With neurosis, hallucinations. Disorders of perception, sensations and ideas - a complete classification Which doctors should be consulted if you have a Disorder of perception and imagination

Illusions J. Eskirol (1838) defined, in contrast to hallucinations, as distorted, incorrect, false perceptions of the surrounding reality. The reasons for the distortion of perception are not always rooted in the painful properties of the perceiver, they can also lie in special properties. the environment, and in the physiological characteristics of the human body, being in certain cases obligatory for everyone. Like hallucinations, they differ in the sense organs in which they are detected. According to the conditions of their occurrence, they are divided into physical, physiological and mental (J. Sally, 1881). As an artistic illustration, we present various excerpts from the ballad of JV Goethe "The Forest Tsar".

Who rides, who rushes under the cold haze?

The rider is belated, with him a young son.

To the father, shuddering, the baby clung to;

The old man hugs him and warms him.

"Child, why did you clung to me so timidly?" -

“Darling, the forest king flashed in my eyes:

He is wearing a dark crown and a bushy beard. "

"Oh no, the fog is white over the water."

“Child, look around; baby, to me;

There is a lot of fun in my side:

Turquoise flowers, jet pearls;

My palaces have been poured from gold! "

“Darling, the forest king says to me:

He promises gold, pearls and joy. " -

“Oh no, my baby, you misheard:

Then the wind, waking up, swayed the sheets ... "

The characteristic features of essential senestopathies are reflected in the following clinical description (A.B.Smulevich, 1987).

“S., 56 years old. From childhood, he was distinguished by his prudence and degree. In unfamiliar surroundings, he tried to shy away. Obedient, executive, took diligence at school. He studied mediocre. Hobbies boiled down to hunting and fishing. He did not show affection to anyone, suffered losses (death of his mother and grandmother) without expressed emotions. I was more upset when I had to leave the village - "I missed the freedom." I read a little, mostly adventure literature, "for the company" I visited cinemas and a dance floor. He served in the navy, did not feel the hardships of military service, had gratitude from the command. Immediately after leaving the reserve, he married a teacher - "attracted to educated." He was equally equal to both his adopted and his own daughter. For 13 years (up to the age of 35) he studied at night school and technical school, spending a lot of effort to get an education and be "no worse than others." He worked as an electrician, was among the best; becoming a foreman, he could not cope with his duties - he could not find an approach to people, quickly make a decision, show flexibility where necessary. If there was a free day, he tried to hunt or went to the shooting range to practice shooting. Having received a diploma, without regret, he left his previous job and got a job as a foreman at a plant at a research institute.

The first signs of the disease date back to the age of 35. I felt unwell, did not fall asleep well. In the area of ​​the forehead and temples, there was a feeling of heat, creeping. I decided that I was overworked while working on my diploma, turned to a neurologist and a month later forgot about the illness for a while. However, several months later, new, more unpleasant sensations suddenly appeared - pressing headaches, which reached maximum intensity by the middle of the day. Was forced to take "respite". Previously reliable, now, under any pretext, he tried to avoid official and household chores; became a regular at the polyclinic, where before that he did not even have an outpatient card. 8 years after the onset of pain (43 years) due to the unusual nature of the complaints and the ineffectiveness of treatment by doctors of different specialties, he was referred to a psychiatrist. He said that he was constantly experiencing a painful sensation of a "cooling star" in the forehead, "emitting rays", he felt "trembling of the brain." Gradually he became more and more phlegmatic and at the same time to the point of pettiness corrosive. He constantly monitored the order in the house, delved into every purchase, turning this issue into a subject of discussion for a whole week. I sold my gun, I stopped hunting. At work, he sat out his due, understood that he was coping only because he rarely received new tasks that required quick orientation and certain efforts. He almost never left the house, followed the doctor's orders punctually, did physical exercises, but due to the intensification of painful sensations in the head and the appearance of "internal pain in the eyes", he left these classes as well.

At the age of 47, I felt a deterioration in health: the sensations in my head became more intense and varied - tingling turned into pressure, “hissing pains”; in the area of ​​the forehead, "above the star", a new focus was formed - "a circle of pinching pain." Could not work, was hospitalized in mental asylum where his disability was determined over timeIIgroups.

Mental state: the vocabulary is not rich. He is verbose, gesticulates, asks not to interrupt, otherwise he will not be able to answer, collect his thoughts. Even leading questions he ponders for a long time, he must present everything in order, from the very beginning. Curiously pedantic - he keeps special notes in which he records the entire day, including the time spent on the toilet, procedures, minute by minute; tries, but unsuccessfully, to express the nuances of well-being.

He finds it difficult to describe complaints: he seeks to convey in all details the nature of his illness, but cannot find comparisons that reflect the unusualness of his sensations. She notes that after the course of treatment, only "pommel, awkwardness in my head" remained, but she constantly expects an exacerbation of painful symptoms. Believes that he suffers from some kind of bodily disease, but there are no more specific judgments - doctors know better. He does not delve into treatment issues - it is important for him to feel at least a slight relief. In the absence of any somatic or neurological objective pathology, he experiences constant fatigue. He is inactive, inactive, does not read, he sits at the TV only for a few minutes. Limits the workload, which includes even asking about family matters.

