Constant stay around delirious for patients diagnosed with paranoid syndrome is natural. 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 danger.

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

The most well-known human disorder is schizophrenia - a paranoid syndrome in which thinking is partially or completely impaired and does 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 occur under the influence of psychotropic and narcotic substances and alcohol on the body.

Classification and symptoms of the disorder

Doctors agree that they are paranoid and 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 every clinical case the 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;
• the views, gestures and speech of strangers are associated 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, the statement 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. It is accompanied by frequent occurrence of hallucinations and pseudohallucinations.

In most clinical cases, the syndrome is preceded by the strongest in the form of aggression and neurosis. The patients are in constant feeling 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 in initial stage If these feelings cannot be overcome, then sleep disturbances subsequently develop, up to complete absence, A 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 conditions caused by the 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 examination. This is the method 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 treatment light form means shown:

• "Propazine."
• "Etaperazine."
• "Levomepromazine."
• "Aminazine."
• "Sonapax".

Syndrome medium degree treated with the following drugs:

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

IN difficult situations doctors prescribe:

• "Tizercin."
• "Haloperidol."
• "Moditen Depot".
• "Leponex".

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 the 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.

Paranoid syndrome is not an independent disease. Its occurrence is considered a manifestation of mental disorder or intoxication with psychotropic substances.

The most effective treatment for this disorder is when you see a doctor early, when the disease is just beginning to manifest itself. Treatment of the acute phase should take place in a hospital setting under the systematic supervision of specialists.

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What is paranoid syndrome?

Paranoid (paranoid) syndrome is a symptom complex characterized by the presence of delusions, hallucinatory syndrome, pseudohallucinations, mental automatisms, obsessions of persecution, and physical and mental trauma in the patient.

Delirium in this disorder is of a varied nature. According to the patient, sometimes it is a clearly planned surveillance scheme, or it may not have any consistency at all. In both cases, the patient demonstrates excessive concentration on his own personality.

Paranoid syndrome is part of the clinical picture of many mental illnesses and completely changes the patient’s behavior and lifestyle.

The severity of the symptoms of the paranoid symptom complex characterizes the severity and depth of the disorder.

Such specific manifestations of this disorder as distrust reaching the point of absurdity, increased suspicion of the patient, and secrecy significantly complicate diagnosis. In some cases, the diagnosis is made based on indirect signs and the results of careful observation of the patient.

Reasons for the development of pathology

Experts find it difficult to definitively answer the question about the causes of this disorder. Diseases that include this syndrome have different etiologies: they are formed on the basis of genetic predisposition, pathologies nervous system congenital in nature, or diseases acquired during life, disorders in the metabolism of neurotransmitters.

A common feature of such diseases is the presence of changes in biochemical processes in the tissues of the central nervous system.

In cases of abuse of alcohol, narcotic or psychotropic drugs, the causes of the paranoid syndrome are obvious.

In people under the influence of prolonged, strong, pronounced Negative influence on the psyche and stress, the phenomenon of paranoia is often recorded. In healthy people, in case of isolation from stressful situation Symptoms may gradually disappear on their own.

At risk of developing paranoid syndrome are:

1. 1. Patients suffering from mental illness in chronic form(most often this is schizophrenia).
2. 2. Patients with organic brain damage (encephalitis, neurosyphilis and others).
3. 3. Persons who have the habit of abusing large doses of alcohol or taking narcotic or psychotropic substances.

From the analysis of statistical data it is known that paranoid syndrome is most often registered in men.

Symptoms first appear at a young age (20 to 30 years).



Manifestations

Paranoid syndrome is characterized by the following symptoms:

• constant increased suspicion towards friends, colleagues, acquaintances, relatives;
• absolute conviction that everyone around him is conspiring against himself;
• inadequate, overly acute reaction to harmless remarks, searching for a hidden threat in them;
• excessive grievances;
• suspicions of loved ones of betrayal, infidelity, formation of delusions of jealousy.

Diagnosis is complicated by a number of specific features disorders: secrecy, suspicion, isolation of patients.

Subsequently, as the disease progresses, auditory hallucinations develop, signs of persecution mania, secondary systematized delusions are recorded (the patient is able to clearly explain how, by what means and on what day the surveillance of him began, who is doing it, by what signs he established this fact). Sensory impairments also occur.

The progression of paranoid syndrome occurs along a hallucinogenic or delusional path of development.



Delusional-paranoid syndrome

The delusional type of disorder is the most difficult to manage, is difficult to treat and requires long-term therapy. The reasons for such features lie in the patient’s reluctance to come into contact with anyone, much less be treated.

Hallucinatory-paranoid syndrome

This type of disorder is characterized by hallucinatory syndrome and pseudohallucinations.

