Sensory disorders: types, symptoms, treatment. Sensory and gnostic disorders. Disorders of sensation and perception Question: Hallucinations. Objective signs of hallucinations. Clinical characteristics and diagnostic value

This group includes perception disorders:

• own body,
• spatial relations,
• forms of surrounding reality.

They are very close to illusions, but differ from the latter in the presence of criticism.

The group of sensory synthesis disorders includes:

• depersonalization,
• derealization,
• violations of the body diagram,
• a symptom of something already seen (experienced) or never seen, etc.

Depersonalization- this is the patient’s belief that his physical and mental “I” have somehow changed, but he cannot explain specifically what and how has changed. There are types of depersonalization.

Somatopic depersonalization- the patient claims that his bodily shell, his physical body has changed (the skin is somehow stale, the muscles have become jelly-like, the legs have lost their former energy, etc.). This type of depersonalization is more common with organic brain lesions, as well as with some somatic diseases.

Autopsychic depersonalization- the patient feels a change in the mental “I”: he has become callous, indifferent, indifferent or, conversely, hypersensitive, “the soul cries for an insignificant reason.” Often he cannot even verbally explain his condition, he simply states that “the soul has become completely different.” Autopsychic depersonalization is very characteristic of schizophrenia.

Allopsychic depersonalization- a consequence of autopsychic depersonalization, a change in the attitude towards the surrounding reality of an “already changed soul.” The patient feels like a different person, his worldview and attitude towards loved ones have changed, he has lost the feeling of love, compassion, empathy, duty, the ability to participate in previously beloved friends. Very often, allopsychic depersonalization is combined with autopsychic depersonalization, forming a single symptom complex characteristic of the schizophrenic spectrum of diseases.

A special variant of depersonalization is the so-called weight loss. Patients feel how their body weight is steadily approaching zero, the law of universal gravitation ceases to apply to them, as a result of which they can be carried into space (on the street) or they can soar to the ceiling (in a building). Understanding with their minds the absurdity of such experiences, patients nevertheless, “for peace of mind,” constantly carry some kind of weight with them in their pockets or briefcase, not parting with them even in the toilet.

Derealization- this is a distorted perception of the surrounding world, a feeling of its alienation, unnaturalness, lifelessness, unreality. The surroundings are seen as painted, devoid of vital colors, monotonously gray and one-dimensional. The size of objects changes, they become small (micropsia) or huge (macropsia), extremely brightly lit (galeropia) until a halo appears around, the surroundings are colored yellow (xanthopsia) or purplish-red (erythropsia), the sense of perspective changes (porropsia) , shape and proportions of objects, they seem to be reflected in a distorting mirror (metamorphopsia), twisted around their axis (dysmegalopsia), objects double (polyopia), while one object is perceived as many photocopies of it. Sometimes there is rapid movement of surrounding objects around the patient (optical storm).

Derealization disorders differ from hallucinations in that there is a real object present, and from illusions in that, despite the distortion of shape, color and size, the patient perceives this object as exactly this, and not any other. Derealization is often combined with depersonalization, forming a single depersonalization-derealization syndrome.

With a certain degree of convention, a special form of derealization-depersonalization can include symptoms of “already seen” (deja vu), “already experienced” (deja vecu), “already heard” (deja entendu), “already experienced” (deja eprouve), “ never seen" (jamais vu). The symptom of “already seen”, “already experienced” is that the patient, who finds himself for the first time in an unfamiliar environment, an unfamiliar city, is absolutely sure that he has already experienced exactly this situation in the same place, although with his mind he understands: in fact, he is here for the first time and never seen this before. The “never seen before” symptom is expressed in the fact that in a completely familiar environment, for example in his apartment, the patient experiences the feeling that he is here for the first time and has never seen this before.

Symptoms of the “already seen” or “never seen” type are short-term, lasting a few seconds and often occur in healthy people due to overwork, lack of sleep, and mental stress.

Close to the “never seen” symptom is the “object rotation” symptom, which is relatively rare. It manifests itself in the fact that a well-known area seems to be turned upside down by 180 degrees or more, and the patient may experience short-term disorientation in the surrounding reality.

The symptom of “violation of the sense of time” is expressed in the feeling of accelerating or slowing down the passage of time. It is not pure derealization, since it also includes elements of depersonalization.

Derealization disorders, as a rule, are observed with organic brain damage with localization of the pathological process in the region of the left interparietal groove. In short-term variants, they are also observed in healthy people, especially those who suffered “minimal brain dysfunction” in childhood - minimal brain damage. In some cases, derealization disorders are paroxysmal in nature and indicate an epileptic process of organic genesis. Derealization can also be observed during intoxication with psychotropic drugs and narcotic drugs.

Violation of the body diagram(Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of one’s body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head increases to the size of a room, his torso either shortens or lengthens. Sometimes there is a feeling of pronounced disproportion between body parts. For example, the head shrinks to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Sensations of changes in the body diagram can appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of body diagram disorders is their correction by vision. Looking at his legs, the patient is convinced that they are of normal size, and not multi-meter; looking at himself in the mirror, he discovers the normal parameters of his head, although he experiences the feeling that his head reaches 10 m in diameter. Vision correction ensures that patients have a critical attitude towards these disorders. However, when vision control ceases, the patient again begins to experience a painful feeling of changes in the parameters of his body.

Violation of the body diagram is often observed in organic pathologies of the brain.

Disorders of sensations. Clinical characteristics.

Sensation is the simplest mental process; reflection of individual properties of objects when they impact the senses.

