Paranoid syndrome symptoms. Paranoid syndrome is delusions, hallucinations and affect in one funnel of consciousness. Scientific and practical conference “Current problems of psychiatry, narcology and psychotherapy”

indicates a significant depth of mental disorder, which covers all areas of mental activity, changing the patient’s behavior. The syndrome is characterized by a predominance of figurative delusions, closely associated with auditory hallucinations, anxiety and depressed mood. Delirium can arise like insight and does not require confirmation by facts. When everything around the patient seems to be filled with hidden meaning (understandable only to him alone), then we are talking about delusions of special significance. If it seems to the patient that strangers on the street are paying attention to him, “hinting” at something, and looking at each other meaningfully, then we are most likely talking about delusions of attitude. The combination of delusional ideas with hallucinations of any type forms the common hallucinatory-paranoid syndrome. Paranoid syndrome can be acute and chronic: in acute cases, affective disorders are more pronounced and systematic delusions are less pronounced. Paranoid syndrome manifests itself in many mental illnesses: alcoholism (alcoholic paranoid), presenile psychoses (involutional paranoid), exogenous (intoxication, traumatic paranoid) and psychogenic disorders (reactive paranoid), epilepsy (epileptic paranoid), etc.

25. Kandinsky-Clerambault syndrome. Structure. Clinical and social significance.

Kandinsky-Clerambault syndrome= external influence syndrome

Kandinsky-Clerambault syndrome- (Kandinsky, 1880; Clerambault, 1920) - a symptom complex, including: 1. delusional ideas of influence, mental and/or physical, as well as delusional ideas of mastery that are largely identical to them (see), 2. pseudohallucinations of different modalities, mainly acoustic and optical (see) and mental automatisms (mental acts that occur independently or contrary to the efforts of the patient’s mental self (see) and 3. openness symptoms, when the feeling that the inner world, the psyche of the individual disappears is exclusively his personal property, absolutely inaccessible to perception from the outside (see). Observed, according to the descriptions of Viktor Khrisanfovich Kandinsky, mainly in ideophrenia (schizophrenia), this is what K. Schneider later designated as “symptoms of the first rank" of schizophrenia. Individual manifestations of the disorder can be found in many other diseases (schizoaffective psychoses, epilepsy, intoxication psychoses, etc.)

psychopathological symptom complex, manifested by alienation or loss of belonging to one’s own “I” mental processes (mental, sensory, motor) in combination with a feeling of the influence of some outside force; accompanied by delusions of mental and physical influence and (or) delusions of persecution.

IN clinical picture There are three types of mental automatisms: associative (ideational, or mental), senestopathic (sensory, or sensual) and motor (motor). Associative automatism often begins with a feeling of impaired thinking. The patient's thoughts speed up, slow down, or suddenly stop. The appearance of thoughts and ideas is accompanied by the feeling that this is happening against his will ( mentism). The patient thinks that others know his thoughts and feelings ( openness symptom thoughts) or they repeat his thoughts out loud (echo thoughts). Subsequently, there is a “taking away” of thoughts, their violent interruption, violent memories; mental communication arises with various persons, primarily with the pursuers, who argue, swear, and order with the patient. As the disorder progresses, associative automatism manifests itself in mental voices, conversations shower, “inner voices” (verbal pseudo-hallucinations), affecting various aspects of life. Patients claim that them feelings change mood.

Senestopathic automatism manifests itself in various parts of the body, most often in internal organs, unpleasant, painful, painful sensations, accompanied by the belief that they were caused specifically from the outside. In this case, patients experience a feeling of heat, burning, pain, sexual arousal, unpleasant taste sensations, they believe that they are delayed urination, defecation.

Motor automatism - the patient’s belief in what they are doing movement and actions not of their own free will, but under the influence of external influences. Motor automatism also includes forced speaking: language the patient, against his wishes, utters words and phrases, often indecent.

The listed disorders may be accompanied by delusions of persecution or influence. Impact on mental processes called delirium of mental influence. In cases where the influence affects feelings and movements, they speak of delirium of physical influence. In this case, the source of impact may be hypnosis, electrical and atomic energy, radiation, etc. The impact is carried out by both individuals and organizations, often with the aim of causing harm to the patient. Subsequently, patients may become convinced that not only they are experiencing a variety of influences, but also those around them ( transitivism).

According to the flow, acute and chronic forms of K. - K. s. are distinguished. Acute form occurs in short term, is characterized by a paroxysmal course, figurative delirium, variability, inconsistency and fragmentation of symptoms, chaotic excitement, vividness of emotions (not only fear, suspicion, hostility, but also high spirits). The chronic form develops gradually, gradually; lasts for years. Usually clinical picture becomes more complicated - the number of associative automatisms increases, they are joined by senestopathic ones, then motor ones. Pathological sensations in patients and sources of influence take on fantastic content (for example, they were taken out stomach, blocked the intestines: they are influenced from other continents with the participation of CIA employees, aliens, etc.).

Kandinsky-Clerambault syndrome occurs more often in schizophrenia ( Schizophrenia); can develop, as a rule, in an acute form, with epileptic symptoms (see. Epilepsy), traumatic (see Traumatic brain injury) and alcoholic psychoses ( Alcoholic psychoses), being the culmination of their development.

Treatment is carried out in a psychiatric hospital. Therapy aimed at the main disease. Assign neuroleptics(triftazine, haloperidol, trisedyl, etaparazine, leponex, etc.). In cases where K. - K.s. occurs in an acute form, forecast may be favorable.

26. Affective-paranoid syndrome. Structure. Clinical and social

meaning.

Affective-paranoid syndromes

Depressive-paranoid syndrome - complex syndrome. Its leading symptoms are affective disorders (anxious-sad mood) and sensory delirium (hypochondriacal, guilt, condemnation, persecution). Mandatory symptoms are volitional disorders in the form of alternating periods of motor retardation (hypokinesia) with motor excitation (agitation reaching the point of raptus), disruption of the flow of associations from deceleration to acceleration, reaching the level of a “whirlwind of ideas.” Additional symptoms are delusions of intermetamorphosis, of special significance, double symptom, automatisms, pareidolia, functional hallucinations, affective verbal illusions, individual catatonic symptoms.

Depressive-paranoid syndrome is a dynamic psychopathological formation that has a number of stages of development.

At the initial stage hypodynamic subdepression occurs with a tinge of anxiety, ideas of low value, guilt; The prodromal stage is characterized by an anxiety-depressive syndrome, which is accompanied by fear, ideas of interpretation, attitudes, accusations that have depressive content, and the phenomena of mentalism.

Transition to the manifestation stage usually occurs acutely - insomnia appears, the severity of the leading symptoms increases. The delirium of self-blame acquires the features of enormity, and the sensual delirium of persecution clearly appears. Obligatory symptoms change their character. Motor retardation turns into pronounced agitation, slowing down the pace of thinking turns into acceleration. Additional symptoms appear, such as delusions of special significance, automatisms, illusions, hallucinations, and elements of catatonic disorders.

At the stage of full development syndrome (Cotard's syndrome), the leading symptoms are maximally expressed: ideas take on the fantastic nature of hypochondriacal delirium or delusions of the destruction of the world, agitation reaches the level of raptus, and the acceleration of the pace of thinking reaches the level of a “whirlwind of ideas.” The appearance of such additional symptoms as delusions of intermetamorphosis and double is characteristic.

The development of the syndrome may stop at one of the stages.

Depressive-hallucinatory syndrome. Leading symptoms: melancholy, verbal true or false hallucinations of depressive content, often of a continuous nature. Mandatory symptoms coincide with those of depressive-paranoid syndrome. Additional symptoms include sensory delusions of persecution and condemnation.

Manic-delusional syndrome delusions of persecution, protectorate, high origin.

Manic-hallucinatory syndrome unlike classic manic, it is complex. Its leading symptoms are euphoria and almost continuous “informing” true or false auditory hallucinations, Mandatory symptoms Additional symptoms - delusions of grandeur, altruistic, reformist, erotic, high origin.

Affective-paranoid syndromes occur in fur-like and recurrent schizophrenia, involutional psychoses, at the stages of development of oneiroid or acute paraphrenia.

27. Syndromes of non-paroxysmal loss of consciousness (stunning, stupor, coma). Dynamics. Clinical and social implications.

Quantitative nar-I of consciousness (coma, stupor, ogl-e).

Consciousness– the quality of the human psyche, which ensures the combination, purposefulness and expediency of all ongoing mental processes.

Subject of consciousness– consciousness of the surrounding world (includes orientation in place and time)

Self-awareness– consciousness of one’s own personality, “I”.

Depending on the degree of depth of decrease in clarity of consciousness, the following are distinguished: stage of switching off consciousness: obstruction, stunning, doubtfulness, stupor, coma. In many cases, as the condition worsens, these stages successively replace each other.

1.Nullification- “cloudy consciousness”, “veil on consciousness”. The patients' reactions, primarily speech, slow down. Absent-mindedness, inattention, and errors in answers appear. A carefree mood is often noted. Such states in some cases last for minutes, in others, for example, with some initial forms progressive paralysis or brain tumors, there are long periods.

