:
No. 1. an influx of verbal hallucinations,
No. 2. predominance of hallucinations over delusional disorders,
Number 3. the predominance of the fantastic nature of hallucinations and delusions,
No. 4. all of the above,
No. 5. none of the above.
Confabulatory paraphrenia is characterized by:
No. 1. abundant fantastic confabulations,
No. 2. the presence of a symptom of unwinding memories,
Number 3. lack of formal memory impairment,
No. 4. all of the above,
No. 5. none of the above.
Catatonic stupor is manifested by all of the following except:
No. 1. immobility of a frozen, amimitic face,
No. 2. increase muscle tone
Number 3. pronounced depressive effect
No. 4. long-term maintenance of one posture,
No. 5. denial of speech, negativism.
Catatonic substupor is manifested by all of the following, except:
No. 1. incomplete immobility,
No. 2. false memories,
Number 3. more or less pronounced mutism,
No. 4. long-term maintenance of the same total body position,
No. 5. unnatural, pretentious postures.
Stupor with waxy flexibility is manifested by all of the following except:
No. 1. state of immobility
No. 2. saving any change in posture,
Number 3. sharp muscle tension with resistance when trying to change the posture,
No. 4. the appearance of wax flexibility in the masticatory muscles, then in the muscles of the neck, upper and lower extremities,
No. 5. the disappearance of wax flexibility in reverse order.
Stupor with torpor is manifested by all of the following except:
No. 1. extreme muscle tension
No. 2. constant stay in the same position,
Number 3. phenomena of wax flexibility,
No. 4. stay more often in the intrauterine position,
No. 5. the appearance of the “proboscis” symptom (stretched lips with tightly clenched jaws).
Apathetic (adynamic, aspontaneous) stupor is manifested by all of the following except:
No. 1. false memories,
No. 2. absolute indifference,
Number 3. complete inactivity,
No. 4. extreme impotence, reaching prostration,
No. 5. pronounced helplessness.
Raptus appears:
No. 1. in an unsharply expressed form of motor excitation,
No. 2. in prolonged psychomotor agitation, suddenly interrupted by episodes of lethargy,
Number 3. in the fact that patients rush about, scream, injure themselves,
No. 4. all of the above,
No. 5. none of the above.
Depressive arousal is manifested by all of the following, except:
No. 1. motor excitation,
No. 2. hopeless despair,
Number 3. painful, unbearable longing,
No. 4. excitement, in which patients groan, sob, try to injure themselves,
No. 5. feeling of "doneness" of the state.
Anxiety manifests itself:
No. 1. general motor restlessness
No. 2. anxiety, fear,
Number 3. varying degrees of agitation,
No. 4. all of the above,
No. 5. none of the above.
Ecstatic (bewildered-pathetic) excitement is manifested by all of the following, except:
No. 1. chaotic excitement with aggression,
No. 2. theatricality of postures, recitations, singing, etc.,
Number 3. the predominance of the expression of delight, mystical penetration, ecstasy,
No. 4. loftiness, inconsistency of speech,
No. 5. the possibility of episodes of stupor and substupor.
Impulsive arousal is manifested by all of the following, except:
No. 1. unexpected behavior,
No. 2. theatricality of poses,
Number 3. aggression, violent rage,
No. 4. the occurrence of short-term episodes of stupor,
Number 3. the predominance of stereotypically repeated words in speech (echolalia, verbigeration).
Hebephrenic arousal is manifested by all of the following, except:
No. 1. foolishness, grimacing,
No. 2. the predominance of "infective" delight, ecstasy,
Number 3. ridiculous, senseless laughter,
No. 4. jumps, antics,
No. 5. inappropriate flat jokes.
Silent (silent) catatonic excitation manifests itself:
No. 1. chaotic, senseless, non-purposeful excitement with aggression,
No. 2. violent resistance,
Number 3. possible infliction of serious damage to oneself and others,
No. 4. all of the above,
No. 5. none of the above.
Impulsive actions are manifested by all of the following, except:
No. 1. feelings of "doneness"
No. 2. performing an action without conscious control,
Number 3. occurrence with a profound mental disorder,
No. 4. sudden and rapid onset
No. 5. unmotivated and senseless action.
Impulsive desires are manifested by all of the following, except:
No. 1. sharp, from time to time arising aspirations, seizing the mind,
No. 2. senseless chaotic motor excitations,
Number 3. instincts that subjugate the behavior of the patient,
No. 4. accompanied by the suppression of all competing thoughts,
No. 5. incompleteness, inconsistency of memories of the time of their reign.
Oneiroid catatonia is manifested by all, except:
No. 1. ecstatic, impulsive, hebephrenic excitement,
No. 2. stupor with phenomena of waxy flexibility, stuporous states,
Number 3. oneiroid clouding of consciousness,
No. 4. all of the above,
No. 5. none of the above.
Lucid catatonia manifests itself:
No. 1. catatonic state,
No. 2. as a rule, a stupor with negativism and numbness,
Number 3. lack of clouding of consciousness,
No. 4. all of the above,
No. 5. none of the above.
Emergency care for acute hallucinatory-delusional, hallucinatory and paraphrenic conditions consists of:
No. 1. in emergency hospitalization
No. 2. in the relief of excitation with sedative neuroleptics (chlorpromazine, tizercin, chlorprothixene),
Number 3. in the relief of psychotic symptoms with neuroleptics-antipsychotics (haloperidol, stelazin), etc.,
No. 4. possible use of atypical antipsychotics
No. 5. in all of the above,
Emergency care for catatonic arousal includes all of the following except:
No. 1. emergency hospitalization,
No. 2. injection of neuroleptics with a predominantly sedative effect (chlorpromazine, tizercin, leponex),
Number 3. the use of powerful neuroleptics-antipsychotics (mazheptil, haloperidol, trisedil),
No. 4. use of antidepressants.
Syndromes of obscuration of consciousness are manifested by all of the following, except:
No. 1. violations of the reflection of the real world both in its external and internal relations,
No. 2. detachment from the outside world: difficulty or complete impossibility of perceiving what is happening around,
Number 3. disorientation in time, place, surrounding persons, sometimes in one's own personality,
No. 4. incoherence of thinking along with weakness or inability to develop a judgment, complete or partial amnesia of a period of clouding of consciousness,
No. 5. feeling of "done".
Delirium is characterized by all of the following except:
No. 1. catatonic inclusions,
No. 2. clouding of consciousness,
Number 3. an influx of pareidolia and scene-like visual hallucinations,
No. 4. pronounced motor excitations,
No. 5. the possibility of verbal hallucinations, acute sensory delusions, affective disorders with a predominance of visual hallucinations.
The first stage of delirium is manifested by all of the following except:
No. 1. mood variability, inconsistency, talkativeness, hyperesthesia,
No. 2. sleep disorders with difficulty falling asleep and vivid dreams,
Number 3. pseudo hallucinatory disorders,
No. 4. change of elated mood with anxiety, capriciousness, resentment,
No. 5. an influx of vivid memories, figurative representations of past events.
The second stage of delirium is characterized by all of the following except:
No. 1. catatonic disorders,
No. 2. the predominance of pareidolia,
Number 3. an increase in the lability of affect,
No. 4. increased sleep disorder
No. 5. the appearance of frightening dreams that are confused with reality.
The third stage of delirium is characterized by all of the following except:
No. 1. an influx of visual, usually scene-like hallucinations,
No. 2. chaotic disorderly excitement within the bed,
Number 3. sharp motor excitement with fear and anxiety,
No. 4. the presence of light gaps with asthenia,
No. 5. amplification of hallucinatory disorders in the evening.
Occupational delirium manifests itself:
No. 1. deeper than with ordinary delirium, clouding of consciousness,
No. 2. the predominance of excitation in the form of automated motor acts under the influx of hallucinations,
Number 3. deep disorientation in the environment and lack of reaction to the environment,
No. 4. all of the above,
No. 5. none of the above.
Stun is manifested by all of the following except:
No. 1. lowering up to the complete disappearance of clarity of consciousness,
No. 2. pronounced hallucinatory and delusional inclusions,
Number 3. increase the threshold of excitability for all external stimuli,
No. 4. slowness, difficulty in thinking and understanding the situation as a whole with a correct assessment of the most elementary phenomena of the environment,
No. 5. spontaneity, immobility.
The stages of turning off consciousness are:
No. 1. obnubilation,
No. 2. stun,
Number 3. sopor,
No. 5. all of the above
Obnubilation manifests itself:
No. 1. slowness of motor reactions
No. 2. the appearance of "cloudiness of consciousness", "veil on consciousness",
Number 3. retardation of verbal responses,
No. 4. lasting from minutes to a long time,
No. 5. all of the above
Doubtfulness is manifested by all of the following, except:
No. 1. half asleep (most of the time the patient lies with his eyes closed)
No. 2. lack of spontaneous speech
Number 3. confabulatory disorders,
No. 4. correct answers to simple questions
No. 5. the ability of external stimuli to relieve symptoms for a while
Sopor manifests itself:
No. 1. pathological sleep,
No. 2. immobility of patients (with closed eyes and amimia),
Number 3. causing strong stimuli only stereotyped undifferentiated defensive reactions,
No. 4. all of the above,
No. 5. none of the above
There are the following degrees of stunning, except:
No. 1. obnubilation,
No. 2. light,
Number 3. moderate,
No. 4. heavy
No. 5. terminal
A kind of psychosensory disorder in which one object seems to be multiple (Korolenko Ts.P., 1983):
No. 1. optical allesthesia,
No. 2. "optical storm"
Number 3. polyopia,
No. 4. "split" perception,
No. 5. no right answer
The initial stage of development of oneiroid is manifested:
No. 1. affect lability,
No. 2. the predominance of low mood with a touch of capriciousness of unmotivated anxiety, or high mood with a touch of enthusiasm, exaltation,
Number 3. the occurrence of sleep disorders: the alternation of unusually vivid dreams with insomnia, appetite disorders, headaches, discomfort in the heart,
No. 4. all of the above,
No. 5. none of the above
The stage of acute fantastic paraphrenia is manifested by all of the following, except:
No. 1. fantastic modifications of previous mental disorders,
No. 2. the appearance of asthenic disorders,
Number 3. acquisition by real events of fantastic content,
No. 4. the emergence of fantastic retrospective delusions,
No. 5. appearance of Manichaean delirium
The oriented oneiroid stage is manifested by all of the following, except:
No. 1. the emergence of involuntary fantasizing with vivid ideas about flights, travel, wars, world catastrophes,
No. 2. the coexistence of such fantasizing with the perception of the real world and orientation in the environment,
Number 3. an influx of true visual hallucinations,
No. 4. slight change in fantastic delusional constructions under the influence of changes in the environment, violation of the sense of time,
No. 5. the predominance of either confused pathetic excitement, or substupor.
A fantastically illusory oneiroid manifests itself:
No. 1. engulfment by vivid sensual fantastic representations abundantly popping up in the mind,
No. 2. fragmentary reflection of the real world,
Number 3. an influx of confabulatory experiences,
No. 4. all of the above,
No. 5. none of the above
A dreamlike oneiroid manifests itself in all of the following, except:
No. 1. complete detachment from the environment,
No. 2. feeling like a participant in fantastic events,
Number 3. predominance of verbal pseudo-hallucinations,
No. 4. the predominance in the mind of the patient of visualized fantastic ideas associated with the inner world of the patient,
No. 5. the frequency of dissociations between the content of consciousness and the motor sphere.
Twilight stupefaction manifests itself:
No. 1. sudden, often short-term loss of clarity of consciousness,
No. 2. complete detachment from the environment,
Number 3. maintaining (sometimes) a fragmentary and distorted perception of the environment when performing automated actions,
No. 4. all of the above,
No. 5. none of the above
Congrade amnesia is characterized by:
No. 1. loss of the ability to remember, lack of memory for current events,
No. 2. loss of memories of events that occurred in that period of time when the patient's consciousness was impaired.
Number 3. loss of memories of events immediately following the end of an unconscious state or other mental disorder,
No. 4. loss of memory of events immediately preceding the unconscious state,
No. 5. there is no correct answer.
Oriented twilight clouding of consciousness is characterized by the fact that:
No. 1. there is an incomplete detachment from the environment,
No. 2. patients in the most general terms know where they are and who surrounds them,
Number 3. it develops against the background of severe dysphoria,
No. 4. all of the above,
No. 5. none of the above
A simple form of twilight clouding of consciousness is characterized by all of the following, except that:
No. 1. develops suddenly
No. 2. patients are disconnected from reality, it is impossible to make contact with them,
Number 3. spontaneous speech is either absent or limited to the repetition of individual words,
No. 4. either short-term stuporous states develop, or episodes of impulsive arousal with negativism,
No. 5. a complete recollection of the experiences of the period of clouded consciousness is preserved.
Varieties of a simple form of twilight clouding of consciousness are:
No. 1. ambulatory automation,
No. 2. fugue or trance,
Number 3. somnambulism or sleepwalking (ambulatory automatism that occurs during sleep),
No. 4. all of the above,
No. 5. none of the above
Features of twilight clouding of consciousness with productive disorders are all of the following, except that:
No. 1. it is continuous and alternating,
No. 2. its duration is from several hours to weeks,
Number 3. amnesia after leaving it is partial, retarded or complete,
No. 4. attitude to one's own actions, committed during the period of clouding of consciousness, as alien,
No. 5. orientation to place and time.
