Moderate zone with paranoid syndrome. Paranoid (paranoid syndrome)

Paranoid syndrome It can develop both reactively and chronically, but most often it is dominated by poorly systematized (sensual delirium).

The paranoid syndrome should not be confused with the paranoid one - although the content of delusional ideas may be similar, these conditions differ both in their “scope” and speed of development, as well as in the characteristics of their course and further prognosis. In paranoid syndrome, delusions most often develop gradually, starting with small ideas and growing into a strong, systematized delusional system that the patient can clearly explain. With sensory delusions, which usually develop as part of the paranoid syndrome, systematization is quite low. This is due to the fact that delirium is either fantastic in nature, or due to the rapid increase in painful symptoms, it is still little realized by the patient, in whose picture of the world it suddenly appears.

Paranoid syndrome can develop both as part of schizophrenia, psychotic disorders with organic brain lesions, and as part of bipolar disorder affective disorder(formerly manic-depressive psychoses). But still more often with the first and last.

Forms of paranoid syndrome

Depending on which specific symptoms appear most clearly in the clinical picture, within the framework of the paranoid syndrome the following are distinguished:

affective-delusional syndrome, where there is sensory delirium and a change in affect, there can be two variants: manic-delusional and depressive-delusional (depressive-paranoid syndrome), depending on the leading affect. It is worth noting that the content of delusional ideas will correspond here to the “pole” of affect: with depression, the patient can express ideas of self-blame, condemnation, persecution; and with mania - ideas of greatness, noble origin, invention, etc.
hallucinatory-delusional (hallucinatory paranoid syndrome), where hallucinations come to the fore, that this does not exclude the presence of affective delusional disorders, but they are not in the foreground here.
hallucinatory-delusional syndrome with the presence of mental automatisms- in this case we can talk about Kandinsky-Clerambault syndrome,
actually paranoid syndrome without other pronounced and prominent other disorders. Only unsystematized, sensual delirium prevails here.

Treatment of paranoid syndrome

Treatment of paranoid syndrome requires urgent intervention from specialists, since, as practice shows, neither delusions nor hallucinations, especially against the background of endogenous (caused internal reasons) diseases that do not go away “on their own”, their symptoms only tend to increase, and treatment has the greatest effect when it begins as early as possible. Indeed, it happens that in some cases people live in a delusional state for years. But loved ones need to understand that the prognosis of the disease, and the person’s life history in the future, depend on the quality of the care provided and its timeliness.

Treatment of paranoid syndrome, like any disorder characterized by hallucinations and delusions, usually requires hospitalization: after all, it is necessary to effectively relieve the existing symptoms, and before that, to comprehensive diagnostics and determine the cause of the condition. All this can be effectively implemented only in a hospital setting. The presence of hallucinations or delusions in the clinical picture is always an indication for the use of pharmacological therapy. No matter how negatively some ordinary people view it, it is thanks to pharmacology that psychiatrists have been able to successfully cope with acute psychotic conditions for decades, thereby returning patients to normal activity and the opportunity to live fully.

Again, you need to understand that sensory (unsystematized) delusions, accompanied by hallucinations, can be a source of danger both for the patient himself and for the people around him. Thus, with delusions of persecution (and this is one of the most common types of delusions), a person may begin to flee or defend himself, thereby causing irreparable damage to his own health. Delusions of self-deprecation, which often develop with depressive-paranoid syndrome, are also dangerous.

Often the situation develops in such a way that the patient himself does not consider net worth as painful, and, naturally, resists not only the possibility of inpatient treatment, but also a simple visit to the doctor. However, loved ones need to understand that there is no other way to help a person other than to treat him inpatiently.

Some psychiatrists cite as examples sad cases when a paranoid state with sensory delusions and hallucinations first manifests itself, for example, in childhood. But relatives, due to stereotypes, not wanting to “label the child,” go not to doctors, but to healers, resort to the use of religious rituals, which only triggers the disease, making it chronic. You can also often see examples of how relatives, not understanding the seriousness of the illness of a person close to them, resist with all their might the hospitalization of adults.

However, if there is someone to take care of the patient, but he himself does not want to acute condition receive necessary treatment, then the law specifically for these cases provides for the possibility of involuntary hospitalization. (Article No. 29 of the Law on the provision of psychiatric care). The law provides for involuntary hospitalization if the patient's condition threatens his own safety or the safety of others. Also this kind help can be provided if the patient cannot ask for it due to illness, or if failure to provide him with help will lead to further deterioration of his condition.

Every citizen of our country has the right to receive this type of assistance free of charge. However, many are frightened by publicity, and the very prospect of falling into medical institution. If the issue of private provision of psychiatric care, as well as complete anonymity, is of fundamental importance to you, then you should contact a private psychiatric clinic, where even a treatment option is possible when you are offered to remain completely anonymous.

Modern medicine has long been able to treat this kind of disorder, diagnose the underlying cause of the disease and offer various ways treatment.

Thus, only a qualified psychiatrist is able to determine both the underlying disease and prescribe quality treatment for paranoid syndrome.