2.1. Psychology of perception and images of representation Perception - view cognitive activity, the result of which are sensory images of objects that directly affect the senses. Unlike sensation in perception, heterogeneous impressions are integrated into discrete structural units — images of perception; cognitive activity is experienced as a fact of personal activity, directed by a specific task, and not an act of passive registration of impressions. Perception images are composed of external and internal (primarily kinesthetic) sensations. In this case, the “contribution” of different types of sensitivity is not the same. It is obvious that the perception images of the blind and the seeing, the deaf and hearing, the color blind and the individual with “normal” color sensitivity are different. This relativity does not mean that the external world is nothing more than a subjective construction. The fact that someone does not perceive a melody does not mean that this melody does not exist. As, however, and the fact that the plausibility of the deception of perception does not prove the reality of the apparent object. Perception is the process of "creating" an image from "sensory" material. There are the following phases: - perception - the primary selection of a complex of stimuli from the mass of others, as related to one specific object. In other words, this is the phase of delimiting the figure and the background; - apperception - comparison of a primary image with an analogous or similar one stored in memory. If the primary image is identified as already known, this corresponds to recognition. If the information is new and ambiguous, identification occurs by putting forward and testing hypotheses in search of the most plausible or acceptable. In this case, the object is regarded as previously unknown; - categorization - assignment of the image of perception to a certain class of objects. For this purpose, the object is further investigated in search of typical features. of this class objects; - projection - the addition of the image of the perceived object with details inherent in the established class, but for various reasons turned out to be "behind the scenes". The image of perception is thereby "brought" to a certain standard. The images of perception reflect such qualities of objects for which there are no special receptors: shape, size, rhythm, heaviness, position in space, speed, time. In this sense, the image of perception is, as it were, a supersensible phenomenon, intermediate between sensory and rational cognition. Psychologically, perception is characterized by: - ​​constancy - stability of images of objects in different conditions perception. For example, the hands are located at different distances from the eyes, but their size seems to be the same; - integrity - combining different experiences into a coherent unity. The laws of holistic perception are studied in gestalt psychology ("psychology of images"); - volumetric - perception in three dimensions. This is achieved through binocular vision and binauricular hearing. At a distance of over 15 m, the perception of space is carried out thanks to linear, aerial perspective, parallax and interposition effects; - objectification of images of perception - associated with the state of consciousness and search research activity. Early sensory experience is essential here. In perception, the activity of consciousness, attention, memory, and other mental structures is expressed. This is important to consider for the analysis and assessment of perception disorders. In the latter, traditionally referred to as sensory disorders, various disorders of all mental functions, as well as of the personality as a whole, are found. By the time of birth, the baby has efficiently functioning senses. By the age of one year, the visual acuity of an infant reaches the level of adults. Best of all, he perceives objects at a distance of 19 cm from his face. Perhaps because to see the mother's face while nursing. From the fourth day, the infant shows an innate preference for the perception of the human face. By two months he recognizes the face of his mother, and at four months he distinguishes blue, red, yellow and green colors. The perception of the depth of space is already being formed by two months. In early infancy, attention is also attracted by moving objects, curvilinearity, contrasts. From the first hours after birth, children are able to distinguish sounds of different intensities, to recognize the mother's voice. They also distinguish between smells. Taste perception develops later. The categorical nature of perception is formed by the end of the first year, and it becomes constant by the age of 12-13. There is a hypothesis that perception develops on the basis of innate "cognitive schemas." The latter allow the child to highlight the most important impressions and structure them in a certain way. The necessary conditions for the development of perception are: - active movement. Observations have shown that restriction of free movement disrupts the development of spatial perception; - Feedback. It is necessary for correcting perception errors; - maintaining the optimal amount of incoming sensory information. “Sensory“ hunger ”interferes with the development of perception, and under experimental conditions leads to psychotic disorders; - structuring of external impressions. The monotony of the latter (deserts, snowy plains, etc.) does not contribute to the formation of perceptual schemes, and in adults it is one of the reasons for the appearance of mirages. The image of a representation is the most complex type of figurative memory (Luria, 1975). When we say that we have an idea of ​​a tree, lemon, or a dog, it means that the previous experience of perception and practical activity with these objects left their traces in us. The images of the presentation resemble visual images, differing from the latter in less detail, brightness and clarity, but not only this. The image of the presentation reflects the results of the intellectual processing of the impression of the subject, highlights the most significant features in it. So, we do not represent a specific tree, but we are dealing with a generalized image, which can include a visual image of a birch, a pine, and another tree. The fuzziness and pallor of the image of a representation testifies to its generalization, the potential wealth of the connections behind it, is a sign that it can be included in any relationship. A performance image is not a mere memory. It is not stored in memory in an unchanged form, but is constantly transformed, in it the most relevant features are highlighted, emphasized, and individual characteristics are erased. Representation images are subjective, they are not projected outward. They arise in consciousness indirectly, thereby drawing closer to figurative thinking. Associations of images can go beyond ordinary impressions, thanks to the imagination, they become available to creativity. The following types of pathology of perception and images of representation are observed: violation of the constancy of perception, splitting of perception, illusion, hallucinations, pseudo-hallucinations, hallucinoids, eidetic phenomena, disturbances in sensory synthesis. 2.2. Psychopathology of perception and images of representation Violation of the constancy of perception. Distortion of images of objects depending on changes in the conditions of perception. While walking, the patient sees how the soil "bounces", "sways", "rises", "falls", trees and houses "stagger", move with him. When the head is turned, the objects “turn”, the body turns in the opposite direction. The patient feels as if objects are moving away or approaching, and not he is walking towards them or away from them. Distant objects are perceived as small, while close up they become unexpectedly large and vice versa. Split perception. Loss of the ability to form a holistic image of an object. Correctly perceiving individual details of an object or its image, the patient cannot connect them in unified structure, for example, sees not a tree, but separately the trunk and foliage. Splitting of perception is described in schizophrenia, some intoxications, in particular, psychedelic substances. A similar (violation occurs when the secondary parts of the visual cortex are damaged (fields 18, 19 Brodmann). Patients, examining the image (for example, glasses), say: “... what is this? .. a circle and another circle ... and a crossbar ... probably a bicycle "Some patients, looking at the famous Boring drawing (where you can see the profile of a young woman or an old woman), report that they see both images at the same time, which indicates not a split in perception, but possibly a simultaneous participation in perception of the left and right hemispheres. the ability to synthesize sensations of different modalities, for example, visual and auditory. Perceiving a sounding radio receiver, the patient can look for a sound source in another place. This disorder is observed in senile dementia (Snezhnevsky, 1970). With damage to the parieto-occipital parts of the brain, a slightly different perception disorder occurs - simultaneous agnosia.The patient adequately perceives individual objects, regardless of their size s, but at the same time is able to see only one object or its image. If he is shown an image of a circle and a triangle, then after a series of quick exposures he can declare: "... after all, I know that there are two figures here — a triangle and a circle, but I see only one each time." Illusions. The term is translated by the words "deception, deceptive representation" - false, with a violation of identification, the perception of really existing and relevant at the moment objects and phenomena. For the first time, they were identified as an independent deception of perception and separated from hallucinations by J. Eskirol in 1817. There are various types of illusory perception. In physical illusions, the misperception of an object is due to physical properties the environment in which it is located - a spoon in a glass of water at the border of the water-air environments seems to be broken. The emergence of a number of illusions is associated with the psychological characteristics of the perception process. After a train stops, for example, it continues to appear for a while that it is still moving. In the well-known Muller-Lyer illusion, the length of individual lines is perceived differently depending on the shape of the figures they are part of. The color of the same part of the surface is perceived differently if you change the color of the figure as a whole. The development of illusions is facilitated by factors that violate the clarity of perception: the color and illumination of objects, features of sound, visual and hearing defects. The appearance of illusions depends on expectations, an affective state, and an attitude. A fearful person, walking along a deserted street at night, may mistake the silhouette of a bush for the figure of a lurking person. With the illusions of inattention (Jaspers, 1923), instead of one word, another, similar in sound, is heard; a stranger is mistaken for a friend, the wrong word is read in the text, etc. The influence of the attitude on perception is demonstrated by the experiments of NI Uznadze: of two balls of the same weight, the larger one seems to be heavier. A metal ball feels heavier than a plastic ball of the same weight (Deloff test). These types of illusions are not a symptom of a mental disorder. Pathological illusions have a number of important features. This is their psychological incomprehensibility, falling out of the semantic context of the situation. Visual images are completely absorbed, overlapped by imaginary ones, and are subjected to gross distortion. The content of pathological illusions expresses the ideas of persecution, others painful experiences... There is no critical appraisal of illusory images. Sometimes it is difficult to distinguish between illusions and hallucinatory images, as well as to catch the moment of transition of the former to the latter. There are the following types of pathological illusions: affective, verbal and pareidolic (pareidolia). Affective illusions. Associated with fear, anxiety. The patient in the frosty patterns of the window "sees" the face of the robber, in the folds of the blanket - the murderer lurking on the bed, takes a pen for a knife. Instead of the usual noises, knocking, ringing he hears the clicking of the bolt, guns, shots, footsteps and breathing of pursuers, death moans. Verbal illusions. They contain separate words, phrases that replace the real speech of others. Accusations, threats, abuse, exposure, insults are heard. Verbal illusions that arise against the background of fear or anxiety are considered a verbal version of affective illusions (Snezhnevsky, 1983). Intense, abundant and plot-related verbal illusions are termed "illusory hallucinosis" (Schroder, 1926) . Verbal illusions should be distinguished from delusional relationship ideas. With the latter, the patient hears the speech of others correctly, but is convinced that it contains "hints" about him. Affective and verbal illusions are psychopathologically heterogeneous. Some of them are associated with depression (blame, blame). Others reflect the influence of delusional moods (threats, shooting, unpleasant taste of food). Some of the illusions are consonant with distinct delusional beliefs. So, a patient with delirium of jealousy, instead of a rustle, hears the steps of a lover sneaking towards his wife. Pareidolia. They are visual illusions with fantastic content. When looking at shapeless spots, ornaments (patterns of wood lines, weaving of roots, the play of light and shade in the leaves of trees, clouds), one sees exotic landscapes, enchanting scenes, mythical heroes and fairy-tale creatures, bizarre plants, people in unusual masks, ancient fortresses, battles, palaces. Portraits come to life. The faces depicted there begin to move, smile, wink, lean out of the frame, make grimaces. Pareidolia occurs spontaneously, rivets the attention of patients, accompanied by lively emotional reactions. Illusions are characteristic of states of shallow stupefaction (the second stage of delirium, according to S. Libermeister), occur in acute symptomatic psychoses. They are also observed with delusional and affective psychoses of a different etiology. Episodic and unstable illusions are found in neuroses, neurosis-like states. The role of hypnoid states of cortical analyzers is assumed in the pathogenesis of illusions. Hallucinations("Delirium", "vision"). Imaginary perceptions, false images that arise spontaneously, without sensory stimulation. MG Yaroshevsky (1976, p. 23) mentions Bhatt, the ancient philosopher of the Mimansa school, who expressed conjectures about the deception of perception, consonant with modern ones. The reality or illusory nature of the image, Bhatta argued, is determined by the nature of the relationship between the organ and the external object. Perverting this relationship leads to an illusory perception. The reasons for the latter can be peripheral (a defect in the sense organs), as well as central (manas), when memory images are projected into the outside world and become hallucinations. In the same way, according to Bhatt, dreams arise. Until now, the definition of hallucinations by V. Kh. Kandinsky has not lost its meaning: “By the name of hallucinations I mean, directly from external impressions, the independent excitation of the central sensory areas, and the result of such excitement is a sensory image that appears in the perceiving consciousness with the same character of objectivity and reality, which, under ordinary conditions, belongs only to sensory images resulting from the direct perception of real impressions. " A hallucination is an image of a representation that the patient identifies with a visual image. In the definitions of hallucination, the following symptoms are usually indicated. The appearance of hallucinations is not directly related to the perception of real and existing objects (with the exception of functional and reflex hallucinations). This is how hallucinations differ from illusions. A hallucinating patient, simultaneously with false images, can adequately perceive reality. At the same time, his attention is distributed unevenly, often shifting towards deceptions of perception. Sometimes it is so absorbed by the latter that reality is almost or not at all noticed. In such cases, they speak of detachment or hallucinatory workload. Hallucinations are characterized by sensory liveliness, projection into the real world (they are relatively rarely deprived of a certain projection: "Voices from nowhere ... The hand reaches out of nowhere ..."), spontaneous appearance and alienation to the content of consciousness They are characterized, in addition, by the feeling of their own intellectual activity - the patient " himself ”with interest or fear“ listens ”,“ looks ”,“ peers ”. An integral expression of these qualities of deception of perception is the experience of the corporeality of imaginary images, their identification with images real objects... The understanding of the painfulness of hallucinations is largely lacking. Under the impression of them, the patient behaves in exactly the same way as if what seemed to him were actually happening. Often, hallucinations, no matter how irrational their content may be, are more relevant to the patient than reality. He finds himself in great difficulty if imaginary and real images enter into a relationship of antagonism and have equal power to influence behavior. With such a “split” personality, the patient seems to exist in two “dimensions” at once, in a situation of conflict between the conscious and the unconscious. There are the following types of hallucinations: visual, auditory, olfactory, gustatory, tactile and general feeling hallucinations (enteroceptive, visceral, endosomatic). Vestibular and motor hallucinations are close to the latter. Visual hallucinations. Elementary and complex optical illusions are observed. Elementary hallucinations - photopsies, phosphrenes - are simple optical illusions that do not fold into an object image: flashes of light, sparkles, fog, smoke, spots, stripes, dots. Complex visual hallucinations