The delusional version of the "psychotic" form of twilight clouding of consciousness is characterized by the fact that:
No. 1. figurative nonsense prevails with ideas of persecution, influence,
No. 2. delusions of greatness and messianism often prevail,
Number 3. often there are religious and mystical delusional statements,
No. 4. all of the above,
No. 5. none of the above
Pathological prosonic state (drunk sleep) is characterized by all of the following, except that:
No. 1. it occurs during slow awakening and from deep sleep, accompanied by vivid, including nightmare dreams,
No. 2. consciousness remains inhibited when the functions related to movement are released,
Number 3. dreams are clearly remembered, taken for reality, dreams are intertwined with a misperception of the environment,
No. 4. it ends with sleep and the subsequent retention in the memory of fragments of former dreams,
No. 5. states are in the nature of "doneness".
The prodrome of paroxysms is characterized by the following non-specific disorders that occur a few seconds (minutes, hours, days) before the onset of a paroxysm:
No. 1. asthenic,
No. 2. affective
Number 3. senestopathic,
No. 4. all of the above,
No. 5. none of the above
In the development of a generalized convulsive seizure, there are:
No. 1. tonic phase.
No. 2. clonic phase,
Number 3. the phase of clouding of consciousness (stunning or twilight disorder of consciousness),
No. 4. all of the above,
No. 5. none of the above
Status epilepticus is characterized by:
No. 1. a series of continuous large epileptic seizures, between which the consciousness does not clear up,
No. 2. lasting from several hours to several days,
Number 3. stay of the patient for a long time in a coma, stupor or stunning,
No. 4. all of the above,
No. 5. none of the above
The clinical structure of the Kandinsky-Clerambault syndrome is determined by the following features, except:
No. 1. delusions of persecution
No. 2. pseudo hallucinations
Number 3. depersonalization
No. 4. delusional impact
No. 5. mental automatisms
Emergency care for status epilepticus is based on the following basic principles:
No. 1. early start of treatment
No. 2. complexity of therapeutic measures,
No. 3. the use of dosed anesthesia,
No. 4. all of the above are correct
Non-convulsive paroxysms are divided into the following groups:
No. 1. with deep confusion,
No. 2. with a deep clouding of consciousness,
Number 3. without confusion,
No. 4. none of the above
No. 5. to all of the above.
Memory disorders include all of the following except:
No. 1. dysmnesia,
No. 2. amnesia,
Number 3. confabulation,
No. 4. paramnesia,
No. 5. "made" memories.
The weakening of the selective reproduction of memory is manifested by:
No. 1. early onset of memory impairment,
No. 2. difficulty in reproducing the material needed at the moment,
Number 3. primarily by the difficulty in reproducing dates, names, titles, terms,
No. 4. all of the above,
No. 5. none of the above
Retrograde amnesia is characterized by all of the following except:
No. 1. loss of memory of events immediately preceding the unconscious state,
No. 2. loss of ability to remember, lack of memory for current events,
Number 3. the inability to reproduce the events, circumstances that were before the loss of consciousness or the onset of the disease,
No. 4. the spread of such oblivion for a different period.
Anterograde amnesia is characterized by:
No. 1. loss of memories of events immediately following the end of an unconscious state or other mental disorder,
No. 2. the spread of such oblivion for a different period (hours, days, weeks),
Number 3. the correct behavior of patients in this, then forgotten period,
No. 4. none of the above
No. 5. all of the above.
Fixation amnesia is characterized by:
No. 1. loss of the ability to remember
No. 2. lack of memory for current events,
Number 3. loss of memory of events that immediately preceded the momentary state
No. 4. all of the above,
No. 5. none of the above
Paramnesias are all of the following except:
No. 1. false memories,
No. 2. actual events, past or possible in the past, moved in the near future,
Number 3. ordinary events often associated with the profession, replacing the gap in the patient's memory,
No. 4. pathological imaginations in the form of memories,
No. 5. "made" memories.
Motivation disorder manifests itself:
No. 1. increased volitional activity,
No. 2. decrease in volitional activity,
Number 3. lack of motivation
No. 4. perversion of volitional activity,
No. 5. all of the above.
Hypobulia is manifested by all of the following except:
No. 1. decreased volitional activity, poverty of motives, lethargy, inactivity,
No. 2. meager devoid of expressiveness of speech, decreased motor activity,
Number 3. weakening of attention, impoverishment of thinking,
No. 4. communication restrictions due to decreased responsiveness,
No. 5. increase in muscle tone.
Abulia is manifested by all of the following except:
No. 1. lack of motivation
No. 2. loss of desire
Number 3. complete indifference and inactivity,
No. 4. termination of communication due to the disappearance of responsiveness,
No. 5. refusal to speak (mutism).
Hyperbulia is manifested by all of the following except:
No. 1. increase of volitional activity, strengthening of motives,
No. 2. high activity,
Number 3. feelings of "doneness" of the state,
No. 4. impetuosity, initiative,
No. 5. speaking, mobility.
Congenital dementia (mental retardation) is divided into degrees, except:
No. 1. light,
No. 2. moderate
Number 3. heavy
No. 4. social ped neglect
No. 5. deep.
Acquired dementia occurs as:
No. 1. partial (lacunar),
No. 2. total (global),
Number 3. insanity (deep mental decay),
No. 4. all of the above are correct
No. 5. all of the above are incorrect.
^ 2.1. Psychology of perception and images of representation
Perception is a kind of cognitive activity, the result of which is sensual images of objects that directly affect the senses. Unlike sensation in perception, heterogeneous impressions are integrated into discrete structural units - images of perception; cognitive activity is experienced as a fact of personal activity directed by a specific task, and not as an act of passive registration of impressions.
Perceptual images are made up of external and internal (primarily kinesthetic) sensations. The “contribution” of different types of sensitivity is not the same in this case. Obviously, the images of perception of the blind and the sighted, the deaf and the hearing, the color-blind and the individual with "normal" color sensitivity are different. This relativity does not mean that the outside world is nothing more than a subjective construction. The fact that one does not perceive the melody does not mean that the melody does not exist. As, however, and that, the plausibility of a deception of perception does not prove the reality of the apparent object.
Perception is the process of "creating" an image from "sensory" material. The following phases are distinguished:
Perception - the primary selection of a complex of stimuli from the mass of others, as related to one specific object. In other words, this is the phase of the distinction between figure and ground;
Apperception - comparison of the primary image with a similar or similar one stored in memory. If the primary image is identified as already known, this corresponds to recognition. If the information is new and ambiguous, identification occurs by putting forward and testing hypotheses in search of the most plausible or acceptable one. The object is regarded as previously unfamiliar;
Projection is the addition of the image of the perceived object with the details inherent in the established class, but for various reasons turned out to be “behind the scenes”. The image of perception is thereby "brought" to a certain standard.
The images of perception reflect such qualities of objects for which there are no special receptors: shape, size, rhythm, heaviness, position in space, speed, time. In this sense, the image of perception is, as it were, an over-sensible phenomenon, intermediate between sensory and rational cognition.
In psychological terms, perception is characterized by:
Constancy - the stability of the images of objects in different conditions of perception. For example, the hands are located at different distances from the eyes, but their size seems to be the same;
Wholeness is the unification of different experiences into a cohesive unity. The laws of holistic perception have been studied in Gestalt psychology (“the psychology of images”);
Volume - perception in three dimensions. This is achieved through binocular vision and binauricular hearing. At a distance of more than 15 m, the perception of space is carried out thanks to a linear, aerial perspective, parallax and interposition effects;
Objectification of images of perception is associated with the state of consciousness and search research activity. Early sensory experience is important here.
Perception expresses the activity of consciousness, attention, memory, and other mental structures. This is important to take into account for the analysis and evaluation of perceptual disorders. In the latter, traditionally referred to as sensory disorders, various disorders of all mental functions, as well as the personality as a whole, are found.
By the time of birth, the child has effectively functioning sense organs. By the age of one year, the visual acuity of an infant reaches the level of adults. Best of all, he perceives objects at a distance of 19 cm from his face.
Perhaps because to see the face of the mother during feeding. From the fourth day, the infant shows an innate preference for the perception of the human face. By two months, he recognizes his mother's face, and at four months he distinguishes blue, red, yellow and green colors. The perception of the depth of space is formed by the age of two months. In early infancy, attention is also attracted by moving objects, curvilinearity, and contrasts. From the first hours after birth, children are able to distinguish sounds of different intensities, recognize the mother's voice. They also smell. Taste perceptions develop later. The categorical perception is formed by the end of the first year, and it becomes constant by the age of 12-13.
There is a hypothesis according to which perception develops on the basis of innate "cognitive schemes". The latter allow the child to highlight the most important impressions and structure them in a certain way.
The necessary conditions for the development of perception are:
active movement. Observations have shown that the restriction of free movement disrupts the development of spatial perception;
Feedback. Needed to correct perceptual errors;
Maintaining the optimal amount of incoming sensory information. “Sensory “hunger” prevents the development of perception, and under experimental conditions leads to psychotic disorders;
Structuring of external impressions. The monotony of the latter (deserts, snowy plains, etc.) does not contribute to the formation of perceptual schemes, and in adults it is one of the reasons for the appearance of mirages.
The image of representation is the most complex type of figurative memory (Luria, 1975). When we say that we have an idea of a tree, a lemon, or a dog, this means that the previous experience of perception and practical activity with these objects has left their traces in us.
The images of representation resemble visual images, differing from the latter in less detail, brightness and clarity, but not only in this. The image of representation reflects the results of the intellectual processing of the impression about the subject, highlights the most significant features in it. So, we are not representing any specific tree, but we are dealing with a generalized image, which can include a visual image of a birch, a pine, and another tree. Blurring and pallor of the image of the representation testifies to its generalization, the potential richness of the connections behind it, is a sign that it can be included in any relationship.
The image of a performance is not a mere memory. It is not stored in memory in an unchanged form, but is constantly transformed, the most relevant features are highlighted in it, the most relevant features are emphasized, and individual features are erased. Images of representation are subjective, they are not projected outside. They arise in consciousness indirectly, thereby approaching figurative thinking. Associations of images can go beyond ordinary impressions, thanks to the imagination they become available to creativity.
The following types of pathology of perception and images of representation are observed: violation of the constancy of perception, splitting of perception, illusions, hallucinations, pseudohallucinations, hallucinoids, phenomena of eidetism, violations of sensory synthesis.
^ 2.2. Psychopathology of perception and images of representation
Violation of constancy of perception. Distortions of images of objects depending on changes in the conditions of perception. While walking, the patient sees how the soil “jumps”, “sways”, “rises”, “falls”, trees and houses “stagger”, move with him. When the head is turned, objects “turn”, the body is felt to turn in the opposite direction. The patient feels as if objects are moving away or approaching, rather than he is walking towards or away from them. Distant objects are perceived as small, and near become unexpectedly large and vice versa.
^ Splitting of perception. Loss of the ability to form a holistic image of the object. Correctly perceiving the individual details of an object or its image, the patient cannot link them into a single structure, for example, he sees not a tree, but a trunk and foliage separately. Splitting of perception is described in schizophrenia, some intoxications, in particular, psychedelic substances. Similar (a violation occurs when the secondary parts of the visual cortex are damaged (Brodmann fields 18, 19). Patients, looking at the image (for example, glasses), say this: “... what is it? .. a circle and another circle ... and a crossbar ... probably a bicycle ".
Some patients, looking at the famous Boring drawing (where you can see the profile of a young woman or an old woman), report that they see both images at the same time, which indicates not a split in perception, but possibly simultaneous participation in the perception of the left and right hemispheres.
Sometimes there is a loss of the ability to synthesize sensations of different modalities, for example, visual and auditory. Perceiving a sounding radio receiver, the patient may look for the source of the sound elsewhere. This violation is observed in senile dementia (Snezhnevsky, 1970).
With damage to the parieto-occipital regions of the brain, a slightly different perception disorder occurs - simultaneous agnosia. The patient adequately perceives individual objects, regardless of their size, but at the same time is able to see only one object or its image. If he is shown an image of a circle and a triangle, then after a series of quick exposures, he can say: "... because I know that there are two figures here - a triangle and a circle, but I see only one each time."
Illusions. The term is translated by the words "deception, deceptive representation" - a false, with a violation of identification, the perception of objects and phenomena that really exist and are relevant at the moment. For the first time they were singled out as an independent deception of perception and separated from hallucinations by J. Esquirol in 1817.
There are different kinds of illusory perception. In physical illusions, the incorrect perception of an object is due to the physical properties of the environment in which it is located - a spoon in a glass of water at the water-air interface seems to be broken. The appearance of a number of illusions is associated with the psychological characteristics of the process of perception. After a train stops, for example, it continues to appear to be moving for a while. In the well-known Muller-Lyer illusion, the length of individual lines is perceived differently depending on the shape of the figures they are part of. The coloring of the same part of the surface is perceived differently if the color of the figure as a whole is changed. The development of illusions is facilitated by factors that violate the clarity of perception: the color and illumination of objects, features of sound, defects in vision and hearing. The appearance of illusions depends on expectations, affective state, attitude. A timid person, walking along a deserted street at night, may mistake the silhouette of a bush for the figure of a lurking person. With illusions of inattention (Jaspers, 1923), instead of one word, another is heard that is close in sound; an outsider is mistaken for a friend, the wrong word is read in the text, etc. The influence of attitude on perception is demonstrated by the experiments of N. I. Uznadze: out of two balls of the same weight, the larger one seems heavier. A metal ball feels heavier than a plastic ball of the same weight (Deloff test).