Pathology of sensations:

A. change in intensity
Hypesthesia - reduced sensitivity to stimuli (increased threshold of perception). Hot things feel warm, bright lights feel dull, loud sounds feel soft, etc. Occurs in depressive syndrome, asthenic syndrome, and in states of loss of consciousness.
Anesthesia – lack of sensation (for example, lack of temperature or pain sensitivity). Occurs in neurological diseases, in catatonic syndrome.
Hyperesthesia - increased sensitivity to stimuli (lowered perception threshold). Sounds are perceived as unnaturally loud, the usual lighting is perceived as bright, sometimes blinding, causing pain in the eyes. Hyperalgesia – increased pain sensitivity. Most often observed with asthenic syndrome.
B. qualitative disorders
Paresthesia
Senestopathies - painful, often extremely painful sensations, are localized in the internal organs (more often) or in various superficial areas of the body (in the skin, under the skin; less often) and do not have objective reasons for their occurrence (ascertained by objective examination methods).
Features of senestopathies: Polymorphism, Unusual, Unpleasant, Persistent nature of sensations, Localization unusual for the symptoms of somatic diseases.
Occurs in depression, schizophrenia and organic brain diseases.

Question: Asthenic syndrome. Clinical characteristics and diagnostic significance. Treatment of asthenic conditions.

Question: Illusions.Clinical characteristics and diagnostic value.

Question: Hallucinations. Objective signs of hallucinations. Clinical characteristics and diagnostic value.

Hallucinations are the perception of images that appear without a real stimulus, a real object (false, imaginary perception, perception without an object).
1. Classification by analyzers:
Visual (elementary - photopsia; macro- and microptic; scene-like; hypnagogic - before falling asleep)
Auditory (elementary - acoasms; in the form of speech - verbal; mono- and polyvocal; condemning, threatening, praising, commenting, imperative - commanding)
Tactile - a clearly differentiated sensation (as opposed to senestopathies) of the presence of animate (insects, worms, etc.) or inanimate (glass, metal dust, sand) objects on the surface of the skin, inside or under it, in internal organs
Flavoring
Olfactory
2. According to the mechanism of formation: true and pseudohallucinations

True hallucinations are characterized by: Extraprojection (into the surrounding space; the image enters the brain using the senses), the hallucinatory image is perceived as real as other objects, objective signs of the presence of hallucinations are always expressed (the behavior of patients depends on what they perceive) .
Pseudohallucinations are characterized by: Intraprojection (into subjective space; the image enters the brain bypassing the analyzing system), the hallucinatory image does not have the character of a real object, there is a feeling of “being made”, influence from the outside (arise in connection with delusions of persecution, for example, words are transmitted at a distance by special device into the brain), objective signs of hallucinations may be absent. Most often, pseudohallucinations occur within the Kandinsky-Clerambault syndrome in paranoid schizophrenia.

Question: Sensory synthesis disorders (psychosensory disorders). Clinical characteristics and diagnostic significance.

Psychosensory disorders are a distorted perception of really existing objects in the surrounding world, one’s own body, mental processes or one’s own “I”. These include:

This group includes disturbances in the perception of one’s own body, spatial relationships and the shape of the surrounding reality. They are very close to illusions, but differ from the latter in the presence of criticism.

The group of sensory synthesis disorders includes depersonalization, derealization, disturbances in the body diagram, a symptom of something already seen (experienced) or never seen, etc.

Depersonalization - this is the patient’s belief that his physical and mental “I” have somehow changed, but he cannot explain specifically what and how has changed. There are types of depersonalization.

Somatopsychic depersonalization - the patient claims that his bodily shell, his physical body has changed (the skin is somehow stale, the muscles have become jelly-like, the legs have lost their former energy, etc.). This type of depersonalization is more common with organic brain lesions, as well as with some somatic diseases.

Autopsychic depersonalization - the patient feels a change in the mental “I”: he has become callous, indifferent, indifferent or, conversely, hypersensitive, “the soul cries for an insignificant reason.” Often he cannot even verbally explain his condition, he simply states that “the soul has become completely different.” Autopsychic depersonalization is very characteristic of schizophrenia.

Allopsychic Depersonalization is a consequence of autopsychic depersonalization, a change in the attitude toward the surrounding reality of an “already changed soul.” The patient feels like a different person, his worldview and attitude towards loved ones have changed, he has lost the feeling of love, compassion, empathy, duty, the ability to participate in previously beloved friends. Very often, allopsychic depersonalization is combined with autopsychic depersonalization, forming a single symptom complex characteristic of the schizophrenic spectrum of diseases.

A special variant of depersonalization is the so-called weight loss. Patients feel how their body weight is steadily approaching zero, the law of universal gravitation ceases to apply to them, as a result of which they can be carried into space (on the street) or they can soar to the ceiling (in a building). Understanding with their minds the absurdity of such experiences, patients nevertheless, “for peace of mind,” constantly carry some kind of weight with them in their pockets or briefcase, not parting with them even in the toilet.

Derealization - this is a distorted perception of the surrounding world, a feeling of its alienation, unnaturalness, lifelessness, unreality. The surroundings are seen as painted, devoid of vital colors, monotonously gray and one-dimensional. The size of objects changes, they become small (micropsia) or huge (macropsia), extremely brightly lit (galeropia) until a halo appears around, the surroundings are colored yellow (xanthopsia) or purplish-red (erythropsia), the sense of perspective changes (porropsia) , shape and proportions of objects, they seem to be reflected in a distorting mirror (metamorphopsia), twisted around their axis (dysmegalopsia), objects double (polyopia), while one object is perceived as many photocopies of it. Sometimes there is rapid movement of surrounding objects around the patient (optical storm).

Derealization disorders differ from hallucinations in that there is a real object, and from illusions in that, despite the distortion of shape, color and size, the patient perceives this object as this particular object, and not any other. Derealization is often combined with depersonalization, forming a single depersonalization-derealization syndrome.

