Rave - Disorder of thinking, which is characterized by the emergence of judgments that do not correspond to reality (usually painful), which seem to the patient to be completely logical and which do not lend themselves to correction, persuasion.

This definition is based on the so-called Jaspers triad. In 1913, C.T. Jaspers identified three key characteristics of any delusion:

- delusional judgments do not correspond to reality,

- the patient is completely convinced of the consistency of their,

- delusional judgments cannot be challenged, corrected.

VM Bleikher gave a slightly different definition of delirium: "... a set of painful ideas, reasoning and conclusions that take possession of the patient's consciousness, distortedly reflecting reality and not amenable to correction from the outside." This definition emphasizes the fact that delirium takes possession of the patient's consciousness. As a result, the patient's behavior is largely subject to this delirium.

It is very important to understand that delirium, of course, is a disorder of thinking, but it is a consequence of damage, dysfunction of the brain. This is only a consequence, and, according to the views of modern medicine, it is pointless to treat delirium with the help of psychological methods or, for example, by increasing the “culture of thinking”. It is necessary to identify the biological root cause and treat this cause appropriately (for example, with antipsychotic medications).

The famous schizophrenia specialist E. Bleuler noted that delusion is always egocentric, that is, it is essential for the patient's personality, and has a bright affective coloration. There is, as it were, an unhealthy fusion of the emotional sphere and thinking. Affectiveness disturbs thinking, and disturbed thinking arouses affectivity through absurd notions.

The clinical picture of delirium has no pronounced cultural, national and historical characteristics. However, the content of delirium changes - both depending on the era and depending on the person's personal experience. So in the Middle Ages were "popular" delusional ideas associated with obsession with evil spirits, magic, love spell, etc. In our time, delusions of influence are often encountered with topics such as aliens, biocurrents, radars, antennas, radiation, etc.

It is necessary to distinguish the scientific concept of "delirium" from everyday life. In colloquial language, delirium is often called:

- unconsciousness of the patient (for example, at a high temperature),

- hallucinations,

- all sorts of meaningless ideas.

Whether delirium can be observed in a completely mentally healthy person is a big question. On the one hand, in psychiatry it is unambiguously believed that delirium is only a consequence of pathological processes. On the other hand, any affectively colored act of thinking to a small or significant extent may correspond to the Jaspers triad. A fairly typical example here is the state of youthful love. Another example is fanaticism (sports, political, religious).

It should be noted, however, that Jaspers' triad, like Bleicher's definition, is only a definition in a first approximation. In psychiatric practice, the following criteria are used to establish delirium:

- the occurrence on a pathological basis, that is, delirium is a manifestation of the disease;

- paralogicality, that is, building on the basis of one's own internal logic of delirium, emanating from the internal (always affective) needs of the patient's psyche;

- in most cases, except for some variants of secondary delirium, consciousness remains clear (there is no disturbance of consciousness);

- redundancy and inconsistency in relation to objective reality, however, with a persistent conviction in the reality of delusional ideas - this is the manifestation of the "affective basis of delusion";

- resistance to any correction, including suggestions and the invariability of a delusional point of view;

- intelligence, as a rule, is preserved or slightly weakened, with a strong weakening of intelligence, the delusional system disintegrates;

- with delirium, there are deep personality disorders caused by centering around the delusional plot;

- Delusional fantasies differ from delirium in the absence of persistent conviction in their reliability and in that they do not in any way affect the subject's being and behavior.

The professional experience of a specialist psychiatrist is of great importance for diagnosis.

Delirium is characterized by the exploitation of any one need or an instinctive pattern of behavior. For example, the patient may be "fixated" on his maternal debt. The exploitation of resentment is very common. If for a healthy person resentment is associated with an innate ability for latent aggression, which is turned on from time to time, then for a patient the topic of resentment is a cross-cutting, captivating consciousness. Delusions of grandeur are characterized by the exploitation of an innate need for social status. Etc.

Some types of delusions

If delirium completely takes over consciousness and completely subordinates the patient's behavior, this condition is called acute delirium.

Sometimes the patient is able to adequately analyze the surrounding reality, if it does not concern the subject of delirium, and to control his behavior. In such cases, delirium is called encapsulated.

At primary delusions only thinking, rational cognition is affected. Distorted judgments are consistently supported by a number of subjective evidence that has its own system. The patient's perception remains normal. It remains functional. With him, you can freely discuss things that are not related to the delusional storyline. When the delusional plot is affected, affective tension and "logical failure" occur. This type of delusion includes, for example, paranoid and systematic paraphrenic delusions.

At secondary delirium(sensual, figurative) illusions and hallucinations are observed. Secondary delirium is called so because it is a consequence of them. Delusional ideas no longer have integrity, as in primary delusions, they are fragmentary, inconsistent. The nature and content of delirium depends on the nature and content of the hallucinations.

Secondary delusions are divided into sensual and imaginative. At sensual delirium the plot is sudden, visual, concrete, rich, polymorphic and emotionally vivid. This is a delusion of perception. At figurative delirium there are scattered, fragmentary representations of the type of fantasies and memories, that is, the delusion of representation.

Delirium with a plot persecution... Includes a wide variety of shapes:

- the actual delirium of persecution;

- delusion of damage (belief that the patient's property is damaged or stolen);

- delirium of poisoning (the belief that someone wants to poison the patient);

- delusional relationship (the actions of other people are allegedly related to the patient);

- delirium of meaning (everything in the patient's environment is given special importance that affects his interests);

- delirium of physical influence (the patient is "influenced" with the help of different rays, devices);

- delirium of mental influence ("influence" by hypnosis and in other ways);

- delirium of jealousy (belief in the betrayal of a sexual partner);

- delirium of litigation (the patient is fighting to restore justice with the help of complaints, courts);

- staging delirium (the patient's belief that everything around is specially set up, scenes of a performance are being played out, or some kind of psychological experiment is being conducted);

- delirium of obsession;

- presenile dermatozoal delirium.

Delirium with a plot of its own greatness(expansive delirium):

- delirium of wealth;

- nonsense of invention;

- nonsense of reformism (ridiculous social reforms for the good of mankind);

- nonsense of origin (belonging to the "blue blood");

- delirium of eternal life;

- erotic delirium (the patient is a "sex giant");

- delirium of love (it seems to a patient, usually a woman, that someone very famous is in love with him);

- antagonistic delirium (the patient is a witness or participant in the struggle between the forces of Good and Evil);

- religious delirium - the patient considers himself a prophet, claims that he can work miracles.

Delirium with a plot of its own insignificance(depressive delirium):

- delirium of self-accusation, self-abasement and sinfulness;

- hypochondriacal delirium (belief in the presence of a serious illness);

- nihilistic delirium (the belief that in fact the world does not exist or that it will soon collapse);

- delusions of sexual inferiority.

Stages of delirium development

1. Delusional mood... There is a certainty that there have been some changes around, that trouble is coming from somewhere.

2. Delusional perception... The feeling of anxiety increases. A delusional explanation of the meaning of certain phenomena appears.

3. Delusional interpretation... Expansion of the delusional picture of the world. Delusional explanation of all perceived phenomena.

4. Crystallization of delirium... Formation of harmonious, complete delusional ideas, concepts.

5. Fading delirium... Appears and develops criticism of delusional ideas - "immunity" to them.

6. Residual delirium... Residual delusional phenomena.

We need a blockbuster (about the use of crazy plot lines in cinema).

Delirium is a persistent belief that has arisen on pathological grounds, which is not susceptible to the influence of reasonable arguments or evidence to the contrary and is not an instilled opinion that could be assimilated by a person as a result of appropriate upbringing, education received, the influence of traditions and cultural environment.

This definition aims to separate delusions of mental disorder from other types of persistent beliefs that may occur in healthy people. Usually (but not always) delusion is a false belief. The criterion of delirium is that it staunchly rests on an inadequate foundation, that is, this belief is not the result of normal processes of logical thinking. The strength of conviction is such that it cannot be shaken even by seemingly irrefutable evidence to the contrary. For example, a patient with a delusional idea that his pursuers lurked in the next house will not give up this opinion even when he sees with his own eyes that the house is empty; against all odds, he will maintain his conviction, assuming, for example, that the pursuers left the building before it was examined. It should be noted, however, that normal people with ideas of a non-delusional nature sometimes remain deaf to the arguments of reason, an example of this is the common beliefs of people with common religious or ethnic roots. Thus, a person brought up in the tradition of believing in spiritualism is unlikely to change his beliefs under the influence of strong evidence to the contrary, convincing to anyone whose worldview is not associated with such beliefs.

Although usually, as already noted, Crazy idea is a false belief, under exceptional circumstances it may turn out to be true or become so later. A classic example is morbid jealousy (see p. 243). A man may develop delusions of jealousy towards his wife in the absence of any substantiated evidence of her being unfaithful. Even if the wife is truly unfaithful at this time, the belief is still delusional if there is no reasonable basis for it. The point that should be emphasized is that it is not the falsity of a belief that determines its delusional nature, but the nature of the mental processes that led to this belief. Meanwhile, it is known that in clinical practice, the stumbling block is the tendency to consider a belief false just because it seems strange, instead of checking the facts or figuring out how the patient came to such an opinion. For example, seemingly incredible stories of persecution by neighbors or the attempts of a spouse to poison a patient sometimes have real basis, and as a result, it can be established that the corresponding conclusions are the result of normal processes of logical thinking and that they are in fact true.

In the definition of delusion, it is emphasized that a characteristic feature of a delusional idea is its stability. However, the conviction may not be as strong before (or after) the delusions are fully developed. Sometimes delusional ideas arise in a person's mind already fully formed, and the patient from the very beginning is absolutely convinced of their truth, in other cases they develop more gradually. Likewise, while recovering, the patient may go through a stage of increasing doubt about their delusional ideas before finally discarding them as false. The term is sometimes used to refer to this phenomenon Partial delirium As, for example, in the Status Survey (see page 13). It is advisable to use this term only if it is known that either the partial delusion was preceded by complete delusion, or it subsequently developed into complete delusion (retrospective approach). Partial delusions can be detected early. However, when this symptom is detected, one should not draw certain conclusions regarding the diagnosis only on this basis. A thorough examination should be carried out to detect other signs of mental illness. Despite the fact that the patient may be completely confident in the truth of the delusional idea, this belief does not necessarily affect all his feelings and actions. This separation of belief from feelings and actions is known as Dual orientation, Most often found in chronic schizophrenics ^ Such a patient, for example, believes that he is a member of the royal family, but at the same time lives quietly in a house for discharged from a hospital mentally ill. It is necessary to distinguish delusion from Overvalued ideas Which were first described by Wernicke (1900). Overvalued idea- it is an isolated, all-consuming belief of a different nature than delusions and obsessions; it sometimes dominates the patient's life for many years and can influence his actions. The roots of the belief that occupies the patient's thoughts can be understood by analyzing the details of his life. For example, a person whose mother and sister have died of cancer one after the other may succumb to the belief that cancer is contagious. While it is not always easy to distinguish between delusion and an overvalued idea, in practice it rarely leads to serious problems, since the diagnosis of mental illness depends on more than the presence or absence of any one symptom. (For more information on overvalued ideas, see McKenna 1984.)

