Hemostasis Physiology and Clinical correlations by Dr Faiza.pdf
Disorders of perception
1.
2. Individuals capable of receiving information
on sensation. Data is then organized to make
it meaningful and comprehensible. The
organized entities are called percepts. This
processing of the data to represent reality is
called PERCEPTION.
3. Sensory Distortion- Constant real perceptual
object which is perceived in a distorted way
Sensory Deception- new perception that may
occur that may or may not be in response to
external stimuli
Disorders in the experience of time
4. Changes in Intensity - Increased intensity of
sensation- hyperesthesia seen in increasing
sensations or lowering of physiological
threshold.
Seen in
anxiety
depressive disorder,
Hangover from alcohol
Migraine
hypochondria cal personalities
6. Visual perception – affected by this are
brought about by toxic drugs
Xanthopsia- Coloring of Yellow
Chloropsia - Coloring of green
Erythropsia- Coloring of red
Derealization- Everything looks unreal and
strange
Mania- looks perfect and beautiful
7. Change in percieved shape of an object
Retinal disease
Disorders of accommodation
Temporal and Parietal Lobe Lesions
Poisoning with Atropine and Hyoscine
SCHIZOPHRENIA
8. Micropsia – a visual disorder in which the
patient sees objects
o Smaller than they really are
o Farther away than they really are
Macropsia – opposite to micropsia
9. Experience of retreat of subjects into the
distance without any change in space -
porropsia
Edema of the retina
Partial Paralysis of accomdation
Diseases affecting the nerves controlling
accommodation
10. MACROPSIA : Scarring of retina with
retraction
and complete paralysis of accommodation.
DYSMEGALOPSIA: Objects are perceived
larger in one side and smaller in the other.
Atropine, Hyoscine poisoning
Chronic arachnoiditis
METAMORPHOSIA: Irregular in shape.
11. Psychopathological point of view
Physical- Determined by physical events
Personal- Personal judgement of passage of
time
Mania- Time passes quickly
Depression- Time passes slowly
Acute Schizophrenia- personal time goes in fits
and starts
Acute organic states (temporal disorientation)
disorders of time is seen in milder form there
may be over estimation of time.
12. Illusions- Misinterpretation of a single stimuli
arising from a single stimuli
Stimuli from a perceived object are combined
with a mental image to produce a false
perception.
Derived from set and lack of perceptual
clarity
Delirium
Severe depression with delusions of guilt
13. Complete Illusion – These depends on
misreading words in newspapers or missing
misprints because we read the word as if it
were capable
Affect Illusion- These arise in the context of
particular mood state
Paradolia – vivid illusions occur without the
patient making any effort ; are the result of
excessive fantasy thinking and a vivid visual
imagery.
14. False perception which is not a sensory distortion
or misinterpretation but which occurs at the
same time as real perception.
Essential criteria for an operational definition
1. Percept like experience in the absence of an
external stimuli
2. Percept like stimuli which has full force and
impact of real perception
3. Percept like experience which is unwilled,
occurs spontaneously and cannot be readily
controlled by percipient.
15. Intense emotions
Suggestion
Disorders of sense organs
Sensory deprivation
Disorders of CNS
Psychiatric disorders
16. depressed patients with delusions of guilt;
hallucination tends to be disjointed or short
phases
Occurrence of continuous persistent
hallucinatory voices in severe depression
should arouse the suspicion of schizophrenia
or some intercurrent physical disease.
17. Normal subjects can be made to hallucinate
Hypnotic hallucinations do not produce
objective effects similar to those produced by
ordinary perceptions such as complimentary
after images and so on
18. Hallucinatory voices may be heard in ear
disease
Visual hallucination is seen in eye diseases
but usually there is disorder of the CNS as
well.
Peripheral lesions of sense organs may play a
part in hallucinations in organic states
19. If all incoming stimuli are related to minimum
in a normal subject they will begin to
hallucinate after few hours
Usually these are changing visual
hallucinations and repetitive phrases
BLACK PATCH DISEASE delirium following
cataract extraction in the aged result of
sensory deprivation and mild senile brain
changes
20. Lesions of diencephalons and cortex can
produce hallucination that are not only visual
but can be auditory.
