Sensory disorders: types, symptoms, treatment. Sensory and Gnostic Disorders

This is a disorder of the complex synthetic functions of perception and representation (which are the result of the joint work of several sense organs).

They can occur in extreme situations (in space, under water) or in case of mental illness. They can be paroxysmal (patients experience a feeling of horror) or persistent.

1. Somatotopagnosia (violation of the body scheme) - the perception of one's body, its shape, individual parts is disturbed (they may be absent or multiply). But this is felt only with the help of bodily feeling (and in the mirror the patient sees himself as normal). There are partial (part of the body) or total.

2. Violation of the optical-spatial properties of objects (metamorphopsia) - a violation of the perception of the number of objects, their shape, etc.:

a). Illusion of "peak"- the object is in the room, and it seems to the patient that he is behind the wall.

b). Dysmegalopsia(micropsia or macropsia) - distortion of the size of objects.

in). Polyopia and Diplopia- multiplying (or doubling) the number of objects

G). Dysmorphopsia- distortion of the shape of objects.

e). Optical allesthesia- the object appears to be displaced to the side.

e). porropsia- the object appears closer or further away.

g). Turning symptoms- horizontally or vertically (usually 90 or 180 degrees).

h). Dyslexia- violation of reading (it seems that the letters are upside down).

and). negative hallucinations are used in hypnosis.

to). Optical immobility Everything around seemed to freeze.

l). Optical Storm Symptom All objects are moving around.

m). Symptom of the "death of the world"- Everything is falling apart.

n). Changing the natural color of objects.

about). Bifurcation of perception- branches are perceived separately, and the trunk - separately.

P). The collapse of a holistic image (usually with dementia) - for example, the phone rings, and the patient does not know where the sound comes from.

3. Depersonalization - experiencing the strangeness of the surrounding world. See below for details.

Depersonalization happens:

a). Hyperpathic - the whole world appears bright, alive.

b). Hypopathic - the whole world - dull, lifeless.

4. The experience of "already seen" and "seen for the first time." Pathology of thinking

Thinking- this is a form of cognitive activity, II stage of knowledge (logical). This is a generalized, indirect reflection of reality in its natural and most significant connections and relationships.

Thanks to thinking, the cognitive abilities of a person expand, he cognizes the essence of objects.

In a healthy person, thinking is based on sensation, perception and representation, it is also closely related to practice (without it, it becomes illogical). Thinking is closely related to speech, therefore, when evaluating speech, pay attention to :

2). Its comprehensibility

3). Expressiveness of speech

4). The impact of speech.

Thinking disorders

I. Violations of the form of thinking:

one). Distortion of generalization processes :

a). Symbolism- replacement of 1 concept by another, which becomes a symbol of the first). Symbolic thoughts are often accompanied by appropriate pictures and speech.

b). Neologisms- new words that patients have come up with. Maybe even its own language - cryptolalia.

2). Violation of the dynamics of mental activity (inconsistency of judgments or inertia of thinking):

a). Excited thinking- patients speak quickly and loudly, sprinkle witticisms and figurative expressions, compose impromptu poems, but at the same time jumping from one topic to another (like a child), they are distracted by random stimuli.

At the same time, external associations(and not semantic, as in the norm):

Associations by consonance (constipation-axe),

Associations by contrast (constipation-diarrhea),

Associations by adjacency (name nearby objects).

These patients are characterized by extraordinary frankness.

b). Leap of ideas(manic incoherence of thinking) - thoughts swirl in the head (the language does not keep up with them - therefore the speech is incoherent),

in). Inhibition of thinking- patients speak slowly, quietly, with difficulty choosing words ( oligophasia). Extreme degree - m utism(silence).

G). Viscosity of thinking(pathological consistency, labyrinth thinking) - patients get stuck on minor details, unproductive verbosity is characteristic.

e). Perseveration of thinking- "trampling in place".