There are many types of delusions, which are described below. In the next section, the reader will be helped by table. 1.3.

Primary, secondary and induced delusions

Primary, or autochthonous, delusions- this is delirium that arises suddenly with full conviction of the truth of its content, but without any psychic events that led to it. For example, a patient with schizophrenia may suddenly develop a complete conviction that his gender is changing, although he had never thought of anything like this before and this was not preceded by any ideas or "events that could have prompted such a conclusion. in a logical way. A belief suddenly arises in the mind, fully formed and in an absolutely convincing form. Presumably, it is a direct expression of the pathological process that is the cause of mental illness - the primary symptom. Not all primary delusional states start with an idea; delusional mood (see p.21) or delusional perception (see p.21) can also occur suddenly and without any previous events explaining them. Of course, it is difficult for the patient to remember the exact sequence of such unusual, often painful mental phenomena, and therefore it is not always possible to establish with complete certainty which of them is primary. Inexperienced doctors tend to diagnose primary delusions too easily without paying due attention to the investigation of previous events. Primary delusions are of great importance in the diagnosis of schizophrenia, and it is very important not to register it until there is complete confidence in its presence. Secondary delirium Can be regarded as a derivative of any previous pathological experience. Experiences of several types can cause a similar effect, in particular (for example, a patient who hears voices, on this basis comes to the belief that he is being persecuted), mood (a person in deep depression may believe that people consider him insignificant); In some cases, delusions develop as a consequence of a previous delusional idea: for example, a person with a delusion of impoverishment may fear that, because of the loss of money, he will be sent to prison, because he will not be able to pay debts. It seems that in some cases, the secondary delusions perform an integrating function, making the initial sensations more understandable to the patient, as in the first of the above examples. At times, however, it appears to have the opposite effect, increasing the feeling of persecution or failure, as in the third example. The accumulation of secondary delusional ideas can be the cause of the formation of a confusing delusional system in which each idea can be regarded as stemming from the previous one. When a complex set of interrelated ideas of this kind is formed, it is sometimes defined as systematic delusion.

Induced delusions occur under certain circumstances. As a rule, others consider the patient's delusional ideas to be false and argue with him, trying to correct them. But it happens that a person who lives with the patient begins to share his delusional beliefs. This condition is known as induced delusion, or Insanity together (Folic A Deux) ... As long as the couple stays together, the second person's delusional beliefs are as strong as those of the partner, however, they tend to quickly diminish when the couple is separated.

Table 1.3. Description of delirium

1. By persistence (degree of conviction): full partial 2. By the nature of occurrence: primary secondary 3. Other delusional states: delusional mood delusional perception retrospective delusions (delusional memory) 4. Content: persecutory (paranoid) relationship of greatness (expansive) guilt and of low value nihilistic hypochondriacal religious jealousy sexual or love control delusions

delusions about owning your own thoughts delusions of transmitting (broadcasting, broadcasting) thoughts

(In the domestic tradition, these three symptoms are considered as the ideational component of the syndrome of mental automatism) 5. According to other signs: induced delirium

Delusional mood, perception, and memories (retrospective delusions)

Typically, when a patient develops delirium for the first time, he also has a certain emotional reaction, and he perceives the environment in a new way. For example, a person who believes that a group of people are going to kill him is likely to feel fear. Naturally, in this state, he can interpret the reflection of the car seen in the car's rear-view mirror as evidence that he is being watched.

In most cases, delirium first occurs, and then the rest of the components are added. Sometimes the reverse order is observed: first, the mood changes - often this is expressed in the appearance of a feeling of anxiety, accompanied by a foreboding (it seems that something terrible is about to happen), and then delirium follows. In German, such a change in mood is called WaJinstimmung, Which usually translates as Delusional mood. The latter term cannot be considered satisfactory, because in fact we are talking about the mood from which delirium arises. In some cases, the change that has occurred is manifested in the fact that familiar objects of perception suddenly, for no reason, appear before the patient as if carrying a new meaning. For example, an unusual arrangement of objects on a colleague's desk can be interpreted as a sign that the patient has been chosen by God for some special mission. The described phenomenon is called Delusional perception; This term is also unfortunate, since it is not perception that is abnormal, but a false meaning that is attached to a normal object of perception.

Despite the fact that both terms are far from meeting the requirements, there is no generally accepted alternative to them, so you have to resort to them if you need to somehow designate a certain state. However, it is usually best to simply describe what the patient is experiencing and record the order in which ideas, affect and interpretation of sensations have changed. With a corresponding disorder, the patient sees a familiar person, but believes that he was replaced by an impostor who is an exact copy of the present. This symptom is sometimes referred to in French. Villusion De Sosies(double), but this, of course, is nonsense, not an illusion. The symptom can last so long and persistently that even the syndrome (Capgras) is described, in which this symptom is the main characteristic feature (see p. 247). There is also a wrong interpretation of the experience, opposite in character, when the patient admits the presence of different appearances in several people, but believes that behind all these faces the same make-up persecutor is hiding. This pathology is called (Fregoli). A more detailed description of it is given below on page 247.

Some delusional ideas refer to past events rather than present events; in this case they talk about Delusional memories(retrospective delirium). For example, a patient convinced of a conspiracy to poison him may attribute new meaning to the memory of an episode of vomiting after eating long before the delusional system began. This experience must be distinguished from the exact memory of a delusional idea that was formed at that time. The term "delusional memory" is unsatisfactory because it is not the memory that is delusional, but its interpretation.

In clinical practice, delusional ideas are grouped according to their main themes. This grouping is useful because there is some overlap between certain topics and major forms of mental illness. However, it is important to remember that there are many exceptions that do not fit into the generalized associations mentioned below.

Often call Paranoid Although this definition has, strictly speaking, a broader meaning. The term "paranoid" is found in ancient Greek texts with the meaning of "insanity", and Hippocrates used it to describe feverish delirium. Much later, this term was applied to delusional ideas of greatness, jealousy, persecution, as well as erotic and religious. The definition of "paranoid" in its broad sense is still used today in relation to symptoms, syndromes and personality types, while remaining useful (see Chapter 10). Persecutory delusions are usually directed at an individual or entire organizations that the patient believes are trying to harm him, tarnish his reputation, drive him insane, or poison him. Such ideas, although typical, do not play a significant role in the diagnosis, since they are observed in organic conditions, schizophrenia and severe affective disorders. However, the patient's attitude to delirium can have a diagnostic value: it is characteristic that in severe depressive disorder the patient is inclined to accept the alleged activities of the persecutors as justified, due to his own guilt and worthlessness, while the schizophrenic, as a rule, actively resists, protests, expresses his anger. When evaluating such ideas, it is important to remember that even seemingly incredible stories of persecution are sometimes supported by facts, and that in certain cultural environments it is considered normal to believe in witchcraft and attribute failure to someone else's wiles.

Delusional relationship it is expressed in the fact that objects, events, people acquire special meaning for the patient: for example, a newspaper article read or a remark sounded from a television screen are perceived as being addressed to him personally; a radio play about homosexuals is "specially broadcast" in order to inform the patient that everyone knows about his homosexuality. Relationship delusions can also be action-oriented or gestures of others, which, according to the patient, carry some information about him: for example, if a person touches his hair, this is a hint that the patient is turning into a woman. Although most often attitudinal ideas are associated with persecution, in some cases the patient may give his observations a different meaning, believing that they are intended to testify to his greatness or to calm him down.

Delusions of grandeur, or expansive delusions,- This is a hypertrophied belief in their own importance. The patient may consider himself rich, endowed with extraordinary abilities, or generally an exceptional person. Such ideas take place in mania and schizophrenia.

Delirium of guilt and inferiority most commonly seen in depression, so the term depressive delusions is sometimes used. Typical of this form of delusion is the idea that some minor violation of the law that the patient has committed in the past will soon be revealed and he will be disgraced, or that his sinfulness will bring God's punishment on his family.

Nihilistic Delirium is, strictly speaking, a belief in the non-existence of a person or object, but its meaning expands and includes the patient's pessimistic thoughts that his career is over, that he has no money, that he will soon die, or that the world is doomed. Nihilistic delusions are associated with extreme depressive moods. Often it is accompanied by appropriate thoughts about disturbances in the functioning of the body (for example, that the intestines are allegedly clogged with rotting masses). The classic clinical picture is called Cotard syndrome after the French psychiatrist who described it (Cotard 1882). This condition is discussed further in Ch. eight.

Hypochondriacal delirium consists in the belief about the presence of the disease. The patient, in spite of medical evidence to the contrary, stubbornly continues to consider himself sick. Such delusions are more likely to develop in older adults, reflecting the growing health concerns that are common at this age and in people with a normal psyche. Other delusional ideas may be related to cancer or sexually transmitted diseases, or the appearance of body parts, especially the shape of the nose. Patients with delusions of the latter type often insist on plastic surgery (see the subsection on body dysmorphic disorder, ch. 12).

Religious nonsense that is, delusions of religious content were much more common in the 19th century than at present (Klaf, Hamilton 1961), which seems to reflect the more significant role that religion played in the lives of ordinary people in the past. If unusual and strong religious beliefs are encountered among members of religious minorities, then it is recommended that you first talk to another member of the group before deciding whether these ideas (for example, clearly extreme judgments about God's punishment for minor sins) are pathological.

Delirium of jealousy more common in men. Not all thoughts caused by jealousy are delusions: less intense manifestations of jealousy are typical enough; in addition, some obsessive thoughts can also be associated with doubts about the spouse's fidelity. However, if these beliefs are delusional, then they are especially important because they can lead to dangerous aggressive behavior towards someone who is suspected of being unfaithful. Special attention is needed if the patient "spies" on the spouse, examines her clothes, trying to find "traces of semen", or rummages in her purse in search of letters. A person suffering from delusions of jealousy will not be satisfied with the lack of evidence to support his belief; he will persevere in his search. These important issues are discussed further in Chap. ten.

Sexual or love delirium is rare, mostly women are susceptible to it. Delusional ideas associated with intercourse are often secondary to somatic hallucinations felt in the genitals. A woman with a delirium in love believes that she has a passion for a man inaccessible under normal circumstances, occupying a higher social position, with whom she has never even spoken. Erotic delusions are the most common trait Clerambault syndrome Which is discussed in chap. ten.

