Delusions of perception. Delirium, delusional states - symptoms, diagnosis, help. Diagnostics and differential diagnostics

Delusional ideas - false, erroneous judgments arising on a pathological basis, take possession of the entire consciousness of the patient, do not lend themselves to logical correction, despite the obvious contradiction with reality.

Classification of delusional ideas: A. by content (story of delusion) 1. Delusional ideas persecution(persecution, exposure, staging, litigation, poisoning, harm, jealousy) 2. Delusional ideas greatness(reform, wealth, love charm, high birth, invention) 3. Delusional ideas self-deprecation(guilt, impoverishment, sinfulness, dysmorphomania, hypochondriacal delirium)

According to the plot, those. on the main content of the delusional concept ( system of pathological inferences) in accordance with the classification of the German psychiatrist V. Griesinger, there are three types of delusions: persecution (persecutory), depressive and greatness. Each of these types of delusions includes many different clinical variants.

1) Persecutory delirium: persecution itself, poisoning, property damage, jealousy, impact, relationship, witchcraft (damage), mastery. The last three concepts (of course, and some of their other variants, which is associated with specific ethnocultural characteristics of the patient) constitute the so-called archaic forms of delirium, the content of which directly follows from the ideas prevailing in society.

Delusional ideas of persecution, especially at the stage of their occurrence, are often accompanied by anxiety, fear, often act as a determining factor in the patient's behavior, which can cause his danger to others and may require urgent hospitalization in an involuntary manner. The danger increases when the “evil” inflicted, in the patient's opinion, finds a specific carrier from the immediate environment.

2) Depressive delusions can occur in the following clinical variants: self-accusation, self-deprecation, sinfulness, evil power, hypochondriacal, dysmorphomanic, nihilistic. Each of these options can have its own characteristics and storyline. However, they all exist against the background of a depressed mood. Establishing the sequence of the appearance of psychopathological phenomena is of diagnostic significance here: what is primary - delusional ideas of the corresponding content or depressive mood.

Depressive ideas can determine the behavior of patients and, accordingly, lead to social danger of the patient (primarily for himself, since suicide attempts are possible).

The most intense and complex depressive delirium occurs with prolonged anxiety depression. In these cases, Kotard's delirium often develops. Cotard's delirium is characterized by fantastic ideas of denial or enormity. In the presence of ideas of denial, the patient reports on his lack of moral, intellectual, physical qualities (no feelings, conscience, compassion, knowledge, ability to feel). In the presence of somatopsychic depersonalization, patients often complain of the absence of the stomach, intestines, lungs, heart, etc. etc. They can talk not about the absence, but about the destruction of internal organs (the brain has dried up, the intestines have atrophied). The idea of ​​denying the physical "I" is called nihilistic delirium. Denial can extend to various concepts of the external world (the world is dead, the planet has cooled down, there are no stars, no centuries).

Often, with Kotard's delirium, patients blame themselves for all sorts of accomplished or impending global cataclysms (delirium of negative power) or express ideas about eternal torment and the impossibility of dying (delirium of painful immortality).

3) Delusional ideas of greatness are always noted against the background of increased self-esteem of the patient and include the following clinical options: delirium of invention, reformism, high origin, wealth. This also includes the so-called love delirium (love charm) and the absurd megalomaniac delirium of grandeur, proceeding, as a rule, against the background of pronounced dementia. At the same time, the patient's statements about his extraordinary abilities, position or activity acquire a grandiose scope, and their inadequacy is striking to any person (“I rule the globe and all the Gods of the universe”). Ideas of greatness are most often characteristic of later stages of mental illness or for severe, rapidly progressing and leading to dementia organic brain lesions.

According to the degree of completeness of the system of delusional inferences (pathological system of evidence), delusions are usually divided into systematized and unsystematized (sketchy).

A systematized delusion is characterized by an extensive system of evidence "confirming" the plot underlying the pathological ideas. All the facts given to the patient are interrelated and have an unambiguous interpretation. As the disease progresses, an increasing number of reality phenomena are included in the delusional system, and the thinking process itself becomes more and more detailed with the unconditional preservation of the main painful idea. In the presence of a pronounced systematization of delirium, a longer, chronic nature of the mental disorder should be assumed. For acute conditions, unsystematized delusions are more often characteristic. The same delirium can also be noted with rapidly progressive organic lesions of the brain, when, along with the disintegration of the psyche (the formation of dementia), the previously harmonious system of delusional structures also disintegrates.

Delirium is also usually divided into the so-called primary and secondary ( although, according to various researchers, this division is conditional).

In case of primary delirium, the patient's delusional constructions are primarily determined by a disorder of the sphere of thinking, leading to an inadequate interpretation of real-life phenomena (hence the other name for this delusion - interpretive).

Secondary delirium arises on the basis of existing disorders of other areas of mental activity in the presence of other psychopathological phenomena (hallucinations, affective disorders, memory disorders, etc.).

According to the mechanisms of occurrence, the following types of delusions can be distinguished: katatimny, holotimny, induced, residual, confabulatory.

Catatim delirium is built on the basis of an emotionally colored complex of dominant (in some cases, overvalued) ideas and perceptions.

At the heart of holotimnogo delirium (according to E. Bleuler) are changes in the emotional sphere, the content of delusional ideas here corresponds to a changed mood (delirium of love charm with an increase in mood in a manic state and as a contrast-delusion of self-accusation in depression).

With induced delirium, a kind of infection occurs, the transmission of delusional experiences existing in the initially ill person (inductor) to a person who has not previously shown signs of mental disorder.

In some cases, the content of delusional ideas in closely communicating (and more often living together) people can have far-reaching similarities, despite the fact that each of them suffers from an independent mental disorder of a different genesis. Such nonsense (of very different content) is usually called conformal, putting into this concept only the coincidence of the main plot of delusional constructions, with the possibility of a certain discrepancy in the specific statements of each of the patients.

Residual delirium (according to Neisser) arises after the transferred state of disturbed consciousness and is built on the basis of memory disorders associated with this (such as "island memories") in the absence of any connection with the real phenomena of reality that actually occur after the disappearance of the acute state.

In confabulatory delusions, the content of delusional constructions is determined by false memories, which, as a rule, are of a fantastic nature.

