Month: September 2019

Syndromes. Entry

If the picture of the disease had to be divided into levels of complexity, I would prefer three main gradations: symptoms-syndromes-the actual disease in its entirety. Moreover, the disease should include not only a set of symptoms and syndromes characteristic of each particular nosology, but also reflect the dynamics of these symptoms and syndromes: what was, what will be, than the heart will calm down — and you can no longer go to the fortune-teller.

So, syndromes are the next (after symptoms) step to understanding what happened to the patient. Syndrome (from Greek. syndrome, a cluster, confluence) is not just a set of symptoms. There is no arbitrary combination of them, simply because the card is so laid. Pathogenesis with the layout is not joking, then cry “stick to the soap!” no way. All symptoms are combined in strict accordance with what kind of disease, and what stage we are now seeing. And if the diagnosis was made correctly — and at all it is possible to make cautious predictions.

Of course, the syndrome is not a disease, and to complete the clinical picture often need a lot: from properly collected history (born-baptized-married-what’s amiss) to analyses and abusive-rave reviews specialists. However, the correct recognition of the syndrome can help determine the tactics of further management of the patient (delirium, oneiroid and catatonic syndrome — in the hospital, asthenic-can be treated on an outpatient basis), with prescriptions of drugs (Yes, already at this stage). What can I say — the international classification of diseases 10th revision, aka ICD-10, is mainly based on syndromic approach to classification. And again, knowing the syndromes, we can easily identify a simulant that demonstrates some symptoms, but can not show the whole picture of the disease (there are, of course, the master in this case, but such units).

There is one more subtlety of medical practice: each syndrome it is necessary though time in life to see in the presence of a teacher who will tell you: “Watch and remember, it’s paraphrenic syndrome, and this syndrome Kandinsky — clerambault, it’s the asthenic syndrome of the neurotic, and the depletion of mental activity of a schizophrenic, I feel the difference in each pair and look for patients, is something that words cannot Express or describe it so that you can avoid misunderstandings and double interpretation“. That’s why there is no correspondence study at the doctor. Only personally, internally, through the stage of joyful recognition — “that’s it, I was taught this!” – to the shining peaks of intuition and infallible medical guess (this is almost the same as the military savvy — allows one fleeting glance at the grenade flew into the trench to determine that in fact it mimicked the Northern fur-bearing beast).

All psychopathological syndromes can be divided into positive and negative.

Positive psychopathological syndromes (they are “plus-symptoms”) are new, previously absent in the psyche syndromes, which normally should not be. In other words, it was not — there was add on (however, the pros and positivism come to an end).

Recognizing a certain conventionality of disposition, by the degree of increasing complexity, severity and totality of manifestations, as well as by the degree of disturbance of mental activity and as reversibility decreases, positive syndromes could be arranged in the following order:

  • Asthenic syndromes (positive);
  • Affective symptoms;
  • Neurotic syndromes;
  • Hebeny syndrome;
  • Syndromes of overvalued ideas;
  • Hallucinatory-delusional syndromes;
  • Lucene catatonic syndromes;
  • Syndromes of impaired consciousness;
  • Convulsive disorders;
  • Psychoorganic syndrome (aka organic psychosyndrome — Faberge, self-portrait, fragment, different camera angles).

Negative psychopathological syndromes (they are deficit syndromes, they are “minus symptoms”) are characterized by the fact that from mental activity (such as it should be normal) with the inherent set of qualities and properties of a normal person something of these falls, is lost. Accordingly, damage is caused to mental activity and a personality defect is formed.

According to the degree of increase of negative syndromes can be arranged as follows:

  • Asthenic syndrome (as negative);
  • Change of the subjective “I” (or subjectively perceived change “I”),
  • Objective personality changes;
  • The disharmony of the individual;
  • Reduction of energy potential (REP);
  • A decrease in the level of the individual;
  • The regression of the individual;
  • Amnestic disorder;
  • Total dementia;
  • Mental insanity.