2. Stun- a decrease, up to the complete disappearance of clarity of consciousness and its simultaneous devastation. The main manifestations of stunning are an increase in the threshold of excitability for all external stimuli. Patients are indifferent, their surroundings do not attract their attention, they do not immediately perceive questions asked of them, and are able to comprehend only relatively simple or only the simplest of them. Thinking is slow and difficult. Vocabulary is poor. The answers are monosyllabic, and perseverations are common. The ideas are poor and indistinct. Motor activity is reduced, the patients make movements slowly; motor awkwardness is noted. Facial reactions are impoverished, memory and reproduction disorders are pronounced. There are no productive psychopathological disorders. They can be observed in a rudimentary form only at the very beginning of stunning. The period of stunning is usually complete or almost complete amnesia.

3.Doubtfulness- a state of half-asleep, most of the time the patient lies with his eyes closed. There is no spontaneous speech, but simple questions are answered correctly. More complex issues are not thought through. External stimuli can temporarily reduce the symptoms of numbness and doubtfulness.

4. Sopor - pathological sleep. The patient lies motionless, eyes closed, face expressionless. Verbal communication with the patient is impossible. Strong stimuli (bright light, strong sound, painful stimuli) cause undifferentiated, stereotypical protective motor and vocal reactions.

5. Coma- complete loss of consciousness with lack of reaction to any stimuli.

Blackouts occur with intoxication (alcohol, carbon monoxide, etc.), metabolic disorders (uremia, diabetes, liver failure), traumatic brain injury, brain tumors, vascular and other organic diseases of the central nervous system.

28 Delirious syndrome. Structure. Clinical and social implications.

Delirium(classical) - acute confusion of consciousness, manifested by false orientation in place and time, while maintaining orientation in one’s own personality, an abundance of illusions, an influx of bright, visual, scene-like hallucinations (vivid, frightening, massive), sharp agitation of the patient and often amnesiac upon exit. Having developed gradually, in stages.

First stage- mood swings, talkativeness, restlessness, hyperesthesia, sleep disorder. Elevated mood periodically gives way to anxiety, anticipation of trouble, and sometimes irritability, capriciousness, and touchiness are noted. Memories are accompanied by figurative ideas about past events and excessive talkativeness, speech is inconsistent, hyperesthesia is incoherent. All disorders, as a rule, increase in the evening. Sleep disorders are expressed in vivid dreams of unpleasant content, difficulty falling asleep, feeling groggy and tired when waking up.

Second stage - pareidolia: patients see a variety of fantastic, motionless and dynamic, black-and-white and color images in the patterns of the carpet, wallpaper, cracks on the walls, the play of chiaroscuro, and at the height of the state the image completely absorbs the contours of the real object, the lability of affect. Hyperesthesia increases sharply, photophobia appears. Illusory disorders disappear, consciousness of the disease appears. Sleep disorders become even more significant, sleep is shallow

Third stage- arise visual hallucinations. Along with the influx of visual, usually scene-like, images, there are verbal hallucinations and fragmentary acute sensory delirium. Sharp motor agitation is usually accompanied by fear and anxiety. asthenia. In the evening, hallucinatory and delusional disorders sharply intensify, and excitement increases. In the morning the described state changes stuporous short sleep. This is where the development of delirium ends in most cases. Recovery from the disease is accompanied by pronounced emotional weakness (mood variability: alternating tearful depression with sentimental contentment and enthusiasm. Delirium usually goes away after a long sleep (16-18 hours), but by the next night relapses of hallucinatory experiences are possible. There are several types of delirium:

undeveloped (abortive)– illusions and hallucinations are observed, but orientation is preserved, lasting up to several hours;

mumbling– a more severe version (with deep confusion of consciousness) – disordered chaotic excitement, incoherent, mumbling speech, with shouting of individual words or syllables, meaningless grasping movements take place;

professional- automated motor actions are observed: he hammers non-existent nails, planes, saws, etc.

29 Amentive syndrome. Structure. Clinical and social implications.

Amentive syndrome

(lat. amentia madness; synonymamentia )

one of the forms of clouding of consciousness, in which predominant confusion, incoherence of thinking and speech, chaotic movements. It can occur in various acute infectious psychoses against the background of a pronounced worsening of the underlying somatic disease (see. Symptomatic psychoses).

A patient with A. s. perceives stimuli from the environment, but their connection with each other and with past experience is carried out partially and superficially, as a result of this, the integral knowledge of the external world and self-awareness. The patient is disoriented, confused, helpless, spontaneously utters incoherent phrases and individual words; communication with him is impossible. Hallucinations with A. s. random, fragmentary, sometimes worse at night. Delusional ideas are scant and fragmentary. Mood changeable (sadness, fear, tearfulness, bewilderment, gaiety replace each other), verbal expressions reflect mood. Moderate motor movement is observed excitation, sometimes occurs briefly stupor or sudden excitement. Characteristic amnesia. In rare cases, severe agitation with refusal from food may cause extreme exhaustion. The syndrome occurs without clear intervals and, depending on the dynamics of the underlying somatic disease, lasts several days or weeks. Exit from it it is gradual, the asthenic state persists for a long time. In the most severe cases, A. s. goes into Psychoorganic syndrome . Treatment is aimed at the underlying somatic disease; also prescribed psychotropic drugs

30 Twilight state of consciousness. Structure. Clinical options. Clinical and social implications.

Twilight blackout- a type of clouding of consciousness in which there is disorientation in the environment, combined with the development of hallucinosis and acute sensory delirium, an affect of melancholy, anger and fear, frantic excitement or, much less frequently, outwardly ordered behavior. Twilight stupefaction develops suddenly and ends suddenly; its duration ranges from several hours to several days or more. Due to anxiety, hallucinations or delusions, patients are prone to aggressive actions, confusion, twilight is divided into three options.

Crazy option. For a long time, the patient’s behavior is outwardly orderly, but attention is drawn to an absent look, special concentration and silence. Careful questioning reveals delusional experiences during the period of stupefaction, which the patient speaks about quite critically.

Hallucinatory variant. hallucinatory experiences predominate. A pronounced state of excitement, aggression.

Dysphoric (oriented) variant. Patients exhibit elementary orientation in the environment, but have amnesia for their actions and actions. However, amnesia can be retarded, that is, delayed: immediately after the resolution of the twilight state for several minutes or hours, but patients remember events and their behavior in a darkened state, amnesia subsequently develops.

Twilight stupefaction in the structure of individual diseases. Twilight stupefaction is observed in epilepsy, as well as in organic diseases of the brain.

31 Catatonic syndrome. Options. Structure. Clinical and social

meaning.

Catatonic syndrome

(Greek katatonos tense, tense)

a symptom complex of mental disorders in which movement disorders predominate in the form of agitation, stupor, or their alternation.

For K. s. stereotypies (monotonous repetitions) of movements and postures are characteristic; verbigeration(monotonous repetition of words and phrases); echosymptoms- repeating the movements of another person ( echopraxia, or echokinesia) or its words and phrases ( echolalia, or echophrasia); negativism(with passive negativism sick does not fulfill requests addressed to him, with active - he performs other actions instead of the proposed ones, with paradoxical negativism he performs actions that are directly opposite to those that he is asked to perform); catalepsy- a disorder of motor function, consisting in the fact that certain parts of the patient’s body ( head, arms, legs) can keep the dowry them position; in addition, the patient himself may freeze in any position, even an uncomfortable one, for a long time.

In some cases clinical picture exhausted by the listed symptoms (“empty” catatonia), but often with K. s. Affective, hallucinatory and delusional disorders are also noted. Consciousness in some patients it remains undisturbed (lucid catatonia), in others the symptoms of K. s. appear against the background of confusion, often oneiroid (oneiric catatonia). After acute condition the patient has amnesia real events, but he can tell (fragmentarily or in sufficient detail) about the disorders observed during that period.

Movement disturbance in the form of stupor during K. s. (catatonic stupor) is expressed in increased muscle tone. Sick moves little and slowly (substuporous state) or lies, sits or stands motionless for hours and days ( stuporous state). Catatonic stupor is often accompanied by somatic and autonomic disorders: cyanosis and swelling of the extremities, salivation, increased sweating, seborrhea, decreased HELL. Against the background of stupor, other catatonic symptoms appear in various combinations and varying intensities. In the most severe cases, the patient lies in the fetal position, all of his muscles extremely tense lips stretched forward (stupor with muscle numbness).

Movement disturbance in the form of excitation during K. s. (catatonic excitation) is expressed in the form of unmotivated (impulsive) and inappropriate actions; echosymptoms, active negativism, and stereotypies are noted in the patient’s movements and verbal expressions. Excitation suddenly on a short time may give way to catatonic stupor and mutism (lack of verbal communication); it is often accompanied by severe affective disorders (anger, rage, or indifference and indifference). Sometimes, with exalted excitement, patients clown around, grimace, grimace, and perform unexpected, ridiculous antics ( hebephrenic syndrome).