Delusions can also be characterized in terms of stages its development:

delusional mood - the experience of the surrounding world with a sense of its change and a kind of expectation of upcoming grandiose events such as impending disaster;

delusional perception - the incipient delusional interpretation of certain phenomena of the surrounding world along with increased anxiety;

delusional interpretation - delusional explanation of the perceived phenomena of reality;

crystallization of delirium - completion of the construction of varying degrees of complexity and "logical" sequence of the system of delusional inferences;

reverse development of delirium - the emergence of criticism of individual delusional constructions or delusional system as a whole.

Delusional syndromes: A. Paranoid syndrome: represented by systematized interpretive (primary) delusions, not accompanied by hallucinations or mood disorders, usually monothematic (for example, reformism, invention, jealousy, querulism, etc.) B. Paranoid syndrome: Represented by secondary sensory delusions. Delirium arises against the background of the affect of anxiety, fear, depression, hallucinations, mental automatisms, catatonic disorders. Therefore, depending on the disorders prevailing in the clinical picture, they talk about: Paranoid syndrome Hallucinatory-paranoid syndrome Depressive-paranoid syndrome Syndrome of mental automatisms of Kandinsky-Clerambo, etc. Paraphrenic syndrome: represented by all manifestations of Kandinsky-Klerambo s-ma (delusions of persecution and influence, pseudohallucinations, mental automatisms) + Megalomanic delusions (fantastic delusions of grandeur) ...

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, the 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 delirium 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, and 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 options for the 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 nonsense, 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 delusion 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. P.

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 combined 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 psychosis 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 - delirium of persecution, exposure, poisoning, hypnotic influence; for circular depression - the idea of ​​self-blame; for age-related psychoses - delirium of damage, stealing.

Some authors point out the dependence “ focus»Themes, 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 opposite points of view about 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 tend 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 a typical, or specific, for some psychoses, the content of delusion does not exclude the possibility of the emergence of delusional ideas close to the plot in various mental illnesses. This circumstance does not give grounds for 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 “late 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. Ye. 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 in 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. E. 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 "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 hypochondriacal 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, the delusion is abstracted, 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]; the 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. Goffman (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 that include 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, greatness, 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 accepted. 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 delusion into intellectual and sensual are, to a certain extent, based on certain 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, considering 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 placement of accents 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 sensory 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 (with the exception 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 delirium 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 found 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 the primary delusion 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 delusion with elements of sensual delusion and notes that, according to French psychiatrists, in such cases they speak of delusion of 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" delusion, 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 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 the modern nomenclature - acute interpretive delirium) occurs in various acute psychoses, including psychoses 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 by 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 have been clarified and supplemented: this delusion is distinguished 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 the formation of ideas, sometimes the presence of critical doubts, individual scattered illusions and hallucinations. It is also characterized by instantaneous 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 sensual delusions [Kontseva 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 constantly change - metabolic delirium, there is also delirium of a positive and negative double - acquaintances are made up as strangers, and strangers are made up under friends, relatives, everything that happens around the action, 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 creature 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.

Definition problem:

On the one hand, the word delirium is the name of a disease, for example, lingering alcoholic delirium, infectious delirium, on the other hand, it is the designation of a certain psychopathological phenomenon, a characteristic phenomenon, but still only a separate symptom found in a variety of diseases.

In order to avoid misunderstandings, instead of a broad and insufficiently defined term, one should speak in appropriate cases about delirium and delusional ideas as separate signs of psychosis or about deliriums, delirious states of alcoholic, infectious or some other origin.

Crazy ideas in a short definition, these are delusions that have arisen on a painful basis, inaccessible to correction either through persuasion or in any other way. In their essence, these are incorrect, false thoughts, errors of judgment, but they stand out from a number of other delusions, for example, prejudices, superstitions, common but incorrect opinions, precisely because they develop on painful soil; they are individual, they constitute something inherent in this particular psychic personality.

Rave can almost exhaust the clinical picture of psychosis, being, as it were, a monosymptom, for example, in paranoid states, at the same time, all authors agree that delirium is heterogeneous, that it is not a single disorder in structure, and that there are several forms of delusion.

Some definitions:

Ø Delirium is an incorrect conclusion arising on a pathological basis, completely changing the patient's worldview, not amenable to correction from the outside and from the inside, and over time undergoing a certain dynamics (A.V. Snezhnevsky).

Ø Delirium is 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 (Bleicher, Kruk 1996).

Ø Delirium is a false opinion based on a distorted view of reality, which is stubbornly defended against the opinions of the absolute majority and despite irrefutable and obvious evidence to the contrary (DSM-IV 1994)

Delusional criteria (according to K. Jaspers):

• subjective conviction of a person in his righteousness
• impossibility of correction
• delirium may or may not correspond to reality, or somehow agree with it - the specificity of delirium is that it does not need to be confirmed or refuted

The concept of delirium crystallization:

• Delusional mood :

ü Intense foreboding of an impending catastrophe;

ü Inexplicable excruciating anxiety;

ü Acquisition of other meaning to others;

ü Perception of yourself and the world around you as changed

• Delusional perception : a person notices some strange things in the world that confirm his delusional mood

Delusional perception can be preceded by a delusional mood based on the same process, an experience of anxiety, less often - elation. In this vague mood, delusional perception often means "something", but so far nothing definite. The specific content of delusional perception cannot be understood on the basis of an indefinite delusional mood: the second, at best, is part of the first, but cannot be deduced from it.

Emotionally, a delusional mood does not even have to coincide with the subsequent delusional perception: a delusional mood can be anxious, and a delusional perception can be blissful.

Talking about delusional perception should be in cases where actual perception without rationally or emotionally explainable reason is given an abnormal meaning, mostly in terms of connection with one's own personality... This meaning is of a special kind: almost always important, urgent, to a certain extent attributable to its own account, as some kind of sign, a message from another world. It is as if the perception expresses "the highest reality," in the words of one of the patients.

§ Since we are not talking about a noticeable change in the perceived, but about an anomalous interpretation, poor perception does not refer to disturbances in perception, but to disturbances in "thinking".