The mentioned varieties of illusions are not a sign of a mental disorder. Pathological illusions have a number of important features. This is their psychological incomprehensibility, falling out of the semantic context of the situation. Visual images are completely absorbed, overlapped by imaginary ones, and are subjected to gross distortion. The content of pathological illusions expresses ideas of persecution and other painful experiences. There is no critical assessment of illusory images. Sometimes it is difficult to distinguish between illusions and hallucinatory images, as well as to catch the moment of transition of the first to the second.
There are the following types of pathological illusions: affective, verbal and pareidolic (pareidolia).
^ affective illusions. Associated with fear and anxiety. The patient in the frosty patterns of the window "sees" the face of the robber, in the folds of the blanket - the murderer lurking on the bed, takes the pen for a knife. Instead of the usual noises, knocking, ringing, he hears the clicking of a shutter, guns, shots, the steps and breathing of his pursuers, and death groans.
^ verbal illusions. They contain separate words, phrases that replace the real speech of others. Accusations, threats, abuse, exposures, insults are heard. Verbal illusions that arise against the background of fear or anxiety are considered a verbal version of affective illusions (Snezhnevsky, 1983). Intense, profuse and plot-related verbal illusions are termed "illusory hallucinosis" (Schroder, 1926) .
Verbal illusions must be distinguished from delusional ideas of relationship. With the latter, the patient hears the speech of others correctly, but is convinced that it contains “hints” addressed to him.
Affective and verbal illusions in psychopathological terms are heterogeneous. Some of them are associated with depression (accusations, censure). Others reflect the influence of delusional mood (threats, shooting, unpleasant taste of food). Some of the illusions are consonant with distinct delusional beliefs. Thus, a patient with delusions of jealousy hears the steps of a lover sneaking towards his wife instead of a rustle.
Pareidolia. They are visual illusions with fantastic content. When looking at shapeless spots, ornaments (patterns of tree lines, weaves of roots, the play of chiaroscuro in the leaves of trees, clouds), one sees exotic landscapes, enchanting scenes, mythical heroes and fairy-tale creatures, bizarre plants, people in unusual masks, ancient fortresses, battles, palaces. Portraits come to life. The faces depicted there begin to move, smile, wink, protrude from the frames, make grimaces. Pareidolia occurs spontaneously, attracts the attention of patients, is accompanied by lively emotional reactions.
Illusions are characteristic of states of shallow stupefaction of consciousness (the second stage of delirium, according to S. Libermeister), occur in acute symptomatic psychoses. They are also observed in delusional and affective psychoses of a different etiology. Episodic and unstable illusions occur in neurosis, neurosis-like states. In the pathogenesis of illusions, the role of hypnoid states of cortical analyzers is assumed.
hallucinations(“delusions”, “visions”). Imaginary perceptions, false images that arise spontaneously, without sensory stimulation. M. G. Yaroshevsky (1976, p. 23) mentions Bhatt, an ancient philosopher of the Mimams school, who expressed consonant modern guesses about the deceptions of perception. The reality or illusory nature of the image, Bhatta argued, is determined by the nature of the relationship between the organ and the external object. The perversion of these relationships leads to illusory perception. The causes of the latter can be peripheral (a defect in the sense organs), as well as central (manas), when images of memory are projected into the external world and become hallucinations. In the same way, according to Bhatt, dreams arise. Until now, the definition of hallucinations by V. Kh. Kandinsky has not lost its significance: “By the name of hallucinations, I mean the excitation of the central sensory areas that does not depend directly on external impressions, and the result of such excitation is a sensual image that appears in the perceiving consciousness with the same character of objectivity and reality, which under ordinary conditions belongs only to sensory images obtained by direct perception of real impressions. A hallucination is an image of a representation identified by the patient with a visual image. The definitions of hallucinations usually indicate the following signs.
The appearance of hallucinations is not directly related to the perception of real and available objects (the exception is functional and reflex hallucinations). This is where hallucinations differ from illusions. A hallucinating patient, along with false images, can adequately perceive reality. At the same time, his attention is distributed unevenly, often shifting towards deceptions of perception. Sometimes it is so absorbed in the latter that reality is almost or not noticed at all. In such cases, one speaks of detachment or hallucinatory congestion.
Hallucinations are characterized by sensual liveliness, projection into the real world (rarely they are devoid of a certain projection: “Voices from nowhere ... The hand reaches out from nowhere ...”), spontaneous appearance and alienation to the content of consciousness They are characterized, in addition, by the feeling of their own intellectual activity - the patient " himself" with interest or fear "listens", "looks", "peers". An integral expression of these qualities of perceptual deceptions is the experience of the corporality of imaginary images, their identification with images of real objects. Understanding the pain of hallucinations is largely lacking. Impressed by them, the patient behaves in exactly the same way as if what seems to him were actually happening. Often hallucinations, no matter how irrational their content, are more relevant to the patient than reality. He finds himself in great difficulty if imaginary and real images enter into relations of antagonism and have an equal power of influence on behavior. With such a "split" personality, the patient seems to exist in two "dimensions" at once, in a situation of conflict between the conscious and the unconscious.
There are the following types of hallucinations: visual, auditory, olfactory, gustatory, tactile and general sense hallucinations (enteroceptive, visceral, endosomatic). Close to the latter are vestibular and motor hallucinations.
^ visual hallucinations. Elementary and complex optical illusions are observed.
Elementary hallucinations - photopsies, phosphrenes - are simple optical illusions that do not add up to an objective image: flashes of light, sparkles, fog, smoke, spots, stripes, dots.
Complex visual hallucinations are characterized by subject content. Taking into account the latter, some special types of them are distinguished.
Zoological hallucinations - zoopsia - visions of animals, insects, snakes known from past experience.
Demonomanic hallucinations - visions of devils, mermaids, angels, gods, houris, and other characters from the field of mysticism and mythology. Fairy-tale creatures and monsters, "aliens", and other fantastic images can be perceived.
Anthropomorphic hallucinations are visions of images of close acquaintances and strangers, both living and dead. In recent decades, some authors have noted a decrease in demonomaniac and an increase in anthropomorphic perceptual deceptions. Sometimes, in imaginary images of relatives, according to patients, strangers, unfamiliar, hostile people can “disguise themselves” and vice versa. There are hallucinatory visions of fragments of the human body: eyes, head, limbs, pupils, internal organs - fragmentary hallucinations. Autoscopic hallucinations are visions of oneself. The phenomenon of geatoscopy is described: an imaginary perception of one's body, projected inside one's own body.
Polyopic hallucinations - multiple images of imaginary objects: glasses, bottles, devils, coffins, mice. False images can be located on a line that goes into the distance, and gradually decrease in size. Diplopic hallucinations - visions of double imaginary images: "People split in two - the same one is seen on the right and on the left."
Panoramic hallucinations - static visions of colorful landscapes, landscapes, space scenes, pictures of the consequences of atomic explosions, earthquakes, etc.
Scene-like hallucinations - visions of hallucinatory scenes, plot-related and sequentially arising from one another. Funerals, demonstrations, trials, executions, battles, afterlife scenes, adventures, adventurous and detective events are perceived. A variant of the stage-like hallucinations are pantophobic hallucinations of Levi-Valensi - frightening stage visions for patients.
Segla's visual verbal hallucinations are visions of letters, words, texts. The content of such symbolic hallucinations may be other sound systems: numbers, mathematical formulas, symbols of chemical elements, musical notes, heraldic signs.
Endoscopic (visceroscopic) hallucinations - visions of objects inside your body: "I see that my head is filled with large white worms"). Autovisceroscopic hallucinations - visions of one's own internal organs, sometimes affected by an imaginary disease: "I see my shrunken lungs." There are hallucinatory visions of one's organs, the images of which are taken out into the outside world, sometimes projected onto some surface, for example, onto a wall.
Negative visual hallucinations - a short-term blockade of the ability to see separate real objects.
Visual hallucinations also differ in color, size, clarity of contours and details of imaginary images, the degree of similarity with real objects, mobility, localization in space. Imaginary images can be black and white, painted indefinitely or predominantly in one color. For example, in epilepsy, they are intensely red or blue.
The color scheme of false images can reflect the peculiarities of color perception inherent in the individual. For colorblind people, for example, it lacks red. Normoptic hallucinations - the sizes of imaginary images are adequate to the size of the corresponding real objects; macrooptical, gulliver hallucinations - visions of enormous dimensions; microoptical, midget hallucinations - extremely small. For example, “I see bodies on the wall, as if under a microscope.” There are hallucinations with an ugly distorted form of imaginary images, elongated in one direction, remote, approaching, skewed - metamorphoptic hallucinations. Reduced and seemingly distant hallucinatory images are a phenomenon known as Van Bogart microtelopsia. Relief hallucinations - the contours and details of false images are perceived very clearly, voluminously. Adelomorphic hallucinations - visions are foggy, blurry, "ghostly", "airy" ("ghosts, ghosts", as defined by patients). Cinematic hallucinations - imaginary images are devoid of depth, volume, sometimes projected onto the surface of walls, ceilings and are replaced "as on a screen." Patients at the same time believe that they are "showing a movie." Cinema, as noted by E. Breuler (1920), existed for patients long before its discovery.
Hallucinatory images are mobile, sometimes changing kaleidoscopically quickly or chaotically. They can be perceived as moving from left to right and back, moving in a vertical direction. Sometimes they are motionless like statues - stable hallucinations. The localization of optical illusions in space is different. For the most part, they are projected into the real environment, perceived along with the surrounding objects or obscure the latter. With extracampal hallucinations, optical illusions are localized outside the field of vision - from the side, from above, more often "behind the back". Hemianoptic hallucinations - perceptual delusions are localized in one of the halves of the visual field. Visions can occur in one eye - monocular hallucinations.
Visual (and auditory) hallucinations should be distinguished from the phenomenon of personified awareness (or extraneous presence), which is an imaginary experience of the presence of another, often hostile person. This is also a false sensation of someone else's gaze ("someone is looking out the window", "watching"). Descriptions of patients are so detailed that these experiences can be mistaken for hallucinations. So, the patient reports: “I feel a man standing behind me, a man, tall, all in black, he extended his hand to me and wants to say something ... I don’t see him, but I clearly feel that he is.” In another observation, the patient "felt" the deaf-mute father standing on the side and talking with gestures, so that she could understand what he was "talking about". Imaginary speech can be perceived in the same direct way: the patient “clearly hears” how neighbors scold her, give offensive nicknames. Upon detailed questioning, he clarifies: “I don’t hear, but the feeling is that they are scolding. I listen - no one is talking, but still I continue to feel how they scold me.
Sometimes the structure of visions is schematic, contour, very general, so that it rather resembles a model, a prototype of an object. It is known that the development of perception is built on the basis of "cognitive schemes", which can be likened to a geometric pattern. It seems that the "maturation" of the hallucinatory image may repeat the early stages of perceptual formation.
The clinical features of visual hallucinations are of known diagnostic value, indicating the nature of the disease or the localization of the lesion. Thus, extracampal hallucinations are usually observed in schizophrenia (Bleyler, 1920). Cinematic hallucinations are more common with intoxication, in particular, alcoholic psychoses. Intoxication psychoses are more common demonomaniac, zoological and polyopic hallucinations. The presence of abundant visual illusions of perception with disorientation in the location, environment and time indicates a delirious clouding of consciousness. Hemianopsic hallucinations are observed in organic diseases of the brain (Banshchikov, Korolenko et al., 1971). These authors observed autoscopic hallucinations during cerebral hypoxia and expressed the opinion that such optical illusions indicate severe brain pathology. Multiple visual hallucinations are found in the structure of the epileptic aura - Jackson's visual hallucinations (1876). Pantophobic hallucinations and hallucinations of fantastic content are found in oneiroid stupefaction. Micro-, macrooptical hallucinations, as well as ugly distorted visions moving in a certain direction, bear the imprint of a local, organic brain lesion. The clinical significance of many details of visual deceptions is far from fully disclosed. Perhaps their most common feature is the symbolic content, which is not directly translated into the language of verbal-logical formulas. Thus, the patient's thirst is manifested by visions of a river, a stream, a fountain, a waterfall; pains form images of a biting dog, a biting snake, etc. An analogy with dreams seems appropriate, the hidden meaning of which cannot always be precisely established. In dreams, as in visual deceptions, the regression of thinking to the figurative level of its organization is reflected, while verbal hallucinations indicate at least partial preservation of mature structures of logical thinking. This may also mean that visual deceptions occur with a deeper lesion of mental activity than verbal hallucinations.
^ auditory hallucinations. Like visual ones, they are the most frequent and varied in content. There are acoasms, phonemes and verbal hallucinations, as well as hallucinations of musical content.
Acoasma - elementary non-speech hallucinations. Separate sounds such as noise, hiss, rumble, creak, buzz are heard. Often there are more specific, subject-related, though also non-verbal auditory deceptions: footsteps, breathing, stomping, knocking, phone calls, kissing, car horns, sirens, floorboards creaking, dishes clinking, teeth grinding, and more.
Phonemes, elementary speech deceptions - shouts, cries, groans, crying, sobs, laughter, sighs, coughs, exclamations, individual syllables, fragments of words are heard.
