Megalomania

In clinical psychiatry, megalomania is defined as a form of a psychopathological state or one of the varieties of an affective syndrome in which a person has a false belief that he possesses outstanding qualities, is omnipotent and famous. Often possessed by delusions of grandeur - with complete absence of any objective grounds - so overestimates the importance and importance of his personality, which he considers an unrecognized genius.

In addition, there may be illusions of having close relationships with famous people or fantasies about receiving from the higher powers a special message and a special mission, the value of which no one understands ...

Epidemiology

According to international studies, megalomania for drug addiction and substance abuse occurs in 30% of cases, in patients with depression - in 21%.

In bipolar disorder of the psyche, this pathology develops in patients younger than 20 years in 75% of cases, equally in men and women, and in individuals 30 years and older (at the beginning) - in 40%.

In addition, megalomania is much more likely to develop in people with a higher level of education, more emotional and prone to affectation.

[1], [2], [3], [4]

Causes of the megalomania

Psychiatrists admit that it is difficult to determine the specific causes of megalomania. Some consider this mental disorder to be an extreme manifestation of the syndrome of narcissism; others associate it with bipolar affective disorders (in the stage of increased excitability) and argue that most megalomania is a symptom of the paranoid type of schizophrenia.

Obviously, this is close to the truth, since almost half (49%) of persons suffering from this form of schizophrenia are obsessed with megalomania. In addition, comorbidity (ie, a combination of pathogenetically interrelated diseases) of narcissism syndrome and bipolar disorder is noted: approximately 5% of patients with bipolar disorder have a narcissistic personality disorder. At the same time, both diseases potentiate each other, and then delusions of grandeur (59%) can be diagnosed.

Among the main reasons for megalomania are also distinguished:

• Defeat or anatomical abnormalities of the brain, in particular, its frontal lobe, amygdala of the temporal lobe or cortex of the parietal lobe.
• Genetically caused increase in the concentration of neurotransmitters or changes in the density of dopaminergic receptors in the brain. That is, the pathogenesis of mental pathology is due to the fact that in some areas of the brain there is an overabundance of dopamine neurotransmitters with a simultaneous deficiency of its receptors, and this leads to overactivation or inadequate activation of the specific hemisphere (as studies have shown, most often this left hemisphere). Among the reasons for the megalomania of 70-80% is precisely the genetic factors.
• Neurodegenerative diseases (Alzheimer's disease, Huntington's disease, Parkinson's disease, Wilson's disease), although the percentage of patients who can develop mental disorder as secondary megalomania in these diagnoses is relatively small.
• Drug addiction, as narcotic substances cause drug-induced psychosis (very often with delusions of superiority and omnipotence).
• The use of certain drugs. In particular, this applies to the use of levodopa (L-dopa) for cognitive disorders in Parkinson's disease, the withdrawal of this drug alters the monoaminergic function of dopamine mediators.

[5]

Risk factors

Call such psychological and emotional risk factors for the emergence of this pathological state of the psyche, such as:

• severe depressive disorders (in which the megalomania becomes a protective mechanism of the psyche);
• a focus on achieving the highest educational development and socio-economic status;
• long-term living alone, lack of family-related relationships.

In addition, the risk factors for developing secondary megalomania are attributed to foreign psychiatrists with vitamin B12 deficiency, thyrotoxicosis and carcinoid syndrome in the presence of neuroendocrine (catecholamine-producing) tumors.

Symptoms of the megalomania

Some symptoms of megalomania were identified at the very beginning of the publication. It remains to add that - in addition to being convinced of their extraordinary abilities and profound knowledge - a person believes in his own invulnerability and believes that he does not need other people.

The first signs can manifest in the form of a constant desire to be at the center of universal attention, the need for admiration, and also in recognizing and asserting one's superiority over others. That is, the capacity for objective self-esteem disappears and emotional egocentrism begins to develop.

In most cases, those possessed with megalomania are pathologically boastful and behave pretentiously and expansively. Their mood very often and without cause changes, the energy is replaced by irritability and outbursts of anger. There is a decrease in the need for sleep and rest, a violation of appetite (overeating or refusal of food), as well as tahipsihiya - jumping from one thought to another, speeding up the pace of speech.

Conflicts with others are perceived by patients as an unwillingness of others to recognize the unique qualities of one's own personality (existing only in the imagination of the patient). Some patients believe that they are kings, great generals or inventors, or direct descendants of banners. In comparison with the syndrome of narcissism with megalomania, patients are usually more active and aggressive.

Stages

As the symptoms of megalomania progress, three stages of the given psychopathological state are distinguished:

• initial (above, her first signs were listed);
• Progressive stage (accompanied by auditory hallucinations and confabulation);
• the stage of extreme severity - paranoid ravings of grandeur or psychosis with a fantastic hallucinosis, attacks of aggressiveness, a decrease in mental abilities.

[6]

Complications and consequences

Consequences and complications are associated with a violation of human behavior and its functioning in society. However, according to most psychiatrists, patients with megalomania have a lower risk of suicidal thoughts and attempts.

[7], [8], [9], [10]

Diagnostics of the megalomania

The main diagnosis of megalomania involves identifying this pathology with the help of a special Yang test, which was developed by a group of foreign psychiatrists.

The so-called Young Mania Assessment Scale (YMRS) includes eleven questions with five answers. The questions concern: mood level, motor activity and level of energy; sexual interests; duration and quality of sleep; the degree of irritability; evaluation of speech, thinking disorders and the content of the patient's conversations; explosive or aggressive behavior; (neatness or negligence in clothes, etc.), as well as the degree of awareness of the presence of the disease or the complete negation of any changes in behavior (in most cases, such states are characterized by egocentricity, that is, the patient perceives his behavior from the standpoint of his own standards ).

The psychiatrist compares the results of the testing (which, as shown, has a sufficiently high level of false assessments) with symptoms that the patient or, most often, his relatives complain about, as well as with the clinical signs that were manifested and identified by the doctor during the conversation with the patient.

[11], [12]

Differential diagnosis

In psychiatry, differential diagnosis is very important, because both schizophrenia and bipolar afferent disorders are a mental disorder with loss of contact with reality and psychotic behavior. And it is necessary to clearly define the disadaptive personality traits to avoid an erroneous diagnosis and to find specific approaches necessary for treatment.

Treatment of the megalomania

Treatment of megalomania is carried out to improve the patient's condition, since it is impossible to cure this mental pathology.

Individual patients can be helped by individual sessions of cognitive-behavioral therapy, which is aimed at correcting irrational thinking and inadequate behavior. Interpersonal or interpersonal therapy is also helping others, aimed at developing algorithms for resolving conflict situations in which the patient enters.

When circadian rhythms are disturbed, associated with bipolar disorder, social rhythm therapy is used - a form of behavioral therapy.

For patients suffering from a severe form of megalomania, drug-induced psychotropic drugs are needed - antipsychotics and antipsychotics that stabilize the mental state.

Also in the treatment of this pathology, the patient's realized adherence to all medical prescriptions (compliance-therapy) is of great importance.

The prognosis depends on the severity of the disease and the intensity of its manifestation. In any case, megalomania is a sign of an abnormal, inadequate mental activity of a person.