Persecution mania
Last reviewed: 23.04.2024
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In modern psychiatry, persecution mania or persecution syndrome is considered one of the subtypes of delusional (paranoid) disorder, which consists in the existence of a false belief in a person that others - either specific people or vague "they" - constantly monitor him and seek to harm in any way .
The persecution mania gives rise to obsessive thoughts that completely distort real facts and falsely interpret the motives of actions and the actions of others themselves - despite the obvious evidence of no malicious intentions. This psychotic disorder can cause in the sick imagination very strange ideas and absurd "plots". For example, a person suffering from a persecution mania may think that all neighbors have conspired against him, that his phone conversations are tapped or that one of his relatives wants to poison him and pours poison into his food ...
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Epidemiology
Specialists attribute the persecution mania to the most common forms of paranoia. According to the estimates of the American Psychiatric Association, approximately 10-15% of people may experience paranoid thoughts, and in some cases these thoughts are fixed and become the "foundation" of the developing persecution mania. Many people who experience this disorder have either schizoaffective personality disorder or schizophrenia.
How common is the persecution mania in elderly people with Alzheimer's disease, can be judged from the statistics of this disease. According to the latest WHO data, there are almost 44 million people worldwide who have this disease, with the leading countries in Western Europe and North America (in the US - 5.3 million, that is, every third resident over the age of 75-80 years ).
In addition, as of 2015, there were 47.5 million people with dementia in the world; up to 68% of elderly citizens have cognitive impairments and psychotic disorders, including delusions.
There have also been studies showing that 82% of women with schizophrenia tend to suffer persecution mania, and among men with a similar diagnosis it is 67%. Therefore, foreign experts conclude that women in general are more prone to pursuit mania.
Causes of the persecution mania
What is the reason for the development of persecution mania? First of all, delirium of persecution as a symptom is noted in paranoid schizophrenia, bipolar disorder (in the depressive phase), psychotic depression and in alcoholic or narcotic delirium. It should also be noted that among persons with severe depression, the transient persecution craze may be triggered by neuroleptic drugs (dopaminergic drugs) or antidepressants.
In cases of neurodegenerative pathologies of the brain, the persecution mania in the elderly is a frequent symptom of senile dementia, Alzheimer's disease, and dementia with Levi bodies (protein formations in neurons of certain brain structures) in parkinsonism.
Psychiatrists have long been studying the mechanisms of the onset of personality disorders, but the exact causes of persecution mania have not yet been established. It is assumed that some patients have a special structure of the central nervous system, predisposing to the development of certain mental disorders. For example, psychologists say, individuals of an external type tend to be paranoid, that is, they are convinced of the decisive role in their lives of external circumstances and surrounding people.
Risk factors
The risk factors for this disorder are: craniocerebral trauma, elderly age, the influence of alcohol and drugs on the central nervous system, as well as the high level of suspicion inherent in some individuals, which, with age in itself, can cause depressive-paranoid changes in the way people think and think behavioral reactions.
Pathogenesis
Pathogenesis of persecute (persecution) syndrome can be caused by neuromorphological disorders (including traumatic origin) of the amygdala body of the subcortex of the temporal lobe, the prefrontal and temporal regions, the striatum bodies of the frontal lobes, and rarely the cortex of the posterior parietal region. The result of the violation of these structures of the brain is their partial dysfunction, which can be expressed as a discrepancy between experience and expectation, that is, between the ability to analyze what is actually happening and the forecasting of the consequences.
Also, the pathogenesis can be based on the excessive concentration of neurotransmitters in the ventral striatum - a special subcortical region of the brain that participates in the production of dopamine and which has a direct effect on human emotions.
Delusional persecution ideas may arise due to genetic polymorphism and mutations of genes responsible for dopaminergic neurotransmission, which can cause increased sensitivity of specific neurochemical CNS receptors to dopamine.
In such cases, experts speak of a persecutory subtype of paranoia, delusional disorder or "dopamine psychosis," leading to severe forms of persecution mania.
The development of persecution mania can be caused by calcium deposits in the basal ganglia (Phara's disease), which indicate problems with the exchange of calcium, calcium phosphorus or sodium in the body.
Symptoms of the persecution mania
The severity of the symptoms of persecution mania is due to the stage of development of this psychotic personality disorder.
At the initial stage, the first signs include an increased level of anxiety, excessive suspicion and a propensity for self-isolation (isolation). Often, patients think that others are talking behind their backs and gossiping about them, laughing at them and doing everything they can to damage their reputation.
Cognitive impairment is not observed, but attributive shifts begin to appear: reasoning about the motives of actions and intentions of other people are extremely negative.
With the onset of the second stage, the symptoms of persecution mania increase. The distrust and inclination to distort the perceived events prevails over rational thinking to such an extent that there is an obsession with the "total conspiracy" (including close relatives) against the patient: everyone persecutes him, threatens him, wants to harm him, he is in constant danger. The patient hardly comes into contact even with the closest people, often irritated, there may be problems with sleep. But the person does not consider himself to be sick.
At the third stage, the patient has attacks of psychomotor agitation, panic attacks, uncontrolled outbursts of aggression; there is a general depression and depression, a feeling of overwhelming fear for one's life, apartment, personal effects.
Complications and consequences
The most frequent consequences and complications of delusions of persecution are persistent negative changes in a person's personal qualities, loss of a normal level of self-awareness, a decrease in cognitive abilities, inadequate behavior in some situations. All this makes it extremely difficult to maintain relationships and communicate with the patient.
Diagnostics of the persecution mania
Diagnosis of the persecution mania of psychiatrists on the basis of the main symptoms, the study of the anamnesis, including the family one, for the presence of psychotic disorders among the relatives of the older generation is carried out. It turns out which medications the patient takes, whether he is abusing alcohol or not using psychoactive substances.
It may be necessary to study the function of the brain to identify possible anatomical or traumatic morphological disorders of its individual structures and the state of the cerebral vessels, for which EEG (electroencephalography), CT or MRI is prescribed.
Differential diagnosis
Differential diagnostics is also performed to distinguish an independent persecution mania from a comorbid delusional state in schizophrenia (primarily paranoid); dementia and Alzheimer's disease; schizophreniform and obsessive-compulsive disorders; psychotic disorder induced by certain chemicals.
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Treatment of the persecution mania
Currently, medical treatment of persecution mania is carried out with the help of neuroleptic drugs, such as antipsychotics. Drugs of this group act as antagonists of dopamine receptors, they inhibit the action of this neurotransmitter in the brain and reduce the severity of symptoms.
The most commonly prescribed drugs are: Lithium carbonate (Liticarb, Litonate, Litan, Camcolit, Neurolepsin and other trade names), valproate preparations (Valproate, Apilepsin, Depakin, Everiden), Carbamazepine (Amizepin, Karbazep, Carbagrete, Temporal and etc.), Pimozide.
Lithium carbonate (in 300 mg tablets), doctors recommend taking one or two tablets twice a day. Do not use lithium drugs in case of serious kidney and heart diseases (arrhythmias) and thyroid problems. Among their side effects are dyspepsia, decreased muscle tone, thirst, tremor, and increased drowsiness. During treatment with lithium, continuous monitoring of its content in the blood is necessary.
Valproate is taken twice a day for 0.3 g (along with food). Contraindications for use are liver dysfunction, pancreatic disease, decreased blood clotting and pregnancy. Side effects can be in the form of hives, decreased appetite, nausea and vomiting, as well as tremors and impaired coordination of movements.
Antidepressant Carbamazepine (in tablets of 0.2 g) should be taken first half a tablet (0.1 g) up to three times a day, with a possible increase in the dose (determined by the doctor). This drug is not used for violations of cardiac conduction and liver failure; and side effects are the same as those of Valproate.
Dosage of neuroleptic drug Pimozide (in tablets of 1 mg) is determined individually, but the maximum daily dose should not exceed 8 mg. Pimozide is contraindicated if the patient suffers from hyperkinesis and other motor disorders, attacks of aggression and depression. Side effects are manifested by weakness, poor appetite, a drop in blood pressure and suppression of hematopoiesis.
Also, the treatment of persecution mania is carried out by the method of cognitive-behavioral therapy, the purpose of which is to help a person master effective ways of overcoming fear of persecution.
In addition, it is necessary to treat the underlying disease, that is, schizophrenia, dementia, Alzheimer's disease, etc. Read more - Treatment of schizophrenia
Forecast
It is impossible to accurately predict this type of paranoid disorder, although it is clear that a person in this state has significant limitations in the social, professional and other spheres of life.
In conclusion - the answer to the question, how to behave with a sick mania of persecution? Psychiatrists advise avoiding persistent persuasion of a man obsessed with the persecution mania in his erroneous views: this will only aggravate his condition and make you one of the "pests" or even "the enemy number one". People with this psychotic disorder do not recognize their illness, and no arguments on them do not work. Try to resort to the help of a good specialist who can unobtrusively communicate with the patient and give recommendations to his relatives.
Persecution mania is a difficult diagnosis, and you need to establish positive feedback from the patient on the care of his sense of security and not give cause for concern and destructive behavior when communicating with you.