Along with perceptual deceptions, there are disorders in which the recognition of objects is not impaired, however, their individual qualities are transformed in a painful way - size, shape, color, position in space, angle of inclination to the horizon, heaviness. Such phenomena are called psychosensory disorders, or sensory synthesis disorders, examples of which can be changes in the color of all surrounding objects (red coloring - erythropsia, yellow color - xanthopsia), their sizes (increase - macropsia, decrease - micropsia), forms and surfaces (metamorphopsia), doubling, a sense of their instability, falling; rotate the surrounding by 90° or 180°; sensation as if the ceiling were descending and threatening to crush the patient.

One type of psychosensory disorder is body schema disorder, which manifests itself extremely differently in different patients (feeling that the arms “swollen and do not fit under the pillow”; the head became so heavy that it “is about to fall off the shoulders”; the arms lengthened and “hang down to the floor”; the body “became lighter than air” or "cracked in half"). With all the brightness of the feelings experienced, patients immediately notice, when controlled with their eyes, that their internal sensations deceive them: in the mirror they see neither a “doubled head” nor a “nose sliding off the face”.

More often, manifestations of such psychosensory disorders occur suddenly and do not last long in the form of separate paroxysmal seizures. Like other paroxysms, they can appear in many organic diseases of the brain as independent psychosensory seizures or as part of the aura preceding a grand mal seizure (see section 11.1). MO Gurevich (1936) pointed out peculiar disorders of consciousness accompanying psychosensory disorders, when the environment is perceived incompletely, fragmentarily. This allowed him to designate such seizures as special states of consciousness.

Psychosensory disorders include violation of the perception of time, accompanied by a feeling that time stretches indefinitely or has stopped altogether. Such disorders are often observed in depressive patients and are combined in them with a sense of hopelessness. In some variants of special states of consciousness, on the contrary, there is an impression of a jump, flashing, incredible speed of the events taking place.

Derealization and depersonalization

The phenomena of derealization and depersonalization are very close to psychosensory disorders and are sometimes combined with them.

Derealization called the feeling of change in the surrounding world, giving the impression of "unreal", "alien", "artificial", "rigged".

Depersonalization- this is a painful experience of the patient's own change, the loss of one's own identity, the loss of one's own Self.

Unlike psychosensory disorders, a violation of perception does not affect the physical properties of surrounding objects, but concerns their inner essence. Patients with derealization emphasize that, like an interlocutor, they see objects of the same color and size, but perceive the environment somehow unnaturally: “people are like robots”, “houses and trees are like theatrical scenery”, “the environment does not immediately reach consciousness like through a glass wall. Patients with depersonalization characterize themselves as "losing their own face", "lost the fullness of feelings", "stupid", despite the fact that they cope well with complex logical tasks.

Derealization and depersonalization rarely occur as independent symptoms - they are usually included in a syndrome. The diagnostic value of these phenomena largely depends on the combination with which symptoms they are observed.

Yes, at acute sensory delusion syndrome(see section 5.3) derealization and depersonalization are both transient productive symptoms, reflecting the extremely pronounced feelings of fear and anxiety inherent in this condition. Patients see the reasons for the change in the environment in the fact that, “maybe a war has begun”; they are amazed that "all people have become so serious, tense"; sure that “something happened, but no one wants” them “to tell about it”. Their own change is perceived by them as a catastrophe ("maybe I'm going crazy ?!"). Let's take an example.

A 27-year-old patient, a student, after a successful defense of his diploma, felt tense, uncollected, did not sleep well. Willingly agreed with the parents' advice to spend a few days on the Black Sea coast. Together with 2 fellow students, he went by plane to Adler, where they settled in a tent right on the seashore. However, over the next 3 days, the young man hardly slept, was anxious, quarreled with friends and decided to return to Moscow alone. Already on the plane, he noticed that the passengers were significantly different from those flying with him from Moscow: he did not understand what had happened. On the way from the airport, I noticed the fundamental changes that had taken place over the past 3 days: devastation and desolation were felt everywhere. I was scared, I wanted to get home faster, but I couldn’t recognize the familiar stations in the subway, I got confused in the designations, I was afraid to ask the passengers for directions, because they seemed somehow suspicious. He was forced to call his parents and asked them to help him get home. At the initiative of his parents, he turned to a psychiatric hospital, where he received treatment for an acute attack of schizophrenia for a month. Against the background of the ongoing treatment, the feeling of fear quickly decreased, the feeling of alignment and unnaturalness of everything that happened disappeared.