With hallucinations of musical content, the playing of musical instruments, singing, and choirs are heard. Well-known melodies, their fragments sound, sometimes unfamiliar music is perceived. Musical hallucinations are often observed in alcoholic psychoses. Usually these are vulgar ditties, obscene songs, songs of drunken companies. Musical deceptions of perception may occur in epileptic psychoses. Here they look different - this is the sound of the organ, sacred music, the ringing of church bells, the sounds of magical, "heavenly" music. Hallucinations of musical content are also observed in schizophrenia. So, the patient constantly hears songs in the retro style - "melodies of the 30s." "Concerts" have not been interrupted for more than six months. One hears songs and orchestral works that she remembers, as well as those long forgotten by her. Melodies arise and change on their own or begin to sound as soon as she thinks about them - "concert by request." Sometimes the same melody is compulsively repeated many times in a row.
Verbal (verbal) hallucinations are much more common. Separate words, phrases, conversations are perceived. The content of hallucinatory statements may be absurd, devoid of any meaning, but for the most part they express various ideas that are far from always indifferent to patients. S. S. Korsakov (1913) considered a hallucination as a thought dressed in a bright sensual shell. V. A. Gilyarovsky (1954) points out that hallucinatory disorders are not something divorced from the patient's inner world. They express various disorders of mental activity, personal qualities, the dynamics of the disease as a whole. According to V. Milev (1979), hallucinations reveal echolalia, perseverations, broken thinking, inadequacy or paralogy. All this makes clinical analysis of the content of hallucinations in general and verbal hallucinations in particular useful.
At the beginning of a mental disorder, verbal hallucinations are in the form of calls by name, surname, usually single and rarely repeated. Calls are heard in reality, when falling asleep, waking up, in silence or noisy environments, alone and surrounded by people, in situations where patients expect to be called. It is not always possible to determine whether it was a hallucination, a call was actually made, or an illusory perception took place. When repeating hails, patients often identify hearing deceptions themselves. At the same time, it is often indicated that the “calls” are repeated in the same voice. There are "silent" hails. Sometimes patients refer calls to another person: "They call, but not me."
Commentary or evaluative hallucinations reflect the opinion of "voices" about the patient's behavior - benevolent, caustic, ironic, condemning, accusing. "Voices" can talk about current and past actions, as well as evaluate what he intends to do in the future.
In a state of fear, hallucinations acquire a threatening character, consonant with the delusional ideas of persecution. Imaginary threats of murder, reprisals, revenge, brutal torture, rape, and discredit are perceived. Sometimes the "voices" have a distinctly sadistic connotation.
Dangerous for others and the patients themselves, a variety of auditory deceptions are imperative hallucinations containing orders to do something or prohibitions on actions. Patients more often attribute the orders of the votes to their own account. They are less often considered to be related to others. So, the voice orders others to kill the patient. Voices may demand actions that are directly contrary to conscious intentions - to hit someone, insult, commit theft, attempt suicide or self-harm, refuse to eat, medicine or talk with a doctor, turn away from the interlocutor, close your eyes, clench your teeth, stand still , walking without any purpose, rearranging objects, moving from one place to another.
Sometimes the orders of "voices" are "reasonable". Under the influence of hallucinations, some patients turn to psychiatrists for help, without being aware of the fact of a mental disorder. Some patients point to a clear intellectual superiority of the "voices" over them.
The content of imperative deceptions and the degree of their influence on behavior are different, so the clinical significance of this type of deception may be different. So, "orders" of a destructive, absurd, negativistic nature indicate a level of personality disorganization close to catatonic. Such orders, like catatonic impulses, are realized automatically, unconsciously. Commands with a sense of compulsion are also carried out, but the patient tries to resist or at least realizes their unnaturalness. The content of such orders is no longer always destructive or absurd. Orders of persecutory content are observed. Contradictory, ambiguous orders of voices are encountered, when, along with absurd ones, quite reasonable orders are also heard. Sometimes orders are heard that are consonant with the patient's conscious attitudes.
There are imperative hallucinations of magical content. Thus, the “voices” force the patient to stretch ropes, threads in the apartment, put things in the indicated places, and not touch some objects. "Voices" claim that there is a mysterious connection between the mentioned actions and the well-being of loved ones. In response to the refusal to obey the orders of the "voices" predict inevitable death. In another observation, the "voices" demanded that they wash their hands for a strictly defined number of times - seven or twelve. The patient believed that in the number "seven", there is a hint of her family - "seven is a family." Washing hands seven times means saving the family from misfortune. The number "twelve" contained an allusion to the twelve apostles. If she washed her hands the indicated number of times, then she was “cleansed” by this from all sins. The “voices” told a patient with alcoholic psychosis: “Listen, we are sawing a log. As soon as we cut it, you will die.” Or a voice orders: “Take a mirror and destroy the witch, - she moved into the mirror. It happens that the voices belong to "witches", "demons", "devils". From the above examples it is clear that in verbal hallucinations the regression of thinking to the archaic (magical) level of its organization is expressed.
Hallucinatory orders, as mentioned, are not always implemented. Sometimes patients do not attach importance to them, or consider them ridiculous, meaningless. Others find the strength to hold themselves back or “in spite of the voices” to do the opposite. More often than not, imperative hallucinations have an irresistible influence. Patients do not even try to oppose them by following the wildest orders. According to patients, at this time they feel "paralysis" of their will, act like "machine guns, zombies, puppets." The irresistible imperativeness of hallucinations testifies to their proximity to catatonia and phenomena of psychic automatism. According to V. Milev (1979), imperative orders can be classified as schizophrenic symptoms of the first rank.
Hallucinations show some similarity with imperative hallucinations, containing not orders, but persuasion, exhortations, false information, which acquire great persuasive power for patients. So, the “voice” persuades the patient to commit suicide: “Jump from the bridge. Don't be afraid, it's not scary. Why live, understand, life has ended for you a long time ago. There are hallucinations with the character of suggestion. The schizophrenic patient did not hesitate to believe that he had committed the murder when the "voices" told him about it. He clearly "remembered" the details of the "crime" and declared himself to the police. “Voices” can further assure the existence of witchcraft, the afterlife, predict the future, and report absurd and fantastic information. Hallucinatory fictions do not leave patients indifferent, their truth may seem obvious to them. “Voices” can not only “suggest” what should be done, but also the very way to perform this or that act. So, the “voice of the father” pushes the patient to commit suicide, calls to her at the cemetery. He says that you need to poison yourself with vinegar essence, indicates where to get it. The patient, indeed, finds the essence in this place, although earlier she seemed to be unable to find it anywhere.
Auditory hallucinations are observed with the nature of ascertaining - an accurate recording of what the patients themselves perceive or do: “This is the station ... The policeman is coming ... This is the wrong bus ... He got up ... He goes ... He puts on shoes ... He hid under the bed ... He took the ax ... ". Sometimes voices name objects not seen by the patient. So, he wants to and cannot determine the name of the street he is walking on, and the “more observant” voice correctly tells him this. Statements concern not only external impressions and actions, but also motives, intentions: “I am duplicated, repeated. I'll just think of doing something, and the voice will say it. I want to leave the house and immediately I hear people talking about it…”. Patients believe that they are "recorded, listened to, photographed, videotaped." Sometimes "voices" require patients to say out loud or mentally the names of perceived objects, repeat what has been said many times. And, on the contrary, the same word, phrase, uttered by the patient or someone from those around him, can be repeated in voices like an “echo”, sometimes 2-3 times or more. Such auditory delusions can be referred to as echolalic or iterative hallucinations.
Hallucinations can "duplicate" not only the statements of others or the patients themselves. Own thoughts begin to "sound" - the "voice" immediately "repeats" what the patient thought about. When reading, the content of what is read is copied - a symptom of echo-reading. The voice "reads" what the patient has written - "echo letters". The repetition of thoughts can be repeated. According to the patient, before going to bed, he “inspires” himself: “I calmed down, relaxed, I want to sleep, I fall asleep.” Following this, he hears a "voice" that says this phrase five times - "now I do without sleeping pills, my voice is lulled." The tempo of repetition can be slowed down, accelerated or changes, speeding up towards the end of pronunciation. Sometimes repetition concerns individual words, the end of a phrase. So, the voice "inside" every second repeats the threat: "I'll plant" and says this for days. As you speak, the volume of the sound gradually fades, the timbre of the voice changes. Repetitions are not always identical; variations in shades of sound and meaning are possible. One of the patients reported repeating phrases 6 times, but each time in a different voice and some change in content.
There are stereotypical hallucinations - the same thing is constantly heard. A patient with Huntington's chorea for a number of years had a hallucination in the form of the phrase repeated from time to time: "Vitya, cuckoo!". At first I thought that they were “playing hide-and-seek” with him, looking for the hiding person, but then I was convinced of the deception of hearing and stopped paying attention to him. In a repeated attack of illness, sometimes the same voices “return” and say the same thing as before. There are "double voices" - one of them a little later exactly copies what was said first.
Verbal hallucinations can be in the form of a monologue - the "voice" is an endless story about something, not allowing either to interrupt himself or change the subject. For example, the “voice” recalls and tells in detail the biography of the patient, giving such details that he “has long forgotten”. Hallucinations can be multiple (polyvocal). Several voices simultaneously talk about different things, talk to each other. With hallucinations in the form of a dialogue, two “voices” “argue” with each other about the patient, and one of them praises, approves, emphasizes his merits and virtues, the other, on the contrary, accuses, condemns, demands punishment, physical destruction. Contrasting hallucinations - one of the "voices" says or orders to do one thing, and the other at the same time - just the opposite. There are scene-like auditory hallucinations - many "voices" create a visible impression of a complex situation that is developing dynamically. There are hallucinations of poetic content - "voices" compose poems, epigrams, puns.
Verbal hallucinations can maintain complete autonomy from patients, not to enter into "contacts" with them, or even "think" that they do not hear them. Sometimes they speak instead of the patient. Thus, a “voice” answers the doctor’s questions, while the patient “does not think” at this time, she only “repeats” his answers. Voices can also address the patients directly, ask, ask to repeat something, talk with them. So, the “voice” comes to the patient every morning, wakes up, greets, and says goodbye in the evening. Sometimes he notifies that he will leave him for a while, returning by the appointed time. Answers the patient's questions, gives advice, asks in detail about his life, as if collecting an anamnesis. Before disappearing, he announces that he "leaves forever, dies." Or the voice tells about the patient and specifies the year and place of her birth, the details of school, life, family, is interested in work, children. Through the mediation of patients, it is possible to "talk to the voices." When answering questions, “voices” can refuse, fall silent, get lost, and laugh mockingly. Some of them report different information about themselves. So, in response to a questioning “voice”, the patient says: “Does he (that is, the doctor) really understand that I am a disease. I have nothing to say about myself. I will disappear as soon as the illness passes. At the same time, the patient herself believed that the “voices” were a messenger of “another, invisible world.” Or “voices” speak, give their names, age, describe their appearance, claim that they hold high important positions, that they intend to commit suicide or that they “hear voices themselves”, that they suffer from seizures, express a desire to be treated, etc.
Voices often express judgments, evaluations independent of the patient, show interest in external events, express their own desires, talk about their origin, make plans for the future. They can also say what coincides with the patient's opinion, express his views and expectations. With "smart" voices, patients "advise". So, the patient consults with the “voice” whether she will go to the hospital in the future. To which he cautiously replies, “Most likely, yes.” Sometimes it is possible to test the mental capabilities of voices. They perform arithmetic operations, interpret proverbs and sayings in their own way. The level of their "thinking" for the most part is lower than that of patients. The emotional context of the utterances of voices - and this can be seen from the tone, speech forms, content of what was said - is more often unfriendly, aggressive, cynical, rude. All this shows that "voices" are the expression of a complex pathological structure that integrates various psychological functions into a holistic formation at a different, usually reduced level. They represent a kind of personality neoplasm, often opposed to the personality of the patient.
There are hallucinations with the character of anticipation. "Voices" seem to be ahead of events and predict that the patient will soon feel, think about or find out. They notify that he will have a headache, there will be an “urge” to urinate, defecate, vomit, or he will soon “want” to eat, sleep, say something. And, indeed, these predictions often come true. The patient has not yet had time to realize what happened, and the "voice" informs about what actually happened. It also happens that when reading, the “voice” runs ahead and “reads” what is written at the bottom of the page, while the patient looks only at the top lines. It turns out that voices perceive subthreshold signals that do not reach the level of consciousness.
"Voices" can speak slowly, in a singsong voice, in a patter. So, voices that are normal in tempo, with an exacerbation of the condition, begin to say “very quickly”. Their previously connected speech becomes broken, reminiscent of a set of separate words. Sometimes the voices come in swells, sometimes they are interrupted by sudden pauses. Meanwhile, in hallucinations, there are practically no such phenomena as stuttering, paraphasia, aphasia, dysarthria and other neurological pathology, even if it is in the speech of patients.
There are verbal hallucinations in the form of neologisms, as well as verbigeration - a stringing of words that are incomprehensible to either the patient or others. Sometimes patients claim that they hear voices in "foreign languages" and at the same time perfectly understand what was said, although they themselves do not speak any languages - cryptolalic hallucinations. For polyglots, "voices" can sound in foreign languages, including those that are forgotten - xenolal hallucinations.
