30. 11. 2018

Consciousness Attention Imagination

Ján Pečeňák Dpt. of Psychiatry, FM UC, Bratislava

Conciousness . integrative function . based on normal function of CNS . higher integration of feelings/activities to inner world (space) which is very subjective (knowledge of existence) . problem of assessment . patients with severe dementia / intellectual deficit / intoxications / severe acute pschosis

Main features of

. main features . vigility . lucidity . self- - idiognosia

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Vigility

. vigility (alertness, arousal) . reticular formation . responsiveness . quantitative dimension of consciousness . somnolence, sopor, coma

Lucidity of consciousness

. qualitative dimension . clearness of consciousness . assessed by orientation . who are you? - person . where we are? - place . what time and date is it? - time . why we are here? - situation

. people with sever deficit of intelligence

Qualitative disturbances of consciousness . clouding of consciousness . patient is able to answer appropriately if contact is forced and structured . confusion . problem with orientation, anxiety, uneasiness, unpredictable behavior

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Consciousness - delirium

. syndrome . qualitative disturbance (orientation) . fluctuation of state / worsening during night . attention disturbed . disturbed speech – up to severe incoherence . psychotic features – often visual (provoked ), delusions, misinterpretation of situation . memory impairment (sometimes identified ex-post) . disorganized behavior . aggression, non-compliance with treatment procedures, psychotically motivated behavior

Delirium - forms

. “superimposed on” . dementia . hypoxia, metabolic disbalance, fever …. . hyperkinetic vs. hypokinetic . furibund delirium (delirium acutum grave) vs. foloccigenium . working delirium (patient is doing working activity) . alcoholic, usually withdrawal = (microzoopsiae)

Obnubilation

. called dreamy states . short start, short end . may be the sign of non-seizure epilepsy . present at the top of pathological affect . automatic behavior (could be a little strange, but organized) without clear aim known to a person . vigil-ambulatory form . almost complete amnesia . “island amnesia”

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Idiognosis . self awareness, “me” . ability to recognize difference between “me” and “not me” . changes . depersonalization . feeling of disconnection from mind (mental self) or body . alteration of personality (multiple personality) . “broaden consciousness” – intoxication with hallucinogens or intensive meditation . dreams . near death experience . déjà vu – I know that I am first time in some situation but feel like this situation was experienced in the past (the opposite is jamais vu) . psychosis – loss of ability to differentiate inner and outer processes

Sleep . physiological change of consciousness . slow wave sleep needed for feeling relaxed . dreams during the REM phase . sleep disturbances – special topic

Attention

. direction of mental activity at the time . voluntary (learning) vs. involuntary (obsessive intrusion) . dimensions . concentration – focusing attention to some topic/event/activity . tenacity of attention – ability to stay focused . sustained attention (tonic alertness) . distribution – ability to be focused on different directions (or quickly change focus?) . vigilance – ability to identify important signal from background (crying child)

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Disturbances of Attention . Hypoprosexia .  concentration,  tenacity,  distribution  vigilance . exhaustion, , negative syndrome of . Aprosexia . manifests in severe states like catatonia, severe melancholic depression, dissociation . Hyperprosexia . ↑ ↑ intensity of concentration without ability to distribute attention . hypochondriacs, paranoid persons, jealousy

Perception

Perception . traditional five . Sight . . . Smell . Touch

. . nociception . balance/vestibular . sense for gravity

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Sensory organs are only channels for stimuli coming to the

. sensation – registration/reaction to . depends on physiology of sensory organs . we can evaluate this reaction e.g. by evoked potentials

. perception (percept), also called apperception . sensory information processed by brain circuits . interpretation of sensations . some percepts are independent from sensory organs (voices in the head, )

Subliminal perception

. information which is not creating the percept but is influencing our mind . advertisement, marketing – mind control without awareness . influence on brain activity can be identified by fMRI

Sensory distortions

. change of quality and intensity of external signals . hyperacusis . micropsia, macropsia . sensitivity to light

. higher cognitive functions: . perceptual aphasia

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Quantitative disturbances

. inhibition of perception . exhaustion, depression . augmentation of perception . mainly intoxications . stimulants . halucinogenes

