HALLUCINATIONS (Latin. hallucinatio nonsense, visions; synonym: deception of feelings, mnimovospriyatiya) — one of types of disturbance of sensual cognition which is characterized by the fact that representations, images arise without real irritant, a real object in the perceived space and, gaining unusual intensity, sensuality [a corporality, according to Jaspers (To. Jaspers)], become for consciousness of the patient indistinguishable from real objects, from images of objects of reality. At G., as well as at any symptom of a mental disease, all activity of a brain changes: not only perception or representation, but also the relation of the patient to surrounding, his affects and his thinking change.
The first definition of G. as imaginary perceptions and an otgranicheniye them from illusions (see) — wrong perceptions — it was given in 1817 by Zh. Eskirol in the report submitted to them to the Parisian academy of Sciences «About hallucinations at the insane».
The term «hallucinations» designate not one specific phenomenon, but group of deception of the feelings similar on the main structure, but various on the maintenance, figurativeness, brightness, a corporality, sharpness of experiences, features of a projection and localization of images on time, conditions of their emergence.
Sometimes the term «hallucinations» designate such phenomena, to-rye have no relation to them. So, e.g., tell memories about G. though in this case the speech usually goes about wrong reminiscence, but not about imaginary perception. Reference to G. and so-called fantazm is disputable. This term Tsiyen (Th. Ziehen, 1906) designated the dreams in reality which is able to-rykh fantastic images reach various brightness and distinctness. It is impossible to carry G. to eydetizmu (grech, eidos an image) — abilities of nek-ry persons to mentally represent an image of an object (preferential visual or tactile) with such sensual brightness and distinctness that they really as if see, perceive what for the term short before was persistently considered or perceived. This ability was described for the first time by Urbanchich (V. Urbantschitsch, 1888). Though the eydetizm is «perception without an object», but the eydetichesky image, unlike G., usually is result of action of the previous external irritant and differs from a usual image in high degree of a sensornost. Eydetizm normal is more often svoystven to children and teenagers.
With age it, as a rule, disappears. In this regard one authors consider an eydetizm as a stage of age development, others — as more or less constant constitutional line. It is shown (E. A. Popov) that manifestations of an eydetizm can be also temporary painful feature of the persons suffering from true G. (see below).
- 1 Options of hallucinations and their systematization
- 2 Various forms of hallucinatory states and their clinical current
- 3 Gallyutsinoza and hallucinatory syndromes
- 4 Features of hallucinatory states at blind people and deafs
- 5 A pathogeny
- 6 Diagnostic value of hallucinations
- 7 The forecast
- 8 Treatment and prevention
Options of hallucinations and their systematization
are the cornerstone of G.'s systematization various signs: G.'s emergence in the field of one of analyzers, character of a projection of a hallucinatory image, condition, at to-rykh G., degree of similarity of G. with real images of perception, G.'s structure, etc.
G., as a rule, not isolated frustration, and a hallucinatory state develop: e.g., visual G. arise against the background of conditions of stupefaction, acoustical G. develop more often in structure of a crazy syndrome. These states on structure, sharpness, plurality, firmness, a combination to other mental disorders, and also on extent of identification of hallucinatory images with real impressions in clinic it is accepted to subdivide into true G., pseudohallucinations, hallucinoids, functional and reflex G., gallyutsinoza and hallucinatory syndromes.
Options of hallucinations On area of emergence in one or several analyzers
On area of emergence in one or several analyzers are distinguished by the following G.: 1) visual, or optical; 2) acoustical, or acoustic; 3) olfactory; 4) flavoring; 5) tactile (tactile); 6) Of the general feeling — enterotseptivny, vestibular, motor.
Quite often G. are combined: visual and acoustical, visual and tactile, acoustical and olfactory, visceral and visual etc. One of options of such combination are sinesteticheskiye hallucinations Maier-Gross (W. Mayer-Gross, 1928) — patients see the moving figures of people and at the same time hear their speech; see flowers and catch their smell.
Visual hallucinations on the features are quite various. They can be shapeless, elementary — so-called photopsias (light flashes, spots, strips, sparks, a flame, smoke) and difficult. In the latter case the patient can see various objects, people, animals, insects, fantastic beings (devils, monsters, etc.)» the whole scenes (a wedding, a funeral, a ball, fight, natural disasters etc.), fruits of creativity of the person. Visions can be motionless and mobile, uniform and changeable according to contents. Hallucinatory images can be colourless as black-and-white photos, color or one-color (e.g., at epilepsy everything can be painted in red or blue color). The patient can see several or one figure completely (e.g., a figure of the person) or only its part (a face, one ear, a nose, one eye); in the latter case the patient perceives these fragments as the part belonging to a real-life object.