Auditory hallucinations can be different in volume, distinctness, naturalness. Most often they sound the same as the conversation of the surrounding people. Sometimes subtle, indistinct, “rustling” sounds are heard, or they sound deafeningly loud. There are "premonitions" of voices - "they are not there, but I feel that they are about to appear." There is a fear of voices that "should" appear. Hallucinations are usually perceived as living, natural speech, but they can be heard as "on the radio", from a tape recorder, sound like in a "stone bag". Sometimes they seem "unreal". Quite often they are individualized, the persons known to patients are recognized in them. Sometimes the patient's own voice is heard. Recognition of the voice of this or that person, apparently, is a fact of delusional interpretation. The same voice may belong to different persons. There are "fake", "similar to familiar" voices, which, according to the patients, belong to unknown persons, and, on the contrary, the voices of loved ones, "on purpose" distorted beyond recognition. For example, voices "imitate" the speech and thoughts of real people. The patient even "sees" at the same time "images" of people whose voices she hears.
The source of hallucinations is localized by patients, as a rule, in a real environment. Voices are perceived as sounding somewhere nearby, even the direction from which they come is indicated. Sometimes they sound "around", and patients cannot determine from which side they hear them. Sometimes the voices are localized at a great distance, far beyond real audibility. They can also be perceived near or on the surface of the body, near the ears ("whisper in the ear"), in the ear canals. But even in such cases, the voices are perceived as coming from the outside towards the sick. The opposite happens less often: the voices “fly off”, go from the patients in the outward direction. The patient reports that the voice sometimes "flies" out of her head, she even sees a receding gleam. At this time, he thinks that the voice becomes audible to others. For the most part, voices are picked up by both ears, but can be perceived with one ear - one-sided hallucinations. There are hearing deceptions that occur simultaneously with a variety of synesthetic sensations.
Auditory hallucinations are observed mostly with formally unchanged consciousness in the clinical picture of various diseases. Some features of auditory hallucinations may be of diagnostic value. Threatening hallucinations, for example, indicate a paranoid mood swing, blame or induce suicide, indicate depression, benevolent, approving, laudatory - an elevated mood. The symptom of sounding thoughts, the symptom of echo-reading, duplicate hallucinations, hallucinations with the nature of iterations (multiple repetition), contrasting hallucinations are more common in schizophrenia. The alcohol theme of the content of hearing deceptions is revealed in alcoholic psychoses.
^ Olfactory hallucinations. Imaginary perceptions of various smells. These can be familiar, pleasant, disgusting, vague or unfamiliar smells that you have not encountered before. The projection of olfactory hallucinations is different. Patients may believe that smells come from surrounding objects or claim that they smell from themselves, from the legs, genitals, from the mouth, etc. Sometimes they say that the source of “the smell is the internal organs.
There is an unusual projection of deceptions of smell - smells are perceived, for example, inside the head. Imaginary smells are often associated with crazy ideas. So, unpleasant odors emanating from the body are combined with the phenomena of dysmorphomania (delusions of physical deficiency), odors with an external projection - with the delusions of poisoning; smells coming from within - with nihilistic and hypochondriacal delusions. The appearance of olfactory hallucinations often precedes the development of the delusion itself.
^ Taste hallucinations. False taste sensations that occur out of connection with the intake of food or any substances. Taste hallucinations can also occur during eating - there is an unusual, uncharacteristic daisy food permanent taste (“metallic”, “taste of copper, potassium cyanide, unknown poison”, etc.). Taste delusions are sometimes localized "inside" the body and are explained by patients with "rotting, decomposition" of the internal organs.
^ Hallucinations of the skin sense. Various perceptual delusions associated with various types of skin sensitivity.
Tactile hallucinations - imaginary sensations of touch, touch, crawling, pressure, localized on the surface of the body, inside the skin, under it. Deceptions of perception are subjective in nature. Patients claim that they feel the touch of hands, stroking, feel how they are sprinkled with sand, dust, pricked with a needle, scratched with nails, hugged, bitten, patted, pulled by the hair, they believe that living beings are on the skin or inside it and move. Often, tactile hallucinations are localized in the oral cavity, where the presence of hair, crumbs, wires, and other foreign objects is felt. The imaginary presence of a hair in the oral cavity is considered characteristic of psychoses that occur in connection with tetraethyl lead poisoning. Cocaine psychoses are characterized by imaginary sensations under the skin of small objects, crystals, insects - a symptom of Manyan.
Haptic hallucinations are imaginary sensations of a sharp grasp, blows, shocks, coming, according to patients, from outside.
Erotic (genital) hallucinations are imaginary sensations of obscene manipulations performed by someone from the outside on the genitals.
Stereognostic hallucinations - imaginary sensations of the presence in the hand of an object - a matchbox, a glass, a coin, etc. - Ravkin's symptom.
Temperature (thermal) hallucinations - false sensations of burning, cauterization, cooling of a part of the body surface. Unlike senestopathies, thermal hallucinations are of an objective nature - “apply a red-hot wire, burn it with an iron”, etc.
Hygric hallucinations - a false sensation of the presence on the surface of the body or under the skin of drops of liquid, streams, streaks, blood, etc.
^ Interoceptive (visceral hallucinations, hallucinations of the general feeling). False feeling of the presence inside the body of foreign bodies, living beings: mice, dogs, snakes, worms, feeling of additional internal organs, "sewn-in devices", other objects. They differ from senestopathies in physicality, objectivity. The following observation may serve as an illustration. The patient claims that for many years she has been "tormented by worms." Helminths, which previously filled the abdominal cavity, recently penetrated into the chest and head. He clearly feels how the roundworms move, twist into balls, crawl from place to place, stick to internal organs, touch the heart, squeeze blood vessels, close the lumen of the bronchi, swarm under the skull. The patient insists on an immediate operation, believing that otherwise she is in danger of death. Visceral hallucinations are usually accompanied by delusions of possession. A variety of interoceptive hallucinations are transformation hallucinations, expressed by a feeling of change in specific internal organs: “The lungs fell asleep, the intestines stuck together, the brain melted, the stomach wrinkled, etc.”
^ Motor (kinesthetic) hallucinations. Imaginary sensations of simple movements or complex actions. Patients feel how their fingers are clenched into a fist, their head turns or shakes, their body bends, their hands rise, their tongue sticks out, their face twists. In acute psychotic states, particularly in delirium tremens, they feel as if they are going somewhere, running away, performing professional activities, pouring wine, while actually lying in bed. There are kinesthetic verbal and graphic hallucinations with imaginary sensations of movement of the articulatory apparatus and hands, characteristic of speaking and writing. False sensations of movement can be violent - patients are "forced" to speak, write, move around. Motor deceptions of verbal content mostly belong to pseudo-hallucinations. Sometimes there are automatisms of written speech. According to the elephants of one of the patients, she communicates with God in a very unusual, "amazing" way. Her hand involuntarily writes texts, and the patient herself learns about the content of the latter later, only after reading what was written. She writes, she "without thinking", at this time "there are no thoughts in my head." Something is moving her hand, some extraneous force, she only meekly obeys her.
^ Vestibular hallucinations (hallucinations of the sense of balance). Imaginary sensations of falling, lowering and lifting up, as in an elevator or in an airplane; rotation, tumbling of one's own body. There may be a feeling of movement of surrounding objects, directed in a certain direction or disorderly, chaotic - an optical storm.
The object of hallucinatory perception can be one's own body. With typhus, there is a feeling of doubling the body - a symptom of a double (Gilyarovsky, 1949). In a state of confused consciousness, the patient feels another person lying next to him, exactly the same person as himself. There are hallucinations of reincarnation in animals (zooanthropy): lycanthropy - in a wolf, galeanthropy - a cat, kynthropy - a dog. There may be a sense of transformation into inanimate objects. Thus, the patient has a feeling
It was as if his body had turned into a passenger car with a bucket in front. The patient, as he later said, moved along the carriageway in accordance with all the rules of the street: “braked”, “honked” on turns, clenching his fists, etc. The normal sensation of the body disappeared for this time. The phenomena of such reincarnation can be considered as a hallucinatory variant of depersonalization. Such phenomena are often characteristic of the state of oneiroid clouding of consciousness.
Depending on the conditions of occurrence, the following types of hallucinations are distinguished.
^ Functional (differentiated) hallucinations. They develop simultaneously with the perception of a real stimulus and within the same modality of sensation. More often these are auditory, less often - visual hallucinations. For example, under the sound of wheels, a repetition of the phrase is simultaneously heard: “Who are you, what are you, who are you, what are you ...”. When the train stops, the hallucination disappears. At the sight of a passerby, the patient notices how someone's head is peeking out from behind him. Unlike illusions and illusory hallucinosis, imaginary images in functional hallucinations coexist with an adequate perception of real objects.
^ Reflex hallucinations. Unlike functional ones, they are an imitation of a real stimulus in a different modality of sensation. The patient reports: “I hear a knock, a cough, a door creak, and at the same time it echoes in my chest - as if they knocked, coughed, turned.” Reflex hallucinations may be delayed. So, the patient saw a broken window, and a little later she felt broken glass in her stomach. In the morning she spilled kerosene, and by lunch she felt as if “all soaked in it”, even heard his smell coming from inside.
^ Hypnagogic hallucinations. Occur in a half-sleep, when falling asleep, with eyes closed, in a state of light drowsiness. Often portend delirious stupefaction. Usually these are visual, auditory, tactile hallucinations. Sometimes motor and speech-motor hallucinations may appear - it seems to patients that they get up, walk, talk, shout, open doors ... Hypnagogic hallucinations are clearly distinguished by patients with dreams. Understanding the pain of perceptual deceptions appears some time after waking up.
^ Hypnopompic hallucinations. Occurs when waking up from sleep. Usually these are visual, less often - auditory deceptions of perception. Hypnagogic and hypnopompic hallucinations are combined with sleep disturbances and can be considered as particular variants of oneiric perceptual deceptions. Hallucinations, as clinical observations show, can be timed not only to the phases of "slow" it. Thus, there are unusually vivid dreams, which later patients refer to as real events. Apparently, hallucinations also occur during REM sleep.
^ Hallucinations Bonnet . First described in a patient suffering from senile cataract. Their appearance is associated with eye pathology - cataracts, retinal detachment, inflammatory processes, operations on the eyeball. These are visual single or multiple, scene-like, in some cases colored and moving visions of people, animals, landscapes. With a low intensity of hallucinations, the critical attitude of patients towards them remains. With the intensification of hallucinations, the understanding of pain disappears, anxiety, fear appear, behavior is disturbed. Damage to the cochlear apparatus, neuritis of the auditory nerve, sulfur plugs can contribute to the development of auditory deceptions. The appearance of Bonnet hallucinations is associated with pathological impulses from receptors, as well as with sensory hypostimulation. Each of the mentioned factors and individually can facilitate the development of hallucinations. Numerous studies show that under conditions of perceptual and sensory deprivation (limitation of the flow of internal and external stimuli), various mental disorders develop - the illusion of body rotation, a decrease in the threshold of visual sensitivity, hallucinations. A significant phenomenological similarity of the mentioned disorders with the symptoms of schizophrenia is noted. Hyperstimulation may also facilitate the onset of hallucinations and influence their clinical structure. Toothache is sometimes accompanied by auditory hallucinations with a projection into the affected teeth. Auditory hallucinations are more likely to increase in silence and disappear in noisy environments, but it can also happen that noise contributes to their appearance.
^ Peduncular hallucinations of Lhermitte. Occur when the brain stem is damaged in the area of \u200b\u200bthe legs. Against the background of incomplete clarity of consciousness, visual midget visual illusions are observed, usually in the evening hours, before going to bed. Animals, birds are perceived, usually mobile and painted in natural colors. Criticism of hallucinations may persist. As they increase, it disappears, joins, anxiety, fear.
^ Plaut's hallucinations . Described in neurolues. Loud verbal deceptions are characteristic, a delusional interpretation is possible with the loss of a critical attitude towards them, and behavioral disorders.
^ Van Bogart hallucinations. Seen in leukoencephalitis. Multiple color visions of zoological content (animals, fish, birds, butterflies) appear in the intervals between attacks of increased drowsiness and are accompanied by anxiety, an increase in the affective coloring of imaginary images. Subsequently, delirium develops, complex acoustic disorders, amnesia for the period of disturbed consciousness.
^ Berce's hallucinations. Combined opto-kinesthetic perceptual delusions. Patients see luminous telegrams on the walls, written by someone's invisible hand. Occur in alcoholic psychosis. We observed patients with schizophrenia reading short printed, usually stereotyped phrases on the wall that did not have any clear meaning. Phrases appeared spontaneously, but could also occur after the patient's attention could be drawn to this phenomenon.
^ Pick's hallucinations. Visual illusions in the form of people, animals, perceived through the walls of the building. During hallucinatory episodes, nystagmus and diplopia are detected in patients. Described with damage to the brain stem in the region of the fourth ventricle.
^ Hallucinations of Dupre's imagination. Associated with ideas and ideas that are long cherished in the imagination and are consonant with the latter in content. It develops especially easily in children and persons with a painfully heightened imagination. V. A. Gilyarovsky called such hallucinations identical. Close to them are “paranoid reflex hallucinations of the imagination” (Zavilyansky et al., 1989, p. 86) - a vivid visualization of the images of representation with their alienation from the personality and projection outside. Hallucinations are unstable, fragmentary. Their genesis is associated with a heightened morbid imagination.
