Features of Representations and Subjective Experience of the Images of Hallucinations, Fantasies, Dreams, and Imagination in Patients with Mental Disorders

Background: imagination, fantasies, dreams and hallucinations are relatively independent mental processes associated with the operation of images reflecting realistic or non-existent objects and situations. Researchers note the diagnostic potential of the features of experiencing these processes in patients with mental disorders, especially at the early stages. The aim of the study is to examine cognitive representations of the processes of imagination, fantasy, dreams and hallucinations, and the subjective experience of their perception in patients with psychotic and non-psychotic mental disorders. Patients and methods: the study involved respondents aged 16 to 29 years: patients with psychotic disorders (n = 54), non-psychotic mental disorders (n = 50) and conditionally healthy individuals (n = 63). A structured clinical interview and a drawing technique (an example of an image of imagination, fantasy, dreams and hallucinations) were used. Results: it was revealed that 90% of healthy respondents were able to distinguish between the studied mental processes, compared with 77% of patients with non-psychotic and 35% of patients with psychotic disorders. In addition, the respondents’ concepts corresponded to highlighted scientific criteria in 85% of healthy individuals, 34% of patients with non-psychotic and 11% with psychotic disorders. Patients with psychotic disorders, in comparison with other groups, were significantly less able to control their imagination (p = 0.001) and fantasies (p = 0.001) and more often reported negative emotional experiences of imagination (p = 0.001). Patients of both clinical groups were significantly more likely than healthy respondents to report having a negative dream experience (p < 0.005). They used significantly fewer colors when depicting images of imagination and fantasy, compared with the control group (p = 0.001). Conclusions: mentally healthy people distinguish between images of imagination, fantasy, dreams and hallucinations; in patients with non-psychotic mental disorders, the boundaries between these processes are less rigid, and in patients with psychotic disorders they are practically blurred. Patients with non-psychotic disorders associate predominantly positive emotions with imagination, whereas patients with psychotic disorders — predominantly negative emotions. There are no statistically significant differences in emotional response to fantasies, dreams and hallucinations between these groups.

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