Delusions of grandeur

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

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

Epidemiology

According to international studies, delusions of grandeur occur in 30% of cases of drug addiction and substance abuse, and in 21% of cases of depression.

In bipolar mental disorder, this pathology develops in patients under 20 years of age in 75% of cases, equally in men and women, and in people 30 years of age and older (at the time of onset) - in 40%.

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

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Causes megalomaniacs

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

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

The main causes of megalomania also include:

• Damage or anatomical abnormalities of the brain, particularly the frontal lobe, amygdala, temporal lobe, or parietal lobe cortex.
• Genetically determined increase in the concentration of neurotransmitters or change in the density of dopaminergic receptors of the brain. That is, the pathogenesis of mental pathology is associated with the fact that in some areas of the brain there is an excess of dopamine neurotransmitters with a simultaneous deficiency of its receptors, and this leads to overactivation or inadequate activation of a specific hemisphere (as studies have shown, most often this is the left hemisphere). Among the causes of megalomania, 70-80% are genetic factors.
• Neurodegenerative diseases (Alzheimer's disease, Huntington's disease, Parkinson's disease, Wilson's disease), although the percentage of patients who, with these diagnoses, may develop a mental disorder in the form of secondary delusions of grandeur is relatively small.
• Drug addiction, since narcotic substances cause drug-induced psychosis (very often with delusions of superiority and omnipotence).
• Use of certain medications. In particular, this concerns Levodopa (L-dopa), used to treat cognitive impairment in Parkinson's disease, the withdrawal of this drug changes the monoaminergic function of dopamine mediators.

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Risk factors

The following psychological and emotional risk factors for the development of this pathological mental state are named:

• severe depressive disorders (in which megalomania becomes a defense mechanism of the psyche);
• obsession with achieving the highest educational development and socioeconomic status;
• long-term living alone, lack of family and kinship relations.

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

Symptoms megalomaniacs

Some symptoms of megalomania were mentioned at the very beginning of the publication. It remains to add that – in addition to the conviction of one’s extraordinary abilities and deep knowledge – the person believes in his own invulnerability and believes that he does not need other people.

The first signs may manifest themselves in the form of a constant desire to be the center of everyone's attention, the need for admiration, as well as the recognition and assertion of one's superiority over others. That is, the ability for objective self-assessment disappears and emotional egocentrism begins to develop.

In most cases, those with megalomania are pathologically boastful and behave pretentiously and expansively. Their mood changes very often and without reason, energy is replaced by irritability and outbursts of anger. There is a decrease in the need for sleep and rest, appetite disorders (overeating or refusal to eat), as well as tachypsychia - jumping from one thought to another, acceleration of the rate of speech.

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

Stages

As the symptoms of megalomania progress, three stages of this psychopathological condition are distinguished:

• initial (its first signs were listed above);
• progressive stage (accompanied by auditory hallucinations and confabulation);
• stage of extreme severity – paranoid delusions of grandeur or psychosis with fantastic hallucinations, attacks of aggression, and decreased mental abilities.

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Complications and consequences

The consequences and complications are associated with a disruption of human behavior and functioning in society. At the same time, according to most psychiatrists, patients suffering from delusions of grandeur have a lower risk of suicidal thoughts and attempts.

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Diagnostics megalomaniacs

The main diagnostics of megalomania involves identifying this pathology using a special Young test, which was developed by a group of foreign psychiatrists.

The so-called Young Mania Rating Scale (YMRS) includes eleven questions with five answer options. The questions concern: mood level, motor activity and energy level; sexual interests; duration and quality of sleep; degree of irritability; assessment of speech, thought disorders and the content of the patient's conversations; explosive or aggressive behavior; features of appearance (neatness or carelessness in clothing, etc.), as well as the degree of awareness of the presence of the disease or complete denial of any changes in behavior (in most cases, such states are characterized by egosyntonicity, that is, the patient perceives his behavior in terms of his own standards).

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

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Differential diagnosis

In psychiatry, differential diagnosis is very important, since both schizophrenia and bipolar afferent disorders are mental disorders with loss of contact with reality and psychotic behavior. And it is necessary to clearly identify maladaptive personality traits in order to avoid misdiagnosis and find specific approaches needed for treatment.

Treatment megalomaniacs

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

Some patients may benefit from individual sessions of cognitive behavioral therapy, which is aimed at correcting irrational thinking and inappropriate behavior. Others benefit more from interpersonal or interpersonal therapy, which is aimed at developing algorithms for resolving conflict situations in which the patient finds himself.

For circadian rhythm disturbances associated with bipolar disorder, social rhythm therapy, a type of behavioral therapy, is used.

For patients suffering from severe forms of megalomania, psychotropic medications are needed – neuroleptics and antipsychotics that stabilize the mental state.

Also, in the treatment of this pathology, the patient’s conscious 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 abnormal, inadequate mental activity of a person.