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Persecution mania
Last reviewed: 04.07.2025
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In modern psychiatry, persecution mania or persecution syndrome is considered one of the subtypes of delusional (paranoid) disorder, which consists of a person having a false belief that others - either specific people or an undefined "they" - are constantly watching him and are trying to harm him in any way.
Persecution mania gives rise to obsessive thoughts that completely distort real facts and falsely interpret the motives for actions and the actions of others – despite obvious evidence of the absence of malicious intent. This psychotic disorder can cause very strange ideas and absurd “plots” in the patient’s imagination. For example, a person suffering from persecution mania may think that all the neighbors have conspired against him, that his telephone conversations are being tapped, or that one of his relatives wants to poison him and is putting poison in his food…
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Epidemiology
Experts consider persecution mania to be the most common form of paranoia. According to the American Psychiatric Association, approximately 10-15% of people may experience paranoid thoughts, and in some cases these thoughts become entrenched and become the “foundation” for developing persecution mania. Many people who experience this disorder have either schizoaffective personality disorder or schizophrenia.
The prevalence of persecution mania in elderly people with Alzheimer's disease can be judged by the statistics of this disease. According to the latest WHO data, there are almost 44 million people with this disease worldwide, with Western European countries and North America leading the way (in the USA - 5.3 million, that is, every third resident over the age of 75-80).
In addition, as of 2015, there were 47.5 million people with dementia worldwide; up to 68% of older citizens have cognitive impairment and psychotic disorders, including delusional ones.
There have also been studies showing that 82% of women with schizophrenia tend to suffer from persecution mania, while among men with the same diagnosis, this figure is 67%. Therefore, foreign experts conclude that women are generally more prone to persecution mania.
Causes persecution mania
What is the development of persecution mania associated with? First of all, persecution delusion as a symptom is observed in paranoid schizophrenia, bipolar disorder (in the depressive phase), psychotic depression and in alcohol or drug delirium. It should also be noted that among people with severe depression, transient persecution mania can be provoked by neuroleptic drugs (dopaminergics) or antidepressants.
In cases of neurodegenerative pathologies of the brain, persecution mania in the elderly is a common symptom of senile dementia, Alzheimer's disease, and also dementia with Lewy bodies (protein formations in neurons of certain structures of the brain) in Parkinsonism.
Psychiatrists have long studied the mechanisms 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 them to the development of certain mental disorders. For example, as psychologists claim, external-type personalities are prone to paranoia, that is, those convinced of the decisive role of external circumstances and people around them in their lives.
Risk factors
Risk factors for the development of this disorder include: traumatic brain injury, old age, the effects of alcohol and drugs on the central nervous system, as well as the increased level of suspiciousness characteristic of some individuals, which with age can in itself be the cause of depressive-paranoid changes in a person’s way of thinking and behavioral reactions.
Pathogenesis
The pathogenesis of persecutory syndrome may be caused by neuromorphological disorders (including those of traumatic origin) of the amygdala of the subcortex of the temporal lobe, prefrontal and temporal areas, striatum of the frontal lobes, and less frequently, the cortex of the posterior parietal area. The result of the disorder of these structures of the brain is their partial dysfunction, which may be expressed by a discrepancy between experience and expectation, that is, between the ability to analyze what is actually happening and predict the consequences.
Pathogenesis may also be based on an excess concentration of neurotransmitters in the ventral striatum, a special subcortical region of the brain involved in the production of dopamine and having a direct impact on human emotions.
Delusional ideas of persecution may arise due to genetic polymorphisms and mutations of genes responsible for dopaminergic neurotransmission, which can cause increased sensitivity of specific neurochemical receptors of the central nervous system to dopamine.
In such cases, experts talk about 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 (Fahr's disease), which indicate problems with the metabolism of calcium, phosphorus, calcium or sodium in the body.
Symptoms persecution mania
The severity of the symptoms of persecution mania is determined by the stage of development of this psychotic personality disorder.
At the initial stage, the first signs include increased anxiety, excessive suspiciousness and a tendency to self-isolate (withdrawal). Often, patients think that others are talking behind their backs and gossiping about them, laughing at them and doing everything possible to harm their reputation.
No cognitive impairments are observed, but attributional shifts begin to appear: reasoning about the motives for the actions and intentions of other people is exclusively negative.
With the onset of the second stage, the symptoms of persecution mania intensify. Mistrust and the tendency to distort perceptions of what is happening prevail over rational thinking to such an extent that an obsessive idea of a “total conspiracy” (including immediate family members) against the patient appears: everyone is persecuting him, threatening him, wanting to harm him, he is in constant danger. The patient has difficulty making contact even with the closest people, is often irritated, and may have problems sleeping. But at the same time, the person does not consider himself ill.
At the third stage, the patient experiences attacks of psychomotor agitation, panic attacks, uncontrollable outbursts of aggression; general depression and a state of depression are observed, a feeling of irresistible fear for one's life, apartment, personal belongings.
Complications and consequences
The most common consequences and complications of persecutory delusions are persistent negative changes in a person's personality traits, loss of a normal level of self-awareness, decreased cognitive abilities, and inappropriate behavior in certain situations. All of this makes it extremely difficult to maintain relationships and communicate with the patient.
Diagnostics persecution mania
The diagnosis of persecution mania is carried out by psychiatrists based on the main symptoms, anamnesis study, including family history - for the presence of psychotic disorders in older relatives. It is determined what medications the patient takes, whether he abuses alcohol or uses 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 are prescribed.
Differential diagnosis
Differential diagnostics are also carried out to distinguish independent persecution mania from comorbid delusional states 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 persecution mania
Currently, drug treatment of persecution mania is carried out using neuroleptic drugs, such as antipsychotics. Drugs of this group act as dopamine receptor antagonists, they inhibit the action of this neurotransmitter in the brain and reduce the severity of symptoms.
The most commonly prescribed medications are: Lithium carbonate (Liticarb, Litonat, Litan, Kamkolit, Neurolepsin and other trade names), valproic acid preparations (Valproate, Apilepsin, Depakine, Everiden), Carbamazepine (Amizepine, Carbazep, Carbagretyl, Temporal and others), Pimozide.
Lithium carbonate (in tablets of 300 mg) doctors recommend taking one or two tablets twice a day. Do not use lithium preparations in case of serious kidney and heart diseases (arrhythmia) and problems with the thyroid gland. Among their side effects are dyspepsia, decreased muscle tone, thirst, tremor, increased sleepiness. During treatment with lithium, constant monitoring of its content in the blood is necessary.
Valproate is taken twice a day at 0.3 g (with food). Contraindications for use are liver dysfunction, pancreatic diseases, decreased blood clotting and pregnancy. Side effects may include urticaria, decreased appetite, nausea and vomiting, as well as tremors and impaired coordination of movements.
The antidepressant Carbamazepine (in tablets of 0.2 g) is prescribed to be taken initially 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 cardiac conduction disorders and liver failure; and the side effects are the same as those of Valproate.
The dosage of the 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 movement disorders, attacks of aggression and depression. Side effects include weakness, poor appetite, a drop in blood pressure and suppression of hematopoiesis functions.
Treatment of persecution mania is also carried out using cognitive behavioral therapy, the purpose of which is to help a person master effective ways to overcome the fear of persecution.
In addition, it is necessary to treat the underlying disease, i.e. schizophrenia, dementia, Alzheimer's disease, etc. See more - Treatment of schizophrenia
Forecast
It is impossible to give an accurate prognosis for this type of paranoid disorder, although it is clear that a person in such a state has significant limitations in social, professional and other areas of life.
In conclusion, the answer to the question of how to behave with a person suffering from persecution mania? Psychiatrists advise avoiding persistently trying to convince a person suffering from persecution mania of his erroneous views: this will only worsen his condition and make you one of the "pests" or even "enemy number one". People with this psychotic disorder do not admit their illness, and no arguments work on them. 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 with the patient by caring for his sense of safety and not giving reasons for anxiety and destructive behavior when communicating with you.