Hallucinations vs delusions examples

Paranoid syndrome. Primary systematized delusions of interpretation of various content (jealousy, inventions, persecution, reformism, etc.), often existing as a monosymptom in the complete absence of other productive disorders. If the latter arise, then they are located on the periphery of the paranoid structure and subject to it in plot. Paralogical structure of thinking ("crooked thinking"), delusional detailing are characteristic. The ability to make correct judgments and inferences on issues that do not affect delusional beliefs is not noticeably impaired, which indicates catathymic (that is, associated with an unconscious complex of affectively colored representations, and not a general change in mood) mechanisms of delusional formation. There may be memory impairments in the form of delusional confabulations (“memory hallucinations”). There are, in addition, hallucinations of the imagination, the content of which is associated with dominant experiences. As the delusion expands, an ever wider range of phenomena becomes the object of pathological interpretations. There is also a delusional interpretation of past events. Paranoid syndrome usually occurs against the background of a slightly elevated mood (expansive delusions) or subdepression (sensitive, hypochondriacal delusions). The content of delirium at the remote stages of development may acquire a megalomaniac character. Unlike paraphrenia, delirium continues to be interpretive and, in terms of its scope, does not go beyond what is fundamentally possible in reality (“prophets, outstanding discoverers, brilliant scientists and writers, great reformers,” etc.). There are chronic, existing for a number and even decades, and acute variants of the paranoid syndrome. Chronic paranoid delusions are most often observed with relatively slowly developing delusional schizophrenia. Delusions in such cases are usually monothematic. The possibility that there is an independent form of the disease, paranoia, is not excluded. Acute, usually less systematized paranoid states occur in the structure of attacks of fur-like schizophrenia. At the same time, the delusional concept is loose, unstable and may have several different themes or centers of crystallization of false judgments. nine0005

Some authors consider it justified to distinguish between paranoid and paranoid syndromes (Zavilyansky et al., 1989). Paranoid refers to chronic systematized overvalued delusions (starting with overvalued ideas), arising under the influence of a key traumatic situation for the patient. Paranoid and epileptoid features of a premorbid personality of constitutional, post-procedural or organic genesis have the development of delirium. The mechanisms of delusional formation are associated with psychological rather than biological disorders "psychogenic-reactive" delusional formation. Paranoid syndrome in this interpretation is appropriate to consider in the framework of the pathological development of personality. nine0005

Paranoid or hallucinatory-paranoid syndrome. Includes delusional ideas of persecutory content, hallucinations, pseudohallucinations and other phenomena of mental automatism, affective disorders. There are acute and chronic hallucinatory-paranoid syndromes.

Acute paranoid acute sensory delusions of persecution (in the form of delusions of perception) of a specific direction, accompanied by verbal illusions, hallucinations, fear, anxiety, confusion, incorrect behavior, reflecting the content of delusional ideas. It is observed in schizophrenia, intoxication, epileptic psychoses. Acute paranoid states can also occur in special situations (long journeys associated with insomnia, alcohol intoxication, emotional stress, somatogeny) road or situational paranoids described by S. G. Zhislin. nine0005

Acute hallucinatory-paranoid syndrome is an acute sensory delusion of persecutory content that occurs against the background of fear, confusion and is combined with pseudohallucinations and other phenomena of mental automatism. It is more common in the structure of attacks of fur-like schizophrenia, with atypical alcoholic psychoses.

Chronic hallucinatory-paranoid syndrome (synonyms: Kandinsky-Clerambault syndrome, other eponyms, mental automatism syndrome, intrusion syndrome, deposition syndrome, xenopathic syndrome, parasitism syndrome, influence syndrome, external influence syndrome, alienation syndrome, mastery syndrome, polyphrenia, nuclear syndrome) the difference in the names reflects the dissimilarity in the opinions of their authors regarding what violations should be considered determining the structure of the syndrome: mental automatisms, self-awareness disorders, the experience of openness or delusional ideas of physical and mental influence. nine0005

Psychic automatisms in their completed form represent the experience of violence, intrusion, doneness of one's own mental processes, behavior, physiological acts. There are the following types of mental automatisms.

