Brad - what is it? Signs and symptoms of the disorder. Classification and characteristics of delusional ideas A person is delusional, diagnosed

Delusion is an incorrect, false conclusion that has enormous significance for the patient, permeates his entire life, always develops on a pathological basis (against the background of a mental illness) and is not subject to psychological correction from the outside.

Based on the theme of experiences or content, delirium is divided into three groups:

• persecutory delirium,
• delusions of grandeur,
• Delusional ideas of self-deprecation (or a group of depressive delusions).

To the group persecutory delusion includes the actual delusion of persecution: the patient is firmly convinced that he is constantly being persecuted by people from “certain organizations.” In order to avoid surveillance, to “get rid of the tail,” they instantly change one type of transport to another, jump out of a tram or bus at full speed, at the last second before the automatic closing of the doors, leave the car in the subway, “skillfully cover their tracks,” but nevertheless They constantly feel like a victim of a hunt. For “he is constantly being led.”

Patient X. traveled all over the country for six months (the so-called delusional migration), trying to get rid of “surveillance”, constantly changed trains and directions, disembarked at the first station he came across, but by the voice of the station announcer, by the expression on the face of the policeman on duty or a random passer-by, he understood , that he was “surrendered by some and accepted by other pursuers.”

The circle of persecutors includes not only work colleagues, relatives, but also complete strangers, strangers, and sometimes even pets and birds (Doolittle syndrome).

Delusional relationship is expressed in the fact that the patient is convinced of the bad attitude towards him on the part of those around him, who condemn him, laugh contemptuously, “wink in a special way”, and smile mockingly. For this reason, he begins to retire, stops visiting public places, and does not use transport, since it is in the company of people that he feels the unkind attitude towards himself especially acutely.

A type of relational delusion is delusion of special meaning or special meaning when the patient interprets trivial events, phenomena or details of the toilet in a fatal way.

Thus, the sick Ts., seeing a doctor in a bright tie, decided that this was a hint that he would soon be publicly hanged and his execution would be made into a “bright show.”

Delirium of poisoning- the patient’s persistent belief that they want to poison him; for this purpose, poison is constantly added to food or lethal pills (injections) are given under the guise of medicine, potassium cyanide is mixed into kefir or milk already in the store. For this reason, patients refuse to eat, take medications, and actively resist injections. At home, they eat what they cook themselves, or canned food in metal packaging.

Patient K. refused to eat, because the nurses, according to her, were poisoning the sick, adding poison to their food in order to make room for the next batch of patients.

Delusion of litigiousness(Querulant nonsense) manifests itself in a stubborn struggle to defend one’s allegedly violated rights. Patients file complaints with various authorities and collect huge amounts of documents. This type of delusion is characteristic of schizophrenia and some forms of psychopathy.

Delirium of material damage is associated with the patient’s persistent conviction that he is constantly being robbed by neighbors on the landing or entrance. “Thefts” are usually small-scale, they concern small objects (a teaspoon or an old half-broken cup), old clothes (an old robe used as a doormat), food (three lumps of sugar or several sips of beer from a bottle have disappeared). Patients with such delusions usually have double metal doors in their apartments with several complex locks, and often with a powerful deadbolt. Nevertheless, as soon as they leave the apartment for a few minutes, when they return, they discover traces of “theft” - either they stole a piece of bread, or “bite off” an apple, or took away an old floor rag.

Patients, as a rule, turn to the police for help, write numerous complaints about “thieving neighbors” to law enforcement agencies, comradely courts, and deputies. Sometimes the delusion of material damage logically follows from the delusion of poisoning - they are poisoned in order to take possession of property, an apartment, a dacha. Delusions of material damage are especially characteristic of presenile and senile psychoses.

Delirium of influence- this is the patient’s false belief that he is being influenced at a distance by hypnosis, telepathy, laser beams, electrical or nuclear energy, a computer, etc. in order to control his intellect, emotions, movements in order to develop the “necessary actions”. Particularly common are delusions of mental and physical influence, which are part of the structure of so-called mental automatisms in schizophrenia.

Patient T. was convinced that she had been influenced by “eastern sages” for 20 years. They read her thoughts, make her brains work and use the results of her “spiritual intellectual work” because “although they are sages, they are complete idiots and themselves are not capable of anything.” They also draw wisdom from the patient. In addition, she is influenced by all people of non-Slavic appearance, they, at their own request, change the style of her thinking, confuse thoughts in her head, control her movements, give her unpleasant dreams, forcibly force her to remember the most unpleasant moments of her life, create pain in her heart and stomach , intestines, gave her “persistent constipation”, they also “arranged for her different degrees of beauty, making her either beautiful or ugly.”

Delusions of positive influence are also noted: the patient is influenced by angels, they improve or correct his fate, so that after death he appears before God in a more favorable light. Sometimes patients themselves can influence surrounding people or objects. Thus, patient B. established contact with satellites through television and thus could see “inaccessible channels” with sexual themes.

Delirium of staging- perception of the real situation as “fake”, specially set up, while a performance is played out around the patient, the patients lying with him are disguised employees of the special services, other punitive organizations, or “actors moonlighting due to poverty.”