Important: symptoms of paranoid syndrome can increase rapidly. No matter how strange the behavior may seem to you loved one, which has changed instantly, do not try to look for metaphysical, religious or pseudo-scientific explanations. Every disorder has a real, understandable, and, most often, removable cause.

Contact the professionals. They will definitely help.

Hallucinatory-paranoid syndrome is a condition in which delusions of persecution and influence, phenomena of mental automatism are combined with pseudohallucinations. Delusions of influence are extremely diverse in content: from witchcraft and hypnosis to the most modern technical methods or devices - radiation, atomic energy, laser beams, etc.

Mental automatisms- “made” thoughts, sensations, movements, actions that appear, according to the patient’s conviction, as a result of the influence of one or another external force on the body. Mental automatisms include sensory, ideational and motor components and are manifested by a feeling of mastery of certain mental functions of the patient, resulting from exposure to one or another type of energy.

In a patient, these automatisms are not necessarily observed simultaneously, in aggregate, but develop as the disease progresses, usually in the sequence described below.

Ideatorial (associative) automatisms- the result of an imaginary influence on thinking processes and other forms of mental activity. The first manifestations of ideatorial automatisms are mentism (non-stop, often fast current thoughts, accompanied in some cases by corresponding figurative ideas and a feeling of vague anxiety) and a symptom of openness, expressed in the feeling that the patient’s thoughts are known to others. Ideation automatisms also include the sound of thoughts: no matter what the patient thinks about, his thoughts sound loudly and clearly in his head. The sound of thoughts is preceded by the so-called rustle of thoughts. This type of automatism also includes “thought echo”: those around them repeat the patient’s thoughts out loud. Subsequently, the following symptoms develop: withdrawal of thoughts (the patient’s thoughts disappear from the head), made thoughts (the patient’s conviction that the thoughts he has are fabricated by strangers, usually his persecutors), made dreams (dreams of a certain content, most often with a special meaning, caused by external influences), unwinding of memories (patients, against their will and desire, under the influence of an outside force, are forced to remember certain events of their life, and often at the same time the patient is shown pictures illustrating the memories), made mood, made feelings (patients claim that their moods , feelings, likes and dislikes are the result of external influences).

Senestopathic (sensory) automatisms- extremely discomfort, arising in patients as a result of the imaginary influence of an outside force. These sensations can be quite varied: a feeling of sudden heat or cold, painful sensations in internal organs, head, limbs. Such sensations can be unusual and fanciful: twisting, pulsation, bursting, etc.

Kinesthetic (motor) automatisms: disorders in which patients have the belief that the movements they make are carried out against their will, under the influence of external influences. Patients claim that their actions are controlled, their limbs are moved, and they cause a feeling of immobility and numbness. Kinaesthetic automatisms also include speech motor automatisms: patients claim that their tongue is set in motion for the purpose of pronouncing words and phrases, that the words they utter belong to strangers, usually persecutors.

Pseudohallucinations- perceptions that arise, like hallucinations, without a real object. Unlike hallucinations, they can be projected not only externally, but also be “inside the head” and perceived by the “mind’s eye.” Unlike true hallucinations, pseudohallucinations are not identified with real objects and are perceived as made. The most significant difference: the patient feels that the pseudohallucinations are “made”, “caused” by some external force, cause. The structure of hallucinatory-paranoid syndrome includes visual, auditory, olfactory, gustatory, tactile, visceral, and kinesthetic pseudohallucinations.

Visual pseudohallucinations- “made” visions, images, faces, panoramic pictures that are shown to the patient, as a rule, by his persecutors using certain methods. Auditory pseudohallucinations - noises, words, phrases transmitted to the patient via radio, through various equipment. Pseudo-hallucinations, like true hallucinations, can be imperative and commentary, voices - male, female, children, belonging to familiar and unfamiliar persons. Olfactory, gustatory, tactile, visceral pseudohallucinations are identical in manifestation to similar true hallucinations; the only difference is that they are perceived as done.

Variants of the syndrome according to the course.
Spicy hallucinatory-paranoid syndrome is characterized by a great sensitivity of delusional disorders with no tendency to systematize them, the severity of all forms of mental automatisms, the affect of fear and anxiety, confusion, and transient catatonic disorders.

Chronic hallucinatory-paranoid syndrome. In the clinical picture there is no confusion, no brightness of affect, there is systematization or (with the development of abundant pseudohallucinations) a tendency to systematize delusional disorders. At the height of development, phenomena of delusional depersonalization (the phenomenon of alienation) often arise.

Options for structure.
Hallucinatory version. The picture of the condition is dominated by pseudohallucinations; a relatively insignificant proportion of delusions of influence, persecution, and especially the phenomena of mental automatism is observed.

Crazy option. Delusional ideas of influence and persecution, as well as mental automatisms, come to the fore, and pseudohallucinatory disorders are relatively weakly expressed.

Kandinsky-Clerambault syndrome in the structure of individual diseases. Hallucinatory-paranoid syndromes are observed in various mental illness: schizophrenia, occurring continuously and in the form of attacks, epilepsy, protracted symptomatic psychoses, chronic alcoholic psychoses, organic brain diseases.