Catatonic syndrome is more common in the catatonic form of schizophrenia ( Schizophrenia); however, it is usually combined with hallucinations, delusions and mental automatisms (see. Kandinsky - Clerambault syndrome). Sometimes “empty” catatonia is observed with organic brain damage (for example, with tumors), traumatic, infectious and intoxication psychoses, etc.

Treatment is carried out in a psychiatric hospital; it is aimed at the main disease

Paranoid syndrome (Greek: paranoia insanity + eidos view) is a complex of symptoms, the manifestation of which is expressed in the form of a delusional idea of ​​persecution, causing harm physically and mentally. Accompanied by sensory and verbal hallucinations. The term was coined by the French physician Ernest Charles Lasegue in 1852.

Clinical picture and symptoms

Studying the disease involves great difficulties, since patients who have been diagnosed with paranoid syndrome are characterized by excessive suspicion and distrust.

Paranoid syndrome

In most cases, it is possible to diagnose paranoid syndrome only by indirect evidence, because patients with paranoid syndrome are laconic when communicating with doctors. Therefore, a diagnosis can only be made after careful observation of the symptoms:

• a person is focused on himself, on his person;
• aggressiveness;
• painful perception of real or imagined humiliation;
• excessive sensitivity to lack of attention from others;
• state of confusion, fear;
• groundless belief in deception or persecution;
• excessive caution (for example, having additional locks on the door);
• megalomania (less often).

Paranoid syndrome often has a chronic, sequential development. In this case, interpretive delusion develops over the years, to which not only mental, but also sensory disorders. When acute course disease, figurative delusions appear, accompanied by hallucinations, both visual and auditory. In addition, the patient's condition is aggravated by affective disorders.

Hallucinatory-delusional syndromes differ from paranoid ones, primarily by the presence of pseudohallucinations. In this state, the phenomenon of mental automatism arises - the presence of thoughts, feelings, sensations that, according to the patient, were made under the influence of one force or another. These automatisms develop gradually as the disease progresses. In this case, the patient may be bothered by a feeling of extreme heat or cold, pain in the internal organs, limbs or head. Automatisms included in the hallucinatory-paranoid syndrome:

• motor (the patient claims that the words and phrases he utters sound against his will, under the influence of other people);
• pseudohallucinations (projection occurs not only from the outside, but also inside the patient’s consciousness);
• visual pseudohallucinations (images and faces shown to him allegedly by his pursuers);
• auditory pseudohallucinations (noises and sounds on TV or other audio equipment that are transmitted by pursuers to the patient);
• associative hallucinations (the patient claims that someone is experiencing emotions through him).

The syndrome of mental automatisms is also known as Kandinsky-Clerambault syndrome, alienation syndrome, impact syndrome.

Since hallucinatory-paranoid syndrome is only a consequence arising from the main cause, treatment is mainly aimed at eliminating the underlying disease (schizophrenia, epilepsy, chronic alcoholic psychosis, organic brain disease).

Treatment of paranoid syndrome is carried out under the supervision of a psychotherapist using medications, such as:

What is paranoid syndrome?

It most often develops subacutely - over a number of days and weeks. It can replace an acute polymorphic syndrome (see p. 127) or follow neurosis-like, less often psychopath-like disorders, and even less often a paranoid debut.

Acute paranoid syndrome lasts for weeks, 2-3 months; chronic persists for many months and even years.

Paranoid syndrome consists of polythematic delusions, which may be accompanied by hallucinations and mental automatisms.

Depending on the clinical picture, the following variants of paranoid syndrome can be distinguished.

Hallucinatory-paranoid syndrome is characterized by pronounced auditory hallucinations, to which sometimes olfactory hallucinations are also added. Among auditory hallucinations, the most typical are calls by name, imperative voices that give the patient various orders, for example, to refuse food, commit suicide, show aggression towards someone, as well as voices that comment on the patient’s behavior. Sometimes hallucinatory experiences reflect ambivalence. For example, someone’s voice either forces you to engage in masturbation, or scolds you for it.

Olfactory hallucinations are usually extremely unpleasant for the patient - the smell of a corpse, gas, blood, semen, etc. is felt. Often the patient finds it difficult to say what he smells, or gives the smells unusual names (“blue-green smells”).

In addition to obvious hallucinations, adolescents are also especially prone to “delusional perception.” The patient “feels” that someone is hiding in the apartment nearby, although he has not seen or heard anyone, “feels” the gaze of others on his back. Due to some incomprehensible or indescribable signs, it seems that the food is poisoned or contaminated, although there seems to be no change in taste or smell. After seeing a famous actress on the television screen, a teenager “discovers” that he resembles her and, therefore, she is his real mother.

Delusions in hallucinatory-paranoid syndrome can be either closely related to hallucinations or not stem from hallucinatory experiences. In the first case, for example, when voices are heard threatening to kill, the thought is born of a mysterious organization, a gang that is pursuing the patient. In the second case, delusional ideas seem to be born on their own: the teenager is convinced that they are laughing at him, although he did not notice any obvious ridicule, and simply any smile on the faces of others is perceived as a hint of some kind of own flaw. Among the different types of delusions, delusions of influence are especially characteristic.

Mental automatisms in this syndrome occur as fleeting phenomena. Auditory pseudohallucinations may be more persistent: voices are heard not from somewhere outside, but from inside one’s head.

Kandinsky-Clerambault syndrome [Kandinsky V. X., 1880; Clerambault G., 1920], as well as in adults, is characterized by pseudohallucinations, a feeling of mastery or openness of thoughts and delusions of influence [Snezhnevsky A.V., 1983]. In younger and middle-aged adolescents, visual pseudohallucinations are also encountered: various geometric figures, a grid, etc. are seen inside the head. For older adolescence, auditory pseudohallucinations are more typical.

Among mental automatisms, the most common are “gaps” in thoughts, feelings of moments of emptiness in the head, and less often, involuntary influxes of thoughts (mentism). There is a feeling of thoughts sounding in your head. It seems that one’s own thoughts are heard or somehow recognized by others (a symptom of openness of thoughts). Sometimes, on the contrary, a teenager feels that he himself has become able to read the thoughts of others, predict their actions and actions. There may be a feeling that someone is controlling the behavior of a teenager from the outside, for example, using radio waves, forcing him to perform certain actions, moving the patient’s hands, encouraging him to pronounce certain words - speech motor hallucinations J. Seglas (1888).

Among the various forms of delirium in Kandinsky-Clerambault syndrome, delirium of influence and delirium of metamorphosis are most closely associated with it.

The delusional version of the paranoid syndrome is distinguished by a variety of polythematic delusions, but hallucinations and mental automatisms are either completely absent or occur sporadically.

Delusional ideas in adolescence have the following features.

Delusional relationship occurs more often than others. The teenager believes that everyone looks at him in a special way, grins, and whispers to each other. The reason for this attitude is most often seen in defects in one's appearance - an ugly figure, small stature in comparison with peers. The teenager is sure that from his eyes they guess that he was engaged in masturbation, or are suspected of some unseemly acts. Relationship ideas intensify when surrounded by unfamiliar peers, among the public staring around, in transport cars.

Delusions of persecution often associated with information gleaned from detective films. The teenager is pursued by special organizations, foreign intelligence services, gangs of terrorists and currency traders, robber gangs, and the mafia. Agents sent everywhere are seen watching him and preparing reprisals.

Delirium of influence also sensitively reflects the trends of the times. If earlier we were more often talking about hypnosis, now - about the telepathic transmission of thoughts and orders at a distance, about the action of invisible laser beams, radioactivity, etc. Mental automatisms (“thoughts are stolen from the head” can also be associated with the ideas of influence). “they put orders into your head”) and ridiculous hypochondriacal nonsense (“they spoiled the blood”, “affected the genitals”, etc.).

Nonsense of other people's parents has been described as characteristic of adolescence[Sukhareva G.E., 1937]. The patient “discovers” that his parents are step-parents, that he accidentally ended up with them in early childhood (“confused in maternity hospital"), that they feel it and therefore treat him badly, want to get rid of him, imprisoned him in mental asylum. Real parents often occupy a high position.

Dysmorphomanic delirium differs from dysmorphomania with sluggish neurosis-like schizophrenia in that imaginary deformities are attributed to someone’s evil influence or receive another delusional interpretation (bad heredity, improper upbringing, parents did not care about proper physical development, etc.).

Delirium of infection Teenagers often have a hostile attitude towards their mother, who is accused of being unclean and spreading infection. Thoughts about infection are especially common venereal diseases, moreover, in adolescents who have not had sexual intercourse.

Hypochondriacal delirium in adolescence, it often affects two areas of the body - the heart and genitals.