Psychosensory disorders, derealization and depersonalization can be a manifestation epileptiform paroxysms. Examples of such symptoms are seizures with a feeling already seen(deja vu) or never seen (jamais vu)(Similar symptoms are also described, deja entendu (already heard), dqa eprouve (already experienced), deja fait (already done), etc.). During such an attack, a person at home may suddenly feel that he is in a completely unfamiliar environment. This feeling is accompanied by pronounced fear, confusion, sometimes psychomotor agitation, but after a few minutes it just as suddenly disappears, leaving only painful memories of the experience.

Finally, depersonalization often serves as a manifestation of the negative symptoms characteristic of schizophrenia. With a mild low-progressive course of the disease, irreversible personality changes first of all become noticeable to the patient himself and cause him a painful feeling of his own change, inferiority, loss of fullness of feelings. With further progression of the disease, these changes, expressed by increasing passivity and indifference, are also noticed by others (see section 13.3.1).

hallucinosis syndrome

In the first 4 sections of this chapter, individual symptoms of perceptual disorders were considered, however, as we have already seen, syndromic assessment is more important for accurate diagnosis and the formation of the correct tactics for managing the patient.

Hallucinosis- this is a relatively rare syndrome, expressed in the fact that numerous hallucinations (usually simple, i.e. within one analyzer) constitute the main and almost the only manifestation of psychosis. At the same time, other frequently occurring psychotic phenomena, delusions and disorders of consciousness are not observed.

Since, in hallucinosis, perceptual deceptions affect only one of the analyzers, such types of it as visual, auditory (verbal), tactile, and olfactory are distinguished. In addition, depending on the course, hallucinosis can be recognized as acute (lasting several weeks) or chronic (lasting for years, sometimes for life).

The most typical causes of hallucinosis are exogenous hazards (intoxication, infection, trauma) or somatic diseases (cerebrovascular atherosclerosis). In most cases, these states are accompanied by true hallucinations. Some intoxications are distinguished by special variants of hallucinosis. So, alcoholic hallucinosis more often expressed by verbal hallucinations, while the voices, as a rule, do not address the patient directly, but discuss it among themselves (antagonistic hallucinations), speaking of him in the 3rd person (“he is a scoundrel”, “he has completely lost his shame”, “drank all his brains away”). In tetraethyl lead poisoning (a component of leaded gasoline), sometimes there is a sensation of the presence of hair in the mouth, and the patient all the time unsuccessfully tries to clear his mouth. With cocaine intoxication (as well as with poisoning by other psychostimulants, such as phenamine), they describe a tactile hallucinosis that is extremely unpleasant for its wearer with a feeling of insects and worms crawling under the skin (symptom of Maniac). At the same time, the patient often scratches the skin and tries to extract imaginary creatures.

In schizophrenia, hallucinosis syndrome is extremely rare and is presented exclusively in the form pseudohallucinosis(dominance of pseudohallucinations in the picture of psychosis).

BIBLIOGRAPHY

• Gilyarovsky V.A. The doctrine of hallucinations. - M.: Publishing House of the USSR Academy of Medical Sciences, 1949. - 197 p.
• Kandinsky V.Kh. About pseudohallucinations / Ed. A.V. Snezhnevs. - M., 1952. - 152 p.
• Medelevich D.M. verbal hallucinosis. - Kazan, 1980. - 246 p. Molchanov G.M. Dynamics of hallucinations in patients with schizophrenia: Dis. … cand. honey. Sciences. - M., 1958.
• Rybalsky M.I. Illusions and hallucinations. - Baku, 1983. - 304 p. Snezhnevsky A. V. General psychopathology. - Valdai, 1970.
• Eglitis I.R. Senestopathy. - Riga: Knowledge, 1977. - 183 p. Jaspers K. Collected works on psychopathology in 2 volumes. - M.- SPb., 1996. - 256 p.