Now we can proceed to a more or less thoughtful consideration of each group of syndromes.

Perversion of the rhythm of sleep and wakefulness-wakefulness at night and drowsiness during the day

Sleep disorders: when a person can not sleep for a long time, sleep comes in the middle of the night or in the morning, against this background, there is discomfort and anxiety.

Paradoxical drowsiness – a person wants to sleep, goes to bed, but (that’s disgusting!) drowsiness disappears.

Repressed drowsiness – when a person wants to sleep and even manages to fall asleep, but dreams and experiences in sleep are so strong and exciting that sleep runs away — and no longer occurs.

Obsessive fears — agraphobia (“and suddenly won’t sleep and what is insomnia?”), hypnophobia) (“what if I fall asleep?”) the get (“night, dark, scary!”), ametantrone (“as well as the fall asleep and die in my sleep?”), liturgiology (“so go to sleep and you’ll be buried without a control opening, you could Wake up already in a coffin is too late!”); oneirophobia (“and suddenly in dream nightmares will show?”), somniloquy — fear to be spoken in the dream (nightmare spy and salivahana), noctambulation — fear of segodenya.

Cataplexy sleep (or pageprofile) — when the patient is at the point of falling asleep while still being conscious, suddenly feels that he could neither move nor utter anything, nor — horror of horrors — really breathe.

Intrasonics disorders:

Dissociated sleep which may be accompanied by motor disorders (worry, legs jerk, feet suck, teeth gnash), viscero-motor disorders (here at least shall not lie — nocturnal enuresis, vomiting, coughing, diarrhea), pain (of ginalgin, or nyktalgia), night terrors, bouts of palpitation, shortness of breath, and pauses in breathing — apnea.

Intermittent sleep — usually light, with difficulty falling asleep, frequent awakenings from the slightest rustle or touch; something superficial on the border between sleep and wakefulness. Most often-with abundance of dreams.

Changes in sleep duration-shortening or increasing sleep duration.

Dreams in mental pathology may be particularly bright, imaginative, different liveliness that said V. H. Kandinsky. They can both reflect what a person raved or hallucinated during the day, and, conversely, – dreamed at night, give the patient food for his hallucinations and delirium in the future.

Dream mentalism – it happens that instead of dreams a person has an influx of thoughts, reflections. In some cases, what was thought in a dream, can be further reflected in the content of delusional or neurotic experiences.

Postranjska disorders:

Sleepwalking (somnambulism, sleepwalking) – when the patient performs actions, it is connected and consistent, automatically, being in the power of deep sleep. Most often, unless they are awakened during these activities, patients do not remember their actions.

Prooecia state, when the patient, moving from sleep to wakefulness, is not aware that he was awake, not distinguish reality from dream, while doing automatic unconscious action, often dangerous to themselves and others (especially if you had nightmares, which had to leg it than heavier), memories of whom are not saved.

Cataplexy of awakening (or polyproplene) when a patient is waking up and being well-oriented in the awakening, for a few seconds or minutes can’t open my eyes, to move, to speak.

Loss of sense of sleep (agnosia sleep, giagnoni) — no feel of sleep, its duration.

Note. Prophetic dreams, “dreams in hand”, as well as the dreams of Indian shamans were not presented above, so as not to give scope to rich imagination and fruitless reasonableness, as well as not to multiply the already numerous psychopathologies.

Sleep Disorder

Do often sleep disorders are sensitive and a clear indicator of the disorder in mental activity; in the event of illness or exacerbation of sleep is one of the first is broken and one of the first to recover. The variety and prevalence of symptoms of sleep disorders allowed to stand out a whole direction in medicine and neuroscience — it is called somnology. Pillow with heraldic, heraldic heraldic cradle and same button mass. And the international classification of sleep disorders as a founding document.

First of all, it makes sense to highlight insomnia, or actually insomnia (“sleep disorder, manifested by a violation of falling asleep, intermittent surface sleep and/or premature awakening“) and hypersomnia (pathological drowsiness). The list of diseases and syndromes in which both conditions occur is very extensive, as well as the causes provoking both (to take at least the true and false Pickwick syndrome ), so for now we will limit ourselves to mentioning them only.