^ Psychogenic (affectogenic) hallucinations. O reflect the content of emotionally colored experiences in conditions of mental shock. Psychological comprehensibility of the content of hallucinations, closeness to the actual experiences of the patient, emotional richness, projection of imaginary images outward are characteristic. The difference between hallucinations of the imagination and psychogenic hallucinations can be shown in the following examples.
A patient suffering from tuberculosis of the spine experienced hard physical deformity. He was afraid to appear in public, he believed that everyone was paying attention to him, treating him with a feeling of disgust, laughing at him. In society, he felt very constrained and thought only about the impression that he could leave on others about himself. On the street, I constantly heard passers-by talking about him: “Well, freak! What a freak! Hunchback ... Humpbacked Horse ... ". In this case, one should think of hallucinations of the imagination associated with the dominant experiences of physical deformity and the corresponding expectations.
A young woman, after the death of her only child, was in a psychotic state for two weeks. During the day, more often in the evening, at night I saw my daughter, heard her voice, talked to her, caressed her, braided her hair, fed her, collected her for school, met her after returning from lessons. At that time, she did not realize that her daughter was not alive. In the latter case, we are talking about psychogenic hallucinations that characterize reactive psychosis. Psychogenic inclusions often sound in the hallucinations of endogenous patients. So, in the psychosis of a patient who has lost his wife, her voice is heard, and she herself is seen alive, since the patient managed to "revive" her. Hysterical character traits and high suggestibility contribute to the emergence of psychogenic hallucinations.
Psychogenic hallucinations are obviously associated with the activation of psychological defense mechanisms. The content of perceptual delusions often reproduces the desired situation, while at the same time the real, psycho-traumatic situation is ignored, ideas about it are forced out.
^ Segle's associated hallucinations. Develop in the clinical picture of reactive psychoses. The plot of hallucinations reflects the content of traumatic events. Perceptual delusions appear in a logical sequence: the "voice" announces a fact that is immediately seen and felt. Associated hallucinations can also occur in schizophrenia. So, the “voice” says the following: “If you want to see me, go to the toilet. In a dark corner you will see me in the guise of a devil. The patient, indeed, went and saw a devil in the toilet. The next time, the "voice" made me see myself on the TV screen in the form of a man. Sometimes he demanded to "touch" himself, and the patient clearly felt his hair. In another observation, the "voice of the sorceress" spoke to the patient about how she looks. As it was reported, the patient began to see the eyes, head, torso, limbs, then, finally, saw the whole witch.
^ Combined hallucinations. There are combinations of hallucinations of different sensory modality, united by a common content. One of the options for such a combination is Mayer-Gross's synesthetic hallucinations - patients see moving figures of people and at the same time hear their speech; see flowers and smell them.
^ Induced (suggested) hallucinations. Arise under the influence of external suggestion. They can be collective in nature, facilitated by massive emotional involvement, usually increasing in the crowd and leading to a sharp increase in suggestibility. The existence of such hallucinations has long been known, they are mentioned, in particular, in the Bible. In a crowd stricken with superstitious horror, mystical ecstasy, warlike ardor, especially among easily suggestible persons, various deceptions of perception are rapidly spreading, most often of the same type. Suggested hallucinations are also observed in induced psychoses: perceptual delusions seem to be transmitted from the patient to other members of his family or persons who are in close contact with him. Various hallucinations, including negative ones, can be suggested in a state of deep hypnotic sleep. Upon exiting the latter hallucinations are amnesiac.
There is a special kind of hallucinations that can be induced in patients with the help of special techniques. Lipman's symptom - white-hot visual hallucinations appear at the moment of pressure on the patient's closed eyes. Aschaffenburg's symptom - at the urgent request, the patient hears imaginary speech and talks on the phone (which is disconnected from the network or is faulty). Symptom of Reichardt and Rigert - the patient can be forced to "read" any text on a blank sheet of paper. Purkinje's symptom - pressure on the patient's closed eyes contributes to the appearance of elementary visual hallucinations. Ankylosing spondylitis test - the appearance of visual images suggested with light pressure on the patient's lowered eyelids. Osipov's test - the patient feels an imaginary object in his fist, which the doctor supposedly put in there. The presence of these symptoms indicates an increased readiness for hallucination. Especially often these symptoms are positive in alcoholic psychoses.
Pseudo-hallucinations. For the first time isolated and studied in detail by the Russian psychiatrist V. X. Kandinsky (1890). V. X. Kandinsky considers the following signs to be the most characteristic for pseudohallucinations:
Imaginary images are experienced as being in the represented space, that is, unlike true hallucinations, they are not projected into real space;
Pseudo-hallucinatory images differ from ordinary images of representation in that they are involuntary, intrusive, they are also characterized by completeness, completeness of images, their detail, they are accompanied by a "feeling of torment and melancholy";
Pseudo-hallucinatory images, if there is no stupefaction, do not have the character of objective reality and are not mixed by patients with real objects.
The first feature of pseudohallucinations is clinically manifested as follows. According to the patients, they perceive something not in the real environment, but "inside the head", - "they see with the mind, head, inner eye, mental gaze, brain", "hear with the inner ear, inside the head, hear with the head, mentally". Sometimes pseudohallucinations show a tendency to project beyond the psychic Self. Imaginary images in this case are localized "in the eyes", in the immediate vicinity of them, "in the ears, ear canal, at the roots of the hair."
Another sign of pseudo-hallucinations is that, unlike images of representation, they arise spontaneously, involuntarily, contrary to the desire and direction of the patients' internal activity, and are steadily held in their minds. In other words, pseudo-hallucinations are subjectively experienced as "made", arising under the influence of some external forces. The feeling of one's own activity, which often accompanies the perception of true hallucinations, is absent with pseudohallucinations: the latter "introduce", "invade" the patient's consciousness, are experienced as something alien to his personality. It should be noted that the mention of “tunedness”, “madeness” can accompany various psychopathological phenomena, including true perceptual deceptions. The phenomenon of "made" in pseudohallucinations is a direct, sensual phenomenon, in contrast to the delusions of staging, where what is happening in reality and in deceptions of perception is regarded in the context of an artificially created situation. The occurrence and content of pseudohallucinations are often completely isolated from what is actually perceived or currently experienced. At the same time, an important feature of pseudohallucinations is that the internal aspects of the “I” are not subjected to such total alienation in them, as is characteristic of hallucinations. As V. M. Banshchikov, Ts. P. Korolenko et al. (1971) point out, true hallucinations are more likely to be addressed to the physical “I”, while pseudo-hallucinations are more characteristic of the focus on the mental “I” of patients. This feature of pseudohallucinations is expressed, in particular, in the fact that pseudohallucinatory characters often identify themselves with the personality of patients. So, the voice that sounds “in the back of the head” says the patient: “I am your brain. Everything you hear from me is true. What I make you do, you will do, because my desires are your desires. This is especially evident when pseudo-hallucinations are accompanied by true perceptual deceptions. At the same time, “external voices” are perceived as “outsiders”, and “inner voices” are experienced with a feeling of closeness to the “I”, in an intimate connection with the patient’s inner world - “my voice, as if my soul is talking to me.” The patient simultaneously hears voices "in the soul", "in the head on the right" and outside herself, believing that at times internal conversations "come out." At the same time, she claims that all these voices sound like “her own”. Pseudo-hallucinatory images differ from representational images in sensual brightness, sensitivity, detail, sometimes not inferior in this respect to true hallucinations.
The third feature of pseudohallucinations is that they do not mix with images of perception and representation. Patients talk about "another world", "another dimension", "about special visions and voices" and confidently distinguish them from external objects and memories. At the height of an attack of illness, pseudohallucinations can be identified by patients with reality (Sumbaev, 1958). There is no critical attitude towards pseudo-hallucinations.
It should be noted that the internal projection of perceptual delusions is characteristic not only of pseudohallucinations.
The following observation may serve as an illustration of the foregoing. The patient has been hearing “voices” for a number of years, perceiving them “inside the head”. There are usually several of these "voices" - from seven to twelve, sometimes one or two remain, sometimes there are a lot of them. The patient believes that his own voice sounds, he can "fork" or be divided into many separate voices. All voices, according to the patient, bear his own name. They talk among themselves about him, on other topics, address him directly, he can talk to them. They are perceived distinctly, with a clearly expressed shade of sound, sometimes the “voices” scream loudly. The patient calls them "hallucinations", does not mix with the conversations of others. At the same time, he thinks that “invisible, small people” who are born, live and die live and talk in the head. Deceptions of perception are accompanied by a very painful feeling, a desire to get rid of them, and at the same time there is no consciousness of the disease.
As A. V. Snezhnevsky (1970) emphasizes, the feeling of forcible influence from outside is pathognomonic to pseudohallucinations. Patients report that "voices" do not sound on their own, but they are "made, transmitted, broadcast, evoked, instilled, invested" by means of special equipment, hypnosis. The source of "voices" can be localized by patients at a great distance; "transmissions" are carried out with the help of waves, currents, rays, biofields, which are transformed, "voiced" by the brain or special devices placed in the head. In the same way, patients “make visions, show images, show pictures”, “cause odors”, “irritate the internal organs”, “cauterize the skin”, “make them move”, etc.
Some researchers interpret the violent connotation of experiencing perceptual deceptions differently. V. A. Gilyarovsky (1949) is not inclined to use Kandinsky's pseudo-hallucinations and Bayarger's mental hallucinations, which are alienated from the "I", as synonyms. According to I. S. Sumbaev (1958), it is necessary to distinguish between Kandinsky's pseudohallucinations, which are found in the presence of a single "I" of the patient and mental hallucinations that develop with a disorder of self-consciousness in the form of a doubling of the "I" and are characteristic of the Kandinsky-Clerambault syndrome. The author believes that Bayarger's mental hallucinations arising with the nature of alienation are a special kind of painful ideas (Giro's xenopathic ideas).
^ Objective signs of deceptions of perception and images of representation. In addition to subjective, there are external (objective) signs of perceptual delusions, which are different in hallucinations and pseudo-hallucinations. First of all, these are the behavioral reactions of patients to the fact and content of emerging deceptions.
Patients treat hallucinations in essentially the same way as they treat the corresponding real phenomena. Patients stare at something, turn away, close their eyes, look around, wave away, defend themselves, try to touch or grab something with their hand, listen, plug their ears, sniff, plug their nasal passages, lick their lips, swallow saliva, spit, drop something from the surface of the body. Under the influence of hallucinations, various actions are performed that reflect the content of perceptual deceptions: patients hide, look for something, catch, attack others, try to kill themselves, destroy objects, defend themselves, flee, file complaints with the relevant institutions. With auditory hallucinations, they talk aloud with "voices". As a rule, patients believe that others perceive the same things as they do in hallucinations - they hear the same voices, experience the same visions, smell the same things. Emotional reactions are clearly expressed, the nature of which reflects the content of perceptual deceptions: fear, rage, disgust, enthusiasm. Vegetative reactions are also observed, there are peculiar somatic sensations that accompany hallucinations.
The situation is different with pseudohallucinations. As a rule, there are no signs of external orientation of attention. Patients are absorbed in their experiences, they are diverted to what is happening around with difficulty, without any interest. Pseudo-hallucinations are often accompanied by external inactivity of patients. Behavioral disturbances can nevertheless occur, especially if there are perceptual deceptions of threatening and imperative content. Patients with pseudohallucinations are usually sure that perceptual delusions concern only them and do not extend to others. With verbal pseudo-hallucinations, unlike true ones, patients "communicate" with "voices" mentally, in an outwardly imperceptible way, and not aloud. "Communication" can be involuntary: the patient says that "mentally, involuntarily" she had to answer the questions of "voices".
Hallucinoids. Initial or rudimentary manifestations of visual hallucinations. They are characterized by fragmentation, sensitivity, a tendency to exteroprojection of images with a neutral contemplative and usually critical attitude of patients towards them (Ushakov, 1969). EA Popov indicates that hallucinoids are an intermediate stage in the development or disappearance of true hallucinations (1941).
Eidetism. The ability of some persons to mentally represent and retain for a long time a vivid image of an object or whole pictures after these objects or pictures have been perceived. It is more often expressed in relation to visual, tactile and auditory images. It was first described by V. Urbantschitsch in 1888. In Russian literature, the phenomenon of eidetic images was described by A. R. Luria, who observed a person with a phenomenal visual memory. Eidetic images can remain unchanged for 10 seconds or more. Some eidetics are able to evoke eidetic images long after they were recorded. More often, eidetic abilities are found in childhood and adolescence, then gradually disappear, remaining only in some adults. Some well-known artists possessed such vivid images. In this regard, some researchers consider eidetism as a stage in the age-related development of memory, while others consider it as a more or less permanent constitutional personality trait.
It has been shown that manifestations of eidetism can also be a temporary painful feature of persons suffering from hallucinations (Popov, 1941). The following clinical observation may serve as an illustration. In an acute psychotic state, along with hallucinations, a patient with schizophrenia developed various eidetic images. According to him, he reached the highest degree of yoga - "raja yoga". The patient easily evoked vivid images of people known to him, works of art, illustrations for books, reproduced everyday scenes of the past. He recalled familiar melodies distinctly, with sound. To the accompaniment of music, the products of his imagination were clothed in colorful visible pictures. Images could be unchanged or arbitrarily changed, combined. After leaving the state of acute psychosis, eidetic images disappeared.