Depending on value judgment by the patient of the sizes of objects of visual hallucinatory images distinguish G. normopsichesky — images of objects meet the developed general expectations of their sizes; mikropsichesky («Lilliputian») and makropsicheskiye (huge).
The visual G. identified with specific objects, persons, animal call relief., images to-rykh are developed in the mobile, consistently replaced pictures, the endured scenes of the developing events with the nature of attack, violence etc., designate the term «stsenopodobny hallucinations» («cinema» G.). If in the hallucinated images the developed landscapes prevail, visions of a landscape, often motionless, then such G. call panoramicheskimi.
The projection of hallucinatory images in usual perceived external space remains not in all cases. Visual G. distinguish: ekstrakampinny (E. Bleyler) — images arise out of sight, is more often «behind themselves»; autoskopicheskiye (contemplate) — G. which are followed by vision of own image (in particular, vision of the double); hemianoptic — G.'s images arise in gemianoptpchesky fields of vision; visual verbal G. [J. Seglas, 1914] — vision of the words «written» on a wall in space, on clouds, to-rye the patient can read, having at the same time feeling of exclusive purpose of these «words».
Visual G. arise in evening, night time more often, is frequent in a condition of the dulled consciousness (a delirious state), at the same time changes of consciousness, the relation of the subject to an object take place.
Visual G. at advanced and senile age — a so-called hallucination of Bonnet are known (Ch. Bonnet) which the author connects with defeat of an eyeglobe (e.g., a cataract, amotio of a retina and other cases of loss of sight). At Bonnet's hallucinations there can be single, multiple stsenopodobny, in some cases brightly painted (especially it is characteristic of cases when patients «see» some landscape) hallucinatory images. They can be motionless, moving in space, restricting the patient. If the patient sees people or animals, then these G. are not followed by acoustical deception. At small intensity of such G. of the critic to them remains, but they are, as a rule, surprising; at intensive hallucinatory images the alarm and fear can appear and to change at the same time behavior of the patient.
Auditory hallucinations are also various. Distinguish akoazma, phonemes and verbal hallucinations. Akoazma — elementary, nonverbal G. — to the patient are heard separate sounds, noise, a crash, a roar, hissing. At phonemes and difficult verbal (verbal) G. of the patient hears separate parts of words, words, the speech, a conversation, to-rye can be turned to it. Often the speech, fragments of colloquial situations and scenes of the patient designates as «voice». These «voices» can have various intensity: whisper, the loud or deafening conversation. Verbal G. can be estimated sick as belonging to persons familiar or unfamiliar, to adults or children, men or women.
Acoustical G.' maintenance can be various, and character is quite often connected with features of an affective condition of the patient or with the maintenance of nonsense. «Voices» can be menacing, scolding, condemning, derisive teasing, including and in the form of questions; imperative (imperative) — when «voices» order, «force» the patient to make got or other act, sometimes reprehensible; commenting — voices discuss its actions, acts, experiences in the present or the past; calming, protecting; narrative — stating events. The menacing, accusing acoustical G. arise more often at conditions of oppression and alarm, and kind — at the increased mood of the patient.
Imperative acoustical G. since patients can appear not in forces are especially dangerous to oppose to «threat», «order», «command» and to make dangerous to themselves or surrounding actions up to suicide, attempts of deliberate murder.
At true acoustical verbal G. images are clear, bright, are followed by feeling of objective reality; they are perceived by both ears, the source of a voice is localized outside (behind a window, behind a wall, over a ceiling and so forth); less often voices are caught by one ear — so-called unilateral G. Acoustical G. usually arise at not changed consciousness, a thicket in silence, at night, when the patient is in loneliness.
Olfactory hallucinations are expressed by various, not always accurately differentiated, imaginary smells, is more often unpleasant, leaving feeling of disgust (decay, fake, become permeated with the smell of smoke).
Flavoring hallucinations liquids or feeling of taste unusual, unusual for this food are characterized by emergence of unpleasant flavoring feelings in a mouth without meal (bitter, salty, burning etc.); more often such G. are followed by feeling of disgust.
Not always it is possible to delimit olfactory and flavoring G. from illusions and pseudohallucinations (see below). It is sometimes difficult to exclude existence of the slight smell caught by the patient and not caught by the doctor. Not always it is possible to reject impacts on the flavoring terminations of the remains of food, the substances which are emitted with saliva, etc.
