Paraphrenia: a disease or life in a modified reality

When we say to a friend that he "bears" delirium, we can not even imagine how far we are from the truth, confused in the concepts of delirium and absurdity. In fact, nonsense is a mentally abnormal condition that can have various manifestations. The megalomania inherent in the extremely difficult stage of the delusional state, known as paraphrenia, is also one of the varieties of delirium. But, unfortunately, this is not the only thing.

What is paraphrenia?

Paraphrenia, it's a paraphrenic syndrome, is not just nonsense in the sense in which we understand it. This is a serious mental disorder that occurs in an explicit form for a long period of time, rather than a single case of inadequate expression or behavior.

The paraphrenic syndrome itself is not considered a specific disease, as, indeed, other disease states in medicine, characterized by a certain group of symptoms, but not indicating a specific pathology. Paraphrenia, for example, can be observed in paranoid schizophrenia (one of the types of mental disorder with a predominance of hallucinations and fantastic delusions) or delusional disorder (a mental illness manifested in the form of systematized delusions without elements of freakiness).

Less often the paraphrenic syndrome is observed against the background of exogenously-organic psychoses caused by traumatic factors (stress, mechanical trauma, alcoholism, syphilis, etc.). In some cases, paraphrenia accompanies such pathologies as senile psychosis and dementia.

Praafrafeniya is close to the well-known many paranoia (persecution mania) and the lesser known paranoid (persecution mania combined with outside influences, accompanied by sharp mood changes), also a type of delusional state. These conditions are difficult to distinguish even for people with medical education, in connection with which a lot of controversy is being held around the above-mentioned concepts.

Parafrenic syndrome is considered to be the most severe degree of delusional disorder, in which paranoid ideas are reflected and exaggeration of its significance against the background of persecution mania.

For the first time such phenomenon as paraphrenia was discovered by the German psychiatrist Emil Krepelin at the end of the XIX century. At that time, paraphrenia was attributed to one of the diseases of the human psyche. Nowadays, paraphrenia is not considered a separate disease. This syndrome is inherent in several pathologies of mental development.

A distinctive feature of paraphrenia is the systematization of delusional ideas and concepts, significantly detached from reality and having, as a rule, a fantastic character. At the same time, the connection of delirium with the personality characteristics that contribute to the development of the pathological process, as well as with the disorders of perception and mental state, is little or nonexistent, which can not be said of a paranoid or paranoid syndrome.

Epidemiology

The prevalence of paraphrenia can not be clearly defined, because not all patients turn to psychiatrists for help. Many go to general practitioners who can not always see the symptomatology of mental abnormalities in the patient's words. Other patients generally consider their condition normal, which is typical, for example, in schizophrenia, and therefore their disease can be detected only by chance in connection with other pathologies.

One can only say that paraphrenia is peculiar to develop at a young age. For men, this is about 17-28 years old, for women - 22-32 years. At the same time the risk of development of pathology has a shade of seasonality. So, in people born in the spring-winter period, the probability of developing delusional pathologies is slightly higher than those who were born in the summer or autumn.

In childhood, such a diagnosis does not occur, and in adolescence has a weak expression, manifested in the form of affective-delusional ideas or psychoses.

[1], [2], [3], [4], [5], [6]

Causes of the paraphrenia

Despite the fact that in medical circles paraphrenic syndrome has been known for more than a hundred years, its pathogenesis has not been thoroughly studied yet. The wide prevalence of paraphrenia in the clinical picture of such pathologies of the psyche as schizophrenia and delusional disorder suggests that the origins of the syndrome can be found in the pathogenesis of these diseases. But even here everything is not so simple.

The fact that the pathogenesis of schizophrenia also remains a mystery for scientists who suggest that the hereditary factor, genetic mutations and disorders of neuronal development in the prenatal period and after the appearance of the baby to the light, structural changes in various parts of the brain, as well as social factors. In this case, the trigger triggering the pathological process is the interaction of various risk factors for the development of pathology, one of which always remains the social environment and the upbringing of the child.

In the pathogenesis of delusional disorder also there is no special clarity and uniqueness. As in the case of schizophrenia, there are several theories trying to explain why a person at some point loses touch with reality, giving himself up to the power of delusions and hallucinations.

Many scholars agree that the reason for the delusional disorder is the placement of an individual with a special genetically determined structure of consciousness in certain conditions of the social environment or upbringing. To a special structure of consciousness can be attributed to hidden complexes in the sexual sphere:

• Homosexuality (same-sex sex),
• incestuousness (sexual intercourse with blood relatives),
• exhibitionism (the achievement of sexual satisfaction by demonstrating to others their sexual organs),
• complex castration (the experience of the child about the lack of certain sexual characteristics and fear of castration), etc.

On this basis, various delusional ideas can develop, such as persecution mania, delusions of duplicity or reformism, ideas about extraneous influence on consciousness, and so on. Such state of affairs can be facilitated by excessive suspicion of parents, prolonged stay within a religious sect or community with total control over its inhabitants, the need for emigration (especially in conditions of ignorance of the language), imprisonment, life conflicts and even some diseases (for example, poor hearing or sight, communication disruption).

Delusional ideas can be associated with constitutional personality traits (systematized delirium usually in one direction), as well as some pathologically altered traits: lack of self-criticism, overestimated self-esteem, distrust of others, fixation on one's feelings, etc. Risk factors for such mental disorders can be the abuse of alcohol and drugs, as well as uncontrolled use of psychotropic drugs, resulting in impaired brain activity.

If the reasons for the appearance of delusional states are more or less clear, then the probability of paraphrenia, paranoia or paranoid development on this soil remains questionable. It all depends on which of the factors prevails over consciousness more than others, causing the nature of crazy ideas and their relationship to reality.

[7], [8]

Symptoms of the paraphrenia

Paraphrenia, as a disorder of mental perception, has a rather wide symptomatology. In this case, each case is unique in its manifestations.

The first signs, by which it can be determined that the patient has a paraphrenic syndrome, is the presence of three components:

• a variety of delusional ideas that are often systematized and include: megalomania and persecution, as well as delusions of influence, when a person feels an imaginary part from the side,
• hallucinations and pseudo-hallucinations (visions, divorced from reality, non-existent characters and places),
• mental automatism, when one's own thoughts and actions are perceived by the patient as inspired or inspired from outside, which runs in parallel with the delusions of the impact.

Patients with paraphrenic syndrome stand out against the background of others, as the rich symptomatology of the pathological process is observed against a background of good mood, some kind of euphoria. The prevailing idea of their delirium is the feeling of being a great and all-powerful personality, just the lord of the universe. Someone becomes a newly made Newton or Einstein, while others attribute themselves to non-existent traits, considering themselves non-existent in the real world as a person.

Patients consider themselves truly unique and ascribe to themselves certain super abilities, which gives them confidence in their omnipotence and infallibility. Such ideas are often backed up by hallucinations based on real events and characters. If this does not help to be convinced of its superiority over others, consciousness calls for help pseudo-hallucinations, divorced from reality, in which there are fictional characters and places of action.

Particular attention should be paid to the speech of the patient. She is always confident and emotional. Confidence in their infallibility makes patients convince others of their own, thereby increasing an already unrealistic overestimation of self-esteem. Their crazy ideas parafreniki try to confirm the statements of great people, comparisons, often in digital terms, significant facts that have universal significance, etc.

Patients with paraphrenia are obsessed with the idea of an approaching grandiose event, which they predict at every opportunity, while they themselves, in their opinion, also take an active part in preventing an impending catastrophe or mediate a peace agreement with aliens. Such fantastic stories usually have one theme, but each time are supplemented by new colors, characters and plots. Patients are not inclined to change the meaning of their statements, so this happens very rarely.

Mania of persecution with paraphrenia is not always present, but often it does manifest itself under the appropriate social conditions. The patient, considering himself an outstanding person with multiple important ideas for saving our world, may be afraid that these ideas can be stolen from him as inhabitants of our planet, as well as characters from the other world or aliens. In this paraphrenic can always be convinced of the thought that he is not only being watched, but also trying to control him, casting other people's thoughts and actions, which he stubbornly opposes.

For paraphrenic delirium, the presence of not only negative characters, with whom the patient enters into struggle, is characteristic. For his life, non-existent positive heroes are also fighting, helping the paraphrenic perform his mission and once again convincing him of his own importance.

Symptoms of mental automatism with paraphrenia are often in the field of fantasy. The patient allegedly communicates with fantastic creatures from other worlds or real people who have a lot of weight in society (scientists, politicians, etc.). At the same time, they either feel the influence from the outside, or are convinced that they can manage people and events with their own genius abilities, read minds, make a person do what he does not want, etc.

A fairly frequent symptom of paraphrenic syndrome is the delusion of a negative twin, described in 1923 by a French psychiatrist Joseph Kapgrom. The patient is convinced that an invisible double has replaced him or someone of his own people. In this case, all the bad deeds of a person are attributed to his double. The patient is confused in relations, considering strangers close and relatives, and rejecting any communication with relatives.

Slightly less often among patients with paraphrenia, there are manifestations of Fregoli syndrome (positive double). The patient can consider the people around him the same person, who for some reason changes his appearance. However, there are situations of not recognizing, when one person is perceived as a paraphrenic as two different characters.

Along with hallucinations and pseudo-galaxies, parafrenic phenomena include such phenomena as confabulation (the transfer of the events that have happened long ago, supplemented by fictional details) and obsession (obsessions and ideas that are not related to various persecutory fears and obsessions).

Stages

Paraphrenia can also act as one of the stages of other disorders of the psyche:

• Fantastic paraphrenia is a delusional disorder, saturated with ideas of grandeur, wealth, power, not having a constancy and a certain system. This type of paraphrenic syndrome characterizes the fourth stage of the onyroid syndrome with complete or partial disorientation of a person in his personality, surrounding reality and occurring events with the replacement of reality with fictitious pictures of pseudo-hallucinatory delirium.

• Acute paraphrenia. This condition characterizes the pathology itself as a whole, but rather the recurring attacks of sensual emotional-colored delirium, which are characterized by variability. Trigger such attacks are changes in the environment, certain events in the life of the patient. From these changes, and depends on the nature of delirium. Most often it is a manifestation of schizophrenia or late psychosis.
• Chronic paraphrenia. There is already a certain stable system in the form of monotony of statements against the background of the lack of emotional manifestations. It is characterized by the scarcity of the lexicon, incoherent sentences and phrases.

[9], [10], [11], [12], [13],

Forms

In psychiatric practice, it is customary to distinguish the following types of paraphrenic syndrome:

• Systematized paraphrenia, which is characterized by the persistence and persistence of delusional ideas. It is more characterized by a pronounced manifestation of megalomania, as well as syndromes of a positive or negative twin. Clearly outlined ideas of excellence and negative (sometimes even aggressive) attitude towards others. Hearing hallucinations are also pronounced.
• Hallucinatory paraphrenia, when the patient is completely dominated by hallucinations and pseudo-hallucinations, rarely resorting to verbal manifestations of delusions in the form of dialogues with opponents, proving his delusional ideas. Pseudohallucinations are representable as living beings that do not exist in reality.
• Confabulatory paraphrenia most often develops on the basis of the two above-mentioned varieties of paraphrenic syndrome, and as an independent species is very rare. Here, the megalomania comes to the fore in combination with false memories of heroic events and the participation of patients in them, twisting information about events that happened one day, or memories of events that were not at all.

Nonspecific types of paraphrenic syndrome:

• Manic paraphrenia is a maniacal prevalence of the idea of one's superiority over others, to which verbal nonsense is characteristic. The fantastic component is weakly expressed.
• Expansive paraphrenia, when a variety of unsystematic delusions are presented against the background of increased affect (in a constantly elated mood).

For older patients, such varieties of pathology are also characteristic:

• Melancholic or depressive paraphrenia is closely related to the depressive state. It is considered a subspecies of confabulation paraphrenic syndrome, but with no delusions of grandeur. Patients, on the contrary, consider themselves unworthy of respect and guilty in all mortal sins, for which they must suffer an unavoidable punishment. In their sick mind, they personify the world evil, acting in their untruthful memories with negative characters.
• Involutionary paraphrenia is based on megalomania and persecution delusion. In such patients, memory disorders occur most often when events and dates are replaced by others. They are prone to frequent changes of mood and features of speech.
• Presenile paraphrenia, in which delirium grandeur takes on a special form. The idea of greatness is due to an imaginary sexual connection with the super-great mind (for example, with extraterrestrial inhabitants). This kind of paraphrenia is characterized by the appearance of bright auditory hallucinations in support of the delusion of grandeur. This type of pathology is peculiar to the female population of the planet at the age from 45 to 55 years.
• Erotic paraphrenia arises from the unfavorable experience of family life. It manifests itself in the form of hallucinations, in which the patient acts as an immoral character, conscious of his own defectiveness. On the other hand, in these hallucinations there is also a "positive" character, a "defender" of morality, who accuses the patient of treason and threatens to punish the patient by the "wedge-kicking out" method, i.e. With the help of sexual violence. This type of pathology is not inherent in the persistence of symptoms, its course is paroxysmal. It appears most often in women.
• Late paraphrenia with the conviction of its uselessness, with the ideas that the patient is offended, deprived, do not like. This syndrome is characteristic of senile schizophrenia (aged 70-90 years), which is practically not treated.

In the elderly, it is much more difficult to cope with the disease, so the consequences of systematic paraphrenic delirium are severe late psychosis, and most often senile dementia, which can act as a cause and consequence of paraphrenia.

[14], [15]

Complications and consequences

Usually, chronic paraphrenia develops for a long time as a complication of the hallucinatory-paranoid state, and not as a separate mental pathology.

[16], [17], [18], [19],

Diagnostics of the paraphrenia

The main task of diagnostic studies in paraphrenia is to identify differences between similar pathologies, which indicates the severity of mental disorders, because paraphrenic syndrome is considered to be the most difficult stage of delusional condition. A special role in this case is given to differential diagnosis.

The similarity of some symptoms in paraphrenic, paranoid and paranoid syndromes makes the diagnosis of paraphrenia very difficult. Differentiate the data pathology can only be carefully studied all the symptoms present in the patient.

It is very important to identify the dependence of the appearance of certain symptoms on certain personality traits. With the paranoid syndrome, this dependence is well traced, i.e. Mistrust and suspicion can lead subsequently to a persecution mania.

An important role is played by the connection between the appearance of delirium and pathological disorders of perception, a disturbance of mental balance. With paranoid syndrome, this connection is very good, while paraphrenic can be absent altogether.

Paraphrenia also needs to be differentiated from episodes of delusional conditions that are characteristic of psychosis in adolescence or of organic types of psychosis when taking drugs or psychotropic drugs. Therefore, it is so important to identify the duration of episodes of delirium and their frequency, and also for how long the patient has such a condition.

In some cases, additional neurological studies of brain function may be necessary. Paraphrenia is actually substitution of reality with delusional and fantastic ideas, not related to impairments of brain functions. If the delirium is caused precisely by this reason, the diagnosis will be quite different. For example, early dementia, vascular dementia, senile dementia, in which there are violations in the emotional and volitional spheres.

Paraphrenia as a separate condition arises extremely rarely, so it is important to find out what disease is accompanied by the symptoms of paraphrenic syndrome, and treat the disease itself, rather than its individual manifestations.

[20], [21], [22], [23], [24], [25], [26], [27],

Treatment of the paraphrenia

Only by studying the symptoms in detail and putting the final diagnosis can an effective treatment of paraphrenia be prescribed. Careful study of the symptoms is important in the sense that different types of paraphrenic syndrome can have different manifestations against the background of a certain mental state. One patient can almost always remain in a state of euphoria, while the other has a tendency to depression and self-abasement. Accordingly, the approach to treatment of such patients will be different.

The main thing is that the treatment of this mental disorder is possible with the exception of cases of development of pathology in old age, when changes in the psyche become irreversible. Therapy of paraphrenia can be carried out both in hospital and outpatient settings, but in the latter case, patients are required to visit the hospital at the time set for taking medication.

The main drugs in the therapy of paraphrenic syndrome are neuroleptics, intended for the treatment of psychotic disorders. It is neuroleptics that are called to effectively combat increased anxiety, delirium and hallucinations, mood swings, psychomotor agitation, more or less characteristic of various types of paraphrenic syndrome.

Preference, of course, should be given to atypical neuroleptics ("Clozapine", "Quetiapine", "Rispolept", etc.), which have fewer side effects than their typical "brethren". But on the other hand, patients with paraphrenia often simply forget to come to a medical institution in the allotted time for taking medication, in this case, the prescription of long-acting tablets is preferred, which, unfortunately, are present only among typical neuroleptics.

The administration of doses and the duration of administration of neuroleptics depends on the form in which the pathology proceeds. In acute form, which is characterized by some recurring episodes of delusions, drugs are prescribed in a large dose at precisely those times when there is a special severity of clinical symptoms. For the chronic course of the disease, therapy has a different focus. Neuroleptics are prescribed in the minimal effective dose, which gradually increases. Drugs are taken on an ongoing basis.

If paraphrenia occurs with frequent depressive dramatization, which is especially characteristic of the melancholic and late form of the pathology, antidepressants and psychotherapy sessions designed to combat the oppressed state are prescribed as additional therapies. The choice of drugs in this case always remains with the doctor. It can be like the good old tricyclic antidepressants (Doxepin, Coaxil, etc.), and SSRIs (Fluoxetine, Paroxetine, Sertraline, etc.) or the novelty in the pharmacology of melatoninergic antidepressants (Agomelatin , he is also "Melitor").

In a hospital, patients with severe forms of paraphrenia are treated, presenting a certain danger to others. Preparations in such cases are prescribed in large dosages until the intensity of symptoms decreases. After this, the patient continues to be treated on an outpatient basis using less severe drugs and with a dose adjustment.

Prevention

Prevention of paraphrenia makes sense if there are certain prerequisites for the development of the disease. It can be either genetically conditioned prerequisites, including cases of mental disorders in the family, and the manifestation of certain personality traits, which are a deviation from the norm.

It is clear that excluding all possible triggers is simply unrealistic. But if a person creates a suitable environment, then the disease may never manifest. Parental care and love, good relations in the family, education of positive character traits in the child, work with a psychologist if necessary - all this will help to stop the development of the pathological process still in the bud.

In adult life, everything is much more complicated, because avoiding stressful situations and conflicts is sometimes not so simple. And from the prison and emigration, as recent events show, no one is insured at all. But not to succumb to the negative influence of others with suggestions to "miss a glass" or "drag on", a person can be helped by explaining in all colors what such hobbies can turn out.

[28], [29], [30],

Forecast

The prognosis of the paraphrenic syndrome is difficult, because when it comes to the human psyche to predict something in advance, it's simply impossible. According to some reports, only 10% of patients with a diagnosis of "paraphrenia", after a course of treatment, forget about their illness forever. The rest of the symptoms return in time. But this is not a reason to despair. Many patients who periodically undergo treatment with neuroleptics in combination with psychotherapy sessions in case of relapse of the disease subsequently return to normal life and work activity, because pathology does not cause irreversible disturbances in thinking and memory, and even more so, organic brain damage. So there is still a chance for recovery.

[31], [32]