An example of a patient with schizophrenia “On the stairs of the Catholic convent a dog was waiting for me. She sat up erect, looked at me seriously, and raised her front paw as I approached. By chance, a few meters ahead of me, another man was walking the same way, and I hastened to catch up with him to ask if the dog behaved in the same way with him. His surprised "no" convinced me that I was dealing with some kind of revelation here. "

• Delusional presentation : rethinking the events of a past life
• Delusional awareness : a person suddenly becomes clear, he even experiences some relief - "delirium falls out like a crystal"

Types of delirium:

There are many classifications of delusion, but among all of them two main criteria can be distinguished: form and content. The typology given below is based on the criterion of the form, as well as the substantive aspects of a particular type of delusion are presented in it.

Paranoid delusions(synonyms: systematic, delusional interpretation, interpretive):

• A paranoid patient correctly reflects things, in internal connections they are reflected perversely... Predominantly, abstract cognition is upset, the reflection of not in general, not of external connections, but of internal connections between things, phenomena is disturbed - the reflection of causal, causal connections is upset.
• Such nonsense is always logical.... The patient can prove to develop a chain of logical evidence, his innocence, the correctness of his statement. He endlessly discusses and brings more and more new evidence. Paranoid delusions are always systematized, this is a system, although built on a crooked logic, but still on logic.
• The onset of delirium is preceded by a state of the so-called delusional mood with vague anxiety, a tense sense of an impending threat, a wary perception of what is happening around. The appearance of delirium is accompanied by a subjective feeling of relief, a feeling that the situation has become clear, and vague expectations, vague assumptions have formed into a clear system.
• Characterized by the gradual development and complication of the delusional system... This delirium develops long enough and chronically. Whatever happens around the patient, he will always interpret the events taking place so that they fit into his delusional system. However, sometimes paranoid delirium develops suddenly, acutely, like "insight", "sudden thought".
• Content paranoid delirium can reflect all human feelings, passions, desires (examples):
• delirium of jealousy
• reformist delirium: the patient develops a system of transforming the world, a system of "making happy" people around the globe
• persecution delirium: the patient initially hides his faith, the conviction that he is unkindly treated, he is persecuted, then suddenly begins to fight against his imaginary persecutors, becomes persecuted! pursuer., or, on the contrary, begins to flee from his pursuers. ”migrating paranoids., moving from place to place
• hypochondriacal delirium: there arises a delusional conviction, grounded by "kryvologika", that the soloist suffers from this or that incurable disease. Such big ones will challenge all medical reports, all laboratory tests. Drawing on all the modern medical literature, they prove that they have a disease and require treatment.
• But I must say that patients with paranoid delusions are also distinguished by a tendency to fantasize, daydreaming, immaturity of thinking. Some psychiatrists pointed out that they are generally immature, they also have sexual immaturity, that there is some kind, if not infantilism, then at least juvenile in the personality of such patients.

Paranoid delirium(synonyms: figurative, sensual, unsystematic):

§ Such nonsense is also called secondary, bearing in mind that this is not the primary expression of the process, but delirium, which is born sequentially as a result of hallucinations, disorder of affect, clouding of consciousness (a person hears - hostile voices, therefore, in a “psychologically understandable way” he may have ideas of persecution). With this approach, normal relationships take the place of pathological ones - in the delirium, the patient's attempt is expressed to somehow explain the pathology, a qualitatively excellent condition.

§ If this delusion is approached clinically, descriptively, it should be called delusion sensual, because it lacks logical premises, "curve logic" of the proof. Consequently, with sensual delirium, ideas are inconsistent, conclusions are random. At the same time, an extremely intense affect, impulsive, unmotivated actions and deeds, confusion, fragmentation and inconsistency of thinking are noted.

§ Sensual delirium in its syndromological picture is another syndrome that sharply differs from the paranoid one. During its development, a radical change in the patient's personality is not detected, there is no thoroughness of thinking, on the contrary, thinking is inconsistent, fragmentary, an element of anxiety, fear prevails, confusion is found.

§ In its own way content sensual, imaginative delirium is not the same.

Specific content of delirium :

railroad paranoid : a patient is traveling in a carriage and suddenly all passengers begin to be perceived as bandits who sat down to attack him in the same compartment of the carriage - this is psychogenic (reactive delirium) - a pathological reaction to a changed situation, although a person in all other situations can be quite adequate

delirium of the deaf : a person who is hard of hearing may come to the conclusion that others are talking about him

delirium in a foreign language environment : when a person does not understand the meaning of a particular foreign language, he may also come to a conclusion about what is being said about him

CAP-GRA syndrome:

• Double symptom:

Positive twin symptom: the patient recognizes the familiar in the unfamiliar

Symptom negative twin: the patient sees unfamiliar people in people he knows

• The symptom of false recognitions

Fantastic content of delirium:

Manichean delirium: a person experiences that he is in the center of the struggle between Good and Evil

Delirium of Qatar: a person perceives the death and destruction of his own body.

Delirium is an incorrect, false conclusion, which is of colossal importance for the patient, permeates his whole life, always develops on pathological grounds (against the background of mental illness) and does not undergo psychological correction from the outside.

According to the topic of experiences or content, delirium is divided into three groups.:

• persecutory delirium,
• crazy ideas of greatness,
• delusional ideas of self-deprecation (or a group of depressive delusions).

Into the group persecutory delirium includes the delirium of persecution itself: the patient is firmly convinced that he is constantly persecuted by people from "certain organizations." In order to avoid surveillance, “get rid of the tail,” they instantly change one mode of transport for another, jump out of the tram or bus at full speed, leave the car in the subway at the last second before the automatic closing of the doors, “skillfully cover their tracks”, but nevertheless constantly feel like a victim of the hunt. For "he is constantly being led."

Patient X. for six months traveled all over the country (the so-called delusional migration), trying to get rid of the "surveillance", constantly changing trains and directions, disembarking at the first station that came across, but from the voice of the station announcer, from the expression on the face of a policeman on duty or a random passer-by, he understood that he was "surrendered by some and accepted by other persecutors."

The circle of persecutors includes not only employees at work, relatives, but also completely strangers, strangers, and sometimes even pets and birds (Doolittle syndrome).

Delusional relationship it is expressed in the fact that the patient is convinced of a bad attitude towards him from others, who condemn him, laugh contemptuously, "wink at each other" in a special way, smile mockingly. For this reason, he begins to retire, ceases to visit public places, does not use transport, since it is in the society of people that he especially acutely feels an unfriendly attitude towards himself.

A type of relationship delusion is delirium of special meaning or special meaning when the patient interprets trivial events, phenomena or details of the toilet in a fatal way for himself.