Paranoid syndrome is special kind insanity, which is characterized by a near-delusional state with fragmentary, incoherent ideas. All of them may not even have a thematic connection with each other, which distinguishes this phenomenon from others from the same series (for example, from paranoid syndrome). Often delusional ideas are associated with persecution, hallucinations, and a state of mental automatism. The causes of paranoid syndrome are often a state of stress, anxiety, hallucinations, and fears.

Paranoid syndrome - symptoms

The doctor who notes paranoid symptoms, in most cases, is convinced that the disorder is already of considerable depth. The disease permeates not only the thinking, but also the behavior of the patient. Symptoms of paranoia include:

predominance of figurative delirium;
auditory hallucinations;
anxiety and depressed mood;
systematization of delusional ideas - the patient can name the essence of the phenomenon that he is afraid of (for example, persecution), its date, purpose, means, end result;
the patient himself perceives delirium as insight;
delusional relationship: the patient thinks that strangers on the street they “hint” at something, look at each other;
delusions can be combined with hallucinations of any type;
delusions of persecution;
sensory disorders.

A paranoid state often occurs with somatically caused mental illness and is often accompanied by pseudohallucinations. It is worth noting that there are two options for the course of the disease:

It is believed that it is easier to establish a diagnosis and choose a treatment method for paranoid behavior of the hallucinatory type, since it is possible to find out the characteristics of the patient’s condition.

Paranoid syndrome - treatment

If you notice the symptoms listed above in yourself or someone close to you, be sure to consult a psychiatrist. On early stages Mental illnesses are easier to treat, but in an advanced state the disease becomes very dangerous. As a rule, complex treatment is prescribed: psychotherapeutic techniques are combined with medication.

These disorders tend to progress as the disease progresses. Delusion is one of the most characteristic and common signs of mental illness. The content of delusions can be very different: delusions of persecution, delusions of poisoning, delusions of physical impact, delusions of damage, delusions of accusation, delusions of jealousy, hypochondriacal delusions, delusions of self-abasement, delusions of grandeur. Very often, types of delusions of different content are combined.

Delusions are never the only symptom of mental illness; as a rule, it is combined with depression or manic state, often with hallucinations and pseudohallucinations (see. Affective syndromes, Hallucinatory syndromes), confusion (delirious, twilight state). In this regard, delusional syndromes are usually distinguished, differing not only special forms nonsense, but also a characteristic combination various symptoms mental disorders.

Paranoid syndrome is characterized by systematized delusions of varying content (invention, persecution, jealousy, love, litigious, hypochondriacal). The syndrome is characterized by a slow development with a gradual expansion of the circle of persons and events involved in delirium, and a complex system of evidence.

If you do not touch the “sore point” of thinking, the behavior of patients is not detected significant violations. With regard to the subject of a delusional idea, patients are completely uncritical and cannot be persuaded, easily enrolling those who are trying to dissuade them into the camp of “enemies, persecutors.” The thinking and speech of patients is very detailed, their stories about “persecution” can last for hours, it is difficult to distract them. The mood is often somewhat upbeat, patients are optimistic - they are confident in their rightness, the victory of the “just cause”, however, under the influence of an unfavorable, from their point of view, external situation, they can become angry, tense, commit social dangerous actions. In paranoid delusional syndrome, there are no hallucinations or pseudohallucinations. It is necessary to distinguish paranoid delusional syndrome from an “overvalued idea”, when a real life problem becomes psychologically healthy person excessively large (overvalued) value. Paranoid delusional syndrome most often occurs in schizophrenia (see), less often in other mental illnesses (organic brain damage, chronic alcoholism, etc.).

Paranoid syndrome is characterized by systematic delusions of persecution, physical impact with hallucinations and pseudohallucinations and phenomena of mental automatism. Typically, patients believe that they are being persecuted by some kind of organization, whose members are watching their actions, thoughts, and actions, because they want to disgrace them in the eyes of people or destroy them. “Persecutors” operate with special devices emitting electromagnetic waves or atomic energy, using hypnosis, controlling thoughts, actions, moods, and activities internal organs(phenomena of mental automatism). Patients say that their thoughts are taken away from them, that they put in other people’s thoughts, that they “make” memories, dreams (ideational automatism), that they specifically cause unpleasant painful sensations, pain, that their heartbeat increases or slows down, urination (senestopathic automatism), that they are forced to various movements, speaking their language (motor automatism). In paranoid delusional syndrome, the behavior and thinking of patients is impaired. They stop working, write numerous statements demanding protection from persecution, and often take measures themselves to protect themselves from rays and hypnosis ( special ways insulating the room, clothes). Fighting against “persecutors,” they can commit socially dangerous actions. Paranoid delusional syndrome usually occurs in schizophrenia, less often in organic diseases of the central nervous system. nervous system(encephalitis, cerebral syphilis, etc.).