Tactile (tactile) hallucinations, the patient usually has unpleasant feelings of crawling on a body, tickling, pressure in skin, muscles; sometimes these feelings are localized in skin or under skin.
Tactile G. need to be distinguished from senesthopathias (see). Understand burdensome, intolerable, painful feelings in various parts of a body as senesthopathias, often so unusual that patients are forced them to call by own definitions. Patients feel painful stomach aches, intestines, spinning, a turning, burning, special striking as current etc.; similar feelings can be in heart and other bodies. Patients feel gurgle in the head, «turning» of a brain etc. However, unlike tactile G., at senesthopathias there is no concreteness — the accurate description physical. signs that causes a feeling.
It is necessary to distinguish so-called gaptichesky G. from tactile G. and senesthopathias — feeling of a sharp touch, skhvatyvaniye, sting (nek-ry estimate the terms «tactile» and «gapticheskiya» as synonyms). They can be shown separately, but is more often as a part of difficult stsenopodobny G.
Hallucinations of the general feeling. Carry enterotseptivny, motor and vestibular G to them.
At enterotseptivny (visceral) hallucinations of the patient feels existence of foreign objects, living beings and even «little men», to-rye hearts move in vessels, went. - kish. a path, causing these or those changes in internals.
Feeling in a body of the living being (worms, snakes, etc.) it is usually combined with nonsense of obsession. Many cases of the described type belong not to G., and to crazy interpretation patol, feelings. The term «endoscopic hallucinations» designate vision of internals of own body, the term of «a hallucination of transformation» — feeling of specific convertibility of internals, bodies, persons in the absence of the corresponding objective signs. Two terms became stronger and gained distribution: senestezichesky hallucinations [Sivadon] — unusual feelings in a body or in internals, to-rye the patient estimates as a result of external influence (burns, tinglings and so forth), and genital hallucinations (V. Manyan, 1895, 1896) — the feeling of the obscene, shameless, cynical actions made on its generative organs experienced by the patient.
Among motor hallucinations distinguish: kinestezichesky — feelings of reduction of muscles at their objective immovability; kinestezichesky verbal (full verbal motor) — feeling of the movement of language and kinestezichesky graphic (full graphic motor) — motion sense of the letter, and both of these feelings in some cases have character of a nasilstvennost (the patient is «forced» to move language, to write).
Vestibular hallucinations (G. of sense of equilibrium) — mnimovospriyaty disbalances, arising first of all in visual and kinaesthetic spheres. At the same time patients feel feeling of suspension, loss of balance, falling, flights. In other cases they experience feeling of loss of stability of surrounding, see the accruing inclination, rapprochement of walls of the room, falling of a ceiling. Similar G.' mechanism is difficult presented to so-called illusions of Peak (A. Pick, 1909) — the patient sees how the people surrounding it pass through a wall, move behind it; it is result of discrepancy between visual and vestibular irritations. The diplopia and nystagmus accompany.
Options of hallucinations depending on conditions, in to-rykh they develop
Depending on the period and extents of wakefulness are distinguished by G.: gipnagogichesky — arising in a light slumber, during backfilling or at the closed eyes; gipnopompicheskiye — preferential visual, the acoustical and other G. arising during the awakening are more rare; bordering [encadrantes, Wolff (E. Wolff), 1957] — the imagined space is replaced with the space perceived. Perceptions of the patient are localized in the imagined space, as in dreams.
Are described pantofobicheskiye by G. [Lewi-Valensi] at oneiroid (see. Oneiric syndrome ) — before eyes of the patient frightening scenes of events, and also visual hallucinations of J. Jackson (1876) — aura, or an epileptic equivalent, in the form of a twilight state with abundance of visual true G move.
Psychogenic G. reflect the content of emotionally charged experiences. More often visual or acoustical. Are typical: temporary communication with a mental shock, psikhol, clearness of contents, proximity to urgent experiences of an individual, emotional saturation of images, their projection outside. Acoustical psychogenic G. in the form of «knocks» and «calls» were described by Alenshtil (H. Ahlenstiel, 1960), to-ry considers them as a form of a peculiar «acoustic memory» at mentally healthy faces. They usually arise in situations of intense expectation and alarm.
Of imagination of Dyupre (E. Dupre) — G., a plot to-rykh directly follows from the closest, is long the ideas born in imagination. Especially easily appear at persons with painfully aggravated imagination or at children. The so-called collective induced G. (usually visual) developing under the influence of suggestion and a massive emotional okhvachennost (it is preferential in crowd) at the subjects which are easily inspired and the more so inclined to hysterical reactions can reach big expressiveness.
Negative G.: 1) result of the hypnotic suggestion suppressing vision of persons or objects [Dessuet]; 2) feeling of lack of internals (see. To flocks and a syndrome).
The associated (connected) G. [J. Seglas] — images appear in the logical sequence: «voice» announces the fact, to-ry sees immediately, felt. Develop in a wedge, a picture of the reactive psychoses and states which resulted from a massive mental shock. Such G. are combined by unity of a plot of hallucinatory experiences with the maintenance of the psychoinjuring circumstance.
Functional and reflex G. — phenomena of disturbance of sensory perception, on manifestations similar to G., however on origins and a condition of consciousness of patients take the intermediate place between actually G. and illusions. They quite often are an initial symptom of mental diseases and in some cases precede, accompany or replace hallucinatory states (see below).
Various forms of hallucinatory states and their clinical current
G. are the important symptom of many mental diseases having clinical and in some cases predictive value. The isolated, incidental (single) G. can develop also at almost healthy faces one or several times throughout life; they arise usually in a condition of emotional pressure and, thus, can be carried to psychogenic G. (in a broad sense), are regarded as temporary, incidental disturbance of sensory perception without mental disease.
True hallucinations (full, developed, original, pertseptorny) are characterized by clarity, dimensions, a corporality, sensual vivacity, a clear eksteroproyektion of an image, full conviction of the patient in his objective reality, insufficiency of criticism.
True G. can be single and multiple, treat the sphere of one of sense bodys (visual, acoustical, tactile, olfactory, flavoring a mnimovospriyatiya) or several. Are inherent in them: value judgment of scale of hallucinatory images kinematografichnost or panoramichnost, dependence on the period and extent of wakefulness. True G. differ from representations not only in the bigger brightness and distinctness (bigger sensual vivacity), but also other signs. Among them are most typical localization of a hallucinatory image (eksteroproyektion) and feeling of objectivity of this image outside.
Pseudohallucinations differ from true G. in lack of feeling of objective reality of images, sensual vivacity, an uncertain projection or more often an internal projection of images — they are localized by the patient not in «objective», and «subjective» space — seem «spiritual eyes», «mentally, mind, an internal eye, an eye of the mind»; are heard by «inner ear», etc.; not expressed sensornost, a small ocherchennost and a konturirovannost are typical for images.
Lack of nature of objective reality at pseudohallucinations — their main difference from true G. At pseudohallucinations patients speak about special visions, about special «voices», i.e. they do not identify them with the real phenomena as it happens at true G., and distinguish them from reality. Besides, pseudohallucinations, unlike true G., as a rule, arise with the nature of perfection of influence: the patient does not hear «voice», and «transfer it voices», «do voices», «cause» sounding of thoughts, «cause» visions in a dream, in the head; patients are «filled» with microbes, insects etc.
Pseudohallucinations as well as true G., can be visual, olfactory, flavoring, visceral and (most often) acoustical with all features inherent in them. E.g., pseudo-hallucinatory visual objects can be colourless, one-color, natural flowers, total and partial, at acoustical pseudohallucinations of «voice» can be the silent, loud, said familiar and unfamiliar faces in the form of the monologue, the story, with contents reproaching, scolding up to imperative character. In most cases to pseudohallucinations, but not also kinaesthetic G belong to true G.
Among pseudohallucinations distinguish: katatimny acoustical [H. Weitbrecht, 1967] — the voices of the menacing or anticipatory character arising more often at the alarming excited elderly persons; verbalnomotorny (a giperendofaziya, or an autoendofaziya, on Segl) — the strengthened products of the internal speech; pseudo-hallucinatory pseudo-memoirs (V. of X. Kandinsky) — the representations of the past arising in consciousness of the patient instantly become pseudohallucination and are mistakenly estimated by it as reminiscence of an actual fact (one of mechanisms «enlightenments», «inspirations» at diseases).
Are close to pseudo-memoirs on so-called G.'s structure of reminiscence and G. of memory. Of reminiscence — hallucinatory reference by the patient of the fact in the past whereas at G.'s moment dated by it was not (arise also in the field of sight). Of memory (a mnestichesky ekmneziya, across Dessyue) — an ekforirovaniye, recovery in consciousness of visual objects in «the perverted inappropriate form» (3. Freud).
In process of development of a mental disease, especially at its progreduated current, it is possible to track as at the patient gradually true
G. are replaced by pseudohallucinations with the nature of perfection. Very often, e.g., this transition can be observed in process of development hron, alcoholic hallucinosis, hron, crazy schizophrenia, and transition usually is followed by simultaneous development of nonsense physical. also points influences (see Nonsense) to deterioration in the forecast of disease.
Hallucinoids — initial rudimentary manifestations of visual G., the Crimea are inherent a fragmentariness, a sensornost, a tendency to an eksteroproyektion of an image at the neutral, contemplate attitude towards him (G. K. Ushakov, 1969). It is a number of intermediate phenomena between simple representation or image of reminiscence and true.
According to E. A. Popov, hallucinoids are an intermediate stage at development or true G. V disappearance cases when true G. arise or disappear rather quickly, it is difficult to catch hallucinoids. But if this process proceeds gradually, then it is possible to track as at first hallucinoids appear, then they pass into true G., to-rye at recovery in turn are replaced by hallucinoids, and, at last, deception of feelings disappears at all. Hallucinoids can remain throughout all disease.
Functional and reflex hallucinations on a nek-eye remind manifestations true G., but on origins differ both from them, and from illusions. These G. sometimes precede or replace true G. or coexist with true. To functional (To. Kalbaum), or differentiated, G. carry acoustical, visual G. are more rare, to-rye arise in the presence of a real sound irritant (whistles, noise of transport, tick of hours, a rhythmical sound of swing of a pendulum, noise of the flowing water, a scratch of the writing feather and so forth) and exist until this real irritant remains. Unlike illusions, at to-rykh in a false manner, a real object is mistakenly perceived, treated, at functional G. there is as if a dual perception — real and imaginary coexist. E.g., from the crane water flows, and the patient at the same time and separately hears both noise of the following water, and hallucinatory «voices» (e.g., abuse, threats to the address). In these cases the irritant affects the same analyzer, in the area to-rogo there are G., and with disappearance, e.g., objective noise also hallucinatory «voice» disappears.
A version are so-called reflex G., to-rye arise in the field of one analyzer (visual, acoustical, tactile) at action of a real irritant on other analyzer: acoustical G. at irritation of eyes; the visual G. arising at a sound of a tuning fork; At a meeting with the particular person or performance of a certain action. E.g., the patient at turn of a key in a keyhole feels in himself the same movement of a key, «turning in his heart».
Also reflex pseudohallucinations are described (V. I. Rudnev, 1911) — the patient, having heard the word, at the same time psevdogallyutsinatorno hears other word or even the phrase.
Hallucinatory frustration not of a patognomonichna for any one mental disease. It is possible to speak only about types of these frustration characteristic or typical for this or that nosological form. At boundary psychological frustration and reactive psychoses only psychogenic, paranoic G.' options (G. K. Ushakov, 1971) as G. of imagination are observed. At psychoses difficult G are most typical. At exogenous psychoses there are true visual more often, acoustical (verbal) or tactile G are more rare. The acoustical and other G. entering Kandinsky's syndrome — Klerambo are more typical for endogenous psychoses (schizophrenia) (see. Kandinsky-Klerambo syndrome ).
True G. and pseudohallucinations are quite often combined with the crazy ideas and along with them belong to frustration, especially often observable at a number of mental diseases.
Functional G. — one of initial symptoms of acute disorder of mental activity as at intoksikatsionny psychoses, and (quite often) at sharply beginning schizophrenia. At schizophrenia this frustration is often looked through.
Gallyutsinoza and hallucinatory syndromes
Depending on sharpness of hallucinatory frustration, their firmness, plurality, a combination to other mental symptoms distinguish two groups of hallucinatory syndromes — gallyutsinoza and so-called hallucinatory syndromes (symptom complexes). Gallyutsinoza can become complicated and be replaced by hallucinatory syndromes; the last in turn can become simpler and be replaced by gallyutsinoza, i.e. between these two groups of syndromes there is no clear boundary.
Gallyutsinoza (K. Vernike), or condition of a continuous gallyutsinirovaniye (V. of X. Kandinsky) — psikhopatol, states with any one plentiful G.' dominance (their combinations are much more rare), while the others psikhopatol. frustration pale into insignificance and do not dominate in a wedge, a picture.
