30. 11. 2018
Consciousness Attention Perception 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 consciousness
. main features . vigility . lucidity . self-awareness - 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 hallucinations (provoked illusions), 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 = delirium tremens (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 . illusion 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, depression, negative syndrome of schizophrenia . 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 senses . Sight . Hearing . Taste . Smell . Touch
. proprioception . nociception . balance/vestibular sense . sense for gravity
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Sensory organs are only channels for stimuli coming to the brain
. sensation – registration/reaction to stimulus . 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, phantom limb pain)
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. hallucination
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 . emotions . 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
. auditory hallucination . 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 disease (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, drugs; 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
. formication . Tactile hallucination involving the sensation that tiny insects are crawling over the skin. Seen in cocaine 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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