Hallucinatory paranoid syndrome. Paranoid syndrome
Hallucinatory-paranoid syndrome is a condition in which delusions of persecution and influence, phenomena of mental automatism are combined with pseudohallucinations. Delusions of influence are extremely diverse in content: from witchcraft and hypnosis to the most modern technical methods or devices - radiation, atomic energy, laser beams, etc.
Mental automatisms- “made” thoughts, sensations, movements, actions that appear, according to the patient’s conviction, as a result of the influence of one or another external force on the body. Mental automatisms include sensory, ideational and motor components and are manifested by a feeling of mastery of certain mental functions of the patient, resulting from exposure to one or another type of energy.
In a patient, these automatisms are not necessarily observed simultaneously, in aggregate, but develop as the disease progresses, usually in the sequence described below.
Ideatorial (associative) automatisms- the result of an imaginary influence on thinking processes and other forms of mental activity. The first manifestations of ideatorial automatisms are mentism (a non-stop, often rapid flow of thoughts, accompanied in some cases by corresponding figurative ideas and a feeling of vague anxiety) and a symptom of openness, expressed in the feeling that the patient’s thoughts are known to others. Ideation automatisms also include the sound of thoughts: no matter what the patient thinks about, his thoughts sound loudly and clearly in his head. The sound of thoughts is preceded by the so-called rustle of thoughts. This type of automatism also includes “thought echo”: those around them repeat the patient’s thoughts out loud. Subsequently, the following symptoms develop: withdrawal of thoughts (the patient’s thoughts disappear from the head), made thoughts (the patient’s conviction that the thoughts he has are fabricated by strangers, usually his persecutors), made dreams (dreams of a certain content, most often with a special meaning, caused by external influences), unwinding of memories (patients, against their will and desire, under the influence of an outside force, are forced to remember certain events of their life, and often at the same time the patient is shown pictures illustrating the memories), made mood, made feelings (patients claim that their moods , feelings, likes and dislikes are the result of external influences).
Senestopathic (sensory) automatisms- extremely unpleasant sensations that occur in patients as a result of the imaginary influence of an outside force. These sensations can be very diverse: a feeling of sudden heat or cold, painful sensations in the internal organs, head, limbs. Such sensations can be unusual and fanciful: twisting, pulsation, bursting, etc.
Kinesthetic (motor) automatisms: disorders in which patients have the belief that the movements they make are carried out against their will, under the influence of external influences. Patients claim that their actions are controlled, their limbs are moved, and they cause a feeling of immobility and numbness. Kinaesthetic automatisms also include speech motor automatisms: patients claim that their tongue is set in motion for the purpose of pronouncing words and phrases, that the words they utter belong to strangers, usually persecutors.
Pseudohallucinations- perceptions that arise, like hallucinations, without a real object. Unlike hallucinations, they can be projected not only externally, but also be “inside the head” and perceived by the “mind’s eye.” Unlike true hallucinations, pseudohallucinations are not identified with real objects and are perceived as made. The most significant difference: the patient feels that the pseudohallucinations are “made”, “caused” by some external force, cause. The structure of hallucinatory-paranoid syndrome includes visual, auditory, olfactory, gustatory, tactile, visceral, and kinesthetic pseudohallucinations.
Visual pseudohallucinations- “made” visions, images, faces, panoramic pictures that are shown to the patient, as a rule, by his persecutors using certain methods. Auditory pseudohallucinations - noises, words, phrases transmitted to the patient via radio, through various equipment. Pseudo-hallucinations, like true hallucinations, can be imperative and commentary, voices - male, female, children, belonging to familiar and unfamiliar persons. Olfactory, gustatory, tactile, visceral pseudohallucinations are identical in manifestation to similar true hallucinations; the only difference is that they are perceived as done.
Variants of the syndrome according to the course.
Spicy hallucinatory-paranoid syndrome is characterized by a great sensitivity of delusional disorders with no tendency to systematize them, the severity of all forms of mental automatisms, the affect of fear and anxiety, confusion, and transient catatonic disorders.
Chronic hallucinatory-paranoid syndrome. In the clinical picture there is no confusion, no brightness of affect, there is systematization or (with the development of abundant pseudohallucinations) a tendency to systematize delusional disorders. At the height of development, phenomena of delusional depersonalization (the phenomenon of alienation) often arise.
Options for structure.
Hallucinatory version. The picture of the condition is dominated by pseudohallucinations; a relatively insignificant proportion of delusions of influence, persecution, and especially the phenomena of mental automatism is observed.
Crazy option. Delusional ideas of influence and persecution, as well as mental automatisms, come to the fore, and pseudohallucinatory disorders are relatively weakly expressed.
Kandinsky-Clerambault syndrome in the structure of individual diseases. Hallucinatory-paranoid syndromes are observed in various mental illnesses: schizophrenia, occurring continuously and in the form of attacks, epilepsy, affected symptomatic psychoses, chronic alcoholic psychoses, organic diseases of the brain.
The term "paranoid" can refer to symptoms, syndromes, or personality types. Paranoid symptoms are delusional beliefs most often (but not always) associated with persecution. Paranoid syndromes are those in which paranoid symptoms form part of a characteristic constellation of symptoms; an example would be morbid jealousy or erotomania. The paranoid (paranoid) personality type is characterized by such traits as excessive concentration on one’s own person, increased, painful sensitivity to real or imagined humiliation and neglect of oneself by others, often combined with an exaggerated sense of self-importance, belligerence and aggressiveness.
PARANOID SYMPTOMS
“Paranoid” is a painful distortion of ideas and attitudes regarding the interaction and relationship of the individual with other people. If someone has a false or unfounded belief that he is being persecuted, or deceived, or exalted, or that he is loved by a famous person, in each case it means that the person interprets the relationships between himself and other people painfully in a distorted way.
Relationship ideas arise in overly shy people. The subject is unable to get rid of the feeling that he is being paid attention to in public transport, in restaurants or in other public places, and those around him notice a lot of things that he would prefer to hide. A person realizes that these sensations are born in himself and that in reality he is no more conspicuous than other people. But he cannot help but experience the same sensations, completely disproportionate to any possible circumstances.
The delusion of relation is a further development of simple ideas of relation; the falsity of the ideas is not realized. The subject may feel that the whole neighborhood is gossiping about him, far beyond what is possible, or he may find mention of himself in television programs or on the pages of newspapers. He hears as if they are talking on the radio about something related to the question he has just been thinking about, or he imagines that they are following on his heels, watching his movements, and what he says is being recorded on a tape recorder.
Delirium of persecution. The subject believes that some person or organization or some force or power is trying to harm him in some way - ruin his reputation, cause bodily harm, drive him crazy, or even lead him to the grave.
This symptom takes various forms - from the subject’s simple belief that people are persecuting him, to complex and bizarre plots in which any kind of fantastic constructions can be used.
Delusions of grandeur (megalomaniacal delusions). The PSE Glossary offers a distinction between delusions of grandiose characteristics and delusions of self-greatness.
A subject with delusions of grandiose ability believes that he has been chosen by some powerful force or destined by fate for a special mission or purpose due to his extraordinary talents. He believes that he has the ability to read other people's thoughts, that he has no equal when it comes to helping people, that he is smarter than everyone else, that he has invented wonderful machines, created an outstanding piece of music, or solved a mathematical problem that most people cannot understand.
A subject with delusions of grandeur believes that he is famous, rich, titled, or related to prominent people. He may believe that his real parents are royalty, from whom he was kidnapped, replaced with another child, and transferred to another family.
CAUSES OF PARANOID SYMPTOMS
When paranoid symptoms appear in connection with a primary disease - an organic mental state, affective disorder or schizophrenia - the leading role is given to those etiological factors that determine the development of the primary disease. The question still arises as to why some people develop paranoid symptoms and others do not. This has usually been explained in terms of premorbid personality characteristics and factors leading to social isolation.
Many scientists, including Kraepelin, believed that the occurrence of paranoid symptoms was most likely in patients with premorbid personality traits of the paranoid type. Data from modern research on so-called late paraphrenia support this opinion (see Chapter 16). In particular, Kau and Roth A961) found paranoid or hypersensitive personality traits in more than half of the 99 patients they examined. Freud hypothesized that predisposed individuals may develop paranoid symptoms through the defense mechanisms of denial and projection Freud 1911). He believed that a person does not allow himself to realize his inadequacy and lack of faith in himself, but projects them onto the outside world. Clinical experience generally supports this idea. The examined patients with paranoid symptoms often reveal internal dissatisfaction associated with a feeling of inferiority with increased self-esteem and ambitions that do not correspond to real achievements. According to Freud's theory, paranoid symptoms can arise when denial and projection are used as a defense against unconscious homosexual tendencies. He came to these ideas by studying Daniel Schreber, president of the Dresden Court of Appeal (see Freud 1911). Freud never met Schreber, but read the latter's autobiographical notes on his paranoid illness (it is now generally accepted that he suffered from paranoid schizophrenia) and the report of his attending physician Weber. Freud believed that Schreber could not consciously accept his homosexuality, so the idea “I love him” was denied and counteracted by the opposite formula “I hate him.” Then, through projection, it was transformed into “it is not I who hate him, but he who hates me,” which in turn became “he is persecuting me.” Freud was of the opinion that all paranoid delusions can be presented as a refutation of the formula “I (the man) love him (the man).” At the same time, he went so far as to argue that delusions of jealousy can be explained by subconscious homosexuality: a jealous husband is subconsciously attracted to a man for whom he accuses his wife of loving him; the construction in this case was: “it’s not me who loves him, it’s she who loves him.” At one time, these ideas were widespread, but today they have few supporters, especially since they are clearly not confirmed by clinical experience. Kretschmer also argued that paranoid disorders are more common in people with predisposing or. “sensitive” personality traits (Kretschmer 1927). In such people, the relevant precipitating event may give rise (in Kretschmer's terminology) to sensitive Beziehungswahri, which manifests itself as an understandable psychological reaction. In addition to internal psychological factors present in the patient himself, social isolation can also lead to paranoid symptoms. Prisoners who are kept in solitary confinement, refugees, and migrants are prone to paranoid development, although the data provided by various researchers is contradictory. Deafness can create the effect of social isolation. In 1915, Kraepelin pointed out that paranoid manifestations could be caused by chronic deafness. Houston and Royse (1954) found an association between deafness and paranoid schizophrenia, while Kau and Roth (1961) found hearing impairment in 40% of patients with late paranoid paraphrenia. However, it should be remembered that the vast majority of deaf people do not become paranoid. (See Corbin and Eastwood 1986 for a review of the relationship between deafness and paranoid disorders in older people.)
Paranoid (paranoid) personality disorder
A person with this disorder is characterized by excessive sensitivity to failure and disruption, suspiciousness, a tendency to misinterpret the actions of others as hostile or humiliating, and a disproportionately exaggerated sense of personal rights and an aggressive willingness to defend them. It is clear from the DSM-IIIR and ICD-10 definitions that the concept of paranoid personality covers a wide range of types. At the same time, one extreme is a painfully shy, timid young man who avoids social contacts and thinks that everyone disapproves of him; the other extreme is an assertive and aggressively demanding person who flares up at the slightest provocation. Between these two poles there are many gradations. It is necessary to distinguish different types of paranoid personality from paranoid syndromes, since this has significant implications from a treatment point of view. Making such a distinction is often very difficult. Sometimes one imperceptibly transforms into another throughout a person’s life, as was the case, for example, with the philosopher Jean-Jacques Rousseau. The basis for differentiation is that with a paranoid personality there are no hallucinations and delusions, but only overvalued ideas.
ORGANIC MENTAL STATES
Paranoid symptoms are common in delirium. Since the patient in this state has an impaired ability to understand the essence of the events taking place around him, this creates the ground for anxiety and misinterpretation, and thereby for suspicion. Then delusional ideas may arise, usually transient and unsystematized; they often lead to behavioral disorders such as querrulation or aggressiveness. An example is drug-induced conditions. Similarly, paranoid delusions can occur in dementia caused by any number of causes, including trauma, degeneration, infection, metabolic disorders, and endocrine disorders. In clinical practice, it is important to remember that in elderly patients with dementia, paranoid delusions sometimes occur before the first signs of intellectual decline are detected.
AFFECTIVE DISORDERS
Paranoid delusions are relatively common in patients with severe depressive illnesses. These latter are in most cases characterized by a feeling of guilt, lethargy and such “biological” manifestations as loss of appetite and weight loss, sleep disturbances and decreased sexual desire. These disorders are more typical for middle and old age. It is characteristic that in a depressive disorder the patient usually perceives the alleged actions of the persecutors as justified by his own guilt or the evil that he allegedly caused, and in schizophrenia the patient most often expresses his indignation on the same occasion. It is sometimes difficult to determine whether paranoid features are secondary to a depressive illness or, conversely, whether the depression is secondary to paranoid symptoms due to another cause. The primacy of depression is more likely if mood changes have occurred before, and they are more pronounced than paranoid features. The distinction is important because it may indicate the appropriateness of treatment with either antidepressants or phenothiazine antipsychotics. Paranoid delusions are also sometimes observed in manic patients. More often this is a delusion of grandeur than a delusion of persecution - the patient pretends to be extremely rich, or occupies the highest position, or is of great importance.
PARANOID SCHIZOPHRENIA
In contrast to the hebephrenic and catatonic forms of schizophrenia, the paranoid form usually manifests itself at a more mature age - rather in the fourth decade than in the third. The main symptom of paranoid schizophrenia is delusional ideas, which become relatively persistent over time. Most often these are delusions of persecution, but there may also be delusions of jealousy, noble birth, messianism, or bodily changes. In some cases, delusions are accompanied by hallucinatory “voices,” the utterances of which are sometimes (but not always) related in content to ideas of persecution or greatness.
When diagnosing, it is important to distinguish paranoid schizophrenia from other paranoid conditions. In doubtful cases, schizophrenia is suggested rather than a delusional disorder if the paranoid delusion is particularly strange in its content (psychiatrists often call it pretentious or ridiculous). If the delirium is of an absurd nature, then there is no doubt about the diagnosis. For example, a middle-aged woman is convinced that a certain member of the government has a special interest in her and cares about her well-being. She believes that he is at the controls of the plane that flies over her house every day just after noon, and therefore she waits for this moment in her garden every day. As the plane flies over, the lady throws up a large red beach ball. According to her, the pilot always responds to these actions by “swinging the wings of the airplane.” When the absurdity of delirium is not as clearly expressed as in the described case, the doctor makes a judgment regarding the degree of its pretentiousness or absurdity arbitrarily, at his own discretion.
Special paranoid states
Some paranoid states are recognized by certain characteristic features. They can be divided into two groups: conditions with specific symptoms and conditions that appear in special situations. Specific symptoms include delusions of jealousy, litigious delusions, erotic delusions, and delusions related to Capgras and Fregoli. Special situations include close contacts, close (kinship, family, etc.) relationships (folie a deux*), migration and imprisonment. Many of these symptoms were of particular interest to French psychiatrists (see: Pichot 1982, 1984).
PATHOLOGICAL JEALOUSY
The defining, integral feature of pathological, or morbid, jealousy is the abnormal belief that the marital partner is unfaithful. The condition is called pathological because this belief, which may be associated with delusion or with an overvalued idea, does not have sufficient grounds and is not amenable to reasonable arguments. Pathological jealousy was examined in the works of Shepherd 1961) and Mullen and Maack 1985). Such a belief is often accompanied by strong emotions and characteristic behavior, but these in themselves do not constitute the essence of pathological jealousy. A husband who finds his wife in bed with her lover may feel extreme jealousy and, losing control of himself, do something bad, but in this case we should not talk about pathological jealousy. This term should only be used when jealousy is based on painful ideas, unfounded “evidence” and reasoning. Pathological jealousy has been frequently described in the literature, mostly in the form of one or two case reports. It has been given various names, including sexual jealousy, erotic jealousy, morbid jealousy, psychotic jealousy, and Othello syndrome. The main sources of information are the results published by Shepherd 1961), Langfeldt 1961), Vauhkonen 1968), Mullen and Maack 1985) of their studies of cases of morbid jealousy. Shepherd studied the medical records of 81 hospital patients in England (London), Langfeldt did similar work with 66 medical records in Norway, Vauhkonen conducted a study based on a survey of 55 patients in Finland; Mullen and Maack analyzed the medical records of 138 patients. The incidence of morbid jealousy in the general population is unknown. But this condition is not so rare in psychiatric practice, and most practicing clinicians see one or two such patients a year. These patients deserve special attention not only because they cause suffering to their spouses and families, but also because they can be extremely dangerous. All evidence suggests that morbid jealousy is more common in men than in women. In three of the above studies, the ratio between men and women was: 3.76:1 (Shepherd), 1.46:1 (Langfeldt), 2.05:1 (Vauhkonen).
Clinical signs
As stated above, the main characteristic feature of pathological jealousy is an abnormal belief in the partner’s infidelity. This may be accompanied by other pathological beliefs, for example, the patient may believe that his wife is plotting something against him, trying to poison him, deprive him of sexual abilities, or infect him with a venereal disease.
The mood of a morbidly jealous patient can vary depending on the underlying disorder, but most often it is a mixture of distress, anxiety, irritability and anger. As a rule, the patient's behavior is characteristic. Usually he conducts a persistent and intense search for evidence of his partner’s infidelity, for example, through a scrupulous study of diaries and correspondence, and a thorough examination of bed and underwear in search of traces of genital discharge. The patient can spy on his wife or hire a private detective to spy on him. It is typical that such a jealous person constantly subjects his partner to “cross-examination,” which can lead to wild quarrels and cause fits of rage in the patient. Sometimes a partner, having reached complete despair and exhaustion, is eventually forced to make a false confession. If this happens, jealousy flares up even more than it dies down. Interestingly, the jealous person often has no idea who the intended lover might be or what kind of person he might be. Moreover, the patient often avoids taking measures that would provide irrefutable evidence of the guilt or innocence of the object of jealousy. The behavior of a patient with morbid jealousy can be strikingly abnormal. A successful businessman, a representative of London's commercial circles, carried a machete in his briefcase along with financial documents, preparing to use it against any lover of his wife whom he could track down. A carpenter built a complex system of mirrors into his house so he could watch his wife from another room.
The third patient, while driving, avoided stopping next to another car at a traffic light, fearing that while waiting for the green signal, his wife, who was sitting in the passenger seat, would secretly make an appointment with the driver of the neighboring car.
Etiology
In the studies described earlier, morbid jealousy was found to occur in a variety of primary disorders, the incidence of which varies depending on the population studied and the diagnostic criteria used. Thus, paranoid schizophrenia (paranoia or paraphrenia) was observed in 17-44% of patients with pathological jealousy, depressive disorder - in 3-16%, neurosis and personality disorder - in 38-57%, alcoholism - in 5-7%, organic disorders - in 6-20%. Primary organic causes include exogenous ones - associated with the use of substances such as amphetamine or cocaine, but more often - a wide range of brain disorders, including infections, neoplasms, metabolic and endocrine disorders and degenerative conditions. The role of personality traits in the genesis of pathological jealousy should be emphasized. It often turns out that the patient experiences an all-consuming feeling of inferiority; there is a discrepancy between his ambitions and real achievements. Such a person is especially vulnerable to anything that can cause and aggravate this feeling of inferiority, for example, to a decrease in social status or to impending old age. Giving up in the face of such threatening events, a person often projects guilt onto others, which can be expressed in the form of jealous accusations of infidelity. As already mentioned, Freud argued that subconscious homosexual impulses play a role in all types of jealousy, and especially in its delusional form. He believed that such jealousy could arise if these impulses were subjected to repression, denial, and the subsequent formation of a reaction. However, none of the studies reviewed above documented a link between homosexuality and morbid jealousy.
Many authors believe that morbid jealousy may be caused by erectile difficulties in men and sexual dysfunction in women. In studies conducted by Langfeldt and Shepherd, such a relationship was either not detected at all, or only minor evidence of its existence was obtained. Vauhkonen, however, reports sexual difficulties in more than half of the men and women he sees, but his data were partly obtained from a marriage and family counseling clinic.
The prognosis depends on a number of factors, including the nature of the underlying mental disorder and the premorbid personality of the patient. There are few statistical data on forecasts. Langfeldt examined 27 of his patients 17 years later and found that more than half of them still suffered from constant or recurring jealousy. This confirms the general clinical observation that the prognosis is generally poor.
Risk of violence
Although there are no direct statistics regarding the risk of violence in morbid jealousy, there is no doubt that the risk can be extremely high. Mowat 1966) examined patients with homicidomania who were hospitalized at Broadmoor Hospital for several years and found morbid jealousy in 12% of men and 15% of women. In Shepherd's group of 81 patients with morbid jealousy, three showed homicidal tendencies. In addition to this, there is undoubtedly a significant risk of bodily harm caused by such patients. In the group of Mullen and Maask 1985), few of the 138 patients were criminally charged, but approximately one in four threatened to kill or injure their partner, and 56% of men and 43% of women were aggressive or threatening toward perceived rivals.
Assessment of the patient's condition
Assessment of the condition of a patient with pathological jealousy must be thorough and comprehensive. It is extremely important to obtain as complete an idea as possible of his mental state; Therefore, you should first meet alone with the patient's spouse and then with him. Information about the patient's painful ideas and actions, reported by his wife, is often much more detailed than information that can be obtained directly from him. The doctor should try to tactfully find out how firmly the patient is convinced of his partner’s infidelity, how great his indignation is, and whether he is planning to commit an act of retaliation. What factors provoke him to bursts of indignation, accusations and attempts to arrange a “cross-examination”? How does your partner react to such outbursts? How does the patient, in turn, react to the partner’s behavior? Were any violent acts committed? If yes, in what form? Was there any serious damage?
In addition to this, the doctor should collect a detailed history of the marital and sexual life of both partners. It is also important to diagnose the underlying mental disorder as this will have implications for treatment.
Treatment
Treatment of morbid jealousy is often associated with certain difficulties, since such a patient may feel that treatment has been imposed on him, and may not show much desire to comply with medical prescriptions. Adequate treatment of any underlying disorder such as schizophrenia or affective psychosis is of paramount importance.
Psychotherapy may be indicated for patients with neurotic or personality disorders. The goal is usually to relieve tension by allowing the patient (and his or her spouse) to openly express and discuss their feelings. Behavioral techniques have also been proposed (Cobb and Marks 1979). When used, in particular, they encourage the partner to develop behavior that helps reduce jealousy, for example, through counter-aggression or by refusing to argue, depending on the specific case.
If outpatient treatment is unsuccessful or if the risk of violence is high, hospitalization may be necessary. It often happens, however, that in the hospital the patient seems to improve, but immediately after discharge a relapse begins. When a doctor believes that violent actions may follow on the part of a patient, he is obliged to warn the patient’s spouse about this.
In some cases, for safety reasons, it is necessary to recommend separation of a married couple. As the old axiom says, the best treatment for morbid jealousy is geographical.
EROTIC DELUSION (CLERAMBO SYNDROME).
De Clerambault (1921; see also 1987) proposed a distinction between paranoid delusions and delusions of passion. The latter is distinguished by its pathogenesis and the fact that it is accompanied by excitement. The presence of an idea of a goal is also characteristic: “all patients in this category - regardless of whether they exhibit erotomania, litigious behavior or morbid jealousy - from the moment the disease occurs, there is a precise goal, which from the very beginning sets the will in motion.
This is the hallmark of this disease." This distinction is of interest only from a historical point of view, since it is no longer made. However, erotomania syndrome is still known as Clerambault syndrome. It is extremely rare (for further information see Enoch and Trethowan 1979).
Although the disorder is typically seen in women, Taylor et al. A983) reported four cases in a group of 112 men accused of committing violent acts.
In erotomania, the subject is usually a lonely woman who believes that a person from higher spheres is in love with her. The intended suitor is usually unavailable because he is either already married, has a much higher social position, or is a famous entertainer or public figure. According to Clerambault, a woman in the grip of reckless passion believes that it was the “object” who first fell in love with her, that he loves more than she, or even that only he loves. She is sure that she was specially chosen by this man from the highest spheres and that it was not she who took the first steps towards him. This faith serves as a source of satisfaction and pride for her. She is convinced that the “object” cannot be a happy or complete person without her.
Often the patient believes that the “object” cannot open his feelings for various reasons, that he is hiding from her, that it is difficult for him to approach her, that he has established indirect communication with her and is forced to behave in a paradoxical and contradictory manner. A woman with erotomania sometimes annoys the “object” so much that he goes to the police or sues. Sometimes even after this, the patient’s delusion remains unshakable, and she comes up with explanations for the paradoxical behavior of the “object.” She can be extremely stubborn and impervious to reality. In some patients, delusions of love develop into delusions of persecution. They are ready to insult the “object” and publicly accuse him. This is described by Clerambault as two phases: hope gives way to indignation.
It is likely that most patients with erotic delusions suffer from paranoid schizophrenia. In cases where currently available data are insufficient to establish a definitive diagnosis, this illness can be classified as erotomanic delusional disorder according to DSM-IIIR.
Litigation and reformist nonsense
Litigative delirium was the subject of a special study by Krafft-Ebing in 1888. Patients with this type of delusion are drawn into an extensive campaign of accusations and complaints directed against the authorities. There is a lot in common between these patients and the paranoid litigious people who initiate a whole series of legal proceedings, participate in countless trials, and during the hearing of the case they sometimes become furious and threaten the judges. Baruk 1959) described "reformist delirium" that focused on religious, philosophical, or political themes. People with such delusions constantly criticize society, and sometimes take elaborate actions that can be violent, especially if the delusion is political in nature. Some political assassins should be classified in this group.
Delirious Capgras
Although similar cases have been reported before, the condition now known as Capgras syndrome was first described in detail by Capgras and Reboul-Lachaux in 1923 (see Serieux and Capgras 1987). They called it Villusion des sosies (the illusion of a double). Strictly speaking, this is not a syndrome, but a single symptom, and the term delusion (rather than illusion) of a double is more appropriate to it. The patient believes that a person very close to him - usually a spouse or relative - has been replaced by a double. He recognizes that the one he mistakenly identifies as a double is very similar to the “switched”, but is still convinced that it is a different person. This condition is extremely rare; it is more common among women than men and is usually associated with schizophrenia or a mood disorder. The history often reflects depersonalization, derealization, or deja vu. It is believed that in most cases there is fairly strong evidence for the presence of an organic component, as evidenced by clinical manifestations, results of psychological testing and data from radiological studies of the brain (see: Christodoulou 1977). However, an analysis of 133 published cases concluded that more than half of the patients suffered from schizophrenia; in 31 cases a somatic disease was established (Berson 1983).
Brad Fregoli
This condition is usually called Fregoli syndrome - after the actor who had the amazing ability to transform and change his appearance. This condition is observed even less frequently than Calgra delirium. It was originally described by Courbon and Fail in 1927. The patient mistakenly identifies different people he meets with the same person known to him (usually the one he considers to be his stalker). He claims that although there is no external resemblance between these people and the person he knows, they are nonetheless psychologically identical. This symptom is commonly associated with schizophrenia. Here too, clinical signs, psychological testing and brain x-rays suggest an organic component to the etiology (Christodoulou 1976).
Paranoid states that manifest themselves in certain situations
INDUCED PSYCHOSIS (FOLIE L DEUX)
Induced psychosis is said to occur if a paranoid delusional system develops in a person as a result of close contacts with another person who already has an established delusional system of a similar type. This is almost always a delusion of persecution. In the DSM-IIIR, such cases are classified as induced psychotic disorder, and in the ICD-10 - as induced delusional disorder. Although the incidence of induced psychosis has not been established, it is clear that it is a rare phenomenon. Sometimes more than two people are involved, but this is extremely rare. This condition was sometimes observed in two people who were not in a family relationship, but in at least 90% of the described cases we were talking about members of the same family. There is usually a dominant partner with a persistent delusion who appears to induce similar delusions in the dependent or suggestible partner (at first, perhaps overcoming the latter's resistance). As a rule, these two live together and maintain close contacts for a long time, and they are often isolated from the outside world. Once established, the condition in question subsequently becomes chronic.
Induced psychoses are more common in women than in men. Gralnick A942) studied a group of patients with cfolie a deux and identified the following combinations (in descending order of frequency of cases): two sisters - 40; husband and wife - 26; mother and child - 24; two brothers - 11; brother and sister - 6; father and child - 2. In nine cases, this phenomenon was observed between persons not related by kinship or family ties.
A detailed and comprehensive description of induced psychoses can be found in Enoch and Trethowan 1979).
MIGRATION PSYCHOSIS
It seems logical that people who move to other countries are more likely to develop paranoid symptoms because their appearance, speech, and behavior draw attention to them. Odegaard 1932) found that among immigrants of Norwegian origin living in the United States, the incidence of schizophrenia (including paranoid schizophrenia) is twice as high as among the general Norwegian population. However, these data, apparently, can be explained not so much by the pathogenic experiences associated with emigration, but by the fact that people in a prepsychotic state are more likely to emigrate compared to their more balanced compatriots. Later, Astrup and Odegaard 1960) found that the incidence of initial hospitalization for psychotic illnesses was generally significantly lower among persons migrating within their own country than among those who did not leave the place where they were born and raised. The authors suggested that migrating within one's own country may be a natural occurrence for enterprising youth, while moving abroad is likely to be a much more stressful experience. Thus, to a certain extent, they supported the exogenous hypothesis. Data from studies of immigrants are difficult to interpret. When factors such as age, social status, occupation, level of professional training, employment situation, and ethnic group membership are taken into account, doubts arise as to whether there is a real significant relationship between migration and the incidence of mental illness (Murphy 1977). The highest incidence of mental illness was observed among refugees whose migration was forced (Eitinger 1960); however, they may have experienced persecution in addition to the experiences of losing their homeland and adapting to the conditions of a foreign country.
PRISON PSYCHOSIS
Data related to imprisonment are inconsistent. Birnbaum 1908 suggested in his work that isolation in prison, especially in solitary confinement, can lead to the development of paranoid disorders that resolve when the prisoner is allowed to communicate with other people. Eitinger 1960 reports that paranoid states were not uncommon among prisoners of war. However, Faergeman 1963 believes that such phenomena were rarely observed even among concentration camp prisoners.
Paranoid syndrome. Primary systematized delirium of interpretation of various contents (jealousy, invention, persecution, reformism, etc.), occasionally existing as a monosymptom in the complete absence of other productive disorders. If the latter arise, they are located on the periphery of the paranoid structure and are subordinated to it. Characterized by a paralogical structure of thinking (“crooked thinking”) and delusional detailing.
The ability to make correct judgments and conclusions on issues that do not affect delusional beliefs is not noticeably impaired, which indicates catathymic (that is, associated with an unconscious complex of affectively colored ideas, and not a general change in mood) mechanisms of delusion formation. Memory disturbances in the form of delusional confabulations (“memory hallucinations”) may occur. In addition, there are hallucinations of the imagination, the content of which is associated with dominant experiences. As delirium expands, an ever wider range of phenomena becomes the object of pathological interpretations. There is also a delusional interpretation of past events. Paranoid syndrome usually occurs against the background of somewhat elevated mood (expansive delusions) or subdepression (sensitive, hypochondriacal delusions).
The content of delusions at distant stages of development can acquire a metallomaniac character. Unlike paraphrenia, delusion continues to be interpretive and in its scope does not go beyond the scope of what is fundamentally possible in reality (“prophets, outstanding discoverers, brilliant scientists and writers, great reformers”, etc.). There are chronic, existing for a number or even decades, and acute versions of paranoid syndrome. Chronic paranoid delusions are most often observed in relatively slowly developing delusional schizophrenia. Delirium in such cases is usually monothematic. The possibility cannot be ruled out that there is an independent form of the disease - paranoia.
Acute, usually less systematized paranoid states are more common in the structure of attacks of fur-like schizophrenia. The delusional concept is loose, unstable and can have several different themes or centers of crystallization of false judgments.
Some authors consider it justified to distinguish between paranoid and paranoid syndromes (Zavilyansky et al., 1989). Chronic, systematized, overvalued delusions (beginning with overvalued ideas) that arise under the influence of a key psychotraumatic situation for the patient are called paranoid. Paranoid and epileptoid features of the premorbid personality of constitutional, post-processual or organic origin contribute to the development of delusions. The mechanisms of delusion formation are associated with psychological rather than biological disorders - “psychogenic-reactive” delusion formation. Paranoid syndrome in this interpretation is appropriate to consider within the framework of pathological personality development.
Paranoid or hallucinatory-paranoid syndrome. Includes delusional ideas of persecutory content, hallucinations, pseudohallucinations and other phenomena of mental automatism, affective disorders. There are acute and chronic hallucinatory-paranoid syndromes.
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Acute paranoid is an acute sensory delusion of persecution (in the form of delusions of perception) of a specific orientation, accompanied by verbal illusions, hallucinations, fear, anxiety, confusion, and abnormal behavior reflecting the content of delusional ideas. It is observed in schizophrenia, intoxication, and epileptic psychoses. Acute paranoid states can also occur in special situations (long journeys associated with insomnia, alcohol intoxication, emotional stress, somatogenies) - road or situational paranoids, described by S.G. Zhislin.