Since it is customary to consider three periods of sleep (prasonissi — asleep, interconnecti — the actual sleep postranecky — awakening), and sleep disturbances, respectively, can be divided into three groups.

Pathology of the Motor Sphere

Submitted to oppression, and strengthening the perversion of physical activity.

Inhibition of motor activity

Hypomimiawhen facial movements are scarce and inexpressive, the amim — they are entirely absent, the face more like a mask.

Hypokinesia (movement inhibition, stupor) — slowing of voluntary movements, and a reduction in their volume and amplitude. Complete immobility is akinesia.

Found depressed hypokinesia where there is a slowdown and an overall reduction in the number of voluntary movements, accompanied by poor-poor depressed facial expressions (the man frozen in grief and had made great efforts already to just move, not to mention other things); manic hypokinesia (usually short, replaced by maniacal excitement): a man so overcome overwhelm his senses that froze in ecstasy, and only the richest facial expression conveys how he is now well. There is also a hallucinatory hypokinesia, especially if hallucinations peremptory or threatening (or both) — the patient stiffens, listening and dreading (“the COMMAND was SIT!!!”); and crazy hypokinesia, usually accompanying delusions of exposure, facial expressions of anxiety and fear (“Ah, THEY began again for me!”).

Mutism (remember the mute button on the TV remote?)- this is when a person can not speak spontaneously or answer a question, despite the fact that he understands speech, as well as in PRINCIPLE able to speak.

Enhancing locomotion

It is represented by obsessive, compulsive and impulsive actions, as well as various variants of hyperkinesia and convulsions.

Obsessive actions are implemented obsessive desire, often having the character of ritual action (say Hello, washed my hands, stepped across the threshold three times touched the jamb).

Compulsive actions are implemented compulsive desire (the same campaign for a beer in a stall on the second stage of alcoholism or dose to the patient puchero issued with heroin addiction). There is no longer a struggle of motives, but the goal is still present.

Impulsive action is action sudden, without a motive, without a target, without much colouring emotions: only that all was quiet, and suddenly the man seemed to explode from the inside like got invisible push and here it already where-that rushed, something ruined, aggressiveness and a tendency to fracture under impulsive action occurs very, very often.

Violent actions are movements and actions that arise by themselves, without any motives, involuntarily, but are perceived by the patient as alien to him, interfering and superfluous, while the consciousness remains clear (ridiculous movements of hands, feet, head, violent cry, crying, laughing, etc.).

The hyperkinesis is, increased physical activity, up to initiation with a loss of focus and expediency motions.

Distinguish euphoric (manic) the hyperkinesis, when revival movements happening against the backdrop of mania (“Oh, del bunch, Oh, I ran”), euphoria; anxiety-depressive hyperkinesis (agitation) that occurs at the height of anxiety and depressive affect and manifested unfocused restlessness (“Oh, now that would be something, Oh, what to do, what to do?”) into the excitation (melancholic raptus); the hallucinatory hyperkinesis when hallucinations frighten the patient or cause him rage, he either flees or tries to attack their alleged source; crazy hyperkinesis (usually with delusions of persecution, or when the patient hides from his pursuers, or he’s on the prowl); a catatonic hyperkinesis — in this case, the action is chaotic, repetitive (the patient may spend hours rocking from side to side or go from corner to corner, or sit-up), with the negativity (try to get him to stop doing it or where to take).

The perversion of locomotor activity (paragenesia).

Negativism — unmotivated opposition, active (when it is possible ogresti) and passive (when the patient will passively let you to do anything against him).

Passive podchinyalas — pathological inclination to execute any instructions without thinking said “follow me” — will go tail all day.