Patient Ts., being in psychosis and in the acute ward of a psychiatric hospital, believed that she was “in the dungeons of the KGB”, the patients and doctors around were actually disguised actors who were playing some kind of incomprehensible performance especially for her, any question I perceived doctors as an interrogation, and drug injections as torture with addiction.

Delirium of accusation- the patient’s painful conviction that people around him are constantly blaming him for various crimes, accidents, catastrophes and tragic incidents. The patient is forced to make excuses all the time, to prove his innocence and non-involvement in certain crimes.

Delirium of jealousy- the patient begins to feel that his wife, for no reason at all, becomes indifferent to him, that she receives suspicious letters, secretly makes new acquaintances with a large number of men, and invites them to visit him in his absence. Those suffering from this delusion see traces of betrayal in everything, constantly and “biasedly check the bedding and underwear of their spouse. When they find any stains on the linen, they regard this as absolute proof of betrayal. They are characterized by extreme suspicion, trivial actions of the spouse are interpreted as a sign of depravity, lust. Delusions of jealousy are typical for chronic alcoholism and some alcoholic psychoses, it is supported by a decrease in potency. However, this pathology can also be observed in other mental disorders. Sometimes delusions of jealousy are of a very absurd nature.

An 86-year-old patient who suffered from senile psychosis was jealous of his wife of about the same age for a four-year-old boy from a neighboring apartment. His delirium of jealousy (marital infidelity) reached such a degree that he sewed his wife up in a bag of sheets at night. Nevertheless, in the mornings he found that his wife (who, by the way, could barely move her legs) at night “sewed up, ran to her lover and stitched up again.” He saw proof in a different shade of white thread.

Sometimes it is not the spouses who are involved in the delirium of jealousy, but the lovers. With this variant of the disorder, the patient is jealous of his mistress for her husband, completely ignoring the real betrayal of his own wife. Delusions of jealousy, especially in chronic alcoholism, often lead to offenses in the form of murder of a wife (husband), imaginary lovers (mistresses) or castration.

Delirium of witchcraft, damage- the patient’s painful conviction that he has been bewitched, damaged, jinxed, brought in some serious illness, taken away from his health, replaced by a “healthy biofield with a painful one,” and “created a black aura.” Such nonsense should be distinguished from the usual delusions of superstitious people and the cultural characteristics of various population groups.

Patient S. remembered that she bought bread every day at a bakery, where the seller was a gloomy woman with a strikingly sharp gaze. The patient suddenly realized that this saleswoman had jinxed her and took away all her health. It was not for nothing that in recent days she began to greet S. and “prepared” - “probably my health, which she took from me, suited her very well.”

Delirium of obsession is expressed in the patient’s conviction that he has been possessed by some other living creature (“evil spirits,” a devil, a werewolf, a vampire, a demon, a deity, an angel, another person). In this case, the patient does not lose his “I”, although he may lose power over his own body; in any case, two different creatures coexist (peacefully or non-peacefully) in his body. This type of delusion belongs to archaic delusional disorders and is often combined with illusions and hallucinations.

Patient L. claimed that Christie (a diminutive of the word Jesus Christ in the English version) possessed her. He was inside her body and controlled her movements, and, if possible, controlled her thoughts and needs. Their peaceful life together lasted for two weeks, after which he began to leave the hospital at night and cheat on her with other women. The patient could not come to terms with this and every day, waiting for his return, she made scandals for him, not particularly shy in her expressions. Soon Christy got tired of this and he invited the patient to fly with him to heaven, “where it is not customary to be jealous and swear.” To do this, she had to go out to the ninth floor balcony and jump down. Christy had to catch her on his wings at the eighth floor level and ascend. The patient tried to jump from the balcony, but was detained by a neighbor. In the psychiatric hospital, she, naturally, was in the women's ward and constantly suffered from incredible jealousy, because Christy began to leave her not only at night and cheated on her with all the more or less attractive patients, to whom the patient made complaints, called them names, and tried to beat them. The patient always clearly separated herself from Christy, knew when he was in her and when he went out to “loosely.”

Delirium of metamorphosis manifests itself in a patient who believes that he has turned into some kind of animate living creature (zooanthropy), for example, into a wolf, bear, fox, swan, crane or other bird. At the same time, the patient loses his “I”, does not remember himself as a person and, like the animal into which he has turned, howls, growls, bares his teeth threateningly, bites, squeals, runs on all fours, “flies”, coos, pecks those around him, laps up food etc. Recently, due to the appearance of a large number of films and books about Dracula and his accomplices, the delusion of vampirism has become very relevant, when the patient is convinced that for some reason he has turned into a vampire and begins to behave like a vampire. However, unlike his literary or cinematic brother, he never attacks other people, much less kills them. A patient with corresponding delirium obtains blood either in medical institutions, or, working near a slaughterhouse, drinks the blood of freshly slaughtered animals.

Much less often, transformation is carried out into an inanimate object.

Patient K., “who became an electric locomotive,” tried to recharge himself with energy from an electrical outlet and only miraculously survived. Another patient, who turned into a locomotive, gnawed on coal and tried to move on all fours along the rails, making locomotive whistles (he lived not far from the railway station).