Differential diagnosis must be made with reactive paranoids if the paranoid syndrome arose after mental trauma. Currently, reactive paranoids in adolescents are quite rare. They can be encountered in the situation of a forensic psychiatric examination [Natalevich E. S. et al., 1976], as well as as a consequence of a real danger to the life and well-being of a teenager and his loved ones (attacks by bandits, disasters, etc.) . The picture of reactive paranoid is usually limited to delusions of persecution and relation. Hallucinatory (usually illusory) experiences arise episodically and in content are always closely related to delusion. The development of reactive paranoids in adolescents can be facilitated by an environment of constant danger and extreme mental stress, especially if they are combined with lack of sleep, as was the case in areas temporarily occupied by the Nazis during the Great Patriotic War. Patriotic War[Skanavi E. E., 1962].

But mental trauma can also be a provocateur for the onset of schizophrenia. The provoking role of mental trauma becomes obvious when the paranoid syndrome drags on long after the traumatic situation has passed, and also if delusions of persecution and relationships are joined by other types of delusions that do not in any way arise from the experiences caused by mental trauma, and, finally, if hallucinations begin to occupy an increasing place in the clinical picture and at least fleeting symptoms of mental automatisms appear.

Prolonged reactive paranoids are not characteristic of adolescence.

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Paranoid syndrome - delusions, hallucinations and affect in one funnel of consciousness

IN medical practice Several terms are used that combine disorders of mental stability, which are accompanied by delusions, delusions of persecution and harm, and hallucinations.

Paranoid (paranoid) syndrome is a symptom complex characterized by the manifestation of delusions, hallucinations, pseudohallucinations and mental automatism syndrome. It is expressed in the idea of ​​persecution and infliction of physical or mental injury.

This term appeared thanks to the French psychiatrists Ernest Charles Lasegue (1852) and Jean-Pierre Falret (1854). The paranoid syndrome was described by them as the “persecutor-pursued” syndrome. In medical sources you can find the following names for this condition: hallucinatory-paranoid, paranoid, or hallucinatory-delusional syndrome.

In other words, paranoid syndrome is unfounded beliefs that in most cases are associated with persecution. Brad can wear different character: it may represent a clearly planned surveillance system from the first manifestations to the final goal (outcome), or it may not have such certainty. In both cases, there is an excessive focus on one’s own personality.

Paranoid syndrome (from other Greek: insanity + appearance) accompanies mental disorders and changes the patient’s behavior. Its symptoms characterize the depth of the disorder.

Due to the patient's isolation and mistrust, the diagnosis can be made based on indirect manifestations through careful observation of the patient.

Development of the disorder and the nature of the patient’s actions

The development of the syndrome may continue for several years. The person is closed, all his attention is directed to himself. The patient sees others as a threat and an unfriendly attitude towards himself. As a rule, others evaluate such an individual as a self-centered person with high self-esteem, closed and distant from reality.

The delusional state develops gradually with small ideas. Delirium can be systematized. In this case, the patient can prove what his fears are based on. When a delusional idea is not systematically manifested, the patient is lost and cannot explain the reason for suspicion, but also sees everyone as an enemy and persecutor. Delirium of persecution occurs without clouding of consciousness.

The patient's firm belief that enemies are watching him and using certain actions to control a person's thoughts, desires and actions is called Kandinsky-Clerambault syndrome or mental automatism.

Mental automatism is divided into three groups according to the nature of the apparent impact:

Patients try in every possible way to “protect themselves” from their enemies. They write numerous statements asking to be protected from persecution and sew protective clothing. Their actions become dangerous to others. For example, they can destroy electrical wiring in an apartment so that enemies cannot use their devices.

Where does the disorder begin?

Until now, medicine has found it difficult to name the exact cause or complex of provoking factors. The phenomenon can have a very different etiology. The syndrome is formed on the basis of genetic predisposition, congenital or acquired diseases of the nervous system, which are characterized by changes in the biochemical processes of the brain.

In cases of the use of narcotic or psychotropic drugs, or alcohol abuse, the cause of the paranoid syndrome is clearly defined. A short-term phenomenon of paranoia can be observed in people under the influence of prolonged severe stress.

Patients with mental illnesses are primarily at risk of developing this disorder. chronic form(most often schizophrenics), sometimes patients with organic lesions of the brain and central nervous system (encephalitis, cerebrovascular disease and others).

Medical statistics indicate that paranoid syndrome is most often observed in men.

And the first symptoms of deviations may appear in at a young age(from 20 years old).

In some cases, there is a rapid increase in characteristic symptoms.

Clinical picture

Due to the isolation and suspicion of patients, difficulties arise in diagnosing mental disorders. There are a number indirect symptoms, by which paranoid syndrome is diagnosed:

• constant suspicion towards colleagues and friends;
• conviction that everyone around you is conspiring against you;
• inappropriate attitude towards harmless remarks, search for a hidden threat in them;
• severe grievances;
• suspicion of loved ones of betrayal and infidelity.

Subsequently, auditory hallucinations, persecution mania, secondary systematized delusions develop (the patient clearly explains how and on what day the surveillance began, and how it manifests itself) and sensory impairment.

Paranoid syndrome progresses along delusional or hallucinogenic paths of development. The delusional nature of the disorder is more complex and requires long-term treatment. The reason is the patient’s reluctance to contact anyone. Hallucinogenic can occur as an acute mental disorder. He is classified as mild form deviations due to the patient’s communication skills. The prognosis for treatment is quite optimal.

Manifestations of mental disorder are expressed in various forms.

Hallucinatory-paranoid syndrome

In addition to the patient’s feeling of constant surveillance with the aim of causing harm to health or even murder, this condition is characterized by hallucinations and pseudohallucinations. Most often, this condition occurs after a severe affective disorder, manifested in aggression and neurosis (hence the second name affective paranoid syndrome). There is a strong constant feeling fear and a variety of delusional ideas.

This condition is characterized consistent development. The stages of formation of paranoid syndrome of the hallucinatory type have a certain order:

• rapid change of emerging thoughts, the patient has a strong belief that outsiders can read his thoughts and influence them;
• the next stage is characterized by increased heart rate, which the patient feels, withdrawal symptoms, convulsions and hyperthermia;
• on final stage This form of pathology gives the patient confidence in controlling his subconscious from the outside.

In each of these stages, hallucinations appear in the form of unclear images or blurry spots. The patient cannot describe what he saw, but he is convinced of an outside influence on his thinking.

Depressive disorder

Symptoms of depressive-paranoid syndrome are expressed as follows:

• there is a decrease in self-esteem, the joy of life disappears, there is no sexual desire;
• the patient develops suicidal tendencies;
• then an obsessive idea of ​​suicide appears;
• delirium is noted in all manifestations.

This condition often occurs against the background of complex mental trauma. Depressed state and depression lead to sleep disturbances, and then to its complete absence. There is inhibition in behavior. This condition develops within 3 months. The patient suddenly loses weight and develops problems with the cardiovascular system.

Manic spectrum

In this state, the patient experiences excessive agitation. He thinks quickly and voices his own thoughts. Often similar condition occurs due to the use of alcohol and drugs.

Emotional outbursts of the subconscious lead to persecution of the opposite sex with the aim of committing violent acts. This picture can be observed due to severe stress.

Diagnostic criteria

Due to a decrease in the patient’s communication skills, the diagnosis may not be made immediately, but after long-term observation and a series of psychological tests.

The syndrome is differentiated with a number of organic changes, such as dementia, as well as with stress and affective changes in epilepsy.

Particular attention is paid to little things, the specificity of experiences is assessed - overestimation of personality and excessive detail distinguish paranoid syndrome from similar signs of disorders of other etiologies.

Treatment approach

Treatment of paranoid syndrome requires hospital conditions. Relatives of the patient should understand that an important role in the prognosis of treatment belongs to early detection pathology. This condition does not go away on its own, but is characterized by an increase in symptoms.

The therapy program is selected individually in each case. The doctor prescribes antipsychotics(Aminazine, Sonapax, Triftazin, etc.), with the help of which the patient is brought into a stable state of mind. The timing depends on the degree of the disease and can range from one week to one month.

Therapy started at the first manifestations has a good effect dangerous symptoms. The patient is quickly returned to stable mental condition. If treatment is delayed, the situation worsens and treatment takes longer.

Relatives of the patient need to know that it is impossible to achieve a complete recovery in such patients. But under certain conditions, loved ones can prevent further deterioration of the disease.

Paranoid syndrome: description, causes, symptoms and treatment

A constant stay in a near-delirium state is natural for patients diagnosed with paranoid syndrome. Moreover, people with such a disorder are divided into two types: those who can systematize their delirium, and those who are unable to do this. In the first case, the patient clearly understands and can tell others when he noticed that he was being watched; can name the date of the onset of a persistent feeling of anxiety, how it manifests itself, and, moreover, even names a specific person from whom he feels threatened.

Most patients, unfortunately, cannot systematize delirium. They understand their condition general outline and create conditions for preserving life: they often change their place of residence, observe increased security measures in various situations, and lock the doors with all the locks.

The most well-known disorder of a person’s mental state is schizophrenia - a paranoid syndrome in which thinking is partially or completely impaired, and emotional reactions do not correspond to natural ones.