Paraphrenic syndrome is characterized by delusions of persecution, influence, and phenomena of mental automatism, combined with fantastic delusions of grandeur. Patients say that they are great people, gods, leaders, the course of world history and the fate of the country in which they live depend on them. They talk about meetings with many great people (delusional confabulations), about incredible events in which they were participants; at the same time, there are also ideas of persecution. Criticism and awareness of the disease are completely absent in such patients. Paraphrenic delusional syndrome is observed most often in schizophrenia, less often in psychosis late age(vascular, atrophic).

Acute paranoid. With this type of delusional syndrome, acute, concrete, figurative, sensory delusions of persecution with an affect of fear, anxiety, and confusion predominate. There is no systematization of delusional ideas, they occur affective illusions(see), individual hallucinations. The development of the syndrome is preceded by a period of unaccountable anxiety, anxious anticipation of some kind of misfortune with a feeling of unclear danger (delusional mood). Later, the patient begins to feel that they want to rob him, kill him, or destroy his relatives. Delusional ideas are changeable and depend on the external situation. Every gesture and action of others causes a delusional idea (“there is a conspiracy, they are giving signs, preparing for an attack”). The actions of patients are determined by fear and anxiety. They may suddenly run out of the room, leave the train, bus, seek protection from the police, but after short period calm, a delusional assessment of the situation in the police begins again, and its employees are mistaken for “members of the gang.” Usually, sleep is severely disturbed and there is no appetite. Characterized by a sharp exacerbation of delirium in the evening and at night. Therefore, during these periods, patients need enhanced supervision. Acute paranoid can occur with a variety of mental illnesses (schizophrenia, alcoholic, reactive, intoxication, vascular and other psychoses).

Residual delusions are delusional disorders that remain after psychoses that occur with clouding of consciousness have passed. May continue different times- from several days to several weeks.

Patients with delusional syndromes must be referred to a psychiatrist at a psychiatric clinic, patients with acute paranoid - to a hospital. The referral must contain fairly complete objective information (from the words of relatives and colleagues) about the characteristics of the patient’s behavior and statements.

Symptoms of paranoid psychosis. Classification, complications and treatment

Paranoid or paranoid psychosis is a personality disorder accompanied by delusional ideas of various nature, often through actions and threats. Hallucinations are uncommon. There is no obvious organic cause of the disease. Maybe like isolated syndrome, and a manifestation of schizophrenia or the result of alcohol abuse (alcoholic paranoid).

Classification

The most common classification of psychoses of the paranoid type is based on variants of delusional ideas.

Delirium of grandeur. Attributing superpowers to oneself, identifying with famous people, book heroes, mythological characters and any other popular personalities. Taking credit for inventions and discoveries. There is a variant of religious delusions of grandeur, in which case the patient often becomes the head of a new religious cult.
Erotomanic delusions are similar to delusions of grandeur and involve attributing to oneself loving affection from others. famous personalities. In most cases it is romantic love without a sexual context. The object of attachment is not necessarily familiar to the patient.
Somatic delirium. Belief that you have a physical injury or an incurable disease.
Delirium of persecution. It occurs more often than others. A variant of a delusional disorder in which the patient is convinced that he or his relatives are being watched with the aim of causing harm.
Delirium of jealousy. Confidence in the betrayal of a partner or spouse. It can refer to both recent times and extend into the past. It may be aggravated by the idea that children are born from someone else’s man. This version of delusion is very characteristic of alcoholic paranoid.
Unspecified variant of delusional disorder. In this case, there is either a combination of several types of delusions, for example, grandeur and persecution, or complaints that are not typical for the above options of delusions. There are many options for nonsense. For example, patients may be convinced that all people have been replaced by doubles, or that the patient himself has a double, that the patient is a werewolf, that everyone around him is one person changing his appearance.

Symptoms of paranoid psychosis

In all forms of paranoid personality change, one can distinguish common features:

Suspicion, mistrust. This is the main one distinguishing feature paranoid psychosis. Suspicions are completely unfounded, often absurd. Their target can be anyone, from immediate family to a person who travels to work with the patient. He arbitrarily selects one or a group of people “conducting surveillance” or “plotting a crime” and in the future all their words and actions are perceived as confirmation of the patient’s conjectures.
The words of others are perceived as threats and hints. This applies not only to those whom the patient considers enemies, but also to everyone around him. The patient sees hints even in completely harmless phrases; it seems that people are looking at him too closely, winking, agreeing on something behind his back.
Ideas about betrayal by friends and colleagues. Once they arise, these ideas constantly find confirmation. The patient sees sidelong glances, hears whispers, and suspects everyone around him of a conspiracy.
Inappropriate response to criticism. Paranoid psychosis causes a sharp impatience with all types of criticism. The smallest comments, attempts to correct anything made by the patient are perceived sharply negatively. The patient sees in these gestures signs of a general conspiracy to harm him, to hide the planned evil from him. Even completely sincere concern is perceived as a disguise for a conspiracy.
Inability to forgive, resentment. All grievances, including far-fetched ones, are remembered by the patient and serve as a source of constant reproaches to loved ones. Even in cases where the patient is clearly wrong, he does not admit it, and perceives the situation as another confirmation of a universal conspiracy.