Delirium of intermetamorphosis often combined with delusions of staging and is manifested by the conviction that the people around have undergone significant external and internal changes.

Delirium of a positive double It is noted when the patient considers complete strangers to be his relatives or friends, and explains the external dissimilarity as a result of successful makeup. Thus, patient D. believed that her son and husband were “kidnapped by Chechens,” and so that she would not worry, they “slipped” their professionally made-up doubles to her.

Delirium of a negative double manifests itself in the fact that the patient considers his relatives and friends to be complete strangers, strangers, specially made up to look like his loved ones. Thus, sick X., whose wife was allegedly killed by bandits and in return “introduced” a copy of her into the family, treated the latter with sympathy, felt sorry for her, and every evening affectionately persuaded her to go to the police and “confess everything.”

Delirium of the hard of hearing and delirium of the foreign language environment- particular types of delusions of relationship. The first is noted when there is a deficiency of verbal information with hearing loss, when the patient is convinced that others are constantly talking about him, criticizing and condemning him. The second is quite rare; it can manifest itself in a person in a foreign language environment in the form of the conviction that others speak negatively about him.

Nonsense of other people's parents is expressed in the fact that biological parents, in the opinion of the patient, are substitutes or simply educators or doubles of parents. " Valid“The parents occupy important positions in the state or are outstanding, but secret spies, hiding for the time being their family ties with the patient.

Patient Ch. believed that at the age of two months he was kidnapped by “Soviet subjects”, who formally became his parents. His real parents are the closest relatives of the Queen of Great Britain. He treats Soviet parents with disdain, as people who are obliged to serve him. He studied poorly at school and barely completed six grades. However, in the hospital he claimed that through “sound communication” (neologism from English sound - sound) he graduated from Cambridge University and officially works as an adviser to American President Carter on Kremlin issues. Often "by geotransition" (neologism) happens in the USA, he does not need any planes. Several times he actually tried to enter the territory of the English embassy with ideas about his close family ties with the Queen of Great Britain. For all his failures he blames “Soviet educators” (i.e. parents), whose attitude towards them becomes more and more negative over time. The “arrogant condescension” towards them at the beginning of the illness gave way to outright aggression.

Delusional ideas of greatness is a group of disorders that includes delusions of high origin, delusions of wealth, delusions of invention, reformatory delusions, love or erotic delusions, as well as altruistic and Manichaean delusions.

Delirium of high origin is that the patient is unshakably convinced that he belongs to a noble family, known if not to the whole world, then to the whole country, that he is the son of an important statesman, a popular movie star, or has extraterrestrial cosmic origin.

The patient, born in Crimea, was sure that she was the last of Dante’s family, since one of the poet’s relatives once lived there.

Another patient claimed that he was the fruit of violent love between an alien and an earthly woman, who, in turn, originated from Jesus Christ.

Another patient claimed that he was a descendant of the illegitimate son of Nicholas II and on this basis laid claim to the Russian throne.

The patient J., who has already been mentioned several times, was convinced that in the male line he is a descendant of the Prophet Muhammad, moreover, the most brilliant in the entire history of mankind. He is capable of producing great ideas for restructuring the economic and political life of Russia. Russian cosmonauts are sent into space specifically to capture these brilliant ideas that they themselves have not yet realized, because these ideas become understandable only outside the Earth. American astronauts fly in order to “drown out” these thoughts; they themselves are not able to understand, much less implement, them.

Delirium of wealth is a person’s false belief that he is rich. This nonsense can be plausible when an objective beggar claims that he has 5 thousand rubles in his bank account, and absurd when the patient is sure that all the diamonds in the world belong to him, that he has several houses made of gold and platinum in different countries, which are also his property. Thus, Guy de Maupassant, right before his death, claimed that the Rothschild family left all their capital to him.

Delirium of invention- the patient is convinced that he made an outstanding discovery, found a cure for all incurable diseases, deduced the formula for happiness and eternal youth (Makropoulos remedy), discovered all the missing chemical elements in the periodic table.

Patient F., after spending two hours in line for meat, invented a formula for artificial meat. The formula consisted of chemical elements (C38H2O15) found in the air, so he proposed “stamping meat directly from the atmosphere”, “to solve the problem of hunger on Earth forever.” With this idea, he began to go to different authorities until he ended up in a psychiatric hospital.

Reformist nonsense is associated with the patient’s confidence in his ability to transform the existing world by, for example, changing the speed of the Earth’s rotation around its axis and general climate change in a favorable direction. Reformism often has political overtones.

Patient Ts. argued that a hydrogen bomb should be detonated simultaneously at the southern and northern poles of our planet. As a result, the speed of rotation of the Earth around its axis will change, in Siberia (the patient from Siberia) there will be a tropical climate and pineapples and peaches will begin to grow. The fact that many countries would be flooded from melting glaciers did not worry the patient at all. The main thing is that it will be hot in her beloved Siberia. She repeatedly approached the Siberian Branch of the Academy of Sciences with this idea, and when she was “not understood,” she came to Moscow.

