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Psychiatry 1 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 1 30. 11. 2018 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 2 30. 11. 2018 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” 3 30. 11. 2018 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) 4 30. 11. 2018 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 5 30. 11. 2018 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 6 30. 11. 2018 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 7 30. 11. 2018 8 30. 11. 2018 Illusional perception 9 30. 11. 2018 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 10 30. 11. 2018 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) 11 30. 11. 2018 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. " 12 30. 11. 2018 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 13 30. 11. 2018 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) 14.
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