Complications of paranoid psychosis

Constant suspicion and high psycho-emotional stress in patients with paranoid psychosis lead to various social and personal consequences:

Lack of sense of responsibility. People around them are usually blamed for the patient’s disturbed state, as a result of which the patient himself does not consider it necessary to make efforts to change the situation.
Poor stress tolerance. In response to stress, reactions that are inadequate in strength occur, manifestations of affect or depressive states are frequent.
The emergence of addictions (alcoholism, drug addiction).
Refusal of treatment.

Treatment

The issue of hospitalization is decided individually. If there is a threat to the life or health of others from the patient, suicidal tendencies, the likelihood of causing damage during work, severe social maladaptation - treatment should occur in inpatient conditions. Hospitalization is also recommended if further examination is necessary to clarify the diagnosis.

Most patients can be convinced of the need for hospitalization. In case of persistent resistance, it may be necessary to resort to forced hospitalization in agreement with relatives.

For cupping acute attacks delirium, accompanied by motor agitation, tranquilizers are prescribed. The drugs of choice for maintenance therapy are neuroleptics and antipsychotics. It is possible to delay the start of treatment to achieve greater patient compliance with treatment. It is imperative to warn the patient about the side effects of medications - their unexpected appearance can contribute to increased delusions of persecution and harm.

Psychotherapy is mandatory component treatment. It is important to establish maximum trust between the patient and the doctor. The goal of treatment at the first stage is to convince the patient to take medications regularly. At the beginning of treatment, one should not concentrate on the inconsistency of delusional ideas. Paranoid psychosis is manifested by mood swings, anxiety, feeling unwell. The emphasis should be on treating these symptoms. And when the medications begin to work, gradually show the patient the inconvenience of delusional ideas in life and interest him in real events.

Explicit cooperation between a doctor and relatives is usually difficult, since the patient regards it as a “conspiracy.” However, such cooperation is necessary. The family must trust the doctor, monitor the implementation of his prescriptions, and help create a healthy atmosphere in the patient’s environment.

Despite significant advances in medicine, paranoid psychosis cannot always be completely cured. The main criterion for the success of therapy is the restoration of social connections and the patient’s adaptation to public life, and not the disappearance of delusional ideas.

All about paranoid (paranoid) psychosis

Paranoid or paranoid psychosis refers to delusional mental disorders and at the same time to acute psychoses. Experts believe this state one of the most common forms mental disorders, and the reasons for the development of paranoid psychosis can be quite diverse.

The central symptom of paranoid psychosis is a pronounced picture of delusion, in which the patient is most often convinced that someone is stalking him or that something is threatening him. As a rule, this psychosis develops in people with a certain personality type: suspicious, anxious, suspicious by nature.

Causes of development of paranoid psychosis

Most common cause This mental disorder is caused by organic brain damage, and paranoid psychosis can occur when chronic alcoholism, drug use. This form of psychosis is characterized by feelings of anxiety, persecution mania, motor agitation, attacks of fear and even aggression.

In addition, paranoid psychosis can be one of the manifestations of schizophrenia. In this case, the basis of the symptoms is almost always Kandinsky-Clerambault syndrome (“alienation syndrome”), in which the patient seems to feel someone else’s influence on his own behavior and thoughts, and sometimes believes that a certain force also influences the people and objects around him.

By the way, you've probably heard about cases when older people begin to complain about “bad” neighbors who are trying to “poison them through the socket” and plot other intrigues of a similar nature. Such complaints are not always paranoid psychosis, but they certainly indicate the development of a mental illness in a person.

Classification of paranoid psychoses

Types of paranoid psychosis are determined by specialists based on the variants of delusional ideas that the patient describes:

The most common clinical picture is delusion of persecution, when the patient constantly feels that someone is threatening him and wants to cause harm.
Delusions of jealousy manifest themselves in the form of obsessive thoughts about a partner’s infidelity. According to statistics, men are more likely to suffer from this condition than women.
Somatic delirium is expressed in the patient's complaints about disturbances in physical health. A person constantly thinks that he is suffering from a serious and even incurable disease.
Delusions of grandeur can manifest themselves in different ways: in one case, the patient identifies himself with the real historical character, a literary hero, a great politician, a pop star, and so on, in another - he considers himself capable of global achievements (of which in reality there is no talk).
Erotomanic delirium, on the contrary, is directed at some famous person. It seems to the patient that this person has love and passion for him, although in fact the patient and the object of his desire may not even be familiar.
At mixed type delusional disorder, the above ideas may appear together or replace each other.

Kandinsky-Clerambault syndrome, delusions of influence. In the video, the patient describes her feelings, explaining her own reactions and thoughts to outside influences.

Symptoms of the disease

In addition to the expanded clinical picture delusions, all paranoid disorders have common features. These symptoms of psychosis appear in almost all patients, so psychiatrists pay special attention to such complaints in order to make the correct diagnosis.

Patients with this form mental disorder distinguished by suspicion and distrust of people around him. Such thoughts can begin to develop long before the disease enters acute phase. Expecting a trick from outside world Over time, it takes on obsessive forms, and sometimes complete strangers, with whom the patient has nothing in common, come under suspicion. Any extraneous conversation is perceived by a person as a threat or a hint of it, which forces a person with a disturbed psyche to constantly live in a state of tension, readiness to defend.