So, sick Ts., Seeing a doctor in a bright tie, decided that this was an allusion to the fact that he would soon be publicly hanged and make a "bright show" out of his execution.

Delirium of poisoning- a persistent conviction of the patient that they want to poison him, for this purpose poison is constantly poured into food or lethal pills (injections) are given under the guise of drugs, potassium cyanide is added to kefir or milk already in the store. For this reason, patients refuse to eat, take medications, actively resist injections. At home, they eat what they cook themselves, or canned food in a metal package.

Patient K. refused to eat, as the nurses, according to her, poison the patients, pouring poison into the food in order to make room for the next batch of patients.

Delirium of litigation(querulant delirium) manifests itself in a stubborn struggle to defend their allegedly trampled rights. Patients complain to all kinds of authorities, collecting huge amounts of documents. This type of delusion is characteristic of schizophrenia and some forms of psychopathy.

Delirium of material damage associated with the patient's persistent conviction that he is constantly robbed by neighbors on the staircase or entrance. “Thefts” are usually small-scale, they concern small items (a teaspoon or an old half-broken cup), old clothes (a shabby dressing gown used as a doormat), food (three pieces of sugar or a few sips of beer have disappeared from a bottle). Patients with such delusions in the apartment, as a rule, have double metal doors with several complex locks, and often with a powerful bolt. Nevertheless, as soon as they leave the apartment for a few minutes, when they return, they find traces of "theft" - either they stole a piece of bread, then they "bit off" an apple or took away an old floor rag.

Patients, as a rule, turn to the police for help, write numerous complaints about their “neighbors-thieves” to law enforcement agencies, comradely courts, and deputies. Sometimes the delirium of material damage logically follows from the delusion of poisoning - they are poisoned in order to take possession of property, an apartment, a summer residence. The delusion of material damage is especially characteristic of presenile and senile psychoses.

Delirium impact- this is the patient's false conviction that hypnosis, telepathy, laser beams, electrical or nuclear energy, a computer, etc. act on him at a distance. in order to control his intellect, emotions, movements to develop "the right actions." Especially common delusions of mental and physical influences are included in the structure of the so-called mental automatisms in schizophrenia.

Patient T. was convinced that she had been influenced by the "Eastern sages" for 20 years. They read her thoughts, make her brains work and take advantage of the results of her "spiritual intellectual work", because "although they are sages, they are round idiots and are not capable of anything themselves." They also draw wisdom from the patient. In addition, all people of non-Slavic appearance affect her, they voluntarily change the style of her thinking, confuse thoughts in her head, control her movements, arrange unpleasant dreams for her, forcibly force her to remember the most unpleasant moments of her life, arrange painful sensations in the heart, stomach , intestines, arranged for her "persistent constipation", they also "arrange for her to varying degrees of beauty, making her now beautiful, now ugly."

There is also a delusion of a positive effect: angels influence the patient, they improve or correct his fate, so that after death he will appear before God in a more favorable light. Sometimes patients themselves can influence people or objects around them. Thus, patient B. made contact with satellites through the TV and thus could see “inaccessible channels” with sexual themes.

Staging delirium- the perception of the real situation as "fake", specially adjusted, while a performance is played around the patient, the patients lying with him are disguised employees of special services, other punitive organizations, or "actors moonlighting because of poverty."

Patient Ts., Being in psychosis and being in the acute ward of a psychiatric hospital, believed that she was "in the dungeons of the KGB," the patients and doctors around were in fact disguised actors who especially for her were playing some incomprehensible performance, any question doctors perceived as interrogation, and injections of drugs as torture with addiction.

Delusional accusation- painful conviction of the patient that the people around him constantly accuse him of various crimes, accidents, catastrophes and tragic incidents. The patient is forced to make excuses all the time, to prove his innocence and innocence to certain crimes.

Delirium of jealousy- the patient begins to think that his wife, for no reason, becomes indifferent to him, that she receives suspicious letters, secretly makes new acquaintances from him with a large number of men, invites them to visit in his absence. Suffering from this delirium see traces of treason in everything, constantly and “biasedly check the bed and underwear of the spouse (spouse). Finding any stains on the linen, they regard this as absolute proof of treason. They are characterized by extreme suspicion, trivial actions of the spouse (spouse) are interpreted as a sign of depravity, lust. Delirium of jealousy is typical for chronic alcoholism and some alcoholic psychoses, it is reinforced by a decrease in potency. However, this pathology can also be noted in other mental disorders. Sometimes the delirium of jealousy is very ridiculous.

An 86-year-old patient suffering from senile psychosis was jealous of his wife of about the same age for a four-year-old boy from a neighboring apartment. Delirium of jealousy (adultery) he reached such a degree that he sewed his wife for the night in a bag of sheets. Nevertheless, in the mornings he found that his wife (by the way, barely moving her legs) at night "unbuttoned, ran to her lover and sewed up again." He saw the proof in a different shade of white thread.

Sometimes the delirium of jealousy includes not spouses, but lovers, mistresses. With this variant of the disorder, the patient is jealous of the mistress of her husband, completely oblivious to the real betrayal of his own wife. Delirium of jealousy, especially in chronic alcoholism, often leads to offenses in the form of murder of a wife (husband), imaginary lovers (mistresses) or castration.

Delirium of witchcraft, damage- painful conviction of the patient that he was bewitched, damaged, jinxed, brought in some kind of serious illness, taken away health, replaced "healthy biofield with a painful one", "induced a black aura." Such nonsense must be distinguished from the common delusion of superstitious people and cultural backgrounds of various populations.

Patient S. recalled that she bought bread every day at a bakery, where the seller was a sullen woman with an amazingly sharp look. The patient suddenly realized that this saleswoman had jinxed her and took away all her health. It was not for nothing that she began to greet S. in the last few days and “grew kinder” - “probably my health, which she took away from me, suited her very well”.

Delirium of obsession expressed in the conviction of the patient that some other living creature has moved into him ("unclean force", devil, werewolf, vampire, demon, deity, angel, another person). At the same time, the patient does not lose his “I”, although he may lose power over his own body, in any case, two different creatures coexist (peacefully or non-peacefully) in his body. This type of delusion belongs to archaic delusional disorders and is often combined with illusions and hallucinations.