Delusions of control expressed in the fact that the patient is convinced that his actions, motives or thoughts are controlled by someone or something from the outside. Since this symptom gives a strong suspicion of schizophrenia, it is important not to register it until its presence is clearly established. It is a common mistake to diagnose control delusions in their absence. Sometimes this symptom is confused with the experience of a patient who hears hallucinatory voices giving commands and voluntarily obeys them. In other cases, misunderstanding arises due to the fact that the patient misunderstands the question, believing that he is being asked about the religious attitudes regarding the divine providence governing human actions. A patient with delusions of control firmly believes that the behavior, actions and every movement of the individual are directed by some kind of extraneous influence - for example, his fingers take the appropriate position for the sign of the cross, not because he himself wanted to cross himself, but because they were forced by an external force ...

Delusions about owning thoughts characterized by the fact that the patient loses the confidence, natural for every healthy person, that his thoughts belong to himself, that these are purely personal experiences that can become known to other people only if they are uttered aloud or discovered by a facial expression, gesture or action. The lack of a sense of ownership of your thoughts can manifest itself in different ways. Patients with Delirium of nesting other people's thoughts We are convinced that some of their thoughts do not belong to them, but are embedded in their consciousness by an external force. Such an experience is different from the experience of a patient with obsessions, who may suffer from unpleasant thoughts, but never doubts that they are generated by his own brain. As Lewis (1957) said, obsessions "are produced at home, but the person is no longer the master." A patient with a delusion of nesting thoughts does not admit that the thoughts have arisen in his own mind. Patient with Delirium of taking away thoughts I am sure that thoughts are drawn from his mind. Such delirium usually accompanies memory lapses: the patient, feeling a break in the stream of thoughts, explains this by the fact that the "missing" thoughts were taken away by some outside force, the role of which is often assigned to the alleged persecutors. At Delirium transfer(openness) of thoughts to the patient it seems that his unspoken thoughts become known to other people through transmission using radio waves, telepathy or in some other way. Some patients also find that others can hear their thoughts. This belief is often associated with hallucinatory voices that seem to speak out loud of the patient's thoughts. (Gedankenlautwerderi). The last three symptoms (In Russian psychiatry, they belong to the syndrome of mental automatism) are found in schizophrenia much more often than in any other disorder.

Causes of delirium

Against the background of the obvious scarcity of knowledge about the criteria of normal beliefs and about the processes underlying their formation, our almost complete ignorance of the causes of delusion does not seem surprising. The lack of such information did not prevent, however, the construction of several theories, devoted mainly to the delusions of persecution.

One of the most famous theories was developed by Freud. The main ideas were set forth by him in a work originally published in 1911: “The study of many cases led me, like other researchers, to the opinion that the relationship between the patient and his persecutor can be reduced to a simple formula. It turns out that the person to whom the delirium attributes such power and influence is identical to someone who played an equally important role in the emotional life of the patient before his illness, or to an easily recognizable substitute. The intensity of the emotion is projected onto the image of an external force, while its quality is reversed. The person who is now hated and feared as a persecutor was once loved and respected. The main purpose of the delusional persecution of the patient is to justify a change in his emotional attitude. " Freud then summarized his point of view, claiming that it is the result of this sequence: “I am not I love His - I Hate Him because he is following me ”; erotomania follows the series “I don’t love His-I love Her because She loves Me", And the delirium of jealousy is the sequence “this is not I AM Loved this man is She Loves him ”(Freud 1958, pp. 63-64, original emphasis).

So, according to this hypothesis, it is assumed that patients experiencing delusions of persecution suppressed homosexual impulses. Until now, attempts to verify this version have not provided convincing evidence in its favor (see: Arthur 1964). However, some authors agreed with the basic idea that a projection mechanism is involved in persecution delusions.

Existential analysis of delirium has been repeatedly carried out. In each case, the experience of delusional patients is described in detail, and the importance of the delusion affecting the whole being is emphasized, that is, it is not just a separate symptom.

Conrad (1958), using the approach of Gestalt psychology, described delusional experiences, dividing them into four stages. In accordance with his concept, a delusional mood, which he calls three (fear and awe), through a delusional idea, for which the author uses the term "alophenia" (the appearance of a delusional idea, experience), leads to the patient's efforts to discover the meaning of this experience by revising his vision the world. These efforts are broken down at the final stage ("apocalypse"), when signs of thought disorder and behavioral symptoms appear. However, although this type of sequence can be observed in some patients, it is certainly not constant. Learning theory attempts to explain delusion as a form of avoidance of extremely unpleasant emotions. For example, Dollard and Miller (1950) suggested that delusion is an internalized interpretation of events that avoids feelings of guilt or shame. This idea is as unsupported by evidence as all other theories about the formation of delusions. Readers wishing to learn more on this subject should refer to Arthur (1964).

There are many conflicting judgments and related disputes regarding the classification of delusions. These conflicting judgments and disputes are due to two circumstances:

• firstly, a hopeless attempt is being made to bring the whole variety of delusional phenomena into a single classification scheme that takes into account and combines such different characteristics as a state of consciousness, preferably an intellectual or sensory disorder, a mechanism of delusional formation, the structure of delusional syndrome, the theme and plot of delusional experience, the rate of occurrence, and development of delirium, its stages, periods, phases, stages;
• secondly, a variety of designations are used to name classification groups, in which authors often put different content. Among such designations, the most common forms, types, types, classes, categories, variants of delirium, etc.

A variety of mechanisms of delusional formation, polymorphism of manifestations (clinical picture) of delusional
phenomena, as well as the lack of a reliable understanding of the anatomical, physiological and energetic foundations of the thinking process and its disorders make it extremely difficult to substantiate the systematics of these disorders.

Along with the criteria for the clinical assessment of the signs of delusional syndrome, which we have named parameters of delusion, the assessment of a number of " clinical characteristics". It is necessary to briefly dwell on the indicated "clinical characteristics".

Manifestation, theme and content of delusional experiences... Manifestations of delusion should be considered as the most characteristic, direct reflection of the personality, intellect, character, constitution of the patient. Some authors, conducting a clinical analysis of delusional experiences, evaluate delirium as an independent, isolated, incomprehensible psychopathological phenomenon, while others "dissolve" delusion in other psychopathological formations. Any delusional experiences, delusional ideas can manifest themselves in the form of delusional tendencies, delusional statements, delusional behavior.

Delusional tendencies, constituting the "dominant of the psyche", determine all the "mental" and practical aspirations of the patient: the direction of his emotional and affective attitudes, associations, judgments, inferences, ie, all intellectual, mental activity.

Delusional statements in some cases are adequate to delusional experiences and reflect their essence, in others they correspond to delusional intellectual "developments" without directly reflecting the elements of delusional inferences, and finally, in third cases, the patient's statements reflect delusional experiences not directly, but indirectly, which is revealed, for example , when included in these statements of neologisms that have an incomprehensible meaning to others.

Differences in the forms of manifestation of delirium are due to the essence and characteristics of the ratio (in some cases, the relationship) of the "delusional I" of the patient with his premorbid "I" or intact elements of mental status; subjective attitudes, intentions, plans; the objective world in general, the objective environment, specific people. The invariability of the "pathological conditions" underlying the disease, according to IA Sikorsky, determines the stereotype, "stereotyped" delusional tendencies and judgments of patients.

The behavior of patients is largely predetermined by the theme, focus and content of delusional ideas. However, such interrelated factors as the relevance of delusional experiences, their affective "saturation", constitutional and characterological characteristics of the patient's personality, the manner of his relationship with others, premorbid life experience also have a direct impact on their behavior.

The variety of possible types of delusional behavior of patients is well illustrated by the materials of G. Huber and G. Gross (1977), who observed various variants of reactions and actions of patients with schizophrenia. These options include:

• in the delirium of persecution - protection and self-defense, verbal dialogue with "persecutors", seeking protection from others, flight, change of residence, threatening warnings to "persecutors", persecution of "persecutors", attempts at aggression, suicidal attempts, informing others about the "persecutors", a panic reaction in connection with the alleged danger to life, destruction of possibly compromising documents, fear of poisoning and refusal to take food, medicines;
• with hypochondriacal delirium - self-defense against improper treatment, doubts about the competence of doctors and nurses, active acquaintance with popular and scientific and medical literature, accusation of doctors in “concealing the diagnosis” for the sake of “saving the honor of the uniform,” suicidal attempts due to fear of future fate, which is associated with a certain disease;
• with delirium of greatness - an effective desire to convince others of their importance, the demand for recognition and support, the desire to participate in public life in a meaningful role, the demand for admiration and obedience, the division of others into “supporters” and “opponents”, aggressive actions towards “opponents” ", Interference in other people's problems with the aim of someone's defense or accusation, resentment against" supporters "because of their lack of" devotion ", attempts to appropriate property and power of others (they believe that both belong to them), rejection of the profession, positions, elements of work as unworthy of their own personality, etc.

Any delusion, regardless of its form, structure, syndromological, nosological affiliation, content, can be mono- and multiplot, plausible and fantastic, ordinary and hyperbolic, consistent (coherent) and fragmentary, hyper- and hypothetical, understandable in meaning and incomprehensible.

For methodological reasons, it is advisable to distinguish between a general idea, or plot, delirium, its thematic design and specific content. In this case, the plot of delirium is understood as a set of judgments expressing the basic concept of delusion, that is, the direction of the general delusional inference. This "focus" affects a narrower delusional judgment in the form of a delusional theme, but does not predetermine its specific content.

The main essence of delirium, its plot, may, for example, consist in the idea of ​​persecution without any definite plot: it is the presence of enemies, opponents, some kind of force, the purpose of which is to harm the patient. Delusional judgment, the topic is often narrowed down to the idea that the goal of the "pursuers" is to destroy the patient. This thought sometimes makes up a specific content, including not only the reasons for the hostile attitude towards the patient, but also the clarification of the way this attitude is realized, for example, murder by poisoning in order to rid his wife and her lover of him.

Thus, the main plot of the delusional experiences of the patient P. under our supervision is the pessimistic idea that appeared 2 years ago that his future is predetermined by “poor health”. At first, this idea had the character of a "delusional assumption" about the presence of an incurable disease without specifying it. Then there was a firm conviction that this disease was brain syphilis. Acquaintance not only with popular, but also with special literature "allowed" the patient to construct all the content of delirium, he "guessed" from whom he contracted syphilis, and realized that the disease would lead to progressive paralysis, and then to death, and this disease would not only hopeless, but also shameful.

Numerous observations, including our own, allow us to conclude that the nature of the onset and development of a delusional mental illness that is not accompanied by clouding of consciousness, as well as many other accompanying factors to a certain extent predetermine the plot of delusion and indirectly, in the process of the development of the disease, its theme ... At the same time, the specific content of delirium most often does not depend on the pathogenetic properties of a given mental illness and can be caused by random factors (someone's story, a poster by chance, a television program, a motion picture, etc.).

The plot, theme and content of delirium arising from a darkened consciousness are formed somewhat differently. In this case, there is a "fusion" of the concepts of plot, theme and content of delirium, which entirely depend on the nature and form of the clouding of consciousness.

The presence of a certain dependence of the content of delirium on external circumstances is confirmed by the fact that in the same historical epoch, marked by the same events, there is a certain similarity in the content of delusional experiences of mentally ill patients, regardless of the ethnic originality and characteristics of the country in which these patients live. So, for example, after the explosion of atomic bombs in Hiroshima and Nagasaki, the launch of the first controlled artificial Earth satellite in psychiatric clinics of various states located in different parts of the world, there appeared the "inventors" of atomic bombs, "cosmonauts" who flew to the Moon, Mars, etc. NS.

Literature data and our own observations allow us to agree with the statements of a number of researchers who believe that the content of delusion, in addition to events of a personal and social nature, is equally influenced by various factors.

Such factors, for example, include:

• constitutional personality traits, premorbid and actual interoceptive sensations, influencing "through consciousness on thinking about the cause of painful sensations";
• the level of culture, education, profession, life experience, mood, degree of affective stability, psychogenic factors, in which even "minor psychogenias" approach the content of delusional experiences, "like a key to a lock";
• subconscious and unconscious associations, apperceptions, ideas, because of which it is often not possible to establish the motives that predetermined the content of delirium, since these motives are not realized by the patient himself, "hidden" from him.

Syndromological or nosological features of the delusional plot are not always revealed. In some cases, the content of delirium does not depend on the form of mental illness, in others, it is typical for certain nosological forms, in the third, merging with some symptoms of the disease (confusion, dementia, etc.), may be specific for a particular psychosis. For example, for progressive paralysis, delirium of greatness and wealth in combination with dementia can be recognized as specific, for alcoholic delirium - clouding of consciousness with delirium of persecution and the experience of an immediate threat to one's own life, for psychoses of a later age - the nihilistic delirium of Kotard, conviction in the death of the universe, destruction of internal organs in combination with dementia of a greater or lesser degree of severity.

Nonspecific, but typical enough:

• for chronic alcoholic psychosis - delirium of jealousy;
• for epileptic psychosis - religious delirium, characterized by concreteness, relative constancy, limited plot, practical orientation;
• for schizophrenia - hypochondriacal delirium with ideas of impending physical suffering and death, etc.

To the above, we can add that, according to I. Ya.Zavilyanskiy and V.M.Bleikher (1979),

"Characteristic delusional phenomena" can be considered: for schizophrenia - delusions of persecution, exposure, poisoning, hypnotic influence; for circular depression - the idea of ​​self-blame; for age-related psychosis - delirium of damage, robbery.

Some authors point out the dependence “ focus»The topic, the content of delirium, not only from the form of mental illness, but also from the stage, period, structure of the disease. BI Shestakov (1975) believes that with a late-onset schizophrenic process, his first long paranoid period is characterized by ideas of attitude and meaning ("delusion of evaluation" according to Serbian). In the future, the delirium of persecution develops, the immediate danger with the "loosening" of the delusional system in the paraphrenic period and the influence on the delusional structure of disrupted thinking. A. V. Snezhnevsky (1983) notes the intellectual, consistently systematized content in the primary and figurative - in the secondary sensory forms of delirium. BD Zlatan (1989), referring to the "opinion of many authors", recognizes the isolation of its content from reality as characteristic of schizophrenic delirium, in contrast to exogenous delusion, the content of which is directly related to the surrounding reality.

To the above, we should add the judgment of E. Bleuler (1920), who considers “dependent” delusional ideas typical of schizophrenia, which are a direct consequence of earlier ideas (“he is the son of a count, so his parents are not real”). We would call this content of delirium "mediated", "paralogical."

In determining the parameters of delirium, it has already been noted that according to the degree of realism of the content, delusional ideas can be divided into three categories: unrealistic in general, absurd, absurd; unrealistic for a given patient and a given situation, but in principle plausible; real for a given patient, plausible, but in content they do not correspond to reality.

There are two diametrically opposed points of view regarding the randomness or regularity of the content of delirium. Some authors, for example A.B.Smulevich, M.G. Shirin (1972), believe that the content of delirium can be considered as a consequence of the progressive dynamics of psychopathological disorders, that is, delusion is a "mental formation" inseparable from the mental process, constituting the result of pathological activity of the brain, and therefore, the content of delirium is determined by the activity of the brain and it cannot be considered as a random phenomenon independent of this activity. Other psychiatrists, considering the occurrence of delirium as a natural consequence of the development of this mental illness, believe that the content of delusion can be accidental. This idea "only" 140 years ago was expressed by P.P. Malinovsky, who noted that "... in insanity, delirium is an expression of the essence of the disease, but the subject of delirium, for the most part, is an accidental circumstance, depending on the patient's imagination or on external impressions ".

We are inclined to join the point of view of P.P. Malinovsky, but at the same time we must make some clarification: the occurrence of delusional experiences is always a natural result of the development of a progressively current mental illness, one of the stages of the psychopathological process, the consequence of which is also the main ideological direction of delusion, its main form - the idea of ​​"persecution", "greatness", "hypochondriacal", etc. However, the plot design, specific content, details of delirium can be accidental.

The presence of delusional content typical, or specific for some psychoses, does not exclude the possibility of occurrence of delusional ideas close to the plot in various mental illnesses. This circumstance does not give grounds for a categorical denial of the diagnostic value of the content of delirium in all cases [Smulevich AB, Shchirina MG, 1972]. In this case, of course, one should not confuse the concepts of "content" and "structure" of delirium.

Dependence of the content of delusions on gender and age... We were unable to find reliable information on the frequency of various forms of delusion in men and women separately, obtained on representative material. However, it is generally accepted that delusions of damage and love delusions are more often observed in women, and delusions of jealousy in men. According to G. Huber and G. Gross (1977), delirium of guilt and committed crime, love and jealousy, impending death "at the hands of loved ones", "impoverishment and robbery", "high origin" is more common in women; hypochondriacal delusions and delusions of "delayed action" are more typical for men. Regardless of gender, the "ability to delusional" increases with age [Gurevich MO, Sereyskiy M. Ya., 1937], but with an increase in atherosclerotic or senile dementia, it decreases.

G.E.Sukhareva (1955) notes that delusional ideas are extremely rare in childhood and are manifested in the form of an unformed sense of danger. Occasionally, the "ridiculous statements" observed in children are inconsistent, not related to each other, do not look like crazy ideas in the full sense of the word. Sometimes such statements, which are close in form to delusional, are of a playful nature, contain thoughts about reincarnation into animals, or arise in the process of "delusional fantasizing." Delusional constructions reflecting life experience, requiring the ability to abstract and intellectual creativity, do not occur in childhood. G. Ye. Sukhareva emphasizes that delusional ideas in young children often arise against the background of a dim consciousness and, less often, on the basis of frightening visual hallucinations with a "persecution motive." The emergence of these ideas may be preceded by fear and "violation of feelings of sympathy" for the parents. EE Skanavi (1956), V.V. Kovalev (1985), as well as G.E.Sukhareva (1937, 1955), point to the "early source" of the further development of delirium characteristic of children in the form of a change in attitude towards parents , which then turns into "the delirium of other people's parents." At the same time, the authors note that in cases of early schizophrenia, delusional ideas are gradually transformed "from dreamy, catesthetic forms," ​​from paranoid and hypochondriac interpretations at the onset of the disease to delirium of poisoning. At the same time, the connection between the content of delirium and a specific situation becomes less pronounced, delirium is abstracted, and its "affective saturation" is lost.

In adolescence, monomanic delusional ideas and paranoid delusions are observed, sometimes with auditory hallucinations, turning into the phenomenon of mental automatism [G. Ye. Sukhareva, 1955]; development of paranoid symptoms in juvenile schizophrenia, depressive-delusional states with ideas of self-accusation, occasionally persistent systematized paranoia delirium, as well as the complication of delusional experiences associated with the expansion of social communication [Skanavi EE, 1962].

In late schizophrenia, less meaningful delusions and sometimes delusions of "small scope" with a specific everyday theme are noted. The delusional plot in patients with age-related organic vascular diseases is less developed than in functional psychoses, in particular schizophrenic [Sternberg E. Ya., 1967].

The combination of delirium with other psychopathological symptoms... The relationship of delirium, delusional ideas with other mental disorders can be varied. Such disorders include clouding of consciousness, more or less pronounced intellectual decline (including memory impairment), illusions, hallucinations, pseudohallucinations, etc. The listed symptoms and syndromes in some cases are closely related to delusional experiences, pathogenetically interdependent with them, and in others they develop conditionally isolated.

Disorder of consciousness of any form, accompanied and not accompanied by hallucinatory experiences, serves as a fertile ground for the development of delirium. It can cause the appearance of delusional ideas or accompany them in cases where delusion precedes a disorder of consciousness. The structure, character, phenomenological manifestation, development of delusional ideas are modified in any variant of their relationship with the clouding of consciousness. Intellectual decline can only indirectly "participate" in the pathogenesis of delirium. Usually, dementia of one degree or another is reflected only in the plot, content, design of delusional ideas, preventing the emergence of delusion in the most severe cases. In some cases, delusional experiences can arise on the basis of confabulations (patients take their own fantasies for real, filling in the gaps in memory) or on the basis of cryptomnesia, that is, "hidden" memories. At the same time, the basis for the development of delirium is taken for their own heard or read information about various events, other people's thoughts, discoveries, as well as their own memories, "lost the traits of familiarity" and therefore perceived as new [Korolenok K. X., 1963]. One cannot completely agree with the last judgment, since cryptomnie, like co-fabulation, affects only the design of the plot of delirium, but does not serve as a basis for its emergence and development.

Most often, delusional ideas that arise with a darkened and unclouded consciousness are observed simultaneously with illusions, hallucinations, pseudo-hallucinations.

In the differential diagnostic relation in each specific case, it is important to assess the order of occurrence in time of illusions, hallucinations, delusions and their plot dependence on each other.

The plot connection between illusions or hallucinations and delusions can be direct (the content of hallucinations coincides with delusional experiences) and indirect (the content of hallucinations "adapts" to delirium by paralogical reasoning of the patient himself). In alcoholic hallucinosis, according to A.G. Hoffman (1968), delirium is usually closely associated with deceptions of perception, but its content is not limited only to the plot of these "deceptions", and he believes that delusional ideas of influence more often than other experiences accompany verbal hallucinations , especially commenting on the movements, actions, sensations and thoughts of patients.

Often, in patients with ideas of attitude and persecution, it is impossible to separate the illusory experiences that have arisen at the same time, "delusional illusions" from any specific delusional plots, including only the ideas of persecution or only the ideas of attitude. In some cases, it is impossible to determine the priority (by the time of occurrence or significance) of illusions, hallucinations, delusions, closely related to each other in a single delusional composition. Exact coincidence in the content of verbal pseudo-hallucinations and delusional experiences that arise simultaneously with them and after them is often observed with paraphrenic delusions.

In cases where the basis of the disease is paranoid syndrome and the patient complains about “ smells”, It is practically impossible not only to determine whether these are illusions or hallucinations, but also to establish the nature of the patient's experiences themselves: whether they really include a sensory, sensory component, that is, whether the smell is really felt, or there is only a delusional conviction of the patient in the presence of a smell. A similar delusional conviction is observed in paranoid forms of delusion with an interpretive delusional interpretation of what is happening around. So, one patient under our supervision often, especially during periods of low mood, notices that the people around him (acquaintances and strangers) are trying to move away from him, turn away, sip the air - sniff. On their faces, the patient notices grimaces of disgust. He has long been established in the idea that an unpleasant smell comes from him. At times, without due confidence, he believes that he himself smells this smell, but usually confirms that he guesses about the smell from the behavior of others. In this case, one cannot talk about a combination of olfactory hallucinations and delusional ideas. Here we are talking only about delusional experiences with the inclusion in them not of actual olfactory hallucinations, but delusional illusions. Olfactory hallucinations are always more or less thematically associated with delusions. The same can be said for gustatory and tactile hallucinations. At the same time, in clinical terms, it is of interest to analyze the ratio of delusional experiences with tactile hallucinations and tactile pseudo-hallucinations in the same patient.

The delusional interpretation of tactile hallucinations is manifested either in their direct connection with delusional ideas of persecution, or in combination with delusion-thematic, and not plot connection with it. Pathological sensations, close to tactile ones, can be localized not only on the surface of the body, but also in the subcutaneous fatty tissue, bones, internal organs, and the brain. These are not just senestopathic sensations or soma caused by visceral illusions. In contrast to them, tactile hallucinations are clothed in the form of a concrete experience and are more or less meaningful. In all cases, they are interpreted in a delusional way. The plots of such hallucinations and their delusional design are varied. Sometimes tactile hallucinations and their delusional interpretation occur simultaneously. In some cases, "delusional understanding" of tactile deceptions develops gradually.

The well-known syndromological interdependence between delusion, on the one hand, and hallucinations or pseudo-hallucinations, on the other, can be detected when delirium occurs simultaneously with pseudo-hallucinations corresponding to it according to the plot or after them, and when true: hallucinations based on a previous delusional plot appear.

With verbal, visual and other hallucinations arising from delirium, corresponding to it in the plot and inseparable from it, it is difficult to exclude the auto-suggestive nature of their occurrence. Some authors call such hallucinations delusional. A similar genesis is, for example, hallucinations in a patient who developed delirium of persecution and poisoning, and then the voices of pursuers heard outside the wall of the house, the smell of poisonous gas, the metallic taste of food, etc. The suggestive and auto-suggestive mechanism of the appearance of not only hallucinations, but also delusions is revealed in the analysis of induced psychoses.

Over the course of the current century, domestic psychiatrists and scientists from other countries have been paying great attention to the study of the nature of syndromological and clinical relationships between delusions and illusions, hallucinations, and pseudo-hallucinations. Individual statements on the named problem and judgments about the results of the corresponding studies deserve a brief review.

Due to the multidimensionality, multidisciplinary nature, as well as the repeatability, typicality, or specificity of delusional syndromes, which has already been mentioned, it is impossible to present their clinic in a strict, unambiguous scheme. However, we consider the most acceptable consistent clinical description of various delusional syndromes according to the main classes - delusions of disturbed, or upset, consciousness, sensual and intellectual delusions. The suggested order of presentation is based on the following provisions.

1. The clinical characteristics of delusional syndrome include an analysis of the conditions of delusion, developmental features and properties of a particular stage (paranoid, paranoid, paraphrenic), thematic focus and content of “delusional experiences.
2. Phenomenologically, the same forms of delusion can occur with impaired consciousness, sensual and intellectual delirium of undisturbed consciousness (for example, delirium of persecution is observed equally often with delirium of clouded consciousness, in particular delirious, and intellectual schizophrenic delusion, as well as with sensory delirium of exogenous organic nature).
3. Delusional syndromes similar in psychopathological manifestation differ significantly depending on the nosological form of mental illness (for example, delusional ideas of jealousy arising in schizophrenia and related to intellectual delirium differ significantly from the delusional ideas of jealousy observed in the sensory delirium of patients with cerebrosclerotic psychosis, epilepsy or alcoholic psychosis ).
4. Mixed forms of delirium are possible (for example, oneiroid delusions, pathologically associated with intellectual schizophrenic delusions, but arising with oneiric confusion).

In connection with the above, it is necessary to bear in mind the conditional nature of the following division of delusional syndromes according to the main classes of delusion - intellectual, sensual, impaired consciousness. At the same time, if intellectual delirium occurs only in mental illnesses, in particular schizophrenia, and sensual delirium - in various psychoses, proceeding with more or less "interest" in the neuro-somatic sphere, then delirium of disturbed consciousness is necessarily pathogenetically associated with a disorder of consciousness of varying severity , ranging from hypnagogic and hypnopompic, hysterical or epileptic and ending with delirious or oneiroid.

Given the complexity of the delusional problem, as well as the lack of reliable knowledge about the essence of normal and pathological mental activity, we propose a multidimensional systematics of delusional phenomena, including their division into the following consolidated groups:

• classes characterized by attitudes toward higher mental functions — delirium of a darkened consciousness, sensual delirium, intellectual delirium;
• categories - incoherent, interpretive, emerging, crystallized, systematized delirium;
• types of the mechanism of delusional formation - essential, holotimic (catesthetic, catatimic), affective;
• flow types - acute, subacute, chronic and undulating, as well as stages, periods, stages of delusional syndrome;
• forms of subject matter and plot - delirium of persecution, grandeur, etc.

In addition, one should distinguish between the typical, or specific, syndromological and nosological belonging of delirium.

The main classes of delusional phenomena... The division of delusion into primary - intellectual and secondary - sensual in Russian, German, French, Italian and a number of other psychiatric schools is generally recognized. The essence of this division is considered in the overwhelming majority of articles, manuals, monographs on psychiatry published over the past 100 years, and is presented in a fairly uniform manner.

However, not all psychiatrists, analyzing delusional syndromes, designate them "primary" or "secondary". These authors often subscribe to the opinion of A. Ey (1958), who considers any nonsense to be secondary.

The prerequisites for dividing delirium into intellectual and sensual are to a certain extent based on some provisions of formal logic, according to which two types of delusional thinking can be distinguished: at the first, the cognitive sphere is disturbed - the patient reinforces his distorted judgment with a number of subjective evidence combined into a logical system; in the second, the sensory sphere is also disturbed: the patient's delirium is figurative in nature with a predominance of dreams and fantasies [Karpenko LA, 1985]. AA Mehrabyan (1975) emphasizes about the same, believing that there is an "internal duality of the psyche" formed by the mental and sensory functions. In the available review of the literature on psychiatry of the second half of the XIX and XX centuries. the existence of a framework that limits the structure of the classification of delusional states to phenomena caused by violations of the predominantly intellectual or predominantly sensory sphere is fully confirmed.

In recent years, the identification of the main classes of delusion has not undergone any fundamental changes. As in previous decades, it corresponds to the two main functions of the human psyche - intellectual and affective. As before, intellectual delirium is designated as primary and in most cases is identified with interpretative delusions, while affective, or sensual, delusions are considered secondary, and some authors combine it with figurative delusions, while others differentiate with them. The proofs of the correctness of this classification or its modifications do not differ in originality, only the wording changes, sometimes the emphasis or the list of constituent elements.

The correctness of dividing delirium into sensual, intellectual, or interpretive, and mixed raises doubts, since with the so-called sensory delirium, disturbances of sensations and perceptions according to the law of eccentric projection can be caused by a violation of the thought process and, therefore, are not an etiopathogenetic factor, but at the same time an interpretive delirium can arise from an initial disturbance of the sensory sphere.

Recognizing the clinical validity of including the classes of intellectual and sensual delusion in the systematics of delusional states, we believe that they should be supplemented by a class of delusional phenomena arising from the darkened consciousness. We are talking about delusional experiences that began from the moment of dimming of consciousness or from the moment of exposure to the causes that caused it and disappearing (except in cases of residual delirium) when consciousness clears up. Sensual delirium does not belong to this class if its occurrence is not associated with a clouding of consciousness, and consciousness is disturbed at the height of the development of sensual delirium. Note that A. Ey (1954) insisted on identifying the form of delirium associated with a disorder of consciousness. In addition, the preservation of the main sections of traditional taxonomy requires the following additional explanations:

• the designation of a delusional phenomenon by the term "intellectual" delusion, unlike other forms of delusion, is not entirely justified, since any delusion is caused by an intellectual disorder and is intellectual;
• concepts " intellectual" and " sensual»Delusions reflect the mechanism of delusional formation, characterize the psychopathological structure of the debut, course, outcome of the corresponding delusional phenomenon, but do not exclude the participation of sensory elements in the development of intellectual delusion and in the development of sensory delusion of the components of intellectual delusion;
• concepts " primary" and " intellectual"Delirium can be considered synonymous, while the concept of" interpretive "indicates psychopathological elements encountered in different clinical variants of acute and chronic delusions, and does not determine the belonging of this delusion to one or another class;
• the existence of the concept "combined" delirium is legitimate, combining into classes of sensual delirium "figurative", "hallucinatory" delusions and delusions of "imagination".

The division of delusional phenomena into primary - intellectual and secondary - sensual. Primary - intellectual - delirium is often also referred to as "true", "systematized", "interpretive". Thus, K. Jaspers (1923) writes that we call true delusional ideas precisely those whose source is a primary pathological experience or a necessary prerequisite for the emergence of which is a change in personality; true delusional ideas can be indistinguishable from reality and coincide with it (for example, with delirium of jealousy); primary delusion is divided into delusional perception, delusional presentation, delusional awareness. MI Vaysfeld (1940) agrees with Roller and Meyser that primary delirium arises not as a result of a mental process, but directly in the brain. A. V. Snezhnevsky (1970, 1983) emphasizes that the facts and events of the external world and internal sensations distorted by the interpretation of patients serve as the starting point for intellectual delirium. VM Morozov (1975) points to the possibility of "infiltration" of interpretive systematized delirium with elements of sensual delusion and notes that, according to French psychiatrists, in such cases they speak of delusion of the imagination, which, including a reassessment of one's own personality and even megalomanic ideas , intensifies and accompanies interpretive paranoid delusions.

The term " interpretive delirium "and the concept of" delusional interpretation "are ambiguous, since they characterize various aspects of the psychopathological phenomenon.