are characterized by subject content. Taking into account the latter, some special types of them are distinguished. Zoological hallucinations - zoops - visions of animals, insects, snakes known from past experience. Demonomaniac hallucinations are visions of devils, mermaids, angels, gods, hourias, and other characters from the field of mysticism and mythology. Fabulous creatures and monsters, "aliens" and other fantastic images can be perceived. Anthropomorphic hallucinations are visions of images of close acquaintances and strangers, both living and dead. In recent decades, some authors have noted a decrease in demonomanic and an increase in anthropomorphic deceptions of perception. Sometimes in the imaginary images of loved ones, in the opinion of patients, strangers, unfamiliar, hostile people can be “disguised” and vice versa. There are hallucinatory visions of fragments of the human body: eyes, head, limbs, pupils, internal organs - fragmentary hallucinations. Autoscopic hallucinations are visions of oneself. The phenomenon of geatoscopy is described: an imaginary perception of one's own body, projected into one's own body. Polyopic hallucinations are multiple images of imaginary objects: glasses, bottles, devils, coffins, mice. False images can be located on a line extending into the distance, and gradually decrease in size. Diplopean hallucinations are visions of doubled imaginary images: "People are doubled - one and the same is seen on the right and left." Panoramic hallucinations are static visions of colorful landscapes, landscapes, cosmic plots, pictures of the consequences of atomic explosions, earthquakes, etc. Scene-like hallucinations are visions of hallucinatory scenes that are plotted and consistently flowing from one another. Perceived funerals, manifestations, trials, executions, battles, scenes of the afterlife, adventures, adventurous detective events. A variant of the stage-like hallucinations are Levi-Valenci's pantophobic hallucinations - stage visions frightening patients. Segla's visual verbal hallucinations are visions of letters, words, texts. The content of such symbolic hallucinations may be other sound systems: numbers, mathematical formulas, symbols chemical elements , sheet music, heraldic signs. Endoscopic (visceroscopic) hallucinations - seeing objects inside your body: "I see that my head is filled with large white worms"). Autovisceroscopic hallucinations - visions of their own internal organs, sometimes affected by an imaginary disease: "I see my shriveled lungs." There are hallucinatory visions of their organs, the images of which are taken out into the outside world, sometimes projected onto some surface, for example, on a wall. Negative visual hallucinations are a short-term blockade of the ability to see individual real objects. Visual hallucinations also differ in color, size, clarity of contours and details of imaginary images, degree of similarity with real objects, mobility, localization in space. Imaginary images can be black and white, colored indefinitely, or predominantly in one color. For example, in epilepsy, they are intensely red or blue. The color scheme of false images can reflect the peculiarities of color perception inherent in an individual. For color blind people, for example, it lacks red. Normoptical hallucinations - the sizes of imaginary images are adequate to the size of the corresponding real objects; macroptic, gulliver hallucinations - visions of enormous proportions; microptic, lilliputian hallucinations - of extremely small magnitude. For example, "I see bodies on the wall, as if under a microscope." There are hallucinations with an ugly distorted form of imaginary images, elongated in one direction, distant, approaching, skewed - metamorphosis hallucinations. Reduced and distant hallucinatory imagery is a phenomenon known as Van Bogart microtelopsy. Embossed hallucinations - the contours and details of false images are perceived very clearly, three-dimensionally. Adelomorphic hallucinations - visions are hazy, blurred, "ghostly", "airy" ("ghosts, ghosts", as defined by patients). Cinematic hallucinations - imaginary images are deprived of depth, three-dimensionality, sometimes they are projected onto the surface of walls, ceilings and are replaced “like on a screen”. At the same time, patients believe that they are "shown a movie." Cinematography, as noted by E. Breiler (1920), existed for the sick long before its discovery. Hallucinatory images are mobile, sometimes changing kaleidoscopically quickly or chaotically. They can be perceived as moving from left to right and back, moving in a vertical direction. Sometimes they are motionless like statues - stable hallucinations. The localization of optical illusions in space is different. For the most part, they are projected into a real environment, perceived along with surrounding objects, or obscure the latter. With extracampine hallucinations, visual illusions are localized outside the field of vision - from the side, from above, more often "behind the back". Hemianoptic hallucinations - deceptions of perception are localized in one of the halves of the visual field. Visions can occur in one eye - monocular hallucinations. Visual (and auditory) hallucinations should be distinguished from the phenomenon of personified awareness (or extraneous presence), which is an imaginary experience of the presence of another, more often hostile person. It is also a false sense of someone else's gaze ("someone is looking out the window", "watching"). Patient descriptions are so detailed that these experiences can be mistaken for hallucinations. So, the patient reports: "I feel there is a man behind my back, a tall man, all in black, he stretched out his hand to me and wants to say something ... I do not see him, but I clearly feel that he is." In another observation, the patient “felt” the deaf-mute father standing on the side and talking with gestures, so that she could understand what he was “talking about”. Imaginary speech can be perceived in the same direct way: the patient "clearly hears" how her neighbors scold her and give offensive nicknames. When asked in detail, he clarifies: “I don’t hear, but the feeling is that they are being scolded. I will listen - no one speaks, but still I continue to feel how they scold me ”. Sometimes the structure of visions is schematic, outline, very general, so that it looks more like a model, a prototype of an object. It is known that the development of perception is based on "cognitive schemes", which can be likened to a geometric pattern. It seems that the "maturation" of the hallucinatory image may repeat the early stages of the formation of perception. The clinical features of visual hallucinations have a known diagnostic value, indicate the nature of the disease or the localization of the lesion. So, extracampal hallucinations are usually observed in schizophrenia (Bleuler, 1920). Cinematic hallucinations are more common in intoxication, in particular, alcoholic psychoses. Intoxication psychoses are more typical of demonomaniac, zoological and polyopic hallucinations. The presence of abundant visual deceptions of perception with disorientation in the location, setting and time indicates a delirious clouding of consciousness. Hemianopsic hallucinations are observed in organic diseases of the brain (Banshchikov, Korolenko, etc. , 1971). These authors observed autoscopic hallucinations during cerebral hypoxia and expressed the opinion that such visual illusions indicate severe cerebral pathology. Multiple visual hallucinations are found in the structure of the epileptic aura - Jackson's visual hallucinations (1876). Pantophobic hallucinations and hallucinations of fantastic content are found with oneiric confusion. Micro-, macroptic hallucinations, as well as ugly distorted visions moving in a certain direction bear the imprint of local, organic brain damage. The clinical significance of many of the details of visual deception is far from fully disclosed. Perhaps their most common feature is their symbolic content, which cannot be directly translated into the language of verbal-logical formulas. So, the patient's thirst is manifested by visions of a river, stream, fountain, waterfall; pains form images of a biting dog, a stinging snake, etc. The analogy with dreams seems to be appropriate, the hidden meaning of which cannot always be accurately established. In dreams, as in visual deceptions, the regression of thinking to the figurative level of its organization is reflected, while verbal hallucinations indicate at least partial preservation of mature structures logical thinking... This may also mean that visual deception occurs with a deeper lesion. mental activity than verbal hallucinations. Auditory hallucinations. Like the visual ones, they are the most frequent and varied in content. Distinguish between acoasms, phonemes and verbal hallucinations, as well as hallucinations of musical content. Acoasms are elementary non-speech hallucinations. Separate sounds are heard such as noise, hiss, rumbling, creaking, buzzing. There are often more specific ones related to certain objects, although non-verbal auditory deceptions are also found: steps, breathing, stomping, knocking, phone calls, kisses, car horns, sirens, floorboards creak, crockery clinking, teeth grinding and much more. Phonemes, elementary speech deceptions - shouts, screams, moaning, crying, sobbing, laughter, sighing, coughing, exclamations, individual syllables, fragments of words are heard. With hallucinations of musical content, the playing of musical instruments, singing, choirs is heard. Famous melodies sound, their fragments, sometimes unfamiliar music is perceived. Musical hallucinations are often observed in alcoholic psychosis. Usually these are vulgar ditties, obscene songs, songs of drunken companies. Musical deceptions of perception can occur in epileptic psychosis. Here they look different - this is the sound of the organ, sacred music, the ringing of church bells, the sounds of magic, "heavenly" music. Hallucinations of musical content are also observed in schizophrenia. So, the patient constantly hears songs in the retro style - "melodies of the 30s". "Concerts" have not been interrupted for more than six months now. Songs and orchestral works that she remembers, as well as those long forgotten by her, are heard. Melodies appear and change on their own or begin to sound as soon as she thinks about them - "a concert on request." Sometimes the same melody is obtrusively repeated many times in a row. Verbal (verbal) hallucinations are much more common. Individual words, phrases, conversations are perceived. The content of hallucinatory statements may be absurd, devoid of any meaning, but for the most part they express various ideas that are not always indifferent to the patient. S. S. Korsakov (1913) considered hallucination as a thought, dressed in a bright sensory shell. VA Gilyarovsky (1954) indicates that hallucinatory disorders are not something divorced from the patient's inner world. They express various disorders of mental activity, personal qualities, the dynamics of the disease as a whole. According to V. Milev (1979), hallucinations show echolalia, perseverations, disrupted thinking, inadequacy or paralogy. All this makes a clinical analysis of the content of hallucinations in general and verbal hallucinations in particular useful. At the onset of a mental disorder, verbal hallucinations are in the form of hail by name, surname, usually single and rarely repeated. Hells are heard in reality, when falling asleep, waking up, in silence or a noisy environment, alone and surrounded by people, in situations where patients expect to be called. It is not always possible to determine whether it was a hallucination, it was actually called, or an illusory perception took place. With repeated calls, patients often identify deceptions of hearing themselves. At the same time, it is often indicated that the "calls" are repeated with the same voice. There are "silent" calls. Sometimes patients refer to the calls to another person: "They call, but not me." Commentary or evaluative hallucinations reflect the opinion of "voices" about the patient's behavior - benevolent, caustic, ironic, condemning, accusing. "Voices" can talk about present and past actions, and also evaluate what he intends to do in the future. In a state of fear, hallucinations acquire a threatening character, consonant with the delusional ideas of persecution. Imaginary threats of murder, reprisals, revenge, brutal torture, rape, and discrediting are perceived. Sometimes the “voices” have a distinctly sadistic connotation. Dangerous for others and the patients themselves, a variety of auditory deceptions are imperative hallucinations containing orders to do something or prohibitions on actions. Patients often attribute the orders of the votes to their own account. Less commonly, they believe that they relate to others. So, the voice orders those around to kill the patient. Voices can demand actions that directly contradict conscious intentions - hitting someone, insulting, committing theft, attempting suicide or self-harm, refusing to eat, medication, or talking to a doctor, turn away from your interlocutor, close your eyes, grit your teeth, stand still , walk without any purpose, rearrange objects, move from one place to another. Sometimes the orders of the “voices” are “reasonable”. Under the influence of hallucinations, some patients turn to psychiatrists for help, without themselves being aware of the fact of a mental disorder. Some patients indicate a clear intellectual superiority of "voices" over them. The content of imperative deceptions and the degree of their influence on behavior are different, so that the clinical significance of this type of deception may be different. Thus, “orders” of a destructive, ridiculous, negativistic nature indicate a level of personality disorganization close to catatonic. Such orders, like catatonic impulses, are realized automatically, unconsciously. Orders with a feeling of coercion are also carried out, but at the same time the patient tries to resist or at least realizes their unnaturalness. The content of such orders is no longer always destructive or absurd. Orders of persecutory content are observed. There are contradictory, ambiguous orders of the voices, when, along with ridiculous ones, quite reasonable orders sound. Sometimes orders are heard that are consonant with the patient's conscious attitudes. There are imperative hallucinations of magical content. So, "voices" make the patient stretch ropes, threads in the apartment, put things on the indicated places, not touch some objects. Voices claim that there is a mysterious connection between these actions and the well-being of loved ones. In response to the refusal to obey the orders, the “voices” predict imminent death. In another observation, the "voices" demanded to wash their hands a strictly defined number of times - seven or twelve. The patient believed that the number "seven" hides a hint of her family - "seven is a family." Washing your hands seven times means saving your family from misery. The number "twelve" hinted at the twelve apostles. If she washed her hands the specified number of times, then she was “cleansed” of all her sins. To a patient with alcoholic psychosis, the “voices” said: “You hear, we are sawing a log. As soon as we saw through, you will die. " Or a voice orders: “Take a mirror and destroy the witch - she moved into the mirror. " It happens that the voices belong to "witches", "demons", "devils". It can be seen from the examples given that in verbal hallucinations the regression of thinking to the archaic (magical) level of its organization is expressed. Hallucinatory orders, as mentioned, are not always implemented. Sometimes patients do not attach importance to them, or consider them ridiculous, meaningless. Others find the strength to restrain themselves or "to spite the voices" to do the opposite. More often than not, imperative hallucinations have an overwhelming effect. Patients do not even try to oppose themselves to them, following the wildest orders. According to the patients, at this time they feel "paralysis" of their will, they act like "automatic machines, zombies, puppets." The irresistible imperativeness of hallucinations testifies to their proximity to catatonia and the phenomena of mental automatism. According to V. Milev (1979), imperative orders can be attributed to schizophrenic symptoms of the first rank. Hallucinations that contain not orders, but persuasions, admonitions, reports of false information, which acquire a great power of persuasion for patients, reveal some similarity with imperative ones. Thus, the “voice” persuades the patient to commit suicide: “Jump off the bridge. Don't be afraid, it's not scary. Why live, understand, life is over for you long ago. There are hallucinations with the character of suggestion. The schizophrenic patient did not hesitate to believe that he had committed the murder when the "voices" informed him of it. He clearly "remembered" the details of the "crime" and reported himself to the police. “Voices” can further assure of the existence of witchcraft, the afterlife, predict the future, and communicate absurd and fantastic information. Hallucinatory fictions do not leave patients indifferent, their truth may seem obvious to them. "Voices" can not only "prompt" what should be done, but also the very way to accomplish this or that act. Thus, the “voice of the father” pushes the patient to commit suicide, invites her to her cemetery. He says that you need to poison yourself with vinegar essence, indicates where to get it. The patient, indeed, finds the essence in this place, although previously it was as if she could not find it anywhere. There are auditory hallucinations with the character of a statement - an accurate registration of what the patients themselves perceive or do: "This is a station ... A policeman is walking ... This is not the bus ... Got up ... Going ... He puts on his shoes ... Hid under the bed ... I took the ax ...". Sometimes voices refer to objects that the patient has not noticed. So, he wants and cannot determine the name of the street along which he is walking, and the "more observant" voice correctly prompts him to do so. The statements concern not only external impressions