This group includes violations of the perception of one's own body, spatial relations and forms of the surrounding reality. They are very close to illusions, but differ from the latter in the presence of criticism.

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

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

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

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

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

A special variant of depersonalization is the so-called weight loss. Patients feel how their body mass is steadily approaching zero, the law of universal gravitation ceases to act on them, as a result of which they can be carried away into space (on the street) or they can soar up to the ceiling (in a building). Understanding by reason the absurdity of such experiences, the sick, nevertheless, "for the peace of mind" constantly carry any burdens with them in their pockets or briefcase, not parting with them even in the toilet.

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

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

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

Symptoms such as "already seen" or "never seen" are short-term, lasting a few seconds and are often found in healthy people due to overwork, lack of sleep, mental strain.

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

Symptom "disturbances in the sense of time" expressed in the sensation of speeding up or slowing down the passage of time. It is not pure derealization, as it also includes elements of depersonalization.

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

Violation of the body schema(Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of your body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head grows to the size of a room, his torso shortens, then lengthens. Sometimes there is a feeling of pronounced disproportion of body parts. For example, the head is reduced to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Feelings of a change in the body scheme may appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of violations of the body scheme is their correction by vision. Looking at his legs, the patient is convinced that they are of normal size, and not many meters; looking at himself in the mirror, he discovers the normal parameters of his head, although he feels that the head in diameter reaches 10 m. Correction with vision provides a critical attitude of patients to these disorders. However, when visual control ceases, the patient again begins to experience a painful feeling of a change in the parameters of his body.

Violation of the body scheme is often noted in organic pathology of the brain.

Recently, they are becoming more and more frequent. This is due to the aging of the nation, frequent head injuries. A special place among neurological pathology is occupied by sensory and gnostic disorders.

What is meant by these disorders?

Sensory and gnostic dysfunction is a failure in the recognition in the brain or peripheral nerve endings of certain stimuli or objects. This happens due to incorrectly constructed neural connections in the brain or in the presence of an obstacle that prevents penetration into it. If such a violation is observed in the cerebral cortex, then such a violation is called secondary and referred to as gnostic (since in it, as well as in some other brain structures, all information coming from peripheral neurons is processed).

If peripheral nerve endings or pathways are first affected, then in this case sensory synthesis disorders occur (since the afferent branch of the spinal nerve mainly suffers, and it becomes an impossible task to correctly create an electrical impulse). Since the cerebral cortex and peripheral nerve endings can only perform their function together, disorders are considered as a single block.

Difference between central and peripheral lesions

Disorders of central genesis, as the name implies, manifest themselves with damage to the brain - the center for processing all incoming information. The brain tissue is extremely sensitive to the influence of various factors, which is why gnostic disorders prevail in severity. Since usually all its structures are involved in the pathological process, mental disorders can also develop. In this case, psychosensory disorders take place. Sensory disorders are the cause of damage to the peripheral part of the nervous system - receptors, as well as directly to the cranial nerve trunks. They develop much more often and usually do not require treatment (an exception is neuropathy).

Combined disorders are most often mixed. Their cause is usually intoxication with psychotropic compounds (not necessarily drugs and alcohol) or systemic diseases of the nervous system.

Types of sensory systems of the human body

The main function assigned to the sense organs is the perception of stimuli coming from outside. In order to adapt to the environment, nature conceived the creation of special structures designed to perceive all information coming from outside.

Due to the fact that all impulses are different in their structure and nature, five groups of sensory systems are distinguished - vision, hearing, smell, touch, taste. Each of them is strictly specific, has its own organs of perception, its own centers in the cerebral cortex, responsible for processing incoming information.

Each of these systems has its own receptors located in a certain place (not counting the skin, on which the receptors are located on its entire surface). Receptors differ both in their structure and in the type of influence on them.

