Schizophrenia and delusional syndrome

The content of schizophrenic delirium can be varied, but the idea of hostile influence from the outside always goes through the delusions of delusion. Specialists call schizophrenia typical of a gradually developing persecutory nonsense in combination with the patient’s confidence that everything that happens is not accidental, but is addressed to him: words, gestures, remarks, actions of others. This perception is called the delirium of the relationship, and it is detected, according to some sources, in about seven out of ten diagnosed schizophrenics. The patient constantly feels himself in the center of what is happening, and perceives the judgments and actions of others at his own expense, and evaluating their value is almost always negative. As already mentioned, for schizophrenia, the most pathognomic is chronic systematic delirium, caused by a specific allegorical interpretation of the surrounding events (delusional perception).

According to the severity and development of the disease, they are distinguished in accordance with the stages of the development of the disease (the main differences are described above): paranoid, paranoid and paraphrenic syndromes. [1]

The role of deception in deliberation is considered proven. Everyone knows about auditory hallucinations in schizophrenics, pseudo-hallucinations are well described, the issue of illusions is less covered, but all these phenomena play a large role in the formation of delirium. Fraud perception usually occurs later than delirium, sometimes a sufficiently long period of time passes. Thanks to them, delirium becomes less systematized and real. The presence of both positive symptoms is characteristic of paranoid schizophrenia and is called hallucinatory-delusional (hallucinatory-paranoid) syndrome. V.A. Gilyarovsky noted that when the hallucinatory phase has passed, the delusional plot becomes more distinct, and when combined with bright hallucinations, the delirium dims and “collapses”. [2]

Kandinsky-Clerambo syndrome, which is quite common in schizophrenia in the paranoid and paraphrenic stages, is a type of hallucinatory-delusional syndrome with manifestations of mental automatism. The patient believes that he does not rule either his thoughts or his body, they control him from the outside, like a puppet (thoughts are stolen, words, facial expressions, gestures, movements are replaced, even internal organs work at the direction of evil manipulators). In this case, there is a combination of delusions of persecution and influence.

The visual perception is also distorted in patients: they do not recognize friends and relatives or see completely different faces in them, but when they recognize, they claim that they were made up and replaced. The phenomena of delusional perception include disorientation - the patient does not understand where he is. From delusional perception is formed through pathological fantasies and later painful understanding of the perceived. Logical constructions correspond to the main plot of delirium. [3]

Patients feel reality accordingly with their delusional experiences and without deception. For example, seeing a crowd on the street, the patient can be sure that she gathered for him, and by no means with friendly intentions. It seems to him that all eyes are riveted to him, conversations are only about him, he even “hears” his name, threats or condemnation addressed to him. This reinforces his ideas. [4]

The content of delusional syndrome in schizophrenia is divided into the following types:

• nonsense of the relationship - everything that happened from facial expressions and gestures to words and actions is related to the patient and is interpreted by him in a negative way (they condemn me, they try to interfere with me, they hate me, etc.);
• persecutory delirium - the patient is sure that he is being pursued by real or fictional characters with the goal of causing damage, and with schizophrenia they are often representatives of formations unusual for this culture and surrounding reality (extraterrestrial civilizations, Masonic or magical organizations, foreign intelligence);
• delirium of influence - the patient is convinced that he acts and thinks according to someone else's, basically, hostile will: he claims to be zombified, magnetic (electric) fields, radio waves, magic act on him; as an option - the penetration of foreign objects into the brain, heart, other parts of the body; this also includes openness and theft of thoughts.

These types of delirium are most common with schizophrenia, they are combined with one another and practically do not delimit from each other. A fairly common version of the delirium of relations, sometimes mixing of the main types of delirium, the scramble syndrome (querulantism) - endless complaints to various instances, filing statements of claim to the courts, and the patient usually disputes any decisions made. It is impossible to satisfy him. Dissatisfaction can have a real basis, often complaints relate to shortcomings in the housing and communal services sector, noisy neighbors, but it can also be delusional - complaints of persecution, witchcraft, attempts to kill (more often this is delirium poisoning). [5]

