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