and actions, but also motives, intentions: “I am duplicated, repeated. I’ll just think about doing something, and the voice will say it. I want to leave the house and immediately hear people talking about it ... ”. Patients believe that they are "recorded, listened to, photographed, filmed." Sometimes "voices" require patients to pronounce aloud or mentally the names of perceived objects, to repeat what has been said many times. And, on the contrary, one and the same word, phrase uttered by the patient or someone around, can be repeated in voices, like "echo", sometimes - 2-3 times or more. Such deceptions of hearing can be referred to as echolalic or iterative hallucinations. Hallucinations can "duplicate" not only the statements of others or the patients themselves. Own thoughts begin to "sound" - the "voice" immediately "repeats" what the patient thought about. When reading, the content of the read is copied - a symptom of an echo reading. The voice "reads" what is written by the patient - "echo letters". The repetition of thoughts can be multiple. According to the patient, before going to bed, he "inspires" himself: "I calmed down, relaxed, I want to sleep, I fall asleep." Following this, he hears a "voice" that says this phrase five times - "now I do without sleeping pills, it puts my voice to sleep." The repetition rate can be slowed down, accelerated, or changes, speeding up towards the end of the pronunciation. Sometimes the repetition concerns individual words, the end of a phrase. So, the voice "inside" every second repeats the threat: "I will put it" and speaks like this for days. As you speak, the sound volume gradually fades, the timbre of the voice changes. Repetitions are not always identical; variations in shades of sound and meaning are possible. One of the patients reported 6-fold repetition of phrases, but each time in a different voice and some change in content. There are stereotypical hallucinations - the same thing is constantly heard. For a number of years, a patient with Huntington's chorea had a hallucination in the form of the phrase repeated from time to time: "Victor, cuckoo!" At first I thought that they were playing hide and seek with him, I was looking for someone hiding, but then I became convinced of the deceit of hearing and stopped paying attention to him. In a repeated attack of the disease, sometimes the same voices "return" and say the same as before. There are "double voices" - one of them a little later exactly copies what was said by the first. Verbal hallucinations can be in the form of a monologue - the "voice" leads an endless story about something, not allowing you to interrupt yourself or change the topic. For example, the "voice" recalls and tells in detail the patient's biography, giving such details that he "forgot long ago." Hallucinations can be multiple (polyvocal). Several voices are simultaneously talking about different things, talking to each other. In hallucinations in the form of a dialogue, two "voices" "argue" with each other about the patient, and one of them praises, approves, emphasizes his merits and dignity, the other, on the contrary, accuses, condemns, demands punishment, physical destruction. Contrasting hallucinations - one of the "voices" says or orders to do one thing, while the other at the same time - exactly the opposite. There are scene-like auditory hallucinations - many "voices" create a visible impression of a complex situation that is developing dynamically. Hallucinations of poetic content are observed - "voices" compose poems, epigrams, puns. Verbal hallucinations can maintain complete autonomy from patients, not "in contact" with them, or even "believe" that they do not hear them. It so happens that they speak instead of the patient. Thus, a “voice” answers the doctor’s questions, and the patient “does not think” at this time, she only “repeats” his answers. Voices can also address patients directly, ask, ask to repeat something, talk with them. So, the "voice" appears to the patient every morning, wakes up, greets, and in the evening says goodbye. Sometimes he notifies that he will leave it for a while, returning by the appointed date. Answers the patient's questions, gives advice, asks in detail about his life, as if collecting anamnesis. Before disappearing, he announces that he “leaves forever, dies”. Or the voice tells about the patient and specifies the year and place of her birth, details of school, life, family, is interested in work, children. Through the mediation of patients, it is possible to "talk to voices." Answering questions, "voices" can deny, become silent, get lost, laugh derisively. Some of them report different information about themselves. So, in response to a questioning, the “voice” of the patient says: “Does he (that is, the doctor) really do not understand that I am a disease? I have nothing to say about myself. I will disappear as soon as the disease passes. " At the same time, the patient herself believed that the "voices" were the messenger of "another, invisible world." Or "voices" speak, give their names, age, describe their appearance, claim that they occupy high important posts, that they intend to commit suicide, or that they "hear voices themselves" that they suffer from seizures, express a desire to be treated, etc. e. Voices often express opinions and assessments independent of the patient, show interest in external events, express their own desires, talk about their origins, and make plans for the future. They can also say what coincides with the opinion of the patient, express his views and expectations. Patients "consult" with "smart" voices. So, the patient consults with the "voice", whether she will go to the hospital in the future. To this he cautiously replies: "Most likely, yes." Sometimes it is possible to test the mental capabilities of the voices. They perform arithmetic operations, interpret proverbs and sayings in their own way. The level of their "thinking" for the most part turns out to be lower than that of patients. The emotional context of the voices' statements - and this is evident from the tonality, speech forms, the content of what was said - is often hostile, aggressive, cynical, rude. All this shows that "voices" are an expression of a complex pathological structure that integrates various psychological functions into a holistic education at a different, usually reduced level. They represent a semblance of a personality neoplasm, often in opposition to the patient's personality. There are hallucinations with the character of anticipation. The “voices” seem to anticipate events and predict that the patient will soon feel what he will think about or learn about. They notify that he has a headache, there will be an “urge” to urinate, defecate, vomit, or he will soon “want” to eat, sleep, or say something. And, indeed, these predictions often come true. The patient has not yet had time to realize what has happened, and the "voice" informs about what actually happened. It also happens that when reading, the "voice" runs ahead and "reads" what is written at the bottom of the page, while the patient looks only at the top lines. It turns out that voices perceive subthreshold signals that do not reach the level of consciousness. "Voices" can speak slowly, in a chant, patter. Thus, when the condition is exacerbated, the voices of ordinary pace begin to speak “very quickly”. Their previously coherent speech becomes torn, reminiscent of a set of separate words. Sometimes voices arise in the form of influxes, sometimes their sound is interrupted by sudden pauses. In hallucinations, meanwhile, there are practically no such phenomena as stuttering, paraphasia, aphasia, dysarthria and other neurological pathology, even if it is in the speech of patients. Verbal hallucinations are observed in the form of neologisms, as well as verbigeration - stringing of words that are incomprehensible either to the patient himself or to those around him. Sometimes patients claim that they hear voices on " foreign languages"And at the same time they perfectly understand what was said, although they themselves do not speak any languages ​​- cryptolalic hallucinations. For polyglots, "voices" can sound in foreign languages, including those that are forgotten - xenolalic hallucinations. Auditory hallucinations can be different in volume, distinctness, naturalness. Most often, they sound the same as the conversation of the people around them. Sometimes they are barely audible, indistinct, "rustling", or they sound deafeningly loud. There are "premonitions" of voices - "they are not, but I feel that they are about to appear." There is a fear of voices that "should" appear. Hallucinations are usually perceived as living, natural speech, but they can be heard as "on the radio", from a tape recorder, sound like in a "stone bag". Sometimes they seem "unreal". Often they are individualized, they are recognized by persons known to the sick. Sometimes the patient's own voice sounds. Recognizing the voice of a person seems to be a fact of delusional interpretation. The same voice can belong to different persons... There are “fake”, “familiar” voices, which, as the patients believe, belong to unknown persons, and, on the contrary, the voices of loved ones, “specially” distorted beyond recognition. For example, voices "imitate" speech and thoughts real people... The patient even "sees" at the same time "images" of people whose voices she hears. The source of hallucinations is localized by patients, as a rule, in a real environment. Voices are perceived to be sounding somewhere nearby, even the direction from which they come is indicated. Sometimes they sound “around”, and patients cannot determine from which side they are heard. Sometimes voices are localized at a great distance, far beyond the limits of real hearing. They can also be perceived near or on the surface of the body, near the ears ("whispering in the ear"), in the ear canals. But even in such cases, voices are perceived as coming from the outside towards the sick. Less often, the opposite happens: the voices "fly off", go from the patients in the direction outward. The patient reports that the voice from the head sometimes "flies out" outward, she even sees a receding brilliance. At this time, he thinks that the voice becomes audible to those around him. For the most part, voices are picked up by both ears, but can also be heard in one ear - one-sided hallucinations. There are deceptions of hearing that occur simultaneously with a variety of synesthetic sensations. Auditory hallucinations are observed for the most part with formally unchanged consciousness in the clinical picture of various diseases. Certain features of auditory hallucinations can be diagnostic. Hallucinations of threatening content, for example, indicate a paranoid mood shift, blaming or encouraging suicide, indicative of depression, benevolent, approving, laudatory - of an elevated mood. The symptom of sounding thoughts, the symptom of echo reading, duplicate hallucinations, hallucinations with the nature of iterations (multiple repetitions), contrasting hallucinations are more common in schizophrenia. The alcoholic theme of the content of deceptions of hearing is revealed in alcoholic psychosis. Olfactory hallucinations. Imaginary perception of various odors. These can be familiar, pleasant, disgusting, vague, or unfamiliar smells that have never been encountered before. The projection of olfactory hallucinations is different. Patients may believe that the smells come from surrounding objects or claim that they smell from themselves, from the legs, genitals, from the mouth, etc. Sometimes they claim that the source of “the smell is the internal organs. There is an unusual projection of deceptions of smell - smells are perceived, for example, inside the head. Imaginary smells are often associated with delusional ideas. So, unpleasant odors emanating from the body are combined with the phenomena of dysmorphomania (delirium of physical disability), odors with an external projection - with delirium of poisoning; smells coming from within - with nihilistic and hypochondriacal delusional ideas. The appearance of olfactory hallucinations often outstrips the development of delirium itself. Gustatory hallucinations. False taste sensations arising out of connection with food intake or any substances. Taste hallucinations can also occur while eating - an unusual, unusual for dainty food, a permanent taste appears ("metallic", "smack of copper, cyanide, unknown poison", etc.). Taste deceptions are sometimes localized "inside" the body and are explained by patients with "rotting, decomposition" of internal organs. Hallucinations of the cutaneous sense. Various deceptions associated with different types of skin sensitivities. Tactile hallucinations are imaginary sensations of touch, touching, crawling, pressure, localized on the surface of the body, inside the skin, under it. Deceptions of perception are of a substantive nature. Patients claim that they feel the touch of their hands, stroking, feel how they are sprinkled with sand, dust, pricked with a needle, scratched with nails, hugged, bite, patted, pulled by the hair, believe that living beings are and move on the skin or inside it. Often, tactile hallucinations are localized in the oral cavity, where the presence of hair, crumbs, wires, and other foreign objects is felt. The apparent presence of hair in the mouth is considered characteristic of psychosis associated with tetraethyl lead poisoning. Cocaine psychoses are characterized by imaginary sensations under the skin of small objects, crystals, insects - Magnan's symptom. Haptic hallucinations are imaginary sensations of a sharp seizure, blows, jolts, coming, in the opinion of patients, from the outside. Erotic (genital) hallucinations are imaginary sensations of obscene manipulation performed by someone from the outside on the genitals. Stereognostic hallucinations - the imaginary sensation of the presence of an object in the hand - a matchbox, glass, coin, etc. - is a Ravkin symptom. Thermal (thermal) hallucinations - false sensations of burning, moxibustion, cooling of a part of the body surface Unlike senestopathies, thermal hallucinations are objective in nature - "they apply a hot wire, burned with an iron", etc. Gigric hallucinations - a false sensation of presence on the surface of the body or under drops of liquid, jets, streaks, blood, etc. Interoceptive (visceral hallucinations, hallucinations of general feeling). A false sensation of the presence inside the body of foreign bodies, living beings: mice, dogs, snakes, worms, a feeling of additional internal organs, "sewn devices", and other objects. They differ from senestopathies in physicality, objectivity. The following observation can serve as an illustration. The patient claims that for many years she has been "tormented by worms." Helminths that previously filled the abdominal cavity have recently penetrated into the chest and head. He clearly feels how "roundworms" move, curl into balls, crawl from place to place, stick to internal organs, touch the heart, squeeze blood vessels, close the lumen of the bronchi, swarm under the skull. The patient insists on an immediate operation, believing that otherwise she is in danger of death. Visceral hallucinations are usually accompanied by delusions of possession. A variety of interoceptive hallucinations are transformation hallucinations, which are expressed by the feeling of a change in specific internal organs: “The lungs have fallen asleep, the intestines have stuck together, the brain has melted, the stomach has shrunk, etc.”