Love, erotic delirium manifests itself in the patient’s pathological conviction that he is loved from a distance by a famous person who expresses his feelings by the color of his clothes, significant pauses during television debates, timbre of voice, and gestures. Patients usually pursue the object of their adoration, invade his personal life, carefully study the daily routine and often arrange “unexpected meetings”. Often, delusions of love are accompanied by delusions of jealousy, which can lead to certain offenses. Sometimes erotic delirium takes frankly ridiculous forms. Thus, the patient Ts., suffering from progressive paralysis, claimed that all the women in the world belonged to him, that the entire population of Moscow was born from him.

Altruistic nonsense(or delusion of messianism) contains the idea of ​​a high mission of a political or religious nature entrusted to the patient. Thus, the sick L. believed that the holy spirit had entered into him, after which he became the new Messiah and must unite good and evil into one whole, create a new, unified religion on the basis of Christianity.

Some researchers include the so-called Manichaean delusion (Manichaeism is a mystical, religious teaching about the eternal and irreconcilable struggle between good and evil, light and darkness) into the group of delusions of grandeur. A patient with such delusions is sure that he is in the center of this struggle, which is being waged for his soul and passing through his body. This delirium is accompanied by an ecstatic mood and at the same time expressed fear.

Often, delusions of grandeur are complex and combined with pseudohallucinations and mental automatisms.

Patient O. believed that he was simultaneously the Thirteenth Imam, the Prince of Karabakh, the Jewish King Herod, the Prince of Darkness, Jesus Christ, the incarnation of the 26 Baku commissars and the lesser and greater Satan. At the same time, he is the forerunner of all gods and religions. He also reported that at the age of one, while playing with blocks, he created the state of Israel. The aliens who settled in his head told him this. Through his head they learn to control the entire planet. I am sure that the best intelligence services in the world are fighting for his head.

Delusions of self-deprecation (depressive delusions) consists in belittling the patient’s dignity, abilities, capabilities, and physical data. Patients are convinced of their insignificance, squalor, worthlessness, unworthiness even to be called people, for this reason they deliberately deprive themselves of all human comforts - they do not listen to the radio or watch TV, do not use electricity and gas, sleep on the bare floor, eat scraps from a trash can , even in cold weather they wear a minimum of clothing. Some try, like Rakhmetov, to sleep (lie, sit) on nails.

This group of mental disorders includes delusions of self-blame (sinfulness, guilt), hypochondriacal delusions in all its variants, and delusions of physical impairment.

The delusion of self-humiliation in its pure form is almost never found; it is always closely related to the delusion of self-blame, forming a single delusional conglomerate within the framework of depressive, involutional and senile psychoses.

Delirium of self-blame(sinfulness, guilt) is expressed in the fact that the patient constantly accuses himself of imaginary misconduct, unforgivable mistakes, sins and crimes against individuals or groups of people. Retrospectively, he evaluates his entire life as a chain of “black deeds and crimes”; he blames himself for the illnesses and deaths of close friends, relatives, neighbors, and believes that for his misdeeds he deserves life imprisonment or a slow execution by “quartering.” Sometimes patients with this pathology resort to self-punishment through self-harm or even suicide. Self-incrimination may also be based on this type of pathology (remember the self-incrimination of Salieri, who allegedly poisoned Mozart). Delusions of self-blame most often occur against the background of depression and, therefore, are noted in affective-delusional pathology (manic-depressive psychosis, presenile and senile psychoses, etc.). Thus, sick N., a former rural party functionary, at the age of 70 began to blame herself for the fact that it was only her fault that the Soviet Union collapsed, because she was “distracted by her family and did not work in her party position with full dedication.”

Delirium of physical impairment(delirium of Quasimode), also called dysmorphophobic. Patients are convinced that their appearance is disfigured by some defect (protruding ears, ugly nose, microscopic eyes, horse teeth, etc.). This defect, as a rule, concerns a visible, often almost ideal or ordinary part of the body. The pettophobic version of this delusion is the patient’s belief that intestinal gases or other unpleasant odors are constantly coming out of him. Often, with delirium of physical disability, patients resort to self-operation, and sometimes die from bleeding.

Delusions of physical impairment occur in psychoses that debut in adolescence or young adulthood (in particular, schizophrenia).

Patient G., who considered her nose to be ugly wide, tried to narrow it on her own, because doctors refused to perform plastic surgery. For this purpose, she put a clothespin on her nose for 6 hours every day.

Hypochondriacal delirium is a pathological belief in the presence of a serious, incurable disease or dysfunction of any internal organ. Patients undergo numerous tests for AIDS, cancer, leprosy, syphilis, and demand more and more “solid” consultations from the doctor, but any consultation leaves them with an acute feeling of dissatisfaction and a firm conviction that they have an incurable disease.

If the hypochondriacal delusional experience is based on senestopathies or some sensations emanating from the internal organs, such delirium is called catasthetic. A common type of hypochondriacal delusion is the so-called nihilistic delirium, or delusion of denial. Patients say that their liver has atrophied, the blood has “hardened”, there is no heart at all, since “nothing beats in the chest”, the urinary tract has dissolved, so urine is not excreted, but is absorbed back into the body, poisoning it. Delusion of denial is an important component of Cotard's syndrome and occurs in involutional and senile psychoses, schizophrenia and severe organic diseases of the brain.