Patient L. claimed that Christie possessed her (diminutive for the word Jesus Christ in the English version). He was inside her body and controlled her movements, as far as possible controlled her thoughts and needs. Joint peaceful life lasted two weeks, after which he began to leave the patient at night and cheated on her with other women. The patient could not come to terms with this, and every day, after waiting for his return, she arranged scandals for him, not being particularly embarrassed in expressions. Soon Christie got tired of it and he suggested that the patient fly with him to paradise, "where it is not customary to be jealous and swear." To do this, she had to go to the balcony of the ninth floor and jump down. Christie had to catch her on his wings at the level of the eighth floor and ascend. The patient tried to jump out of the balcony, but was detained by a neighbor. In a psychiatric hospital, she, of course, was in the women's department and constantly suffered from incredible jealousy, because Christie began to leave her not only at night and cheated on her with all the less attractive patients whom the patient made claims, called them names, tried to beat. The patient always clearly separated herself from Christy, she knew when he was in her, and when he went out to "debauch".

Delirium of metamorphosis manifests itself in a patient who believes that he has turned into some kind of animated living being (zooanthropy), for example, a wolf, bear, fox, swan, crane or another bird. At the same time, the patient loses his “I”, does not remember himself as a person, and how the animal he has become, howls, growls, grins his teeth threateningly, bites, squeals, runs on all fours, “flies”, cooes, bites others, lapping food etc. Recently, in connection with the appearance of a large number of films and books about Dracula and his accomplices, the delirium of vampirism has become very relevant, when the patient is convinced that for some reason he has turned into a vampire and begins to behave like a vampire. However, unlike his literary or cinematic brother, he never attacks other people, much less kills them. A patient with a corresponding delirium gets blood either in medical institutions, or, having labored near the slaughterhouse, drinks the blood of animals that have just been slaughtered.

Much less often, transformation is carried out into an inanimate object.

Patient K., who “became an electric locomotive,” tried to recharge himself with energy from an electrical outlet and only miraculously survived. Another patient, turned into a steam locomotive, gnawed on coal and tried to walk on all fours along the rails, emitting locomotive whistles (he lived not far from the railway station).

Delirium of intermetamorphosis is often combined with the delusion of staging and is manifested by the belief that the people around them have undergone significant external and internal changes.

The delusions of a positive double it is noted when the patient considers people completely unfamiliar to him as his relatives or friends, and explains the external dissimilarity with a successful make-up. Thus, the patient D. believed that her son and husband were “kidnapped by the Chechens”, and so that she would not worry, they “slipped” their professionally made-up counterparts to her.

Negative double delusions manifests itself in the fact that the patient considers his relatives and friends to be completely strangers, strangers, specially made up for his loved ones. Thus, sick X., whose wife was allegedly killed by the bandits and instead "implanted" a copy of her into the family, treated the latter with sympathy, pitied her, every evening he kindly persuaded to go to the police and "confess everything."

Delirium of the deaf and delirium of a foreign language environment- particular types of delusional relationship. The first is noted with a deficit of verbal information with hearing loss, when the patient is convinced that others are constantly talking about him, criticizing and condemning him. The second is quite rare, it can manifest itself in a person in a foreign language environment in the form of a conviction that others are negative about him.

Delirium of other people's parents it is expressed in the fact that the biological parents, in the patient's opinion, are dummy or simply educators or twins of the parents. " Valid“The parents occupy important positions in the state or are outstanding, but conspiratorial spies, hiding for the time being their family ties with the patient.

Patient Ch. Believed that at the age of two months he was kidnapped by "Soviet subjects", who formally became his parents. His real parents are the closest relatives of the Queen of Great Britain. He treats Soviet parents with disdain as people who are obliged to serve him. He studied poorly at school, barely finished six classes. However, in the hospital he claimed that he graduated from the University of Cambridge in terms of "sound communication" (neologism from the English sound - sound), and officially works as an adviser to American President Carter on Kremlin issues. Often "by geo-transfer" (neologism) happens to the USA, he does not need any planes. Several times he actually tried to enter the territory of the British embassy with ideas about his close family ties with the Queen of Great Britain. For all his failures, he blames the “Soviet educators” (ie, parents), the attitude towards whom over time becomes more and more negative. "Arrogant indulgence" towards them at the beginning of the disease was replaced by outright aggression.

Delusional ideas of greatness a group of disorders is called, which includes delusions of high origin, delusions of wealth, delusions of invention, reformist delusions, love, or erotic delusions, as well as altruistic and Manichean delusions.

High-born delusions lies in the fact that the patient is unshakably convinced of his belonging to a noble family, known if not to the whole world, then to the whole country, that he is the son of an important statesman, a popular movie star, or has an extraterrestrial cosmic origin.

The patient, who was born in the Crimea, was sure that she was the last of the Dante family, since one of the poet's relatives once lived there.

Another patient claimed that he was the fruit of the violent love of an alien and an earthly woman, originating in turn from Jesus Christ.

Another patient claimed that he was a descendant of the illegitimate son of Nicholas II and on this basis claimed the Russian throne.

The already mentioned patient J. was convinced that in the male line he was a descendant of the Prophet Muhammad, moreover, the most brilliant in the history of mankind. He is capable of producing great ideas for the restructuring of the economic and political life of Russia. Especially in order to catch these ingenious ideas that he himself still did not realize, Russian cosmonauts are sent into space, for these ideas become understandable only outside the Earth. American astronauts fly in order to "drown" these thoughts, but they themselves are not able to understand and even more so to realize them.

Delirium of wealth- this is a person's false belief that he is rich. This nonsense can be plausible when an objective beggar claims that he has 5 thousand rubles in his bank account, and absurd when the patient is sure that all the diamonds in the world belong to him, that he has several houses made of gold and platinum in different countries, which are also his property. So, Guy de Maupassant, already before his death, claimed that the Rothschild family left all their capital to him.

Delirium of invention- the patient is convinced that he made an outstanding discovery, found a cure for all incurable diseases, deduced the formula for happiness and eternal youth (Makropulos remedy), discovered all the missing chemical elements in the periodic table.

Patient F., after spending two hours in line for meat, invented a formula for artificial meat. The formula consisted of chemical elements (С38Н2О15) in the air, so he proposed "stamping meat directly from the atmosphere", "in order to permanently solve the problem of hunger on Earth." With this idea, he began to go to different authorities until he ended up in a psychiatric hospital.

Reform delirium associated with the patient's confidence in his ability to transform the existing world by, for example, changing the rate of rotation of the Earth around its axis and general climate change in a favorable direction. Reformism is often politically motivated.

Patient C. claimed that a hydrogen bomb should be detonated simultaneously at the south and north poles of our planet. As a result, the speed of rotation of the Earth around its axis will change, in Siberia (a patient from Siberia) there will be a tropical climate and pineapples and peaches will grow. The fact that many countries would be flooded from the melting of glaciers did not bother the patient at all. The main thing is that the heat will come in her beloved Siberia. With this idea, she repeatedly turned to the Siberian branch of the Academy of Sciences, and when she was "not understood", she came to Moscow.

Love, erotic delirium manifests itself in the patient's pathological conviction that a famous person loves him at a distance, who expresses his feelings with the color of his clothes, meaningful pauses during televised debates, the timbre of his voice, gestures. Patients usually pursue the object of their adoration, invade his personal life, carefully study the daily routine and often arrange "unexpected meetings." Often, love delirium is accompanied by a delusion of jealousy, which can lead to certain offenses. Sometimes erotic delirium takes on frankly ridiculous forms. Thus, the patient C., suffering from progressive paralysis, claimed that all the women of the world belonged to him, that the entire population of Moscow was born from him.

Altruistic delusions(or delirium of messianism) contains the idea of ​​a high mission of a political or religious nature entrusted to the patient. Thus, sick L. believed that the holy spirit had infiltrated him, after which he became the new Messiah and must unite good and evil into one whole, create a new, single religion on the basis of Christianity.

Some researchers refer to the group of delusions of grandeur and the so-called Manichean delusions (Manichaeism is a mystical, religious teaching about the eternal and irreconcilable struggle between good and evil, light and darkness). A patient with such delirium is sure that he is in the center of this struggle, which is being waged for his soul and passing through his body. This delusion is accompanied by an ecstatic mood and, at the same time, expressed fear.

Often delusions of grandeur are complex and combined with pseudo-hallucinations and mental automatisms.

Patient O. believed that he was at the same time the Thirteenth Imam, the Prince of Karabakh, the King of Judah Herod, the Prince of darkness, Jesus Christ, the embodiment of 26 Baku commissars and the great and small Satan. At the same time, he is the forerunner of all gods and religions. He also said that at the age of one year, playing cubes, he created the state of Israel. He was told about this by the aliens who settled in his head. Through his head, they learn to rule the entire planet. I am sure that the best intelligence services in the world are fighting for his head.

Self-deprecating delusions (depressive delusions) consists in belittling the patient's dignity, abilities, capabilities, physical data. Patients are convinced of their insignificance, squalor, worthlessness, unworthiness even to be called people, for this reason they deliberately deprive themselves of all human comforts - they do not listen to the radio or watch TV, do not use electricity and gas, sleep on a bare floor, eat leftovers from the garbage can , even in cold weather they wear a minimum of clothes. Some try, like Rakhmetov, to sleep (lie, sit) on nails.

This group of mental disorders includes delusions of self-accusation (sinfulness, guilt), hypochondriacal delusions in all its variants, and delusions of physical disability.

Delirium of self-abasement in its pure form is almost never found, it is always closely associated with delusion of self-accusation, making up a single delusional conglomerate within the framework of depressive, involutional and senile psychoses.

Delirium of self-accusation(sinfulness, guilt) is expressed in the fact that the patient constantly accuses himself of imaginary misconduct, unforgivable mistakes, sins and crimes against individuals or groups of people. In retrospect, he assesses his whole life as a chain of "black deeds and crimes", he blames himself for illness and death of close friends, relatives, neighbors, believes that for his misdeeds he deserves life imprisonment or slow execution by "quartering." Sometimes patients with a similar pathology resort to self-punishment by self-harm or even suicide. Self-incrimination can also be based on this type of pathology (recall Salieri's self-incrimination, who allegedly poisoned Mozart). Delirium of self-accusation occurs most often against the background of depression and, therefore, is noted in affective-delusional pathology (manic-depressive psychosis, presenile and senile psychoses, etc.). Thus, sick N., a former party functionary of a rural scale, at the age of 70 began to accuse herself that it was only through her fault that the Soviet Union collapsed, for she was "distracted by her family and did not work in a party position with full dedication."

Delirium of physical handicap(Quasimoda delirium), is also called dysmorphophobic. Patients are convinced that their appearance is disfigured by some kind of defect (protruding ears, ugly nose, microscopic eyes, horse teeth, etc.). This defect, as a rule, concerns a visible, often almost ideal or normal part of the body. The pettophobic version of this delirium is the patient's conviction that intestinal gases or other unpleasant odors are constantly coming out of him. Often, with delirium of physical disability, patients resort to self-operations, while sometimes they die from bleeding.

Delirium of physical disability occurs in psychosis, debuting in adolescence or adolescence (in particular, with schizophrenia).

Patient G., who considered her nose to be ugly wide, tried to narrow it on her own, because the doctors refused to carry out plastic surgery. To this end, she put a clothespin on her nose every day for 6 hours.

Hypochondriacal delirium- This is a pathological belief in the presence of a serious, incurable disease or dysfunction of any internal organ. Patients undergo numerous tests for AIDS, cancer, leprosy, syphilis, require more and more "solid" consultations from the doctor, but any consultation leaves them with an acute feeling of dissatisfaction and a firm conviction in the presence of an incurable disease.

If senestopathy or some sensation emanating from the internal organs are at the heart of a hypochondriacal delusional experience, such delusion is called catastrophic. A common type of hypochondriacal delusion is the so-called nihilistic delusion, or the delusion of denial. Patients say that their liver has atrophied, the blood “hardened”, there is no heart at all, since “nothing beats in the chest”, the urinary canal has dissolved, so urine is not released, but is absorbed back into the body, poisoning it. Delirium of denial is an important component of Cotard's syndrome; it is found in involutional and senile psychosis, schizophrenia, and severe organic brain diseases.

Patient K. stated that she had not had a stool for three years, because her whole intestine had rotted. Another explained her poor health and weakness by the fact that she had only three red blood cells left in her body and they all work with overload - one serves the head, the other the chest, the third - the stomach. There are no erythrocytes for the arms and legs, so they gradually dry out, "mummify".

In addition to the above three groups of delusional experiences, there are induced and conformal rave.

Induced(grafted, induced) delusion consists in the fact that the patient's delusional ideas begin to be shared by a mentally healthy member of his family. Induction has the following reasons:

• close, sometimes symbiotic relationship between the inductor and the inducible;
• inductor - indisputable by authority for the inducted;
• the presence of increased suggestibility, lower intelligence of the inducible in comparison with the inductor;
• the plausibility and lack of absurdity in the delusional ideas of the inductor.

Induced delusions are rare and are always fueled by close contact with the inducer. However, it is worth separating the inducible from the inducer, as this delusion can disappear without any treatment.

Patient I. expressed ideas of attitude and persecution, and soon his wife began to experience the same ideas, and a month later his 10-year-old daughter too. All three were placed in different departments of the psychiatric hospital. Two weeks later, the patient's daughter stopped feeling being watched, realized that those around her were unprejudiced, and two weeks later the same happened to his wife. The patient himself (inductor) was able to get rid of this delirium only after intensive treatment for two months.

Even less common is the so-called conformal delusion, when two close mentally ill relatives begin to express identical delusional ideas. This is also where induction takes place. For example, a paranoid schizophrenic patient expresses certain delusional ideas of persecution. His sister, who suffers from a simple form of schizophrenia, for whom, as you know, delusions are not typical at all, suddenly begins to express exactly the same ideas of persecution applicable to herself and her brother. In this case, the patient's sister has delirium of a conformal nature.

According to the characteristics of the formation, there are primary (interpretive, systematized) and figurative (sensual) delirium.

Primary delusions is based on abstract ideas and a delusional assessment of the facts of reality without disturbances in sensory cognition (i.e., in the absence of senestopathies, illusions and hallucinations). It should be emphasized that adequately perceived facts of reality are interpreted in a delusional way - according to the laws of paralogical thinking. From all the variety of facts, the patient selects only those that are consistent with his main delusional idea ("delusional stringing of facts"). All other real facts and events that do not agree with the patient's delusional idea are rejected by him as insignificant or insignificant. In addition, patients with primary (interpretive) delusions tend to overestimate their past according to the laws of para-logic in a delusional way (delusional interpretation of the past). Primary delusions are quite persistent, prone to chronic course and relatively uncoolable. According to the interpretative type, delusional ideas of the most varied content are formed (jealousy, wealth, high origin, invention, persecution, etc.).

In the emergence of figurative (sensory) delirium the main role is played by disturbances of sensory cognition in the form of imagination, fantasies, fictions, dreams. Delusional judgments are not the result of complex logical work, there is no consistency in the substantiation of ideas, there is no system of evidence so characteristic of primary interpretive delusion. Patients with figurative delusions express their judgments as a given, not subject to doubt, as something self-evident and not needing proof and justification. Unlike the primary delirium, figurative delirium arises sharply, according to the type of insight and is always accompanied by illusions, hallucinations, anxiety, fears and other psychopathological formations. Often, with sensual delirium, delusional orientation in the environment, staging delusions, false recognitions, symptoms of a positive or negative double are noted.

The dynamics of delirium (according to V.Manyan)

In the process of development of mental illness, delusional ideas undergo a certain evolution. The French psychiatrist Magnan, as a result of many years of research, found out that if delirium is not influenced by drugs, then it has the following dynamics:

Delusional prodromal state or delusional mood... The patient, for no reason or reason, feels the strongest physical and mental discomfort, diffuse anxiety associated with real events and the environment, experiences a feeling of impending disaster, misfortune, tragedy, alert suspicion, internal tension and a sense of impending threat. This period, being a kind of precursor to delirium, lasts from several hours to several months.

Crystallization of delirium... The patient develops delusional ideas of a persecutory nature. Crystallization of delirium occurs as an inspiration. Suddenly the patient realizes why he felt bad for a certain period, restless and anxious; it turns out that he was influenced by some kind of rays from a neighboring house and foreign intelligence officers tried to "confuse" him. The second stage, as a rule, lasts many years, sometimes tens of years and even the patient's entire life. It is from this stage that the main population of psychiatric hospitals is recruited.

Formation of delusions of grandeur... In painful pondering why they are pursuing and reading the thoughts of him, and not of any other person, the patient gradually comes to the conviction that the choice fell on him, since he has "a bright head, extraordinary abilities, talented brains" or he is a lateral branch of the famous dynasty of nuclear physicists. This is how delusions of grandeur are formed with the corresponding pretentious behavior and an absurd lifestyle. Patients periodically arrange "grand dukes' receptions" or "gather on space expeditions." The transition of delirium to the stage of greatness usually indicates an unfavorable course of the endogenous process and is essentially a sign of the intensification of the weakening process.

The disintegration of the delusional structure occurs after the stage of delusions of grandeur and testifies to such a degree of dementia when the patient's psyche is no longer able to maintain a harmonious, albeit built according to the laws of paralogics, delusional structure. Delirium breaks down into separate fragments that do not already determine the patient's behavior style. So, a patient who proudly claims that he is the richest man on the planet, after a few minutes obsequiously asks a roommate for a few rubles to buy cigarettes or picks up cigarette butts. At the same time, minute episodes of delusions of grandeur become more and more rare over time and can arise only as reflections against the background of the final (apathetic-abulic) state.

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Delusional disorder is expressed in the presence of persistent beliefs in a person, which in reality are absolutely wrong, but for himself completely believable, which explains his sincere belief in them. Having a delusional disorder is not the same as having schizophrenia (which is often confused with). Delusional disorder differs in that with it, a person develops and lasts a month or more erroneous beliefs and beliefs that are completely normal for him; otherwise, human behavior is absolutely healthy.

The Diagnostic and Statistical Manual of Mental Disorders identifies 6 types of delusional disorder: erotomania, megalomania (grandiose delusions), jealous delusions, persecutory delusions, hypochondriacal delusions, and mixed delusions. Each of these types is explained in detail in this article to make it easier for you to recognize one or another type. As you become familiar with this disorder, remember that our minds are incredible powers, capable of taking on the forms of the strangest fantasies that may seem completely real to us.