. Motor (kinesthetic) hallucinations. Apparent sensations of simple movements or complex actions. Patients feel how their fingers are clenched into a fist, the head turns or sways, the body bends, the arms are raised, the tongue sticks out, the face is twisted. In acute psychotic states, in particular, with delirium tremens, they feel as if they are going somewhere, running away, performing professional actions, pouring wine, while actually lying in bed. There are kinesthetic verbal and graphic hallucinations with imaginary sensations of movement of the articulatory apparatus and hands, characteristic of speaking and writing. False sensations of movement can be violent - patients are "forced" to speak, write, move. Motor deceptions of verbal content for the most part belong to pseudo-hallucinations. Sometimes there are automatisms written speech... According to the elephants of one of the patients, she communicates with God in a very unusual, "amazing" way. Her hand involuntarily writes texts, moreover, the patient herself learns about the content of the latter later, only after reading what was written. She writes, “without thinking”, at this time “there are no thoughts in my head”. Something moves her hand, some kind of extraneous force, she only submits to her meekly. Vestibular hallucinations (hallucinations of a sense of balance). Imaginary sensations of falling, lowering and lifting up, like on an elevator or on an airplane; rotation, somersault of your own body. There may be a feeling of movement of surrounding objects, directed in a certain direction, or chaotic, chaotic - an optical storm. The object of hallucinatory perception can be one's own body. With typhus, there is a feeling of duplication of the body - a symptom of a double (Gilyarovsky, 1949). In a state of confusion, the patient feels another person lying next to him, exactly the same person as himself. There are hallucinations of reincarnation in animals (zooanthropy): lycanthropy - into a wolf, galleanthropy - a cat, kinanthropy - a dog. There may be a sense of transformation into inanimate objects. Thus, the patient had the feeling that his body had turned into a passenger car with a bucket in front. The patient, as he later said, moved along the carriageway in accordance with all the traffic rules: “braked”, “honked” at turns, clenching his fists, etc. The normal body sensation at this time disappeared. The phenomena of such reincarnation can be considered as a hallucinatory variant of depersonalization. Such phenomena are often characteristic of the state of oneiric confusion. Depending on the conditions of occurrence, the following types of hallucinations are distinguished. Functional (differentiated) hallucinations. They develop simultaneously with the perception of a real stimulus and within the same modality of sensation. More often these are auditory, less often - visual hallucinations. For example, under the sound of the wheels, the phrase is repeated at the same time: "Who are you, what are you, who are you, what are you ...". When the train stops, the hallucination disappears. At the sight of a passer-by, the patient notices how someone's head peeps out from behind him. Unlike illusions and illusory hallucinosis, imaginary images in functional hallucinations coexist with adequate perception of real objects. Reflex hallucinations. Unlike functional ones, they are an imitation of a real stimulus in a different modality of sensation. The patient reports: "I hear a knock, a cough, a creak of a door, and at the same time it is given in my chest - as if someone had knocked, coughed, turned over there." Reflex hallucinations may be delayed. So, the patient saw a broken window, and a little later felt broken glass in her stomach. In the morning she spilled kerosene, and by lunchtime she felt as if “everything was saturated with it,” she even heard its smell coming from within. Hypnagogic hallucinations. They arise in half-sleep, when falling asleep, with closed eyes, in a state of light drowsiness. Delirious clouding of consciousness is often foreshadowed. Usually these are visual, auditory, tactile hallucinations. Sometimes motor and speech-motor hallucinations may appear - it seems to patients that they get up, walk, speak, shout, open doors ... Hypnagogic hallucinations are clearly distinguished by patients from dreams. An understanding of the painfulness of perceptual delusions appears some time after awakening. Hypnopompic hallucinations. Occur on awakening from sleep. Usually these are visual, less often - auditory deceptions of perception. Hypnagogic and hypnopompic hallucinations are combined with sleep disturbances and can be considered as particular variants of oniric deceptions of perception. Hallucinations, as clinical observations show, can be confined not only to the phases of "slow" it. So, there are unusually vivid dreams, which later patients refer to as real events. Apparently, hallucinations also occur during REM sleep. Bonnet's hallucinations... First described in a patient suffering from senile cataract. Their appearance is associated with eye pathology - cataracts, retinal detachment, inflammation, eyeball surgery. These are visual single or multiple, scene-like, in some cases colored and mobile visions of people, animals, landscapes. With a low intensity of hallucinations, a critical attitude of patients towards them remains. With the intensification of hallucinations, the understanding of pain disappears, anxiety, fear appear, and behavior is disturbed. The defeat of the cochlear apparatus, neuritis of the auditory nerve, sulfur plugs can contribute to the development of auditory deceptions. The appearance of Bonnet hallucinations is associated with pathological impulses from receptors, as well as with sensory hyperstimulation. Each of these factors and individually can facilitate the development of hallucinations. As numerous studies show, in conditions of perceptual and sensory deprivation (restriction of the flow of internal and external stimuli), various mental disorders develop - the illusion of body rotation, a decrease in the threshold of visual sensitivity, hallucinations. There is a significant phenomenological similarity of these disorders with the symptoms of schizophrenia. Hyperstimulation can also alleviate the appearance of hallucinations and influence their clinical structure. Toothache is sometimes accompanied by auditory hallucinations with a projection into the affected teeth. Auditory hallucinations often intensify in silence and disappear in noisy environments, but it also happens that noise contributes to their appearance. Lermitt's peduncular hallucinations. They occur when the brainstem is affected in the area of ​​the legs. Against the background of incomplete clarity of consciousness, visual midget deceptions of vision are observed, usually in the evening hours, before bedtime. Perceived animals, birds, usually mobile and painted in natural colors. Criticism of hallucinations may persist. As they intensify, it disappears, joins in, anxiety, fear. Plaut's hallucinations... Described for neurolysis. Loud verbal deceptions are characteristic, delusional interpretation is possible with the loss of a critical attitude towards them, behavioral disturbances. Hallucinations of Van Bogart. Observed with leukoencephalitis. Multiple color visions of zoological content (animals, fish, birds, butterflies) appear in the intervals between bouts of increased sleepiness and are accompanied by anxiety, an increase in the affective coloring of imaginary images. Subsequently, delirium develops, complex acoustic disorders, amnesia for a period of impaired consciousness. Bertse's hallucinations. Combined optical-kinesthetic deceptions of perception. Patients see glowing telegrams on the walls, written by someone's invisible hand. They are found in alcoholic psychosis. We have seen patients with schizophrenia read short, typed phrases on the wall, usually stereotypical phrases with no clear meaning. The phrases appeared spontaneously, but could also arise after the patient's attention was drawn to this phenomenon. Peak Hallucinations. Visual deception in the form of people, animals, perceived through the walls of the building. During hallucinatory episodes, patients show nystagmus, diplopia. Described with lesions of the brain stem in the region of the fourth ventricle. Hallucinations of Dupre's imagination. They are associated with long-term ideas, ideas, and are consonant with the latter in content. They develop especially easily in children and persons with a painfully heightened imagination. V.A. Gilyarovsky called such hallucinations identical. Close to them are “paranoid reflex hallucinations of the imagination” (Zavilyanskiy et al., 1989, p. 86) - a vivid visualization of images of a representation with their alienation from the personality and projection outward. Hallucinations are unstable, fragmentary. Their genesis is associated with a heightened morbid imagination. Psychogenic (affectogenic) hallucinations. O reflect the content of emotionally colored experiences in conditions of mental shock. Characterized by the psychological clarity of the content of hallucinations, closeness to the patient's actual experiences, emotional saturation, the projection of imaginary images outward. The difference between imaginary hallucinations and psychogenic hallucinations can be shown in the following examples. A patient suffering from tuberculosis of the spine was seriously worried about physical deformity. He was afraid to appear in public, believed that everyone was paying attention to him, treated with a feeling of disgust, and made fun of him. In society, I felt very constrained and thought only about the impression that I could leave with others about myself. On the street I constantly heard passers-by talking about him: “What a freak! What a freak! Hunchback ... Little Humpbacked Horse ... ". In this case, one should think about the hallucinations of the imagination associated with the dominant experiences of physical deformity and the corresponding expectations. After the death of her only child, the young woman was in a psychotic state for two weeks. During the day, more often in the evening, at night I saw my daughter, heard her voice, talked to her, caressed her, braided her hair, fed her, gathered her to school, and met her when she returned from school. At this time, she did not realize that her daughter was not alive. In the latter case, we are talking about psychogenic hallucinations that characterize reactive psychosis. Psychogenic inclusions often sound in the hallucinations of endogenous patients. So, in the psychosis of a patient who has lost his wife, her voice is heard, and she herself is seen alive, since the patient was able to "revive" her. The emergence of psychogenic hallucinations is facilitated by hysterical character traits, high suggestibility. Psychogenic hallucinations are obviously associated with the activation of psychological defense mechanisms. The content of perceptual deceptions often reproduces the desired situation, at the same time, the real, traumatic situation is ignored, ideas about it are repressed. Seglo's associated hallucinations. They develop in the clinical picture of reactive psychoses. The plot of hallucinations reflects the content of traumatic events. Deceptions of perception appear in a logical sequence: a "voice" announces a fact that is immediately seen, felt. Associated hallucinations can also occur in schizophrenia. So, the “voice” says the following: “If you want to see me, go to the toilet. In a dark corner you will see me in the form of a devil. " The patient really went and saw a devil in the toilet. The next time the "voice" made me see myself on the TV screen in the form of a man. Sometimes he demanded to "touch" himself, and the patient clearly felt his fur. In another observation, the “voice of the witch” told the patient how she looked. As it was reported, the patient began to see the eyes, head, torso, limbs, then finally saw the whole witch. Combined hallucinations. There are combinations of hallucinations of different sensory modality, united by a common content. One of the variants of such a combination is Mayer-Gross synesthetic hallucinations - patients see moving figures of people and at the same time hear their speech; see flowers and smell them. Induced (suggested) hallucinations. They arise under the influence of external suggestion. They can be collective in nature, fueled by massive emotional engagement, usually growing in crowds and leading to dramatic increases in suggestibility. The existence of such hallucinations has been known for a long time, they are mentioned, in particular, in the Bible. In the crowd, struck by superstitious horror, mystical ecstasy, warlike fervor, especially among easily suggested persons, various deceptions of perception, which are most often of the same type, spread rapidly. Induced hallucinations are also observed in induced psychoses: deceptions of perception are, as it were, transmitted from the patient to other members of his family or to persons in close contact with him. Various hallucinations, including negative ones, can be induced in a state of deep hypnotic sleep. Upon exiting the latter, hallucinations are amnestied. There is a special kind of hallucinations that can be caused in patients with the help of special techniques. Lipman's symptom - white-hot visual hallucinations appear at the moment of pressing on the patient's closed eyes. Aschaffenburg's symptom - at the urgent request, the patient hears an imaginary speech and speaks on the phone (which is disconnected from the network or faulty). Symptom Reichardt and Riegert - the patient can be made to "read" any text on a blank sheet of paper. Purkinje symptom - pressure on the patient's closed eyes contributes to the appearance of elementary visual hallucinations. Ankylosing spondylitis test - the appearance of visual images suggested by light pressure on the patient's lowered eyelids. Osipov's test - the patient feels in his fist an imaginary object, which the doctor supposedly put there. The presence of these symptoms indicates an increased readiness for hallucinations. Especially often these symptoms are positive in alcoholic psychoses. Pseudohallucinations. First isolated and studied in detail by the Russian psychiatrist V. Kh. Kandinsky (1890). V. Kh. Kandinsky considers the following signs to be the most characteristic of pseudo-hallucinations: - imaginary images are experienced as being in the imagined space, that is, unlike true hallucinations, they are not projected into real space; - pseudo-hallucinatory images differ from ordinary images of representation in that they are involuntary, intrusive, they are also characterized by completeness, completeness of images, their detailing, they are accompanied by "a feeling of torment and melancholy"; - pseudo-hallucinatory images, if there is no clouding of consciousness, do not have the character of objective reality and are not mixed by patients with real objects. The first feature of pseudo-hallucinations is clinically manifested as follows. According to the patients, they perceive something not in a real environment, but “inside the head” - “they see with the mind, head, inner eye, mental eye, brain”, “hear with the inner ear, inside the head, hear with the head, mentally”. Sometimes pseudo-hallucinations show a tendency to projection outside the psychic "I". In this case, imaginary images are localized "in the eyes", in the immediate vicinity of them, "in the ears, the auditory canal, at the roots of the hair." Another sign of pseudo-hallucinations is that they, in contrast to the images of representation, arise spontaneously, involuntarily, contrary to the desire and direction of the patient's internal activity, are stably kept in their consciousness. In other words, pseudo-hallucinations are subjectively experienced as "made", arising under the influence of some external forces... The feeling of one's own activity, which often accompanies the perception of true hallucinations, is absent during pseudo-hallucinations: the latter "take root", "invade" the patient's consciousness, are experienced as something alien to his personality. It should be noted that the mention of "adjusted", "made" can accompany various psychopathological phenomena, including true deceptions of perception. The phenomenon of "made-up" in pseudo-hallucinations is a direct, sensory phenomenon, in contrast to the delirium of staging, where what is happening in reality and in the deception of perception is regarded in the context of an artificially created situation. The emergence and content of pseudo-hallucinations is often completely isolated from what is perceived in reality or is currently being experienced. At the same time, an important feature of pseudo-hallucinations is that the internal aspects of the “I” are not subjected to such total alienation in them, as is characteristic of hallucinations. As VM Banshchikov, Ts. P. Korolenko et al. (1971) point out, true hallucinations are more likely addressed to the physical "I", while pseudo-hallucinations are more characteristic of the focus on the mental "I" of patients. This feature of pseudo-hallucinations is expressed, in particular, in the fact that pseudo-hallucinatory characters often identify themselves with the personality of patients. Thus, a voice sounding “in the back of the head” says the patient: “I am your brain. Everything you hear from me is true. What I force you to do, you will fulfill, since my desires are your desires. " This is especially evident when pseudo-hallucinations are accompanied by true deceptions of perception. In this case, "external voices" are perceived as "outsiders", and "internal voices" are experienced with a feeling of closeness to the "I", in an intimate connection with inner peace patient - "my voice, as if my soul was talking to me." The patient simultaneously hears voices "in the shower", "in the head on the right" and outside herself, believing that at times the internal conversations "come out". At the same time, she claims that all these voices sound like "her own." Pseudo-hallucinatory images differ from images of representation by sensory brightness, sensory, detail, sometimes not yielding in this respect to true hallucinations. The third feature of pseudo-hallucinations is that they do not mix with the images of perception and representation. Patients talk about “another world,” “another dimension,” “special visions and voices,” and confidently distinguish them from external objects and memories. At the height of the disease attack, pseudo-hallucinations can be identified by patients with reality (Sum-baev, 1958). There is no critical attitude towards pseudo-hallucinations. It should be noted that the internal projection of perceptual deceptions is characteristic not only of pseudo-hallucinations. The following observation can serve as an illustration of the above. The patient for a number of years hears "voices", perceiving them "inside the head." There are usually several of these "voices" - from seven to twelve, sometimes one or two remains, at times there are a lot of them. The patient thinks that his own voice sounds, he can "bifurcate" or split into many separate voices. All voices, according to the patient, bear his own name. They talk among themselves about him, on other topics, address him directly, he can talk to them. They are perceived clearly, with a clearly pronounced shade of sound, sometimes "voices" shout loudly. The patient calls them "hallucinations", does not confuse them with the conversations of others. At the same time, he thinks that “invisible, little people” who are born, live and die live and talk in his head. Deceptions of perception are accompanied by a very painful feeling, a desire to get rid of them, while there is no consciousness of the disease. As emphasized by A.V. Snezhnevsky (1970), pseudo-hallucinations are pathognomonic a feeling of violent influence from the outside. Patients report that "voices" do not sound by themselves, but they are "made, transmitted, broadcast, evoked, inspired, invested" by means of special equipment, hypnosis. The source of "voices" can be localized by patients at a great distance; "Transmissions" are carried out with the help of waves, currents, rays, biofields, which are transformed, "sounded" by the brain or special devices placed in the head. In the same way, patients “make visions, show images, demonstrate pictures,” “cause odors,” “irritate internal organs,” “burn the skin,” “make them move,” etc. Some researchers interpret the violent shade of experiencing deceptions of perception differently. VA Gilyarovsky (1949) is not inclined to use Kandinsky's pseudo-hallucinations and Bayard's mental hallucinations, alienated from the “I”, as synonyms. According to IS Sumbaev (1958), it is necessary to distinguish between Kandinsky's pseudo-hallucinations, which are found in the presence of a single “I” of the patient, and mental hallucinations that develop in a disorder of self-awareness in the form of a doubling of “I” and characteristic of the Kandinsky-Clerambo syndrome. The author believes that Bayard's mental hallucinations arising with the nature of alienation are a special kind of painful ideas (Giraud's xenopathic ideas). Objective signs of deception of perception and images of representation. In addition to the subjective, there are external (objective) signs of deception of perception, which are different in hallucinations and pseudo-hallucinations. First of all, these are the behavioral reactions of patients to the fact and content of the emerging deceptions. Patients treat hallucinations in essentially the same way as for the corresponding real phenomena. Patients gaze intently at something, turn away, close their eyes, look around, wave away, defend themselves, try to touch or grab something with their hand, listen, plug their ears, sniff, lay their nasal passages, lick, lick, swallow saliva, spit, drop something from the surface of the body. Under the influence of hallucinations, various actions are performed that reflect the content of perception deception: patients hide, look for something, catch, attack others, try to kill themselves, destroy objects, defend themselves, flee, and file complaints with the appropriate institutions. With auditory hallucinations, one speaks aloud with "voices." As a rule, patients believe that others perceive the same as they do in hallucinations - they hear the same voices, experience the same visions, smell. Emotional reactions are clearly expressed, the nature of which reflects the content of perception deceptions: fear, rage, disgust, enthusiasm. Autonomic reactions are also observed, a kind of somatic sensations arise that accompany hallucinations. The situation is different with pseudo-hallucinations. As a rule, there are no signs of an external focus of attention. Patients are absorbed in their experiences, they are distracted by what is happening around them with difficulty, without any interest. Pseudo-hallucinations are often accompanied by external inactivity of patients. Behavioral disturbances can nevertheless occur, especially if deceptions of threatening and imperative content occur. Patients with pseudo-hallucinations are usually sure that the deceptions of perception concern only them and do not apply to others. In verbal pseudo-hallucinations, in contrast to true ones, patients "communicate" with "voices" mentally, outwardly imperceptibly, and not aloud. “Communication” can be involuntary: the patient says that “mentally, involuntarily” she had to answer the questions of the “voices”. Hallucinoids. Initial or rudimentary visual hallucinations. They are characterized by fragmentation, sensibility, a tendency to exter-projection of images with a neutral contemplative and usually critical attitude of patients towards them (Ushakov, 1969). EA Popov points out that hallucinoids are an intermediate stage in the development or disappearance of true hallucinations (1941). Eidetism. The ability of some persons to mentally imagine and maintain a vivid image of an object or whole pictures for a long time after these objects or pictures have been perceived. More often expressed in relation to visual, tactile and auditory images. First described by V. Urbantschitsch in 1888. In Russian literature, the phenomenon of eidetic images is described by AR Luria, who observed a person with phenomenal visual memory. Eidetic images can be kept unchanged for 10 seconds or more. Some eidetics are capable of evoking eidetic images long after they have been fixed. More often, eidetic abilities are found in childhood and adolescence, then they gradually disappear, remaining only in some adults. Some famous artists had such vivid images. In this regard, some researchers consider eidetism as a stage age development memory, others - as a more or less permanent constitutional personality trait. It has been shown that manifestations of eideticism can also be a temporary painful feature of persons suffering from hallucinations (Popov, 1941). The following clinical observation can serve as an illustration. In an acute psychotic state, along with hallucinations in a patient with schizophrenia, various eidetic images arose. According to him, he achieved the highest degree of yoga - "raja yoga". The patient easily evoked vivid images of people known to him, works of art, illustrations for books, reproduced everyday scenes of the past. He recalled familiar melodies clearly, with sound. To the accompaniment of music, the products of his imagination were clothed in colorful visible pictures. The images could be unchanged or arbitrarily replaced, combined. Upon exiting the state of acute psychosis, the eidetic images disappeared. Perhaps one should not equate eidetic images with the dynamic and very vivid memories mentioned in the observation just cited. Strictly speaking, the eidetic image is a passive static imprint of the one just perceived from the real world. The special vividness of memories in mental patients often concerns not only fresh, but also distant impressions. Fantasy images can be just as vivid. In this case, the play of the imagination is rather passive and is directed by katatim mechanisms. When intensified, it takes shape in delusional fantasies, in figurative delirium, and with a significant exacerbation of the painful condition - in hallucinations. Eidetism, like hallucinations, can be defined as "perception without an object." Unlike hallucinations, eidetism is the result of the action of previous external stimuli, images arise and disappear arbitrarily, are not identified with reality. Eidetic differs from the usual image of representation by a high degree of sensibility and detail. With mental illness, there may also be a weakening or loss of the ability to imagine and vivid memories. Thus, a depressed patient “lost the idea” of how her husband, children, relatives, acquaintances look, “forgot” what her apartment is like, she is afraid that she will not be able to recognize her home. She cannot remember the smell of perfume, she does not recall a single melody, she has forgotten how the voices of loved ones sound. Only occasionally and for a short while in her mind appear stingy and faded images of the past. Before the illness, according to her, she always had a good figurative memory. Loss of images of representation is a sign of intellectual inhibition, characteristic of depressive states. Sensory synthesis disorders. Distorted perception of the size, shape of your body and surrounding objects. The identification of objects, in contrast to the illusion, is not violated. Metamorphopsias. Violation of the perception of the size and shape of objects and space in general. Objects seem to be enlarged - macropsia, reduced - micropsia, twisted around the axis, elongated, oblique - dysmegalopsia. Instead of one, several identical objects are seen - polyopsy. Distortion of the scheme of perceived objects is usually accompanied by a change in the perception of the structure of space. It shrinks, lengthens, objects move away, approach, the street seems infinitely long (porropsy), buildings are seen taller, lower, shorter than they really are. Metamorphopsias occur as a result of organic damage to the parietotemporal regions of the brain. Since the perception of spatial relationships is provided by the right (subdominant) hemisphere, it should be expected that metamorphopsies are associated with the topic of the lesion in the right hemisphere. Quite often, metamorphopsies are observed in the clinical structure of partial epileptic seizures. Often there are complaints of patients that outwardly resemble metamorphopsia, but in reality are due to other reasons. "Everything has somehow moved aside, perceived by the small, as at a distant distance." There is no actual distortion in the perception of the size and structure of objects, we are talking about a loss of empathy, emotional response, a sense of the alienation of the environment. Autometamorphopsia (body pattern disorder) ... Distortion of the shape or size of your body. With total autometamorphopsia, the body is perceived as enlarged - macrosomia, reduced - microsomia. With partial autometamorphopsia, individual parts of the body are perceived as enlarged or reduced. Sometimes a feeling of enlargement in one part of the body is perceived simultaneously with a feeling of a decrease in another. The body, any part of it, can be perceived as changed in only one dimension - to seem elongated, elongated, shortened. Changes may relate to volume, shape: thickening, weight loss. The head, for example, appears to be "square". These disorders occur more often with closed eyes, and disappear under the control of vision. They can be persistent or episodic, appearing especially often when falling asleep. With pronounced violations, the body is perceived as distorted beyond recognition, in the form of a shapeless mass. So, with closed eyes, the patient feels her body in the form of a puddle spreading over the chair, running down to the floor and spreading over its cracks and cracks. When the eyes are open, the body is perceived normally. The perception of the position of body parts in space may be impaired: the head seems to be turned with the back of the head forward, the legs and arms - twisted, the tongue - curled up into a tube. One of the patients had a sensation as if the legs were lifted up, embraced the neck and entwined around it. There is a violation of the perception of the unity of the body, its individual parts are felt in isolation from each other. The head is perceived at some distance from the body, the skull lid seems to rise and hang in the air, the eyes are out of their orbits and are in front of the face. When walking, it seems as if the lower body is in front, and the upper is behind, the legs are felt somewhere on the side. The body can be perceived as a mechanical connection of separate parts, “scattered, glued together”. The phenomena of autometamorphopsia are heterogeneous. Some of them are undoubtedly due to local organic brain damage, in other cases they should be considered in the context of somatopsychic depersonalization. Differential diagnosis is very difficult. Deceptions of orientation in space can manifest themselves in the form of a syndrome of turning the environment. The environment seems to be rotated 90 or 180 ° horizontally, less often vertically. Distinguish between subsonic, situational and "epileptic" variants of the surrounding rotation syndrome (Korolenok, 1945). In the first case, disorientation occurs in a state of subsonic stunnedness, usually in the dark with closed eyes. Waking up, the patient cannot figure out for a long time where the door, windows are, in which direction his head and legs are. Situational deceptions of orientation arise in the waking state with functioning vision, but only in a special spatial situation — the localization of the main landmark outside the field of vision. The "epileptic" variant of the turning syndrome is observed in the waking state, in the usual spatial situation, and is supposedly associated with transient vegetative-vascular disorders in the systems that provide the perception of space. It can be combined with the phenomena of derealization. Time perception disorders. Violation of the perception of the speed and smoothness of the flow of time, as well as the rate of flow of real processes. The passage of time can be perceived as accelerated - time passes quickly, imperceptibly, the duration of time intervals seems to be sharply reduced. The patient reports that she does not notice how time passes. It seems to her that it has not come even noon, when in fact it is already evening. She lay down to rest a little and did not notice how the day went. In the morning she wakes up with the feeling that she just went to bed, barely managed to close her eyes, the night flew by in an instant. The passage of time can be perceived as slow - "the night, it seems, will never end ... I wake up with the feeling that it should be morning, I will look at the clock, and I slept only for a few minutes ...". Sometimes there is a feeling of stopping time: "Time does not go, it stands still." A feeling of discreteness of time, its discontinuity may appear - only individual moments are recorded in consciousness, and the intervals between them do not leave any trace in the memory, the chain of events is interrupted, time suddenly, without sequential development, in the form of a leap becomes the past. “It seems that the morning is immediately followed by evening, the sun is immediately replaced by the moon, people go to work and immediately come back ...”. The distinction between the past, present and future may be lost: “The past, present and future are on the same plane, they are nearby, and I can rearrange them, like cards, from one place to another. I will not be surprised if I see a knight or a gladiator on the street - for me they are not in the past, but in today. I am talking to you now, and it will remain in me as what is happening now, but for you it will go into the past. The future is also happening now, it is not what will be sometime, but it already exists at the moment. " It so happens that distant events (they are remembered as having just happened, and what happened very recently refers to the past. The pace of real processes can also be perceived as accelerated or slowed down. It seems that transport, people move faster than usual, everything is perceived as on the accelerated film - a light traffic. Sometimes, on the contrary, the movements and speech of others seem to be slowed down, the cars go unusually slowly - zeitlupen. Self-perception can be projected outward. So, an excited patient believes that the people around him are restless and move very quickly; not her movements are slowed down, but those present. The mechanisms behind the onset of perceptual disorders have not been adequately studied. There is no unified theory explaining the pathogenesis of hallucinations. Historically, the first was the peripheral theory of the origin of hallucinations, according to which they arise in connection with painful irritation of the peripheral part of the corresponding sense organ (eyes, ear, skin receptors, etc.). The peripheral theory has now lost its meaning. It has been established that hallucinations occur in most cases when the sensory organs are in a normal state. They can be observed even with the complete destruction of the sense organs or the cutting of the corresponding conductors of sensitivity. From the standpoint of psychological theory, the appearance of hallucinations is explained by the strengthening of images of representation, confirmation of which was seen in the peculiarities of eidetism. Neurological theory linked the appearance of hallucinations with damage to certain cerebral structures, in particular, subcortical formations. SS Korsakov (1913) preferred the central theory of excitation of the cortical apparatus with irradiation of this excitation in the direction of the sensory apparatus. OM Gurevich (1937) explained the occurrence of hallucinations by the violation of the coordination of lethal and fugal components of perception and their disintegration, which is facilitated by disturbances in consciousness, autonomic regulation and disorders of proprioceptive sensitivity. Physiological theories of the onset of hallucinations are mainly based on the teachings of I.P. Pavlov. At the heart of hallucinations, according to I.P. Pavlov, is the formation of foci of pathological inertness of excitation in various instances of the cerebral cortex, providing the analysis of the first and second signals of reality I.P. Pavlov believed that these violations of the highest nervous activity due to biochemical changes in the brain. EA Popov (1941) emphasizes the role of hypnoid, phase states and, first of all, the paradoxical phase of inhibition in the genesis of hallucinations. Based on pharmacological experiments with the use of caffeine and bromine and the results of studies of sleep mechanisms, he showed that weak stimuli - traces of previously experienced impressions in the presence of a paradoxical phase of inhibition, can sharply increase and generate images of ideas, subjectively experienced as images of direct impressions. A.G. Ivanov-Smolensky (1933) explained the exter-projection of images of true hallucinations by the spread of inert excitation on the cortical projection of visual or auditory accommodation. Pseudo-hallucinations, according to the author, differ from true hallucinations by the local nature of the phenomena of pathological inertness of the irritable process, which extends mainly to the visual or auditory area. The similarity of pathological changes in the psyche in conditions of isolation and "sensory hunger" with the psychopathological phenomena observed in various psychoses gave rise to studies in which the role of sensory deprivation in the origin of hallucinations was established. Modern researchers of the electrophysiological nature of sleep associate the mechanism of hallucination with a shortening of the REM sleep phase with a kind of penetration of the REM sleep phase into wakefulness (Snyder, 1963). Numerous works of the last decades have revealed a connection between the appearance of various mental disorders, including hallucinations, and disorders of the exchange of neurotransmitters in the central nervous system. A significant place is given to dopamine metabolism disorders and an increase in the activity of dopaminergic structures of the brain. The use in the treatment of patients with psychotropic substances that bind to dopamine receptors, for example, haloperidol, leads in some cases to a sharp decrease in the intensity of hallucinations up to their complete cessation. Since the discovery of endogenous morphine-like peptides, enkephalins and endorphins (Huges et al., 1975; Telemacher, 1975), there have been indications that some of them perform mediator functions in specific neuronal systems of the brain. A hypothesis has been put forward about the role of endorphins in the pathogenesis of mental illness (Verebey et a]., 1978; Gamaleya, 1979), according to which the latter are associated with a lack of endorphins at the receptor sites or with an anomaly of endorphins. The endorphin antagonist naloxone has been shown to attenuate auditory hallucinations in schizophrenic patients.

Illusions(lat. illusio deception, delusion) - a false, erroneous perception of objects or phenomena that really exist at a given moment. The main difference between I. hallucinations is the presence of a falsely perceived real object at I. for example, a rolled-up robe on the bed looks like a figure of a lying person, stains on linen - insects, in the noise of the rain you can hear the sound of footsteps, in the conversation of people on the street - individual words and phrases addressed to this person, food tastes like an inedible substance, for example, clay, smell bread is perceived as a rotten smell.

There are visual, auditory, gustatory, olfactory, tactile I. Auditory I., the content of which is individual words or phrases, are called verbal. Pronounced, constantly emerging verbal I. is designated by the term "illusory hallucinosis." They appear against the background of a painfully altered affective state, mainly anxiety and fear, and are accompanied by delusional interpretation.

Jaspers (K. Jaspers, 1959) divided I. into three types: illusions, depending on inattention, affective I. and pareidolia. When I., associated with inattention, instead of one word, another is heard, similar in sound, a stranger is taken for a friend, etc. Affective I. arise under the influence of the affects of fear, anxiety. For example, a fearful person, walking along a deserted street at night, easily takes the shadow of an object for the figure of a lurking person.

Affective And. Are especially frequent with painful changes in the emotional state. Pareidolias are visual images of fantastic, fairy-tale content that arise when the figurative imagination is strengthened. So, in real objects, for example, in a wallpaper pattern, a carpet pattern, cracks and spots on the walls and ceiling, you can see changing exotic landscapes, ancient fortresses, pictures of battles, people's faces, and bizarre animals.