Patient K. claimed that she had not had stool for three years because her entire intestine had rotted. Another explained her poor health and weakness by the fact that she had only three red blood cells left in her body and they were all working under overload - one served the head, the other the chest, the third the stomach. There are no red blood cells for the hands and feet, so they gradually dry out and “mummify.”

In addition to the three groups of delusional experiences described above, there are induced And conformal rave.

Induced(vaccinated, induced) delusion is that the patient’s delusional ideas begin to be shared by a mentally healthy member of his family. Induction has the following reasons:

• close, sometimes symbiotic relationship between the inducer and the inducible;
• inductor - unquestionable authority for the inductee;
• the presence of increased suggestibility, lower intelligence of the induced compared to the inducer;
• plausibility and absence of absurdity in the inductor’s delusional ideas.

Induced delirium is rare and is always fueled by close contact with the inducer. However, once you separate the induced from the inducer, this delusion can disappear without any treatment.

Patient I. expressed ideas about relationships and persecution; soon his wife, and a month later, his 10-year-old daughter, began to experience the same ideas. All three were placed in different departments of a psychiatric hospital. After two weeks, the patient’s daughter stopped feeling like she was being watched and realized that those around her were treating her without prejudice, and two weeks later the same thing happened to his wife. The patient himself (the inductor) was able to get rid of this delirium only after intensive treatment for two months.

Even less common is the so-called conformal delusion, when two close mentally ill relatives begin to express identical delusional ideas. Induction also occurs here. For example, a patient suffering from paranoid schizophrenia expresses certain delusional ideas of persecution. His sister, suffering from a simple form of schizophrenia, for which, as we know, delirium is not characteristic at all, suddenly begins to express exactly the same ideas of persecution applicable to herself and her brother. In this case, the patient’s sister’s delirium is conformal in nature.

According to the characteristics of formation, they distinguish primary (interpretative, systematized) And figurative (sensual) delirium.

Primary delirium is based on abstract ideas and delusional assessment of the facts of reality without disturbances of sensory cognition (i.e. in the absence of senestopathies, illusions and hallucinations). It should be especially emphasized that adequately perceived facts of reality are interpreted in a delusional way - according to the laws of paralogical thinking. From the entire variety of facts, the patient selects only those that are consistent with his main delusional idea (“delusional stringing of facts”). All other real facts and events that do not agree with the patient’s delusional idea are rejected by him as insignificant or insignificant. In addition, patients with primary (interpretive) delusions are inclined, according to the laws of para-logic, to delusionally overestimate their past (delusional interpretation of the past). Primary delirium is quite persistent, prone to chronicity and is relatively incurable. According to the interpretative type, delusional ideas of the most varied content (jealousy, wealth, high birth, invention, persecution, etc.) are formed.

In the occurrence of figurative (sensual) delirium the main role is played by disturbances of sensory cognition in the form of imagination, fantasies, fictions, and dreams. Delusional judgments are not the result of complex logical work, there is no consistency in the substantiation of ideas, there is no system of evidence so characteristic of primary interpretative delusion. Patients with figurative delusions express their judgments as a given, beyond doubt, as something self-evident and not in need of proof or justification. Unlike primary delusions, figurative delusions arise acutely, like an insight, and are always accompanied by illusions, hallucinations, anxiety, fears and other psychopathological formations. Often, with sensory delusions, delusional orientation in the environment, delusions of staging, false recognitions, and symptoms of a positive or negative double are noted.

Dynamics of delirium (according to V. Magnan)

During the development of mental illness, delusional ideas undergo a certain evolution. The French psychiatrist Magnan, as a result of many years of research, found that if delirium is not influenced by drugs, it has the following dynamics:

Delusional prodrome or delusional mood. The patient, without any reason or reason, feels severe physical and mental discomfort, diffuse anxiety associated with real events and the environment, experiences a feeling of impending trouble, misfortune, tragedy, wary suspicion, internal tension and a sense of impending threat. This period, being a kind of precursor to delirium, lasts from several hours to several months.

Crystallization of delirium. The patient develops delusional ideas of a persecutory nature. Crystallization of delirium occurs as an insight. Suddenly the patient realizes why he felt unwell for a certain period, restless and anxious; It turns out that he was exposed to some kind of rays from a neighboring house and foreign intelligence services tried to “confuse” him. The second stage, as a rule, lasts many years, sometimes decades and even the entire life of the patient. It is from this stage that the main population of psychiatric hospitals is recruited.

Formation of delusions of grandeur. In painful consideration of why he, and not any other person, is being persecuted and read, the patient gradually comes to the conviction that the choice fell on him, since he has a “bright head, extraordinary abilities, the most talented brains” or he is a side branch of the famous dynasty of nuclear physicists. This is how delusions of grandeur are formed with corresponding pretentious behavior and an absurd lifestyle. Patients periodically arrange “grand-ducal receptions” or “gather on space expeditions.” The transition of delirium to the stage of greatness usually indicates an unfavorable course of the endogenous process and is essentially a sign of intensification of the weakening process.