Associative or ideational automatism disorders of mental activity, memory, perception, affective sphere, proceeding with the experience of alienation and violence: influxes of thoughts, non-stop flow of thoughts, states of blockade of mental activity, symptoms of insertion, reading thoughts, a symptom of unwinding memories, pseudo-hallucinatory pseudo-memories, sudden delays in memories, phenomena of figurative mentism, etc. Manifestations of ideational automatism include, in addition, auditory and visual pseudo-hallucinations, as well as a number of affective disorders: “made” mood, “induced” fear, anger, ecstasy, “caused” sadness or indifference and others. "Done" dreams adjoin this group of automatisms. The inclusion of auditory verbal and visual pseudo-hallucinations in the group of ideational automatisms is due to their close connection with the processes of thinking verbal pseudo-hallucinations with verbal, and visual with figurative forms of thinking. nine0005

Senestopathic or sensory automatism - a variety of senestopathic sensations, the appearance of which patients associate with the influence of external forces. In addition, this includes olfactory, gustatory, tactile and endosomatic pseudohallucinations. Sensory automatism includes various changes in appetite, taste, smell, sexual desire and physiological needs, as well as sleep disturbances, vegetative disorders (tachycardia, excessive sweating, vomiting, diarrhea, etc.), "caused", according to patients, from outside . nine0005

Kinesthetic or motor automatism urges to activity, individual movements, actions, deeds, expressive acts, hyperkinesis arising from the experience of violence. Receptive processes can also proceed with the phenomena of doneness: “They make you look, listen, smell, look with my eyes”, etc.

Speech-motor automatism phenomena of forced speaking, writing, as well as kinesthetic, verbal and graphic hallucinations.

The formation of psychic automatisms takes place in a certain sequence. At the first stage of the development of ideator automatism, “strange, unexpected, wild, parallel, intersecting” thoughts appear, alien in content to the entire personality structure: “I never think like that”. At the same time, sudden interruptions of necessary thoughts may occur. Alienation concerns the content of thoughts, but not the process of thinking itself (“thoughts are mine, only very strange ones”). Then the feeling of one's own activity of thinking is lost: “Thoughts float, go on their own, flow non-stop” or there are states of blockade of mental activity. In the future, alienation becomes total the feeling of belonging to one’s own thoughts is completely lost: “The thoughts are not mine, someone thinks in me, in the head the thoughts of other people ”. Finally, there is a feeling that the thoughts “Come from outside, are introduced into the head, invested”. There are "telepathic" contacts with other people, the ability to directly read the thoughts of others, mentally communicate with others. At the same time, patients may claim that at times they are deprived of the ability to think or "pull out thoughts", "steal". nine0005

Verbal pseudo-hallucinations may develop in the following way. At first, the phenomenon of sounding one’s own thoughts arises: “Thoughts rustle, sound in the head.” Then your own voice begins to be heard in your head, repeating the thoughts. This could be called hallucinations of inner speech. The content of statements is gradually expanding (statings, comments, advice, orders, etc.), while the voice "doubles, multiplies". Further, "alien voices" are heard in the head. The content of their statements is becoming more and more diverse, divorced from reality and the personality of patients. In other words, the alienation of the process of internal speaking also grows in a certain sequence. Finally, the phenomenon of "made, induced voices" arises. At the same time, the voices speak on a variety of topics, often abstracted from personal experiences, sometimes they convey absurd and fantastic information: “The voices behind the ears speak on local topics, and in the head on state ones. ” The degree of alienation of what is said by voices can therefore be different. nine0005