Delusional interpretation is always expressed in a delusional interpretation of what is happening around, dreams, memories, own interoceptive sensations, illusions, hallucinations, etc. The symptom of delusional interpretation is polymorphic and can occur in any delusional psychosis. Interpretive delusions, or "delusions of interpretation" [Wernicke K-, 1900], are divided into acute and chronic according to the type of course. Each of these types is independent, they differ in the mechanism of occurrence, psychopathological manifestations, developmental features and nosological affiliation. In all domestic studies, P. Serier and J. Capgras (1909) are recognized as the founders of the doctrine of interpretive delirium, who identified two variants of interpretive delusion. To the first, the main, they attributed a syndrome that includes delusional concepts - "conceptual" delirium, to the second, symptomatic, - delusions of interpretation in the form of "speculative delusions" and "interrogative delusions". The main interpretive delusion (according to the modern nomenclature - chronic interpretive delusion), which occurs mainly in the structure of schizophrenia, includes systematized delusional ideas and is characterized by most of the signs of primary, or intellectual delusion. The relationship, the interdependence of the delusional concept, delusional inference and delusional interpretation in the case of primary intellectual delusion, accompanied by chronic interpretive delusional syndrome, can be twofold in terms of the mechanism of formation. In the first case, a delusional concept arises suddenly in the form of a delusional insight-"insight" followed by a chronic paralogical development of interpretive delusions; in the second, delusional interpretations with paralogical constructions precede the crystallization and subsequent systematization of delirium, and then continue in the form of an interpretation of the past, present and supposed future in accordance with the plot of the crystallized delusion.

Symptomatic interpretive delusions(according to modern nomenclature - acute interpretive delirium) occurs in various acute psychoses, including psychosis of dull consciousness.

In these cases, according to P. Serier and J. Capgras, the clinical picture is characterized by a lack of tendency to systematization, sometimes confusion, psychotic outbursts, intermittent flow, etc. It consists in a painfully perverted interpretation of "real facts" or sensations, usually with illusions and less often with hallucinations. According to J. Levi-Valency (1927), acute interpretive delirium differs from chronic interpretive delusion in the absence of a tendency to systematize; less depth, severity and complexity of interpretative constructions; more pronounced affective accompaniment, a tendency to anxiety and depressive reaction; more curable.

Since about the middle of this century, interest in the clinic of "delusion of interpretation" has increased markedly. At the same time, the manifestations of chronic interpretive delirium were still identified with manifestations of primary intellectual delusion, considering it as one of the sides of its inherent psychopathological picture, in most cases typical or even specific for schizophrenic delusion. Acute interpretive delusions, which occur in most psychoses, including schizophrenia, cannot be fully identified with secondary sensory delusions in all cases.

The clinical characteristics of acute sensory delirium compiled by J.Levy-Valenci are clarified and supplemented: this delusion is characterized by variability, inconstancy, instability, incomplete delusional ideas, the absence of a logical development of the plot, little dependence on the personality structure, the rapid pace of formation of ideas, sometimes the presence of critical doubts, individual scattered illusions and hallucinations. It is also characterized by the instantaneousness of occurrence, filling the plot of delirium happening at the moment around the patient without delusional retrospection and phenomenological, dynamic elements that allow us to consider acute interpretive delusion as an intermediate syndrome between chronic interpretive and acute sensory delusions [Kontsevoy VA, 1971; Popilina E. V., 1974]. A. Ey (1952, 1963), G.I. Zaltsman (1967), I.S. Kozyreva (1969), A.B.Smulevich and M.G. Shirin (1972), M.I. Fotianov (1975), E.I. Terent'ev (1981), P. Pisho (1982), V.M. Nikolaev (1983).

Secondary delirium- sensual, its clinical manifestations are described in a huge number of works by Russian, German, French psychiatrists, etc. In Russian psychiatry, especially in the second half of the 20th century, the term “sensual delirium” is used more often than others, but often the terms “affective delirium "," delirium of the imagination "," figurative delirium ", etc. The definition of the concept of" sensual delirium "throughout the century was given by many authors, correcting and complementing each other. In recent decades, consolidated definitions of the term "sensual delirium" have been repeatedly drawn up. So, A.V. Snezhnevsky (1968, 1970, 1983), summarizing the statements of a number of psychiatrists, writes that sensual delirium from the very beginning develops within the framework of a complex syndrome along with other mental disorders, has a clearly figurative character, is devoid of a coherent system of evidence, logical justification, differs in fragmentation, inconsistency, ambiguity, instability, change of delusional ideas, intellectual passivity, predominance of imagination, sometimes absurdity, accompanied by confusion, intense anxiety, often impulsivity. At the same time, the content of sensual delirium is built without active work on it, includes events, both real and fantastic, dreamlike.

Fantastic delirium is accompanied by confusion. It can manifest itself in the form of antagonistic delirium - a struggle between two principles, good and evil, or an almost identical Manichean delirium - a struggle between light and darkness with the participation of a patient in it, delirium of greatness, noble birth, wealth, power, physical strength, genius abilities, expansive , or grandiose, delirium - the patient is immortal, exists for thousands of years, possesses untold riches, the power of Hercules, is more brilliant than all geniuses, directs the entire Universe, etc. events with an assessment of what is happening around as a specially played staging - staging delirium. With sensual delirium, people and the environment are constantly changing - metabolic delirium, there is also delirium of a positive and negative double - acquaintances are disguised as strangers, and strangers - under acquaintances, relatives, all actions that take place around, auditory and visual perceptions are interpreted with special meaning - symbolic delirium, delirium values.

The fantastic delirium also includes the delirium of metamorphosis - transformation into another being and delirium of obsession. A type of figurative delusion is an affective delusion accompanied by depression or mania. Depressive delirium includes delusions of self-accusation, self-abasement and sinfulness, delusions of condemnation by others, delusions of death (loved ones, the patient himself, property, etc.), nihilistic delusions, Kotar's delusions.

A person often uses the word "delirium" in his speech. However, he understands by this the meaningless expression of thoughts that are not associated with a disorder of thought. In clinical manifestations, the symptoms of delusion and its stages resemble insanity, when a person really talks about something that is devoid of logic and meaning. Examples of delusions help in identifying the type of disease and its treatment.

You can rave even when you are healthy. However, the clinical ones are often more serious. The online magazine site discusses serious mental disorder under the simple word delirium.

What is nonsense?

Delusional disorder and its triad were considered by KT Jaspers in 1913. What is nonsense? This is a mental disorder of thinking, when a person makes unthinkable and unrealistic conclusions, reflections, ideas that cannot be corrected and in which the person unconditionally believes. He cannot be persuaded or shaken in his faith, since he is completely subject to his own delirium.

Delirium is based on the pathology of the psyche and mainly affects such areas of his life as emotional, affective and volitional.

In the traditional sense of the word, delusion is a disorder accompanied by a combination of ideas, conclusions and reasoning of a morbid nature that has taken possession of the human mind. They do not reflect reality and cannot be corrected from the outside.

Psychotherapists and psychiatrists deal with delusional states. The fact is that delirium can act both as an independent disease and as a consequence of another disease. The main reason for the appearance is brain damage. Bleuler, who studies schizophrenia, singled out the main feature in delusions - egocentricity, based on affective internal needs.

In colloquial speech, the word "delirium" is used in a slightly distorted meaning, which cannot be used in scientific circles. So, delirium is understood as the unconscious state of a person, which is accompanied by incoherent and meaningless speech. Often this condition is observed with severe intoxication, during an exacerbation of infectious diseases or after an overdose of alcohol or drugs. In the scientific community, such a state is called amentia, which is characterized, not thinking.

Also, delirium is understood as a vision of hallucinations. The third everyday meaning of delirium is the incoherence of speech, which is devoid of consistency and reality. However, this value is also not used in psychiatric circles, since it is devoid of the triad of delusions and can only indicate the presence of delusions in the reasoning of a mentally healthy person.

Any situation can be an example of delusion. Delusions are often associated with sensory perception and visual hallucinations. For example, a person may think that he can be recharged from electricity. Someone may argue that he lives for a thousand years and has participated in all significant historical events. Some crazy ideas are associated with extraterrestrial life, when a person claims that he communicates with aliens or that he himself is an alien from another planet.

Delirium is accompanied by vivid images and heightened mood, which further reinforces the delusional state.

Delusional symptoms

Delirium can be identified by the characteristic symptoms that correspond to it:

• Influence on affective behavior and emotional-volitional mood.
• Conviction and redundancy of a delusional idea.
• Paralogism is a false conclusion, which manifests itself in a discrepancy with reality.
• Weakenedness.
• Maintaining clarity of consciousness.
• Changes in personality that occurs under the influence of immersion in delirium.

It is necessary to clearly distinguish delusion from a simple delusion that can occur in a mentally healthy person. This can be determined by the following features:

1. Delirium is based on a certain pathology, delusion has no mental disorders.
2. Delirium cannot be corrected, since the person does not even notice the objective evidence refuting it. Delusion lends itself to correction and change.
3. Delirium arises on the basis of the inner needs of the person himself. Misconceptions are based on real facts that are simply misunderstood or not fully understood.

There are different types of delusions, which are based on certain reasons, have their own manifestations:

• Acute delirium - when an idea completely subordinates a person's behavior.
• Encapsulated delirium - when a person can adequately assess the surrounding reality and control his behavior, however, this does not apply to the topic of delusion.
• Primary delusion is illogical, irrational cognition, distorted judgment, supported by subjective evidence, which has its own system. Perception is not impaired, but emotional stress is noted when discussing the topic of delirium. It has its own system, progression and resistance to treatment.
• Hallucinatory (secondary) delirium is a violation of the perception of the environment, which also causes illusions. Delusional ideas are fragmentary and inconsistent. Impaired thinking is the result of hallucinations. Inferences are in the form of insights - bright and emotionally colored insights. There are the following types of secondary delusions:

1. Figurative - nonsense of presentation. It is characterized by fragmentary and scattered representations in the form of fantasies or memories.
2. Sensual - paranoia that what is happening around is a performance organized by a certain director who controls the actions of both those around and the person himself.
3. Delirium of imagination - based on fantasy and intuition, and not on distorted perception or erroneous judgment.

• Holotimny delirium is a disorder in affective disorders. In a manic state, delusions of grandeur arise, and during depression, a delusion of self-abasement.
• Induced (infection with an idea) delirium is the attachment of a healthy person to the delirium of a sick individual with whom he is constantly in contact.
• Catesthetic delirium is an occurrence against the background of hallucinations and senestopathy.
• Sensitive and katatimny delusions - the occurrence with severe emotional disorders in sensitive people or suffering from personality disorders.

Delusional states are accompanied by three delusional syndromes:

1. Paranoid syndrome - lack of systematization and the presence of hallucinations and other disorders.
2. Paraphrenic syndrome - systematized, fantastic, accompanied by hallucinations and mental automatisms.
3. Paranoia is a monothematic, systematic and interpretive delusion. There is no intellectual-mnestic weakening.

The paranoid syndrome, which is characterized by an overvalued idea, is considered separately.

Depending on the plot (the main idea of ​​delusion), there are 3 main groups of delusional states:

1. Delirium (mania) of persecution:

• Damage delusion is the idea that someone is harming or robbing a person.
• Delusions of influence - the idea that a person is influenced by some external forces, which subordinates his thoughts and behavior.
• Delirium of poisoning - the belief that someone wants to poison a person.
• Delirium of jealousy - the belief in the infidelity of a partner.
• Relationship delusion is the idea that all people have something to do with a person and it is conditioned.
• Erotic delirium is the belief that a person is being pursued by a certain partner.
• Delirium of litigation - a person's tendency to constantly fight for justice through courts, letters to management, complaints.
• Delirium of obsession - the idea that a certain living force, an evil creature, has infiltrated a person.
• Staging delirium is the belief that everything around is played out like a performance.
• Presenile delirium - ideas of condemnation, death, guilt under the influence of a depressive state.

1. Delirium (megalomania):

• Delirium of reformism - the creation of new ideas and reforms for the benefit of humanity.
• Delirium of wealth - the conviction that one has innumerable treasures and riches.
• The delirium of eternal life is the conviction that a person will never die.
• Delirium of invention - the desire to make new discoveries and create inventions, the implementation of various unrealistic projects.
• Erotic delirium is a person's conviction that someone is in love with him.
• Descent - the belief that parents or ancestors are noble or great people.
• Love delirium - the conviction that a famous person is in love with a person or everyone with whom he at least once communicated or met.
• Antagonistic delirium is a person's conviction that he is an observer of the war of some two opposing forces.
• Religious nonsense - the idea of ​​a person that he is a prophet can work miracles.

1. Depressive delusions:

• Nihilistic delirium - the end of the world has come, the person or the world around him does not exist.
• Hypochondriacal delirium - the belief in the presence of a serious illness.
• Delirium of sinfulness, self-blame, self-deprecation.

Stages of delirium

Delirium is divided into the following stages of the course:

1. Delusional mood - a premonition of trouble or the conviction of a change in the world around us.
2. An increase in anxiety due to delusional perception, as a result of which delusional explanations of various phenomena begin to arise.
3. Delusional interpretation - the explanation of phenomena by delusional thinking.
4. Crystallization of delirium is a complete, harmonious formation of delusional inference.
5. Delusional fading - criticism of a delusional idea.
6. Residual delusions are residual effects after delusions.

Thus delirium is formed. At any stage, a person can get stuck or go through all the stages.

Delirium treatment

Delirium treatment implies a special effect on the brain. This is feasible with antipsychotics and biological methods: electric shock, drug shock, atropine or insulin coma.

Psychotropic drugs are chosen by the doctor depending on the content of the delusion. For primary delirium, selective drugs are used: Triftazin, Haloperidol. With secondary delirium, a wide range of antipsychotics are used: Aminazin, Frenolone, Melleril.

Delusional treatment is carried out inpatiently followed by outpatient therapy. An outpatient clinic is appointed in the absence of aggressive tendencies towards reduction.

Forecast

Is it possible to save a person from delirium? If we are talking about mental illness, then you can only stop the symptoms, for a short while allowing the person to feel the reality of life. Clinical delirium gives unfavorable prognosis, since patients left unattended can harm themselves or those around them. Only an everyday understanding of delirium can be cured, allowing a person to get rid of delusions that are natural for the psyche.

Delirium is an inference that is false and does not correspond to reality, arising in connection with diseases. Unlike errors of judgment, in healthy people, delusional ideas are illogical, absurd, fantastic and persistent.

Delirium is not the only sign of mental illness; quite often it can be combined with hallucinations, provoking hallucinatory delusional states. It happens with thought disorder and with perception disorders.

A delusional state is characterized by mental confusion, impaired coherence of thoughts, clouded consciousness, in which a person cannot concentrate and sees hallucinations. He is immersed in himself, fixed on one idea and is not able to answer questions or hold a conversation.

For most people, the delusional state lasts for a fairly short period. But if, before the onset of delirium, the patient did not differ in special mental and physical health, then an acute delusional state can last for several weeks. If the disease is not treated, it becomes chronic.

Even after treatment, the remnants of delusional ideas can remain with a person for life, for example, delirium of jealousy in chronic alcoholism.

The difference between a delusional state and dementia

With somatic diseases, a delusional state is a consequence of organic lesions due to trauma, intoxication, lesions of the vascular system or the brain. Also, delirium can occur against a background of fever, medication or drugs. This phenomenon is temporary and reversible.

In mental illness, delirium is a major disorder. Dementia or dementia is a breakdown of mental functions, in which the delusional state is irreversible and practically does not respond to drug treatment and progresses.

Also, dementia, unlike delirium, develops slowly. In the early stages of dementia, there is no problem concentrating, which is also a hallmark.

Dementia is congenital, the cause of it is intrauterine damage to the fetus, birth trauma, genetically determined diseases, or acquired due to tumor trauma.

Causes of delirium

The cause of delirium is a combination of certain factors that lead to the fact that the work of the brain is disrupted. There are several of them:

• Psychological or environmental factor. In this case, the trigger for delirium can be stress, alcohol or drug abuse. It also includes taking certain medications, hearing and vision problems.
• Biological factor. The cause of delirium in this case is an imbalance of neurotransmitters in the brain.
• Genetic factor. The disease can be inherited. If a family member suffers from delusional disorder or schizophrenia, then there is a possibility that the disease will manifest itself in the next generation.

Signs of delusional ideas

Delusional ideas are an important and characteristic sign of mental disorder. These are misconceptions that cannot be corrected without the use of drugs. People with the disease do not lend themselves to persuasion. The content of delusional ideas can be different.

Signs of delusional ideas are:

• The appearance of implausible, incomprehensible to others, but at the same time meaningful statements. They add significance and mystery to the most mundane topics.
• The behavior of a person in the family circle changes, he can be withdrawn and hostile or groundlessly cheerful and optimistic.
• There are unfounded fears for your life or the life and health of your relatives.
• The patient may become anxious and fearful, begin to close doors or carefully curtain windows.
• A person can start actively writing complaints to various authorities.
• May refuse food or check food thoroughly before consuming.

Delusional syndromes

Delusional syndromes are mental disorders that are characterized by the emergence of delusional ideas. They differ in forms of delusion and a characteristic combination of symptoms of a mental disorder. One form of delusional syndrome can turn into another.

Paranoid Syndrome

Paranoid syndrome is delusional disorder of thought. It develops slowly, gradually expanding and involving new events and persons in delirium, while using a complex system of evidence. Delirium in this case is systematized and different in content. The patient, for a long time and in detail, can talk about some significant idea.

With paranoid syndrome, there are no hallucinations and pseudo-hallucinations. There are imperceptibly certain violations in the behavior of patients, until the moment when it comes to a delusional idea. In this respect, they are not critical and easily add to the category of enemies those persons who are trying to convince them.

The mood in such patients is upbeat and optimistic, but can change quickly and become angry. In this state, a person can perform socially dangerous actions.

Kandinsky-Clerambeau syndrome

Paranoid syndrome occurs in schizophrenia. In this case, the patient develops a delusion of persecution, physical influence with hallucinations and phenomena of mental automatism. The most common idea is persecution by some powerful organization. Usually, patients believe that their thoughts, actions, dreams are being watched (ideatorial automatism), and they themselves want to be destroyed.

According to them, the pursuers have special mechanisms operating on atomic energy or electromagnetic waves. Patients argue that someone controls the work of their internal organs and forces the body to perform different movements (mental automatism).

The patients' thinking is disturbed, they stop working and do their best to "protect" themselves from the persecutors. They can commit socially dangerous actions, and can also be dangerous to themselves. In an aggravated state of delusion, the patient may commit suicide.

Paraphrenic syndrome

With paraphrenic syndrome, delusions of grandeur are combined with delusions of persecution. Such a disorder occurs in schizophrenia, various types of psychosis. In this case, the patient considers himself to be an important person on whom the course of world history depends (Napolene, the president or his relative, a direct descendant of the king or emperor).

He talks about great events in which he participated, while the delusions of persecution may persist. Criticism from such people is completely absent.

Acute paranoid

This type of delusion occurs with various mental illnesses. It can occur with schizophrenia, alcohol or drug intoxication. In this case, the figurative, sensual delirium of persecution prevails, which is accompanied by a feeling of fear and anxiety.

Before the development of the syndrome, there is a period of unaccountable anxiety and foreboding of trouble. The patient begins to think that they want to rob or kill him. The condition can be accompanied by illusions and hallucinations.

Ideas of delusion depend on the external environment and actions are determined by fears. Patients can suddenly run away from the premises, seek protection from the police. Usually, these people have disturbed sleep and appetite.

With organic brain damage, delusional syndrome worsens at night and in the evening, therefore, during this period, patients need increased supervision. In this state, the patient is dangerous to others and to himself, he can commit suicide. With schizophrenia, the time of day does not affect the patient's condition.

Types of delusions

Primary delusions

Primary or autochthonous delusions arise abruptly, before that there are no mental shocks. The patient is fully convinced of his idea, although there was not the slightest prerequisite for its emergence. It can also be a mood or perception of a delusional character.

Signs of primary delusion:

• Its complete formation.
• Suddenness.
• An absolutely convincing shape.

Secondary delirium

Secondary delirium, sensual or imaginative, is a consequence of a pathological experience that has taken place. May occur after a previously manifested delusional idea, depressive mood or hallucination. With a large number of crazy ideas, a complex system can be formed. One delusional thought pulls another. This is a systematic delusion.

Signs of secondary delirium:

• Delusional ideas are fragmentary and inconsistent.
• The presence of hallucinations and illusions.
• Appears against the background of mental shock or other delusional ideas.

Secondary delirium with a special pathogenesis

Secondary delirium with a special pathogenesis (sensitive, katatimny) is a non-schizophrenic paranoid psychosis that occurs as a result of long-term and serious experiences including insult to pride and humiliation. The patient's consciousness is affectively narrowed and self-criticism is absent.

With this type of delirium, personality disorder does not occur and there is a favorable prognosis.

Induced delirium

Induced delusion or insanity together is characterized by the fact that delusional ideas are collective. A close person, for a long time and unsuccessfully tries to convince the obsessed with delusional ideas, and over time he begins to believe in them and adopt. After the couple is separated, the manifestations of the disease disappear in a healthy person.

Induced delusions often occur in sects. If a person suffering from a disease, a strong and authoritative person, has the gift of oratory, then weaker or mentally retarded people succumb to his influence.

Delirium of imagination

Delusional ideas in this case are implausible, devoid of any logic, consistency and system. For the occurrence of such a condition, a person suffering from an ailment must with signs of psychopathy, withdrawn, weak in character or mentally retarded.

Themes of delirium

There are many themes of delusion, and they can flow from one form to another.

Relationship	The patient is worried about something in himself, and he is convinced that others notice it and experience similar feelings.
Persecutors	Persecution mania. The patient is sure that some person or group is pursuing him in order to kill, rob, etc.
Guilt	The patient is sure that others condemn him for what he allegedly committed, an unreliable act.
Metabolic	A person is sure that the environment changes and does not correspond to reality, and objects and people are reincarnated.
High origin	The patient is sure that he is a descendant of people of high origin, and considers his parents to be fake.
Archaic	The contents of this nonsense are associated with the representation of the past tense: the Inquisition, witchcraft, etc.
Positive double	Patients recognize strangers as relatives.
Negative double	People suffering from this delusion see strangers in their relatives.
Religious	The patient considers himself a prophet and is convinced that he can perform various miracles.
Delirium of invention	A person implements fantastic projects without having a special education. For example, he invents a perpetual motion machine.
Delusions about owning thoughts	A person is sure that his thoughts do not belong to him and that they are being extracted from his mind.
Greatness	Megalomania. The patient greatly overestimates his importance, popularity, wealth, genius, or considers himself omnipotent.
Hypochondriacal	Exaggerating fears for your health. The patient is confident that he has a serious illness.
Hallucinatory	It manifests itself in the form of intense hallucinations, most often auditory.
Apocalyptic	The patient believes that the world will soon perish in a global catastrophe.
Dermatozoic	The patient believes that insects live on or under his skin.
Confabulatory	The patient has fantastic false memories.
Mystical	It can be of religious and mysterious content.
Impoverishment	The patient believes that they want to deprive him of material values.
Doubles	The patient is sure that he has several doubles who commit unseemly acts and dishonor him.
Nihilistic	It is characterized by negative ideas about one's own personality or the world around it.
Masturbators	It seems to the patient that everyone knows about his self-satisfaction, they laugh and hint to him about it.
Antagonistic	A person believes that he is at the center of the struggle between good and evil.
Abortive	In which there are separate and scattered ideas that disappear very quickly.
By my own thoughts	It seems to the patient that his own thoughts sound too loud, and their contents become known to other people.
Obsessions	A person imagines that some fantastic creatures live inside him.
Pardons	This delusion occurs in persons who spend a long time in prison. It seems to them that they should be pardoned, reconsider the indictment and change the sentence.
Retrospective	The patient has false judgments about any events preceding the disease.
Damage	A person is convinced that his property is deliberately damaged and plundered.
Inferiority	The patient believes that a small offense committed in the past will become known to everyone and therefore he and his loved ones will be condemned and punished for this.
Love delirium	Mostly women are susceptible to this. The patient believes that a famous man is secretly in love with him, whom he has not met in reality.
Sexual	Delusional ideas associated with intercourse, somatic hallucinations felt in the genitals.
Control	The patient is convinced that his life, actions, thoughts and actions are controlled from the outside. Sometimes he can hear hallucinatory voices and obey them.
Transmission	The patient thinks that his unspoken thoughts become known to other people using telepathy or radio waves.
Poisoning	The patient is convinced that they want to poison him by adding or spraying poison.
Jealousy	The patient is convinced that his partner is sexually unfaithful.
Beneficial impact	It seems to the patient that he is being influenced from the outside with the aim of enriching him with knowledge, experience or re-education.
Protections	The person is sure that he is being prepared for a responsible mission.
Querulianism	Fight for your own or someone else's, allegedly trampled dignity. Assigning a mission to combat imaginary flaws.
Dramatizations	The patient thinks that all around are actors and play their roles according to their script.

Causes of a delusional state

The risk zone for delusional states includes the following factors:

• Elderly age.
• Prolonged insomnia.
• Serious illnesses.
• Diseases of the hearing or vision.
• Hospitalization.
• Operational interventions.
• Severe burns.
• Dementia.
• Memory impairment.
• Lack of vitamins.

Change in body temperature

Changes in body temperature include fever or hypothermia. At the height of the fever, confusion of consciousness, a change in mental activity can sometimes be observed. There is a feeling of inability to control consciousness, lack of ingenuity. In this case, crowds of people, events, parades, the sound of music or songs are often seen. Especially often, this condition can occur in young children.

With hypothermia and a decrease in body temperature of less than thirty degrees, mental activity is disturbed, a person does not control himself and is not able to help himself. The condition may be accompanied by a ruptured delirium.

Disturbances in the circulatory system

Delusional states in this case can occur with pathologies such as:

• Arrhythmia.
• Heart attack.
• Stroke.
• Heart attack.
• Heart failure.

In this case, delirious disorders often occur, which can be accompanied by euphoria, or feelings of fear and anxiety. In the early periods of a heart attack, illusory-hallucinatory disorders, depression, anxiety, and loss of self-esteem may appear. As the disease progresses, delusional ideas appear.

Attacks of angina pectoris are accompanied by fear, anxiety, hypochondria, fear of death.

Disturbances in the nervous system

Delusional symptoms can occur with disturbances in the functioning of the nervous system, namely:

• Infections.
• Head trauma.
• Convulsive seizures.

In some cases, head injuries or seizures can trigger delusional states. More often than not, the leading symptom of this psychosis is persecution delusions.

Such symptoms can appear, both immediately after an injury or an epileptic seizure, and in the form of long-term consequences.

With infections and intoxications, delusions of persecution mainly develop.

Medicines and substances

Various chemicals and medications can trigger delusions. Each of them has its own mechanism of action:

• Alcohol. It affects the central nervous system, as a result of which secondary delusions develop. This is most often manifested during the period of stopping the use of alcoholic beverages. During the acute period, alcoholics suffer from delusions of jealousy and persecution, which may persist in the future.
• Drugs. A severe delusional state, in contrast to alcoholic one, occurs after taking drugs. It is usually accompanied by hallucinations, a change in attitude. Often in this case, there is a religious delirium or delusion of their own thoughts.
• Medicines: antiarrhythmics, antidepressants, antihistamines, anticonvulsants. And also barbiturates, beta-blockers, glycosides, digatalisa, lithobid, penicillin, phenothiazines, steroids, diuretics. Delirium and delusional ideas can occur with an overdose or prolonged and uncontrolled medication. In this case, paranoid syndrome may develop.

Salts in the body

Excess or deficiency of calcium, magnesium or sodium has a negative effect on the human body. In this case, violations occur in the circulatory system. The consequence of this is hypochondriacal or nihilistic delusions.

Other causes of delirium

• Kidney failure.
• Liver failure.
• Cyanide poisoning.
• Lack of oxygen in the blood.
• Low blood sugar.
• Disorder of the functions of the glands.

In these cases, a twilight state occurs, accompanied by torn delirium and hallucinosis. The patient does not understand well the speech addressed to him, cannot concentrate attention. The next stage is the loss of consciousness and coma.

Diagnostics and differential diagnostics

In order to diagnose the disease, the doctor must conduct a survey and identify:

• The presence of diseases and injuries.
• Eliminate the use of narcotic or medicinal products.
• Determine the time and rate of change in the mental state.

Differential diagnosis

This is a method that allows you to exclude possible diseases in a patient that are not suitable for any symptoms or factors, and to establish the correct diagnosis. In the differential diagnosis of delusional disorders, it is necessary to identify the differences between organic diseases from schizophrenia and psychogenic and affective psychoses.

Schizophrenia can be characterized by a wide range of manifestations, and there are certain difficulties in its diagnosis. The main criterion is typical disorders in which personality change occurs. It should be limited from atrophic processes, affective psychoses and organic diseases and from functional psychogenic disorders.

Personality defect and productive symptoms in organic diseases differ from schizophrenic ones. In affective disorders, there is no personality defect, as in schizophrenia.

Analyzes and studies that are carried out to diagnose the disease

Delirium is usually a symptom of a disease, and in order to find out its cause, special tests will be needed:

• General analysis of blood and urine (in order to exclude infectious diseases)
• Determine the level of calcium, potassium, sodium.
• Determine the patient's blood glucose level.

If you suspect a certain disease, special studies are carried out:

• Tomography. Helps eliminate the presence of tumors.
• Electrocardiogram. It is carried out for heart disease.
• Encephalogram. It is carried out with signs of seizures.

In some cases, tests for kidney, liver, and thyroid function and a spinal tap are done.

Treatment

Treatment of a delusional state is carried out in several stages:

1. Active therapy. It begins to be carried out from the moment the patient or his relatives apply for help, before a stable remission occurs.
2. Stabilization stage. In this case, the maximum remission is formed, and the patient returns to the previous level of psychological labor and social adaptation.
3. Preventive stage. It is aimed at preventing the development of seizures and relapses of the disease.

Psychosocial therapy for delusional states

• Individual psychotherapy. Helps the patient correct distorted thinking.
• Cognitive Behavioral Therapy. Helps the patient to recognize and change the train of thought.
• Family therapy. Helps family and friends of the patient to communicate effectively with a person suffering from delusional disorders.

Drug treatment

If the cause of delirium is organic brain damage due to intoxication or injury, then first of all, drugs are prescribed to treat the underlying disease. A doctor with a specialized specialization is engaged in the treatment of the underlying disease.

For the treatment of mental illness, in particular delusions and delusional ideas, antipsychotic drugs are used. The very first antipsychotic is Aminazine and its derivatives. These drugs block dopamine receptors in the brain. There is a theory that it is they who are the provocateurs of delirium. Best of all, the drug Triftazin removes the delusional component.

These drugs have many side effects and can cause neurolepsy in about 25% of cases. To correct this side effect, use the drug Cycladol. Malignant neurolepsy can be fatal.

Atypical antipsychotics are new generation drugs that block, in addition to dopamine receptors, and serotonin ones. These medicines include Azaleptin, Azaleptol, Haloperidol, Truxal.

In the future, the patient is prescribed tranquilizers, mainly benzodiazepine derivatives: Phenazepam, Gidazepam. Sedatives are also used: Sedasen, Deprim.

After treatment with antipsychotics, a gross defect remains in the form of a decrease in intelligence, emotional coldness. The dosage of drugs and the course of treatment should be prescribed by a doctor.

Supportive care

If necessary, the patient needs help in everyday situations, he needs to help him take food, teach him to navigate in time and space. To do this, you need to hang a calendar and clock in the room where it is located. It is worth reminding the patient where he is and how he got here.

If the treatment takes place in a specialized institution, you need to bring the patient's belongings from home so that he can feel calmer. The patient is given the opportunity to perform simple manipulations himself, for example, dress, wash.

You need to communicate with a person who has experienced a delusional state very calmly, once again, without provoking conflict situations.