With a certain degree of convention, symptoms can be attributed to a special form of derealization-depersonalization “already seen” (deja vu), “already experienced” (deja vecu), “already heard” (deja entendu), “already experienced” (deja eprouve), “never seen” (jamais vu). The symptom of “already seen”, “already experienced” is that the patient, who finds himself for the first time in an unfamiliar environment, an unfamiliar city, is absolutely sure that he has already experienced exactly this situation in the same place, although with his mind he understands: in fact, he is here for the first time and never seen this before. The “never seen before” symptom is expressed in the fact that in a completely familiar environment, for example in his apartment, the patient experiences the feeling that he is here for the first time and has never seen this before.

Symptoms of the “already seen” or “never seen” type are short-term, lasting a few seconds and often occur in healthy people due to overwork, lack of sleep, and mental stress.

Close to the "never seen before" symptom "object rotation" relatively rare. It manifests itself in the fact that a well-known area seems to be turned upside down by 180 degrees or more, and the patient may experience short-term disorientation in the surrounding reality.

Symptom "impaired sense of time" is expressed in a feeling of acceleration or deceleration of time. It is not pure derealization, since it also includes elements of depersonalization.

Derealization disorders, as a rule, are observed with organic brain damage with localization of the pathological process in the region of the left interparietal groove. In short-term variants, they are also observed in healthy people, especially those who suffered in childhood “minimal brain dysfunction” - minimal brain damage. In some cases, derealization disorders are paroxysmal in nature and indicate an epileptic process of organic genesis. Derealization can also be observed during intoxication with psychotropic drugs and narcotic drugs.

Violation of the body diagram(Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of one’s body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head increases to the size of a room, his torso either shortens or lengthens. Sometimes there is a feeling of pronounced disproportion between body parts. For example, the head shrinks to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Sensations of changes in the body diagram can appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of body diagram disorders is their correction by vision. Looking at his legs, the patient is convinced that they are of normal size, and not multi-meter; looking at himself in the mirror, he discovers the normal parameters of his head, although he experiences the feeling that his head reaches 10 m in diameter. Vision correction ensures that patients have a critical attitude towards these disorders. However, when vision control ceases, the patient again begins to experience a painful feeling of changes in the parameters of his body.

Violation of the body diagram is often observed in organic pathologies of the brain.

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Marilov V. V
M25 General psychopathology: Textbook. aid for students higher textbook establishments. - M.: Publishing center "Academy", 2002. - 224 p. ISBN 5-7695-0838-8 V uch

Pathology of sensations
Sensation is an elementary act of the cognitive process, a function of reflecting individual qualities and properties of the surrounding reality. Philo- and ontogenetically, sensation is one and

Illusions
Illusions are the erroneous, altered perception of really existing objects or phenomena, “perversion of perception” (J. Esquirol), “delusion of the imagination” (F. Pinel), “imaginary perception

Hallucinations
Hallucinations are perception disorders when the patient sees, hears and feels something that does not actually exist in a given situation. This is the so-called perception without an object.

Thought disorders
Thinking is the highest form of human mental activity, which includes the active processing of sensory sensations and perceptions, i.e. this is an indirect reflection of connections and

Pathology of the associative process
The acceleration of thinking is expressed in the fact that, conditionally, more associations are formed per unit of time than normal, while their quality suffers. Quickly replacing each other

Pathology of judgment
The pathology of judgment includes obsessive states, overvalued, delusional and delusional ideas. Obsessive states (obsessions) T

Super valuable ideas
Extremely emotionally charged and plausible ideas that are not ridiculous in nature, but for some reason have

Delusional ideas
Delirium is an incorrect, false conclusion that has enormous significance for the patient, permeates his entire life, always developing on a pathological basis (against the background of mental

Delusional ideas
Delusional (delusion-like) ideas are false conclusions closely associated with emotional disorders; they arise in the structure or at the peak of manic and depressive disorders.

Delusional syndromes
Paranoid syndrome is a plausible, systematized delusion of a monothematic nature, devoid of absurdity. Another component of the JAV syndrome

Pathology of memory
Memory is a special type of mental activity associated with the perception (reception), retention (retention) and reproduction (reproduction) of information. Memory is integral

Pathology of intelligence
Intelligence is a concept that combines a person’s ability to rational cognition, judgment, inference, analysis and synthesis, separating the main from the secondary, however

Congenital dementia
Depending on the level of intellectual underdevelopment, there are three degrees of severity of oligophrenia - idiocy (severe mental underdevelopment), imbecile

Dementia
If people with mental retardation are “poor from birth,” then those suffering from dementia are “ruined rich.” Dementia is low-mindedness that develops as a result

Symptoms of emotional disturbances
Pathological affect is a violent emotional reaction of anger or rage that occurs in response to insignificant stimuli and is accompanied by aggressive actions.

Manic syndrome
This syndrome is manifested by the so-called manic triad of main symptoms: pathologically elevated mood (euphoria), acceleration of the associative process and motor activity.

Depressive syndrome
Depressive syndrome is characterized by a triad of interrelated symptoms: pathologically low mood (dysthymia), slowing of the associative process and motor inhibition.

Apathetic syndrome
Apathy (indifference) as a symptom is often combined with abulia (lack of will), forming into a single apathetic-abulic syndrome, also called apathetic. This is the final state of schizophrenia

Will and its violations
Will is a mental process that manifests itself as the ability to choose actions related to overcoming internal and external obstacles, i.e. this is an individual ability

Hypobulia
A decrease in volitional activity can manifest itself in various mental illnesses, especially in schizophrenia and stuporous states of various origins. Katatonic

Parabulia
This perversion of volitional activity is especially clearly manifested in catatonic excitement. Parabulia is expressed in chaotic, stereotypical, meaningless movements made in

Drive disorders
This group of pathological conditions includes a perversion of instinctive desires for food, a violation of the instinct of self-preservation and disorders of sexual desire. Perverted

Impulsive drives
An irresistible craving for certain actions and deeds, without internal struggle, completely takes possession of the patient’s consciousness and determines his behavior. Impulsive drives are perceived as more

Psychomotor disorders
This group of disorders includes manifestations of stupor (catatonic, depressive, psychogenic), catatonic agitation, hebephrenic syndrome (all described above) and

Differences between epileptic and hysterical seizures
Signs Epileptic seizure Hysterical seizure Onset Sudden Psychological

Symptoms of impaired consciousness
Consciousness is the highest form of reflection of reality and the ability to purposefully influence it. Pathology of consciousness accompanies many mental and severe somatic illnesses.