Causes of the disease

Doctors find it difficult to name the exact cause or their complex, which can provoke a violation of a person’s psycho-emotional state. The etiology can be completely different and is formed under the influence of genetics, stressful situations, congenital or acquired neurological pathologies, or due to changes in brain chemistry.

Some clinical cases of the development of paranoid syndrome still have a clearly established cause. To a greater extent, they arise under the influence of psychotropic and narcotic substances, alcohol.

Classification and symptoms of the disorder

Doctors agree that paranoid and paranoid syndromes have similar symptoms:

• patients are more likely to be in a state of secondary delusion, which manifests itself in the appearance of various images, rather than in a state of primary delirium, when they do not understand what is happening to them;
• in each clinical case, a predominance of auditory hallucinations over visual phenomena was noted;
• the state of delirium is systematized, which allows the patient to tell the reason and name the date of origin of anxious feelings;
• in most cases, each patient clearly understands that someone is spying on him or stalking him;
• Patients associate the views, gestures and speech of strangers with hints and a desire to harm them;
• sensory impairment.

Paranoid syndrome can develop in one of two directions: delusional or hallucinatory. The first case is more severe, because the patient does not make contact with the attending physician and loved ones; accordingly, making an accurate diagnosis is impossible and is postponed indefinitely. Treatment of delusional paranoid syndrome takes longer and requires strength and perseverance.

Hallucinatory paranoid syndrome is considered a mild form of the disorder, which is due to the patient’s sociability. In this case, the prognosis for recovery looks more optimistic. The patient's condition can be acute or chronic.

Hallucinatory-paranoid syndrome

This syndrome is a complex mental disorder of a person, in which he feels the constant presence of strangers who are spying on him and want to cause physical harm, even murder. He is accompanied frequent occurrence hallucinations and pseudohallucinations.

In most clinical cases, the syndrome is preceded by severe affective disorders in the form of aggression and neurosis. Patients are in a constant feeling of fear, and their delirium is so diverse that against its background the development of automaticity of the psyche occurs.

The progression of the disease has three stable stages, following one after another:

1. A lot of thoughts swarm in the patient’s head, which every now and then pop up on top of those that have just disappeared, but at the same time it seems to him that every person who sees the patient clearly reads thoughts and knows what he is thinking about. In some cases, it seems to the patient that the thoughts in his head, not his, but those of strangers, are imposed by someone through the power of hypnosis or other influence.
2. At the next stage, the patient feels an increase in the heart rate, the pulse becomes incredibly fast, cramps and withdrawal begin in the body, and the temperature rises.
3. The culmination of the condition is the patient's awareness that he is in the mental power of another being and no longer belongs to himself. The patient is sure that someone is controlling him by penetrating his subconscious.

Hallucinatory-paranoid syndrome is characterized by the frequent appearance of pictures or images, blurry or clear spots, while the patient cannot clearly describe what he sees, but only convinces others of the influence of an outside force on his thoughts.

Depressive-paranoid syndrome

The main cause of this form of the syndrome is the experience of a complex traumatic factor. The patient feels depressed and is in a state of depression. If these feelings are not overcome at the initial stage, then sleep disturbances subsequently develop, up to complete absence, and general state characterized by lethargy.

Patients with depressive-paranoid syndrome experience four stages of disease progression:

• lack of joy in life, decreased self-esteem, impaired sleep and appetite, sexual desire;
• the emergence of suicidal thoughts due to a lack of meaning in life;
• the desire to commit suicide becomes persistent, the patient can no longer be convinced otherwise;
• the last stage is delirium in all its manifestations, the patient is sure that all the troubles in the world are his fault.

This form of paranoid syndrome develops over a fairly long period of time, about three months. Patients become skinny, their blood pressure is compromised, and their heart function suffers.

Description of manic-paranoid syndrome

Manic-paranoid syndrome is characterized by elevated mood for no good reason, patients are quite active and mentally excited, they think very quickly and immediately reproduce everything they think. This condition is episodic and is caused by emotional outbursts of the subconscious. In some cases, it occurs under the influence of drugs and alcohol.

Patients are dangerous to others because they are prone to pursuing the opposite sex for sexual purposes, with possible physical harm.

Quite often, the syndrome develops against the background of severe stress. Patients are confident that those around them are plotting criminal acts against them. Hence arises permanent state aggression and mistrust, they become withdrawn.

Diagnostic methods

If paranoid syndrome is suspected, it is necessary to take the person to a clinic, where they should undergo a thorough general medical checkup. This is a method of differential diagnosis and allows us to clearly exclude mental disorders associated with stress.

When the examination is completed, but the cause remains unclear, the psychologist will schedule a personal consultation, during which a number of special tests will be performed.

Relatives should be prepared for the fact that after the first communication with the patient, the doctor will not be able to make a final diagnosis. This is due to reduced communication skills of patients. Long-term observation of the patient and constant monitoring of symptomatic manifestations are required.

For the entire diagnostic period, the patient will be placed in a special medical facility.

Treatment of patients diagnosed with paranoid syndrome

Depending on what symptoms the paranoid syndrome shows, in each clinical case the treatment regimen is selected individually. In modern medicine, most mental disorders can be successfully treated.

The attending physician will prescribe the necessary antipsychotics, which, when taken in combination, will help bring the patient into a stable mental state. The duration of therapy, depending on the severity of the syndrome, is from a week to one month.

IN exceptional cases, if the form mild illness, the patient can undergo therapy on an outpatient basis.

Drug therapy

The leading specialist in solving problems of mental personality disorder is a psychotherapist. In certain cases, if the disease is caused by the influence of drugs or alcohol, a specialist must work in tandem with a narcologist. Depending on the degree of complexity of the syndrome medical supplies will be selected individually.

For mild treatment forms showing means:

Syndrome medium degree treated with the following drugs:

• "Aminazine."
• "Chlorprothixene."
• "Haloperidol."
• "Levomepromazine."
• "Triftazine"
• Trifluperidol.

IN difficult situations doctors prescribe:

The attending physician determines which medications to take, their dosage and regimen.

Prognosis for recovery

It is possible to achieve the stage of stable remission in a patient diagnosed with “paranoid syndrome”, provided that an appeal for medical care was done in the first days of discovery mental disorders. In this case, therapy will be aimed at preventing the development of the exacerbation stage of the syndrome.

It is impossible to achieve an absolute cure for paranoid syndrome. The patient’s relatives should remember this, but with an adequate attitude to the situation, the disease can be prevented from worsening.

anxiety-paranoid syndrome

Large medical dictionary. 2000.

See what “anxiety-paranoid syndrome” is in other dictionaries:

Anxiety-paranoid syndrome- - a combination of anxiety and primary delusions of persecutory content; agitation, psychomotor agitation, illusions and verbal hallucinations are also often observed. Occurs in schizophrenia and exogenously organic psychoses... encyclopedic Dictionary in psychology and pedagogy

Syndromes- (Greek syndromos - running together, syndrome - a combination of signs of illness). A system of disease symptoms interrelated in pathogenesis. Nosological diagnosis is possible by taking into account the statics and dynamics of S. According to A.V. Snezhnevsky (1983), development... ... Explanatory dictionary of psychiatric terms

Anxiety- Affect that arises in anticipation of an uncertain danger, an unfavorable development of events. T. differs from fear in that it is pointless, while fear is a reaction to a specific threat. This feature of T. may be a consequence... ... Explanatory dictionary of psychiatric terms

Obsession- Felix Plater, scientist who first described obsessions... Wikipedia

List of ICD-9 codes- This article should be Wikified. Please format it according to the article formatting rules. Transition table: from ICD 9 (chapter V, Mental disorders) to ICD 10 (section V, Mental disorders) (adapted Russian version) ... ... Wikipedia

Psychoses- (psych + oz). Severe forms of mental disorders, in which the patient’s mental activity is characterized by a sharp discrepancy with the surrounding reality, the reflection of the real world is grossly distorted, which manifests itself in behavioral disorders and... ... Explanatory dictionary of psychiatric terms

Rave- (Latin delirium, German Wahn). Thinking disorder. A set of painful ideas, reasoning and conclusions that take possession of the patient’s consciousness, distortedly reflect reality and cannot be corrected from the outside. According to A.V. Snezhnevsky (1983) ... Explanatory dictionary of psychiatric terms

Schizophrenia- I Schizophrenia (schizophrenia; Greek schizō split, divide + phrēn mind, mind; synonymous with Bleuler’s disease) mental illness with a long-term chronic progressive course, accompanied by dissociation of mental processes, motor skills and... ... Medical encyclopedia

Paranoid syndrome. Primary systematized delirium of interpretation of various contents (jealousy, invention, persecution, reformism, etc.), occasionally existing as a monosymptom in the complete absence of other productive disorders. If the latter arise, they are located on the periphery of the paranoid structure and are subordinated to it. Characterized by a paralogical structure of thinking (“crooked thinking”) and delusional detailing.