Separately, it is necessary to note the delirium of greatness. It represents a pathological unwavering confidence of the patient in his own exclusivity and significant superiority over others. Delirium or delusions of grandeur is much more common in other disorders - paranoid disorder, in the clinic of manic syndrome, organic lesions of cerebral structures, paralytic dementia. Schizophrenia with crazy ideas of greatness, according to experts, speaks of a deep damage to the brain, and occurs at least at the paranoid stage of the disease. This type of delirium is most characteristic of the late, paraphrenic stage, its undeveloped episodes are found in severe forms of schizophrenia - catatonic (typical is the theatrically proud pose of a patient with schizophrenia with delusions) or hebephrenic, for example, in a state of euphoria. Moreover, against the background of a decline in emotional reactions, the patient's behavior can be mistaken for paralytic dementia. Overvalued ideas can develop into a delirium of greatness syndrome. Also, over time, the pathological conviction of persecution becomes delusional knowledge that enemies are interested in destroying or capturing a patient who owns a great secret. Hand in hand with the delirium of greatness comes with a syndrome of invention, or rather, creativity (patients are convinced not only of their great discoveries, but also attribute to themselves the known achievements in the field of science and art made by others). [6]

The following subjects are less pathognomic, according to psychiatrists:

• hypochondriacal delirium - deep confidence in the presence of a severe somatic pathology, with very eccentric and absurd complaints of the patient and behavior that is not consistent with the described condition;
• delirium poisoning - typical for age-related patients, may have the presence of real symptoms of pathology of the digestive organs;
• delirium of jealousy (Othello syndrome) - according to experts, it does not occur in schizophrenics as often as in other mental disorders (chronic alcoholism, organic brain damage, schizoid psychopathy), in female patients it is usually combined with severe depressive disorder, for men it is characterized by excitement -aggressive behavior;
• erotic delirium (Clerambo syndrome) - it is based on the crazy idea that someone is in love with a patient (an object is real, almost always inaccessible - an actor, politician, astronaut), the patient interprets the views, gestures, words of the object in favor of his conviction, spending most of his time in fantasies about a relationship with him; more common in women, a well-known, wealthy man with a higher social status is chosen as an object; usually systematized; the plot is reduced to the fact that various circumstances interfere with the reunion of lovers, the initiative came from the object, the theme of its own significance for it is being discussed;
• archaic nonsense - the foundation is a variety of religious movements, superstition, witchcraft, legends of vampires, werewolves, etc.;
• false recognition (Kapgra syndrome) - the belief that people can change their appearance, of course, the purpose of such a transformation is to harm the patient; the schizophrenic does not recognize well-known people, but in strangers he recognizes loved ones; combined with delusions of persecution, greatness, creativity and others;
• affective delusional syndrome in schizophrenia - delirium with mood disorders more often in the direction of reducing emotional reactions with the ideas of self-accusation, persecution, relationships, often leading to an attempt at suicide, is the most common with schizophrenia; nevertheless, in some cases there are manifestations of hyperthymia (among inventors and other "great" figures) and vivid emotional outbursts of fun, joy or rage, anger.

The tendency to aggression in schizophrenia also stands out in the syndrome. The presence of delusions of persecution, attitude and / or influence, especially in combination with the imperative voices of criminal-sadistic content, are an indication of the high probability of the patient's dangerous actions directed at himself or others. Most often, unprovoked aggression is manifested by persons with paranoid schizophrenia.

With delusional schizophrenia, depersonalization / derealization syndrome may develop. It manifests itself in seizures or takes a chronic lingering course and is combined with mental automatism syndrome. Delusional autopsychic depersonalization results in delusions of obsession, mental transformation, Kapgra syndrome; somatopsychic provokes the delirium of denial, physical transformation into another creature; delusional derealization is manifested by the delirium of a change in elements or the whole surrounding reality (intermetamorphosis); nonsense about parallel worlds, the end of the world. [7]

Total depersonalization and derealization lead to the development of a rather rare syndrome called Kotar delirium. It manifests itself against the background of an oppressed mood and is characterized by fantastic nihilistic delusions of a global scale at the level of his guilt in the death of mankind, the destruction of civilization, hypochondriacal delirium about his own destruction (“living dead”). Psychiatrists interpret it as a nihilistic and decadent delirium of greatness with a minus sign.

Not all psychiatrists admit that with schizophrenia there may be a oneeroid stupefaction, causing fantastic delusional experiences. However, the majority believes that oneiric syndrome occurs, although due to the peculiarities of the patient’s behavior it is not difficult to “look through” it.

Obsessive-compulsive syndrome often develops with a delusional form of schizophrenia, since obsession and delirium according to I.P. Pavlov has a single mechanism - the inertia of the focus of excitation. The obsessions in schizophrenics are manifold, quickly overgrow with protective rituals, which are absurd and reminiscent of a syndrome of mental automatism. They are not caused by external influences - no connection with the stressful situation is established, but often a connection with hypochondriacal delirium is traced. They tend to generalize. There is a noticeable time interval between obsessions (obsessions) and compulsions (ritual protective actions). Obsessive thoughts are usually complemented by delusions. Of the obsessive states, the most common is misophobia and oxyphobia - fear of pollution and fear of sharp objects.