Disturbances in the perception of incoming stimuli are strictly specific for each system, and that is why each of them should be analyzed.

visual agnosia

Visual impairments are usually manifested by fuzzy vision of objects, vagueness, and they are caused by a violation of the function of eye structures. In contrast, a violation of sensory perception lies in the defeat of the pathways (in this situation, the optic nerves) and the cerebral cortex (usually with damage to the occipital lobe of the brain). Visual agnosia is also usually accompanied by damage to long-term memory, in particular, it is associated with the memorization and creation of images of an object in the mind.

Sensory vision disorder is usually accompanied by the color scheme of the subject. It appears when the cones - receptor cells located on the retina are damaged, as a result of which color blindness develops. The disorder may be characterized by a distortion of the shape of an object in consciousness (knowing that an object, for example, a ball, is round, a sick person sees it as oval, with growths - this condition usually develops with hallucinations, especially true ones, and in this situation refers to gnostic disorders) . Sensory and gnostic visual disturbances occur with hallucinations of various origins.

Violation of sound perception

Hearing is due to the normal functioning of the conductive system of the ear - the tympanic membrane, the ossicles of the middle ear and the inner cochlea. Sensory disturbances (deafness) usually develop with damage or underdevelopment of the auditory ossicles (anvil hammer, stirrup). If the pathology lies in the defeat of the hypothalamus (the main center of perception of all impulses from the sense organs), as well as in the temporal lobe of the cerebral cortex, then in this case sensory disorders of the auditory analyzer are implied. Typically, such disorders appear already at an early age, which is why questions about childhood sensory disorders are quite often raised.

Gnostic disorders also occur when there are changes in the temporal lobes. They manifest themselves most often in impaired perception of sound intensity (a quiet sound seems deafeningly loud and vice versa), impaired understanding of what is heard (in parallel with the temporal lobe, Wernicke's area, the center of speech perception, is involved in the process).

Olfactory disturbance

Sensory disorders of smell usually develop as a result of damage to the mucous membrane of the nasal cavity (in particular, its upper third, where the peripheral nerve endings are located). This usually occurs as a result of inhalation of pungent odors, burns of the mucous membrane when hot steam enters, and also with injuries to the nasopharynx. the receptors of these endings cannot perceive aromatic molecules, which is why insensitivity to odors develops.

Violation of odor recognition appears with brain injuries, hemorrhage in the hippocampus and limbus, as well as as a result of the formation of a focus of pathological impulses in these areas, which appears due to the use of psychoactive substances - such as LSD, spices, and also against the background of some psychiatric diseases, accompanied (for example, with schizophrenia, some types of encephalopathies).

Touch disorder

It is caused by receptors located on almost the entire surface of the skin. They are responsible for the perception of an object and some of its characteristics (size, weight, temperature, shape). All this is carried out due to the formation of complex impulse connections coming from all receptors simultaneously. With damage to the peripheral link of the nerves (endings and trunks), only a decrease in sensitivity develops. The image of the object itself is created in the cerebral cortex, usually in the frontal lobe and partially in the temporal lobe. The central defeat of these zones (traumatic brain injury, stroke, cerebral infarction, poisoning with certain poisons) can lead to the formation of a lesion in which all neural connections will be broken, due to which a person will not be able to perceive and create an image of an object in his mind . Often, in such disorders, due to the restructuring of connections, the image is perceived incorrectly according to one or several criteria (round seems flat, and warm - hot or cold).

Taste agnosia

Taste buds are located mainly on the tip of the tongue, as well as on its lateral surfaces. Sensory disorders usually develop with burns of the mucous membrane of the tongue, which dulls the sense of taste. A similar condition can also develop when they are blocked by certain substances (for example, the taste is felt weaker after eating cold foods or hot spices). Damage to the trunk of the taste nerve is observed as a result of injuries to the area of ​​the muscles of the chin, as well as neuropathy or trauma to the tongue.