Most often, hallucinatory-paranoid syndrome develops after a strong affective shock. The patient has severe constant feeling fear. Delusional ideas are varied.

Disorder when this type paranoid syndrome has the following order:

1. 1. The patient has no doubt that strangers read his thoughts and can influence them.
2. 2. The second stage is characterized by an increase in the patient’s heart rate, the occurrence of convulsions, the development of hyperthermic syndrome, a condition similar to withdrawal symptoms.
3. 3. The final stage is characterized by the formation of confidence in the patient in controlling his physical condition and subconscious from the outside.

Each stage of development is accompanied by hallucinations in the form of clear images or blurry spots. The patient finds it difficult to describe what he saw, but is convinced that the visions were generated by extraneous influence on his thinking.

The hallucinatory variant of paranoid syndrome can occur in the form of an acute or chronic disorder. It is considered a relatively mild form of it. The prognosis for the treatment of the hallucinatory variant of this pathology is relatively favorable. The patient is sociable, makes contact, and follows the doctor’s instructions.

Paranoid syndrome with depression

The cause of this disorder is complex mental trauma. A depressed state that exists over a long period of time causes sleep disturbances, up to its complete absence.

The patient's behavior is characterized by lethargy. The development of the disorder takes about 3 months. The patient begins to experience problems with of cardio-vascular system, loses body weight. Characteristic symptoms:

1. 1. Gradual or a sharp decline self-esteem, loss of ability to enjoy life, lack of sexual desire.
2. 2. The appearance of suicidal thoughts.
3. 3. Transformation of inclinations into an obsession with suicide.
4. 4. Formation of delirium.

Manic variant

The patient's condition is characterized by excessive agitation - psychoemotional and often motor. The pace of thinking is high, the patient voices his own thoughts.

Often the occurrence of this deviation is a complication of alcohol or drug use or severe stress.

Treatment of paranoid syndrome should be carried out in a hospital in a psychiatry department. The patient’s social circle and relatives should understand that the success of therapy and the prognosis of the disease depend on the timely detection of pathology. This disorder does not progress on its own. Diseases in the structure of which paranoid syndrome is detected are characterized by a progressive course with an increase in symptoms.

The therapeutic regimen is selected individually for each patient.

The prescriptions contain antipsychotic drugs (Aminazine, Sonapax and others) necessary to introduce the patient into a stable state of consciousness. The timing of use of these medications depends on the severity of the disease and the dynamics of symptoms; they are usually used for a period of one week to a month. Therapy started at early stages illness, at the first manifestations of symptoms.

Introduction

The term "paranoid" can refer to symptoms, syndromes, or personality types. Paranoid symptoms are delusional beliefs most often (but not always) associated with persecution. Paranoid syndromes are those in which paranoid symptoms form part of a characteristic constellation of symptoms; an example would be pathological jealousy or erotomania (described below). The paranoid (flax) personality type is characterized by such traits as excessive concentration on one’s own person, increased, painful sensitivity to real or imagined humiliation and neglect of oneself by others, often combined with an exaggerated sense of self-importance, belligerence and aggressiveness. The term "paranoid" is descriptive, not diagnostic. If we qualify this symptom or the syndrome as paranoid, then this is not yet a diagnosis, but only a preliminary stage on the way to it. In this regard, we can draw an analogy with the situation when the presence of stupor or.

Paranoid syndromes present significant difficulties in classification and diagnosis. The reason for this can be explained by dividing them into two groups. The first group includes cases where paranoid traits manifest themselves in connection with a primary mental illness, such as schizophrenia, affective disorder or organic mental disorder. In the second group, in the presence of paranoid traits, no other - primary - mental disorder, however, is detected; thus, paranoid traits appear to have arisen independently. In this book, in accordance with the DSM-IIIR and ICD-10 classifications, the term "" is applied to the second group. It is with the second group that significant difficulties and confusion are associated with classification and diagnosis. For example, there has been much debate about whether this condition is a special form or stage in the development of schizophrenia - or whether it should be recognized as a completely independent nosological entity. Since such problems often arise in clinical practice, an entire chapter is devoted to them.

This chapter begins by identifying the most common paranoid symptoms; The following is an overview of their reasons. This is followed by brief information about the corresponding personality disorder. This is followed by a discussion of primary mental disorders, such as organic mental states, affective disorders, and mood disorders, in which paranoid manifestations are common. These diseases are discussed in detail in other chapters of the book, while here the focus is on differentiating them from those discussed below. At the same time, a special place is given to paraphrenia; these terms are discussed in historical context. It then describes a number of characteristic paranoid symptoms and syndromes, some of which are quite common and some that are extremely rare. In conclusion, the basic principles of assessing the condition and treating patients with paranoid manifestations are outlined. .