The patient may consider those closest to him to be potential traitors who are just waiting to harm him. As the disease progresses, the patient finds “confirmation” of his suspicions, which leads to gradual isolation from society.

Sharp intolerance even towards constructive criticism may also be a symptom of developing paranoid psychosis. Attempts to point out to the patient his mistakes cause a violent reaction and are perceived by him as manifestations of a general conspiracy to harm and humiliate his dignity.

Sincere care and participation in the eyes of a mentally ill person turn into a “cover” for the implementation of ideas of a conspiracy against him. Attempts to help may be perceived as a desire to gain confidence in order to cause moral or physical pain. Therefore, friendship with such a person will never work out, since he perceives any manifestation of participation as a potential threat.

With paranoid disorder, the patient carefully “collects” his grievances, completely unable to forgive them. He may remember something that happened many decades ago - but for his sick imagination, the old resentment will be just as sharp and deep, no matter how much time has passed. The accumulation of grievances gives rise to constant reproaches and the emergence of new disappointments in loved ones.

Paranoid psychosis tends not only to progress quickly, but also to turn into chronic form. In the absence of treatment, over time, the patient almost completely loses his sense of responsibility (in any situation, from his point of view, other people or undefined “higher powers” will be to blame), depression may develop, alcohol addiction and others pathological conditions. Any stress becomes unbearable for a mentally ill person, even to the point of suicidal thoughts and even attempts. In severe cases, it is possible to develop affective state, when the patient moves from suspicion to real action in order to physically “deal” with many of his enemies and simply unpleasant people.

Treatment of paranoid psychosis

Unfortunately, paranoid psychosis is not always completely curable. This is partly explained by the fact that even the very fact of treatment is perceived by the patient as part of a conspiracy against him, so even doctors are not always able to persuade the patient to take medications or go to the hospital.

If a person agrees to accept professional help, then the issue of hospitalization is decided individually in each case. Treatment in a hospital is definitely necessary if the patient exhibits symptoms that are dangerous to himself or others. In this case, most often hospitalization becomes compulsory.

Important! Paranoid psychosis must be differentiated from other disorders with similar symptoms. For example, depressive-paranoid manifestations are characteristic of delusional depression, and excessive anxiety about own health maybe even banal hypochondria. Only experienced doctor can accurately determine what kind of disorder he is dealing with; self-medication and self-diagnosis for such disorders are categorically unacceptable!

After a thorough examination of the patient, doctors prescribe therapy:

tranquilizers to relieve motor agitation;
antipsychotics to relieve symptoms of psychosis;
antidepressants if signs of depression are present;
psychotherapy to teach the patient to accept his condition and adapt to life in society again.

The earlier treatment is started, the greater the patient’s chances of returning to normal life. But it is worth remembering that paranoid psychosis cannot be cured in one month; this disease can remain with a person all his life, and it is not always possible to cure it completely. However, in any case, the patient must maintain contact with the attending physician, attend appointments on time and regularly take prescribed medications. If the patient “goes into denial” again, then the likelihood of relapse increases significantly, and the consequences can be quite severe - both for the patient himself and for the people around him.

What is paranoid psychosis

Paranoid psychosis is a severe mental disorder accompanied by delusions. The current is characterized by ideas of persecution and aggression. Hallucinations do not occur in paranoid psychosis.

The disorder can develop independently or be a consequence of schizophrenia or alcohol abuse. It is a more severe form than paranoia, but milder than paraphrenia.

Types of paranoid psychoses are differentiated depending on the delusional states accompanying the course of the disorder:

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Causes

Paranoid psychosis is of organic origin. It occurs with pre-existing somatic disorders. As causal factors may include: brain injuries, progressive cerebral syphilis, vascular atherosclerosis.

The occurrence of this type of psychosis is influenced by external and internal factors.

reasons related to metabolic processes in organism;
diseases caused external influence or internal pathological processes;
factors of neuroendocrine nature (damage to the nervous system and endocrine glands);
hereditary predisposition;
the circumstances under which the formation of personality took place.

Alcoholic paranoid develops with chronic alcoholism, manifested by delusions of persecution, anxiety states and phobias, motor agitation.

Read here what Korsakoff psychosis is.

Symptoms

With paranoid psychosis of any type, a typical clinical picture can be observed:

This hallmark paranoid psychosis.
All suspicions are illogical and devoid of common sense.
The characters can be both close people and complete strangers.
The patient randomly forms a group of “pursuers” or chooses one person (it is enough to get off the transport with him at the same stop), and in the future any conversations or actions will be considered as confirmation of his speculations.

Moreover, this applies not only to those people with whom the patient is in conflicting relationships, but also to everyone else.
The patient feels that they are looking at him too closely, and that a conspiracy is being hatched behind his back.

The slightest and completely logical attempts by another person to intervene cause a storm of negative emotions.
Moreover, even a sincere desire to help is seen as an attempt to harm.

All grievances, including far-fetched ones, are a reason for constant reproaches.
The patient will never admit that he is wrong, and in general will view the situation as another attempt to harm him.

In combination with schizophrenia, it manifests itself as mental automatisms and pseudohallucinosis.

Sooner or later, paranoid psychosis leads to self-isolation.

Diagnostics

The diagnosis is made after examining the patient and talking with him. In this case, an imbalance of personal positions and disharmony in behavior should be revealed, which affect several areas of the patient’s life.

The specialist can detect inadequate defensive reactions in the patient.

The final confirmation is the patient’s complete denial of his condition and the need for treatment, even after discussing the negative consequences.

Treatment

The peculiarity of the disease is that it becomes chronic, and without treatment a person will behave the same throughout his life.

The decision to hospitalize a patient with paranoid psychosis is considered individually. In cases of aggressive behavior, suicidal tendencies, a threat to the life and health of others, the likelihood of causing damage, etc. – placement in a hospital is mandatory. Hospitalization is recommended in cases where additional examinations are required.

Some patients can be convinced of the need for treatment. If this cannot be done, then compulsory hospitalization can be used after agreement with relatives.

Drug treatment is not always prescribed, but only in cases where the symptoms are excessive or in the presence of concomitant diseases.

The doctor should tell the patient about the prescribed medications and their side effects, since their influence may increase persecutory delusions.

For exacerbations of delusional states occurring against a background of motor agitation, tranquilizers are prescribed. Neuroleptics are used for maintenance therapy. The doctor may delay treatment if there is a possibility that the patient himself may agree to the need for it.

To the complex therapeutic measures Psychotherapy is definitely included. It is this that is the basis of treatment. At the same time, at the initial stage, the main task of the doctor is to create a friendly atmosphere and a trusting atmosphere.

First of all, it is necessary to convince the patient of the advisability of taking the drugs. Initially, it is not necessary to focus the patient’s attention on treatment delirious state. Since paranoid psychosis is manifested by mood swings and anxiety, it is better to treat these manifestations at the first stage.

When someone is sick, it is better for relatives not to communicate with the doctor or discuss the course of the disease, as these actions will be regarded as collusion. However, loved ones can contribute to a speedy recovery by monitoring the intake of medications and creating a normal atmosphere in the patient’s environment.

Paranoid psychosis is not always treatable. The goal of therapy is not only to rid the patient of delusional ideas, but also to return the person to normal life, achieving adaptation in society.

Physiotherapy treatments can also be prescribed - massage, balneotherapy, which help restore the nervous system.

Complications

Psycho-emotional stress, accompanied by constant suspicion, can cause various social and personal consequences:

relinquishing one's sense of responsibility; the patient blames others for the resulting disorder, not wanting to take any actions aimed at recovery;
inability to tolerate stressful situations; usually manifested by a state of passion and severe depression;
addictions develop (alcohol, drugs);
categorical refusal of treatment.

Treatments for alcohol psychosis are listed in another publication.

The consequences of acute psychosis are listed here.

10. Basic delusional syndromes (paranoid, paranoid, paraphrenic), their dynamics, diagnostic significance.

Paranoid syndrome is a primary interpretive delusion with high degree systematization, characterized by plots of persecution, jealousy, invention, sometimes hypochondriacal, litigious delusions, material damage. There are no hallucinations in paranoid syndrome. Delusional ideas are formed not on the basis of errors of perception, but as a result of a paralogical interpretation of the facts of reality. Often the manifestation of paranoid delusions is preceded by the long existence of overvalued ideas. Therefore on initial stages illness, such nonsense can give the impression of plausibility. The patient’s passion for a delusional idea is expressed by thoroughness and persistence in presenting the plot (“monologue symptom”). Paranoid syndrome tends to be chronic and difficult to treat with psychotropic drugs. It may occur

not only in schizophrenia, but also in involutional psychoses, decompensations of paranoid psychopathy. Some psychiatrists describe it as independent disease. In schizophrenia, paranoid syndrome is prone to further development and transition to paranoid delirium.

A characteristic sign of paranoid syndrome is the presence of hallucinations (usually pseudohallucinations) along with systematized ideas of persecution.

The occurrence of hallucinations determines the emergence of new plots of delirium - ideas of influence (less often poisoning). A sign of the supposedly carried out influence, from the point of view of patients, is a feeling of mastery (mental automatism). Thus, in its main manifestations, paranoid syndrome coincides with the concept of the syndrome

mental automatism of Kandinsky-Clerambault. The latter does not include only variants of the paranoid syndrome, accompanied by true taste and olfactory hallucinations and delusions of poisoning. With paranoid syndrome, there is a certain tendency towards the collapse of the delusional system, delirium acquires features of pretentiousness and absurdity. These features become especially pronounced during the transition to paraphrenic syndrome.