Stun
Stunning, or “paresis of mental activity” (Walter-Buell), is characterized by an increase in the threshold of excitability and impoverishment of mental activity in the form of a slowdown in mental processes.

Delirium
This is one of the most common syndromes of impaired consciousness. In its expressed form, it is characterized by an influx of vivid illusions and hallucinations, disorientation in time and m

Oneiric syndrome
Oneiric clouding of consciousness (oneiroid, dream-like, dream-like disturbance of consciousness) resembles a waking dream - this is a clouding of consciousness with an influx of involuntarily advancing fantastic

Twilight stupefaction
This syndrome is characterized by a sudden onset, the presence of a pronounced intense affect of causeless anger and rage, illusory-hallucinatory symptoms, secondary delusions

Amentia
Amentia (amentive stupefaction) - a deep degree of impairment of consciousness is characterized by incoherence of all types of mental activity. There is severe disorientation in

Self-awareness disorders
Self-awareness is the separation of oneself from the objective world, awareness of one’s personality, one’s body, one’s mental functions. Self-awareness (the private side of consciousness) includes special

Speech disorders
Alalia - loss of the ability to speak. Aphasia is a speech disorder in which speech is partially or completely lost.

Attention disorders
Absent-mindedness - impaired ability to concentrate attention for a long time, concentration with constant transitions from one phenomenon to another, on nothing

Neurotic sleep disorders
With many mental illnesses, various disturbances in the sleep formula are observed - the process of falling asleep, waking up, the duration of sleep, its depth, and distortion also occurs.

Asthenic syndrome
This condition is characterized by irritable weakness, increased excitability, quickly followed by exhaustion, pronounced fatigue, incontinence.

Obsessive Obsessive Syndrome
The clinical picture of this neurotic syndrome is dominated by various obsessions - various phobias, anxious doubts, “mental chewing gum”, blasphemous thoughts, obsessive thoughts.

Hypochondriacal syndrome
Exaggerated concern for one’s health manifests itself in a significant exaggeration of the severity or in the experience of a disease that actually does not exist. Patients constantly listening

Psychopathic conditions
In psychopathic states, mental impairment is expressed in disharmony, imbalance, instability, weakness of various mental processes, disproportionate

Cultural syndromes
Cultural psychiatry (cross-cultural psychiatry, ethnopsychiatry, comparative psychiatry) studies the influence of certain cultural characteristics (beliefs, legends, prejudices)

Corot syndrome
It was first described in 1895 and still continues to attract the attention of psychiatrists as a typical variant of regional cultural mental pathology. Isolated at first only in men

Munchausen syndrome
The pathological condition described in 1951 by the English researcher R. Asher, named after the notorious Baron Munchausen, is still the subject of close attention.

Psychosomatoses
Psychosomatic disorders are considered to be disorders of the functions of organs and systems, in the origin and course of which the leading role belongs to the influence of psychotraumatic factors (stress,

The concept of psychosomatic cycles
To a certain extent, these problems can be solved by the hypothesis about the formation and subsequent self-development of psychosomatic cycles within the framework of psychophysiological syndromes (diseases). D

Functional dysphagia
Functional dysphagia occupies an important place among dyspepsia of non-ulcer origin. More often this pathology is observed in young and middle-aged people of both sexes, but with some

Personal characteristics of patients with dysphagia

Psychogenic nausea and vomiting syndrome
In clinical practice, nausea and vomiting are quite common; these are symptoms of many somatic and mental diseases. Often their appearance indicates aggravation of the

Personal characteristics of patients
Test Personality Traits Sick Healthy R Eysenck Extraversion

Psychogenic gastralgia syndrome
Gastralgia, along with neurogenic nausea and vomiting, is a manifestation of the so-called irritable stomach syndrome. A person feels a sharp pain in the stomach, reminiscent of an ulcer,

Personal characteristics of patients with gastralgia
Test Personality Traits Sick Healthy R Eysenck Extraversion

Irritable bowel syndrome
This is one of the most common types of psychosomatic pathology. This syndrome (SRTC, synonyms: irritable bowel, unhappy bowel, mucous colitis, spastic

Personality characteristics of patients with SRTC
Test Personality Traits Sick Healthy R Eysenck Extraversion

Correlation between age and symptoms in SRTC
Pairs of symptoms Age of maximum severity of the symptom Age-anxiety up to 30 years

Correlation of depression with other symptoms in IBS
Pairs of signs Depression increases Depression-age Before 25 and after 50 years Depression

Dependence of somatization of affect on other symptoms of IBS
Pairs of signs Growth of somatization Somatization-age Up to 35-40 years Somatization-three

The relationship between anxiety and other symptoms in IBS
Pairs of signs Anxiety is growing Anxiety-age Up to 30 years Anxiety-depression