Psychological features of perception play an important role in the origin of I. Illusory perception is facilitated by changes in the concentration of active attention during fatigue,

a state of anxiety, fear and excitement, heightened imagination. Ideas arise especially easily in children who are characterized by insufficient differentiation of perception, rich imagination, and difficulty in distinguishing between fiction and reality. In the appearance of I., factors that reduce the clarity of perception are of a certain importance: insufficient illumination of objects, muffled sounds, as well as defects in vision and hearing. In e I. the role of hypnoid states of cortical analyzers is assumed.

Occasionally, I. can occur in mentally healthy people, but in mental illness they are much more common, more varied and vivid. And. Is most characteristic for states of shallow stupefaction, especially delirium (see.

Delirious syndrome ). They can be in acute intoxication (for example, in the case of alcoholic delirium tremens), infectious and other symptomatic ah. In addition, I. often occurs in patients with delusional and affective-delusional

A person gets to know the world around him through direct contact with it, through sensations and perceptions.

These two components of the general process of sensory cognition play huge role and are inextricably linked with each other.

Sensations help to gain knowledge about color, sound, temperature, taste, and perception adds all this into a common holistic picture.

How do we perceive reality?

So how do you accurately define this complex mental process? Perception is a holistic reflection of objects, objects, phenomena of reality in the aggregate of their parts, properties and qualities through the impact on the human sense organs.

The basis of the process of perception is made up of sensations, but it is impossible to reduce the entire process of cognition only to their sum, it would be too simple.

For example, a book cannot be viewed as a complex of sensations of the color and shape of the cover, the volume and roughness of its constituent pages.

Although without sensations, of course, there can be no perception. This is absolutely certain. But this process is much more complicated: it also includes the previous experience of a person, that is, the knowledge and ideas that are already in consciousness. Perceiving an object, we are not trying to isolate a group of sensations, but, on the contrary, we combine them all together into a single holistic image, which we then begin to analyze, comprehend and understand taking into account the existing experience.

In other words, both memory and thinking are involved in the process of fully assessing reality. Speech also plays an important role here, because the perceived must also be labeled.

How does the perception of certain objects or events take place? Special bodies in human body for that, no. The general activity of the system of analyzers, namely the material coming from it, is the physiological basis of perception.

Objects and phenomena of the surrounding reality are stimuli and trigger the process of perception, which in general can be represented as a result of the activity of the cerebral cortex, namely its somatosensory part, located in the parietal lobe.

A healthy person adequately perceives the surrounding reality, and this is the merit, first of all, of sensations, ideas and imagination.

We see, hear, taste and tactile, smell, change the position of the body in space, and then process all this knowledge gained with the help of the brain and get a complete picture-representation. Perceptual disorders make it impossible to obtain a single generalized image.

There are many possible violations, at the same time, each of them has its own typical features.

Agnosia - I see and hear something, but what?

- a pathological condition that has developed as a result of damage to the cerebral cortex and is characterized by the inability to perceive the information flow coming from the analyzers. This state leads to a change in the perception of the reality of objects and their incorrect assessment.

The causes of this pathology are considered to be damage to the parietal and occipital zones of the cerebral cortex, as well as the development of certain diseases of the central nervous system:

• open or closed type;
• inflammatory process of the brain (,);

The main varieties of agnosia are distinguished, which are then subdivided into private subspecies:

• visual;
• auditory;
• tactile

Visual agnosia is characterized by impaired identification of objects and depicted symbols. This pathology has several varieties:

Auditory agnosia is a result of defeat auditory analyzer... Depending on the area that is affected as a result of illness or injury, various disorders are distinguished:

1. Left hemisphere temple... Loss of the ability to distinguish the sounds of speech, write dictation, read aloud.
2. Right hemisphere... Lack of recognition of sounds and noises.
3. Anterior parts of the brain... Distortion of perception and understanding of the situation. Usually, this is a consequence of mental illness.
4. Right temple... Violation of understanding and reproduction of a certain rhythm, recognition of the intonation of speech of other people.

With the defeat of the parietal lobe of the right or left hemisphere, such a type of pathology as tactile agnosia is observed. With it, the patient cannot recognize shapes and objects tactilely, that is, by touch.

Hallucinations and pseudo-hallucinations

Another type of deviation in the real assessment of reality are. The definition of this phenomenon is as follows - the emergence of an image that does not have any stimulus under it.

This pathology arises as a result of bodily injuries, as well as mental disorders. The reason for the development of hallucinations can be an unlimited intake:

• alcohol;
• drugs;
• toxic substances;
• potent medicines.

The main reasons for the appearance of hallucinosis are the following:

• mental illness;
• diseases of the sense organs;
• heart disease;
• disorders in the functioning of the thyroid gland;
• drinking alcohol in unlimited quantities;
• drug use.

The classification of this pathological disorder of perception includes the following subspecies:

1. Organic... While maintaining a clear consciousness, the presence of auditory, visual and olfactory hallucinations is observed. It is also possible to add disorders in body perception and derealization.
2. Atherosclerotic... Has only a chronic form. The main provoking disease is.
3. Alcoholic hallucinosis or drunkenness... It accompanies the state of binge or is observed immediately after leaving it with a complete restriction of the use of alcoholic beverages. Characterized by the occurrence of verbal hallucinations, reaching the point of delirium.

While we feel - we live

If perception is a holistic picture-representation of the surrounding world, then sensation is the process of displaying individual qualities and properties of objects as a result of their impact on the human sense organs.

The ability to obtain such an experience is only in those living beings that have a nervous system. Awareness of the same sensations comes with the presence of a brain.

Sensation is the initial link in a person's cognition of both the external and his internal world.

The irritants provoking this phenomenon are different, hence the existence of different types of sensations:

• visual;
• cutaneous;
• auditory;
• associated with the muscle system and internal organs.

Pathologies of sensory cognition

Disorders different types sensory cognition include distortions of several processes in the human body at once: sensations, perceptions, representations. And they are also usually divided into different types.

They are classified as follows:

• thermal (burning or cold feeling);
• movement, movement of tissues (twisting, joining or delamination);
• tension;
• feeling of pulsation, transfusion;
• drilling and tearing, burning pain.

Most often, the patient determines the place of distribution of such sensations in the region of the brain. May occur in the chest as well as the abdominal cavity. It is extremely rare - in the upper and lower extremities.

Not suddenly, but out loud ...

If necessary, the primary differential diagnosis of disorders of perception, sensations and representations can be performed even at home: