Delirium - stages, symptoms, examples, treatment of delirium. Primary, secondary and induced delirium

There are a lot of conflicting opinions and related disputes regarding the classification of delirium. These contradictory judgments and disputes are due to two circumstances:
firstly, a hopeless attempt is being made to bring all the diversity of delusional phenomena into a single classification scheme that takes into account and combines such different characteristics as the state of consciousness, preferably an intellectual or sensory disorder, the mechanism of delusional formation, the structure of the delusional syndrome, the theme and plot of the delusional experience, the rate of occurrence and development of delirium, its stages, periods, phases, stages;
secondly, many designations are used to name classification groups, into which the authors often attach different content. Among such designations, the most common are forms, types, types, classes, categories, variants of delirium, etc.

Diversity of mechanisms of delusional formation, polymorphism of manifestations (clinics) of delusional
phenomena, as well as the lack of a reliable understanding of the anatomical, physiological and energetic foundations of the thought process and its disorders (see Chapter 5) make it extremely difficult to substantiate the taxonomy of these disorders.

Along with the criteria clinical assessment signs of a delusional syndrome, which we called the parameters of delusions (see Chapter 2), an essential role in the development of principles for systematizing delusional ideas is played by the assessment of a number of “clinical characteristics”, partially already mentioned earlier. It is necessary to briefly dwell on these “clinical characteristics”.

Manifestation, theme and content of delusional experiences. Manifestations of delirium should be considered as the most characteristic, direct reflection of the patient’s personality, intellect, character, and constitution [Kronfeld A. S., 1939]. Some authors, conducting a clinical analysis of delusional experiences, evaluate delirium as an independent, isolated, incomprehensible psychopathological phenomenon, while others “dissolve” delirium in other psychopathological formations [Kerbikov O. V., 1949]. Any delusional experiences, delusional ideas can manifest themselves in the form of delusional tendencies, delusional statements, delusional behavior.

Delusional tendencies, constituting the “dominant of the psyche” [Shevalev E. A., 1927], determine all the “mental” and practical aspirations of the patient: the direction of his emotional and affective attitudes, associations, judgments, conclusions, i.e., the entire intellectual, mental activity.

Delusional statements in some cases are adequate to delusional experiences and reflect their essence, in others they correspond to delusional intellectual “developments”, without directly reflecting the elements of delusional conclusions, and finally, in third cases, the patient’s statements reflect delusional experiences not directly, but indirectly, which is revealed, for example , when these statements include neologisms that have a meaning that is unclear to others.

The differences in the forms of manifestation of delirium are due to the essence and characteristics of the relationship (in some cases, the relationship) of the patient’s “delusional self” with his premorbid “self” or preserved elements mental status; subjective life attitudes, intentions, plans; the objective world in general, the objective environment, specific people. The immutability of the “pathological conditions” that underlie the disease, according to I. A. Sikorsky (1910), determines the stereotyping, “clutteredness” of delusional tendencies and judgments of patients.

Behavior of patients in to a large extent is predetermined by the theme, direction and content of delusional ideas. However, their behavior is also directly influenced by such interrelated factors as the relevance of delusional experiences, their affective “saturation,” the constitutional and characterological characteristics of the patient’s personality, the manner of his relationships with others, and premorbid life experience.

The variety of possible types of delusional behavior of patients is quite well illustrated by the materials of G. Huber and G. Gross (1977), who observed various variants of reactions and actions of patients with schizophrenia. These options include: in case of delusions of persecution, defense and self-defense, verbal dialogue with the “persecutors”, seeking protection from others, escape, change of place of residence, threatening warnings to the “persecutors”, persecution of the “persecutors”, attempts at aggression, suicide attempts, information others about “persecutors”, a panic reaction due to the supposed danger to life, destruction of possibly incriminating documents, fear of poisoning and refusal to take food or medicine; with hypochondriacal delirium - self-defense from improper treatment, doubts about the competence of doctors and nurses, active familiarity with popular and scientific-medical literature, accusing doctors of “concealing the diagnosis” for the sake of “saving the honor of the uniform”, suicide attempts due to fear of future fate, which is associated with a specific disease; with delusions of grandeur - an effective desire to convince others of one’s importance, a demand for recognition and support, a desire to participate in public life in a significant role, a demand for admiration and obedience, the division of others into “supporters” and “opponents”, aggressive actions towards “opponents” ", interference in other people's problems for the purpose of defending or blaming someone, resentment towards "supporters" because of their lack of "loyalty", attempts to appropriate the property and power of others (they believe that both belong to them), abandonment of the profession, position, elements of work as unworthy of one’s own personality, etc.

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

For methodological reasons, it is advisable to distinguish between the general idea, or plot, of nonsense, its thematic design and specific content. At the same time, the plot of delusion is understood as a set of judgments that express the basic concept of delirium [Terentyev E.I., 1982], that is, the direction of the general delusional conclusion. This “direction” influences a narrower delusional judgment in the form of the theme of delirium, but does not predetermine its specific content.

The main essence of delirium, its plot, may, for example, lie in the idea of ​​persecution without any specific plot: this is the presence of enemies, adversaries, some kind of force, the purpose of which is to cause harm to the patient. A delusional judgment, the topic is often narrowed to the idea that the goal of the “persecutors” is the destruction of the patient. This thought sometimes constitutes specific content, including not only the reasons for the hostile attitude towards the patient, but also a clarification of the method of implementing this attitude, for example, murder by poisoning in order to rid the wife and her lover of him.

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

Numerous observations, including our own, allow us to come to the conclusion that the nature of the onset and development of delusional mental illness, not accompanied by stupefaction, as well as many other accompanying factors, to a certain extent, predetermine the plot of delirium and indirectly, during the development of the disease, its theme . At the same time, the specific content of delusions most often does not depend on the pathogenetic properties of a given mental illness and can be caused by random factors (someone's story, a poster accidentally seen, a television program, a movie, etc.).

The plot, theme and content of delirium that arises with a darkened consciousness are formed somewhat differently. In this case, there is a “merger” of the concepts of plot, theme and content of delirium, which are entirely dependent on the nature and form of clouding of consciousness.

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

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

Such factors, for example, include: constitutional properties of the individual, premorbid and current interoceptive sensations, influencing “through consciousness on thoughts about the cause painful sensations"[Kraft-Ebnng R., 1881]; level of culture, education, profession, life experience, mood, degree of affective stability, psychogenic factors, in which even “minor psychogenies” approach the content of delusional experiences “like a key to a lock” [Frumkin Ya. P., 1958]; subconscious and unconscious associations, apperceptions, ideas, because of which it is often impossible to establish the motives that predetermined the content of delirium, since these motives are not realized by the patient himself, “hidden” from him (Konrad K., 19581.

Syndromological or nosological features of the plot of delirium are not always identified. In some cases, the content of delirium does not depend on the form of mental illness, in others it is typical for certain nosological forms, in others it merges with some symptoms of the disease (stupefaction, dementia, etc.) and may be specific to a particular psychosis. For example, for progressive paralysis, delirium of grandeur and wealth combined with dementia can be considered specific, for alcoholic delirium - stupefaction with delusions of persecution and the experience of an immediate threat to one’s own life, for psychoses of late age - Cotard’s nihilistic delirium, conviction in the death of the universe, destruction of internal organs in combination with dementia of greater or lesser severity.

Non-specific, but quite typical: for chronic alcoholic psychosis - delusions of jealousy; for epileptic psychosis - religious delirium, characterized by specificity, relative constancy, limited plot, practical orientation; for schizophrenia - hypochondriacal delirium with ideas of upcoming physical suffering and death, etc.

To the above, we can add that, according to I. Ya. Zavilyansky and V. M. Bleicher (1979), “characteristic delusional phenomena” can be considered: for schizophrenia - delusions of persecution, influence, poisoning, hypnotic influence; for circular depression-ideas of self-blame; for age-related psychoses - delusions of damage, theft.

Some authors note the dependence of the “direction” of the topic, the content of delirium, not only on the form of mental illness, but also on the stage, period, structure of the disease. B. I. Shestakov (1975) believes that in a late-onset schizophrenic process, its first long paranoid period is characterized by ideas of relation and meaning (“delirium of evaluation” according to Serbsky). Subsequently, delusions of persecution and immediate danger develop with the “loosening” of the delusional system in the paraphrenic period and the influence of fragmented thinking on the delusional structure. A. V. Snezhnevsky (1983) notes the intellectual, consistently systematized content in the primary and figurative in the secondary sensory forms of delirium. B. D. Zlatan (1989), citing “the opinion of many authors,” recognizes that characteristic of schizophrenic delusions is the isolation of its content from reality, in contrast to exogenous delirium, the content of which is directly related to the surrounding reality.

To the above we should add the judgment of E. Bleuler (1920), who considers “non-independent” delusional ideas typical of schizophrenia, which are a direct consequence of previously arisen ideas (“he is the son of a count, which means his parents are not real”). We would call this content of delirium “indirect”, “paralogical”.

When determining the parameters of delusion, it was already noted that according to the degree of realism of the content, delusional ideas can be divided into three categories: unrealistic in general, absurd, ridiculous; unrealistic for a given patient and a given situation, but in principle plausible; real for a given patient, plausible, but in content not corresponding to reality.

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

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

The presence of typical or specific delusional content for some psychoses does not exclude the possibility of the occurrence of delusional ideas similar in plot in various mental illnesses. This circumstance does not provide grounds for categorical denial diagnostic value the content of delirium in all cases [Smulevich A. B., Shchirina M. G., 1972]. At the same time, naturally, one should not confuse the concepts of “content” and “structure” of delirium.

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

G. E. Sukhareva (1955) notes that in childhood delusional ideas are extremely rare and manifest themselves in the form of an unformed sense of danger. Occasionally observed in children, “ridiculous statements” are inconsistent, not connected with each other, and do not resemble delusional ideas in the full sense of the word. Sometimes such statements, close in form to delusional ones, are of a playful nature, contain thoughts about reincarnation into animals, or arise in the process of “delusional fantasy.” Delusional constructions reflecting life experience, requiring the ability to abstract and intellectual creativity, do not occur in childhood. G. E. Sukhareva emphasizes that delusional ideas in young children more often arise against the background of a darkened consciousness and, less often, on the basis of frightening visual hallucinations with a “persecution motive.” The emergence of these ideas may be preceded by fear and “violation of feelings of sympathy” for parents. E. E. Skanavi (1956), V. V. Kovalev (1985), as well as G. E. Sukhareva (1937, 1955), point to an “early source” characteristic of children further development delirium in the form of a change in attitude towards parents, which then turns into “delirium of other people’s parents.” At the same time, the authors note that in cases of early schizophrenia, delusional ideas gradually transform “from dreamlike, cathethetic forms”, from paranoid and hypochondriacal interpretations at the onset of the disease to delusions of poisoning. At the same time it becomes less expressed connection the content of delirium with a specific situation, delirium is abstracted, its “affective richness” is lost.

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

In late schizophrenia, less meaningful delusions and sometimes “small-scale” delusions with specific everyday topics are noted. Delusional plot in patients with age-related organic vascular diseases less developed than in functional psychoses, in particular schizophrenic ones [Sternberg E. Ya., 1967].

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

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

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

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

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

Often in patients with ideas of relationship and persecution, it is impossible to separate the simultaneously arising illusory experiences, “delusional illusions” from any specific delusional plots, including only ideas of persecution or only ideas of relationship. In some cases, it is impossible to determine the priority (by time of occurrence or significance) of illusions, hallucinations, and delusions that are closely related to each other in a single delusional composition. An exact coincidence in the content of verbal pseudohallucinations and delusional experiences that occur simultaneously with and after them is often observed in paraphrenic delusions.

In cases where the basis of the disease is paranoid syndrome and the patient complains about “smells,” it is almost impossible not only to determine whether these are illusions or hallucinations, but also to establish the nature of the patient’s experiences themselves: do they really include a sensory, sensual component, i.e., is the smell really felt, or is there only a delusional belief the patient has an odor. A similar delusional conviction is observed in paranoid forms of delusion with an interpretive delusional interpretation of what is happening around. Thus, one patient under our supervision often, especially during periods of low mood, notices that the people around him (familiar and unfamiliar) are trying to move away from him, turn away, sniff the air through their noses - sniff. The patient notices grimaces of disgust on their faces. He had long been convinced that he had an unpleasant odor. At times, without sufficient confidence, he believes that he himself smells this smell, but usually confirms that he guesses the smell from the behavior of others. In this case, we cannot talk about a combination of olfactory hallucinations and delusional ideas. Here we are talking only about delusional experiences with the inclusion of not actual olfactory hallucinations, but delusional illusions. Olfactory hallucinations are always to a greater or lesser extent thematically related to delusions. The same can be said about taste and tactile hallucinations. At the same time, from a clinical point of view, it is of interest to analyze the correlation of delusional experiences with tactile hallucinations and tactile pseudohallucinations in the same patient.

The delusional interpretation of tactile hallucinations manifests itself either in their direct connection with delusional ideas of persecution, or* in combination with delusions that have a thematic rather than plot connection with it. Pathological sensations close to tactile can be localized not only on the surface of the body, but also in the subcutaneous fatty tissue, bones, internal organs, brain. These are not just senestopathic sensations or soma-induced visceral illusions. In contrast, tactile hallucinations take the form of a specific experience and are more or less meaningful. In all cases they are interpreted in a delusional way. The plots of such hallucinations and their delusional design are varied. Sometimes tactile hallucinations and their delusional interpretation occur simultaneously. In some cases, a “delusional understanding” of tactile deceptions develops gradually.

A well-known syndromological interdependence between delusions, on the one hand, and hallucinations or pseudohallucinations, on the other, can be identified when delusions occur simultaneously with pseudohallucinations corresponding to it in the plot or after them and when true ones appear: hallucinations based on the previous delusional plot.

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

Over the course of the current century, domestic psychiatrists and scientists from other countries have devoted great attention studying the nature of syndromic and clinical relationships between delusions and illusions, hallucinations, pseudohallucinations. Some statements on this issue and judgments about the results of relevant research deserve a brief review.

Due to the multidimensionality, multidisciplinary nature, as well as the repeatability, typicality, or specificity of delusional syndromes, which has already been mentioned, it is impossible to present their clinical picture according to a strict, unambiguous scheme. However, we consider the most acceptable to be a consistent clinical description of various delusional syndromes according to the main classes - delirium of disturbed or upset consciousness, sensory and intellectual delirium. The proposed order of presentation is based on the following provisions.
1. Clinical characteristics of delusional syndrome include analysis of the conditions of delusional formation, developmental features and properties of a specific stage (paranoid, paranoid, paraphrenic), thematic focus and content of “delusional experiences.”
2. Phenomenologically, the same forms of delirium can occur with disturbed consciousness, sensory and intellectual delirium of undisturbed consciousness (for example, delirium of persecution is observed equally often with delirium of darkened consciousness, in particular delirious, and intellectual schizophrenic delirium, as well as with sensory delirium of exo- genetically organic nature).
3. Delusional syndromes with similar psychopathological manifestations differ significantly depending on the nosological form of mental illness (for example, delusional ideas of jealousy that arise in schizophrenia and relate to intellectual delirium are significantly different from delusional ideas of jealousy observed in sensual delirium of patients with cerebrosclerotic psychosis, epilepsy or alcoholic psychosis).
4. Mixed forms of delirium are possible (for example, oneiric delirium, pathologically associated with intellectual schizophrenic delirium, but arising from oneiric clouding of consciousness).

In connection with the above, it is necessary to keep in mind the conditional nature of the division of delusional syndromes given below into the main classes of delirium - intellectual, sensory, impaired consciousness. Moreover, if intellectual delirium occurs only in mental illnesses, in particular schizophrenia, and sensory delirium occurs in various psychoses that occur with more or less “interest” in the neurosomatic sphere, then delirium of impaired consciousness is necessarily pathogenetically associated with a disorder of consciousness of varying degrees of severity , ranging from hypnagogic and hypnopompic, hysterical or epileptic and ending with delirious or oneiric.

Taking into account the complexity of the problem of delusion, as well as the lack of reliable knowledge about the essence of normal and pathological mental activity, we propose a multidimensional taxonomy of delusional phenomena, including their division into the following consolidated groups:
a) classes characterized by relation to higher mental functions - delirium of darkened consciousness, sensory delirium, intellectual delirium;
b) categories - incoherent, interpretative, emerging, crystallized, systematized nonsense;
c) types of delusion formation mechanism - essential, holothymic (cathethetic, catathymic), affective;
d) types of course - acute, subacute, chronic and undulating, as well as stages, periods, stages of delusional syndrome;
e) forms of theme and plot - delusions of persecution, grandeur, etc.

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

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

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

The prerequisites for dividing delusions into intellectual and sensual are to a certain extent based on certain provisions of formal logic, according to which two types of delusional thinking can be distinguished: in the first, the cognitive sphere is disrupted - the patient reinforces his distorted judgment with a number of subjective evidence, combined in logical system; in the second, the sensory sphere is also disrupted: the patient’s delirium is figurative in nature with a predominance of dreams and fantasies [Karpenko L. A., 1985]. Approximately the same is emphasized by A. A. Mehrabyan (1975), who believes that there is an “internal duality of the psyche” formed by mental and sensory functions. In the accessible literature on psychiatry of the second half of the 19th and 20th centuries. the existence of a framework limiting the structure of the classification of delusional states to phenomena caused by disturbances of the predominantly intellectual or predominantly sensory sphere is fully confirmed.

IN last years the identification of the main classes of delirium does not undergo any fundamental changes. Just as in previous decades, it corresponds to two main functions of the human psyche - intellectual and affective. As before, intellectual delirium is designated as primary and in most cases is identified with interpretive delirium, while affective or sensory delirium is considered secondary, and some authors combine it with figurative delirium, while others differentiate it from it. Evidence of the correctness of this classification or its modifications is not original; only the wording changes, sometimes the emphasis or list of constituent elements.

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

Recognizing the clinical validity of including the classes of intellectual and sensory delirium in the taxonomy of delusional states, we believe that they should be supplemented by a class of delusional phenomena arising from darkened consciousness. We are talking about delusional experiences that began from the moment of clouding of consciousness or from the moment of exposure to the causes that caused it and disappear (except for cases of residual delirium) when consciousness clears. Sensual delirium does not belong to this class if its occurrence is not associated with clouding of consciousness, and consciousness is disturbed at the height of development of sensual delirium. Note that A. Hey (1954) insisted on identifying the form of delirium associated with a disorder of consciousness. In addition, the preservation of the main sections of traditional taxonomy requires the following additional explanations:
a) the designation of a delusional phenomenon by the term “intellectual” delirium, in contrast to other forms of delirium, is not entirely justified, since any delusion is caused by an intellectual disorder and is intellectual;
b) the concepts of “intellectual” and “sensual” delirium reflect the mechanism of delusion formation, characterize the psychopathological structure of the debut, course, outcome of the corresponding delusional phenomenon, but do not exclude the participation in the process of development of intellectual delirium of sensory elements and in the process of development of sensual delirium of components of intellectual delirium;
c) the concepts of “primary” and “intellectual” delusions can be considered synonymous, while the concept of “interpretive” indicates psychopathological elements found in different clinical variants of acute and chronic delusions, and does not determine whether this delusion belongs to one class or another;
d) the existence of the concept of “combined” delusion is legitimate, combining “figurative”, “hallucinatory” delirium and “imaginative” delirium into classes of sensory delirium.

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

The term “interpretative delusion” and the concept of “delusional interpretation” are ambiguous, since they characterize different aspects of the psychopathological phenomenon.

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

Symptomatic interpretative delirium (according to modern nomenclature - acute interpretative delirium) occurs in various acute psychoses, including psychoses of darkened consciousness.

In these cases, according to P. Serier and J. Capgras (1909), the clinical picture is characterized by a lack of tendency towards systematization, sometimes confusion, psychotic outbursts, intermittent course, etc. It consists of a painfully perverted interpretation of “ real facts"or sensations, usually with illusions and less often with hallucinations. According to J. Levy-Valency (1927), acute interpretative delirium differs from chronic interpretative delirium by the absence of a tendency to systematize; less depth, expression and complexity of interpretive structures; more pronounced affective accompaniment, a tendency to anxiety and a depressive reaction; greater curability.

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

The clinical characteristics of acute sensory delusions compiled by J-Levy-Valensi have been clarified and supplemented: this delirium is characterized by variability, inconstancy, instability, incompleteness of delusional ideas, lack of logical development of the plot, little dependence on the personality structure, rapid rate of formation of ideas, sometimes the presence of critical doubts, individual scattered illusions and hallucinations [Kuzmina S.V., 1975, 1976]. It is also characterized by instantaneous occurrence, filling the plot of delirium with what is happening at the moment around the patient without delusional retrospection [Vertogradova O.P., 1975, 1976] and phenomenological, dynamic elements that allow us to consider acute interpretive delirium as an intermediate syndrome between chronic interpretative and acute sensory delirium [Kontsevoy V. A., 1971; Popilina E.V., 1974]. The separation or, conversely, identification of acute interpretative and secondary sensory delusions is given attention in their studies by A. Ey (1952, 1963), G. I. Zaltsman (1967), I. S. Kozyreva (1969), A. B. Smulevich and M. G. Shirina (1972), M. I. Fotyanov (1975), E. I. Terentyev (1981), P. Pisho (1982), V. M. Nikolaev (1983).

Secondary delusion is sensual, its clinical manifestations are described in a huge number of works by domestic, German, French psychiatrists, etc. domestic psychiatry, especially in the second half of the 20th century, the term “sensual delirium” is used more often than others, however, the terms “affective delirium”, “delusion of imagination”, “figurative delirium”, etc. can often be found as synonyms. Definition of the concept “sensual delirium” Over the course of a century, many authors contributed, correcting and supplementing each other. In recent decades, consolidated definitions of the term “sensory delirium” have been repeatedly compiled. Thus, A.V. Snezhnevsky (1968, 1970, 1983), summarizing the statements of a number of psychiatrists, writes that sensory delirium from the very beginning develops within the framework of a complex syndrome along with other mental disorders, has a clearly figurative character, is devoid of a coherent system of evidence, logical justifications, characterized by fragmentation, inconsistency, vagueness, instability, changes in delusional ideas, intellectual passivity, predominance of imagination, sometimes absurdity, accompanied by confusion, intense anxiety, and often impulsiveness. At the same time, the content of sensory delirium is constructed without active work on it, and includes both real and fantastic, dream-like events.

Fantastic delirium is accompanied by confusion. It can manifest itself in the form of an antagonistic delirium - a struggle between two principles, good and evil, or an almost identical Manichaean delirium - a struggle between light and darkness with the participation of the patient, delusions of greatness, noble origin, wealth, power, physical strength, genius abilities , expansive, or grandiose, delirium - the patient is immortal, exists for thousands of years, has untold wealth, the strength of Hercules, is more brilliant than all geniuses, rules the entire Universe, etc. Often, sensory delirium is distinguished by extreme imagery, is constantly replenished with new details, usually contradictory, unmemorable sick with a multitude of events with an assessment of what is happening around them as a specially staged staging - delirium of staging. With sensual delirium, people and the situation are constantly changing - metabolic delirium, delirium of a positive and negative double is also observed - acquaintances are made up as strangers, and strangers as acquaintances, relatives, all actions taking place around, auditory and visual perceptions are interpreted with a special meaning - symbolic delirium, nonsense of meaning.

Fantastic delusions also include delusions of metamorphosis - transformation into another creature and delusions of obsession. A type of figurative delusion is affective delirium, accompanied by depression or mania. Depressive delusions include delusions of self-blame, self-abasement and sinfulness, delusions of condemnation by others, delusions of death (of loved ones, the patient himself, property, etc.), nihilistic delusions, and Cotard’s delusions.

Later it was supplemented by the statement that delusions arise only on a pathological basis. Therefore, V.M. Bleicher gives the following definition of what is traditional for the domestic school of psychiatry:

Another definition of delirium is given by G. V. Grule (German) Russian : “establishing a relational connection without a basis,” that is, an uncorrectable establishment of relationships between events without a proper basis.

Current criteria for delirium include:

Within medicine, delirium belongs to the field of psychiatry.

It is fundamentally important that delirium, being a disorder of thinking, that is, the psyche, is also a symptom of a disease of the human brain. Treatment of delirium, according to modern medicine, is possible only with biological methods, that is, mainly with medications (for example, antipsychotics).

According to research conducted by V. Griesinger (English) Russian in the 19th century, in general terms, delirium regarding the mechanism of development does not have pronounced cultural, national and historical characteristics. At the same time, a pathomorphosis of delirium is possible: if in the Middle Ages obsession, magic, love spells prevailed, in our time delusions of influence by telepathy, biocurrents or radar are common.

Often in everyday life, delirium is mistakenly called mental disorders (hallucinations, confusion), sometimes occurring in somatic patients with elevated body temperature (for example, in infectious diseases).

Classification

If delirium completely takes over consciousness, then this state 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.

As a productive psychotic symptomatology, delusions are a symptom of many brain diseases.

Primary (Interpretive, Primordial, Verbal)

At interpretive delirium The primary defeat of thinking is the defeat of rational, logical cognition, the distorted judgment is consistently supported by a number of subjective evidence that has its own system. In this case, the patient's perception is not impaired. Patients can remain functional for a long time.

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.

This variant of delusion includes paranoid and systematized paraphrenic delusions.

Secondary (sensual and figurative)

Hallucinatory delusion arising from impaired perception. This is delusion with a predominance of illusions and hallucinations. Ideas with it are fragmentary, inconsistent - primarily a violation of perception. Disruption of thinking occurs secondarily, there is a delusional interpretation of hallucinations, a lack of conclusions, which are realized in the form of insights - bright and emotionally rich insights. Elimination secondary delirium can be achieved mainly by treating the underlying disease or symptom complex.

There are sensual and figurative secondary delusions. With sensory delirium, the plot is sudden, visual, specific, rich, polymorphic and emotionally vivid. This is nonsense of perception. With figurative delirium, scattered, fragmentary ideas arise, similar to fantasies and memories, that is, delusions of representation.

Syndromes of sensory delirium:

Syndromes develop in the following order: acute paranoid → staging syndrome → antagonistic delusion → acute paraphrenia.

Classic variants of unsystematized delusions are paranoid syndrome and acute paraphrenic syndromes.

In acute paraphrenia, acute antagonistic delirium, and especially staging delirium, intermetamorphosis syndrome develops. With it, events for the patient change at an accelerated pace, like a movie shown in fast mode. The syndrome indicates an extremely acute condition of the patient.

Secondary with a special pathogenesis

Delirium of the imagination

Delusional syndromes

Currently, in Russian psychiatry it is customary to distinguish three main delusional syndromes:

• nonsense relationship- 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;
• nonsense meanings- a variant of the previous plot of delirium, everything in the patient’s environment is given special significance;
• delusions of influence- physical (rays, devices), mental (as an option according to V.M. Bekhterev - hypnotic), forced sleep deprivation, often in the structure of the syndrome of mental automatism;
• option erotic delirium without positive emotions and with the conviction that the partner is allegedly pursuing the patient;
• delirium of litigiousness (querulantism)- the patient fights to restore “trampled justice”: complaints, courts, letters to management;
• delirium of jealousy- the belief that a sexual partner is cheating;
• delirium 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), a combination of delusions of persecution and impoverishment;
• delirium of poisoning- the belief that someone wants to poison the patient;
• delirium of staging (intermetamorphoses)- the patient’s belief that everything around him is specially arranged, scenes of some kind of play are being played out, or an experiment is being conducted, everything constantly changes its meaning: for example, this is not a hospital, but in fact the prosecutor’s office; the doctor is actually an investigator; patients and medical staff are security officers disguised in order to expose the patient. Close to this type of delusion is the so-called “Truman Show syndrome”;
• delirium of obsession;
• presenile dermatozoal delirium.

Induced (“induced”) delirium

Main article: Induced delusional disorder

In psychiatric practice, induced (from Lat. induce- “induce”) delusion, in which delusional experiences are, as it were, borrowed from the patient in close contact with him and in 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 schizophrenic, but not always. Initial delusions in a dominant person and induced delusions are usually chronic nature and are, according to the plot, delusions of persecution, grandeur or religious delirium. Typically, the group involved is closely connected and isolated from others by language, culture, or geography. A person inducing delusions 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 the passive member of the couple or group through contact with the active partner.

Induced hallucinations are rare, but do not exclude the diagnosis of induced delusions.

Stages of development

Differential diagnosis

Delusion must be distinguished from the delusion of mentally healthy people. In this case, firstly, there must be a pathological basis for the occurrence of delirium. Secondly, delusions, as a rule, relate to objective circumstances, while delusions always relate to the patient himself. Moreover, the delusion contradicts his previous worldview. Delusional fantasies differ from delusions in the absence of a strong conviction in their authenticity.

see also

Literature

• Delirium // Thinking disorders. - K.: Health, 1983.
• Kerbikov O.V., 1968. - 448 p. - 75,000 copies. ;
• N. E. Bacherikov, K. V. Mikhailova, V. L. Gavenko, S. L. Rak, G. A. Samardakova, P. G. Zgonnikov, A. N. Bacherikov, G. L. Voronkov. Clinical Psychiatry / Ed. N. E. Bacherikova. - Kyiv: Health, . - 512 s. - 40,000 copies. - ISBN 5-311-00334-0;
• Guide to Psychiatry / Ed. A. V. Snezhnevsky. - Moscow: Medicine,. - T. 1. - 480 p. - 25,000 copies.;
• Tiganov A. S. Hallucinatory-paranoid syndromes // General psychopathology: a course of lectures. - Moscow: Medical Information Agency LLC, . - P. 73-101. - 128 s. - 3000 copies. -

Delirium is a condition that belongs to the category of pathological manifestations of the psyche. Delusion is a disorder of the mental sphere that greatly affects an aspect of the behavior of such an individual. It is impossible not to notice the absurdity of these arguments, since they sound unreasonable, regardless of the structure of the words. But it is impossible to convince them by any means; this will only aggravate communication with an individual suffering from the plot of delusion.

Delirium is rarely a monosymptom and is accompanied by serious concomitant symptoms, which in their manifestation become a provocateur, aggravating the course of the pathology and are often dangerous for the individual or the environment.

What is delirium?

Delusions are a symptom of a wide range of psychiatric disorders. You cannot always perceive the conversations of psychiatry patients as nonsense, since sometimes the strangest reasoning turns out to be true, but only within reasonable limits, naturally not religious or fantastic. The psychiatrist should always approach the patient’s reasoning philosophically, and in no case mock the person or try to convince him otherwise, since the key symptom of delusion is precisely the impossibility of changing its structure or convincing the individual of anything. Delirium itself is not some kind of limited pathology, it is a psychopathological symptom, diagnosing which it is possible to select from the ICD list a pathology whose structure includes delirium.

It is worth noting that very unrealistic things can turn out to be true, so the patient needs to be listened to and, if possible, the story verified. Well, of course, it is important to have reasonable boundaries, since ideas that are clearly impossible will doubtfully be implemented.

Mental processes occur differently in different people, but with delirium their structure changes. In this case, the person is completely captured by delusion and, as a rule, it only intensifies, completely turning off the adequate life of the individual. Delirium is always significant and is considered a serious productive symptom that undoubtedly affects the patient.

Acute delirium is usually formed during a certain kind of acute disorder. That is, it does not progress, gradually getting worse, but appears in its full manifestation, preventing the person from functioning adequately. These types of delusions are very dangerous because they can lead to everyone around becoming entangled in it and pose a danger to society. Acute delirium can also be separately subdivided into transient or transient. Moreover, it is quickly transient and is usually formed due to certain short-term factors.

Chronic delirium is no less common and affects individuals regardless of gender and age. The structure of delirium may change and undergo some pathomorphoses. The influence of this kind of delusion on an individual’s behavior cannot be ruled out.

Worked on the issue of delirium a large number of scientists, these disorders have been known since the Middle Ages, but interest in delirium really increased during the development of clinical psychiatry. A large number of scientists studied it, including Bleuler, Grule, Jaspers, Kraepelin.

Delusional interpretations always change depending on the period of life and place of residence. This is an important criterion, since it is important to understand the approximate customs and beliefs of the locality in order to adequately analyze delusions and classify them into certain categories. This symptom is considered productive due to the fact that it is an additional phenomenon that appears outside normal functioning psyche.

Causes of delirium

Delirium is formed due to huge amount pathologies and is one of primary symptoms for many diseases. Delirium is formed for different underlying reasons and has different pathophysiological mechanisms of manifestation.

Delirium is a symptom of major psychiatry, and it is not inherent in neuroses, but one cannot exclude some kind of complicated course in which delusion can form. Delusions are possible in depression and mania, but they will not be similar in description and structure to delusions of any other origin.

Delirium with depression appears if it reaches psychotic level and its context is always in a depressive structure.

In schizophrenia, schizotypal and schizoaffective disorder there is also delusion. This symptom is usually pronounced and is significant aspect in diagnosing primary The plot of delusions in the schizophrenia spectrum is completely different in its manifestation and can have interesting combinations of delusions. There are even entire science fiction books written by such talented schizophrenics, because their brains simply endlessly produced ideas.

Also nonsense, like an idea pathological manifestation, appears in chronic delusional spectrum disorder. This pathology is typical for old age, but seriously affects the individual’s thinking and fills the brain with delirium. Delirium can also occur in some forms of alcoholism and encephalopathies. For senile dementia and various kinds atrophic diseases brain, the formation of delusions is also possible.

Acute delirium can form in the context organic damage, under the influence of some stressor. This can happen when moving and is called traveler's delirium. Sometimes it is formed in persons with deafness of a certain origin and blindness, and is associated with the personal assumptions of an individual with a disability, a certain kind of ridicule of him and conversations about him.

Delirium has confirmed pathomorphological changes in brain tissue. Disruption of neurotransmitter activity undoubtedly influences the formation of the pathology of delirium. Also, disruption of intersynaptic conduction leaves its influence in the formation of delirium.

The environment can also lead to the formation of delusions, especially in labile individuals. In addition, a tendency to develop delusions is inherent in hypersynthetic individuals who are constantly exposed to excessive suspiciousness and similar character traits.

Neuropsychiatry says that delusions occur when the internal limbic system is damaged, but only in the later stages. There may be many reasons and a psychological spectrum, for example, a tendency to isolation and excessive philosophizing, excessive touchiness and malicious feelings towards the environment due to a certain kind of suspicion.

S. Freud said that not every delusion is a pathology of mental aspects, since it often carries defense mechanism for the psyche. Sometimes this is associated with pathologically incorrect experiences of childhood phases of mental development, which can result in very serious psychiatric pathologies.

Symptoms and signs of delirium

Although delirium is not a separate pathology, but is inherent in a large number of diseases from the category of major psychiatry, there are still some diagnostic criteria. These criteria make it possible to partially generalize the symptoms of delirium and facilitate its diagnosis.

Delusion has a pathological basis, which is what distinguishes it from overvalued ideas, since it is based on a real fact, but it is significantly exaggerated. As a rule, thinking during delirium is paralogical, that is, built on a specific pathological logic, which is inherent only in this particular patient and is completely resistant to any adequate, logical features. This internally constructed logic may differ and come from an affective logic, which is built on some affectively constructed beliefs and comes from the patient’s personal needs and his certain beliefs.

With delirium, a feature is the immutability of consciousness; delirium is characteristic of patients in clear consciousness. In states of confused or darkened consciousness, other psychopathological syndromes appear.

Delirium is always excessive in its manifestation and does not correspond to objective reality, this is where its effectiveness in terms of logic is manifested, since it is significant only for the patient himself. The individual is resistant to attempts to correct the state of thinking; even suggestive techniques cannot convince the patient that ideas are incorrect, which indicates the importance of these persuasion for the internal component of the patient. Intellectual decline usually occurs, but only with a long course of the pathology. In general, delirium is not manifested by a sufficient degree of intellectual decline; it is rather a symptom, which arises against the background of intact intelligence.

Delusions can be very straightforward and relate to specific life facts, but often, on the contrary, go into some fantasy aspects, completely capturing the patient’s attention and protecting him from the outside world. Usually, with prolonged delusional development, especially in schizophrenia, a specific confusion is formed; it develops after the collapse of the delusional system.

Sometimes the concept of delirium is used not as a term for pathology, but as a definition of some kind of misconception. But we must not forget that delusions are formed against a pathological mental background, unlike any kind of delusions. Delirium always refers to the patient himself, and not to something objective, for example, to circumstances. Delusion is a contradiction to the classical worldview of the patient, since it often represents some kind of pathological basis. Delusions are rarely limited in scope; they affect all aspects of a person's life and usually have a limiting influence. Thinking infected with delirium constantly thinks about the same thought, all emotions are also directed only at it.

Stages of delirium

Depending on the pathology that causes delirium, it is divided into several important types.

Primary delusion is a pathology that is formed not on the basis of something, but on its own. It affects only the patient’s sphere of thinking and is based only on the delusional ideas themselves without any additional factors.

Secondary delusions, also called interpretive, are formed on the basis of hallucinations experienced by the patient. This delirium does not have a clear structure and changes along with changes in the experienced sensations; each patient interprets his experiences differently, which is why it is very diverse and polymorphic.

Primary delirium is systematized and has clear stages of formation, which are approximately identical in all patients. But the duration of each stage is individual and depends only on the personality of the patient and the structure of the pathology. Primary delirium only has stages and this is precisely what distinguishes it from other types of productive states.

At the first stage, a clear delusion does not immediately form, but simply a delusional mood appears. This condition is completely poorly diagnosed, and no one ever goes to a specialist with such a symptom. Complaints appear much later and more often from relatives, since patients with delirium usually have very bad criticism. In a delusional mood, the patient becomes suspicious, uncommunicative, he withdraws more often, behaves fearfully, and becomes suspicious.

Further, in the second stage, after some time has passed, a delusional interpretation of the surrounding situation is formed. This is already becoming quite alarming symptom. The patient begins to notice all sorts of suspicious things that, naturally, are not suspicious. He begins to pathologically interpret everything that surrounds him, finding some secret meaning in it.

Enlightenment, or crystallization of delirium, is the third stage. At this stage, the patient finally understands everything and interprets for himself, as it seems to him, absolutely correctly. At the same time, the delirium becomes holothymic and monothematic, all suspicions and thoughts are built into one clear idea, completely structured, and it brings everything that follows into this structure. At this stage, delirium is not subject to any correction at all. The person has no criticism. Most often there is one idea of ​​persecution. Primary delirium is characteristic only of this stage.

The fourth stage is the formation of a hallucinatory-paranoid syndrome, in which delusions are completely dependent on the hallucinatory state and completely change under the influence of hallucinations. Very often, Kandinsky syndrome is formed and states of stupor or excitement are possible under the influence of hallucinatory delusional states. This stage can last quite a long time and occur continuously or with improvements and deteriorations.

With a long course of pathology, last stage delirium and this is a paraphrenic stage, while the structure of delirium completely changes, being replaced by ideas of greatness and slowly leading to the final state, namely specific bewilderment.

Treatment of delirium

Delirium is a productive symptom that undoubtedly requires responsible management. It is not always amenable to therapeutic effects, but the most applicable to it are antipsychotics. Some drugs have a greater affinity for delirium, and they are aimed specifically at relieving delusional symptoms. The most effective symptomatology of delirium is leveled by a typical antipsychotic with a partially stimulating effect - Triftazin, which is used by injection.

In general, the nature of delusional ideas depends on the pathology that caused them. And if this is the case, then it is necessary to use antidepressants, and often this is enough if the delusions are from the structure of depressives. But if, with depression, nonsense or other symptoms that do not correspond to it begin to appear, then you need to connect antipsychotics. Antidepressants include Amitriptyline, Anafranil, Fluoxetine, Paroxetine, Pyrazidone, Moclobemide. The antidepressant effect usually appears after about two to three weeks of use, so it is important to closely monitor the patient's condition. In addition, for both depression and mania, it is important to use mood stabilizers, which will keep the state relatively stable, preventing the mood from changing sharply or worsening. Valprocom, Depakine, Lithium carbonate, Lamotrigine, Carbamazepine are suitable for this.

If delirium is provoked not by a manic or depressive state, but still by schizophrenia or, then it is necessary to use antipsychotics. For manic agitation, antipsychotics are also used. It is most important to begin relief on time, since the condition quickly worsens and the patient can become dangerous both to himself and to others. To begin with, relief is carried out with typical sedative neuroleptics: Aminazine, Haloperidol, Tizercin, Truxal, Clopixol. After relief of the acute condition and normalization of general well-being, you can return to the tablet drug and use antipsychotics from the atypical group, which have combined action: Rispaxol, Soleron, Seroquel, Azaleptol, Azapine. After this, you can try to transfer the patient to depot drugs that are administered less frequently and their effect lasts up to a month: Moniten, Haloperidol depot, Rispaxol consta, Clopixol depot, Olanzapine depot.

Sometimes a combination of the listed drugs with tranquilizers is necessary, which potentiate the effect of the above drugs: Sibazon, Xanax, Gidazepam, Adaptol, Diazepam. Sometimes drugs in combination with Diphenhydramine and Analgin, which also have a hypnotic effect, can be effective.

Sometimes, as a supportive therapy, you can try to help the patient through psychotherapy. This can support the patient and help combat delusions.

Examples of nonsense

The plot of delirium is essentially its example, since it is the basis of delirium, what it is built from. It makes sense to provide examples based on the type of delirium. And on its certainty to a certain series of nonsense.

Depressive delusions include accusatory ideas. A person may think that he is suffering from an excess of certain diseases; usually they attribute to themselves incurable illnesses, such as AIDS, cancer, tuberculosis, syphilis. This can intensify and take over more and more diseases and organs.

The plot of delirium can be nihilistic, while the patient says that he or even the whole world is rotten, everything is dying. The patient may also suffer from delusions of self-blame and self-humiliation, finding himself guilty of everything in which it is possible to find fault and feeling humiliated and worse than others. In addition, the patient may have a feeling of sinfulness, then he feels like a sinner, guilty of all mortal sins.

The plot of manic delirium has in its structure the ideas of greatness, invention, reformism, wealth and special origin. And this nonsense absolutely corresponds to its plot, the patient has the same beliefs.

The peach series of delirium is the most dangerous, especially for others. With delusions of relationship, a person believes that he is being treated poorly, everyone is dealing with him and discussing him. With delusions of influence, one may suspect that someone evil is influencing him negatively through certain physical or psychic methods. Delirium of loss indicates the infliction of certain moral or material damage. The most common are persecution, jealousy, poisoning. Particularly common in juvenile schizophrenia is dysmorphomanic delusion, which consists of some “irregularities” in body proportions, and very absurd ones at that.

Delirium is a disorder of thinking, which is characterized by the appearance of painful ideas, judgments and conclusions that do not correspond to reality and cannot be corrected, which seem absolutely logical and correct to the patient.

ICD-10	F22
ICD-9	297
DiseasesDB	33439
MedlinePlus	D003702

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

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

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

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

General information

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

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

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

The German psychiatrist and neuropathologist Wilhelm Griesinger (1881) also considered delirium to be an independent disease, calling it primary insanity.

The first attempt to classify paranoia and separate it from other forms was the work of V. Zander, published in 1868, “On one special form of primary insanity.” In his work, V. Zander noted that in some cases the disease develops gradually, reminiscent of the developmental process normal character. For such cases, V. Zander proposed using the term “innate paranoia,” linking the formation of a delusional system with the character and personality of the patient.

The gradual development in a number of cases of delusions of persecution, delusions of relation and special significance was also noted by E. Lasegue.

New data made it possible to divide delirium according to the method of occurrence into:

• primary (interpretive or paranoid), which was described in 1909 by P. Sereux, J. Capgras;
• secondary (sensual delirium), which occurs against the background of melancholy or mania (altered affect).

Secondary delusions began to include the delusion of explanation described in 1900 by K. Wernicke, hallucinatory delusion and cathethetic delusion described in 1938 by V. A. Gilyarovsky, which occurs in the presence of painful sensations.

In 1914, the French psychiatrists E. Dupre and V. Logre described delirium of the imagination.

Persecutory delirium (delusion of persecution) was first described by E. Lasegue in 1852. This form of delirium was also described later by J. Falret the Father (1855) and L. Snell (1865).

The stages of delirium formation were first described in 1855 by J. P. Falre.

To exist acute forms delusional disorder was indicated in 1876 by Karl Westphal - the primary delusion described by Westphal did not differ in anything from chronic paranoia, except for the course of the disease.

As part of the study of schizophrenia, delusions and its characteristics were considered by E. Bleuler and E. Kraepelin.

According to research, the general features of delirium and the mechanism of its development do not have pronounced national and cultural characteristics, but a certain cultural pathomorphosis is observed (changes in signs separate disease) - in the Middle Ages, delusions were mainly associated with magic and obsession, and in our time, delusions associated with “the influence of telepathy, biocurrents or radar” predominate.

In everyday life, delirium is the unconscious state that occurs in somatic patients at elevated temperatures, which is accompanied by meaningless and incoherent speech. Since this condition is a qualitative disorder of consciousness, and not a disorder of thinking, it is more correct to use the term “” to denote it.

Forms

Depending on the clinical picture of this thinking disorder are distinguished:

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

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

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

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

There is also a trend towards:

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

This form of delirium includes:

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

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

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

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

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

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

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

Sensory delirium is divided into syndromes including:

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

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

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

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

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

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

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

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

Delusional syndromes

Russian psychiatry identifies 3 main delusional syndromes:

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

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

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

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

The plot of delirium

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

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

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

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

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

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

Delusions of grandeur unite:

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

Delusions of grandeur can be complex.

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

This group includes:

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

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

Reasons for development

As with other mental illnesses, exact reasons The development of delusional disorders has not been established to date.

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

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

Pathogenesis

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

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

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

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

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

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

Symptoms

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

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

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

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

The plot of acute delirium is changeable and unformed.

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

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

Diagnostics

Diagnosis of delirium includes:

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

Currently used criteria for delirium include:

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

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

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

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

Treatment

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

Drug therapy includes the use of:

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

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

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

People use the word "bullshit" a lot. In this way they express their disagreement with what their interlocutors are talking about. It is quite rare to observe truly delusional ideas that manifest themselves in an unconscious state. This is already closer to what is considered nonsense in psychology. This phenomenon has its own symptoms, stages and methods of treatment. Let's also look at examples of delusion.

What is delirium?

What is delirium in psychology? This is a thinking disorder when a person expresses painful ideas, conclusions, reasoning that do not correspond to reality and cannot be corrected, while unconditionally believing in them. Another definition of delusion is the falsity of ideas, conclusions and reasoning that do not reflect reality and cannot be changed from the outside.

In a delusional state, a person becomes egocentric and affective, because he is guided by deeply personal needs, and his volitional sphere is suppressed.

People often use this concept, distorting its meaning. Thus, delirium refers to incoherent, meaningless speech that occurs in an unconscious state. Often observed in patients with infectious diseases.

Medicine views delirium as a disorder of thinking, and not a change in consciousness. This is why it is a mistake to believe that delirium is an occurrence.

Delirium is a triad of components:

1. Ideas that are not true.
2. Unconditional faith in them.
3. The impossibility of changing them from the outside.

The person does not have to be unconscious. People who are completely healthy can suffer from delirium, which will be discussed in detail in the examples. This disorder should be distinguished from the misconceptions of people who incorrectly perceived information or interpreted it incorrectly. Delusion is not nonsense.

In many ways, the phenomenon under consideration is similar to Kandinsky-Clerambault syndrome, in which the patient experiences not only a disorder of thinking, but also pathological changes in perception and ideomotor skills.

It is believed that delirium develops against the background of pathological changes in the brain. Thus, medicine refutes the need to use psychotherapeutic methods of treatment, since it is necessary to eliminate a physiological problem, not a mental one.

Stages of delirium

Delirium has stages of its development. They are as follows:

1. Delusional mood - the conviction of the presence of external changes and impending disaster.
2. Delusional perception is the effect of anxiety on a person’s ability to perceive the world around them. He begins to distortly interpret what is happening around him.
3. Delusional interpretation is a distorted explanation of perceived phenomena.
4. Crystallization of delusions – the formation of stable, comfortable, fitting delusional ideas.
5. The fading of delirium - a person critically evaluates existing ideas.
6. Residual delirium is a residual phenomenon of delirium.

To understand that a person is delusional, the following system of criteria is used:

• The presence of a disease on the basis of which the delirium arose.
• Paralogicality is the construction of ideas and conclusions based on internal needs, which forces one to build one’s own logic.
• No impairment of consciousness (in most cases).
• The “affective basis of delusion” is the discrepancy between thoughts and actual reality and the conviction of the correctness of one’s own ideas.
• The constancy of delirium from the outside, stability, “immunity” to any influence that wants to change the idea.
• Preservation or slight change in intelligence, since with its complete loss, delirium disintegrates.
• Destruction of personality due to concentration on a delusional plot.
• Delusion is expressed by a strong belief in its authenticity, and also affects changes in personality and lifestyle. This should be distinguished from delusional fantasies.

With delirium, one need or instinctive pattern of actions is exploited.

Acute delusion is identified when a person’s behavior is completely subordinated to his delusional ideas. If a person maintains clarity of mind, adequately perceives the world around him, controls his own actions, but this does not apply to those situations that are associated with delirium, then this type is called encapsulated.

Symptoms of delirium

Website psychiatric care The site identifies the following main symptoms of delirium:

• Absorption of thinking and suppression of will.
• Inconsistency of ideas with reality.
• Preservation of consciousness and intelligence.
• The presence of a mental disorder is the pathological basis for the formation of delusions.
• The delirium is addressed to the person himself, and not to objective circumstances.
• Complete conviction in the correctness of a delusional idea that cannot be changed. Often it contradicts the idea that a person held before it appeared.

In addition to acute and encapsulated delusions, there are primary (verbal) delusions, in which consciousness and performance are preserved, but rational and logical thinking is impaired, and secondary (sensual, figurative) delusions, in which the perception of the world is disrupted, illusions and hallucinations appear, and the ideas themselves fragmentary and inconsistent.

1. Imaginative secondary delusion is also called delusion of demise, since pictures appear like fantasies and memories.
2. Sensual secondary delusion is also called delusion of perception, because it is visual, sudden, intense, concrete, and emotionally vivid.
3. Delirium of imagination is characterized by the emergence of an idea based on fantasy and intuition.

In psychiatry, three delusional syndromes are distinguished:

1. Paraphrenic syndrome is systematized, fantastic, combined with hallucinations and mental automatisms.
2. Paranoid syndrome is an interpretive delusion.
3. Paranoid syndrome – unsystematized in combination with various disorders and hallucinations.

Separately, there is a paranoid syndrome, which is characterized by the presence of an overvalued idea that arises in paranoid psychopaths.

The plot of delusion is understood as the content of the idea that regulates human behavior. It is based on the factors in which a person finds himself: politics, religion, social status, time, culture, etc. There can be a large number of delusional plots. They are divided into three large groups, united by one idea:

1. Delirium (mania) of persecution. It includes:

• Delirium of damage - other people steal or damage his property.
• Delusion of poisoning - it seems that someone wants to poison a person.
• Delusion of relationships - people around him are perceived as participants with whom he is in a relationship, and their behavior is dictated by their attitude towards the person.
• Delusion of influence - a person believes that his thoughts and feelings are influenced by external forces.
• Erotic delusion is a person’s belief that he is being pursued by his partner.
• Delusions of jealousy - confidence in the betrayal of a sexual partner.
• The delusion of litigiousness is the belief that a person has been treated unfairly, so he writes letters of complaint, goes to court, etc.
• The delusion of staging is the belief that everything around is staged.
• Delusion of possession - the belief that a foreign organism or evil spirit has entered the body.
• Presenile delirium – depressive images of death, guilt, condemnation.

1. Delusions (delusions) of grandeur. Includes the following forms of ideas:

• Delusion of wealth is the belief that one has countless riches and treasures.
• Delusion of invention is the belief that a person must make some new discovery, create a new project.
• The delirium of reformism is the emergence of the need to create new rules for the benefit of society.
• Delusion of descent is the idea that a person is the ancestor of nobility, a great nation, or the child of rich people.
• The delusion of eternal life is the idea that a person will live forever.
• Love delusion is the conviction that a person is loved by everyone with whom he has ever communicated, or that famous people love him.
• Erotic delusion is the belief that a specific person loves a person.
• Antagonistic delusion is the belief that a person is witnessing some kind of struggle between great world forces.
• Religious delusion – imagining oneself as a prophet, messiah.

1. Depressive delirium. It includes:

• Hypochondriacal delusion is the idea that there is an incurable disease in the human body.
• Delirium of sinfulness, self-destruction, self-abasement.
• Nihilistic delusion is the absence of the feeling that a person exists, the belief that the end of the world has come.
• Cotard's syndrome is the belief that a person is a criminal who is a threat to all humanity.

Induced delirium is called “infection” with the ideas of a sick person. Healthy people, often those who communicate closely with the patient, adopt his ideas and begin to believe in them themselves. It can be identified by the following signs:

1. An identical delusional idea is supported by two or more persons.
2. The patient from whom the idea originated has a great influence on those who are “infected” with his idea.
3. The patient's environment is ready to accept his idea.
4. The environment is uncritical of the patient’s ideas, and therefore accepts them unconditionally.

Examples of nonsense

The types of delusions discussed above can become the main examples that are observed in patients. However, there are a lot of crazy ideas. Let's look at some of their examples:

• A person can believe that he has supernatural powers, assure others of this and offer them solutions to problems through magic and witchcraft.
• It may seem to a person that he reads the thoughts of those around him, or, conversely, that the people around him read his thoughts.
• A person may believe that he is able to recharge through the wiring, which is why he does not eat and sticks his fingers into the socket.
• A person is convinced that he has lived for many years, was born in ancient times, or is an alien from another planet, for example, from Mars.
• A person is sure that he has doubles who repeat his life, actions, and behavior.
• A man claims that insects live under his skin, breed and crawl.
• The person makes up false memories or tells stories that never happened.
• A person is convinced that he can turn into some kind of animal or inanimate object.
• A person is sure that his appearance is ugly.

In everyday life, people often throw around the word “nonsense.” Often this happens when someone is under the influence of alcohol or drugs and tells what happened to him, what he sees, or states some scientific facts. Also, expressions with which people disagree seem to be delusional ideas. However, in reality this is not nonsense, but is considered just a delusion.

Delirium may include clouding of consciousness when a person sees something or poorly perceives the world around him. This also does not apply to delirium among psychologists, since the important thing is to maintain consciousness, but to disrupt thinking.

Treatment of delirium

Since delirium is considered a consequence of brain disorders, the main methods of its treatment are medications and biological methods:

• Antipsychotics.
• Atropine and insulin comas.
• Electric and drug shock.
• Psychotropic drugs, neuroleptics: Melleril, Triftazin, Frenolone, Haloperidol, Aminazine.

Usually the patient is under the supervision of a doctor. Treatment is carried out inpatiently. Only if the condition improves and there is no aggressive behavior, outpatient treatment is possible.

Are psychotherapeutic treatments available? They are not effective because the problem is physiological. Doctors direct their attention only to eliminating those diseases that caused delirium, which is dictated by the set of drugs that they will use.

Only psychiatric therapy is possible, which includes medications and instrumental influence. Classes are also held where a person tries to get rid of his own illusions.

Forecast

At effective treatment and eliminating diseases is possible full recovery sick. The danger lies in those diseases that cannot be treated by modern medicine and are considered incurable. The prognosis becomes disappointing. The disease itself can become fatal, affecting life expectancy.

How long do people live with delirium? The human condition itself does not kill. His actions that he commits and the disease, which can be fatal, become dangerous. The result of the lack of treatment is isolation from society by placing the patient in a psychiatric hospital.

Delusions should be distinguished from ordinary delusions of healthy people, which often arise from emotions, incorrectly perceived information or its insufficiency. People tend to make mistakes and misunderstand things. When there is not enough information, it occurs natural process thinking ahead. Delusion is characterized by the preservation of logical thinking and prudence, which distinguishes it from delusion.