Paranoid syndrome symptoms. Brad is paranoid. Causes of a mental disorder

Hallucinatory-paranoid syndrome is used as a general name for a large group of ailments that have a different clinical course, but are similar in some points, namely, the predominance of obsessive delusions and signs of hallucinations.

After reviewing the information below, you will learn why the hallucinatory-paranoid syndrome develops, how it manifests itself, progresses and is treated.

Causes of the disease

Delusional syndrome can develop against the background of a long stage of such a disorder as paranoid delusions, accompanied by paranoia, delusional ideas, etc.

The list of possible, previous diseases includes personality disorders of the psychopathic type, accompanied by affective fluctuations and disorders of a neurosis-like nature. Also among the provoking factors is a decrease in the personal level against the background of organic causes, accompanied by changes in intelligence.

If appropriate measures have not been taken to combat the above deviations, the initial stage is delayed and progresses to the stage under consideration.

Features of the course of the disease

The studied deviation is included in the number of complex disorders and is able to take its own course, first of all, systematized delirium in the form of a sense of persecution and various variations of mental automatism.

Most often, in the initial stages of the syndrome, ideational failures occur. Initially, these manifest themselves in the form of mentism, which is characterized by an involuntary flow of thoughts, reinforced by a symptom of openness. The patient in this state believes that others know about all his thoughts, intentions and desires, as if everything that he begins to think about immediately becomes known to other people.

Among the disorders of ideational automatism is additionally the obsessive sounding of third-party thoughts. As the disease progresses, patients hear the rustle of various thoughts inside their heads. At first it is not very clear, but over time it turns into loud, obsessive and often repeated words.

The next stage is the syndrome of taking away personal thoughts. A person experiencing this stage of the disease feels that someone from outside takes his thoughts, as if pulling them out from inside the brain and leaving a huge void in his head.

Imposed memories and thoughts may arise. It may seem to the patient that someone is forcing him to remember various unpleasant events from the past, as if putting other people's intentions into his head.

Pseudohallucinations, as well as perceptual delusions, should also be included among the disorders of ideator automatism. The patient can feel them with hearing or vision. They are not always projected outside. A person is able to hear something inside his own head, observing it mentally.

The difference from real hallucinations in such a case is that the objects of pseudo-hallucinations can be combined with reality. Thus, fantastic visions are capable of appearing to the patient, in parallel with which he will normally perceive the existing situation in reality. Most often, pseudohallucinations in such patients are accompanied by a sense of violence and intentional madeness.

Features of the manifestation of pseudohallucinations

The patient may suffer from pseudo-hallucinations of hearing and vision. Among the visual pseudo-hallucinations, the mental communication of the patient with people is most often noted: the patient can seem to hear their thoughts and mentally respond to them.

Additionally, a form of sensory psychic automatism is singled out, the manifestations of which include the sensations made. The patient may feel as if he was deprived of the brain and tongue, internal organs, changed taste. There may be sensations of stretching and twisting of the limbs, etc.

The form of developing automatism, either motor or kinesthetic, manifests itself later. The patient feels the influence of someone else's will, feeling as if someone is moving his limbs, using his tongue to pronounce strange speeches, controlling the body, forcing him to do various actions against his own will, etc.

The state of mental automatism in all cases manifests itself together with the delirium of influence. It seems to the patient that he is being influenced by rays and apparatuses, as if someone is experimenting on him and conducting abnormal research. There is a feeling of continuous surveillance by outsiders who are members of the persecuting organization.

The patient may think that the counter-influence is not only on him, but also on people close to him. Delusions of the paranoid type in most cases do not go anywhere and begin to coexist with such disorders as delusions in the form of physical impact and the previously studied stage of mental automatism.

Variants of the considered syndrome

The studied deviation can manifest itself in several forms. So, if a lot of pseudo-hallucinations prevail, the state of delirium in the form of physical impact is most often relegated to the background. Under such circumstances, the violation is classified as a hallucinatory variant.

In other clinical cases, there is a much stronger severity of delusional components. Here, the dominant role is given to delirium in the format of physical impact. The stage of psychic automatism manifests itself relatively indistinctly. This form is classified as a delusional variant of the disease under study.

The subsequent progression of the disease is accompanied by the emergence of clear evidence of the presence of dementia. The patient degrades and in parallel begins to suffer from manic affect. There is a lack of systematization of delirium. Fantastic ideas of attraction arise.

Features of the course of the acute form

This option is characterized by acute sensual delirium. The psychic automatism itself is manifested in an insufficiently distinct degree. The syndromes are accompanied by obsessive openness and mentism or variations of hypnotic influence. There is a lack of systematization of delirium with high sensuality.

The patient perceives the situation in a delusional way, there is no objective interpretation. Tension, anxiety, fear, and marked confusion are present.

Perhaps a change in consciousness towards fantastic delirium. In especially severe cases, it may seem to patients that they are being taken into space, sent to parallel worlds, etc.

Among the characteristic features of acute forms, one should also include the fact that they quite often, quickly and easily replace each other, being, at the same time, reversible. Chronic ones are not reversible, and if one syndrome passes into another, the former one remains and its manifestations begin to act in conjunction with the signs of a new disorder.

Treatment of hallucinatory-paranoid syndromes

To treat the deviation in question, it is necessary to get rid of the diseases that led to the occurrence of violations.

These lead to:

• schizophrenia;
• persistent alcohol abuse;
• various kinds of encephalitis;
• epileptic disorders;
• brain damage of a syphilitic and rheumatic nature;
• symptomatic psychoses, etc.

At the same time, the mechanisms of the pathogenetic development of the disease are not fully understood. Specialists only note that the dynamics of disorders in the course of their development has stable patterns.

It is impossible to get rid of such a problem on your own.

Paranoid syndrome is a special kind of insanity that is characterized by a para-delusional state with sketchy, incoherent ideas. All of them may not even have a thematic connection with each other, which distinguishes this phenomenon from others from the same series (for example, from paranoid syndrome). Often, delusional ideas are associated with persecution, hallucinations, a state of mental automatism. The causes of the manifestation of paranoid syndrome are often a state of stress, anxiety, hallucinations, fears.

Paranoid syndrome - symptoms

The doctor who notes the paranoid symptoms is convinced in most cases that the disorder is already of considerable depth. The disease permeates not only the thinking, but also the behavior of the patient. Paranoid symptoms include:

• the predominance of figurative nonsense;
• auditory hallucinations;
• anxiety and depressed mood;
• systematization of delusional ideas - the patient can name the essence of the phenomenon that he is afraid of (for example, persecution), its date, goal, means, end result;
• delusions are perceived by the patients themselves as an insight;
• delirium of relationship: it seems to the patient that strangers on the street “hint” at something, exchange glances with each other;
• delusions can be combined with hallucinations of any type;
• delusions of persecution;
• sensory disorders.

A paranoid state often occurs with somatically conditioned mental illness and is often accompanied by pseudohallucinations. It is worth noting that there are two options for the course of the disease:

It is believed that it is easier to establish a diagnosis and choose a method of treatment for paranoid behavior of a hallucinatory type, since it is possible to find out the characteristics of the patient's condition.

Paranoid syndrome - treatment

If you notice any of the symptoms listed above in yourself or someone close to you, consult a psychiatrist without fail. In the early stages, mental illness is easier to treat, but in a neglected state, the disease becomes very dangerous. As a rule, the treatment is prescribed complex: psychotherapeutic methods are combined with medication.

Paranoia- this is an unreasonable or exaggerated distrust of others, sometimes bordering on delirium. Paranoids are those who constantly see evil intentions against themselves in the actions of other people, and believe that people need something from them.

The perception of the paranoid from the outside looks mental illness, may be a manifestation of depression and dementia, but is most often expressed in paranoid schizophrenia, delusional disorders and paranoid personality disorder.

Persons with paranoid schizophrenia and delusional disorders have an irrational but unshakable belief in a conspiracy against them. The persecution confidence is bizarre, sometimes grandiose, and often accompanied by auditory hallucinations. Delusions experienced by the patient delusional disorders, are more plausible, but also do not find a rational justification. People with delusional disorders may appear strange rather than mentally ill, so they never seek medical help.

People with paranoid personality disorder, as a rule, are self-centered, have a high self-importance, withdrawn and emotionally distant. Them paranoia manifests itself in constant suspicion of people. The disorder often hinders social and personal relationships and career advancement. Paranoid personality disorder is more common in men than in women and usually begins at age 20.

Symptoms

There are the following symptoms paranoid personality disorder:

• unfounded suspicions, confidence in a conspiracy against oneself;
• persistent and unreasonable doubts about friends or partners;
• low degree of trust due to fears that information can be used for harm;
• search for a sharp negative meaning in harmless remarks;
• severe resentment;
• perceives any attacks as attacks on reputation;
• unreasonably suspects infidelity of loved ones.

The reasons

Accurate cause of paranoia unknown. Potential factors include: genetics, neurological abnormalities, changes in brain chemistry, and stress. Paranoia can also be a side effect of drug use. For a short time, paranoia can occur in people overwhelmed with stress.

Diagnostics

Patients with paranoid symptoms should undergo a thorough physical examination to rule out possible organic causes (eg dementia) or environmental causes (eg stress). If a psychological cause is suspected, then a psychologist will conduct tests to assess mental status.

Treatment

paranoia, which is symptom of paranoid schizophrenia, delusional disorder, or paranoid personality disorder, should be treated by a psychologist or psychiatrist. At the same time, they are assigned antipsychotic drugs (thioridazine, haloperidol, chlorpromazine, clozapine, risperidone), cognitive therapy and psychotherapy are carried out to help the patient get rid of delusions.

If there is an underlying medical condition, such as depression or drug addiction, then psychosocial therapy is needed to treat the primary disorder.

Description:

Paranoid syndrome (hallucinatory-paranoid, hallucinatory-delusional syndrome) - a combination of interpretive or interpretive-figurative persecution (poisoning, physical or moral harm, destruction, material damage, surveillance), with sensory disorders in the form and (or) verbal.

Symptoms:

The systematization of delusional ideas of any content varies within very wide limits. If the patient talks about what the persecution is (damage, poisoning, etc.), knows the date of its beginning, the purpose used for the purpose of persecution (damage, poisoning, etc.) means, grounds and goals of the persecution, its consequences and end result, then we are talking about systematized delirium. In some cases, patients speak in sufficient detail about all this, and then it is not difficult to judge the degree of systematization of delirium. However, much more often paranoid syndrome is accompanied by one or another degree of inaccessibility. In these cases, the systematization of delirium can be judged only by indirect signs. So, if the persecutors are called "they", without specifying who exactly, and the symptom of the persecuted persecutor (if it exists) is manifested by migration or passive defense (additional locks on the doors, caution shown by the sick when preparing food, etc.) - delirium is rather systematized in general terms. If they talk about persecutors and name a specific organization, and even more so the names of certain individuals (delusional personification), if there is a symptom of an actively persecuted persecutor, most often in the form of complaints to public organizations, then, as a rule, we are talking about a fairly systematized delirium. Sensory disorders in paranoid syndrome may be limited to some true auditory verbal hallucinations, often reaching the intensity of hallucinosis. Typically, such a hallucinatory-delusional syndrome occurs primarily in somatically conditioned mental illness. The complication of verbal hallucinations in these cases occurs due to the addition of auditory pseudo-hallucinations and some other components of ideational mental automatism - "unwinding of memories", a sense of mastery, an influx of thoughts - mentism.
When in the structure of the sensory component of the paranoid syndrome, mental automatism dominates (see below), while true verbal hallucinations recede into the background, exist only at the beginning of the development of the syndrome, or are completely absent. Mental automatism can be limited to the development of only the ideator component, primarily "echo-thoughts", "made thoughts", auditory pseudo-hallucinations. In more severe cases, sensory and motor automatisms join. As a rule, with the complication of mental automatism, it is accompanied by the appearance of delirium of mental and physical influence. Patients talk about outside influences on their thoughts, physical functions, about the effect of hypnosis, special apparatus, rays, atomic energy, and so on.
Depending on the predominance of delusions or sensory disorders in the structure of the hallucinatory-delusional syndrome, delusional and hallucinatory variants are distinguished. In the delusional variant, delirium is usually systematized to a greater extent than in the hallucinatory one; mental automatisms predominate among sensory disorders, and patients, as a rule, are either inaccessible or not available at all. In the hallucinatory variant, true verbal hallucinations predominate. Mental automatism often remains undeveloped, and in patients it is always possible to find out certain features of the state, complete inaccessibility is rather an exception here. In terms of prognosis, the delusional variant is usually worse than the hallucinatory one.
Paranoid syndrome, especially in the delusional version, is often a chronic condition. In this case, its appearance is often preceded by a gradually developing systematized interpretive delusion (paranoid syndrome), to which sensory disorders join after significant periods of time, often years later. The transition of a paranoid state into a paranoid one is usually accompanied by an exacerbation of the disease: confusion, motor excitement with anxiety and fear (anxious-fearful excitement), various manifestations of figurative delirium appear.
Such disorders continue for days or weeks, and then a hallucinatory-delusional state is established.
The modification of the chronic paranoid syndrome occurs either due to the appearance of paraphrenic disorders, or due to the development of the so-called secondary, or sequential,.
In acute paranoid syndrome, figurative delusions predominate over interpretative ones. The systematization of crazy ideas is either absent, or exists only in the most general form. There is always confusion and pronounced affective disorders, predominantly but in the form of tension or fear.
Behavior is changing. Often there is motor excitation, impulsive actions. Mental automatisms are usually limited to the ideator component; true verbal hallucinations can reach the intensity of hallucinosis. With the reverse development of acute paranoid syndrome, a distinct depressive or subdepressive background of mood often persists for a long time, sometimes in combination with residual delirium.
Questioning patients with paranoid syndrome, as well as patients with other delusional syndromes (paranoid, paraphrenic) (see below), often presents great difficulties due to their inaccessibility. Such patients are suspicious, speak sparingly, as if weighing the words indefinitely. To suspect the existence of inaccessibility by allowing statements typical for such patients ("why talk about it, everything is written there, you know and I know, you are a physiognomist, let's talk about something else," etc.). With complete inaccessibility, the patient does not speak not only about his painful disorders, but also about the events of his everyday life. With incomplete accessibility, the patient often reports detailed information about himself regarding everyday issues, but immediately falls silent, and in some cases becomes tense and suspicious when questions are direct or indirect concerning his mental state. This dissociation between what the patient reported about himself in general and how he responded to the question about his mental state always suggests low availability as a constant or very frequent sign of a delusional state.
In many cases, in order to obtain the necessary information from a "delusional" patient, he should be "talked" on topics that are not directly related to delusional experiences. A rare patient during such a conversation does not accidentally drop any phrase related to delirium. Such a phrase often has, it would seem, the most mundane content ("what can I say, I live well, but I'm not entirely lucky with my neighbors ..."). If the doctor, having heard such a phrase, is able to ask clarifying questions of everyday content, it is very likely that he will receive information that is clinical facts. But even if, as a result of questioning, the doctor does not receive specific information about the subjective state of the patient, he can almost always conclude by indirect signs that there is inaccessibility or low accessibility, i.e. about the presence of delusional disorders in the patient.

Causes of occurrence:

Paranoid syndrome is most often found in endogenous procedural diseases. Many are manifested by the paranoid syndrome: alcoholism (alcoholic paranoid), presenile psychoses (involutional paranoid), exogenous (intoxication, traumatic paranoid) and psychogenic disorders (reactive paranoid),    (epileptic paranoid), etc.

Treatment:

For treatment appoint:

Apply complex therapy, based on the disease that caused the syndrome. Although, for example, in France, there is a syndromological type of treatment.
1. Light form: chlorpromazine, propazine, levomepromazine 0.025-0.2; etaperazine 0.004-0.1; sonapax (meleril) 0.01-0.06; meleryl-retard 0.2;
2. Medium form: chlorpromazine, levomepromazine 0.05-0.3 intramuscularly 2-3 ml 2 times a day; chlorprothixene 0.05-0.4; haloperidol up to 0.03; triftazin (stelazin) up to 0.03 intramuscularly 1-2 ml 0.2% 2 times a day; trifluperidol 0.0005-0.002;
3. Aminazine (tizercin) intramuscularly 2-3 ml 2-3 per day or intravenously up to 0.1 haloperidol or trifluperidol 0.03 intramuscularly or intravenously drip 1-2 ml; leponex up to 0.3-0.5; motidel-depot 0.0125-0.025.

paranoid syndrome- This is one of the varieties of delusional syndromes.

In some literary sources on the concept of " hallucinatory-paranoid», « paranoid» syndromes and syndrome mental automatism (Kandinsky-Clerambault) are treated as synonyms. Indeed, the psychopathological structure of these disorders is identical. Differences in the significance (severity) of individual signs in the structure of the syndrome are presented in the table of differential diagnosis of delusional syndromes.

Of primary importance in paranoid disorders, therefore, are the delusions of persecution and (or) influence ("and - or" is indicated in the table above, since "impact" is always associated with persecution: there can be no "impact" if there is no "persecution "- even in cases where the "persecution" and "impact" are carried out with "good" goals, which is much less common, but also occurs in clinical practice). The phrase "other mental automatisms" is given in the table, since pseudohallucinations are (unlike "true" hallucinations) one of the variants of mental automatisms and are considered by many authors as manifestations of the pathology of self-consciousness, and not perception.

The “key” symptom of the hallucinatory-paranoid (hallucinatory-delusional) syndrome, as follows from the table of differential diagnosis, are pseudohallucinations, the criteria for distinguishing which from the so-called “true” hallucinations are given in the table of differential diagnosis of “true” and “false” hallucinations.

Syndrome of mental automatism (Kandinsky-Clerambault)

Mental automatisms- experiencing (reaching the degree of conviction) the alienation of one's own mental acts (thoughts, memories, sensations, etc.). There are the following variants of the syndrome of mental automatism:

1. ideatory (associative),
2. senestopathic,
3. kinesthetic (motor).

Ideatory (associative)

With ideational psychic automatism, patients experience "alienness" ("made", "violence") of their thoughts (memories, "experiences").

“The shade of “madeness”, alienation to the will of the patient ... have, - A. E. Arkhangelsky (1994), - memories of the past and even dreams.

These phenomena are interconnected with the “symptom of openness” often noted in schizophrenia (the conviction that the thoughts and desires of patients are known to others), the symptom of “unwinding of memories”, the phenomenon of “echo of thought” (“sounding” repetition of thoughts), a feeling of “made” dreams. That is, with ideational mental automatism, there is a feeling of artificiality, "imposition" of one's own mental activity: in general, "associative automatism includes, - A. V. Snezhnevsky (1983), - all types of pseudo-hallucinations and alienation of emotions."

Senestopathic

With senestopathic mental automatism, there is a feeling of "violence", "nesting" of sensations from the internal organs: patients report that they "control their heartbeat", "control their breathing", etc.

kinesthetic

With kinesthetic mental automatism, they say that they “do not walk with their own gait”, “involuntarily gesticulate”, “smile in spite of desire” (that is, the patient has a feeling of extraneous “control” of his motor acts). Among the varieties of kinesthetic mental automatism are Segla's "speech-motor" hallucinations, which are part of the structure of the Kandinsky-Clerambault syndrome and are manifested by "alienation" of the articulation of his speech from the will of the patient.

The phenomenon of transitivism

Closely related to ideational psychic automatisms are the phenomena of the phenomenon of transitivism: the conviction of patients that “their” experiences (“voices”, “visions”, etc.) are also experienced by the people around them. Such confidence is sometimes the cause of unexpected and dangerous (for others and himself) behavior of the patient (in an effort to "save" someone from an allegedly threatening danger, the patient harms "third" persons). Jokingly, similar sensations that sometimes occur in healthy people are reflected in a popular modern song: "I looked back to see if she looked back to see if I looked back."

To illustrate the above brief information about the paranoid syndrome, the following clinical observation can be given.

Paranoid syndrome: clinical picture and examples

Patient D., 32 years old, foreman at the plant, not married.

Complaints

Complains of headaches, "sharp anxiety", insomnia that develops when he "takes off his helmet".

Anamnesis

Early development without features. Successfully completed school, university, positively characterized at work.

Clinical picture

About a year ago, he began to notice that a neighbor (an elderly woman from a neighboring apartment, with whom the patient is practically unfamiliar) “somehow is not right”, “with some kind of threat” looks at him. Soon, the patient developed “incomprehensible” headaches, which bothered him only at home, but disappeared outside the apartment (at work, etc.). “Determined” that the intensity of the headache depends on how long (and how often) he met with a neighbor. He tried to avoid meeting her, but the pain persisted. “Realizing” that it “influences” him (“through the wall”, “by some kind of rays”), he made a “helmet from the rays” at work (at the request of the doctor, the relatives brought the “helmet” to the clinic: it is an excellent metal product , resembling a knight's helmet, with narrow slits for the eyes and a "visor" for the mouth). For several months he was at home only in a helmet (both day and night) and felt much better. Then, however, "pains" began to disturb the patient at work. Having decided that the neighbor “has somehow learned to influence at a distance”, he tried to “protect himself” from them (“pains”) with a helmet, but was sent for a psychiatric consultation.

In the clinic, the patient's condition quickly improved, the "pain" did not bother him, he reported that "of course, everything just seemed", "the neighbor is an ordinary pensioner, how can she influence it?" etc. In the final conversation before discharge, he thanked the doctors for their help, reported that "everything passed, and it could not be." However, after the doctor's request to leave the “helmet” for the museum of the department, “he changed his face”, became tense, laconic. The "helmet" was returned to the patient.

This clinical example of a paranoid syndrome is given to illustrate, along with the presence of typical paranoid symptoms, the possibility of the formation of the so-called "residual" delusions: the lack of criticism of the seemingly reduced manifestations of the disease.