Impaired taste recognition usually develops after a stroke, hemorrhage in the thalamus and cerebral cortex, as well as some neuroinfections (meningitis, encephalitis). Gnostic taste disorder (however, taste perversion manifests itself more) can occur in pregnant women against the background of toxicosis or preeclampsia (for example, a nail tastes like an unforgettable and wonderful delicacy).

Combination of different types of sensory disorders

Often, the above sensory disorders can develop independently of each other. However, there are several types of diseases that lead to their combined development. The most obvious example of such diseases are sensory disorders in multiple sclerosis.

This disease is characterized by the development of foci of compaction of the brain tissue with a predominance of connective tissue in them. A similar disorder is usually present in people over 50-60 years old, but there are cases of its development in fairly young people (30-35 years old).

Gnostic disorders appear in those cases when such foci develop in places where incoming impulses are processed (that is, in those parts of the brain where the main centers of perception are projected).

Disturbance of recognition and interpretation is eliminated by adequate therapy of multiple sclerosis, started at an early stage of the disease. If you are late with timely diagnosis, the violations become chronic.

Treatment of sensory and gnostic disorders

There is no specific treatment for sensory disorders. All therapeutic measures are aimed at eliminating the cause (for example, in case of a stroke, it is recommended to limit the focus of hemorrhage as soon as possible (in case of a hemorrhagic form) or reduce pressure to acceptable numbers (with However, therapy should not be started without first consulting a neurologist and psychotherapist, since self-treatment in such situations can cause significant damage to health.

If the cause of the sensitivity disorder is a burn, frostbite, then therapy should be carried out according to the severity of the injury (for mild lesions, sensory disorders can be treated at home, and for moderate and severe injuries, only in a hospital or intensive care unit). will be restored in the process of treatment and physiological renewal of the cellular composition of the tissues of the affected area (since the receptors are mainly located in the mucous membranes or skin, and they, in turn, are tissues with a high regenerative potential).

This group includes violations of the perception of one's own body, spatial relations and forms of the surrounding reality. They are very close to illusions, but differ from the latter in the presence of criticism.

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

Depersonalization is the patient's belief that his physical and mental "I" have somehow changed, but he cannot explain specifically what and how has changed. There are different types of depersonalization.

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

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

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

A special variant of depersonalization is the so-called loss of body weight. Patients feel how their body mass is steadily approaching zero, the law of universal gravitation ceases to act on them, as a result of which they can be carried away into space (on the street) or they can soar up to the ceiling (in a building). Understanding by reason the absurdity of such experiences, the sick, nevertheless, "for the peace of mind" constantly carry any burdens with them in their pockets or briefcase, not parting with them even in the toilet.

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

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

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

Symptoms such as "already seen" or "never seen" are short-term, lasting a few seconds and are often found in healthy people due to overwork, lack of sleep, mental strain.

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

The symptom of "violation of the sense of time" is expressed in the sensation of accelerating or slowing down the passage of time. It is not pure derealization, as it also includes elements of depersonalization.

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

Violation of the body scheme (Alice in Wonderland syndrome, autometamorphopsia) is a distorted perception of the size and proportions of one's body or its individual parts. The patient feels how his limbs begin to lengthen, his neck grows, his head grows to the size of a room, his torso shortens, then lengthens. Sometimes there is a feeling of pronounced disproportion of body parts. For example, the head is reduced to the size of a small apple, the body reaches 100 m, and the legs extend to the center of the Earth. Feelings of a change in the body scheme may appear in isolation or in combination with other psychopathological manifestations, but they are always extremely painful for patients. A characteristic feature of violations of the body scheme is their correction by vision. Looking at his legs, the patient is convinced that they are of normal size, and not many meters; looking at himself in the mirror, he discovers the normal parameters of his head, although he feels that the head in diameter reaches 10 m. Correction with vision provides a critical attitude of patients to these disorders. However, when visual control ceases, the patient again begins to experience a painful feeling of a change in the parameters of his body.

Violation of the body scheme is often noted in organic pathology of the brain.