Steps

1. Watch for signs of erotomania. Erotomania is characterized by the belief that someone is in love with an individual. The situation is especially common when a person suffering from this disorder believes that some celebrity is in love with him, despite the fact that this celebrity is not even able to recognize the person's face, or even completely unfamiliar with him! Signs that a person is suffering from erotomania include:

   • A simple gesture, smile or a kind word turns into a conviction that a person secretly loves an erotomaniac. An innocent gesture can be interpreted as a sign of hidden love or an attempt at romantic rapprochement emanating from what the gesture is made.
   • The need to interpret special "signs" that the person with whom the delusional disorder communicates wants to be with him.
   • Escape from social life and hanging out with people. Instead, the sufferer spends time in fantasies, imagining how the object of his love does what confirms his dreams. For example, a person can type all the films of their favorite movie star, sit at home and watch them over and over again in order to somehow bring their love to life - and all this instead of going out and living a real life.
   • The person suffering from this disorder may send messages or gifts to the object of their erotomania. He may even start chasing that person.

2. Observe people with an insistent sense of grandeur (delusions of grandeur). This type is often very selfish in nature. Day after day, they live with the conviction that they are unrecognized geniuses with special abilities that society has simply not recognized yet. Signs that a person is suffering from delusions of grandeur include:

   • A person may believe that they have an undisclosed or special talent / ability; a person may believe that they have made amazing discoveries that others simply do not understand.
   • A person believes that he can save the world through simple, harmless repetitive actions. Such people have an unrealistic view of the degree of their influence on what is happening and the world around them as a whole.
   • A person believes that he is in a relationship with some important celebrity (king, prince, president, star, mythical or supernatural beings). In their minds, they sincerely believe that this relationship exists in reality. A perfect example would be the person sitting by the phone, waiting for a call from Elvis Presley or another rock star; or the one who believes that the Lord speaks directly to him.

3. Consider strong, intense outbursts of jealousy as signs of possible upset. Most people suffer from jealousy from time to time, the feeling of jealousy does not last long and is soon replaced by rationalization that allows you to move on. However, in a person suffering from jealousy within the delusional disorder, both the intensity and duration are out of bounds. Such manifestations include:

   • A person is convinced that his spouse, lover or partner is acting dishonestly towards him or cheating on him. Even if there is absolutely no evidence in this direction, such people never calm down. They think in such a way that their decision cannot be changed.
   • A delusional disorder can go an incredibly long way to prove that he or she has reason to be jealous. This often takes the form of spying on a partner or organizing a private investigation.

4. Be aware of those who suffer from persecution delusions. In certain life situations, distrust is a necessary means in order not to be used by people who want to harm us. Most of the time, however, our trust radar tells us that most people are good, and that through trust, we can make our relationship with them better and fuller. For those suffering from persecution delusions, trust in others is almost impossible at any time, in any situation. This type believes that a certain group of people is hunting for him, no matter how erroneous this belief may seem. Some signs of the disorder include:

   • The persecuting delusional is convinced that those around him are conspiring against him. Such a person constantly suspects others and closely monitors them.
   • The high level of distrust in others is quite obvious and goes beyond the usual caution. An ideal example of such a disorder would be a person who constantly thinks that the conversations of others among themselves concern something negative in relation to him.
   • The sufferer believes that others want to harm him, undermine his authority, or even destroy in some way. Sometimes these fantasies can lead the sufferer to physically attack the alleged conspirators, making them potentially violent and dangerous.

5. Help people with delusional disorder get professional help. This person can be a member of your family, a work colleague, or a member of a local sports team. It is very important to detect delusional disorder before it destroys the lives of many people - delusional disorder as a whole alienates the sufferer from the people around him, because of it he loses his job, friends and even family ties. And it's not just about caring for the person himself - you must help him also in order to prevent harm that can be caused to other people (delusional disorder can provoke cruelty, harassment, aggressive behavior, etc.). The sooner you help the person get the care they need, the better - the longer the disorder is left untreated, the more likely it is that others (and the patient) will be harmed.

   • Keep in mind that delusional patients rarely seek psychological help on their own. Don't forget - they believe what their mind tells them; they truly believe that their fantasies real.
   • Take the necessary preventive measures to keep the sufferer safe from acts of self-harm, cruelty, violence and neglect towards themselves or others.
   • If you are directly responsible for this person, talk to their family, friends, or other people with whom they live. They may need additional knowledge and a deeper understanding of the situation.
   • If you are in a vulnerable position with someone with delusional disorder, find someone to help you get out of danger. If you are under attack or a dangerous confrontation with a sufferer, do not hesitate to call the police - your safety comes first. Once you are safe, the person will be provided with the necessary assistance.

6. You should understand that if you are in charge of someone with delusional disorder, there will be periods of hospitalization. This means that you and your family members should think about creating an environment in which the person receives all the necessary care for their life, and family and friends share the responsibilities and affairs of the sufferer for the entire period of his stay in the hospital.

   • Delusional disorder is believed to be more common among those with low social and economic well-being; among those who have a family history of schizophrenia (do not forget that this is another disorder), who suffer from constant stress or any kind of brain disease. Hearing loss (or hearing impairment) is also sometimes a cause.
   • Reducing stress is also an important part of helping the person with delusional disorder; It is very important to follow the usual guidelines for a healthy diet, regular exercise and good sleep. This will give some hope for the future; if a person is not employed, find something productive for him that he could do in life. He can sell things from home through eBay, write, make art, create useful home items from wood or metal, volunteer, and more.
   • Awareness will help you know when to seek help if things get out of hand. Usually it is about the awareness of family and friends, since the person himself is rarely able to realize that he is in a state of delusion.
   • The diagnosis of delusional disorder is usually made only when episodes last a month or more, occur repeatedly and over a long period of a person's life.
   • Delusional disorder can be treated with cognitive behavioral therapy and certain antipsychotic medications.
   • Sometimes grandiosity and the pursuit of greatness correspond to ambitious goals. "I wrote 5 stories and got an order for a complete novel from an agent" may be absolutely true. Even "I'm sure this will be a bestseller" may just be optimistic. The delusion of grandeur - to believe that the publisher will offer a multimillion-dollar contract after the first read of the proposal.
   • Certain personality types are more prone to delusional disorders.
   • Sometimes paranoia accompanies delusional disorder. It all depends on the severity of the individual's reaction. Paranoia can not and should not treated as a delusional disorder.