The dynamics of kinesthetic automatism generally corresponds to those described above. Initially, previously unusual impulses for action, impulsive inclinations appear, strange and unexpected actions and deeds are committed for the patients themselves. Subjectively, they are perceived as belonging to one's own personality, although they are unusual in content. There may be short action stops. Subsequently, actions and deeds are performed without a sense of one's own activity, involuntarily: "I do it without noticing it, and when I notice it, it's hard to stop." There are states of blockade or "paralysis" of impulses to action. At the next stage, activity proceeds with a distinct experience of alienation of one’s own activity and violence: “Something is pushing from the inside, prompting, not a voice, but some kind of internal force”. Interruption episodes are also experienced with a touch of violence. At the final stage of the development of motor automatisms, there is a feeling that motor acts are done from the outside: “My body is controlled Someone controls my hands One hand belongs to my wife, the other to my stepfather, my legs mine Looks through my eyes”. With the feeling of external influence, the states of blockade of impulses to action proceed. nine0005

The sequence of development of speech-motor automatisms can be similar. At first, separate words or phrases are broken that are alien to the direction of the patient's thoughts, absurd in content. Often, individual words are suddenly forgotten or the formulation of thoughts is disturbed. Then the feeling of one’s own activity that accompanies speech is lost: “The language speaks by itself, I will say, and then the meaning of what was said Sometimes I start talking”, Or for a short time, the “language” stops, does not obey. Further, a feeling of alienation and violence arises in relation to one's own speech: “It is as if it is not I who speak, but something in me. My doppelgänger uses language and I can't stop talking." Episodes of mutism are experienced as violent. Finally, there is a feeling of external mastery of speech: “Outsiders speak my language They give lectures on international topics in my language, and at that time I don’t think about anything at all.” States of loss of spontaneous speech are also associated with external phenomena. The development of speech-motor automatisms can begin with the appearance of kinesthetic verbal hallucinations: there is a sensation of movement of the articulatory apparatus, corresponding to speech, and ideas about the involuntary mental pronunciation of words. Subsequently, the internal monologue acquires a verbal-acoustic tone, a slight movement of the tongue and lips appears. At the final stage, true articulatory movements occur with the actual pronunciation of words aloud. nine0005

Senestopathic automatism usually develops immediately, bypassing certain intermediate stages. Only in some cases, before its appearance, can one state the phenomenon of alienation of senestopathic sensations: “Terrible headaches, and at the same time it seems that this is happening not with me, but with someone else”.

In the structure of psychic automatisms, Clerambault distinguished two types of polar phenomena: positive and negative. The content of the first is the pathological activity of a functional system, the second is the suspension or blockade of the activity of the corresponding system. Positive automatisms in the sphere of ideational disorders are the violent flow of thoughts, the symptom of investing thoughts, the symptom of unwinding memories, made emotions, induced dreams, verbal and visual pseudo-hallucinations, etc. Their antipode, that is, negative automatisms, can be states of blockage of mental activity, a symptom of withdrawal , pulling out thoughts, sudden loss of memory, emotional reactions, negative auditory and visual hallucinations that occur with a sense of being done, forcible deprivation of dreams, etc. In the sphere of senestopathic automatism, these will be respectively made sensations and loss of sensitivity caused from the outside, in kinesthetic automatism violent actions and states of delay in motor reactions, loss of the ability to make decisions, blockade of motives for activity. In speech-motor automatism, the polar phenomena will be forced speaking and sudden delays in speech. According to Clerambo, schizophrenia is more characteristic of negative phenomena, especially if the disease begins at a young age. In fact, positive and negative automatisms can be combined. So, forced speaking is usually accompanied by a state of blockade of mental activity: “The tongue speaks, but at this time I don’t think about anything, there are no thoughts.” nine0005

Disorders of self-consciousness arising from the syndrome of mental automatism are expressed by the phenomena of alienation of one's own mental processes, the experience of the violence of their course, a split personality and the consciousness of an internal antagonistic double, and later a feeling of mastery of external forces. Despite the seemingly obvious nature of the disorder, patients usually do not have a critical attitude towards the disease, which in turn can also indicate a gross pathology of self-awareness. Simultaneously with the growth of the phenomena of alienation, the devastation of the sphere of the personal "I" is progressing. Some patients even "forget" what it is. Mental acts emanating from the name of one's "I" do not remain at all, alienation has spread to all sides of the "I". At the same time, thanks to appropriation, a person can "acquire" new abilities and features that were not previously inherent in it. Sometimes the phenomenon of transitivism is observed not only the patient, but also others (or mostly others) are the object of external influence and all sorts of violent manipulations, their own feelings are projected onto others. nine0005

