Delirium is a thought disorder: symptoms and treatment methods. Delusional disorder. Delirium - causes, types, symptoms and treatment Delirium differently

In modern psychiatry, delirium (synonyms: thought disorder, delirium) is a complex of ideas or concepts that appeared as a result of a developing brain disease as a symptom. They erroneously reflect reality and are not corrected by new incoming information, regardless of whether the existing conclusion corresponds to reality or No. Most often, delusion is one of the components of the manifestations of schizophrenia or other

In what cases do the words “delirium” have synonyms - “mental disorder” and “insanity”

But in order to talk about the presence of a mental disorder in a patient, one cannot start only from the content of the idea that has overwhelmed him. That is, if for others it looks like complete nonsense, this cannot serve as evidence that a person has

In delirium, what is painful is not the content that falls out of generally accepted ideas, but the disruption of the flow of a person’s life associated with it. A delusional patient is removed from the world, uncommunicative, he is isolated in his belief, which greatly changes his appearance and life values.

Features of delusional ideas

A delusional belief is not amenable to any correction from the outside. Unlike the delusions of a healthy person who firmly defends his point of view, delusion is a kind of unshakable idea that does not require real confirmation, since it exists independently of the events occurring in reality. Even the negative experience of following a delusional idea does not force the patient to abandon it, and sometimes even, on the contrary, strengthens faith in its truth.

Since a delusional idea is always very closely fused with previously occurring cardinal personal changes, it necessarily causes radical changes in the patient’s attitude towards himself and the outside world, turning him into a “different person”.

Delirium is often accompanied by the so-called mental automatism syndrome or alienation syndrome, in which the patient has the feeling that any of his actions or thoughts do not occur of his own free will, but are invested or inspired by an outside force. In these cases, patients suffer from persecutory delusions.

Paranoid delusions are the result of distrust of the environment

Paranoid delusions are formed from opposition to the environment and distrust of other people, transforming over time into extreme suspicion.

At some point, the patient begins to understand that everyone around him treats him unfairly, infringes on his interests, and humiliates him. Due to the paranoid person's inability to interpret the actions and words of others, this belief develops into paranoid syndrome.

In psychiatry it is divided into three types.

Delusion of influence, in which the patient is convinced of an external influence on his behavior and thoughts.
Delusion of attitude, when a person assumes that others are talking about him, laughing at him, looking at him.
Paranoid delusion. This state is expressed in the patient’s deep conviction that some mysterious forces want his death or harm him in every possible way.

By the way, the latter type of thinking disorder in certain situations can be easily transmitted to the patient’s environment, which leads to an incident that is characterized as induction, that is, the borrowing of the beliefs of a sick person by a healthy one.

What is induced delirium

In psychiatry, this phenomenon is called “induced delirium.” This is an induced, borrowed belief that is adopted from the patient by those around him - those who are in the closest contact with him and have not developed a critical attitude towards the patient’s pathological condition, since he is an authority in this group or enjoys trust.

In such cases, those being induced begin to express the same ideas and present them in the same form as the patient-inducer. The person who induces the delusion is, as a rule, a suggestible person who is subordinate to or dependent on the source of the idea. Most often, but not always, the dominant person (inductor) is diagnosed with schizophrenia.

It should be noted that this disorder , just like the initial delusion of the inductor, this is a chronic condition, which, according to the plot, turns out to be delusions of grandeur, persecution, or religious delirium. Most often, groups that find themselves in cultural, linguistic or territorial isolation fall under this influence.

Under what conditions can a diagnosis be made?

In order to make a correct diagnosis, it should be remembered that induced delirium is:

a condition in which several people share the same delusional idea or a system built on it;
support each other in the said belief;
such people have very close relationships;
even passive members of this group are induced after contact with active partners.

When contact with the inductor is terminated, the views instilled in this way most often dissipate without a trace.

How does hypochondriacal delirium occur?

In psychiatric practice, another type of thinking disorder is often encountered - hypochondriacal delusion. characterized by the patient’s deep conviction that he has a serious incurable disease or a shameful one, one that cannot be treated with conventional therapy.

The fact that doctors cannot find it is perceived by a delusional person only as their incompetence or indifference. Data from tests and examinations for such patients are not proof, because they have a deep conviction in their own unique illness. The patient is seeking more and more examinations.

If it begins to grow, then the idea of persecution, which the doctors allegedly organized in relation to the patient, also joins it. These symptoms are often supplemented by the previously mentioned delusion of exposure, which is supported by the belief that the disease is caused by specially organized radiation, which destroys internal organs and even the brain.

How does hypochondriacal delirium change?

Sometimes in patients with hypochondriacal delusions it changes to the idea of the opposite content - that the patient was always absolutely healthy or, most often, that he was suddenly completely healed. As a rule, such delirium is a consequence of a change in mood caused by the disappearance of (usually shallow) depression and the appearance of a hypomanic state.

That is, the patient was and remains fixated on the topic of health, but now his delirium changes vector and, having become a delusion of health, is directed towards healing those around him.

By the way, many so-called traditional healers who distribute personally invented methods for curing all ailments have the described category of thinking disorder. At best, such methods are simply harmless, but this is quite rare!

How delirium becomes systematized

What’s interesting is that delusional constructs in all the above cases are interconnected, consistent and have some logical explanation. Such a thinking disorder indicates that we are faced with systematized delirium.

This disorder is most often observed in people with a good level of intelligence. The structure of systematized nonsense includes the material on the basis of which the idea is built, as well as the plot - the design of this idea. As the disease progresses, it can become colored, become saturated with new details, and even change direction, as shown above.

By the way, the presence of systematized delirium always confirms its long-term existence, since an acutely onset illness, as a rule, does not have a coherent system.

Crazy ideas. Definition of delirium. Classification of delirium by structure (systematized and unsystematized). Classification of delusions by content (delusions with low self-esteem, delusions with increased self-esteem, persecutory delusions, mixed forms of delusions).

Delusional ideas are an error of judgment that arises on pathological grounds, covers the entire consciousness of the patient and determines his behavior, and cannot be dissuaded or corrected.

Delusion is a set of ideas and ideas, a conclusion that did not arise as a result of processing received information and is not corrected by incoming information (it does not matter whether the delusional conclusion corresponds to reality or not).

Criteria:

1. occurs on a pathological basis

2. covers the entire consciousness

3. contradicts the surrounding reality

4. cannot be corrected

In structure, nonsense:

1. primary (systematized, interpretative, logical)

2. secondary (unsystematized: sensory and figurative)

Characteristic:

Primary (systematic, interpretive, logical)	secondary (unsystematized: sensory and figurative)
1. the second stage of the cognitive process suffers	1. the first stage of the cognitive process suffers
2. occurs as the first manifestation of the disease	2. occurs against the background of another psychopath. disorders, such as emotional disorders
3. occurs unnoticed	3. occurs acutely
4. in the patient’s judgments there is a system of evidence, the logic is crooked	4. no system of evidence, no logic
5. behavior is outwardly correct	5. disorganizational behavior
6. Sequence of delusion formation: 1. delusional premonition 2.delusional perception 3.delusional interpretation 4. crystallization and birth of delirium, encapsulation
7. The patient’s personality changes radically	7. personality as a whole does not change
8. difficult to treat, encapsulated	8. responds well to treatment, disappears under the influence of treatment
9. prognosis is unfavorable	9. prognosis is favorable

1. persecutory

The certainty of a threat from outside arises.

- delirium of persecution

- delirium of physical influence (the patient says that he is being controlled like a puppet)

Delirium of mental influence (the patient feels that someone is putting other people’s thoughts into his head, that his emotions, memories, experiences are not his, but are rigged)

- delusion of poisoning (belief about adding poisons to food, drink.)

- delusions of jealousy (belief that a sexual partner is unfaithful)

- delirium of erotic contempt

- delusion of influence (the patient is sure that he is being irradiated with special rays, hypnotized, zombified)

2. expansive (delusions with increased self-esteem)

Reassessment of capabilities and general provisions.

- delirium of grandeur

Delusions of high origin (belief in the accidental or deliberate substitution of parents in childhood, the thought of being born from persons occupying a high position in society)

- delirium of power

- delusion of wealth (painful belief about the presence of imaginary wealth)

- nonsense of invention

Messianic delusion (belief in a high political, religious, scientific or other mission entrusted to the patient)

- erotic delusion (conviction that a certain person(s) is in love with the patient)

3. depressive (delirium with low self-esteem)

Painful exaggeration of existing or imaginary shortcomings or troubles.

- delirium of well-deserved misfortune.

Delirium of self-deprecation (a painful belief about one’s own exclusively negative moral, intellectual, physical qualities, about one’s own insignificance).

Delusions of self-blame (guilt, attribution of imaginary or absurd exaggeration of existing unseemly deeds and actions).

The source of present, future or past misfortune is the patient himself. Often he is not only the source of his own misfortune, but also the cause of disasters to which those around him are exposed - relatives, acquaintances, fellow citizens, the whole world. Depressive delirium is usually poor in content, monotonous and monotonous - the patient constantly repeats the same thing, in the same terms.

4. mixed forms.

A combination of persecutory ideas with delusions of increased or decreased self-esteem.

Differential diagnosis of highly valuable ideas from delusional ones.

Supervaluable ideas, unlike delirium, are not initially absurd or erroneous. The disorder lies in the fact that these thoughts occupy a dominant position in the patient’s psyche that does not correspond to their real meaning. Thus, the natural concerns for any person about preserving the family, joy over a successful solution to a technical problem, dissatisfaction with an employee’s mistake turn into surprisingly strong and persistent feelings (jealousy, indignation, suspicion). All subsequent behavior is subordinated to this basic feeling.

The peculiarity of delusional thoughts is that a person cannot critically evaluate them; he is absolutely confident in the correctness of his behavior. Delirium often occurs against the background of other mental illnesses, in particular schizophrenia. Risk factors may include changes in the living environment, congenital suspiciousness and anxiety in character, hormonal imbalance and heredity.

“You are talking nonsense!” - we often hear this phrase when a person does not agree with our words or they seem absurd to him. Delusion, delusional disorder are terms of psychiatry that mean a certain state of a person in which a disorder of thinking occurs with the appearance of reasoning, thoughts and conclusions that do not correspond to reality. At the same time, the person is completely convinced that his statements do not go beyond the norm and is not ready to accept arguments in favor of the fact that he has delusional thoughts. Delusional disorder is a diagnosis given to a patient with delusional thoughts. In modern psychiatry, the term delusional disorder is also used - the term comes from the Latin word delusio, or delusion. Delusional thoughts are a psychiatric pathology that requires medical intervention and treatment. Let's look at the main types of delusional thoughts:

Delusion of persecution - the patient is sure that he is being pursued by a group of people or one person with the purpose of killing, transmitting information about him to certain structures, causing harm, etc. Persecutors may include co-workers, neighbors, various organizations, and religious groups. At the same time, the patient does not consider his thoughts to be inadequate; moreover, after trying to explain the absurdity of his speculations, the patient will certainly include the arguer in the list of his enemies, who are in collusion with his persecutors. This is the most common type of delirium.
Delusion of influence - the patient talks about the influence of hypnosis, rays, psychotronic weapons, black magic on him by a certain group of people. He is sure that they want to harm him, they are using him in experiments, they want him dead.
Hypochondriacal delusion is the patient’s belief that he has a serious illness, often incurable or unknown to science, which cannot be cured. They often go to doctors, confident that doctors cannot find a disease in them due to unprofessionalism, ineffective diagnostic methods, and indifference. They read a lot of medical literature, look for imaginary symptoms in reference books, the Internet, and the media.
Litigative delusion is the patient’s belief that certain persons have violated his rights, as a result of which he tries to hold these persons accountable by any means (writes complaints to various authorities, files a lawsuit, appeals to the consumer protection society). A distinctive feature of this nonsense is precisely the defense of one’s own, not collective rights.
Delusion of jealousy is a pathological condition in which the patient is convinced that his spouse is cheating, without having real facts and evidence. The behavior of such a patient goes beyond the norm - there may be total control, a lack of logic in conclusions about the presence of betrayal, and in extreme cases there may be outbursts of violence and aggression.
Body dysmorphic delusion is the patient’s belief that he has some kind of physical defect (too large ears, disproportionate body, lack or excess body weight).
Delusions of grandeur - the patient is convinced of his own importance and exclusivity, that he is endowed with special capabilities and abilities.

These are the main types of delusional thoughts that occur most often. The main plot of delirium is obsessive thoughts that a person does not evaluate critically. Delusion as part of the symptomatology is also inherent in diseases such as schizophrenia and bipolar disorder.

Causes of delusional thoughts

The causes of delusional thoughts are generally similar to the causes of any other psychiatric pathologies and disorders:

A stress factor is a strong emotional experience associated with changes in life, protracted unresolved problems, shocks, which can serve as a trigger for the development of delusional disorder
Hereditary factor - the presence of symptoms of delirium in close relatives can cause the development of the disease
Hormonal and electrolytic imbalance of the body - failure of metabolic and hormonal processes can lead to delusional thoughts
Delusional thoughts may indicate the presence of a concomitant illness of a psychiatric, neurological or organic nature
Changing the sociocultural aspect of life - moving to another country with different orders and norms of behavior, social isolation (for example, when reaching retirement age, many people remain unemployed, while relatives have their own families and worries)
Personality characteristics - people with a suspicious, anxious psychotype are at risk of being diagnosed with delusional and obsessive thoughts

Doctors' opinions on patients' delusional thoughts

Patients with delusional and obsessive thoughts come to see a psychiatrist by accident - they are brought by relatives or representatives of authorities who want to conduct a psychiatric assessment of the person’s condition. The doctor conducts a conversation with the patient, finds out the reasons that brought the patient to his office and evaluates his judgments and thoughts. To get a complete picture, a conversation is held with relatives or employees of authorities, since sometimes it is impossible to make an unambiguous conclusion about the presence of pathology. For example, in the practice of the IsraClinic clinic, there was a case when a 48-year-old woman came to an appointment, accompanied by relatives who said that she had delusional and obsessive thoughts. In a clinical interview, a woman complained of harassment from her ex-husband: she constantly sees his car near work, knowing about her love for lilies, he constantly sends these flowers for her through her sister, according to the patient, he bought an apartment in the building opposite because never leaves the thought of returning to her. There were no hints of a delusional plot in the conversation, so the doctor talked with the patient’s relatives. It turned out that the patient’s ex-husband has been living in another city for a long time, next to work she sees a car of the same model and the same color, her sister buys lilies, and her ex-husband definitely does not live in the house opposite. Doctors' opinions about patients' delusional thoughts are clear: if a delusional component is identified, treatment is necessary.

Treatment of delusional thoughts

The treatment strategy for delusional thoughts is based on eliminating the cause of the disease. If the thoughts were caused by a strong stressful experience (divorce, illness, death) - these reasons are worked out, if the disorder is a symptom of a concomitant disease (Alzheimer's disease, schizophrenia, tumor processes) - then treatment is carried out in conjunction with the main diagnosis. In Israel, at the IsraClinic, drug therapy, psychotherapy, and psychiatrist supervision are used to treat a diagnosis of delusional thoughts or obsessive thoughts. Separately, it is worth addressing the issue of prevention of schizophrenia and delirium. If we are talking about the psychological causes of the disease, then you should not hesitate to seek help from psychologists or psychiatrists in the event of a severe stressful situation when you feel that you cannot cope with it. Any stress can cause the development of serious psychiatric pathologies. At the IsraClinic clinic, there is such an area of work with patients as mental hygiene, or mental health care, prevention of mental and nervous system diseases. Among the clinic’s methods for the prevention of schizophrenia and delirium are psychoeducational conversations about factors influencing the development of diseases, about experiences, about the relationship between the mind and body, and about how to cope with difficult situations.

This triad was formulated in 1913 by K. T. Jaspers, who noted that the signs he identified are superficial, since they do not reflect the essence of the disorder and do not define, but only suggest the presence of the disorder.

According to the definition of G.V. Grule, delusion is a set of ideas, concepts and conclusions that arose without reason and cannot be corrected with the help of incoming information.

Delirium develops only on a pathological basis (accompanies schizophrenia and other psychoses), being a symptom of brain damage.

Along with hallucinations, delusions belong to the group of “psychoproductive symptoms.”

General information

Delirium as a pathology of mental activity was identified with the concept of madness back in antiquity. Pythagoras used the term “dianoia” to denote correct, logical thinking, to which he contrasted “paranoia” (going crazy). The broad meaning of the term “paranoia” gradually narrowed, but the perception of delusion as a disorder of thinking remained.

German doctors, relying on the opinion of the director of the Winenthal psychiatric hospital, E. A. von Zeller, opened in 1834, believed until 1865 that delirium develops against the background of mania or melancholia and is therefore always a secondary pathology.

In 1865, the director of the Hildesheim psychiatric hospital, Ludwig Snell, read a report based on numerous observations at a congress of naturalists in Hanover. In this report, L. Snell noted that there are primary delusional forms independent of melancholy and mania.

Forms

Depending on the clinical picture of this thinking disorder, there are:

acute delirium, which completely takes over the patient’s consciousness, as a result of which the patient’s behavior is completely subordinate to the delusional idea;
encapsulated delusion, in the presence of which the patient adequately analyzes the surrounding reality not related to the topic of delirium and is able to control his behavior.

Depending on the cause of the thinking disorder, delusions are distinguished into primary and secondary.

Primary delusion (interpretive, primordial or verbal) is a direct expression of the pathological process. This type of delusion occurs on its own (not caused by affects and other mental disorders) and is characterized by a primary defeat of rational and logical cognition, therefore the existing distorted judgment is consistently supported by a number of specifically systematized subjective evidence.

The patient's perception is not impaired, performance is maintained for a long time. Discussion of topics and subjects affecting the delusional plot causes affective tension, which in some cases is accompanied by emotional lability. Primary delirium is characterized by persistence and significant resistance to treatment.

There is also a trend towards:

progression (more and more parts of the surrounding world are gradually drawn into the delusional system);
systematization, which looks like a subjectively coherent system of “evidence” of delusional ideas and ignoring facts that do not fit into this system.

This form of delirium includes:

Paranoid delusion, which is the mildest form of delusional syndrome. Manifests itself in the form of a primary systematized monothematic delusion of persecution, invention or jealousy. May be hypochondriacal (distinguished by sthenic affect and thoroughness of thinking). Devoid of absurdity, develops with unchanged consciousness, there are no perception disorders. Can be formed from an extremely valuable idea.
Systematized paraphrenic delusion, which is the most severe form of delusional syndrome and is distinguished by a combination of dream-like delusions of grandeur and delusions of influence, the presence of mental automatism and an elevated background mood.

According to K. Jaspers, primary delirium is divided into 3 clinical variants:

delusion of perception, in which what a person perceives at the moment is directly experienced in the context of a “different meaning”;
delusional ideas, in which memories acquire delusional meaning;
delusional states of consciousness in which real impressions are suddenly invaded by delusional knowledge not associated with sensory impressions.

Secondary delusions can be sensual and figurative. This type of delusion occurs as a result of other mental disorders (senesthopathy, deceptions of perception, etc.), that is, impaired thinking is a secondary pathology. It is characterized by fragmentation and inconsistency, the presence of illusions and hallucinations.

Secondary delusions are characterized by a delusional interpretation of existing hallucinations, bright and emotionally rich insights (insights) instead of conclusions. Treatment of the main symptom complex or disease leads to the elimination of delirium.

Sensual delirium (delirium of perception) is characterized by the appearance of a sudden, visual and concrete, polymorphic and emotionally rich, vivid plot. The plot of delirium is closely related to depressive (manic) affect and imaginative ideas, confusion, anxiety and fear. With manic affect, delusions of grandeur arise, and with depressive affect, delusions of self-abasement arise.

Secondary delusions also include delusions of representation, manifested by the presence of scattered, fragmentary ideas such as fantasies and memories.

Sensory delirium is divided into syndromes including:

Acute paranoid, which is characterized by ideas of persecution and influence and is accompanied by pronounced affective disorders. Occurs in disorders of organic origin, somatogenic and toxic psychoses, schizophrenia. In schizophrenia, it is usually accompanied by mental automatisms and pseudohallucinosis, forming Kandinsky-Clerambault syndrome.
Staging syndrome. The patient with this type of delusion is convinced that a dramatization is being played out around him, the plot of which is related to the patient. Delusion in this case can be expansive (delusional increase in self-esteem) or depressive, depending on the existing affect. Symptoms are the presence of mental automatism, delusions of special significance and Capgras syndrome (delusions of a negative double that has replaced itself or a person from the patient’s environment). This syndrome also includes the depressive-paranoid variant, characterized by the presence of depression, delusions of persecution and condemnation.
Antagonistic delirium and acute paraphrenia. In the antagonistic form of delirium, the world and everything that happens around the patient is seen as an expression of the struggle between good and evil (hostile and benevolent forces), in the center of which is the patient’s personality.

Acute paraphrenia, acute antagonistic delusions and delusions of staging can cause intermetamorphosis syndrome, in which events occurring in the patient are perceived at an accelerated pace (a symptom of the patient’s extremely serious condition).

In schizophrenia, sensory delirium syndromes gradually replace each other (from acute paranoid to acute paraphrenia).

Since secondary delirium may differ in its specific pathogenesis, delusions are distinguished:

holothymic (always sensual, figurative), which occurs during affective disorders (delusions of grandeur in a manic state, etc.);
catathymic and sensitive (always systematized), which occurs in those suffering from personality disorders or very sensitive people during strong emotional experiences (delusions of relationship, persecution);
caesthetic (hypochondriacal delirium), which is caused by pathological sensations arising in various organs and parts of the body. It is observed with senestopathies and visceral hallucinations.

Delirium of foreign speakers and those with hearing loss is a type of delusion of relation. The delusion of the hard of hearing is manifested in the belief that people around the patient constantly criticize and condemn the patient. Delusions of foreign speakers are quite rare and are manifested by the confidence of the patient, who is in a foreign language environment, in the negative reviews of others about him.

Induced delusions, in which a person, in close contact with a patient, borrows delusional experiences from him, some authors consider a variant of secondary delusions, but in ICD-10 this form is identified as a separate delusional disorder (F24).

Dupre's delusion of imagination is also considered a separate form, in which delusions are based on fantasies and intuition, and not on perception disorders or logical errors. It is characterized by polymorphism, variability and poor systematization. It can be intellectual (the intellectual component of imagination predominates) and visual-figurative (pathological fantasy and visual-figurative representations predominate). This form includes delusions of grandeur, delusions of invention and delusions of love.

Delusional syndromes

Russian psychiatry identifies 3 main delusional syndromes:

Paranoid, which is usually monothematic, systematized and interpretative. In this syndrome there is no intellectual-mnestic weakening.
Paranoid (paranoid), which in many cases is combined with hallucinations and other disorders. Slightly systematized.
Paraphrenic, characterized by systematization and fantasticness. This syndrome is characterized by hallucinations and mental automatisms.

Hallucinatory syndrome and mental automatism syndrome are often part of the delusional syndrome.

Some authors also include paranoid syndrome as a delusional syndrome, in which, as a result of pathological personality development, persistent overvalued formations are formed that significantly disrupt the patient’s social behavior and his critical assessment of this behavior. The clinical variant of the syndrome depends on the content of highly valuable ideas.

According to N. E. Bacherikov, paranoid ideas are either the initial stage of the development of paranoid syndrome, or delusional, affectively charged assessments and interpretations of facts affecting the interests of the patient. Such ideas often arise in accentuated individuals. During the transition to the stage of decompensation (during asthenia or a psychotraumatic situation), delirium arises, which can disappear during therapy or on its own. Paranoid ideas differ from overvalued ideas in the falsity of judgments and greater intensity of affect.

The plot of delirium

The plot of delirium (its content) in cases of interpretative delirium does not refer to signs of the disease, since it depends on cultural, socio-psychological and political factors influencing the individual patient. In this case, patients usually develop delusional ideas that are characteristic of all humanity at a given time period and characteristic of a certain culture, level of education, etc.

All types of delirium, based on the general plot, are divided into:

Delusion of persecution (persecutory delusion), which includes a variety of delusional ideas, the content of which is the actual persecution and intentional infliction of damage.
Delusion of grandeur (expansive delirium), in which the patient extremely overestimates himself (even to the point of omnipotence).
Depressive delusion, in which the content of the pathological idea that arose against the background of depression consists of imaginary mistakes, non-existent sins and illnesses, uncommitted crimes, etc.

