Which diagnosis does not apply to delusional states? V.M. Bleicher ‹‹Thinking disorders. Some types of delirium

Rave - A thinking disorder, which is characterized by the occurrence of judgments that do not correspond to reality (usually painful), which seem completely logical to the patient and which cannot be corrected or convinced.

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

– delusional judgments do not correspond to reality,

– the patient is completely convinced of their logic,

– delusional judgments cannot be challenged or corrected.

V. M. Bleicher gave a slightly different definition of delirium: “... a set of painful ideas, reasoning and conclusions that take possession of the patient’s consciousness, distortedly reflect reality and cannot be corrected from the outside.” This definition emphasizes the fact that delirium takes possession of the patient’s consciousness. As a consequence, the patient’s behavior is largely subordinate to this delusion.

It is very important to understand that delirium is certainly a disorder of thinking, but it is a consequence of damage and dysfunction of the brain. This is only a consequence, and, according to the ideas of modern medicine, it is pointless to treat delirium using psychological methods or, for example, by increasing the “culture of thinking.” The biological underlying cause must be identified and the underlying cause addressed appropriately (eg, with antipsychotic medications).

The famous specialist on schizophrenia E. Bleuler noted that delusion is always egocentric, that is, it is essential for the patient’s personality, and has a strong affective coloring. There seems to be an unhealthy fusion of the emotional sphere and thinking. Affectivity disturbs thinking, and disturbed thinking excites affectivity with the help of absurd ideas.

The clinical picture of delirium does not have pronounced cultural, national and historical characteristics. However, the content of delirium varies, both depending on the era and depending on the person’s personal experience. Thus, in the Middle Ages, delusional ideas associated with possession by evil spirits, magic, love spells, etc. were “popular.” Nowadays, delusions of influence are often encountered with such topics as aliens, biocurrents, radars, antennas, radiation, etc.

It is necessary to distinguish the scientific concept of “nonsense” from the everyday one. In colloquial language, delirium is often called:

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

– hallucinations,

– all sorts of meaningless ideas.

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

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

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

– paralogicality, that is, construction on the basis of one’s own internal logic of delirium, proceeding from the internal (always affective) needs of the patient’s psyche;

– in most cases, except for some variants of secondary delirium, consciousness remains clear (no disturbances of consciousness);

– redundancy and inconsistency in relation to objective reality, but with a strong conviction in the reality of delusional ideas - this shows the “affective basis of delirium”;

– resistance to any correction, including suggestion and the invariance of a delusional point of view;

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

– with delusions there are deep personality disorders caused by centering around the delusional plot;

– delusional fantasies differ from delusions in the absence of a strong conviction in their authenticity and in the fact that they do not in any way affect the being and behavior of the subject.

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

Delusion is characterized by the exploitation of a single need or instinctive pattern of behavior. For example, a patient may be “fixated” on his maternal duty. Exploitation of resentment is very common. If for a healthy person resentment is associated with an innate ability for hidden aggression, which turns on from time to time, then for a patient the theme of resentment is a cross-cutting one that captures consciousness. Delusions of grandeur are characterized by the exploitation of an innate need for social status. And so on.

Some types of delirium

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

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

At primary delirium Only thinking, rational cognition is affected. Distorted judgments are consistently supported by a number of subjective evidence that has its own system. The patient's perception remains normal. It remains functional. You can freely discuss things with him that are not related to the delusional plot. When the delusional plot is touched upon, affective tension and a “logical failure” occur. This variant of delusion includes, for example, paranoid and systematized paraphrenic delusions.

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

Secondary delusions are divided into sensual and figurative. At sensual delirium the plot is sudden, visual, concrete, rich, polymorphic and emotionally vivid. This is nonsense of perception. At figurative delirium scattered, fragmentary ideas arise, similar to fantasies and memories, that is, delusions of imagination.

Nonsense with a plot persecution. Includes a wide variety of forms:

– actual delusion of persecution;

– delusion of damage (the belief that the patient’s property is being damaged or stolen);

– delusion of poisoning (the belief that someone wants to poison the patient);

– delusions of relation (the actions of other people supposedly have something to do with the patient);

– delusion of meaning (everything in the patient’s environment is given special meaning that affects his interests);

– delirium of physical influence (the patient is “impacted” with the help of various rays and devices);

– delusions of mental influence (“influenced” by hypnosis and other means);

– delusions of jealousy (belief that a sexual partner is cheating);

– delusions of litigiousness (the patient fights to restore justice through complaints and courts);

– delusion of staging (the patient’s belief that everything around him is specially arranged, scenes of some kind of performance are being played out, or some kind of psychological experiment is being conducted);

- delirium of obsession;

– presenile dermatozoal delirium.

Nonsense with a plot of its own greatness(expansive nonsense):

- delirium of wealth;

- delirium of invention;

– nonsense of reformism (ridiculous social reforms for the benefit of humanity);

– delusion of origin (belonging to “blue bloods”);

- delirium of eternal life;

– erotic delirium (the patient is a “sex giant”);

– delirium of love (the patient, usually a woman, thinks that someone very famous is in love with him);

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

– religious delusion - the patient considers himself a prophet, claims that he can perform miracles.

Nonsense with its own plot insignificance(depressive delirium):

– delusions of self-blame, self-abasement and sinfulness;

– hypochondriacal delusion (belief in the presence of a serious illness);

– nihilistic delusion (the belief that the world does not really exist or that it will soon collapse);

- delirium of sexual inferiority.

Stages of development of delirium

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

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

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

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

5. Attenuation of delirium. Criticism of delusional ideas—“immunity” to them—appears and develops.

6. Residual delirium. Residual delusions.

We need a blockbuster (about the use of delusional plots in cinema).

And ideas, an inference that did not arise as a result of processing incoming information and is not corrected by incoming information (it does not matter whether the delusional inference corresponds to reality or not). Component of productive symptoms for and others.

It is fundamentally important that delirium, a manifestation of a human brain disease, is a disorder. Its treatment within the framework of modern medicine is possible only by biological methods, that is, drugs.

The Kandinsky-Clerambault syndrome of mental automatism, in which thinking disorders are combined with pathology of perception and ideomotor skills, is extremely close to delirium.

Delirium is studied by a branch of medicine called.

Species

Spicy

If delirium completely takes over, then this condition is called acute delirium. Sometimes the patient is able to adequately analyze the surrounding reality, if this does not concern the topic of delirium. Such nonsense is called encapsulated.

Being a productive psychotic symptomatology, delirium is a symptom of many brain diseases, but it is especially characteristic of.

Interpretative

At interpretive delirium The primary defeat is thinking - rational cognition is affected, distorted judgment is consistently supported by a number of subjective evidence that has its own system. This type of delirium is persistent and tends to progress and systematization: “evidence” is put together into a subjectively coherent system (at the same time, everything that does not fit into this system is simply ignored), more and more parts of the world are drawn into the delusional system.

Hallucinatory

Hallucinatory or “sensual” delusion arising as a result of a disorder. This is figurative delirium, with a predominance of hallucinations. Ideas with it are fragmentary, inconsistent - primarily a violation of sensory cognition (). The disturbance of thinking occurs secondarily, there is a delusional interpretation of hallucinations, a lack of conclusions, which are carried out in the form of insights - bright and emotionally rich insights. Another reason for the development of secondary delusions can be affective disorders. A manic state causes delusions of grandeur, and is the root cause of ideas of self-abasement. Elimination of secondary delirium can be achieved mainly by treating the underlying disease or symptom complex.

Delusional syndromes

Currently, in Russian psychiatry it is customary to distinguish three main delusional syndromes: paranoid syndrome, paranoid syndrome and paraphrenic syndrome. Close to delusional syndrome are mental automatism and hallucinatory syndrome, which is often included as a component of delusional syndromes (the so-called hallucinatory-paranoid syndrome).

Delirium, by definition, is a system of false judgments and conclusions. Existing criteria for delirium include: 1) occurrence on a “painful” basis, i.e. delusion is a manifestation of a disease, 2) redundancy in relation to objective reality, 3) lack of correction, 4) going beyond the existing socio-cultural characteristics of a given society

Subject (plot) of nonsense

The plot of delirium, as a rule (in cases of interpretive delirium), is not actually a sign of the disease and depends on the socio-psychological, as well as cultural and political factors within which the patient is located. At the same time, in psychiatry several groups of delusional states are distinguished, united by a common plot. These include:

delusions of persecution (persecutory delusions);
delusion of relation - it seems to the patient that the entire surrounding reality is directly related to him, that the behavior of other people is determined by their special attitude towards him;
delirium of reformism;
delusions of love (Clerambault syndrome) - almost always in female patients: the patient is convinced that a famous person loves him (her), or that everyone who meets him (her) falls in love with him (her);
rave;
antagonistic delusion (including Manichaean delirium);
delirium of litigiousness (querulantism) - the patient fights to restore “trampled justice”: complaints, courts, letters to management;
delusions of jealousy - the belief that a sexual partner is cheating;
delusion of origin - the patient believes that his real parents are high-ranking people, or that he comes from an ancient noble family, another nation, etc.
delusion of damage - the belief that the patient’s property is being damaged or stolen by some people (usually people with whom the patient communicates in everyday life);
delusion of poisoning - the belief that someone wants to poison the patient;
nihilistic delusion (characteristic of MDP) - a false feeling that oneself, others or the world around him do not exist or the end of the world is coming;
hypochondriacal delusion - the patient’s belief that he has some kind of disease (usually serious);
the so-called anorexia nervosa in most cases is also a delusional construct.

Induced (“induced”) delirium

In psychiatric practice, induced delusions are often encountered, in which delusional experiences seem to be borrowed from the patient through close contact with him and the absence of a critical attitude towards the disease. A kind of “infection” with delusions occurs: the inductee begins to express the same delusional ideas and in the same form as the mentally ill inductor (dominant person). Usually, delusions are induced by those people from the patient’s environment who communicate especially closely with him and are connected by family relationships.

Psychotic illness in a dominant person is most often, but not always. The initial delusions in the dominant person and the induced delusions are usually chronic in nature and are based on delusions of persecution, grandeur, or religious delusions. Typically, the group involved is closely connected and isolated from others by language, culture, or geography. A person who is induced to delusion is most often dependent or subordinate to a partner with true psychosis.

The diagnosis of induced delusional disorder can be made if:

1) one or two people share the same delusion or delusional system and support each other in this belief;

2) they have an unusually close relationship;

3) there is evidence that the delusion was induced in a passive member of a couple or group through contact with an active partner.

Induced hallucinations are rare but do not exclude the diagnosis.

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-inductor. 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 (inducer) 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, a delusional person perceives 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 delirium of health, is directed towards healing those around him.

By the way, many so-called traditional healers who disseminate 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.

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Delirium (delirium) is a false conclusion that does not correspond to reality, arising in connection with an illness. Delusional ideas, in contrast to errors of judgment in healthy people, are characterized by illogicality, persistence, and often absurdity and fantasticality.

In mental illnesses (for example, schizophrenia), delirium is the main disorder; in somatic illnesses, it can develop due to infections, intoxications, organic and traumatic brain lesions, and also occur after severe psychogenia or other adverse long-term environmental influences. Often delirium is combined with hallucinations, then they speak of hallucinatory-delusional states.

Symptoms

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Acute delusional (hallucinatory-delusional) states

Acute delusional (hallucinatory-delusional) states are characterized by delusional ideas of relationship, persecution, influence, which are often combined with auditory hallucinations, symptoms of mental automatism, and rapidly increasing motor excitation. Affective disorders are clearly identified.

The behavior of patients is determined by the content of hallucinatory-delusional experiences and their extreme relevance, often accompanied by agitation with aggressive, destructive actions, sudden unexpected actions, self-harm, suicidal attempts or attacks on others. The patient believes that everything around him is saturated with a special, threatening meaning for him, he interprets all actually occurring events in a delusional way, seeing in everything a dangerous meaning for him, offensive hints, threats, warnings, etc. The patient often does not understand the meaning of what is happening to him and usually does not seek an explanation for this.

Acute delusional states are characterized by variability, lack of formality in the plot of delirium, and an abundance of auditory hallucinations and mental automatisms. All these phenomena can occur separately (for example, the state is determined only by delusions of persecution, relationship; hallucinations and automatisms may be absent at this stage, etc.), but more often they coexist, intertwined with each other. This structure of the hallucinatory-delusional part of the status usually corresponds to affective disorders in the form of fear, anxiety, confusion, and depression.

Depressive-delusional states

Depressive-delusional states are one of the most common variants of acute delusional syndrome and are characterized by a pronounced affective intensity of psychopathological disorders with a predominance of depression with an anxious and melancholy overtones, excitement, fear, and confusion.

Hallucinatory-delusional symptoms

Hallucinatory-delusional symptoms are closely related to affective disorders: it is not so much ideas of persecution that predominate as delusions of condemnation, accusation, guilt, sinfulness, and imminent death. At the height of the attack, nihilistic delirium may occur. Illusory-delusional derealization and depersonalization are noted. In general, it is not so much the delusion of persecution that is characteristic, but the delusion of staging, when the patient seems that everything around him has a special meaning, in the actions and conversations of people he catches hints addressed to him, scenes are played out especially for him.

Instead of auditory hallucinosis, depressive-paranoid states are characterized by illusory hallucinosis, when the patient attributes real-life conversations of those around him to his own account, interpreting the most insignificant phrases in a delusional sense. He often sees hints addressed to himself in broadcasts on radio, television, and newspapers. False recognitions are also common.

Manic-delusional states

Manic-delusional states are to some extent the opposite of depressive-delusional states and are characterized by a predominance of elevated mood with gaiety or anger, irritability, combined with delusional ideas of overestimating one’s own personality, up to delusions of grandeur (patients consider themselves great scientists, reformers, inventors, etc.) . They are lively, talkative, interfere in everything, do not tolerate objections, and experience a surge of strength and energy. Patients, due to lack of criticality and overestimation of their capabilities for delusional reasons, often experience outbursts of excitement; they commit dangerous actions, they are aggressive and angry. Sometimes the delirium of grandeur takes on an absurdly fantastic character with ideas of enormity and cosmic influences; in other cases, the behavior of patients acquires a litigious-querulyant character with numerous persistent complaints to various authorities about the alleged injustice.

Subacute delusional states - symptoms

In subacute delusional (hallucinatory-delusional) states, psychomotor agitation may be mildly expressed or absent altogether. The patient’s behavior is not so changeable and impulsive: on the contrary, it may outwardly appear orderly and purposeful, which presents the greatest difficulties in correctly assessing the condition and often leads to serious consequences, since the patient’s behavior is determined by delusional ideas of persecution and hallucinations that are quite relevant to him. Unlike acute conditions, he can, to a certain extent, externally control his condition, knows how to hide it from others, and dissimulate his experiences. Instead of the bright affects of an acute state, in subacute states anger, tension, and inaccessibility predominate. The delusion of persecution, having lost its boundlessness, variability, imagery, begins to be systematized. The perception of the surrounding world is divided into delusional and non-delusional: specific enemies and well-wishers appear.

The main distinctive feature of chronic delusional, hallucinatory or hallucinatory-delusional states lies primarily in the persistence and low variability of the main psychopathological symptoms, i.e. delusions and hallucinations, mental automatisms. Particularly characteristic is the systematization of delirium. The relatively low severity of affective disorders is also typical for these conditions; in patients, an indifferent attitude predominates, “getting used to” constantly persisting delusions and hallucinations, while orderly behavior often remains without exacerbations of the condition.

Delirium - Diagnosis

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The presence of delusions is an undoubted sign of mental illness with all the ensuing consequences. Therefore, the diagnosis of delusions is very responsible and requires distinguishing it from obsessions, which also represent errors of judgment and are persistent. However, unlike delusions, with obsessions, not only does a critical attitude constantly remain, but the patient struggles with these pathological experiences. The patient strives to overcome obsessive thoughts and fears (phobias), although he does not always succeed.

For the correct diagnosis of delusional states and their severity, taking into account the implementation of emergency therapy, the current clinical situation is important, which is associated with the unusually widespread use of psychopharmacotherapy, as a result of which almost all orphan patients receive antipsychotic drugs for a long time (sometimes for years). As a result, among the population there is an increase in the number of mentally ill patients with psychopathological (most often delusional) disorders reduced as a result of long-term treatment, who remain outside the walls of psychiatric hospitals for a long time, live at home, often work in production or in specially created conditions (special workshops, medical labor workshops, etc.).
It is due to long-term neuroleptic effects in such patients that the type of progression of the disease decreases, and possibly stops it. However, a deeper remission with a complete reduction of delusions, hallucinations, and mental automatisms often does not occur; they persist, although they lose their “affective charge,” become less relevant and do not determine the patient’s behavior.

Delusional structure in such patients systematized, little changeable, new plot lines usually do not arise for a long time, the patient operates with the same facts, a certain circle of people involved in delirium, etc. Also stable auditory hallucinations, mental automatisms.
Over time, the patient stops responding to persistent disorders and hides them from others. Often in favorable cases, as a result of long-term treatment, elements of a critical attitude arise when patients understand the painful nature of their experiences and willingly undergo treatment. Usually, all these patients are not inclined to talk about their mental illness, about systematic treatment with psychotropic drugs, and often actively hide it, so doctors and other medical workers should be aware of this possibility and, in difficult cases, obtain the appropriate information from the regional psychoneurological dispensary. The above is very relevant from the standpoint of emergency therapy, when possible exacerbations of the condition should be taken into account both under the influence of exogenous factors and for no apparent reason. In these cases, against the background of a chronic, fairly well-compensated state, hallucinations and automatisms intensify, delusional ideas become actualized, affective disorders and agitation increase, i.e. The already described subacute and sometimes acute hallucinatory-delusional states develop.

Urgent Care

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First aid is to ensure safety measures for the patient and surrounding people in case of auto-aggression or aggression. For this purpose, they organize continuous supervision of the patient with constant duty around him of persons who can keep him from inappropriate actions. Sharp objects or other things that could be used for attack should be removed from the patient’s field of vision; it is necessary to block the patient’s access to the windows, to avoid the possibility of his escape.

In especially severe cases, the principles of fixation and transportation of patients with mental disorders should be used. It is very important to create a calm environment around the patient, not to allow manifestations of fear or panic, but to try to calm the patient down and explain that he is not in danger.

Medical assistance

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It is advisable to administer 2-4 ml of a 2.5% solution of aminazine per 2-4 ml of a 2.5% solution of tizercin intramuscularly (given the ability of these drugs to reduce blood pressure, especially after the first doses, it is advisable to place the patient in a horizontal position after the injection). After 2-3, the administration of these drugs can be repeated. In the absence of conditions for parenteral administration, aminazine or tizercin should be administered orally at a dose of 120-200 mg on the first day, then the dose can be increased to 300-400 mg.

Continuing to use sedative antipsychotics (aminazine, tizercin) to relieve agitation (if necessary, further increase in doses), antipsychotics with targeted antidelusional and antihallucinatory action are prescribed: triftazin (stelazine) 20-40 mg per day (or intramuscularly 1 ml 0.2 % solution) or haloperidol 10-15 mg per day (or intramuscularly 1 ml of 0.5% solution). In case of severe depressive-delusional symptoms, it is advisable to add amitriptyline to the therapy - 150-200 mg per day.

Relief of hallucinatory-delusional arousal and general calming of the patient cannot serve as a basis for reducing doses, much less stopping treatment, since a transition to a subacute state with dissimulation is possible, which requires the continuation of all measures of supervision and treatment.

Hospitalization

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Hospitalization in a psychiatric hospital is necessary in all cases of acute, subacute conditions or exacerbation of chronic delusional (hallucinatory-delusional) conditions. Before transportation, the patient is administered chlorpromazine or tizercin, sedated, and the precautions described above are observed.

If the treatment route is long, it should be repeated en route. In the case of delirious states that occur with somatic weakness, high fever (see Infectious delirium), etc., treatment should be organized on the spot.

Delusional syndrome (disorder) is a psychopathological complex of symptoms that is characterized by the presence of delusional ideas that come to the fore. It is classified as a pathology of the content of thinking. Delirium is not a specific symptom of any disease. It can occur in a variety of mental disorders, so it is necessary to clarify its nature (schizophrenia, organic or schizophrenia-like disorder, etc.).

Definition

Delusional ideas (delusions) are false judgments or conclusions that arise as a result of a painful process and take possession of the patient’s consciousness, which cannot be dissuaded (corrected).

They are not true. The patient is firmly convinced of the correctness of his judgment, despite the evidence contradicting this (there is no criticism on the part of the patient). This is a potential problem for the person himself, since he will not seek medical help on his own.

The criteria for delirium are the following characteristics:

it is always a symptom of a disease;
delusional ideas are not true, this can be proven;
are not amenable to persuasion (correction) and critical self-reflection (self-criticism);
they determine the patient’s behavior (his actions), completely dominate the entire psyche (logic, instincts, reflexes), occupying all consciousness.

You should not take any false judgment of a person for nonsense, since confidence and persistence in the expressed thoughts can be a manifestation of a worldview.

Beliefs, unlike delusions, are formed throughout life and are closely related to experience and upbringing. By presenting patients with clear arguments, evidence, evidence aimed at denying the correctness of their thoughts, the doctor sees that they are considered patients.

Delusions and overvalued ideas should not be confused, which is of particular importance in situations where they are the only symptom of a mental disorder. When a real life problem in the mind of a mentally healthy person acquires an excessively large (priority) importance, in this case they speak of an overvalued idea.

Classification

There are many classifications of delusional ideas.

According to the mechanism of formation, they are divided into:

1. Primary - associated with the interpretation and construction of step-by-step logic, understandable only to the patient himself. It is an independent disorder of the sphere of thinking, which does not relate to other symptoms of mental pathologies.
2. Secondary - associated with the formation of holistic images, for example, under the influence of hallucinations or altered mood. It arises as a result of disturbances in other areas of the psyche.
3. Induced. It manifests itself in the fact that the recipient (healthy person) reproduces the delusional system of the inductor (patient). This situation arises as a result of communication with a close relative who suffers from mental illness.

Delirium, according to the degree of systematization, is divided into fragmentary (fragmentary) and systematized. The second indicates the chronic nature of the course of mental illness. As the disease progresses, the phase of disintegration of the delusional system begins. Thoughts that arise acutely are always devoid of harmony. It differs from chronic unsystematized ideas vivid emotional experiences, the presence dramatization relationship, adjustments, excitement, feelings of change.

Acute delirium responds well to treatment. It is usually possible to achieve high-quality remission or recovery. Treatment is carried out by prescribing antipsychotics (Paliperidone, Ziprasidone, etc.)

The following variants of delusional ideas are distinguished by content:

Variety	Characteristics with examples
Delusions of relationship and meaning	The patient feels that others look at him differently, hinting at his special purpose through their behavior. A person is in the center of attention and interprets environmental phenomena that were previously not significant to him as important.
Pursuit Ideas	The patient assures that he is being watched. He finds a lot of evidence (hidden equipment), gradually noticing that the circle of suspects is expanding. Transitive delusions of persecution are also possible, when a person himself begins to follow imaginary individuals, using aggression against them
Ideas of greatness	The patient is convinced that he has power in the form of exceptional energy or strength, due to enormous wealth, divine origin, achievements in the field of science, politics, art, the value of the reforms he proposes
Ideas of jealousy	A person is convinced of adultery, although the arguments are absurd. For example, a patient claims that his partner is having sexual intercourse with another through a wall.
Love delirium	Consists of the subjective belief that he/she is the object of love of a movie star, politician or doctor, often a gynecologist. The person in question is often persecuted and forced to reciprocate
Ideas of self-blame and guilt	The patient is convinced that he is guilty before society and loved ones because of his actions; he is awaiting trial and execution. Usually formed against a background of low mood
Hypochondriacal delirium	A person interprets his somatic sensations, senestopathy, paresthesia as a manifestation of an incurable disease (HIV, cancer). Requires examinations, awaits his death
Nihilistic delirium (Cotard's delirium)	The patient assures that his insides have “rotted”, and similar processes are also taking place in the surrounding reality - the whole world is at different stages of decomposition or is dead
Delirium of staging	It lies in the idea that all events in the surrounding world are specially adjusted, as in the theater. The patients and staff in the department are actually secret service officers in disguise; the patient’s behavior is staged and shown on television.
Delirium of a double	Expressed in the conviction of the presence of a negative or positive double (as opposed to personality traits), which is located at a considerable distance and can be associated with the patient by symbolic or hallucinatory constructions
Manichaean nonsense	A person is convinced that the whole world and himself are an arena for the struggle between good and evil - God and the devil. This system is capable of being confirmed by mutually exclusive pseudohallucinations, that is, voices that argue with each other for possession of the patient's soul
Dysmorphoptic delirium	The patient, often a teenager, is convinced that his face shape has changed, there is an anomaly of the body (most often the genitals), and actively insists on surgical treatment
Delirium of obsession	A person feels himself transformed into some kind of animal. For example, into a vampire, a bear (Lokis symptom), a wolf (lycanthropy) or an inanimate object

The plot of delirium

In psychiatry, there is such a concept as the plot of delirium. It denotes the content or plot of thought. The plot of each person’s delirium is unique and inimitable; in many ways, the content corresponds to the ideas that are popular at a given time in society. The thought is emotionally experienced by the patient, he is able to experience fear, anger, melancholy, joy, etc.

According to one or another dominant emotion, 3 groups of plots are distinguished:

Delusion of persecution (persecutory). Various versions of these ideas are associated with the predominance of fear and anxiety in patients, which often determines their aggressive behavior and in this case is an indication for involuntary hospitalization.
Depressive delirium. It is an expression of deep emotional experiences - depression, melancholy, disappointment, shame, hopelessness.
Delirium of grandeur. Various options are usually accompanied by a joyful, upbeat or complacent, calm mood. In this case, patients are tolerant of the circumstances that constrain them, are not prone to aggression, and are friendly.

Often one patient experiences a combination of several plots:

Analogues of delusional ideas in children

The equivalents of delusional ideas in children are overvalued fears and delusional fantasies.

The child talks about an imaginary world and is sure that it really exists, replacing reality. It contains good and evil characters, love and aggression. Fantasy, like delusional ideas, is not subject to criticism, but is very changeable.

Overvalued fears are expressed in fears towards objects that do not themselves have such a phobic component. An example is a situation where a child is afraid of the corners of the room, the window, the radiator, or parts of the parents’ body.

Stages of formation of delusional syndrome

In the process of formation, delusional syndrome goes through several stages of development. They are the following:

1. Affective stage. Manifested by the presence of delusional mood (vague anxiety). It is expressed in a feeling of vague internal restlessness, suspicion, wariness, confidence that dangerous changes are happening around. Then a delusional perception (special meaning) appears. It represents an assessment of the environment, when, along with the usual idea of a really existing object, an unreal idea appears, logically not connected with reality, with the nature of a special attitude towards the patient.
2. Stage of receptor shift. Delusional perception is replaced by a delusional idea (insight, interpretation). It is characterized by the fact that the patient begins to perceive facts, events, and the words of others in a distorted way, but does not connect his painful conclusions into a single system.
3. Interpretation stage. At this stage, considerations are formalized into a system of ideas (“crystallization of delirium”). This process is called delusional awareness.
4. Stage of system disintegration. The final stage of the existence of delusional syndrome. As the disease progresses, the indifference and calm of the patient, who gradually loses interest in his “persecutors,” become increasingly noticeable.

There are also other stages of development of delusional syndrome proposed by K. Conrad. These include the following: