[Symptomatologic characteristics and psychopathology of expression of an "attack of altered perception" in schizophrenic patients].

Eleven patients with schizophrenia who developed an "attack of altered perception" are reported and discussed from the viewpoints of the symptomatologic characteristics of their mental symptoms, physical symptoms, and drawing expression. It was found that the attack appeared in patients with non-paranoid schizophrenia as well as in non-schizophrenic patients on major tranquilizers. Some patients developed obvious visual and auditory hallucinations, etc. Most visual hallucinations were of, or related to, an eye. The hallucinations were largely non-schizophrenic organic hallucinations that J. Glatzel recognized as "Sinnestäuschung", i.e., a false perception from hallucination. Physical complications which included extrapyramidal symptoms were observed mainly in the eye and its surrounding area in all cases. There were also items in common with tardive oculogyric crisis, complicated by mental symptoms, suggesting a close relationship between "attack of altered perception" and oculogyric crisis. Non-verbal, visual inner experiences during the attack had a strong affinity to the patient's drawing expression, reflecting a psychopathology of expression. Visual illusions, visual hallucinations, sensory distortions and hyperesthesia were found to be related to the drawing subject matter, such as eyes, bodies cut into pieces, heterochromatism, stains and spots. Such specific drawing expression is thought to result from the symptoms of the attack. On the other hand, a difference in the attack's ramifications was apparently dependent on whether or not the primary disease underlying the attack was schizophrenia. It is presumed that schizophrenic patients have a schizophrenia-like expression stamped on their mental symptoms, thus paroxysmal symptoms are modified by their schizophrenic symptoms and personality. Finally, an "attack of altered perception" as a whole is thought to be understandable as a continuum, running from a physical base to physical symptoms, mental symptoms (like inner experience) and expression activity (like drawing). Schizophrenia may modify the attack but should not be considered as the originating cause of the attack.