In addition to the persecution itself, the story of persecution may include:

Delusion of damage, based on the patient’s belief that his property is being stolen or deliberately damaged by some people (usually neighbors or close people). The patient is convinced that he is being persecuted with the aim of ruining him.
Delirium of poisoning, in which the patient eats only home-cooked food or canned food in a tin, because he is sure that they want to poison him.
Delirium of attitude, in which the entire surrounding reality (objects, people, events) acquires a special meaning for the patient - the patient sees in everything a message or hint addressed to him personally.
Delusion of influence, in which the patient is confident in the existence of physical or mental influence on him (various rays, devices, hypnosis, voices) in order to control emotions, intellect and movements so that the patient performs the “right actions”. Frequent delusions of mental and physical influence are included in the structure of mental automatisms in schizophrenia.
Delirium of querulantism (litigiousness), in which the patient feels that his rights have been violated, so he actively fights for the restoration of “justice” with the help of complaints, litigation and similar methods.
Delusion of jealousy, which consists of confidence in the betrayal of a sexual partner. The patient sees traces of betrayal in everything and looks for evidence of it “with passion,” misinterpreting the partner’s trivial actions. In most cases, delusions of jealousy are observed in men. Characteristic of chronic alcoholism, alcoholic psychosis and some other mental disorders. Accompanied by a decrease in potency.
Delirium of staging, in which the patient perceives everything that happens as a performance or an experiment on himself (everything is a set-up, the medical staff are bandits or KGB officers, etc.).
Delusion of possession, in which the patient believes that another entity has taken possession of him, as a result of which the patient occasionally loses control over his body, but does not lose his “I”. This archaic delusional disorder is often associated with illusions and hallucinations.
Delirium of metamorphosis, which is accompanied by the “transformation” of the patient into an animated living being and, in rare cases, into an object. In this case, the patient’s “I” is lost and the patient begins to behave according to this creature or object (growls, etc.).
Delusion of a double, which can be positive (the patient considers strangers to be friends or relatives) or negative (the patient is sure that friends and relatives are strangers). The external resemblance is explained by successful makeup.
Delusion of other people's parents, in which the patient is convinced that his biological parents are educators or doubles of his parents.
Delusion of accusation, in which the patient feels that everyone around him is constantly blaming him for various tragic incidents, crimes and other troubles, so the patient has to constantly prove his innocence.

Adjacent to this group is presenile dermatozoal delirium, which is observed mainly in psychoses of late age and is expressed in the feeling of “insects crawling” in the skin or under the skin that occurs in patients.

Delusions of grandeur unite:

Delusions of wealth, which can be believable (the patient is sure that he has a substantial amount in his account) and implausible (the presence of houses made of gold, etc.).
Delirium of invention, in which the patient creates a variety of unrealistic projects.
Delirium of reformism, in the presence of which the patient tries to transform the existing world (suggests ways to change the climate, etc.). May be politically motivated.
Delusion of origin, accompanied by the belief that the patient is a descendant of a noble family, etc.
Delirium of eternal life.
Erotic or love delirium (Clerambault syndrome), which affects mainly women. Patients are convinced that a person who is inaccessible due to a higher social status (other reasons are possible) is not indifferent to them. Erotic delirium without positive emotions is possible - the patient is convinced that he is being pursued by his partner. This type of disorder is rare.
Antagonistic delusion, in which the patient considers himself the center of the struggle between good and evil.
Altruistic delirium (delirium of messianism), in which the patient imagines himself to be a prophet and miracle worker.

Delusions of grandeur can be complex.

Depressive delirium is manifested by belittling self-esteem, denial of abilities, opportunities, and confidence in the absence of physical characteristics. With this form of delirium, patients deliberately deprive themselves of all human comforts.

This group includes:

Delusions of self-accusation, self-abasement and sinfulness, constituting a single delusional conglomerate, observed in depressive, involutionary and senile psychoses. The patient accuses himself of imaginary sins, unforgivable offenses, illness and death of loved ones, evaluates his life as a series of continuous crimes and believes that he deserves the most severe and terrible punishment. Such patients may resort to self-punishment (self-harm or suicide).
Hypochondriacal delusion, in which the patient is convinced that he has some kind of disease (usually severe).
Nihilistic delusions (usually observed in manic-depressive psychosis). Accompanied by the belief that the patient himself, other people or the world around him do not exist, or are confident that the end of the world is imminent.
Cotard's syndrome is a nihilistic-hypochondriacal delusion in which bright, colorful and absurd ideas are accompanied by nihilistic and grotesquely exaggerated statements. In the presence of severe depression and anxiety, ideas of denial of the outside world dominate.

Separately, induced delirium is distinguished, which is often chronic. The recipient, with close contact with the patient and the absence of a critical attitude towards him, borrows delusional experiences and begins to express them in the same form as the inductor (the patient). Typically, recipients are people from the patient’s environment who are related to him by family relations.

Reasons for development

As in the case of other mental illnesses, the exact causes of the development of delusional disorders have not been established to date.

It is known that delirium can arise as a result of the influence of three characteristic factors:

Genetic, since delusional disorder is more often observed in those people whose relatives had mental disorders. Since many diseases are hereditary, this factor primarily influences the development of secondary delirium.
Biological - the formation of delusional symptoms, according to many doctors, is associated with an imbalance of neurotransmitters in the brain.
Environmental influences - according to available data, the trigger for the development of delirium can be frequent stress, loneliness, alcohol and drug abuse.

Pathogenesis

Delirium develops in stages. At the initial stage, the patient develops a delusional mood - the patient is sure that some changes are happening around him, he has a “premonition” of impending trouble.

The delusional mood due to the increase in anxiety is replaced by delusional perception - the patient begins to give a delusional explanation for some perceived phenomena.

At the next stage, a delusional interpretation of all phenomena perceived by the patient is observed.

Further development of the disorder is accompanied by the crystallization of delusions - the patient develops harmonious, complete delusional ideas.

The stage of attenuation of delirium is characterized by the patient’s emergence of criticism towards existing delusional ideas.

The last stage is residual delusion, which is characterized by the presence of residual delusional phenomena. It is detected after delirium, during hallucinatory-paranoid states and upon recovery from an epileptic twilight state.

Symptoms

The main symptom of delusion is the presence in the patient of false, unfounded beliefs that cannot be corrected. It is important that the delusional ideas that appeared before the disorder were not characteristic of the patient.

Signs of acute delusional (hallucinatory-delusional) states are:

presence of delusional ideas of persecution, attitude and influence;
the presence of symptoms of mental automatism (feelings of alienation, unnaturalness and artificiality of one’s own actions, movements and thinking);
rapidly increasing motor excitement;
affective disorders (fear, anxiety, confusion, etc.);
auditory hallucinations (optional).

The surroundings acquire a special meaning for the patient, all events are interpreted in the context of delusional ideas.

The plot of acute delirium is changeable and unformed.

Primary paranoid delusions are characterized by preservation of perception, persistence and systematization.

Secondary delusions are characterized by impaired perception (accompanied by hallucinations and illusions).

Diagnostics

Diagnosis of delirium includes:

studying the patient's medical history;
comparison of the clinical picture of the disorder with diagnostic criteria.

Currently used criteria for delirium include:

The occurrence of a disorder on a pathological basis (delirium is a manifestation of the disease).
Paralogicality. A delusional idea is subject to its own internal logic, which is based on the internal (affective) needs of the patient’s psyche.
Preservation of consciousness (with the exception of some variants of secondary delirium).
Inconsistency and redundancy of judgments in relation to objective reality, combined with an unshakable conviction in the reality of delusional ideas.
The constancy of a delusional idea with any correction, including suggestion.
Preservation or slight weakening of intelligence (a significant weakening of intelligence leads to the collapse of the delusional system).
The presence of deep personality disorders caused by centering around a delusional plot.

Delusions differ from delusional fantasies by the presence of a strong conviction in their authenticity and a dominant influence on the behavior and life of the subject.

It is important to take into account that misconceptions are also observed in mentally healthy people, but they are not caused by a mental disorder, in most cases they relate to objective circumstances, not the person’s personality, and can also be corrected (correction for persistent misconceptions can be difficult).

Delirium affects all areas of the psyche to varying degrees, especially noticeably affecting the emotional-volitional and affective sphere. The patient’s thinking and behavior are completely subordinated to the delusional plot, but the effectiveness of professional activity is not reduced, since mnestic functions are preserved.

Treatment

Treatment of delusional disorders is based on the complex use of medication and influence.

Drug therapy includes the use of:

Neuroleptics (risperidone, quetiapine, pimozide, etc.), blocking dopamine and serotonin receptors located in the brain and reducing psychotic symptoms, anxiety and restlessness. In case of primary delirium, the drugs of choice are antipsychotics with a selective nature of action (haloperidol, etc.).
Antidepressants and tranquilizers for depression, depression and anxiety.

To switch the patient's attention from a delusional idea to a more constructive one, individual, family and cognitive behavioral psychotherapy are used.

In severe forms of delusional disorders, patients are hospitalized in a medical facility until their condition normalizes.

Delusional ideas are false, erroneous judgments that arise on a pathological basis, take over the entire consciousness of the patient, and are not amenable to logical correction, despite the obvious contradiction with reality.

Classification of delusional ideas: A. by content (plot of delirium) 1. Delusional ideas persecution(persecution, influence, staging, litigiousness, poisoning, damage, jealousy) 2. Delusional ideas greatness(reformism, wealth, love charm, high birth, invention) 3. Delusional ideas self-deprecation(guilt, impoverishment, sinfulness, dysmorphomania, hypochondriacal delirium)

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

1) Pursuant delirium: actual persecution, poisoning, material damage, jealousy, influence, relationship, witchcraft (damage), possession. The last three concepts (naturally, and some other variants of them, which is associated with the specific ethnocultural characteristics of the patient) constitute the so-called archaic forms of delirium, the content of which directly follows from the ideas existing in society.

Delusional ideas of persecution, especially at the stage of their occurrence, are often accompanied by anxiety, fear, and often act as a determining factor in the patient’s behavior, which can make him dangerous to others and may require emergency involuntary hospitalization. The danger intensifies when the “evil” caused, in the patient’s opinion, finds a specific carrier from the immediate environment.

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

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

The most intense and complex in content depressive delirium occurs during prolonged anxious depression. In these cases, Cotard's delirium often develops. Cotard's delusions are characterized by fantastic ideas of denial or enormity. If there are ideas of denial, the patient reports his lack of moral, intellectual, and 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 out, the intestines have atrophied). The idea of denying the physical “I” is called nihilistic delusion. 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 Cotard's delusions, patients blame themselves for all sorts of past or future world cataclysms (delusions of negative power) or express ideas about eternal torment and the impossibility of dying (delusions of painful immortality).

3) Delusions of grandeur are always noted against the background of increased self-esteem of the patient and include the following clinical variants: delirium of invention, reformism, high origin, wealth. This also includes the so-called delirium of love (love's charm) and the absurd, usually occurring against the backdrop of severe dementia, megalomanic delirium of grandeur. At the same time, the patient’s statements about his extraordinary abilities, position or activities 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 grandiosity are most often characteristic of the later stages of mental illness or of severe, rapidly progressing organic brain lesions leading to dementia.

According to the degree of completeness of the system of delusional conclusions (pathological system of evidence), delirium is usually divided into systematized and unsystematized (fragmentary).

Systematized delirium is characterized by an extensive system of evidence that “confirms” the plot underlying the pathological ideas. All the facts given by the patient are interconnected 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, while the main painful idea is unconditionally preserved. If there is a pronounced systematization of delusions, one should assume a longer, chronic nature of the mental disorder. Acute conditions are often characterized by unsystematized delirium. The same delusion can also be observed with rapidly progressing organic lesions of the brain, when, along with the disintegration of the psyche (the formation of dementia), the previously harmonious system of delusional constructs also disintegrates.

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

In primary delusions, the patient's delusional constructions are primarily determined by a disorder in the sphere of thinking, leading to an inadequate interpretation of actually existing phenomena (hence another name for this delusion - interpretive).

Secondary delusions arise on the basis of existing disorders in 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 delirium can be distinguished: catathymic, holothymic, induced, residual, confabulatory.

Catathymic delirium is built on the basis of an emotionally charged complex of dominant (in some cases, overvalued) ideas and concepts.

The basis of holothymic delusions (according to E. Bleuler) are changes in the emotional sphere, the content of delusional ideas here corresponds to an altered mood (delusions of love charm when mood increases in a manic state and as a contrast delusion of self-blame in depression).

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

In some cases, the content of delusional ideas among people who communicate closely (and more often live together) may have far-reaching similarities, despite the fact that each of them suffers from an independent mental disorder of various origins. Such delirium (of the most varied content) is usually called conformal, meaning in 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 sick people.

Residual delirium (according to Neisser) occurs after a state of disturbed consciousness has been suffered and is built on the basis of associated memory disorders (such as “insular memories”) in the absence of any connection with the real phenomena of reality that actually occur after the disappearance of the acute state.

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

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

delusional mood - experiencing the surrounding world with a feeling of its change and a peculiar expectation of upcoming grandiose events such as impending disaster;

delusional perception - the beginning of a delusional interpretation of individual phenomena of the surrounding world, along with increased anxiety;

delusional interpretation - delusional explanation of perceived phenomena of reality;

crystallization of delusion - completion of the construction of varying degrees of complexity and “logical” sequence of a system of delusional conclusions;

reverse development of delusion - the emergence of criticism of individual delusional constructs or the delusional system as a whole.

Delusional syndromes: A. Paranoid syndrome: represented by a systematized interpretative (primary) delusion, not accompanied by hallucinations or mood disorders, usually monothematic (for example, reformism, invention, jealousy, queralism, etc.) B. Paranoid syndrome: Represented by secondary sensory delusions. Delirium occurs against the background of anxiety, fear, depression, hallucinations, mental automatisms, and catatonic disorders. Therefore, depending on the disorders prevailing in the clinical picture, they speak of: Paranoid syndrome Hallucinatory-paranoid syndrome Depressive-paranoid syndrome Kandinsky-Clerambault syndrome of mental automatisms, etc. V. Paraphrenic syndrome: represented by all manifestations of Kandinsky-Clerambault syndrome (delusions of persecution and influence, pseudohallucinations, mental automatisms) + Megalomaniac delusions (fantastic delusions of grandeur) In schizophrenia, over the years, a change in delusional syndromes (dynamics) is often observed: paranoid -> paranoid -> paraphrenic .