Perhaps one should not identify eidetic images with the dynamic and very vivid memories mentioned in the observation just cited. Strictly speaking, an eidetic image is a passive static imprint of what has just been perceived from the real world. The special vividness of memories in mental patients often concerns not only fresh, but also distant impressions. Fantasy images can be just as vivid. The play of the imagination in this case is rather passive in nature and is directed by catatim mechanisms. When intensified, it turns into delusional fantasies, figurative delirium, and with a significant exacerbation of the disease state - into hallucinations.
Eidetism, like hallucinations, can be defined as "perception without an object." Unlike hallucinations, eidetism is the result of the action of previous external stimuli, images appear and disappear arbitrarily, are not identified with reality. The eidetic image differs from the usual way of representation by a high degree of sensitivity and detail.
With mental illness, there may also be a weakening or loss of the ability to imagine and vivid memories. Thus, a depressed patient “lost her idea” of how her husband, children, relatives, acquaintances look like, “forgot” what her apartment is like, she is afraid that she will not be able to recognize her house. She cannot remember the smell of perfume, she does not remember a single melody, she has forgotten how the voices of loved ones sound. Only occasionally and for a short time do stingy and faded images of the past appear in her mind. Before her illness, she said, she always had a good figurative memory. The loss of representational images is a sign of intellectual retardation, characteristic of depressive states.
^ Sensory synthesis disorders. Distorted perception of the size, shape of your body and surrounding objects. The identification of objects, in contrast to the illusion, is not violated.
Metamorphopsia. Violation of the perception of the size and shape of objects and space in general. Objects seem enlarged - macropsia, reduced - micropsia, twisted around the axis, elongated, beveled - dysmegalopsia. Instead of one, several identical objects are seen - polyopia. The distortion of the scheme of perceived objects is usually accompanied by a change in the perception of the structure of space. It shortens, lengthens, objects move away, approach, the street seems to be infinitely long (porropsy), buildings are seen as taller, lower, shorter than they really are.
Metamorphopsia occurs as a result of organic damage to the parietotemporal regions of the brain. Since the perception of spatial relationships is provided by the right (subdominant) hemisphere, it should be expected that metamorphopsias are associated with the topic of the lesion in the right hemisphere. Very often, metamorphopsias are observed in the clinical structure of partial epileptic seizures. Often there are complaints of patients that outwardly resemble metamorphopsia, but in reality due to other reasons. “Everything has somehow moved away, it is perceived as small, as if at a remote distance.” Here there is no actual distortion of the perception of the size and structure of objects, we are talking about the loss of empathy, emotional response, a sense of alienation of the environment.
^ Autometamorphopsia (body schema disorder) . Distortion of the shape or size of your body. With total autometamorphopsia, the body is perceived enlarged - macrosomia, reduced - microsomia. With partial autometamorphopsia, individual parts of the body are perceived as enlarged or reduced. Sometimes the feeling of an increase in one part of the body is perceived simultaneously with the feeling of a decrease in another. The body, any part of it can be perceived as changed only in one dimension - to seem elongated, elongated, shortened. Changes may relate to volume, shape: thickening, weight loss. The head, for example, appears "square". These disorders occur more often with closed eyes, disappear under visual control. They can be constant or episodic, appearing especially often when falling asleep. With pronounced violations, the body is perceived as distorted beyond recognition, in the form of a shapeless mass. So, with her eyes closed, the patient feels her body in the form of a puddle, spreading over the chair, running down to the floor and spreading over its cracks and cracks. With open eyes, the body is perceived normally.
The perception of the position of body parts in space may be disturbed: the head seems to be turned with the back of the head forward, the legs and arms are twisted, the tongue is curled up into a tube. One of the patients felt as if the legs were raised up, clasped the neck and intertwined around it. There is a violation of the perception of the unity of the body, its individual parts are felt in separation from each other. The head is perceived at some distance from the body, the lid of the skull seems to rise and hang in the air, the eyes are out of their sockets and are in front of the face. When walking, it seems as if the lower part of the body is in front, and the upper part is behind, the legs are felt somewhere to the side. The body can be perceived as a mechanical connection of separate parts, "crumbled, glued together."
The phenomena of autometamorphopsia are heterogeneous. Some of them are undoubtedly due to local organic brain damage, in other cases they should be considered in the context of somatopsychic depersonalization. Differential diagnosis is very difficult.
Deceptions of orientation in space can manifest themselves in the form of a syndrome of rotation of the environment. The surroundings seem to be rotated 90 or 180 ° in the horizontal, less often in the vertical plane. There are sleepy, situational and "seizure" variants of the syndrome of rotation of the environment (Korolenok, 1945). In the first case, disorientation occurs in a state of sleepy stupor, usually in the dark with eyes closed. Waking up, the patient for a long time cannot figure out where the door, windows are, in which direction his head, legs. Situational deceptions of orientation occur in the waking state with functioning vision, but only in a special spatial situation - the localization of the main landmark outside the field of vision. The "seizure" variant of the turning syndrome is observed in the waking state, in a normal spatial situation, and is associated, as expected, with transient vegetative-vascular disorders in the systems that provide the perception of space. It can be combined with the phenomena of derealization.
Disorders of perception of time. Violation of the perception of the speed and smoothness of the flow of time, as well as the pace of the flow of real processes. The passage of time can be perceived as accelerated - time passes quickly, imperceptibly, the duration of time intervals seems to have drastically reduced. The patient reports that she does not notice how time passes. It seems to her that it is not even noon, when in fact it is already evening. She lay down for a little rest and did not notice how the day passed. In the morning she wakes up with the feeling that she had just gone to bed, she barely had time to close her eyes, the night flew by in an instant. The flow of time can be perceived as slowing down - “the night seems to never end ...
I wake up with the feeling that it should be morning, I’ll look at the clock, but I slept for only a few minutes ... ”. Sometimes there is a feeling of time stopping: "Time does not pass, it stands still." There may be a feeling of discreteness of time, its fragmentation - only separate moments are fixed in the mind, and the intervals between them do not leave any trace in the memory, the chain of events is interrupted, time suddenly, without sequential development, becomes the past in the form of a jump. “It seems that the morning is immediately followed by the evening, the sun is immediately replaced by the moon, people go to work and immediately come back…”. The distinction between past, present and future may be lost: “The past, present and future are on the same plane, they are nearby, and I can rearrange them like cards from one place to another. I won’t be surprised if I see a knight or a gladiator on the street - for me they are not in the past, but in today. I am talking to you now, and it will remain in me as what is happening now, but for you it will become a thing of the past. The future is also happening now, it is not something that will ever be, but already exists at the moment.” It happens that distant events (are remembered as having just happened, and what happened quite recently refers to the past.
The pace of real processes can also be perceived as accelerated or slowed down. It seems that transport, people move faster than usual, everything is perceived as if it were on an accelerated film - a time-trafter. Sometimes, on the contrary, the movements and speech of others seem to be slowed down, cars drive unusually slowly - zeitlupen.
The perception of oneself can be projected outward. So, an excited patient believes that the people around her are restless and move very quickly; the movements are slowed down not by her, but by those present.
The mechanisms of occurrence of perceptual disturbances are not well understood. There is no single theory explaining the pathogenesis of hallucinations. Historically, the peripheral theory of the origin of hallucinations was the first to develop, according to which they arise in connection with painful irritation of the peripheral part of the corresponding sense organ (eye, ear, skin receptors, etc.). The peripheral theory has now lost its significance. It has been established that hallucinations occur in most cases in the normal state of the sense organs. They can be observed even with the complete destruction of the sense organs or the cutting of the corresponding conductors of sensitivity.
From the standpoint of psychological theory, the occurrence of hallucinations is explained by the intensification of images of representation, confirmation of which was seen in the features of eidetism. The neurological theory associated the appearance of hallucinations with damage to certain cerebral structures, in particular, subcortical formations. S. S. Korsakov (1913) preferred the central theory of excitation of the cortical apparatus with irradiation of this excitation in the direction of the sensory apparatus. O. M. Gurevich (1937) explained the occurrence of hallucinations by a violation of the coordination of lethal and fugal components of perception and their disintegration, which is facilitated by impaired consciousness, autonomic regulation and disorders of proprioceptive sensitivity.
Physiological theories of the occurrence of hallucinations are mainly based on the teachings of IP Pavlov. Hallucinations, according to I. P. Pavlov, are based on the formation of foci of pathological inertia of excitation in various instances of the cerebral cortex, which provide an analysis of the first and second signals of reality. I. P. Pavlov believed that these disorders of higher nervous activity are due to biochemical changes in the brain. EA Popov (1941) emphasizes the role of hypnoid, phase states and, first of all, the paradoxical phase of inhibition in the genesis of hallucinations. Based on pharmacological experiments with the use of caffeine and bromine and the results of studies on the mechanisms of sleep, he showed that weak stimuli - traces of previously experienced impressions in the presence of a paradoxical phase of inhibition can sharply increase and generate images of representations subjectively experienced as images of direct impressions. A. G. Ivanov-Smolensky (1933) explained the exteroprojection of images of true hallucinations by the spread of inert excitation to the cortical projection of visual or auditory accommodation Pseudohallucinations, according to the author, differ from true hallucinations by the locality of the phenomena of pathological inertness of the irritable process, which spreads mainly to the visual or auditory areas.
The similarity of pathological changes in the psyche in conditions of isolation and "sensory hunger" with the psychopathological phenomena observed in various psychoses gave rise to studies in which the role of sensory deprivation in the origin of hallucinations was established. Modern researchers of the electrophysiological nature of sleep associate the mechanism of hallucination with a shortening of the REM sleep phase with a peculiar penetration of the REM phase into wakefulness (Snyder, 1963). Numerous works of recent decades have revealed a connection between the appearance of various mental disorders, including hallucinations, and disorders of neurotransmitter metabolism in the central nervous system. A significant place is given to disorders of dopamine metabolism and increased activity of dopaminergic structures of the brain. The use in the treatment of patients with psychotropic substances that bind to dopamine receptors, for example, haloperidol, in some cases leads to a sharp decrease in the intensity of hallucinations up to their complete cessation.
Since the discovery of endogenous morphine-like peptides - enkephalins and endorphins (Huges et al., 1975; Telemacher, 1975), indications have appeared that some of them perform mediator functions in specific neuronal systems of the brain. A hypothesis has been put forward about the role of endorphins in the pathogenesis of mental illness (Verebey et a., 1978; Gamaleya, 1979), according to which the latter are associated with a lack of endorphins at receptor sites or with an anomaly of endorphins. Naloxone, an endorphin antagonist, has been shown to reduce auditory hallucinations in patients with schizophrenia.
Kumin Alexander Mikhailovich
“Naming and teaching are not carried out except by voice and sign. When the voices and signs are understood and clarified, the real appearance is revealed.” Kukai (Kobo-Daishi, 774-835)
1. Definitions of verbal illusionism and illusory knowledge.
VERBAL ILLUSIONS (VI) is a substitution of knowledge of the essence: the device of objects, their structure, or the algorithm of processes and the nature of driving forces - with knowledge of the name of these objects or processes. As a result of this replacement, "A verbal mirage arises in the minds of people, which obscures and replaces reality. Sooner or later, life experience and social practice dispel such mirages, but sometimes they can captivate the minds of many people for a long time" / 1 p. 88 ./. The negative consequence of these mirages is ILLUSOR KNOWLEDGE (FROM). "Widely widespread, although little realized VI is IS. Its formation begins from early childhood. When a child asks about something: "What is it?", He receives answers: "This is an ant", "This is a TV", "This electric welding". What knowledge does he get from these answers? It is obvious that he does not receive full knowledge about the essence of the subject to which the question relates. The only knowledge that he acquires is the knowledge of the name of the subject. But if then he is asked: " Do you know what it is?" - he can proudly say: "Of course I know! This is an ant (TV, electric welding). "Knowing the name is taken for knowledge about the subject! So imperceptibly we fall into the captivity of words and, growing up, continue to live in this captivity." / 1 p.88-89/
Words in a person's memory are codes for the actual appearance of objects and their movements. When the brain generalizes several images of the same type, abstract abstract concepts are formed. They allow a person to process a much larger amount of information faster, while distracting from insignificant differences, and at the same time, at a "lower" level, brain structures retain initial knowledge about many specific details. However, to the question, for example, about why all bodies fall to the Earth, even the very first level of sensation, identified and designated by the name - "attraction", can no longer give any answer. To do this, it is necessary to have knowledge of the physical processes occurring at lower levels of matter division (atomic, subatomic, etc.). However, this information remained at the level of "sensation" (movement) of atomic and subatomic particles, and it did not enter the brain, so a person is forced to first arbitrarily encode (designate) phenomena, and then build more complex (physical) models of invisible material processes.
There are many such situations in history. For example, Franklin, not in the least doubting that he was right, "substantiated" such a pragmatic approach to physical knowledge with frank egoism. This approach ensured the presence of IS in science in the future, practically, on a "legal" basis. - "For us, the most important thing is not knowing the way in which nature implements its laws, it is enough to know (name, etc.) these laws themselves. It's nice, of course, to know the truth, but we can ensure the integrity of a porcelain product without it." However, without "this" knowledge, we, unfortunately, will no longer be able to save the life of mankind in the cosmic evolution of planets and stars, replete with cataclysms!