Data from clinical material on mental alienation syndrome in various diseases show that in the vast majority of cases, subtle complex psychopathological phenomena are usually accompanied to a greater or lesser extent by more elementary psychosensory disorders. Some authors deny any connection between these disorders and depersonalization, while others simply identify these disorders with the phenomenon of alienation (Ehrenwald and others). We have already indicated that the origins of the development of the doctrine of changes in psychosensory functions rest on the concepts of Wernicke and Jackson about agnosia and violations of spatial images of the body. The anatomical and clinical direction in neurology and psychiatry studied these disorders in gross morphological destructive lesions of the brain using clinical pathological, anatomical and experimental research methods. The study of these phenomena has been particularly facilitated by the phenomenon of phantom limbs in amputees. These phenomena revealed the presence of an unusually persistent structural cortical formation of the body diagram. Somatognostic disorders have been especially studied in hemiplegics. Patients usually do not know about their paralysis because they lose knowledge and sensation of one half of the body. Some forms of anosognosia show close relationships with agnosia and apraxia. Further research showed that although only optical and kinesthetic sensations are part of the body diagram, it turns out that there are certain relationships between sensorimotor, which carries out the position of the body in space, and the visual sphere. Goff believes that all impulses from the vestibular apparatus are suppressed and sublimated in the higher cortical center of the visual sphere, which is the place where complex mechanisms of perception integration are activated. With disturbances in this area, vestibular irritations as products of disintegration of higher visual functions distort visual perception, causing metamorphopsia, macro- and micropsia and other disorders of spatial experiences. Parker and Schilder observed changes in the body diagram when the elevator moved (at a speed of 150-300 meters per minute), which confirms the connection of labyrinthine functions with the structure of the body diagram. At the first moment of going up in the elevator, your legs feel heavier. When descending the shiz, the arms and body become lighter and lengthen slightly. When you stop, your legs become heavier; it feels as if the body continues to descend, so that two more phantom legs are felt under the feet. Petzl and his students place the mechanism of psychosensory disintegration of the perception of the environment at the site of the transition of the parietal lobe to the occipital lobe. They assume here the presence of functions that suck away excitation,” regulating the processes of excitation and inhibition. This area is a phylogenetically young formation, specific to the human brain and tending to further phylogenetic development. Meerovich, in his book on body schema disorders, rightly criticizes Petzl's theory. In his opinion, this theory, which should be considered local anatomical, turns out to be untenable in solving such a basic question of the theory of the “body schema” as the question of how the sensation of one’s own body turns into consciousness of one’s own body. Remaining within the physiological and energetic positions, Petzl is forced to resort to various metaphysical constructs to explain this transformation. Shmaryan cites one operation for a cyst in the right interparietal region and posterior temporal lobe, performed by N. N. Burdenko. During the operation, everything around the patient seemed unnatural and strange, all objects suddenly moved away, decreased in size, everything around was swaying evenly Shmaryan points out that this case convincingly shows the relationship between the deep apparatus of the brainstem and the visual sphere and reveals the role of proprioception in the sense of Sherington in the genesis of the syndrome unreality of perception of the external world. A number of authors talk about the known role of thalamic foci, as well as the certain role of the cerebellum and vestibular system. Chlenov believes that the body diagram requires a constant influx of sensations from the periphery; all kinds of sensory and tonic disturbances, wherever they arise, can be reflected in the body diagram. The author suggests that “the body diagram has its own central substrate with numerous tails extending to the periphery.” Hauptmann, Kleist, Redlich and Bonvicini attribute the occurrence of anosognosia to damage to the corpus callosum; Stockert, in his work on non-perception of half the body, based on the views of Kleist, distinguishes “two forms of splitting off half of the body”: one, in which the disorder is recognized; this form, in his opinion, is localized in the thalamus and supramarginal region; and another form, which is not conscious, is localized in the corpus callosum. Gurevich M. O. put forward the anatomical and physiological concept of interparietal syndrome. According to his point of view, pathophysiological data indicate that the synthesis of sensory functions occurs in the interparietal region, that here in humans there are nodal points of higher sensory mechanisms. This area of ​​the brain is rich in anatomical and physiological connections with the motor fields of the cortex, thalamus optic, corpus callosum, etc. The disorder may be localized in other parts of the brain, but the interparietal cortex is the leading area of ​​the extensive underlying system. Gurevich puts forward two types of this syndrome: a) parieto-occipital, the pathological picture of which is dominated by optical phenomena with phenomena of extensive disturbance of the “body scheme” and depersonalization, b) parieto-postcentral, with a predominance of disorders of the general sense and with more elementary somatotonic partial violations of the “body scheme”. Subsequently, after a thorough study of the cytoarchitectonics of the interparietal cortex, Gurevich abandoned the term interparietal syndrome. He came to the conclusion that psychosensory functions include cortical, subcortical and peripheral mechanisms. These functions can be impaired when various parts of this system are damaged, i.e. in different areas of the brain, but no conclusions can be drawn from this regarding the localization of functions. Golant R. Ya. and collaborators, continuing the clinical traditions of V. M. Bekhterev’s school, studied psychosensory disorders from various angles. She described a number of syndromes and symptoms of these disorders: a syndrome with a feeling of weightlessness and lightness; denial and alienation of speech; feelings of change in the whole body and a violation of the feeling of satisfaction upon completion of physiological needs; violation of the sense of completion of perception; a symptom of the lack of permanence of objects in the external world. With depersonalization, Golant observed a lack of a feeling of satisfaction when swallowing food, defecation, sleep, a violation of the sense of time, and a lack of a sense of space. The author draws attention to certain forms of impairment of consciousness in these pictures of the disease, namely, oneiric, special twilight, and delirious states. Regarding the issue of localization of psychosensory disorders, Golant puts forward the concept of extracortical localization of the primary pathological focus with representation in the cerebral cortex. Meerovich R.I., in his book devoted to body schema disorders in mental illness, gives a detailed clinical analysis of the “tata schema” disorder and the reproduction of this syndrome in an experiment. Experiments aimed at clarifying the localization of the “body schema” disorder in the central apparatus showed the predominant importance of the sensory cortex, parieto-occipital lobe and thalamus optica. The author believes that the “body diagram” is included in the general structure of consciousness: this is confirmed by the fact that this violation is possible only with disorders of consciousness. These disorders arise from lesions of the sensory cortex, in the broad sense of the word. Impairments of consciousness that accompany a disorder of the body diagram are the result of a functional decline in the cortex as a whole. Ehrenwald, Klein, and partly Kleist, consider pathological changes in the body diagram as a manifestation of partial depersonalization, that is, they see only a quantitative difference between these states. Gaug considers various forms of body schema disturbance to be related to depersonalization phenomena, and therefore he calls them depersonalization-like disorders. Indeed, clinical facts show that in states of mental alienation, a number of inclusions can usually be observed in the form of elementary forms of disturbance of the body diagram, disintegration of the optical structure such as metamorphopsia, etc. However, the intensity and nature of the manifestation of these disturbances of sensory synthesis are not the same in different diseases . They are especially pronounced due to organic brain destruction—in tumors, injuries, arteriosclerotic strokes, acute infections and toxic processes. We observed in one patient N. with a tumor of the right temporal lobe in the foreground a picture of the disease with the phenomenon of disturbance of the body diagram and metamorphopsia: the patient says that he has lost his stomach, that he has two heads, with one lying nearby on the bed, he is losing his legs, surrounding objects perceives in a distorted form; walls, beds, tables are twisted, seem broken, the faces of those around them look disfigured; the faces of all people, especially the lower part, are slanted to the right. Another patient with a tumor of the corpus callosum and anterior frontal lobe experienced sensations of increased length and thickness of the nose, the face was allegedly covered with tubercles, and the floor seemed uneven. However, in these cases, no alienation phenomena were noted. Similar phenomena were observed in a patient with a trauma to the parietal region of the skull. During acute infections, psychosensory disorders are especially common in children. In patient V., due to malaria, psychosensory disorders were noted against the background of impaired clarity of consciousness: she saw everything around her in a yellow light, the faces of familiar people somehow changed, they seemed elongated, deathly pale; perceives himself as changed, his hands are somehow different. Another patient, Sh. (13 years old), due to prolonged influenza, experienced paroxysmal symptoms of metamorphopsia: objects increased and decreased, the head seemed to double in size, the nose and ears enlarged and lengthened. Among adults, after acute infections, psychosensory disorders predominantly appeared, which were accompanied by states of alienation of the individual and the external environment. Patient K., after the flu, experienced sensations of gradual retraction of the head into the body and drooping of the insides; the body seems to be divided into separate parts: head, torso and legs; people seemed flat and lifeless, like dolls. Along with this, he complained about the state of unreality and alienness of the surrounding world and his body; phenomena of mentism: “You swim in these thoughts and you can’t jump out of them—it’s like being in a vicious circle.” Patient S., also after the flu, developed body diagram disorders of the following nature: it seemed to her that her head was forked into parts in the back of the head, the bones of the forehead, on the contrary, narrowed, the body was asymmetrical—one shoulder was higher than the other; the torso seemed to have turned 180°, the back was in front and the chest was behind. Along with this, more complex disturbances in the consciousness of her personality appear: it seems to her that her “I” is split into two and the second “I” is in front of her and looking at her; her self seemed to disappear. During rapidly occurring processes of a schizophrenic nature, significantly pronounced elementary psychosensory disorders were noted: in patient P., when perceiving surrounding objects, it seemed that they were changing their spatial relationships: the floor was curved, zigzag, the walls and ceiling of the room were either moving away or approaching. The body is perceived as too small and narrow and as if divided longitudinally in half, the patient feels like an automaton. There are also subtle disturbances of the “I”: the patient thinks that his “I” consists of two “I”. Another patient U. with an acute schizophrenic process also had similar conditions. Patient V. experienced the transformation of a horse: it seemed to her that her legs were turning into hooves, hair was growing on her hips, a “horse spirit” was coming from her mouth, sometimes it seemed that her body was becoming male, she could not feel her mammary glands; at times the legs