21. Hearing
Vision
Smell
Taste
Touch
Pain and deep sensation
Vestibular sensations
The sense of presence
22. Hearing (auditors) may be elementary or
unformed.
Elementary – noises, bells or undifferentiated
whispers ; in organic states
Partly organized- music
Completely organized- hallucinatory voices-
schizophrenia- persecutory in nature
Severe depression also ‘voices’ can be heard
but less well formed than schizophrenia
23. Imperative hallucination
Voices sometimes act upon individuals and
give instructions.
may or may not act upon them
Auditory hallucinations
Adverse
Neutral
Helpful
Incomprehensible nonsense
Neologism
24. Thought echo - hearing one’s own thoughts
being spoken loud, voice may come from
inside or outside the head.
i. GEDANKENAUTWERDEN- thoughts are
spoken at the same time or before they are
occurring.
ii. ECHO DE LA PENSES- thoughts are spoken
just after they occurred.
Running commentary hallucinations are
usually abusive.
25. Elementary- flashes of light
Partly organized- patterns
Completely organized- visions of people
animals or objects.
Scenic hallucinations- whole scenes are
hallucinated like a cinema film
More commonly seen in delirium
seen in psychiatric disorders associated with
epilepsy.
26. Patients with visual and auditory
hallucinations co occur as a whole
Temporal lobe epilepsy
Late onset of schizophrenia (protracted)
27. Visual Hallucinations are more common in
organic states with clouding of consciousness
than in the functional psychoses
Small animals are often hallucinated in
delirium
Extremely rare in schizophrenia
Occasionally without any psychopathology
CHARLES BONNET SYNDROME
Produced by drugs of abuse typically consist
of diffuse distortions of existing visual world.
28. Seen in
Schizophrenia
Organic states like temporal lobe epilepsy
Depression (uncommon)
PADRE PIO PHENOMENON- religious people
can smell around certain saints
30. Formication- a feeling that animals are
crawling over the body; not uncommon in
organic states
Cocaine bug – formication occurring with
delusion of persecution in cocaine psychosis
Sexual Hallucinations- seen in acute and
chronic schizophrenia
32. Thermic – a cold wind blowing across the face
Haptic- feeling a hand brushing against the
skin
Hygic- feeling fluid such as water running
from the head into the stomach
Paraesthetic- pins and needles. Mostly
organic.
33. affects muscles and joints
Patient feels their limbs are being twisted
pulled or moved
Seen in schizophrenics
Organic states such as alcohol intoxication
and benzodiazepine withdrawal
34. Visceral hallucinations (SIMS 2003).
Twisting and tearing pains
Very bizarre complaints- organs being ripped
out and flesh ripped from his body
Seen in chronic schizophrenia
35. Organic states
Schizophrenia
Hysteria
Normal people – feverently religious
36. Type of mental image that although clear and
vivid lack the substantiality of perceptions
Full consciousness
Located in subjective space
Definite outlines, compete sound
Constancy retained
Relevant to emotions, needs and actions
Depends on the observer for existence
Hysterical
Attention seeking personalities
37. Functional hallucinations : a auditory
stimulus causes the hallucination, but it is
experienced as well as the hallucination.
Chronic schizophrenia
Reflex Hallucination : a stimulus in one
sensory field produces a hallucination in one
another. Morbid variety of synaesthesia.
38. Extracampine hallucination : Hallucinations
that is outside the limits of the sensory field.
o Seen in healthy people as hypnagogic
hallucination
o Schizophrenia
o Organic conditions- epilepsy
39. Autoscopy (phantom mirror image) -The
patient sees himself and knows that it is he.