The collapse of the delusional structure occurs after the stage of delusions of grandeur and indicates such a degree of dementia when the patient’s psyche is no longer able to maintain a harmonious, albeit constructed according to the laws of paralogic, delusional structure. The delusion breaks up into separate fragments that no longer determine the patient’s behavior style. Thus, a patient who proudly claims that he is the richest person on the planet, within a few minutes obsequiously asks his roommate for a few rubles to buy cigarettes or picks up cigarette butts. At the same time, minute-long episodes of delusions of grandeur become increasingly rare over time and can appear only as reflections against the background of the final (apathetic-abulic) state.

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 melancholia and mania.

Forms

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

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

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

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

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

There is also a trend towards:

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

This form of delirium includes:

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

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

• delusion of perception, in which what a person perceives at the moment is directly experienced in the context of “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 delirium occurs as a result of other mental disorders (senesthopathy, deceptions of perception, etc.), that is, impaired thinking is a secondary pathology. It is characterized by fragmentation and inconsistency, the presence of illusions and hallucinations.

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

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

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

Sensory delirium is divided into syndromes including:

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

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

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

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

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

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

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

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

Delusional syndromes

Russian psychiatry identifies 3 main delusional syndromes:

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

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

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

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

The plot of delirium

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

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

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

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

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

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 a person who is inaccessible due to a higher social status (other reasons are possible) is not indifferent to them. Erotic delirium without positive emotions is possible - the patient is convinced that he is being pursued by his partner. This type of disorder is rare.
• Antagonistic delusion, in which the patient considers himself the center of the struggle between good and evil.
• Altruistic delirium (delirium of messianism), in which the patient imagines himself to be a prophet and miracle worker.

Delusions of grandeur can be complex.

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

This group includes:

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

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

Reasons for development

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

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

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

Pathogenesis

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

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

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

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

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

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

Symptoms

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

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

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

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

The plot of acute delirium is changeable and unformed.

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

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

Diagnostics

Diagnosis of delirium includes:

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

Currently used criteria for delirium include:

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

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

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

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

Treatment

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

Drug therapy includes the use of:

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

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

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

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

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

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

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

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

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

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

The most intense and complex in content depressive delirium occurs during prolonged anxious depression. In these cases, Cotard's delirium often develops. Cotard's delusions are characterized by fantastic ideas of denial or enormity. If there are ideas of denial, the patient reports his lack of moral, intellectual, and physical qualities (no feelings, conscience, compassion, knowledge, ability to feel). In the presence of somatopsychic depersonalization, patients often complain of the absence of the stomach, intestines, lungs, heart, etc. etc. They can talk not about the absence, but about the destruction of internal organs (the brain has dried out, the intestines have atrophied). The idea of ​​denying the physical “I” is called nihilistic delusion. Denial can extend to various concepts of the external world (the world is dead, the planet has cooled down, there are no stars, no centuries).

Often, with Cotard's delusions, patients blame themselves for all sorts of past or future world cataclysms (delusions of negative power) or express ideas about eternal torment and the impossibility of dying (delusions of painful immortality).

3) Delusions of grandeur are always noted against the background of increased self-esteem of the patient and include the following clinical variants: delirium of invention, reformism, high origin, wealth. This also includes the so-called delirium of love (love's charm) and the absurd, usually occurring against the backdrop of severe dementia, megalomanic delirium of grandeur. At the same time, the patient’s statements about his extraordinary abilities, position or activities acquire a grandiose scope, and their inadequacy is striking to any person (“I rule the globe and all the Gods of the universe”). Ideas of grandiosity are most often characteristic of the later stages of mental illness or of severe, rapidly progressing organic brain lesions leading to dementia.

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

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

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

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

Secondary delusions arise on the basis of existing disorders in other areas of mental activity in the presence of other psychopathological phenomena (hallucinations, affective disorders, memory disorders, etc.).

According to the mechanisms of occurrence, the following types of delirium can be distinguished: catathymic, holothymic, induced, residual, confabulatory.

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

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

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

In some cases, the content of delusional ideas among people who communicate closely (and more often live together) may have far-reaching similarities, despite the fact that each of them suffers from an independent mental disorder of various origins. Such delirium (of the most varied content) is usually called conformal, meaning in this concept only the coincidence of the main plot of delusional constructions with the possibility of a certain discrepancy in the specific statements of each of the sick people.

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

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

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

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

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

delusional interpretation - delusional explanation of perceived phenomena of reality;

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

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

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

It is customary to distinguish between primary and secondary forms of delirium. Primary is called delusion, which appears in the patient’s consciousness in the most direct way, without any intermediate authorities, without connection with other mental disorders. Such delusional ideas, emphasizes K. Jaspers, “we cannot subject... to psychological reduction: in phenomenological terms they have a certain finality.”

Primary delirium sometimes defined as intuitive delirium, since there is some similarity between its experience and acts of intuition. This similarity, we believe, is very superficial; both phenomena are essentially opposite to one another. In fact, acts of intuition, and these are usually acts of creativity, are an underlying continuation of conscious intellectual efforts. In the process of creativity, the structures of creative thinking are transformed, primarily, as some researchers suggest, the structures of the superconscious. It is difficult to imagine that solutions to the most complex problems and lofty ideas are born in the infernal subconscious. Delusional ideas, on the contrary, are the result of regression of thinking, and therefore the result of the collapse of higher intellectual authorities, especially the superconscious. Secondary delusions are those that develop in connection with other mental disorders.

Secondary delusions, according to K. Jaspers, “understandably stem from previous affects, from shocks, humiliations, from experiences that awaken feelings of guilt, from deceptions of perception and sensations, from the experience of alienation of the perceived world in a state of altered consciousness.” Such delusional ideas, he concludes, “we call delusional ideas.” Nevertheless, such delirium, we object, may be genuine, and not at all symptomatic, additive or psychologically understandable. In fact, the feeling of guilt during depression, like any other experience, may well transform into delusion under one indispensable condition, namely: if the mechanism of delusion formation is turned on. The psychological understandability of a particular experience in itself is by no means a decisive criterion that excludes the fact of delirium. It is worth emphasizing, we believe, that the solution to the question of whether there is delusion or not is a question of the adequacy of clinical-psychopathological research. K. Jaspers contradicts himself when he illustrates primary delusion with clinical observations. In his patients, such delusions are combined with “false sensations,” “made up” experiences, “memory deceptions,” and “visions.”

Essentially important clinically is the problem of distinguishing between different variants of primary delirium.

K. Jaspers distinguishes three clinical variants of primary delirium:

Delusional perceptions- direct experience of a different “meaning of things.” People in military uniform, for example, are perceived by the patient as enemy soldiers; a man in a brown jacket is a resurrected archbishop, a passing stranger is a beloved patient, etc. K. Jaspers also includes delusional perception (with a delusional meaning understandable to the patient), as well as delusion of meaning (with a meaning incomprehensible to the patient).

Delusional ideas- memories with a different, delusional meaning. Delusional ideas can appear in the patient’s mind “in the form of sudden thoughts” in connection with real as well as false memories. So, the patient suddenly understands - “how the scales fell from my eyes” - “why over the past years my life has proceeded this way.” Or it suddenly dawns on the patient: “I could become a king.” Before this, he “remembered” that at the parade the Kaiser was staring straight at him.

Delusional states of consciousness- This

• “new knowledge”, sometimes realized without being preceded by any
• “sensory experience,” or “those pure states of consciousness” that “invade” real impressions.

So, a girl reads the Bible and suddenly feels like Mary. Or, finally, it is the suddenly appearing certainty that “there was a fire in another city,” a certainty that extracts “meanings from inner visions.” The difference between the last two forms of primary delusion is mainly, we believe, terminological.

A similar position is taken by K. Schneider (1962). He distinguishes between “delusional thoughts,” combining with this term delusional ideas and delusional states of consciousness, and delusional perception, and he classifies the latter as a first-rank symptom in schizophrenia.

K. Schneider and other authors (in particular, Huber, Gross, 1977) try to distinguish between true delusion and delusional-like phenomena, pointing out that the latter are psychologically inferred, amenable to feeling and are not associated with hypothetical cerebral-organic damage.

Let us, however, pay attention to the other side of the problem. The mentioned variants of primary delusion clearly correspond with the corresponding levels of thinking: delusions of perception - with visual-figurative thinking, delusional ideas - with imaginative thinking, delusional states of consciousness - with abstract thinking. This means that delusion can also arise at the level of visual-effective thinking. Consequently, there are not three, but four variants of primary delirium. Let us present them in a sequence that reflects a decrease in the severity of the damage manifested by delirium (based on the assumption that ontogenetically later structures of thinking suffer first of all during the disease).

Delusional actions- aimless, unmotivated and inadequate actions that the patient performs with objects that are currently in his field of vision. This is nonsense at the level of visual-effective or sensorimotor thinking. The characteristics of delusional actions are identical to catatonic actions, such as O.V. Kerbikov described them (for details, see the chapter on thinking disorders). Let us only note here that delusional actions are usually committed with objects of social purpose and in the context of social relationships.

Delusional perceptions- various types of sensory delirium, the content of which is limited to visual situations. Delusion is manifested by the combination of false content with real impressions about a particular and momentary situation. For example, these are delusions of relation, delusions of meaning, delusions of doubles, delusions of special meaning, delusions of staging. Delusions may not be accompanied by perceptual deceptions. If perceptual deceptions do occur, then their content is identical to the content of delusion. When the situation changes, delirium in some cases immediately disappears. This is usually an introspective delusion. Delirium occurs at the level of visual-figurative thinking.

Delusional ideas- figurative delusion in the form of imaginary memories with delusional meaning, as well as real memories and ideas about the present and future with delusional content. Delusional ideas are not limited to the current situation and the present time. Intra-, pro- and retrospective types of delirium are observed. A change of environment does not have a significant effect on delirium if the current situation is not represented in it in any way. Delusion occurs at the level of figurative thinking.

Hermeneutical nonsense(interpretive delusion, delusion of interpretation) - a false understanding of the meaning of current, past and future experience. A false interpretation can concern not only external impressions (“exogenous interpretations”), but also bodily sensations (“endogenous interpretations”). Characterized by tendentious thinking, “crooked logic”, special resourcefulness of conclusions, as well as the ability to build complex, systematized and extremely plausible delusional structures that persist for a long time. This is usually observed with paranoid syndrome. Delirium occurs at the level of abstract thinking.

Theoretically, primary delusions can occur simultaneously at different levels of thinking, since these levels are interconnected. For example, against the background of delusion of interpretation, delusion of perception may arise. Nevertheless, delusions of one level of thinking are, as a rule, predominant. This means that the appearance of delusions of perception in a patient with delusions of interpretation pushes the latter into the background. This question, however, is unclear.

Secondary delusion presented with the following options.

• Delirium of the imagination- delirium in the form of figurative ideas about imaginary events of the present or future. Often takes on a fantastic character.
• Confabulatory delusion - figurative delirium in the form of memories of imaginary events of the past. Often takes on a fantastic character.
• Hallucinatory delusion- figurative delirium, the content of which is associated with deceptions of perception. Sometimes the deceptions of perception themselves are the object of delusional interpretation. In this case, a diverse delusion arises: one type of delirium is figurative and secondary, its content is presented in deceptions of perception, the other type of delirium is primary and interpretative.
• Holothymic delirium- sensual, figurative or interpretive delirium, the content of which is consonant with a painful mood. It should be noted that affect determines only the content, and not the fact, of delirium. This means that with depression, like mania, primary delusions can occur.
• Induced delirium- figurative or interpretative delusion that arises in a patient, called a codelirant or recipient, due to the influence on him of the delusion of another patient, who is an inducer.

A synonym for the term is the expression symbiotic psychosis. The relationship between the codelirant and the inducer can be different, so there are different variants of induced delirium. With induced delusions, a healthy, but suggestible and dependent individual on a delusional patient shares the latter’s delusional beliefs, but does not actively develop them. In this case, we are talking about a delusional-like state, however, under certain conditions (illness and the activation of delusional mechanisms), true delirium can arise with the content of that of the inducer. The separation of the inducer and the codelirant leads to the elimination of the inspired delusion. In reported psychosis, the recipient initially resists accepting the inducer's delusions. Some time later (weeks, months), he appropriates the inductor’s delirium, and subsequently develops it independently. In other words, such nonsense may be true.

With simultaneous psychosis, delusional patients influence each other and each of them supplements the content of their delusions with the delusions of their partner. In this case, there is not enough reason to talk about the emergence of some new nonsense that complements or complicates the existing one. If there are more than two codelirants with simultaneous psychosis and they form a group that positions themselves to other people, then they talk about conformal psychosis. The number of codelirants with induced delirium can be large - hundreds and thousands of patients. In such cases they talk about a mental epidemic or mass psychosis.

Illustration conformal delirium is, for example, a mystical, commercial or psychotherapeutic sect, but in this case, the actual delusion is usually suffered by one individual, its founder, and the adherents of the sect are the carriers of the induced delusion. A specific variant of induced psychosis is Maine's syndrome - this is an induced delusion among female staff of psychiatric hospitals, the role of inducers is played by delusional patients with whom these women are in constant contact. Cathethetic delusion is a delirium of interpretation associated with painful bodily sensations, especially with senestopathy. The most common disorder is a delusional disorder, but in some cases true delirium occurs.

Residual delirium- delusion that persists for some time after the patient emerges from an acute psychotic state with confusion.

Encapsulated delirium- the phase of the existence of delusion, when the patient acquires the ability to control his own delusional behavior, without being aware of the fact of delirium. We can say it differently: this is a state of split consciousness in a patient who evaluates reality in two ways: adequately and delusionally, while he gets the opportunity to see the consequences of delusional behavior and behave normally.

Overvalued nonsense- nonsense arising from overvalued ideas.

In conclusion, we note the following. The description of delusion definitely indicates that the delusional structure involves not only different levels of thinking, but also some forms of the latter. As for realistic delusions, even traces of it are usually not preserved in the delusional structure. Realistic thinking suffers significantly less outside of delusion; this is easy to see if you examine the patient’s thinking. Delusions of imagination and fantastic delusions are typical examples of painful autistic thinking, not limited by the framework of reality, space and time... Archaic delirium is convincing evidence of involvement in the pathological process of paleothinking, and delusions of attitude, delusions of grandeur, self-deprecation and similar types of delusions clearly indicate participation of egocentric thinking in the formation of delusions.

Delusions occur in various diseases. In schizophrenia, almost all forms and types of delusions are observed, but especially often these are persecutory types of primary delusions. Primary and hallucinatory persecutory delusions characterize some acute and chronic intoxication psychoses. Various types of delusions have been described in acute and chronic epileptic psychoses. Delusions of jealousy are typical of alcoholic paranoia. Holothymic types of delusions often develop within the framework of schizoaffective psychosis. The identification of independent delusional psychoses is disputed by many researchers.

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 behavior 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

The psychiatric help website 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 is 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

With effective treatment and elimination of diseases, a complete recovery of the patient is possible. 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, a natural process of guessing occurs. Delusion is characterized by the preservation of logical thinking and prudence, which distinguishes it from delusion.