Mental automatisms in their completed form represent the experience of violence, invasion, the doneness of one’s own mental processes, behavior, and physiological acts. The following types of mental automatisms are distinguished.
Associative or ideational automatism - disturbances of mental activity, memory, perception, affective sphere, occurring with the experience of alienation and violence: influxes of thoughts, non-stop flow of thoughts, states of blockade of mental activity, symptoms of investing, mind reading, symptom of unwinding memories, pseudohallucinatory pseudomemories, sudden delays in memories, phenomena of figurative mentism and etc.
Manifestations of ideational automatism also include auditory and visual pseudohallucinations, as well as a number of affective disorders: “induced” mood, “induced” fear, anger, ecstasy, “induced” sadness or indifference, etc. This group of automatisms includes “ made” dreams. The inclusion of auditory verbal and visual pseudohallucinations in the group of ideational automatisms is due to their close connection with thinking processes: verbal pseudohallucinations with verbal ones, and visual ones with figurative forms of thinking.
Senestopathic or sensory automatism - various senestopathic sensations, the appearance of which patients associate with the influence of external forces. In addition, this includes olfactory, gustatory, tactile and endosomatic pseudohallucinations. Sensory automatism includes various changes in appetite, taste, smell, sexual desire and physiological needs, as well as sleep disturbances, autonomic disorders (tachycardia, excessive sweating, vomiting, diarrhea, etc.), “caused,” according to patients, from the outside.
Kinesthetic or motor automatism - impulses to activity, individual movements, actions, deeds, expressive acts, hyperkinesis that arise with the experience of violence. Receptive processes can also occur with the phenomena of being made: “They force you to look, listen, smell, look with my eyes...”, etc.
Speech motor automatism - phenomena of forced speaking, writing, as well as kinesthetic verbal and graphic hallucinations.
The formation of mental automatisms occurs in a certain sequence. At the first stage of development of ideatorial automatism, “strange, unexpected, wild, parallel, intersecting” thoughts appear, alien in content to the entire structure of the personality: “I never think like that...” At the same time, sudden interruptions of necessary thoughts may occur. Alienation concerns the content of thoughts, but not the process of thinking itself (“my thoughts, but very strange ones”).
Then the sense of one’s own thinking activity is lost: “Thoughts float, go on their own, flow non-stop...” or states of blockade of mental activity arise. Subsequently, the alienation becomes total - the feeling of belonging to one’s own thoughts is completely lost: “Thoughts are not mine, someone is thinking in me, there are other people’s thoughts in my head...” Finally, a feeling arises as if thoughts “come from the outside, are introduced into the head, invest..." "Telepathic" contacts with other people arise, the ability to directly read the thoughts of others and mentally communicate with others appears. At the same time, patients may claim that at times they are deprived of the ability to think or that they are “pulled out of thoughts” or “stolen.”
The development of verbal pseudohallucinations can occur as follows. First, the phenomenon of the sound of one’s own thoughts arises: “Thoughts rustle and sound in the head.” Then your own voice begins to be heard in your head, “voicing”, and sometimes like an “echo”, repeating your thoughts. This can be called inner speech hallucinations. The content of statements gradually expands (statements, comments, advice, orders, etc.), while the voice “doubles, multiplies.”
Then “other people’s voices” are heard in my head. The content of their statements is becoming more and more diverse, divorced from the reality and personality of the patients. In other words, the alienation of the process of internal speaking also increases in a certain sequence. Finally, the phenomenon of “made, induced voices” arises. The voices speak on a variety of topics, often abstracted from personal experiences, sometimes reporting absurd and fantastic information: “The voices behind the ears speak about local topics, but in the head they speak about national ones.” The degree of alienation of what is said by voices can therefore be different.
The dynamics of kinesthetic automatism generally correspond to those described above. At first, previously unusual impulses to action and impulsive desires appear, and strange and unexpected actions and actions are performed for the patients themselves. Subjectively, they are perceived as belonging to one’s own personality, although unusual in content. There may be short stops of action. Subsequently, actions and deeds are performed without a sense of one’s own activity, involuntarily: “I do it without noticing it, and when I notice it, it’s hard to stop.” Conditions of blockade or “paralysis” of impulses to action arise.
At the next stage, activity proceeds with a clear experience of alienation of one’s own activity and violence: “Something is pushing from within, prompting, not a voice, but some kind of internal force...” Episodes of interruptions in action are also experienced with a tinge of violence. At the final stage of development of motor automatisms, a feeling appears that motor acts are done from the outside: “My body is controlled... Someone controls my hands... One hand belongs to my wife, the other to my stepfather, my legs belong to me... They look with my eyes... “With a feeling of external influence, states of blockade of impulses to action occur.
The sequence of development of speech motor automatisms may be similar. At first, individual words or phrases are broken out, alien to the direction of the patient’s thoughts, absurd in content. Often individual words are suddenly forgotten or the formulation of thoughts is disrupted. Then the feeling of one’s own activity that accompanies speech is lost: “The tongue speaks on its own, I’ll say it, and then the meaning of what was said comes through... Sometimes I start talking...” Or the tongue stops for a short time and does not listen. Next, a feeling of alienation and violence arises in relation to one’s own speech:
“It’s as if it’s not me who speaks, but something in me... My double is using the language, and I’m not able to stop speaking...” Episodes of mutism are experienced as violent. Finally, a feeling of external mastery of speech arises: “Strangers speak my language... They give lectures on international topics in my language, and at this time I don’t think about anything at all...” Conditions of loss of spontaneous speech are also associated with external phenomena. The development of speech motor automatisms can begin with the appearance of kinesthetic verbal hallucinations: there is a feeling of movement of the articulatory apparatus corresponding to speech, and the idea of involuntary mental pronunciation of words. Subsequently, the internal monologue acquires a verbal-acoustic connotation, and a slight movement of the tongue and lips appears. At the final stage, true articulatory movements arise with the actual pronunciation of words out loud.
Senestopathic automatism usually develops immediately, bypassing certain intermediate stages. Only in some cases, before its appearance, can one state the phenomenon of alienation of senestopathic sensations: “Terrible headaches, and at the same time it seems that this is happening not to me, but to someone else...”
In the structure of mental automatisms, Clerambault distinguished two types of polar phenomena: positive and negative. The content of the former is the pathological activity of any functional system, the latter is the suspension or blockade of the activity of the corresponding system. Positive automatisms in the field of ideation disorders are a violent flow of thoughts, a symptom of investing thoughts, a symptom of unwinding memories, made emotions, induced dreams, verbal and visual pseudohallucinations, etc.