Paranoid symptoms

As noted in the introduction, the most common paranoid delusion is perceiving Kutorny (). The term “paranoid” also refers to less common types of delusions - grandiosity, jealousy; sometimes to delusions associated with love, litigation or religion. It may seem counterintuitive that such different types delusions should be grouped into one category. The reason, however, is that central disorder, defined by the term “paranoid,” is a painful distortion of ideas and attitudes regarding the interaction and relationship of the individual with other people. If someone has a false or unfounded belief that he is being persecuted, or deceived, or exalted, or that he is loved by a famous person, then this in each case means that the person interprets the relationship between himself and other people in a painfully distorted way. Many paranoid symptoms are discussed in Chap. 1, but the main ones will be briefly described here for the convenience of readers. The following definitions are taken from the PSE glossary (see Wing et al. 1974).

Relationship ideas occur in overly shy people. The subject is unable to get rid of the feeling that he is being paid attention to in public transport, in restaurants or in other public places, and those around him notice a lot of things that he would prefer to hide. A person realizes that these sensations are born within himself and that in reality he is no more conspicuous than other people. But he cannot help but experience the same sensations, completely disproportionate to any possible circumstances.

Delusional relationship represents a further development of simple ideas of relation; the falsity of the ideas is not realized. The subject may feel that the whole neighborhood is gossiping about him, far beyond what is possible, or he may find mention of himself in television programs or on the pages of newspapers. He hears someone talking on the radio about something related to the question he was just thinking about, or he imagines that he is being followed, his movements are being watched, and what he says is being recorded on a tape recorder.

. The subject believes that some person or organization or some force or power is trying to harm him in some way - to ruin his reputation, cause bodily harm, drive him to madness, or even lead him to the grave.

This symptom takes various forms - from the subject’s simple belief that people are persecuting him, to complex and bizarre plots in which any kind of fantastic constructions can be used.

Description:

Paranoid syndrome (hallucinatory-paranoid, hallucinatory-delusional syndrome) is a combination of interpretative 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, the means used for the purpose of persecution (damage, poisoning, etc.), the grounds and goals of the persecution, its consequences and final result, then we are talking about systematized delirium. In some cases, patients talk about all this in sufficient detail, and then it is not difficult to judge the degree of systematization of delirium. However, much more often paranoid syndrome is accompanied by some degree of inaccessibility. In these cases, the systematization of delirium can be judged only by indirect signs. So, if the pursuers are called “they”, without specifying who exactly, and the symptom of the pursued-persecutor (if it exists) is manifested by migration or passive defense (additional locks on the doors, caution shown by the patient when preparing food, etc.) - nonsense 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, we are, as a rule, talking about a fairly systematized delusion. Sensory disorders in paranoid syndrome may be limited to true auditory verbal hallucinations, often reaching the intensity of hallucinosis. Typically, such a hallucinatory-delusional syndrome occurs primarily with somatically caused mental illness. The complication of verbal hallucinations in these cases occurs due to the addition of auditory pseudohallucinations and some other components of ideational mental automatism - “unwinding of memories”, a feeling of mastery, an influx of thoughts - mentism.
When the structure of the sensory component of paranoid syndrome is dominated by mental automatism (see below), while true verbal hallucinations recede into the background, existing 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 ideational component, primarily “echo-thoughts”, “made thoughts”, auditory pseudo-hallucinations. In more severe cases, sensory and motor automatisms are added. As a rule, when mental automatism becomes more complicated, it is accompanied by the appearance of delusions of mental and physical influence. Patients talk about external influences on their thoughts, physical functions, the effects of hypnosis, special devices, rays, atomic energy, etc.
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 version, the delirium is usually systematized to a greater extent than in the hallucinatory version; among sensory disorders, mental automatisms predominate and patients, as a rule, are either inaccessible or completely inaccessible. 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 condition; complete inaccessibility is rather an exception here. In prognostic terms, the delusional variant is usually worse than the hallucinatory variant.
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 interpretative delusion (paranoid syndrome), to which sensory disorders are added after significant periods of time, often years later. The transition from a paranoid state to a paranoid state is usually accompanied by an exacerbation of the disease: confusion appears, motor agitation with anxiety and fear (anxious-fearful agitation), various manifestations figurative nonsense.
Such disorders last for days or weeks, and then a hallucinatory-delusional state is established.
Modification of chronic paranoid syndrome occurs either due to the appearance of paraphrenic disorders, or due to the development of the so-called secondary, or sequential, syndrome.
In acute paranoid syndrome, figurative delusions predominate over intelligible delusions. Systematization of delusional ideas is either absent, or exists only in the very general view. Confusion and pronounced affective disorders are always observed, mainly in the form of tension or fear.
Behavior changes. Motor agitation and impulsive actions often occur. Mental automatisms are usually limited to the ideational component; true verbal hallucinations can reach the intensity of hallucinosis. With the reverse development of acute paranoid syndrome, a distinct depressive or subdepressive mood background often persists for a long time, sometimes in combination with residual delusions.
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 and speak sparingly, as if weighing their words vaguely. 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're a physiognomist, let's talk about something else," etc.). With complete inaccessibility, the patient does not talk not only about the painful disorders he has, but also about the events of his everyday life. If accessibility is incomplete, the patient often provides detailed information about himself regarding everyday issues, but immediately becomes silent, and in some cases becomes tense and suspicious when asked questions - direct or indirect - concerning his mental state. Such a dissociation between what the patient reported about himself in general and how he reacted to the question about his mental state, always allows one to assume low availability; 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 have no direct relationship to delusional experiences. It is rare that a patient during such a conversation will not accidentally drop some phrase related to delirium. Such a phrase often has seemingly the most ordinary content (“what can I say, I live well, but I’m not entirely lucky with my neighbors...”). If a 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 from indirect evidence that there is inaccessibility or low accessibility, i.e. about the presence of delusional disorders in the patient.

Causes:

Paranoid syndrome most often occurs in endogenous-processual diseases. Paranoid syndrome manifests itself in many ways: alcoholism (alcoholic paranoid), presenile psychoses (involutional paranoid), exogenous (intoxication, traumatic paranoid) and psychogenic disorders (reactive paranoid), (epileptic paranoid), etc.

Treatment:

For treatment the following is prescribed:

Apply complex therapy, based on the disease that caused the syndrome. Although, for example, in France, there is a syndromic type of treatment.
1. Mild form: aminazine, propazine, levomepromazine 0.025-0.2; etaperazine 0.004-0.1; sonapax (meleril) 0.01-0.06; Meleril-retard 0.2;
2. Medium form: aminazine, levomepromazine 0.05-0.3 intramuscularly 2-3 ml 2 times a day; chlorprothixene 0.05-0.4; haloperidol up to 0.03; triftazine (stelazine) 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.

Delusional syndromes are mental disorders characterized by the emergence of inferences that do not correspond to reality - delusional ideas, of the fallacy of which patients cannot be convinced.

These disorders tend to progress as the disease progresses. Delusion is one of the most characteristic and common signs of mental illness. The content of delusions can be very different: delusions of persecution, delusions of poisoning, delusions of physical impact, delusions of damage, delusions of accusation, delusions of jealousy, hypochondriacal delusions, delusions of self-abasement, delusions of grandeur. Very often, types of delusions of different content are combined.

Delirium never happens the only symptom mental illness; as a rule, it is combined with depression or a manic state, often with hallucinations and pseudohallucinations (see Affective syndromes, Hallucinatory syndromes), confusion (delirious, twilight state). In this regard, delusional syndromes are usually distinguished, differing not only special forms nonsense, but also a characteristic combination various symptoms mental disorders.

Paranoid syndrome characterized by systematized delusions of various contents (invention, persecution, jealousy, love, litigious, hypochondriacal). The syndrome is characterized by a slow development with a gradual expansion of the circle of persons and events involved in delirium, and a complex system of evidence.

If you do not touch the “sore point” of thinking, no significant violations are found in the behavior of patients. With regard to the subject of a delusional idea, patients are completely uncritical and cannot be persuaded, easily enrolling those who are trying to dissuade them into the camp of “enemies, persecutors.” The thinking and speech of patients is very detailed, their stories about “persecution” can last for hours, it is difficult to distract them. The mood is often somewhat upbeat, patients are optimistic - they are confident in their rightness, the victory of the “just cause”, however, under the influence of an unfavorable, from their point of view, external situation, they can become angry, tense, commit social dangerous actions. In paranoid delusional syndrome, there are no hallucinations or pseudohallucinations. It is necessary to distinguish paranoid delusional syndrome from an “overvalued idea,” when a real life problem acquires an excessively large (overvalued) meaning in the mind of a mentally healthy person. Paranoid delusional syndrome most often occurs in schizophrenia (see), less often in others mental illness(organic brain damage, chronic alcoholism and etc.).

Paranoid syndrome is characterized by systematic delusions of persecution, physical impact with hallucinations and pseudohallucinations and phenomena of mental automatism. Typically, patients believe that they are being persecuted by some kind of organization, whose members are watching their actions, thoughts, and actions, because they want to disgrace them in the eyes of people or destroy them. “Persecutors” operate with special devices emitting electromagnetic waves or atomic energy, using hypnosis, controlling thoughts, actions, moods, and activities internal organs(phenomena of mental automatism). Patients say that thoughts are taken away from them, that they put in other people’s thoughts, that they “make” memories, dreams (ideational automatism), that they specifically cause unpleasant painful sensations, pain, increase or slow down the heartbeat, urination (senestopathic automatism), force you to various movements, speak their language (motor automatism). In paranoid delusional syndrome, the behavior and thinking of patients is impaired. They stop working, write numerous statements demanding protection from persecution, and often take measures themselves to protect themselves from rays and hypnosis (special methods of isolating a room or clothing). Fighting against “persecutors,” they can commit socially dangerous actions. Paranoid delusional syndrome usually occurs with schizophrenia, less often with organic diseases of the central nervous system (encephalitis, cerebral syphilis, etc.).

Paraphrenic syndrome is characterized by delusions of persecution, influence, and phenomena of mental automatism, combined with fantastic delusions of grandeur. Patients say that they are great people, gods, leaders, the course of world history and the fate of the country in which they live depend on them. They talk about meetings with many great people (delusional confabulations), about incredible events in which they were participants; at the same time, there are also ideas of persecution. Criticism and awareness of the disease are completely absent in such patients. Paraphrenic delusional syndrome is observed most often in schizophrenia, less often in psychoses of late age (vascular, atrophic).

Acute paranoid. With this type of delusional syndrome, acute, concrete, figurative, sensory delusions of persecution with an affect of fear, anxiety, and confusion predominate. There is no systematization of delusional ideas; there are affective illusions (see), individual hallucinations. The development of the syndrome is preceded by a period of unaccountable anxiety, anxious anticipation of some kind of misfortune with a feeling of unclear danger (delusional mood). Later, the patient begins to feel that they want to rob him, kill him, or destroy his relatives. Delusional ideas are changeable and depend on the external situation. Every gesture and action of others causes a delusional idea (“there is a conspiracy, they are giving signs, preparing for an attack”). The actions of patients are determined by fear and anxiety. They can suddenly run out of the room, leave the train, bus, and seek protection from the police, but after a short period of calm, a delusional assessment of the situation in the police begins again, and its employees are mistaken for “members of the gang.” Usually, sleep is severely disturbed and there is no appetite. Characterized by a sharp exacerbation of delirium in the evening and at night. Therefore, during these periods, patients need enhanced supervision. Acute paranoid can occur with a variety of mental illnesses (schizophrenia, alcoholic, reactive, intoxication, vascular and other psychoses).

Residual delirium - delusional disorders, remaining after the passage of psychoses that occurred with clouding of consciousness. It can last for varying periods of time - from several days to several weeks.

Patients with delusional syndromes must be referred to a psychiatrist in psychiatric clinic, patients with acute paranoid - to the hospital. The referral must contain fairly complete objective information (from the words of relatives and colleagues) about the characteristics of the patient’s behavior and statements.

Paranoid delusions

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, sperm, etc. is felt. Often the patient finds it difficult to say what he smells, or gives in to the smell unusual designations(“blue-green smells”).

In addition to obvious hallucinations, teenagers 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 has not noticed any obvious ridicule, and simply any smile on the faces of others is perceived as a hint of some kind of his own shortcoming. Among different types delirium is especially characterized by delirium of influence.

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 young and middle-aged adolescents, visual pseudohallucinations also occur: various images are seen inside the head. geometric figures, mesh, etc. 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 teenager’s behavior 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 different forms delirium in Kandinsky-Clerambault syndrome is most closely associated with delirium of influence and delirium of metamorphosis.

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 early childhood ended up with them (“confused in maternity hospital"), that they feel this and therefore treat him badly, they want to get rid of him, they imprisoned him in a psychiatric hospital. 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 the correct physical development and so on.).

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 [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 are beginning to occupy an increasing place in 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

Paranoid syndrome can develop both reactively and chronically, but most often it is dominated by poorly systematized (sensory delusions).

The paranoid syndrome should not be confused with the paranoid one - although the content of delusional ideas may be similar, these conditions differ both in their “scope” and speed of development, as well as in the characteristics of their course and further prognosis. In paranoid syndrome, delusions most often develop gradually, starting with small ideas and growing into a strong, systematized delusional system that the patient can clearly explain. With sensory delusions, which usually develop as part of the paranoid syndrome, systematization is quite low. This is due to the fact that delirium is either fantastic in nature, or due to the rapid increase in painful symptoms, it is still little realized by the patient, in whose picture of the world it suddenly appears.

Paranoid syndrome can develop as part of schizophrenia, psychotic disorders with organic lesions brain, and within bipolar disorder affective disorder(formerly manic-depressive psychoses). But still more often with the first and last.

Forms of paranoid syndrome

Depending on which specific symptoms appear most clearly in the clinical picture, within the framework of the paranoid syndrome the following are distinguished:

• affective-delusional syndrome, where there is sensory delirium and a change in affect, can be in two variants: manic-delusional and depressive-delusional (depressive-paranoid syndrome), depending on the leading affect. It is worth noting that the content of delusional ideas will correspond here to the “pole” of affect: with depression, the patient can express ideas of self-blame, condemnation, persecution; and with mania - ideas of greatness, noble origin, invention, etc.
• hallucinatory-delusional (hallucinatory-paranoid syndrome), where hallucinations come to the fore, which does not exclude the presence of affective-delusional disorders, but they are not in the foreground here.
• hallucinatory-delusional syndrome with the presence of mental automatisms - in this case we can talk about Kandinsky-Clerambault syndrome,
• paranoid syndrome itself without other pronounced and prominent other disorders. Only unsystematized, sensual delirium prevails here.

Treatment of paranoid syndrome

Treatment of paranoid syndrome requires urgent intervention from specialists, since, as practice shows, neither delusions nor hallucinations, especially against the background of endogenous (caused internal reasons) diseases that do not go away “on their own”, their symptoms only tend to increase, and treatment has the greatest effect when it begins as early as possible. Indeed, it happens that in some cases people live in a delusional state for years. But loved ones need to understand that the prognosis of the disease, and the person’s life history in the future, depend on the quality of the care provided and its timeliness.

Treatment of paranoid syndrome, like any disorder characterized by hallucinations and delusions, usually requires hospitalization: after all, it is necessary to effectively relieve the existing symptoms, and before that, carry out a comprehensive diagnosis and determine the cause of the development of the condition. All this can be effectively implemented only in a hospital setting. The presence of hallucinations or delusions in the clinical picture is always an indication for the use of pharmacological therapy. No matter how negatively some ordinary people view it, it is thanks to pharmacology that psychiatrists have been able to successfully cope with acute psychotic conditions for decades, thereby returning patients to normal activity and the opportunity to live fully.

Again, you need to understand that sensory (unsystematized) delusions, accompanied by hallucinations, can be a source of danger both for the patient himself and for the people around him. So, with delusions of persecution (and this is one of the most common types of delusions), a person may begin to flee or defend himself, which will cause irreparable damage own health. Delusions of self-deprecation, which often develop with depressive-paranoid syndrome, are also dangerous.

Often the situation develops in such a way that the patient himself does not regard his own condition as painful, and, naturally, resists not only the possibility inpatient treatment, but also a simple visit to the doctor. However, loved ones need to understand that there is no other way to help a person other than to treat him inpatiently.

Some psychiatrists cite as examples sad cases when a paranoid state with sensory delusions and hallucinations first manifests itself, for example, in childhood. But relatives, due to stereotypes, not wanting to “label the child,” go not to doctors, but to healers, resort to the use of religious rituals, which only triggers the disease, making it chronic. You can also often see examples of how relatives, not understanding the seriousness of the illness of a person close to them, resist with all their might the hospitalization of adults.

However, if there is someone to take care of the patient, but he himself does not want to acute condition receive necessary treatment, then the law specifically for these cases provides for the possibility of involuntary hospitalization. (Article No. 29 of the Law on the provision of mental health care). The law provides for involuntary hospitalization if the patient's condition threatens his own safety or the safety of others. Also, this kind of help can be provided if the patient cannot ask for it himself due to illness, or if failure to provide him with help will lead to a further deterioration of his condition.

Every citizen of our country has the right to receive this type of assistance free of charge. However, many are frightened by publicity, and even the prospect of ending up in a medical facility. If the issue of private provision of psychiatric care, as well as complete anonymity, is of fundamental importance to you, then you should contact a private psychiatric clinic, where there is even a treatment option where you will be offered to remain completely anonymous.

Modern medicine has long been able to treat this kind of disorder, diagnose the underlying cause of the disease and offer various ways treatment.

Thus, only qualified doctor- a psychiatrist is able to determine both the underlying disease and prescribe quality treatment for paranoid syndrome.

Important: symptoms of paranoid syndrome can increase rapidly. No matter how strange the behavior may seem to you loved one, which has changed instantly, do not try to look for metaphysical, religious or pseudo-scientific explanations. Every disorder has a real, understandable, and, most often, removable cause.

Contact the professionals. They will definitely help.

Paranoid delusions

The term "paranoid" can refer to symptoms, syndromes, or personality types. Paranoid symptoms are delusional beliefs most often (but not always) associated with persecution. Paranoid syndromes are those in which paranoid symptoms form part of a characteristic constellation of symptoms; an example would be morbid jealousy or erotomania. The paranoid (paranoid) personality type is characterized by such traits as excessive concentration on one’s own person, increased, painful sensitivity to real or imagined humiliation and neglect of oneself by others, often combined with an exaggerated sense of self-importance, belligerence and aggressiveness.

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Delusional and hallucinatory syndromes (paranoid, paranoid, paraphrenic)

Paranoid syndrome (gr. paranoia - madness) is manifested by systematized primary (interpretive) delusions. A synonym for paranoid delusion is delusion of interpretation. The content of delirium is limited to certain topics, is distinguished by great persistence and systematization in the form of interpretation of certain phenomena. As with any delusion, there is subjective logic (paralogic). There are no perception disorders (illusions, hallucinations, mental automatism) in the picture of this syndrome.

Thus, only rational cognition suffers, and not the perception of the objects and phenomena of the surrounding world themselves. Character traits: emotional (affective) tension, hypermnesia, thoroughness of thinking, increased self-esteem. Suspicion and distrust towards others are noticeable. Patients are often distinguished by their special obsession and exceptional activity in realizing their ideas.

The primary delusional idea usually arises suddenly, like an insight, and is subjectively perceived by the sufferer with a feeling of relief, since all this was previously preceded by a long and difficult period of subconscious formation of this idea (the period of delusional readiness). The system of delusion is built on a chain of evidence that reveals subjective logic (paralogic). Facts that fit into the delusional system are accepted, everything else that contradicts the concept being presented is ignored.

The occurrence of delirium is preceded by a state of so-called delusional mood in the form of vague anxiety, a tense feeling of an impending threat, unhappiness, and a wary perception of what is happening around, which for the patient has acquired a different, special meaning. The appearance of delirium is accompanied, as already indicated, by subjective relief from the fact that the situation has become clear and vague expectations and suspicions, vague assumptions have finally formed into a clear system and have acquired clarity (from the patient’s point of view).

• delusions of jealousy - the conviction that a partner is constantly cheating (a system of evidence in favor of this is emerging);
• delusion of love - conviction of a feeling of sympathy (love) for the patient on the part of some person, often famous;
• delusion of persecution - a firm belief that a certain person or group of people is watching the patient and pursuing him for a specific purpose;
• hypochondriacal delusion - the belief of patients that they suffer from an incurable disease.

Other variants of the content of paranoid delusions are also common: delirium of reformism, delirium of a different (high) origin, delirium of dysmorphophobia (the latter consists of the patient’s persistent belief in the incorrectness or ugliness of the structure of his body or individual parts, primarily the face).

Paranoid syndrome is present in many functional mental disorders (reactive psychoses, etc.).

Paranoid syndrome (combines the hallucinatory-paranoid Kandinsky-Clerambault syndrome and hallucinosis), in contrast to paranoid syndrome, describes states of unsystematized delusion. This is delirium, usually of absurd (extremely absurd) content, which unfolds against the background of hallucinations, pseudohallucinations and mental automatisms. In paranoid syndrome, unlike paranoid syndrome, in the formation of delusions there is neither strict logical argumentation nor strong cohesion with the personality. The delirium is not so much rational as figurative, sensual, since it is often based on pseudohallucinations and mental automatisms (delusion of alienation). Mandatory symptoms are emotional (affective) tension and delusional agitation.

The chronic form of Kandinsky-Clerambault syndrome occurs in schizophrenia.

Paraphrenic syndrome combines fantastic delusions of grandeur, delusions of persecution and influence with phenomena of mental automatism and changes in affect.

Patients declare themselves rulers: of the Universe, of the Earth, heads of states, commanders-in-chief of armies, etc. The fate of the world, of humanity, is in their power; it depends on their desires whether there will be war or eternal prosperity, etc. Talking about their power, they use figurative and grandiose comparisons, operate with huge numbers, and involve in the circle of fantastic events they describe not only famous figures of our time, but also long-dead ones. The content of fantastic nonsense is not bound by the logic of arguments, is extremely changeable, and is constantly supplemented and enriched with new facts. As a rule, the mood of patients is elevated: from somewhat elevated to severely manic. The symptom of the illusion of doubles, the symptom of false recognition (Capgras symptom), and the symptom of intermetamorphosis (Fregoli) are often observed. In the structure of the syndrome, pseudohallucinations and confabulations relating to both the past (ecmnestic confabulations) and current events, as well as retrospective delirium, in which the past is revised by the patient in accordance with his new worldview.

10. Basic delusional syndromes (paranoid, paranoid, paraphrenic), their dynamics, diagnostic significance.

Paranoid syndrome is a primary interpretative delusion with a high degree of systematization, characterized by plots of persecution, jealousy, invention, and sometimes hypochondriacal, litigious, material damage delusions. There are no hallucinations in paranoid syndrome. Delusional ideas are formed not on the basis of errors of perception, but as a result of a paralogical interpretation of the facts of reality. Often the manifestation of paranoid delusions is preceded by the long existence of overvalued ideas. Therefore, in the initial stages of the disease, such nonsense may give the impression of plausibility. The patient’s passion for a delusional idea is expressed by thoroughness and persistence in presenting the plot (“monologue symptom”). Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs. It may occur

not only in schizophrenia, but also in involutional psychoses, decompensations of paranoid psychopathy. Some psychiatrists describe it as an independent disease. In schizophrenia, paranoid syndrome is prone to further development and transition to paranoid delusions.

A characteristic sign of paranoid syndrome is the presence of hallucinations (usually pseudohallucinations) along with systematized ideas of persecution.

The occurrence of hallucinations determines the emergence of new plots of delirium - ideas of influence (less often poisoning). A sign of the supposedly carried out influence, from the point of view of patients, is a feeling of mastery (mental automatism). Thus, in its main manifestations, paranoid syndrome coincides with the concept of the syndrome

mental automatism of Kandinsky-Clerambault. The latter does not include only variants of the paranoid syndrome, accompanied by true taste and olfactory hallucinations and delusions of poisoning. With paranoid syndrome, there is a certain tendency towards the collapse of the delusional system, delirium acquires features of pretentiousness and absurdity. These features become especially pronounced during the transition to paraphrenic syndrome.

Paraphrenic syndrome is a condition characterized by a combination of fantastic, absurd ideas of grandeur, complacent or high spirits with mental automatism, delusions of influence and verbal pseudohallucinations. Thus, in most cases paraphrenic syndrome can be seen as

the final stage of development of mental automatism syndrome. Patients are characterized not only by a fantastic interpretation of present events, but also by fictitious memories (confabulations). Patients show amazing tolerance to the supposed influence exerted on them, considering this a sign of their exclusivity and uniqueness. Statements lose their former harmony, and some patients experience a collapse of the delusional system. At paranoid schizophrenia paraphrenic syndrome is the final stage of the course of psychosis. In organic diseases, paraphrenic delusions (delusions of grandeur) are usually combined with severe impairments of intelligence and memory. An example of paraphrenic delusion in an organic disease is the extremely ridiculous ideas of material wealth in patients with progressive paralysis (syphilitic meningoencephalitis).

Treatment. In the treatment of delusional syndromes, psychotropic drugs are most effective; The main psychotropic drugs are antipsychotics. Antipsychotics indicated wide range actions (aminazine, leponex) that help reduce the phenomena psychomotor agitation, anxiety, reduce the tension of delusional affect. In the presence of interpretative delusions that show a tendency towards systematization, as well as persistent hallucinatory disorders and phenomena of mental automatism, it is advisable to combine the use of chlorpromazine (or leponex) with piperazine derivatives (triftazine) and butyrophenones (haloperidol, trisedyl), which have a certain selective activity in relation to delusional and hallucinatory disorders ). The presence of significant affective (depressive) disorders in the structure of delusional syndromes is

indication for the combined use of neuroleptics and antidepressants (amitriptyline, gedifen, pyrazidol).

In chronic delusional and hallucinatory-paranoid states, neuroleptics such as haloperidol, trisedyl, triftazine are used for a long time. In case of persistent phenomena of mental automatism and verbal hallucinosis, the effect is sometimes achieved by combining the action of psychotropic drugs: a combination of piperidine derivatives (neuleptil, sonapax) with haloperidol, trisedil, leponex and other antipsychotics.

Outpatient treatment is carried out with a significant reduction in psychopathological disorders (some of which can be considered within the framework of residual delirium) after completion of intensive therapy in a hospital setting.

In the absence of aggressive tendencies (in cases where delusional symptoms are rudimentary and do not completely determine the patient’s behavior), treatment can be carried out on an outpatient basis; use the same drugs as in a hospital setting, but in medium and low doses. When the process stabilizes, it is possible to switch to milder drugs with a limited spectrum of neuroleptic activity (chlorprothixene, sonapax, eglonil, etc.), as well as to tranquilizers. A significant place in outpatient therapy belongs to long-acting antipsychotics, which are prescribed intramuscularly (moditen-depot, piportil, fluspirilen-imap, haloperidol-decanoate) or orally (penfluridol-semap, pimozide-orap). The use of extended-release drugs (especially when parenteral administration) eliminates uncontrolled reception medicines and thereby facilitates the organization of treatment of patients

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