The ability to make correct judgments and conclusions on issues that do not affect delusional beliefs is not noticeably impaired, which indicates catathymic (that is, associated with an unconscious complex of affectively colored ideas, and not a general change in mood) mechanisms of delusion formation. Memory disturbances in the form of delusional confabulations (“memory hallucinations”) may occur. In addition, there are hallucinations of the imagination, the content of which is associated with dominant experiences. As delirium expands, an ever wider range of phenomena becomes the object of pathological interpretations. There is also a delusional interpretation of past events. Paranoid syndrome usually occurs against the background of several high mood(expansive delusions) or subdepression (sensitive, hypochondriacal delusions).

The content of delusions at distant stages of development can acquire a metallomaniac character. Unlike paraphrenia, delusion continues to be interpretive and in its scope does not go beyond the scope of what is fundamentally possible in reality (“prophets, outstanding discoverers, brilliant scientists and writers, great reformers”, etc.). There are chronic, existing over a number of years or even decades, and spicy options paranoid syndrome. Chronic paranoid delusions are most often observed with relatively slowly developing delusional schizophrenia. Delirium in such cases is usually monothematic. The possibility cannot be ruled out that there is an independent form of the disease - paranoia.

Acute, usually less systematized paranoid states are more common in the structure of attacks of fur-like schizophrenia. The delusional concept is loose, unstable and can have several different themes or centers of crystallization of false judgments.

Some authors consider it justified to distinguish between paranoid and paranoid syndromes (Zavilyansky et al., 1989). Chronic, systematized, overvalued delusions (beginning with overvalued ideas) that arise under the influence of a key psychotraumatic situation for the patient are called paranoid. Paranoid and epileptoid features of the premorbid personality of constitutional, post-processual or organic origin contribute to the development of delusions. The mechanisms of delusion formation are associated with psychological rather than biological disorders - “psychogenic-reactive” delusion formation. Paranoid syndrome in this interpretation is appropriate to consider within the framework of pathological personality development.

Paranoid or hallucinatory-paranoid syndrome. Includes delusional ideas of persecutory content, hallucinations, pseudohallucinations and other phenomena of mental automatism, affective disorders. There are acute and chronic hallucinatory-paranoid syndromes.

​	Paranoid syndrome accompanies

Acute paranoid is an acute sensory delusion of persecution (in the form of delusions of perception) of a specific orientation, accompanied by verbal illusions, hallucinations, fear, anxiety, confusion, and abnormal behavior reflecting the content of delusional ideas. It is observed in schizophrenia, intoxication, and epileptic psychoses. Acute paranoid states can also occur in special situations (long journeys associated with insomnia, alcohol intoxication, emotional stress, somatogenies) - road or situational paranoids described by S.G. Zhislin.

Mental automatisms in their completed form represent the experience of violence, invasion, the doneness of one’s own mental processes, behavior, and physiological acts. The following types of mental automatisms are distinguished.

Associative or ideational automatism - disturbances of mental activity, memory, perception, affective sphere, occurring with the experience of alienation and violence: influxes of thoughts, non-stop flow of thoughts, states of blockade of mental activity, symptoms of investing, mind reading, symptom of unwinding memories, pseudohallucinatory pseudomemories, sudden delays in memories, phenomena of figurative mentism and etc.

Manifestations of ideational automatism also include auditory and visual pseudohallucinations, as well as a number of affective disorders: “induced” mood, “induced” fear, anger, ecstasy, “induced” sadness or indifference, etc. This group of automatisms includes “ made” dreams. The inclusion of auditory verbal and visual pseudohallucinations in the group of ideational automatisms is due to their close connection with thinking processes: verbal pseudohallucinations with verbal ones, and visual ones with figurative forms of thinking.

Senestopathic or sensory automatism - various senestopathic sensations, the appearance of which patients associate with the influence of external forces. In addition, this includes olfactory, gustatory, tactile and endosomatic pseudohallucinations. Sensory automatism includes various changes in appetite, taste, smell, sexual desire and physiological needs, as well as sleep disorders, autonomic disorders (tachycardia, increased sweating, vomiting, diarrhea, etc.), “caused,” according to patients, from the outside.

Kinesthetic or motor automatism - impulses to activity, individual movements, actions, deeds, expressive acts, hyperkinesis that arise with the experience of violence. Receptive processes can also occur with the phenomena of being made: “They force you to look, listen, smell, look with my eyes...”, etc.

Speech motor automatism - phenomena of forced speaking, writing, as well as kinesthetic verbal and graphic hallucinations.

The formation of mental automatisms occurs in a certain sequence. At the first stage of development of ideatorial automatism, “strange, unexpected, wild, parallel, intersecting” thoughts appear, alien in content to the entire structure of the personality: “I never think like that...” At the same time, sudden interruptions of necessary thoughts may occur. Alienation concerns the content of thoughts, but not the process of thinking itself (“my thoughts, but very strange ones”).

Then the sense of one’s own thinking activity is lost: “Thoughts float, go on their own, flow non-stop...” or states of blockade of mental activity arise. Subsequently, the alienation becomes total - the feeling of belonging to one’s own thoughts is completely lost: “Thoughts are not mine, someone is thinking in me, there are other people’s thoughts in my head...” Finally, a feeling arises as if thoughts “come from the outside, are introduced into the head, invest..." "Telepathic" contacts with other people arise, the ability to directly read the thoughts of others and mentally communicate with others appears. At the same time, patients may claim that at times they are deprived of the ability to think or that they are “pulled out of thoughts” or “stolen.”

The development of verbal pseudohallucinations can occur as follows. First, the phenomenon of the sound of one’s own thoughts arises: “Thoughts rustle and sound in the head.” Then your own voice begins to be heard in your head, “voicing”, and sometimes like an “echo”, repeating your thoughts. This can be called inner speech hallucinations. The content of statements gradually expands (statements, comments, advice, orders, etc.), while the voice “doubles, multiplies.”

Then “other people’s voices” are heard in my head. The content of their statements is becoming more and more diverse, divorced from the reality and personality of the patients. In other words, the alienation of the process of internal speaking also increases in a certain sequence. Finally, the phenomenon of “made, induced voices” arises. The voices speak on a variety of topics, often abstracted from personal experiences, sometimes reporting absurd and fantastic information: “The voices behind the ears speak about local topics, but in the head they speak about national ones.” The degree of alienation of what is said by voices can therefore be different.

The dynamics of kinesthetic automatism generally correspond to those described above. At first, previously unusual impulses to action and impulsive desires appear, and strange and unexpected actions and actions are performed for the patients themselves. Subjectively, they are perceived as belonging to one’s own personality, although unusual in content. There may be short stops of action. Subsequently, actions and deeds are performed without a sense of one’s own activity, involuntarily: “I do it without noticing it, and when I notice it, it’s hard to stop.” Conditions of blockade or “paralysis” of impulses to action arise.

At the next stage, activity proceeds with a clear experience of alienation of one’s own activity and violence: “Something is pushing from within, prompting, not a voice, but some kind of internal force...” Episodes of interruptions in action are also experienced with a tinge of violence. At the final stage of development of motor automatisms, a feeling appears that motor acts are done from the outside: “My body is controlled... Someone controls my hands... One hand belongs to my wife, the other to my stepfather, my legs belong to me... They look with my eyes... “With a feeling of external influence, states of blockade of impulses to action occur.

The sequence of development of speech motor automatisms may be similar. At first, individual words or phrases are broken out, alien to the direction of the patient’s thoughts, absurd in content. Often individual words are suddenly forgotten or the formulation of thoughts is disrupted. Then the feeling of one’s own activity that accompanies speech is lost: “The tongue speaks on its own, I’ll say it, and then the meaning of what was said comes through... Sometimes I start talking...” Or the tongue stops for a short time and does not listen. Next, a feeling of alienation and violence arises in relation to one’s own speech:

“It’s as if it’s not me who speaks, but something in me... My double is using the language, and I’m not able to stop speaking...” Episodes of mutism are experienced as violent. Finally, a feeling of external mastery of speech arises: “Strangers speak my language... They give lectures on international topics in my language, and at this time I don’t think about anything at all...” Conditions of loss of spontaneous speech are also associated with external phenomena. The development of speech motor automatisms can begin with the appearance of kinesthetic verbal hallucinations: there is a feeling of movement of the articulatory apparatus corresponding to speech, and the idea of ​​involuntary mental pronunciation of words. Subsequently, the internal monologue acquires a verbal-acoustic connotation, and a slight movement of the tongue and lips appears. At the final stage, true articulatory movements arise with the actual pronunciation of words out loud.

Senestopathic automatism usually develops immediately, bypassing certain intermediate stages. Only in some cases, before its appearance, can one state the phenomenon of alienation of senestopathic sensations: “Terrible headaches, and at the same time it seems that this is happening not to me, but to someone else...”

In the structure of mental automatisms, Clerambault distinguished two types of polar phenomena: positive and negative. The content of the first is the pathological activity of any functional system, secondly, suspension or blockade of the activities of the corresponding system. Positive automatisms in the field of ideation disorders are a violent flow of thoughts, a symptom of investing thoughts, a symptom of unwinding memories, made emotions, induced dreams, verbal and visual pseudohallucinations, etc.

Their antipode, that is, negative automatisms, can be states of blockage of mental activity, a symptom of withdrawal, pulling out thoughts, sudden loss of memory, emotional reactions, negative auditory and visual hallucinations that arise with a feeling of accomplishment, forced deprivation of dreams, etc. In the field of senestopathic Automatism will be, respectively, sensations made and loss of sensitivity caused from outside; in kinesthetic automatism - violent actions and states of delayed motor reactions, taking away the ability to make decisions, blocking impulses for activity. In speech motor automatism, the polar phenomena will be forced speaking and sudden speech delays.

According to Clerambault, schizophrenia is more characterized by negative phenomena, especially if the disease begins at a young age. In fact, positive and negative automatisms can be combined. Thus, forced speaking is usually accompanied by a state of blockade of mental activity: “The tongue speaks, but at this time I am not thinking about anything, there are no thoughts.”

Disorders of self-awareness that arise in the syndrome of mental automatism are expressed by the phenomena of alienation of one’s own mental processes, the experience of the violence of their course, dual personality and the consciousness of an internal antagonistic double, and subsequently - a feeling of mastery by external forces. Despite the seemingly obvious nature of the disorder, patients usually lack a critical attitude towards the disease, which, in turn, may also indicate a gross pathology of self-awareness. Simultaneously with the increase in the phenomena of alienation, the devastation of the sphere of the personal Self progresses.

Some patients even “forget” what it is, their own Self; the old Self-concept no longer exists. There are no mental acts emanating from the name of one’s Self at all; this is a total alienation that has spread to all aspects of the inner Self. At the same time, thanks to appropriation, a person can “acquire” new abilities and characteristics that were not previously inherent in him. Sometimes the phenomenon of transitivism is observed - not only the patient, but also others (or mostly others) are the object of external influence and various kinds of violent manipulation, their own feelings are projected onto others. Unlike the projection itself, the patient is not subjectively freed from painful experiences.

The experience of openness occurs with the appearance of various echo symptoms. A symptom of echo thoughts - those around him, according to the patient, repeat out loud what he was just thinking about. Hallucinatory echo - voices from outside repeat, “duplicate” the patient’s thoughts. A symptom of the sound of one’s own thoughts - thoughts are immediately repeated, they clearly “rustle, sound in the head, and are heard by others.” Anticipatory echo - voices warn the patient what he will hear, see, feel or do after some time. Echo of actions - voices state the actions, intentions of the patient: “I am being photographed, my actions are being recorded...” It happens that the voices are read for the patient, but he only sees the text.

Voices can repeat and comment on motives and behavior, give them one or another assessment, which is also accompanied by the experience of openness: “Everyone knows about me, nothing remains to myself.” Echo of writing - voices repeat what the patient is writing. Echo of speech - voices repeat everything the patient said out loud to someone. Sometimes the voices force or ask the patient to repeat for them what he told others, or, on the contrary, to mentally or out loud say again what he heard from someone, and the patient, like an echo, repeats this. The “hallucinatory personality” here seems to be deprived of contact with the outside world, establishing it with the help of the patient.

There is no name for this symptom, but we will conditionally call it the echo-patient phenomenon. The above echo phenomena can be iterative in the form repetition. Thus, a patient (he is 11 years old) has episodes that last two to three hours, when what was said by other people three to five times in someone else’s voice is repeated in his head. One word is repeated more often. During repetitions, he perceives what is happening worse and cannot watch TV. Other echophenomena occur. Thus, the speech of others can be repeated by voices from outside or in the head - a symptom of echo-alien speech.

Voices with external projection are sometimes duplicated by internal ones - a symptom of echovoices. The experience of openness can be observed even in the absence of echo symptoms, and arise in the most direct way: “I feel that my thoughts are known to everyone... There is a feeling that God knows everything about me - I am in front of him like an open book... Voices are silent, which means they are eavesdropping , what I think".

Delirium of physical and mental influence- belief in the impact on the body, somatic and mental processes various external forces: hypnosis, witchcraft, rays, biofields, etc.

In addition to the above-described phenomena of alienation, in the syndrome of mental automatism, opposite phenomena may occur - the phenomena of appropriation, which constitute an active or inverted version of the Kandinsky-Clerambault syndrome. In this case, patients express the belief that they themselves have a hypnotic effect on others, control their behavior, are able to read the thoughts of other people, the latter have turned into an instrument of their power, behave like dolls, puppets, parsleys, etc. Combination of alienation phenomena and assignments V.I. Akkerman (1936) considered a sign characteristic of schizophrenia.

There are hallucinatory and delusional variants of mental automatism syndrome. In the first of them, various pseudohallucinations predominate, which is observed mainly during acute hallucinatory-delusional states in schizophrenia, in the second - delusional phenomena that dominate in chronically ongoing paranoid schizophrenia. In chronic schizophrenic delusions of the interpretative type, associative automatisms come to the fore over time. Senestopathic automatisms may predominate in the structure of attacks of fur-like schizophrenia. In lucid-catatonic states, kinesthetic automatisms occupy a significant place. In addition to schizophrenia, phenomena of mental automatism can occur in exogenous-organic, acute and chronic epileptic psychoses.

Paranoid psychosis is a severe mental disorder accompanied by delusions. The current is characterized by ideas of persecution and aggression. Hallucinations do not occur in paranoid psychosis.

The disorder can develop independently or be a consequence of schizophrenia or alcohol abuse. It is a more severe form than paranoia, but milder than paraphrenia.

Kinds

Types of paranoid psychoses are differentiated depending on the delusional states accompanying the course of the disorder:

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Delirium associated with one's own greatness	The patient may attribute to himself talents, superpowers, and consider himself a brilliant inventor. It is possible to develop a state associated with religious themes - in this case, a person may imagine himself as a new prophet.
Erotomanic	It manifests itself in the belief that a certain famous person has romantic feelings for the patient. As a rule, there is no sexual connotation, and the person himself is not familiar with the celebrity.
Somatic	With this form of the disorder, a person is confident that he has a serious incurable disease or serious injury.
Persecution	The most common form of paranoid psychosis, in which the patient believes that someone is watching him and his loved ones with the intention of causing harm.
Jealousy	Also widespread, often develops against the background of alcoholic paranoia. At the same time, the patient is sure that his spouse is cheating. Delusions of jealousy can relate both to the present time and to past events, and can be aggravated by a man’s confidence that his wife gave birth to children from another person.
Unspecified option	It manifests itself as a combination of the above variants of delirium or other complaints that are not typical for the standard variants. There can be many scenarios for the development of delirium; they are limited only by the patient’s imagination.

Causes

Paranoid psychosis is of organic origin. It occurs with pre-existing somatic disorders. As causal factors may include: brain injuries, progressive cerebral syphilis, vascular atherosclerosis.

The occurrence of this type of psychosis is influenced by external and internal factors.

It can be:

• reasons related to metabolic processes in organism;
• diseases caused by external influences or internal pathological processes;
• factors of neuroendocrine nature (damage to the nervous system and endocrine glands);
• hereditary predisposition;
• the circumstances under which the formation of personality took place.

Symptoms

With paranoid psychosis of any type, a typical clinical picture can be observed:

Suspiciousness, wariness	This is a hallmark of paranoid psychosis. All suspicions are illogical and devoid of common sense. The characters can be both close people and complete strangers. The patient randomly forms a group of “pursuers” or chooses one person (it is enough to get off the transport with him at the same stop), and in the future any conversations or actions will be considered as confirmation of his speculations.
Any information received is perceived as a threat	Moreover, this applies not only to those people with whom the patient is in conflicting relationships, but also to everyone else. The patient feels that they are looking at him too closely, and that a conspiracy is being hatched behind his back.
Suspicions of betrayal of friends and loved ones	If such a thought once arises in a patient’s head, it will never leave him.
A sharp and aggressive reaction to criticism	The slightest and completely logical attempts by another person to intervene cause a storm of negative emotions. Moreover, even a sincere desire to help is seen as an attempt to harm.
Excessive resentment, resentment	All grievances, including far-fetched ones, are a reason for constant reproaches. The patient will never admit that he is wrong, and in general will view the situation as another attempt to harm him.

In combination with schizophrenia, it manifests itself as mental automatisms and pseudohallucinosis.

Sooner or later, paranoid psychosis leads to self-isolation.

Diagnostics

The diagnosis is made after examining the patient and talking with him. In this case, an imbalance of personal positions and disharmony in behavior should be revealed, which affect several areas of the patient’s life.

The specialist can detect inadequate defensive reactions in the patient.

The final confirmation is the patient’s complete denial of his condition and the need for treatment, even after discussing the negative consequences.

Treatment

The peculiarity of the disease is that it becomes chronic, and without treatment a person will behave the same throughout his life.

The decision to hospitalize a patient with paranoid psychosis is considered individually. In cases of aggressive behavior, suicidal tendencies, a threat to the life and health of others, the likelihood of causing damage, etc. – placement in a hospital is mandatory. Hospitalization is recommended in cases where additional examinations are required.

Some patients can be convinced of the need for treatment. If this cannot be done, then compulsory hospitalization can be used after agreement with relatives.

Drug treatment is not always prescribed, but only in cases where the symptoms are excessive or in the presence of concomitant diseases.

For exacerbations of delusional states occurring against a background of motor agitation, tranquilizers are prescribed. Neuroleptics are used for maintenance therapy. The doctor may delay treatment if there is a possibility that the patient himself may agree to the need for it.

To the complex therapeutic measures Psychotherapy is definitely included. It is this that is the basis of treatment. At the same time, on initial stage The main task of the doctor is to create a friendly environment and a trusting atmosphere.

First of all, it is necessary to convince the patient of the advisability of taking the medications. Initially, it is not necessary to focus the patient's attention on treating the delusional state. Since paranoid psychosis is manifested by mood swings and anxiety, it is better to treat these manifestations at the first stage.

When someone is sick, it is better for relatives not to communicate with the doctor or discuss the course of the disease, as these actions will be regarded as collusion. However, loved ones can contribute to a speedy recovery by monitoring the intake of medications and creating a normal atmosphere in the patient’s environment.

Paranoid psychosis is not always treatable. The goal of therapy is not only to rid the patient of delusional ideas, but also to return the person to normal life, achieving adaptation in society.

Physiotherapy treatments can also be prescribed - massage, balneotherapy, which help restore the nervous system.

Complications

Psycho-emotional stress, accompanied by constant suspicion, can cause various social and personal consequences:

• relinquishing one's sense of responsibility; the patient blames others for the resulting disorder, not wanting to take any actions aimed at recovery;
• inability to tolerate stressful situations; usually manifested by a state of passion and severe depression;
• addictions develop (alcohol, drugs);
• categorical refusal of treatment.

Who is susceptible to paranoid psychosis?

• Most often, this diagnosis manifests itself at a young age; mainly men suffer from this disorder.
• The condition greatly affects a person's socialization, negatively affecting their quality of life.
• These people are scandalous, cannot stand criticism and refusal, and are arrogant.
• The patient does things that healthy person seem inadequate, his reactions are unpredictable.

In medical practice, several terms are used that combine disorders of mental stability, which are accompanied by delusions, delusions of persecution and harm, and hallucinations.

Paranoid (paranoid) syndrome is a symptom complex characterized by the manifestation of delusions, hallucinations, pseudohallucinations and syndrome. It is expressed in the idea of ​​persecution and infliction of physical or mental injury.

This term appeared thanks to the French psychiatrists Ernest Charles Lasegue (1852) and Jean-Pierre Falret (1854). The paranoid syndrome was described by them as the “persecutor-pursued” syndrome. In medical sources you can find the following names for this condition: hallucinatory-paranoid, paranoid, or hallucinatory-delusional syndrome.

In other words, paranoid syndrome is an unreasonable belief that in most cases is associated with persecution. Delusion can be of a different nature: it can be a clearly planned surveillance system from the first manifestations to the final goal (outcome), or it may not have such certainty. In both cases, there is an excessive focus on one’s own personality.

Paranoid syndrome (from other Greek: insanity + appearance) accompanies mental disorders and changes the patient’s behavior. Its symptoms characterize the depth of the disorder.

Due to the patient's isolation and mistrust, the diagnosis can be made based on indirect manifestations through careful observation of the patient.

Development of the disorder and the nature of the patient’s actions

The development of the syndrome may continue for several years. The person is closed, all his attention is directed to himself. The patient sees others as a threat and an unfriendly attitude towards himself. As a rule, others evaluate such an individual as a self-centered person with high self-esteem, closed and distant from reality.

The delusional state develops gradually with small ideas. Delirium can be systematized. In this case, the patient can prove what his fears are based on. When a delusional idea is not systematically manifested, the patient is lost and cannot explain the reason for suspicion, but also sees everyone as an enemy and persecutor. Delusions of persecution occur without.

The patient’s firm belief that enemies are watching him and using certain actions to control a person’s thoughts, desires and actions is called mental automatism.

Mental automatism is divided into three groups according to the nature of the apparent impact:

Patients try in every possible way to “protect themselves” from their enemies. They write numerous statements asking to be protected from persecution and sew protective clothing. Their actions become dangerous to others. For example, they can destroy electrical wiring in an apartment so that enemies cannot use their devices.

Where does the disorder begin?

Until now, medicine has found it difficult to name the exact cause or complex of provoking factors. The phenomenon can have a very different etiology. The syndrome is formed on the basis of genetic predisposition, congenital or acquired diseases of the nervous system, which are characterized by changes in the biochemical processes of the brain.

In cases of the use of narcotic or psychotropic drugs, or alcohol abuse, the cause of the paranoid syndrome is clearly defined. A short-term phenomenon of paranoia can be noted in people under the influence of prolonged strong.

Those at risk of developing this deviation are primarily patients with chronic mental illness (most often schizophrenics), sometimes patients with (, and others).

Medical statistics indicate that paranoid syndrome is most often observed in men.

And the first symptoms of deviations can appear at a young age (from 20 years).

In some cases, there is a rapid increase in characteristic symptoms.

Clinical picture

Due to the isolation and suspicion of patients, difficulties arise in diagnosing mental disorders. There are a number of indirect symptoms by which paranoid syndrome is diagnosed:

• constant suspicion towards colleagues and friends;
• conviction that everyone around you is conspiring against you;
• inappropriate attitude towards harmless remarks, search for a hidden threat in them;
• severe grievances;
• suspicion of loved ones of betrayal and infidelity.

Subsequently, auditory hallucinations, persecution mania, secondary systematized delusions develop (the patient clearly explains how and on what day the surveillance began, and how it manifests itself) and sensory impairment.

Paranoid syndrome progresses along delusional or hallucinogenic paths of development. The delusional nature of the disorder is more complex and requires long-term treatment. The reason is the patient’s reluctance to contact anyone. Hallucinogenic can occur as an acute mental disorder. It is classified as a mild form of deviation due to the patient’s communication skills. The prognosis for treatment is quite optimal.

Manifestations of mental disorder are expressed in various forms.

In addition to the patient’s feeling of constant surveillance with the aim of causing harm to health or even murder, this condition is characterized by hallucinations and pseudohallucinations. Most often, this condition occurs after a strong reaction, manifested in aggression and neurosis (hence the second name affective paranoid syndrome). There is a strong constant feeling of fear and a variety of delusional ideas.

This condition is characterized by consistent development. The stages of formation of paranoid syndrome of the hallucinatory type have a certain order:

• rapid change of emerging thoughts, the patient has a strong belief that outsiders can read his thoughts and influence them;
• the next stage is characterized by increased heart rate, which the patient feels, withdrawal symptoms, convulsions and hyperthermia;
• at the final stage of this form of pathology, the patient gains confidence in controlling his subconscious from the outside.

In each of these stages, hallucinations appear in the form of unclear images or blurry spots. The patient cannot describe what he saw, but he is convinced of an outside influence on his thinking.

Depressive disorder

Symptoms of depressive-paranoid syndrome are expressed as follows:

• there is a decrease in self-esteem, the joy of life disappears, there is no sexual desire;
• the patient develops suicidal tendencies;
• then an obsessive idea of ​​suicide appears;
• delirium is noted in all manifestations.

This condition often occurs against the background of complex mental trauma. Depressed state and depression lead to sleep disturbances, and then to its complete absence. There is inhibition in behavior. This condition develops within 3 months. The patient suddenly loses weight and develops problems with the cardiovascular system.

Manic spectrum

In this state, the patient experiences excessive agitation. He thinks quickly and voices his own thoughts. Often this condition occurs due to the use of alcohol and drugs.

Emotional outbursts of the subconscious lead to persecution of the opposite sex with the aim of committing violent acts. This picture can be observed due to severe stress.

Diagnostic criteria

Due to a decrease in the patient’s communication skills, the diagnosis may not be made immediately, but after long-term observation and a series of psychological tests.

Particular attention is paid to little things, the specificity of experiences is assessed - overestimation of personality and excessive detail distinguish paranoid syndrome from similar signs of disorders of other etiologies.

Treatment approach

Treatment of paranoid syndrome requires hospital conditions. Relatives of the patient should understand that early detection of pathology plays an important role in the prognosis of treatment. This condition does not go away on its own, but is characterized by an increase in symptoms.

The therapy program is selected individually in each case. The doctor prescribes antipsychotic drugs (, etc.), with the help of which the patient is brought into a stable state of mind. The timing depends on the degree of the disease and can range from one week to one month.

Therapy started at the first manifestation of dangerous symptoms has a good effect. The patient is quickly returned to a stable mental state. If treatment is delayed, the situation worsens and treatment takes longer.

Relatives of the patient need to know that it is impossible to achieve a complete recovery in such patients. But under certain conditions, loved ones can prevent further deterioration of the disease.