Paraphrenic syndrome is a condition characterized by a combination of fantastic, absurd ideas of grandeur, complacent or high spirits with mental automatism, delusions of influence and verbal pseudohallucinations. Thus, in most cases paraphrenic syndrome can be seen as

the final stage of development of mental automatism syndrome. Patients are characterized not only by a fantastic interpretation of present events, but also by fictitious memories (confabulations). Patients show amazing tolerance to the supposed influence exerted on them, considering this a sign of their exclusivity and uniqueness. Statements lose their former harmony, and some patients experience a collapse of the delusional system. At paranoid schizophrenia paraphrenic syndrome is the final stage course of psychosis. In organic diseases, paraphrenic delusions (delusions of grandeur) are usually combined with severe impairments of intelligence and memory. An example of paraphrenic delusion in organic disease There are extremely ridiculous ideas of material wealth in patients with progressive paralysis (syphilitic meningoencephalitis).

Treatment. In the treatment of delusional syndromes, psychotropic drugs are most effective; The main psychotropic drugs are antipsychotics. Antipsychotics indicated wide range actions (aminazine, leponex) that help reduce the phenomena of psychomotor agitation, anxiety, and reduce the intensity of delusional affect. In the presence of interpretative delusions that show a tendency towards systematization, as well as persistent hallucinatory disorders and phenomena of mental automatism, it is advisable to combine the use of chlorpromazine (or leponex) with piperazine derivatives (triftazine) and butyrophenones (haloperidol, trisedyl), which have a certain selective activity in relation to delusional and hallucinatory disorders ). The presence of significant affective (depressive) disorders in the structure of delusional syndromes is

indication for combined use neuroleptics and antidepressants (amitriptyline, gedifen, pyrazidol).

In chronic delusional and hallucinatory-paranoid states, neuroleptics such as haloperidol, trisedyl, triftazine are used for a long time. In case of persistent phenomena of mental automatism and verbal hallucinosis, the effect is sometimes achieved by combining the action of psychotropic drugs: a combination of piperidine derivatives (neuleptil, sonapax) with haloperidol, trisedil, leponex and other antipsychotics.

Outpatient treatment is carried out with a significant reduction in psychopathological disorders (some of which can be considered within the framework of residual delirium) after completion of intensive therapy in a hospital setting.

In the absence of aggressive tendencies (in cases where delusional symptoms rudimentary and does not completely determine the patient’s behavior) treatment can be carried out on an outpatient basis; use the same drugs as in a hospital setting, but in medium and low doses. When the process stabilizes, it is possible to switch to drugs that are more mild action with a limited spectrum of neuroleptic activity (chlorprothixene, sonapax, eglonil, etc.), as well as tranquilizers. A significant place in outpatient therapy belongs to long-acting antipsychotics, which are prescribed intramuscularly (moditen-depot, piportil, fluspirilen-imap, haloperidol-decanoate) or orally (penfluridol-semap, pimozide-orap). The use of extended-release drugs (especially when administered parenterally) eliminates uncontrolled administration medicines and thereby facilitates the organization of treatment of patients

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Paranoia is an unreasonable or exaggerated distrust of others, sometimes bordering on delusion. Paranoids are those who constantly see evil intentions against themselves in the actions of other people, and believe that people need something from them.

The perception of a paranoid person from the outside looks like mental illness, can be a manifestation of depression and dementia, but is most often expressed in paranoid schizophrenia, delusional disorders and paranoid personality disorder.

Persons with paranoid schizophrenia and delusional disorders have an irrational but unshakable belief in a conspiracy against them. The haunting belief is bizarre, sometimes grandiose, and often accompanied by auditory hallucinations. Misconceptions that the patient experiences delusional disorders, are more plausible, but also do not find rational justification. People with delusional disorders may seem strange rather than mentally ill, so they never seek medical help.

People with paranoid personality disorder, as a rule, are self-centered, have high self-esteem, withdrawn and emotionally distant. Their paranoia manifests itself in constant suspicion of people. The disorder often interferes with social and personal relationships and career advancement. Paranoid personality disorder is more common in men than in women, and usually begins at age 20.

Symptoms

The following are distinguished: symptoms paranoid personality disorder:

unfounded suspicions, confidence in a conspiracy against oneself;
constant and unfounded doubts about friends or partners;
low degree of trust due to fears that information could be used for harm;
searching for sharp negative meaning in harmless remarks;
severe resentment;
perceives any attacks as attacks on reputation;
unreasonably suspects close people of infidelity.

Causes

Accurate cause of paranoia unknown. Potential factors include genetics, neurological abnormalities, changes in brain chemistry, and stress. Paranoia can also be side effect drug use. In the short term, paranoia can occur in people overloaded with stress.

Diagnostics

Patients with paranoid symptoms should undergo a thorough medical examination to rule out possible organic causes (eg, dementia) or environmental reasons(for example, stress). If a psychological cause is suspected, a psychologist will perform tests to assess mental status.

Treatment

Paranoia, which is symptom of paranoid schizophrenia, delusional disorder or paranoid personality disorder, should be treated by a psychologist or psychiatrist. In this case, they are appointed antipsychotic drugs (thioridazine, haloperidol, chlorpromazine, clozapine, risperidone), carried out cognitive therapy and psychotherapy to help the patient overcome delusions.

If there is an underlying disorder, such as depression or drug addiction, then psychosocial therapy is needed to treat the underlying disorder.