DISORDERS OF PERCEPTION

T. Aladashvili

PERCEPTION - (FROM THE LATIN PERCEPTIO,

PERCIPIO) IS THE ORGANIZATION,
IDENTIFICATION, AND INTERPRETATION
OF SENSORY INFORMATION IN ORDER TO
REPRESENT AND UNDERSTAND THE
ENVIRONMENT
 Abnormal
perception

Sensory Sensory
distortions deceptions
 Sensory Distortions
 Increasedintensity of sensation -
Hyperesthesia seen in increasing sensations
or lowering of physiological threshold.

 Increasedsensitivity to noise – Hyperacusis

is associated with Anxiety and depressive
disorders as well as hangover from alcohol
and migraine.
Hyperaesthesia
Complete absence of color
 Micropsia - a visual disorder in which the
patient sees objects
Smaller than they really are
Farther away than they really are
 Macropsia or Megalopsia - opposite to
micropsia
 Object appearing far
Teleopsia away

Object appearing nearer

Pelopsia than it should
 Stimuli
from Mental False
perceived image perception
object
Illusions - Stimuli from a perceived object are combined with a
mental image to produce a false perception

Types of Illusion

 Complete Illusion- These depends on misreading words in newspapers

or missing misprints because we read the word as if it were capable
 Affect Illusion-These arise in the context of particular mood
state
 Pareidolia- vivid illusions occur without the patient making any
effort ; are the result of excessive fantasy thinking and a vivid
visual imagery
 Hallucination
A perception without an object

A false perception which is not a sensory

distortion or a misinterpretation but which occurs
at the same time as real perceptions
Hallucinations and senses

 Hearing
 Vision
 Smell
 Taste
 Touch
 Pain and deep sensation
 Hearing

Hearing may be elementary or unformed

• Elementary – noises, bells or undifferentiated whispers ; in
organic states
• Partly organized- music
• Completely organized –”Voices” are
characteristic of schizophrenia (also occurring in
organic states: delirium, dementia and sometimes
in severe depression or mania)
Hearing
Auditory hallucinations
 Adverse
 Neutral
 Helpful
 Incomprehensible nonsense
 Thought echo - hearing one’s own thoughts being spoken loud, voice may
come from inside or outside the head
GEDANKENAUTWERDEN - thoughts are spoken at the
same time or before they are occurring
ECHO DE LA PENSES - thoughts are spoken just after
they occurred
Vision
• Elementary- flashes of light
• Partly organized- patterns
• Completely organized- visions of people animals or
objects
Scenic hallucinations- whole scenes are

hallucinated like a cinema film

More commonly seen in delirium
Also seen in psychiatric disorders
associated with
epilepsy
Smell (olfactory)

Seen in
• Schizophrenia
• Organic states like temporal lobe epilepsy are
often ushered in by an aura involving an
unpleasant odour such as burning paint or
rubber with or without fit
• Depression (uncommon)
 PADRE PIO PHENOMENON- religious people
can smell roses around certain saints
Taste (gustatory)

Seen in
• Schizophrenia
• Organic states
Depressed patient often describes loss of taste
Touch (Tactile)

• Formication- a feeling that animals are crawling

over the body (organic states)
• Cocaine bug – formication occurring with
delusion of persecution in cocaine psychosis
• Sexual Hallucinations- seen in acute and
chronic schizophrenia
 Pain and deep sensation

• Visceral hallucinations
• Twisting and tearing pains
• Very bizarre complaints- organs being ripped out
and flesh ripped from his body
• Seen in chronic schizophrenia
• Delusional zoopathy in which delusional belief that
there is an animal crawling about in the body and also
a hallucinatory component since the patient feels it &
can describe it
 Thought disorder

A thought disorder is any disturbance in cognition that

adversely affects language and thought content, and thereby
communication
 Content-thought disorder
thought disturbance in which a person experiences multiple,
fragmented delusions, typically a feature of schizophrenia
 Formal thought disorder
also known as disorganized speech – evident
from disorganized thinking, and is one of the hallmark
features of schizophrenia
Types
 Alogia – A poverty of speech, either in amount or
content
 Blocking or thought blocking – An abrupt stop in
the middle of a train of thought
 Circumstantial speech - An inability to answer a
question without giving excessive, unnecessary
detail.
 Echolalia– Echoing of another's speech that may
only be committed once, or may be continuous in
repetition
 Flight of ideas - a form of formal thought disorder
marked by abrupt leaps from one topic to another
 Types
 Illogicality – Conclusions are reached that do not follow logically
 Incoherence (word salad)– Speech that is unintelligible because,
though the individual words are real words, the manner in which
they are strung together results in incoherent gibberish
 Neologisms – forms completely new words or phrases whose
origins and meanings are usually unrecognizable
 Perseveration – Persistent repetition of words or ideas even when
another person attempts to change the topic
 Self reference – Patient repeatedly and inappropriately refers back
to self
 Tangential speech – Wandering from the topic and never returning
to it or providing the information requested
 Delusions

Fixed, false beliefs that conflict with reality.

Despite contrary evidence, a person can’t let
go of their convictions
Themes
 Delusion of control: False belief that another person, group of people, or
external force controls one's general thoughts, feelings, impulses, or
behaviors
 Cotard delusion: False belief that one does not exist or that one has
died
 Delusional jealousy: False belief that a spouse or lover is having an
affair, with no proof to back up
 Delusion of guilt or sin (self-accusation): Ungrounded feeling of
remorse or guilt
 Delusion of mind being read: False belief that other people can know
one's thoughts
 Delusion of reference: False belief that insignificant remarks, events, or
objects in one's environment have personal meaning or significance.
Usually the meaning assigned to these events is negative
Themes
 Erotomania: False belief that another person is in love with
them (usually famous one)
 Religious delusion: Belief that the affected person is a god or
chosen to act as a god
 Delusion of poverty: Person strongly believes they are
financially incapacitated
 Grandiose delusions: False beliefs that one is
famous, omnipotent or otherwise very powerful
 Persecutory delusions: In which the affected person wrongly
believes that they are being persecuted, spied on, attacked,
poisoned or drugged
The individual thinks that the persecutors have the intention to
cause harm