A huge number of people in everyday life do not really need to know how a TV, computer or car works, since knowing the names and operating instructions allows you to use even very complex household and professional appliances. This is also the model of the cell-brain relationship: press - this is an impulse, - get - a picture on the screen or cholesterol in the blood, while the "consumer" is completely indifferent to how this happens. But, unfortunately, at the level of humanity's participation in cosmic evolution, IS already play a huge negative role. They are imperceptibly present in many scientific models and are a latent (hidden, and therefore not resolved for centuries) problem. Because of this, today it is the IS, which is the basis of science, that has become the cause of the crisis of natural science and the brake on the rational and progressive development of mankind!
One can give examples of the presence of IZ in any field of science and religion. First of all, these are myths that explain the forces of nature. In philosophy, it is the "soul" and "free will". In mathematics, this is the number "0". In physics, this is a subjective illusion of the existence of rest and its equivalence with the movement of "bodies"; "attraction" of bodies to each other; and, finally, their movement along "force" or "topological lines". IS are long-term preserved in society, mainly due to the blind faith of most people in the authority of their creators. However, upon closer examination of the IS, it turns out that all of them do not have a mechanism for execution and a clear definition (for checking the verbal model), i.e. they do not have a "real appearance"!!! In order to see the whole danger of the hidden presence of IS in science, as well as to eliminate them, it is necessary to consider how they arose and developed.
2. The history of the appearance of verbal illusions and illusory knowledge.
Language, as a verbal communication system, appears already at the level of communication of fish, birds and animals, and subsequently develops and improves people through living together and collective activities. An important advantage of the language and the messages made on it is the ability to transmit and store information with their help: “Before the advent of writing, the accumulation of knowledge went through oral speech. For many centuries, people through it saved, passed on from generation to generation and, thus, accumulated folk experience" (1 p. 80). "Natural language acts as a means of communication because it is a code in which people transmit information to each other" (1 p. 94). However, at an early stage of human development, oral - verbal communication not only leads to the consolidation of the tribe, the development of logical and figurative thinking, but also contributes to the formation of illusory mythological knowledge. "It differs (from adequate, auth.) in that a person transfers to the surrounding world the properties that he notices in himself: objects (and forces, auth.) of nature appear to him as living, animated beings who, like him have will, desires, thoughts, feelings (i.e., anthropomorphism is born, author). In myths, reality and fiction are indistinguishably combined. But they explain "everything": in them "everything" is made clear, despite the lack of real knowledge.. Myths envelop all forms of human life and act as the main "texts" of primitive culture. Their oral transmission ensures the establishment of a unity of views of all members of the tribal community on the world around. Belief in "one's own" myths holds the community together and at the same time separates its members from strangers, believers in other myths" (1 p. "275). In the opinion of those who believe in this myth, the question of its truth, and even more so, of the grounds for its appearance, should not even arise.
Socrates was executed for defending his views. In 432 BC. e. Anaxagoras was expelled from Athens for dissent (godlessness). In 411. BC e. - Protagoras, who also doubted the existence of the gods. Themistocles died in exile, the last years of his life was under investigation by Pericles. The anathematization of the teachings of N. Copernicus and the tragic fate of D. Bruno testify that "heretics" - that is, people who openly question the generally accepted "truths", are rejected or even destroyed by a solidary, conservative majority if they feel a threat to their existence "their" myths. But, if the object of sincere faith is nevertheless exposed and turned out to be an illusion, this is perceived by many people as a personal insult and causes hatred. So it was in antiquity, so it is now, despite the ostentatious pluralism.
It is the urgent need of many people to maintain mutual understanding in society, accumulated experience and ensure the continuity of knowledge that has the other side of the "medal" - a categorical, and sometimes fanatical rejection of new, even true, knowledge. Namely, thanks to "healthy" conservatism and through well-known words - "empty" names, people imperceptibly preserve IZ. These words are only "fragments" of ancient myths, and their use, as it seems to many, no longer masks ignorance of real processes. However, after the destruction of the old myth, some words (VI) from it pass into new myths, but at the same time they retain their former, anthropomorphic content. Thus, the words known to all ensure the continuity of IZ in the composition of new myths. In already supposedly materialistic theories, they mask the absence of objective knowledge. Empedocles explained all the interactions of material objects (MO) with the help of "love and hate". Aristotle - "the desire of bodies to take their natural places." Newton - "attraction" - the pull of matter to matter. Einstein - movement along "topological lines". What new knowledge has appeared in people's ideas about the mechanism of accelerated displacement of all MOs, their "attraction" or "repulsion"? Has anything changed since the time of Empedocles? NOTHING!
Many examples can be cited of how even today FROM "yesterday's" myths they replace the materialistic understanding of real phenomena: a sprout sprouts, it rains, a charge flows down, etc. It's like connective tissue scars at the site of a healed wound, they supposedly only remind you of how difficult recovery is sometimes achieved, and they are no longer considered a disease, although they replace a full-fledged tissue. Thus, in everyday life and even in science today, many latent IS have been preserved. Anthropomorphic names in them replace the understanding of real processes, for example: "chemical activity", "radiation and absorption", "striving into a potential well". These ISs are included in the orthodox "scientific" picture of the world, they "explain" the movement of matter in modern theories, they are "confirmed" by measurements (at the level of existing accuracy), and therefore they are not noticeable yet. Many logical contradictions and paradoxes, which present undeniable difficulties in explanation, are "swept under the carpet" by clergymen, and it is VI that "closes" them from people's consciousness. Such examples are: "the birth of elementary particles from zero vibrations of the physical vacuum", "power" and "topological lines" or the general "attraction" of matter.
Modern "priests" are well aware that the destruction of faith in existing legends and idealizations in physics will lead to an instant collapse of their mythological teachings. If in the Middle Ages the inviolability of the "temple of God" was vigilantly monitored by the church, suppressing any "heresy", now "academic" science is just as zealously guarding its "laws". Therefore, in the history of human development, there are very few cases when, under the pressure of new facts and empirical knowledge, outdated ideas were revised:
Moses handed down the law from God to the people. Aristotle formulated a system of interrelated ideas about the world. Jesus Christ expounded the theory of the "triunity of Being" and the materiality of the "Spirit of Truth". Ptolemy created a geocentric model of the world. Copernicus discovered the rotation of the Earth and other celestial bodies around the Sun. Galileo and Newton refuted Aristotle, but did not explain the nature of "attraction" and rotation. Einstein "limited" the speed of matter and "curved" space-time, but did not explain the mechanism of acceleration and rotation of matter. Planck discovered the quantum of action, which has, in addition to momentum, an angular momentum - a spin with the dimension of a moment of rotation. But neither relativistic nor quantum mechanics have revealed the nature of "attraction" and rotation of MO, which remain a mystery.
Gustave Le Bon writes: “If ideas can only have an impact after they have slowly descended from the conscious spheres into the unconscious, it is not difficult to understand how slowly they must change, and also why the guiding ideas of any civilization are so few and take so long to develop."
The "New Testament", or rather, the "Gospel" is just such a case. The materialistic teaching, given to people and far ahead of the modern knowledge of people in revealing the truth, has not yet been understood, and therefore rejected by science. The essence of the paradox lies in the fact that no one could imagine the basis of the "trinity" as a materialistic model. People continue to believe in the self-sufficiency of pragmatism, which uses subjective or anthropomorphic concepts (Galileo, Newton, Einstein). Modern theories are compatible with the idealism of mathematics (1-1=0), whose accounting "ego trophic" logic is accepted by most physicists as the true proto-theory for physics. (See the series of articles by the author entitled: "Evolutionary Materialism".)
For several centuries after the appearance of Jesus Christ to the people, through the "efforts" of medieval theologians, his materialistic teaching turned out to be turned into a scholastic discourse about the immaterial soul and the spiritual world. The objective doctrine of the material world was primitively interpreted at the level of everyday images, the only ones available, both at that time, and, unfortunately, even now. Then science, which grew out of the rejection of medieval scholasticism, itself began to zealously guard the idealism cleverly hidden behind idealizations, which lies at its foundation. The nature of such a reincarnation - from birth with a revolutionary content to conservatism in old age - is well shown by B. Dunham in his book "Heroes and Heretics" using the example of political history.
Although the truth set forth in the "New Testament" was supposed to be deciphered by science, it still has not found the necessary cipher, because. The "spirit of truth" is not yet measurable. However, the parables and sermons of Jesus Christ, thanks to the activity of his disciples, have survived to this day and can be deciphered at any time, as soon as the correct "key" is found. In the meantime, not understanding, and because of this not accepting, the true knowledge encoded in the "New Testament", people are replacing the truth - FROM, which consoles them. Therefore, Jesus Christ says: "I will ask the Father, and he will give you another comforter to be with you forever, the Spirit of truth, whom the world cannot receive, because it does not see Him and does not know Him." However, until the vicious circle of idealism is broken, we will not understand the true meaning of these words. Today it is necessary to find those links in the chain of formation of scientific knowledge, where there was a distortion of objective reality. Only by replacing illusions with objective knowledge, humanity will be able to get out of the impending systemic crisis. Already noticed by many experts, the growing comprehensive crisis: scientific, energy, social, economic, environmental - makes us return to the roots of the "tree of knowledge" and once again analyze the entire history of the formation of modern science, starting from its foundations!
3. Fatal mistakes of the classics.
The basis of the incorrect description of the laws of nature was laid in physics, strange as it may seem at first, - Galileo. He formulated two conclusions: the first, that without impact on bodies, they rest or move in a straight line and uniformly (although before that, circular motion was considered natural) and the second, that bodies of any weight fall to the Earth equally quickly. And today we continue to believe that the acceleration of the fall does not depend on the mass of bodies - but both of these conclusions are not true! Then Newton made his contribution to the idealization of physics. He "explained" the accelerated displacement of bodies towards each other not by a physical model (as Lessage, Lomonosov, Poisson, Cartran and other materialists did), but by a hypothesis consisting of just one word - "attraction"! The mathematical apparatus that Newton specially created to calculate the displacement of bodies is also built on an erroneous assumption - on the hypothesis of a continuous and linear division of any physical quantity to an arbitrarily small mathematical quantity, which is also not true! Unfortunately, the followers of Newton resignedly agreed with the fact that the laws of mechanics do not contain the definition and history of the origin of the "body" itself - mass (inertial, inertial or gravitational). That is why mechanics begins with an unacceptable idealization - the transformation of MO into a "material" point, which has neither size nor structuring mechanism. If we do not know how the material compaction was formed, then we can fantasize about the cause and law of its movement. The range of such fantasies is wide: from the assumption of the possibility of the complete absence of any influence on the "body" (Galileo-Newton), to changing the motion of the MO by "power" or "topological lines" (Faraday-Maxwell, Einstein). But, without knowing the law (algorithm) of building matter from matter, it is impossible to correctly describe the law of motion of MO!
Today, even the most perfect physical schemes of the interconversion of "elementary" particles still do not in any way indicate the method of their formation, since this is a very transient process. For example, the process of annihilation of an electron and a positron or their simultaneous "birth". Moreover, according to Maxwell's theory, such a process cannot take place, even in principle. One of its main conclusions reads: "The simultaneous birth of equal charges of the opposite sign at different points in space is impossible." (3 p47). But an electron and a positron are born from two gamma quanta! Consequently, their birth occurs at a point whose dimensions are equal to zero. This is called - we came to where we left - into idealism!
In addition, the reason for today's distorted understanding of really occurring processes lies in the fact that initially in physics, as an idealization, the method of describing the movement of "bodies" in closed systems was unlawfully accepted! In fact, MO in a closed system cannot form and exist, and there is only one dimension in nature (this is the measurement of MO displacement), but in different directions!
From the following articles you will learn that "bodies" - MOs arise and exist only as rotating material systems (VMS) in flowing streams of rotating matter - because they are their integral part. I. Prigogine introduced a new definition for such systems - nested. Nested systems are such systems through which flows of matter “flow”. From the “cooled down” particles of the flowing flows at the “bifurcation points”, MOs are born, which then exist for a long time as material systems rotating around the center of mass, consisting of the same particles as the flowing flows themselves. "In turn, the visible and audible are not self-existent; in fact, they only carry out the "Word, Thought and Action" of the Buddha - the "body of the Law". In the author's hypothesis, the "body of the law" are particles of a new level of division of matter - Darks. ( Dark - dark, invisible) But physicists today, instead of a materialistic understanding of real processes based on ancient Eastern wisdom, have introduced a new VI - "physical vacuum". This double standard, familiar to science, and logical nonsense, and another example of VI is physical, but emptiness!!!
However, if it is not possible for a person to directly "see" the process of assembling microparticles, then, perhaps, in the reality surrounding him, one can find at least an analogue of the secret work of the "field" for the "birth" of the IUD? Fortunately, in nature, on a larger scale, there are processes similar to the formation of "elementary particles" from "particles of a junior level" - this is the evolutionary formation of stars, planets and galaxies. If we scrupulously and correctly consider the motion of matter in these processes, then we can understand the principle of the hidden force that leads these processes, and the logic of its action, which leads the planets, stars and their systems to "crowding" into a spherical shape and rotation. Further, it can be assumed that it is this principle that should "work" as a universal law of the construction of matter from matter at all other (including so far invisible) levels of its division.
Bibliography
For the preparation of this work, materials from the site http://www.sciteclibrary.ru were used.