Their antipode, that is, negative automatisms, can be states of blockage of mental activity, a symptom of withdrawal, pulling out thoughts, sudden loss of memory, emotional reactions, negative auditory and visual hallucinations that arise with a feeling of accomplishment, forced deprivation of dreams, etc. In the field of senestopathic Automatism will be, respectively, sensations made and loss of sensitivity caused from outside; in kinesthetic automatism - violent actions and states of delayed motor reactions, taking away the ability to make decisions, blocking impulses for activity. In speech motor automatism, the polar phenomena will be forced speaking and sudden speech delays.
According to Clerambault, schizophrenia is more characterized by negative phenomena, especially if the disease begins at a young age. In fact, positive and negative automatisms can be combined. Thus, forced speaking is usually accompanied by a state of blockade of mental activity: “The tongue speaks, but at this time I am not thinking about anything, there are no thoughts.”
Disorders of self-awareness that arise in the syndrome of mental automatism are expressed by the phenomena of alienation of one’s own mental processes, the experience of the violence of their course, dual personality and the consciousness of an internal antagonistic double, and subsequently - a feeling of mastery by external forces. Despite the seemingly obvious nature of the disorder, patients usually lack a critical attitude towards the disease, which, in turn, may also indicate a gross pathology of self-awareness. Simultaneously with the increase in the phenomena of alienation, the devastation of the sphere of the personal Self progresses.
Some patients even “forget” what it is, their own Self; the old Self-concept no longer exists. There are no mental acts emanating from the name of one’s Self at all; this is a total alienation that has spread to all aspects of the inner Self. At the same time, thanks to appropriation, a person can “acquire” new abilities and characteristics that were not previously inherent in him. Sometimes the phenomenon of transitivism is observed - not only the patient, but also others (or mostly others) are the object of external influence and various kinds of violent manipulation, their own feelings are projected onto others. Unlike the projection itself, the patient is not subjectively freed from painful experiences.
The experience of openness occurs with the appearance of various echo symptoms. A symptom of echo thoughts - those around him, according to the patient, repeat out loud what he was just thinking about. Hallucinatory echo - voices from outside repeat, “duplicate” the patient’s thoughts. A symptom of the sound of one’s own thoughts - thoughts are immediately repeated, they clearly “rustle, sound in the head, and are heard by others.” Anticipatory echo - voices warn the patient what he will hear, see, feel or do after some time. Echo of actions - voices state the actions, intentions of the patient: “I am being photographed, my actions are being recorded...” It happens that the voices are read for the patient, but he only sees the text.
Voices can repeat and comment on motives and behavior, give them one or another assessment, which is also accompanied by the experience of openness: “Everyone knows about me, nothing remains to myself.” Echo of writing - voices repeat what the patient is writing. Echo of speech - voices repeat everything the patient said out loud to someone. Sometimes the voices force or ask the patient to repeat for them what he told others, or, on the contrary, to mentally or out loud say again what he heard from someone, and the patient, like an echo, repeats this. The “hallucinatory personality” here seems to be deprived of contact with the outside world, establishing it with the help of the patient.
There is no name for this symptom, but we will conditionally call it the echo-patient phenomenon. The above echo phenomena can be iterative in the form of multiple repetitions. Thus, a patient (he is 11 years old) has episodes that last two to three hours, when what was said by other people three to five times in someone else’s voice is repeated in his head. One word is repeated more often. During repetitions, he perceives what is happening worse and cannot watch TV. Other echophenomena occur. Thus, the speech of others can be repeated by voices from outside or in the head - a symptom of echo-alien speech.
Voices with external projection are sometimes duplicated by internal ones - a symptom of echovoices. The experience of openness can be observed even in the absence of echo symptoms, and arise in the most direct way: “I feel that my thoughts are known to everyone... There is a feeling that God knows everything about me - I am in front of him like an open book... Voices are silent, which means they are eavesdropping , what I think".
Delirium of physical and mental influence- belief in the influence of various external forces on the body, somatic and mental processes: hypnosis, witchcraft, rays, biofields, etc.
In addition to the above-described phenomena of alienation, in the syndrome of mental automatism, opposite phenomena may occur - the phenomena of appropriation, which constitute an active or inverted version of the Kandinsky-Clerambault syndrome. In this case, patients express the belief that they themselves have a hypnotic effect on others, control their behavior, are able to read the thoughts of other people, the latter have turned into an instrument of their power, behave like dolls, puppets, parsleys, etc. Combination of alienation phenomena and assignments V.I. Akkerman (1936) considered a sign characteristic of schizophrenia.
There are hallucinatory and delusional variants of mental automatism syndrome. In the first of them, various pseudohallucinations predominate, which is observed mainly during acute hallucinatory-delusional states in schizophrenia, in the second - delusional phenomena that dominate in chronically ongoing paranoid schizophrenia. In chronic schizophrenic delusions of the interpretative type, associative automatisms come to the fore over time. Senestopathic automatisms may predominate in the structure of attacks of fur-like schizophrenia. In lucid-catatonic states, kinesthetic automatisms occupy a significant place. In addition to schizophrenia, phenomena of mental automatism can occur in exogenous-organic, acute and chronic epileptic psychoses.
Paranoid syndrome is a special type of insanity, which is characterized by a near-delusional state with fragmentary, incoherent ideas. All of them may not even have a thematic connection with each other, which distinguishes this phenomenon from others from the same series (for example, from paranoid syndrome). Often delusional ideas are associated with persecution, hallucinations, and a state of mental automatism. The causes of paranoid syndrome are often a state of stress, anxiety, hallucinations, and fears.
Paranoid syndrome - symptoms
The doctor who notes paranoid symptoms, in most cases, is convinced that the disorder is already of considerable depth. The disease permeates not only the thinking, but also the behavior of the patient. Symptoms of paranoia include:
- predominance of figurative delirium;
- auditory hallucinations;
- anxiety and depressed mood;
- systematization of delusional ideas - the patient can name the essence of the phenomenon that he is afraid of (for example, persecution), its date, purpose, means, end result;
- the patient himself perceives delirium as insight;
- delusion of relationship: the patient thinks that strangers on the street are “hinting” at something, looking at each other;
- delusions can be combined with hallucinations of any type;
- delusions of persecution;
- sensory disorders.
A paranoid state often occurs with somatically caused mental illness and is often accompanied by pseudohallucinations. It is worth noting that there are two options for the course of the disease:
It is believed that it is easier to establish a diagnosis and choose a treatment method for paranoid behavior of the hallucinatory type, since it is possible to find out the characteristics of the patient’s condition.
Paranoid syndrome - treatment
If you notice the symptoms listed above in yourself or someone close to you, be sure to consult a psychiatrist. In the early stages, mental illnesses are easier to treat, but in an advanced state, the disease becomes very dangerous. As a rule, complex treatment is prescribed: psychotherapeutic techniques are combined with medication.