seem to disappear, the body becomes “thin, like a candle.” At the same time, the patient experienced changes in her feelings and personality: she doubted whether she existed or not. One patient K. felt the lengthening of one leg so clearly that she tried to shorten this leg surgically. Among patients with schizophrenia, conditions were more often observed when elementary psychosensory disorders were not in the foreground, but only accompanied experiences of alienation and mental automatism. So, in patient P. a state of mental automatism with a hallucinatory-delusional picture of the disease was accompanied by experiences of the emptiness of her body: it seemed that she had no insides; light, almost weightless; walking around like an empty shell. Patient D. experienced metamorphopsia during the first period of the disease—objects changed in shape and size, and their spatial relationships changed. Along with this, it seemed to the patient that his body was taking on the shape of his father’s body; one part of the face seems to resemble Mayakovsky, the other part - Yesenin, and in the middle - himself. It seemed that his "I" had changed, that it had passed into the "I" of his father. In the first period of the disease, patient V. had peculiar disturbances in the body diagram: during the lesson, it seemed that the neck was stretched, like a snake, several meters, and the head began to rummage around in neighboring desks; felt as if he was falling apart into separate pieces. At times he seemed to forget his body somewhere and then come back for it. Subsequently, the patient develops a persistent picture of mental automatism with hallucinatory-delusional phenomena. Psychosensory phenomena were also observed in cyclophrenia; Thus, patient L. periodically felt a simultaneous enlargement of the head and a decrease in the torso, arms and legs; I became light, as if weightless. I compared myself to a stratospheric balloon. Finally, in one case of epilepsy, significantly pronounced, paroxysmally appearing psychosensory disorders were observed: it seemed to the patient that his body was large and light; walking on the ground, he does not feel it; at times, on the contrary, it seems to him that a huge weight is pressing on him, under the influence of which his body contracts, his insides break off, his legs grow into the ground. The light becomes unclear, as if twilight is setting in. Along with this, sometimes a sudden clouding of clarity of consciousness occurs with phenomena of a change in one’s own personality. All of the above cases quite demonstrably prove the fact of the coexistence of complex phenomena of mental alienation and more elementary psychosensory disorders. It is interesting to remember that these two series of related pathological changes in the structure of objective consciousness have been studied for several decades from two sides by various research methods: clinical-psychological and anatomical-physiological. Over this period of time, these directions have come close to each other in this problem. Psychiatrist Gaug is trying to combine the achievements of one and the other direction. In his monograph, he says that it is necessary to assume that a person carries three schemas for himself: one schema from the external world, another from his physicality, and a third from intrapsychic phenomena proper. Accordingly, alienations arise from either one of them, or two, or complete alienation of both a somato- and allo- and autopsychic nature. The author takes as a basis the classical structure of the division of mental disorders according to Wernicke. Further, Gaug points out that depersonalization phenomena can arise through a disorder of central mental functions, which leads to changes in vital energy, tension and vital efficiency. These vital factors, according to the author, are of great importance for higher mental activity. Based on Stertz's triple division into soma, brain stem and cerebral cortex, the author believes that alienation phenomena can arise as a result of disorders in each of these three areas. A number of researchers especially attach importance to disorders of the brain stem, which contains the central functions of motivation, activity, clarity of consciousness and efficiency. These functions of the brain stem are closely related to vasovegetative hormonal regulation. These functions of the brain stem can be disrupted either psychogenically or somatogenically. Kleist’s school, following the position put forward earlier by Reichardt, tries to localize in the area of ​​the brain stem the central function of the “I” of the individual, at least the core of this “I,” assigning a rather modest role to the cortical functions of the brain. Such “consistent” localizationists, imbued with the spirit of mechanism, like Kleist and Clerambault, constantly search in the brain for the “seat of the self,” the “soul,” and at the same time fall into an obvious “brain mythology,” fetishizing the true biological science of man. A significant part of scientists of this type are trying to find the basic, central functions of the personality deep in the brain in the subcortical region, in the diencephalon. This fascination with the diencephalon has arisen since the most important functions of the subcortical regions of the brain were established. Just as at the end of the last century most researchers clearly ignored the subcortical zones, attributing a comprehensive role to the cerebral cortex, so now a number of authors have gone to the other extreme, raising the diencephalon to a fetishistic pedestal. Advances in neuromorphology continued to stimulate narrowly localized searches for higher integrative mental functions in the brain. Thus, in his work “Brain Pathology” K. Kleist compiled a map of the human brain, on which he located the centers of various mental functions, up to the localization of “volitional impulses” and “moral actions”. Kleist, Penfield, Küppers and others persistently try to provide a morphological basis for psychoanalytic concepts about the leading role of animal instincts and drives in human behavior. They search for and supposedly find in the subcortical formations zones that control the consciousness and behavior of the individual. In the famous book “Epilepsy and Brain Localization,” V. Penfield and T. Erikoson write: “Anatomical analysis of the main region of the representation level is very difficult due to the large number of short links of neurons that apparently exist there. However, clinical evidence indicates that the level of final integration in the nervous system lies above the midbrain and within the midbrain. This is an ancient brain, present even in lower animal species; Some of them may still have consciousness.” As can be seen, the authors consider consciousness as an exclusively biological function, inherent not only to humans, but also to lower species of animals. And they consider the highest center regulating the activity of consciousness to be “the area below the cortex and above the midbrain,” “within the interstitial brain.” The metaphysical principle of laying unchangeable abstract functions in certain isolated areas of the brain is completely helpless in explaining the reasons for the emergence of the internal wealth of the social content of human consciousness. Therefore, representatives of psychomorphologism are not content with the interpretation of mental processes as the result of the work of brain cells; they are forced to extend their hand to Freudianism and Husserlianism and pragmatism. The problem of localization of mental functions and mechanisms of their integration is closely related to epistemology and psychological concepts of individual consciousness, and therefore it is quite natural to have such a variety of views. The main flaw of every researcher of this problem is that, being carried away by some fashionable philosophical epistemological concept, he tries to build his view of depersonalization on this shaky ground, sometimes even ignoring and unwittingly distorting clinical facts in favor of this speculative concept. A classic example in this regard can be the followers of the neo-Kantian phenomenological trend: and among them, psychoanalysts hold the palm. Let us consider the problem of sensory synthesis and its pathology in the light of the doctrine of the brain mechanisms of mental abilities and functions that have historically developed in humans. It is known that psychological formations that arose in the course of historical development are reproduced by man not as a result of the laws of biological heredity, but in the course of ontogenetically individual lifetime acquisitions. The concept of mental function in psychology arose similarly to the biological understanding of the function of a particular organ in the body. Naturally, the need arises to search for certain organs that would be carriers of the corresponding mental functions. We have already talked about methodologically flawed psychomorphological attempts to directly localize one or another mental function in individual areas of the brain. As clinical material and laboratory studies accumulated, the correct idea gradually emerged that psychosensory functions are the product of the unification and joint activity of a number of receptor and effector zones of the brain. I. P. Pavlov, developing similar thoughts of I. M. Sechenov, considers it insufficient to adhere to previous ideas about anatomical centers for understanding the behavior of an animal. Here, in his opinion, it is necessary to “add a physiological point of view, allowing for a functional unification through a special pattern of connections of different parts of the central nervous system, in order to perform a certain reflex act.” A.K. Leontyev, developing this concept, notes that the specific feature of these synthetic systemic formations is that “once formed, they further function as a single whole, without showing their composite nature; therefore, the mental processes corresponding to them always have the character of simple and immediate acts.” These features, according to Leontyev, allow us to consider these functional system formations that emerged during life as unique organs, the specific functions of which appear in the form of manifested mental abilities or functions. Here, in this important issue, Leontyev reasonably relies on a very valuable statement by A. A. Ukhtomsky about the “physiological organs of the nervous system.” In his classic work on the dominant, Ukhtomsky wrote: “Usually, with the concept of “organ” our thought associates something morphologically different, constant, with some constant static signs. It seems to me that this is completely unnecessary, and it would be especially characteristic of the spirit of the new science not to see anything obligatory.” It is very significant that these reflex system formations, which have acquired the character of strong, stable and simple acts, once they arise, are then regulated as a single whole. Further, Leontiev, relying on his own, as well as the scientific conclusions of the works of P.K. Anokhin, N.I. Grashchenkov and L.R. Luria, writes that the disruption of processes that arose after damage to a certain area of ​​the brain should be understood “not as a loss of function , but as a collapse, disintegration of the corresponding functional system, one of the links of which is destroyed” On the issue of disorders of sensory synthesis of psychosensory functions M. O. Gurevich adhered to a similar point of view. According to his view, the structures of higher functions are determined by the fact that they develop not so much through the emergence of new morphological formations as through the synthetic use of old functions; in this case, new qualities arise that cannot be derived from the properties of the components included in the new function. Therefore, with the pathology of higher gnostic functions, complex disintegration and a qualitative decline to a lower level occur, which leads to the appearance of decay phenomena. The study of these decay phenomena provides an opportunity to study the complex nature of higher functions. Therefore, localization of a function should be carried out not by searching for individual centers, but by studying individual systems that are internally interconnected. In the chapter on mental automatism, we point out in more detail that the nature of these forms of sensory decay of images in relation to space, time, perspective, shape, size and movement makes it possible to assume the presence of an automated mechanism that displays external phenomena and the human body in the mind in the form of a similarity to systemic cinematic images . This complex process is carried out through the integration and senesthetic use of simple receptor functions. Pathological deautomatization of complex images reveals the role of brain systems: optical, kinesthetic, proprioceptive and vestibular in the construction of object images exactly in the form in which it objectively exists.

This group includes disorders of perception of one's own body,
spatial relations and forms of surrounding reality.
They are very close to illusions, but differ from the latter in the presence of criticism.
The group of sensory synthesis disorders includes: – depersonalization, – derealization, – body diagram disorders,
a symptom of something already seen (experienced) or never seen, etc. Depersonalization is the patient's belief that
that his physical and mental self had somehow changed,
but he cannot explain specifically what and how has changed. Derealization- a distorted perception of the surrounding world,
a feeling of its alienation, unnaturalness, lifelessness, unreality.
Autometamorphopsia. The surroundings are seen as painted, devoid of vital colors, monotonously gray and one-dimensional. Body schema disturbance (Alice in Wonderland syndrome) is a distorted perception of the size and proportions of one’s body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head increases to the size of a room, his torso either shortens or lengthens. Sometimes there is a feeling of pronounced disproportion between body parts. For example, the head shrinks to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Sensations of changes in the body diagram can appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of body diagram disorders is their correction by vision. Looking at his legs, the patient is convinced that they are of normal size, and not multi-meter; looking at himself in the mirror, he discovers the normal parameters of his head, although he experiences the feeling that his head reaches 10 m in diameter. Vision correction ensures that patients have a critical attitude towards these disorders. However, when vision control ceases, the patient again begins to experience a painful feeling of changes in the parameters of his body.

Question 29: Psychomotor disorders(movement disorders )This group of disorders includes manifestations of stupor (catatonic, depressive, psychogenic), catatonic agitation, hebephrenic syndrome (all described above) and various types of seizures. A seizure is a short-term, suddenly occurring painful condition in the form of loss of consciousness and typical convulsions. The most common seizure in psychiatric practice is a grand mal seizure (grand mat). In the dynamics of a grand mal seizure, the following stages can be distinguished: precursors, aura, tonic phase of seizures, clonic seizures, post-seizure state, turning into pathological sleep. Precursors occur several hours or days before the attack and are expressed in general physical and mental discomfort, headache, extreme irritability, weakness, dizziness, low mood with dissatisfaction and grumbling, and sometimes dysphoria. These disorders are not yet a seizure, but rather a precursor to it. The aura (breath) is the overture of the seizure, its actual beginning, consciousness remains clear and the patient clearly remembers the state of the aura. The aura usually lasts a fraction of a second or one or two seconds, but to the patient it seems that centuries have passed by during this time. The clinical content of the aura, which, by the way, is not observed with every seizure, varies, but for each patient it is usually the same. Its character indicates the localization of the pathological focus. Sensory aura is expressed in various paresthesias, sensory synthesis disorders, changes in the perception of the body diagram, depersonalization, olfactory hallucinations, visions of fire, smoke, fire. The motor aura manifests itself in sudden movements of the body, turning the head, the desire to run away somewhere, or a sharp change in facial expressions. The mental aura is more often expressed in the appearance of fear, horror, a feeling of stopping time or changing the speed of its flow; the patient can see scenes of mass murder, an abundance of blood, dismemberment of corpses. It is extremely rare that a patient, on the contrary, experiences an incredible feeling of bliss, ecstasy, in complete harmony with the Universe (also described by Prince Myshkin). Visceral aura is manifested by unpleasant and painful sensations in the area of ​​specific internal organs (stomach, heart, bladder, etc.). Vegetative aura is expressed in the appearance of autonomic disorders (severe sweating, feeling of shortness of breath, feeling of palpitations). Considering the short duration of the aura, not all patients are able to perceive and, most importantly, understand its content; they often say: “Something happened, but I didn’t understand what, and then I don’t remember anything at all.”