The term «hallucinosis» is used in various sense. Fr. psychiatrists [Hey (N. Eu), etc.] use this term preferential for designation of acute states with multiple firm G.' flow, to the Crimea the patient keeps the critical relation. It is mute. researchers hallucinosis call as well a hallucinatory-dilision state with obligatory existence of clear consciousness and apply this concept preferential to verbal hallucinosis. Century of X. Kandinsky described gallyutsinoza as «a continuous gallyutsinirovaniye».
The majority of gallyutsinoz (except for visual) arises at clear consciousness, is not followed by disturbances auto-and allopsikhichesky orientation and often is followed by awareness of the painful nature of experiences by patients.
Affective reactions of patients at gallyutsinoza, as a rule, negative, only sometimes deception of feelings can cause in them positive emotions; at hron, the course of hallucinosis the relation, indifferent, neutral to them, can be developed.
At mentally sick acoustical (verbal) gallyutsinoza most often develop, is more rare visual, tactile and olfactory.
The syndrome of acute hallucinosis (acoustical, tactile) arises sharply, is characterized by flow of acoustical, is more often stsenopodobny, G. or multiple unpleasant painful feelings, often is followed by nonsense, fear, confusion. Arises usually at infectious or intoksikatsionny psychoses.
The syndrome of chronic hallucinosis develops more often after acute. As a rule, acoustical prevail, tactile G are more rare. At it the behavior of patients is more correct; perhaps even critical relation to a state. This syndrome develops at hron, intoxications (alcoholism!) and various organic diseases of a brain.
Visual gallyutsinoza. Allocate the following gallyutsinoza: visual hallucinosis of Van-Bogart, pedunkulyarny hallucinosis of Lerkhmitt and visual hallucinosis at intoxication diethyl amide lysergic to - you are (DLK), hallucinosis like Bonnet.
1. Visual hallucinosis of Van-Bogart is described at encephalitis. After 1 — 2-week of the period of the increased drowsiness narcoleptic attacks appear (see the Narcolepsy), in an interval between to-rymi continuous visual G. in the form of a great number of the butterflies painted in various colors, small fishes, animals are observed; over time the concern increases, affective coloring of images becomes brighter, the delirium with the subsequent amnesia and difficult acoustic frustration develops.
2. Visual hallucinosis Lermitta — acute psikhopatol, the state at incomplete clarity of consciousness connected with damage of legs of a brain. Develops, as a rule, in the evening, before going to bed. Is always visual, affektivno neutral or being surprising; their images (birds, animals) are mobile, but are silent, painted in natural colors, and the patient understands a painful origin of images. In process of deepening of hallucinosis the fear joins, the criticism is broken.
3. Visual hallucinosis at intoxications of DLK [Rosenthal (S. The N of Rosenthal), 1964] arises at the frequent use of DLK. The multiple brightly painted visual G. are typical for it, to-rye quite often are followed by alarm, panic fear. Hallucinosis easily gains long character.
Verbal (acoustical) gallyutsinoza, unlike visual, develop, as a rule, at clear consciousness. They can be or an acute short episode, or proceed many years (hron, acoustical hallucinosis).
The wedge, picture is exhausted by verbal true G. V one cases they can proceed in the form of the monologue turned directly to the patient. In other cases verbal gallyutsinoza have stsenopodobny character: the patient hears the dialogue, a conversation of two or several people among themselves which is not turned to it; in such cases of the patient holds position overhearing, position of the witness of the conducted conversation. Imaginary dialogue, to-ry the patient hears, very often is contrast according to contents: one of talking scolds the patient, another protects it. At development of psychosis sometimes there is verbal hallucinosis in the form of dialogue, then it more and more becomes the monologue turned directly to the patient.
At verbal hallucinosis affective frustration (especially in the beginning) — the fear, alarm are etc. extraordinary intensive. Over time G.'s character changes: in one cases true G. are replaced by pseudohallucinations, i.e. the progrediyentnost of hallucinosis is noted; in other cases true G. are succeeded by verbal illusions or functional G., i.e. the regrediyentnost of hallucinosis is noted.
Acute development of verbal gallyutsinoz is followed by alarm, fear, confusion. Rough flow of plentiful G. can result in so-called hallucinatory confusion. At further strengthening of G. the condition of an obezdvizhennost — a hallucinatory stupor can develop.
Similar on described a wedge, a picture verbal gallyutsinoza arise at the most widespread acute alcoholic psychosis (a delirium tremens of Krepelin), after medicinal intoxications, craniocereberal injuries, infectious diseases of a brain, endogenous intoxications (diabetic, uraemic gallyutsinoz, etc.).
Illusory and fantastic gallyutsinoz, periodic hallucinosis [P. Schroder, 1926, 1933] arise at endogenous and exogenous psychoses. Illusory hallucinosis develops against the background of the expressed alarming depression accompanied with the ideas of the relation. Contents — first of all charges and threats — always corresponds to affect and a plot of crazy representations. Unlike true verbal G., heard it is transferred to patients only in general, there are no characteristics inherent to «voices» — the loudness, tone, specific accessory. At fantastic gallyutsinoza contents patol, feelings from a body has character of improbable sensations.
Tactile gallyutsinoza — states, in a wedge, a picture to-rykh dominate the tactile G. getting especially persistent current.
Algogallyutsinoz (algohallucinosis van Bogaert) — continuously proceeding stump neuralgias irradiating in the amputated part of an extremity.
Hron, tactile hallucinosis [synonym: dermatozoyny hallucinosis of Ekbom (To. A. Ekbom), Bers's hallucinosis — Conrad (Bers, Conrad), «nonsense of skin parasites», dermatozoidny nonsense] — the patient has feeling of crawling, movement of insects on skin, inside, under skin. Arises in old age more often.
Olfactory gallyutsinoza. The isolated olfactory hallucinosis of Gabek (D. Наbeck, 1965) with nonsense of the relation — perception of fetors, coming from own body, Krom is accompanied patol, feelings, the separate tactile G. and the ideas of the relation which are closely connected with imaginary smells.
Hallucinatory-dilision syndrome — a difficult symptom complex of mental disorders, in structure to-rogo preferential auditory verbal hallucinations and nonsense differing in unity of a plot prevail. Depending on features (intensity, duration, extent of systematization, compliance of maintenance of G. and nonsense) the different wedge, options of a syndrome allocate.
Hallucinatory-dilision syndromes are typical for clinic of the corresponding forms of schizophrenia, intoksikatsionny (alcoholic), infectious (syphilis of a brain), involutional, reactive psychoses.
Features of hallucinatory states at blind people and deafs
At patients about G.'s development lost by function of sight or hearing has nek-ry features.
At blind people from the birth or G. which went blind in the early childhood on the basis of visual objects do not form. Their usually acoustical G. are observed, acoustical hallucinosis easily develops (see below). Peculiar disturbances of touch (tactile feeling) are described: the patient feels «presence» near himself strangers, approach of allegedly dangerous, menacing to it persons; usually quickly crazy interpretation of such «presence», «approach» forms. The persons who lost sight at mature age can have also visual
G. U of deaf (deaf-mutes) from the birth or since the early childhood there are G. visual, tactile and G. of the general feeling. Acoustical G. at them form not on the basis of acoustical feelings, and preferential muscular (speech motor) and partly visual. Of hearing arise in a disease only at those persons, to-rye own the speech, or at the deaf-mutes who learned to speak by a special technique. Acoustical G. at the last differ in scarcity, a rudimentarnost, dimness, singularity of verbal images at possible abundance and brightness of hallucinatory images at G. tactile and the general feeling.
there is no Uniform theory explaining origins of G. yet. The existing theories can be united in several basic groups.
The so-called peripheral theory of emergence of G., according to a cut their formation is connected with unusual, painful irritation of peripheral department of appropriate authority of feelings (an eye, fish soup, receptors of skin and so forth), nowadays lost the value. It is clinically established that visual G. can arise even after bilateral enucleation of eyes, and acoustic — after bilateral section of acoustical nerves. Communication with thoughts of the patient testifies to G.'s dependence on the processes happening in bark of cerebral hemispheres.
Can be carried to the «central» theories of emergence of G. so-called psychological, kliniko-morphological and physiological.
Psychological theories of emergence of G. are especially widely presented in the concept of «strengthening of images of representation», edges are approved by a possibility of transition of images of representation (reminiscence) by their strengthening in. Supporters of these theories saw one of their confirmations in features of an eydetizm (see above).
Supporters of kliniko-morphological theories treated G.'s emergence as result of antagonism in activity of a cerebral cortex and the subcrustal centers (due to dominance of excitement or exhaustion of bark). T. Meynert this mechanism proved morfologo-lokalizatsionistsk, V. of X. Kandinsky — kliniko-physiologically, as well as K. Kalbaum.
Physiological theories of emergence of G. in the majority are based on I. P. Pavlov's doctrine. G.'s basis, according to I. P. Pavlov, is formation patol, inertness (different expressiveness) in various instances of a cerebral cortex — in the central projections visual, acoustical, olfactory, kinaesthetic and other analyzers, in the systems providing the analysis of the first or second signals of reality. E. A. Popov considered G.'s basis of feature of brake process in bark of cerebral hemispheres, in particular emergence gipnoidny, phase (transitions from wakefulness to a dream) states, first of all paradoxical phasa. At the same time weak irritants — traces of earlier experienced impressions, extremely amplifying, generate images of representations, to-rye are subjectively estimated as images of direct impressions (perceptions). A. G. Ivanov-Smolensk explained an eksteroproyektion of images of true G. with distribution of inert excitement on a cortical projection of visual or acoustical accommodation. Pseudohallucinations differ from true G. in locality of the phenomena patol, inertness of the irritable process extending preferential to visual or acoustical area.
Modern researchers elektrofiziol. the nature of a dream connect the mechanism G. with shortening of a phase of a REM sleep, a reduction of its delta forms, with a peculiar penetration of a phase of a REM sleep in wakefulness [F. Snyder, 1963].
Disturbances of functions of a dream and wakefulness, undoubtedly, are related to a problem G., but it does not mean that disorders of these functions are the cornerstone of the mechanism. The ratio of a dream and wakefulness represents only partnership in activity of the functional body which is carrying out process of perception, in Krom many systems of a brain participate.
Diagnostic value of hallucinations
the Nosological diagnosis, naturally, cannot be based only on features of hallucinatory frustration. At the same time G.'s quality and the more so syndromes of hallucinatory frustration is one of the most important criteria of qualification of those diseases, to-rykh these frustration are typical for clinic. Differentsialno-diagnostichesky value G. of a different look (see above) is caused by preferential dominance of these or those G. and hallucinatory frustration in a wedge, a picture of a disease. E.g., the Delirious syndrome, visual, true, micro or macroscopic hallucinations of zoopsichesky contents (animals, insects) are presented to Krom, it is typical only for intoksikatsionny psychoses (alcoholic).
G.'s Accession to earlier existing picture of a mental disease confirms complication its wedge, pictures. The forecast becomes more adverse at visual true G.' change by visual pseudohallucinations; visual G. — acoustical verbal; acoustical verbal true G. — verbal pseudohallucinations; hallucinoids — functional G., true G., pseudohallucinations; incidental G. — conditions of a continuous gallyutsinirovaniye (hallucinosis); Of imagination, psychogenic, paranoic G. — verbal true and the more so pseudohallucinations. At identification of the return change of hallucinatory frustration the forecast improves.
Treatment and prevention
Patients with hallucinatory states are subject to obligatory hospitalization; at gallyutsinoza it is necessary to transport the patient accompanied by the average medic. It is necessary to treat a basic disease, at Krom developed.
G.'s prevention also depends on timely treatment of a basic disease and for possible observance of rules of a psychohygiene.
See also Alcoholic psychoses , Amental syndrome , Brain (mental disorders at abscess, tumors, syphilis), Delirious syndrome , Intoksikatsionny psychoses , Infectious psychoses , Oneiric syndrome , Craniocereberal injury (mental disorders), Schizophrenia , Epilepsy (epileptic psychoses).
Bibliography: Gilyarovsky V. A. The doctrine about hallucinations, M., 1949; Kandinsky V. of X. About pseudohallucinations, M., 1952; Popov E. A. Materials to clinic and a pathogeny of hallucinations, Kharkiv, 1941; P at d N of e in V. I. O hallucinations and pseudohallucinations, Kazan, 1911; Ushakov G. K. Semiology of hallucinoids and taxonomist of hallucinations, Zhurn, neuropath, and psikhiat., t. 69, No. 7, page 1051, 1969; it, About paranoic hallucinations of imagination at paranoic states, in the same place, t. 71, No. 1, page 106, 1971; A h 1 e n-s t i e 1 H. Die Klopf-und Klingel-Hal-luzination, Nervenarzt, Bd 10, S. 470, 1960; E y H. Traite des hallucinations, t. 1—2, P., 1973; Habeck D. Beitrag zur Geruchshalluzinose mit Beziehungswahn, Arch. Psychiat. Nervenkr., Bd 207, S. 196, 1965; Rosenthal S. H. Persistent hallucinosis following repeated administra-tion of hallucinogenic drugs, Amer. J. Psychiat., v. 121, p. 238, 1964; W a 1 t-h e r-B ti e 1 H. Le syndrome de 1’hallu-cinose, Psychiat. et Neurol. (Basel), t. 152, p. 345. 1966.
G. K. Ushakov.