Qualitative disturbances

illusion vs.

distortion of present sensation/percept object / stimulus without object / stimulus

Illusions

. real external object is perceived differently . because of physical / physiological characteristics of object an sensory organs . because real object is combined with imagery . attention . . pareidolic illusions

. completion illusions . tendency to finish (completed) an object

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Illusional perception

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Perception - hallucinations . hallucination . False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved. . structure . elementary . noises . spots of light (photoms) . complex . sentences, person, animals . scenic . scenes with several people and complex actions . closeness to reality . normal figure/animal vs. monster

Hallucinations cont.

. modality . auditory, visual, tactile (haptic), gustatory, olfactory, somatic/coenestetic, proprioceptive (kinestetic (flying, ) . inadequate – hearing words by the teeth

. hallucinosis . State in which a person experiences hallucinations without any impairment of consciousness

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Hallucinations and pseudo- hallucinations . pseudo-hallucinations

. In our psychopathology: . acceptance by the patient that his/her perception is distorted

. in English literature . hallucination which are in the body (brain) of patient . in our terminology = intra-psychic hallucinations

Perception - hallucinations

. . False perception of sound, usually voices (verbal – auditory), but also other noises, such as music. . Most common hallucination in psychiatric disorders

. Schneider`s first rank symptoms of schizophrenia . hearing the thoughts aloud . voices which describe “online” one's action . hearing more voices who are arguing

Perception - hallucinations

. visual hallucination . always think of:

. intoxication / withdrawal / delirium . somatogenic delirium . brain (organic etiology)

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Perception - hallucinations

. olfactory hallucination . Hallucination primarily involving smell or odors . quite usual in paranoid syndrome in order people (feeling of gas, ; somebody wants to intoxicate or to torture me) . tumors in limbic system

. gustatory hallucination . hallucination primarily involving taste

. somatic hallucination (coenestetic) . Hallucination involving the perception of a physical experience localized within the body

. haptic hallucination . Hallucination of touch

Perception - hallucinations

. extracampine hallucination . outside the normal range of sensory organ . negative hallucination . not feeling something that exists . Seglas`s hallucinations . somebody is moving my mussels (lips – speech is produced)

Combination of Seglas`s psychomotor hallucination/ Kandinski Clerembault syndrome

Patient: . When it first appeared at home, it was a pleasure at first to have at least one to talk to. But now I'm already bothered. When I came, he forbade me to go with an ambulance, he commanded me everything. I felt a throat cut done by the voice, someone from outside, and he manipulated my hand, it moved, the same with my leg. I thought I was obsessed with a devil. First it was when I was alone, but now she talks through my mouth even when I'm with someone. When I write, she does not bring my hand. "

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Perception - hallucinations

. . Tactile hallucination involving the sensation that tiny are crawling over the skin. Seen in addiction and delirium tremens.

. hypnagogic hallucination . Hallucination occurring while falling asleep, not ordinarily considered pathological. . hypnopompic hallucination . Hallucination occurring while awakening from sleep, not ordinarily considered pathological.

Capgras syndrome Fregoli syndrome . hallucination or delusion? Capgras . irrational belief that someone they know or recognize has been replaced by an imposter Fregoli . different people are in fact a single person who changes appearance

Psychosensoric disturbances

. lilliputian hallucination (micropsia) . Visual sensation that persons or objects are reduced in size; more properly regarded as an illusion . macropsia . surroundings like accelerated movie

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Gnostic disturbances

. more neurological symptoms . Babinski's anosognosia . (in mental disorder “lack of insight”) . phantom limb

Imagination . can be retrieved from the memory (reproductive imagination) . vivid image has pictorial - graphic character (eidetic - eidetism) . artists, autistic children, . images are much often blurred, vague . symbolic meaning . intentional (active, voluntary, productive) imagination . “top down” (regulated by prefrontal cortex) . creativity, fantasy . unintentional imagination . free associations, dreams, day dreaming . unwanted (intrusive) imagination . similar to intrusive thoughts (obsessions)

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