The experience of openness comes with a variety of echo symptoms. A symptom of echo-thoughts surrounding, according to the patient, repeat aloud what he just thought. Hallucinatory echo voices repeat, "duplicate" the thoughts of the patient. A symptom of the sound of one's own thoughts thoughts "rustle, sound in the head, others hear them. " Anticipatory echo voices warn the patient about what he will hear, see, feel or do after some time. Echo of actions voices state the actions, intentions of the patient: “I am photographed, my actions are recorded”. nine0005

Voices can repeat and comment on impulses and behavior, give it this or that assessment, which is also accompanied by an experience of openness: “Everyone knows about me, nothing is kept to oneself.” Echo letters voices repeat; what the patient writes. Reading echo voices repeat what the patient reads to himself. Echoes of speech voices repeat everything said by the patient to someone aloud. Sometimes the voices make the patient repeat for them what he told others, or, on the contrary, mentally or aloud once again say what he heard from someone. The above echo phenomena can be iterative in the form of multiple repetitions. So, a patient (he is 11 years old) has episodes of two, three hours, when what other people say three, five times in a strange voice is repeated “in the head”. More often one word is repeated. During repetitions, he perceives what is happening worse, cannot watch TV. Other echo phenomena occur. So, the speech of others can be repeated by voices from the outside or sounding in the head. Voices with external projection are sometimes duplicated by internal ones. The experience of openness can be observed even in the absence of echo symptoms, it can arise in the most direct way: “I feel that my thoughts are known to everyone There was a feeling that God knows everything about me I am in front of him like an open book The voices are silent, which means they are eavesdropping on what I think ". nine0005

Delusion of physical and mental influence belief in the impact on the body, somatic and mental processes of various external forces: hypnosis, witchcraft, rays, biofields, etc.

In addition to the above-described phenomena of alienation, in the syndrome of mental automatism, opposite phenomena can occur - appropriation phenomena that make up the active or inverted version of the Kandinsky-Clerambault syndrome. In this case, patients express the belief that they themselves have a hypnotic effect on others, control their behavior, are able to read the thoughts of other people, the latter have become an instrument of their power, behave like puppets, puppets, parsley, etc. A combination of alienation phenomena and appropriation of V. I. Akkerman (1936) considered it a symptom characteristic of schizophrenia.

There are hallucinatory and delusional variants of the syndrome of mental automatism. In the first of them, various pseudohallucinations predominate, which is observed mainly during acute hallucinatory-delusional states in schizophrenia, in the second - delusional phenomena that dominate in chronically current paranoid schizophrenia. In chronic schizophrenic delusions of the interpretative type, associative automatisms come to the fore over time. Senestopathic automatisms may predominate in the structure of attacks of fur-like schizophrenia. In lucid-catatonic states, a significant place is occupied by kinesthetic automatisms. In addition to schizophrenia, the phenomena of mental automatism can occur with exogenous organic, acute and chronic epileptic psychoses. nine0005

Paraphrenic syndrome. Combination of systematized or fragmented delusions of persecution and influence, phenomena of psychic automatism with figurative megalomaniac delusions of grandiose content, incredibly absurd and completely divorced from reality (power, grandeur, wealth, etc.), with expansive confabulosis, delusional depersonalization and often somewhat elevated mood. Paraphrenic delusions can be quite coherent systematized paraphrenia. A slender, detailed paraphrenic structure is created by combining a succession of delusional insights and testifies to the known intellectual safety of patients a sign that brings it closer to a paranoid syndrome. By analogy with paranoia, the existence of an independent painful form, paraphrenia, is assumed. Paraphrenic syndrome can arise on the basis of whimsically changeable delusions of the imagination fantastic paraphrenia and fantastic confabulations confabulatory paraphrenia, hallucinations of megalomaniacal content hallucinatory paraphrenia. There are hallucinatory and delusional variants of paraphrenic syndrome. The predominance of hallucinatory disorders over delusional ones generally indicates a deeper disorder of mental activity than their inverse ratio. In addition, there are acute and chronic variants of paraphrenic syndrome. At the height of acute paraphrenia with Manichaean, metabolic delirium, delusions of special significance and intermetamorphosis, which usually occurs against the background of severe affective disorders, oneiroid stupefaction may develop. Paraphrenic states that appear against the background of a manic mood are called expansive paraphrenia, and against the background of depression, depressive paraphrenia. Cotard's syndrome is considered a variant of the latter. nine0005

Systematized and expansive forms of paraphrenia are believed to be more characteristic of schizophrenia (remote stages of the course of paranoid schizophrenia, affective-delusional attacks of fur-like schizophrenia), confabulatory and fantastic paraphrenia - organic processes and late-age psychoses (senile paraphrenia).

Cotard's syndrome (melancholic paraphrenia). Fantastic nonsense of nihilistic and hypochondriacal content, which is formed against the background of an anxious-depressive state and agitation (“everything is lost, all people are dead, life, civilization, the planet, the whole Universe is dead”). Often includes delusional ideas of immortality. Patients claim that they are doomed to endless wanderings and eternal torment - a symptom of Ahasuerus. Cotard's syndrome refers to the manifestations of involutional melancholy. nine0005

Hallucinatory syndromes. Hallucinosis a condition characterized by a predominance of hallucinations in the absence of formal signs of clouding of consciousness. The most common are verbal hallucinations, less often - visual, tactile and olfactory. Usually one kind of hallucinations dominates, their combinations are much more rare. There are acute and chronic variants of the hallucinatory syndrome (any of those listed below).

Acute verbal hallucinosis syndrome. nine0004 Manifested by numerous auditory, often scene-like hallucinations, sometimes related to such an extent that there may be an erroneous impression of the presence of visual illusions of perception. There are also hallucinatory delusions (delusions that have been dissolved in the content of auditory deceptions, or manifested by a delusional assessment of the latter; for example, voices threaten to kill or are assessed by the patient as “rigged”, “special experiment”), fear, confusion, behavioral disturbances. Occurs in schizophrenia, intoxication, infectious psychoses. nine0005

Syndrome of chronic verbal hallucinosis. Often develops after acute. In fact, auditory delusions often turn out to be a mixed phenomenon, with signs of true (bright sensoriality, external projection) and false (made, intimate connection with the mental "I", delusions of influence) hallucinations. Hallucinations and pseudo-hallucinations can coexist at the same time. Patients "get used" to hallucinatory characters, complex relationships develop between them: conflicts, consent, subordination, trust. More often these relationships are antagonistic, and the patient usually finds himself in a dependent position. There are several votes. So, the patient has three voices, they call themselves "A", "B" and "C". Voices love to philosophize, argue, teach. At one time they were fond of the topic of love, so that the patient had to read them books only about this. They constantly provoke the patient to do strange things. “I know why they give me money to be considered crazy,” she explains herself. The mood of the voices changes: sometimes they are hostile, sometimes benevolent, sometimes sad. The behavior of chronically hallucinating patients is generally more ordered than in acute hallucinosis. More often, the attitude towards voices is ambivalent, and a critical attitude to the deceptions of perception may appear. The voices themselves can say that they are a manifestation of the disease, and that they need to be treated, they even say something, for example, "haloperidol". Chronic verbal hallucinosis occurs in the hallucinatory variant of hallucinatory-paranoid schizophrenia, chronic alcoholic psychosis, organic diseases of the brain. nine0005

Visual hallucinosis. Occurs with complete or significant loss of vision (H. Bonnet hallucinations), lesions of the brain stem, Van Bogart encephalitis, intoxication, in extreme old age. Characterized by optical illusions in the form of small (midget) visions of animals, birds, people, colored and mobile. Patients are distant from them, but at night, with the appearance of confusion and excitement, the critical attitude may be lost.