Not just visual hallucination , because even
kinesthetic and somatic sensations are
present
Normal subjects- emotionally disturbed, tired
and exhausted
depressed
Hysteria
Schizophrenia
40. Acute and sub acute delirious states
Epilepsy
Focal lesions in parieto occipital region
Toxic infective states whose effect is greatest
in basal regions of the brain
Drug addiction
Chronic alcoholism
NEGATIVE AUTOSCOPY
INTERNAL AUTOSCOPY
41. Occur when the subject is falling asleep during
drowsiness
Are discontinuous
Appears to force themselves on the subject
Do not form part of an experience in which the
subject participates unlike DREAM
Commonest is auditory. His name being called
May be geometrical designs , abstract shapes ,
faces , figures or scenes from nature
EEG shows alpha rhythm
42. Occurs when the subject is waking up
Hallucinations persisting from sleep when the
eyes are open
More in narcolepsy.
43. Occurs in any sensory modality and may
occur in various neurological or psychiatric
disorders
Depends on
i. General condition of the brain
ii. Recent experiences
iii. Psychodynamic factors
iv. Effect of local lesion
44. Stimulation of visual projection areas in the
walls of the calacrine fissure causes
perception of flashes of light as does
stimulation or irritation of optic radiation.
Lesions of optic tract and lateral geniculate
bodies.
Spontaneous V H – sensory defect
Complex scene hallucination – stimulation of
posterior part of temporal lobe.
45. Almost exclusively the result of lesion which
produces sensory defect
PHANTOM LIMB
Most common organic somatic hallucination
95% of amputation after 6 yrs of age
Pt feels he sees the limb from which in fact he
is not receiving any sensations either because
limb has been amputated or sensory
pathway destroyed.
46. Most phantom limbs are produced by
peripheral and central disorders.
Occasionally it develops from lesion of
peripheral nerve or the medulla or spinal
cord.
Thalamoparietal lesions have phantom third
arm or leg.
Correspond to the previous image of the
limb.
47. Whistling , buzzing, drumming and even bells
heard by patients with middle ear disease or
internal disease
Caused by epileptic foci and space occupying
lesions in the temporal lobes
48. Occurs most often in temporal lobe epilepsy
ass with salivation and chewing and sniffing
Stimulating the depths of the sylvian fissure
around the transverse temporal gyri.
OLFACTORY HALLUCINATIONS
temporal lobe epilepsy.
49. These are multisensory hallucinations but
they do not include somatic sensations,
which is to be expected because the somatic
sensory area is separated from the temporal
lobe by sylvian fissure.
50. 1) Confusional hallucinosis:
i. consciousness is clouded
ii. Visual hallucinosis are prominent
iii. Auditory hall are mainly music , noises or odd words
but connected sentences are already heard.
2) Self reference hallucinosis:
i. Pt hears people talking about him
ii. Rough idea about what the voices are saying but
unable to reproduce them
51. 3) Verbal Hallucinosis
Pt hears clear voices which talk about him and
he can reproduce their content accurately
4) Fantastic hallucinosis
i. Hallucinosis of all kinds seem to occur
ii. Pt describes fantastic experiences based on
auditory and visual hallucination
iii. Sometimes the patient describes dream
experiences as if they were real
iv. These pts usually have mass hallucinations
52. Hyperschemazia – ORGANIC CAUSES
percieved o Brown Sequard
magnifications of body Syndrome
parts o PVD, MS, thrombosis
When part of the body of PICA
feels larger than the NON ORGANIC
normal CAUSES
o Hypochondriasis
o Conversion disorder
o Depersonalization
53. Aschemazia- perception of body parts as
absent
Hyposchemazia – Body parts as diminished
Paraschemazia – distorted of body image as a
feeling that body parts are distorted or
twisted from rest of the body.
Hemisomatognosia- Unilateral lack of body
image in which the person behaves as if one
side of body is missing
54. Anosgnosia- ‘denial of illness’ –Rt hemisphere
strokes denied their knowledge early after
stroke and refused to admit to any weakness
in their left arm
Somatoparaphrenia- delusional beliefs about
the body, distorted, inanimate , severed, or in
any other ways abnormal.