It most often develops subacutely—over a number of days and weeks. It can replace an acute polymorphic syndrome (see p. 127) or follow neurosis-like, less often psychopath-like disorders, and even less often a paranoid debut. Acute paranoid syndrome lasts for weeks, 2-3 months; chronic persists for many months and even years. Paranoid syndrome consists of polythematic delusions, which may be accompanied by hallucinations and mental automatisms. Depending on the clinical picture, the following variants of paranoid syndrome can be distinguished. Hallucinatory-paranoid syndrome is characterized by pronounced auditory hallucinations, to which sometimes olfactory hallucinations are also added. Among auditory hallucinations, the most typical are calls by name, imperative voices that give the patient various orders, for example, to refuse food, commit suicide, show aggression towards someone, as well as voices that comment on the patient’s behavior. Sometimes hallucinatory experiences reflect ambivalence. For example, someone’s voice either forces you to engage in masturbation, or scolds you for it. Olfactory hallucinations are usually extremely unpleasant for the patient - the smell of a corpse, gas, blood, sperm, etc. is felt. Often the patient finds it difficult to say what he smells, or gives the smells unusual names (“blue-green smells”). In addition to obvious hallucinations, adolescents are also especially prone to “delusional perception.” The patient “feels” that someone is hiding in the apartment nearby, although he has not seen or heard anyone, “feels” the gaze of others on his back. Due to some incomprehensible or indescribable signs, it seems that the food is poisoned or contaminated, although there seems to be no change in taste or smell. After seeing a famous actress on the television screen, a teenager “discovers” that he resembles her and, therefore, she is his real mother. Delusions in hallucinatory-paranoid syndrome can be either closely related to hallucinations or not stem from hallucinatory experiences. In the first case, for example, when voices are heard threatening to kill, the thought is born of a mysterious organization, a gang that is pursuing the patient. In the second case, delusional ideas seem to be born on their own: the teenager is convinced that they are laughing at him, although he has not noticed any obvious ridicule, and simply any smile on the faces of others is perceived as a hint of some kind of his own shortcoming. Among the different types of delusions, delusions of influence are especially characteristic. Mental automatisms in this syndrome occur as fleeting phenomena. Auditory pseudohallucinations may be more persistent: voices are heard not from somewhere outside, but from inside one’s head. Kandinsky-Clerambault syndrome [Kandinsky V. X., 1880; Clerambault G., 1920], as well as in adults, is characterized by pseudohallucinations, a feeling of mastery or openness of thoughts and delusions of influence [Snezhnevsky A.V., 1983]. In younger and middle-aged adolescents, visual pseudohallucinations are also encountered: various geometric figures, a grid, etc. are seen inside the head. For older adolescence, auditory pseudohallucinations are more typical. Among mental automatisms, the most common are “gaps” in thoughts, feelings of moments of emptiness in the head, and less often, involuntary influxes of thoughts (mentism). There is a feeling of thoughts sounding in your head. It seems that one’s own thoughts are heard or somehow recognized by others (a symptom of openness of thoughts). Sometimes, on the contrary, a teenager feels that he himself has become able to read the thoughts of others, predict their actions and actions. There may be a feeling that someone is controlling the behavior of a teenager from the outside, for example, using radio waves, forcing him to perform certain actions, moving the patient’s hands, encouraging him to pronounce certain words - speech motor hallucinations J. Seglas (1888). Among the various forms of delirium in Kandinsky-Clerambault syndrome, delusions of influence and delirium of metamorphosis are most closely associated with it. The delusional version of the paranoid syndrome is distinguished by a variety of polythematic delusions, but hallucinations and mental automatisms are either completely absent or occur sporadically. Delusional ideas in adolescence have the following features. Delusional relationship occurs more often than others. The teenager believes that everyone looks at him in a special way, grins, and whispers to each other. The reason for this attitude is most often seen in defects in one’s appearance - an ugly figure, small stature in comparison with peers. The teenager is sure that from his eyes they guess that he was engaged in masturbation, or are suspected of some unseemly acts. Relationship ideas intensify when surrounded by unfamiliar peers, among the public staring around, in transport cars. Delusions of persecution often associated with information gleaned from detective films. The teenager is pursued by special organizations, foreign intelligence services, gangs of terrorists and currency traders, robber gangs, and the mafia. Agents sent everywhere are seen watching him and preparing reprisals. Delirium of influence also sensitively reflects the trends of the times. If earlier we were more often talking about hypnosis, now - about the telepathic transmission of thoughts and orders at a distance, about the action of invisible laser beams, radioactivity, etc. Psychic automatisms (“thoughts are stolen from the head” can also be associated with ideas of influence). “they put orders into your head”) and ridiculous hypochondriacal nonsense (“they spoiled the blood”, “affected the genitals”, etc.). Nonsense of other people's parents was described as characteristic of adolescence [Sukhareva G. E., 1937]. The patient “discovers” that his parents are not his own, that he accidentally ended up with them in early childhood (“they got mixed up in the maternity hospital”), that they feel this and therefore treat him badly, want to get rid of him, and imprison him in a psychiatric hospital. Real parents often occupy a high position. Dysmorphomanic delirium differs from dysmorphomania with sluggish neurosis-like schizophrenia in that imaginary deformities are attributed to someone’s evil influence or receive another delusional interpretation (bad heredity, improper upbringing, parents did not care about proper physical development, etc.). Delirium of infection Teenagers often have a hostile attitude towards their mother, who is accused of being unclean and spreading infection. Thoughts about contracting sexually transmitted diseases are especially common, especially in adolescents who have not had sexual intercourse. Hypochondriacal delirium in adolescence, it often affects two areas of the body - the heart and genitals. Differential diagnosis must be made with reactive paranoids if the paranoid syndrome arose after mental trauma. Currently, reactive paranoids in adolescents are quite rare. They can be encountered in the situation of a forensic psychiatric examination [Natalevich E. S. et al., 1976], as well as as a consequence of a real danger to the life and well-being of a teenager and his loved ones (attacks by bandits, disasters, etc.) . The picture of reactive paranoid is usually limited to delusions of persecution and relation. Hallucinatory (usually illusory) experiences arise episodically and in content are always closely related to delusion. The development of reactive paranoids in adolescents can be facilitated by an environment of constant danger and extreme mental stress, especially if they are combined with lack of sleep, as was the case in areas temporarily occupied by the Nazis during the Great Patriotic War [Skanavi E. E., 1962]. But mental trauma can also be a provocateur for the onset of schizophrenia. The provoking role of mental trauma becomes obvious when the paranoid syndrome drags on long after the traumatic situation has passed, and also if delusions of persecution and relationships are joined by other types of delusions that do not in any way arise from the experiences caused by mental trauma, and, finally, if hallucinations begin to occupy an increasing place in the clinical picture and at least fleeting symptoms of mental automatisms appear. Prolonged reactive paranoids are not characteristic of adolescence.