Waxy flexibility (it is catalepsy, from GK. katalēpsis — grasp, hold) — long-term retention of patients attached to or arising postures when the body as though made of wax, including the symptom of “air pillow” (patient, if you remove the pillow from under the head will keep the head on weight, not touching the bed), the fetal position.

Speech stereotypes is a monotonous repetition of certain words (mantras do not count); they are also called stand-up momentum or symptom gramophone records.

Motor stereotypies involuntary, frequent repetition of bizarre postures and movements, devoid of any meaning.

Echopraxia (from Greek. echo-echo and praxia-action) – meaningless copying of the actions of others.

Agonimia (echo + the Greek. mimia — imitation) — mindless copying facial expressions of others.

Echolalia (echo + Greek. lalia — speech) — mindless copying of the speech of others.

Pathology Indicative of Instinct

Strengthening research instinct is manifested by extreme diversity and variability of interests and aspirations: “dramatic circle, the circle of the photo, and I also sing hunting”; also includes dromomania — pathological attraction to a permanent change of habitat, vagrancy (Gypsies and occupational travellers are not in the bill. Well, almost doesn’t count); the oniomania (from the Greek. onios-for sale, mania-madness) – an uncontrollable desire to make purchases, to acquire things without material and personal interest, without looking at the consequences-just to BUY.

Decrease of research instinct-when it is uninteresting not only to do something and learn, it is when you yourself, in General, already uninteresting.

Perversion of research attraction includes kleptomania — pathological attraction to theft, often unnecessary, useless and repetitive things (for example, the twenty-eighth portrait of the President of the country); arson — the attraction to arson or contemplation of the flame.

Therefore, having felt an urgent need for something, do not rejoice prematurely, but ask yourself sternly: “do I need it?»

Pathology of Sexual Desire

Hyposexualitysexual desire or reduced, or absent. In men, this is some form of impotence (when it’s not so much in the problems of the Executive bodies, as in the crisis, what is called “legislative power”), in women — frigidity.

Hypersexuality – increased sexual desire with appropriate behavior in both men (satyriasis) and women (nymphomania).

Sexual perversion

Autoeroticism is Masturbation, Masturbation and narcissism. This should make an important note: a perversion that should be considered when there are episodes caused by the fact that the partner is unavailable or absent, and when, in addition to yourself, no one would EVER need.

Algolagnia (from Greek. algos — pain and lagneia intercourse, lust) — the need to inflict physical pain or moral suffering to achieve sexual pleasure (including orgasm), yourself (masochism) or sexual partner (sadism).

To vicarious forms of sexual perversion previously attributed homosexuality (in men, sodomy, women lesbianism, tribadism), but now, due to certain nuances, as reasoned in the thesis, and politically hard-won, considered it a sign of broadmindedness and their own sexual preferences. There were visionism, voyeurism (spying on naked faces of the opposite sex, stock up on binoculars, as well as drills and micro-cameras), exhibitionism (exposure of the genitals in the presence of persons of the opposite sex — “and look what I HAVE!”), transvestism, fetishism (idol not only created, but also raped), frotterism (that’s really who the crush in public transport just a joy).

Orientation of sexual attraction to inappropriate objects emit:

  • Pedophilia – sexual attraction to minors;
  • Gerontophilia – sexual attraction to the elderly;
  • Bestiality – sexual attraction to animals;
  • Necrophilia – sexual attraction to corpses;
  • Pygmalionism — sexual attraction to photographs, statues, paintings (ideal place of work-art Museum, such a person can not pay a salary).

Pathology of Self-Preservation Instinct

Strengthening the instinct of self-preservation can manifest itself in two opposite forms of behavior:

Passive defensewhen a person runs from danger, hiding, digging trenches and dugouts, bypasses it for the quarter or pretends to be a hose, a corpse (reaction supposed death).

Active-defensewhen the best method of protection is declared an attack, and is now “in the woods, the worst is we.”

The weakening of the instinct of self — preservation — when life becomes uninteresting, indifferent, and even a burden, and even if the mood is not to hell-everything, hide ropes and sharp objects, remove vinegar and medicines.

The perversion of the instinct of self — preservation is when a comrade does not kill himself, but bites hard, suddenly finding something extraordinarily attractive in self-torture, self-mutilation, swallowing all sorts of uneaten items, like family silver. Sometimes, however, the latter has a strictly defined purpose: for example, when a prisoner swallows a piece of razor tied to a thread, in order to cause stomach bleeding and end up in the infirmary, it is no longer a perversion of the instinct of self — preservation, but a simulation and a convict’s ingenuity.

Pathology of Drives

Disorders of drives (needs, instincts) can be manifested in the form of their pathological strengthening, weakening or perversion.

With the increased craving may be in the nature:

a) Intrusive — at the same time encourage the activities occur beyond the will of a patient when he realizes what attracted him in General that are alien, does not correspond to any moral values or interests, even criticism persists to this alien phenomenon, saying, not mine, not mine! A striking example is when alcohol dependence is just beginning to form, and a person feels that he would like to drink, but still realizes that this does not come from within, and he clearly does not agree with it.

b) Compulsive-impulses to activity in this case already dominate, they have destroyed at the root of the struggle of motives: why, when here it is, the desired, and it is vital to me (in other words, has a vital character), give it here! That is, if a drink is not just possible-it is NECESSARY. Ergo bibamus!

C) Impulsive — when wide horizons of consciousness was curled up in a mesh of sight, and the person who received the internal pendel (aka pulse) is taken up, without thinking: wait, wait… It just eliminates the annoying economic-geographical blunder: the money should be in the store, and alcohol — in the body.

The pathology of food craving:

Bulimia (Greek. bulimía from bús — bull and limós — hunger) — a strong irresistible craving for food, the constant feeling of hunger.

Anorexia (from Greek. an-without and orexis-urge to food) – lowering, the lack of appetite or aversion to food.

Parorexia, the perversion of food craving, manifested by eating of inedible substances (earth, lime), — paralexia pregnant peak, Kala (CE). One lady, being pregnant, and did prefer kerosene. It’s hard to say what she thought the husband, from time to time passing her in the hospital a bottle of the coveted fuel, but until the illegal supply of hydrocarbons is not stopped, the lady had to go through several miscarriages.

Crazy Idea

Can be particularly point to the next basic signs of delirium.

  1. Delirium is a consequence of the disease, its product. It is not a mistake, not a self — deception, not a delusion of a healthy person-it is the product of a sick person, the same as, say, fever for an infectious patient or convulsions for an epileptic.
  2. Despite the possible validity of certain postulates and fragments, nonsense — always erroneous, not corresponding to reality, a distorted reflection of reality. Claiming that the neighbors are not good to him and saw him in the coffin, the patient may not be so wrong — in terms of guessing the vector of the relationship. But all of that complex structure which he has built on this premise, which has become his ideology, subjugated, changed his identity and has provided many years of holivar (from the English. holy war-Holy war), has nothing to do with reality.
  3. Delusional ideas are unshakable, reinforced concrete, they are absolutely not amenable to correction or persuasion. Attempts to dissuade, to convince the patient of the incorrectness of his crazy builds, to give conclusive arguments, including assault and battery, useless. The patient will only further establish himself in his own right, and using your own arguments and arguments as additional evidence in his favor. “What do you mean she’s loyal to me? Why are you telling me this? Well, well, well, something’s not right! Who do we work for?” I understand! You also have access to the body!”By the way, it will not be possible to dissuade such a patient by hypnotic suggestion either.
  4. Delusions inherent in the erroneous grounds (“paralogic”, “logic curve”). We touched upon these violations, considering violations of the associative process of thinking.
  5. In most cases (with the exception of certain categories of secondary delirium) delirium occurs when the patient’s clear, unclouded consciousness. And this sometimes leads to confusion: as, he quite sensibly says, the dates are not confused… Yes, but only until, while you have not touched the plot of his delusions.
  6. Delusional ideas and personality are inextricably linked. Under the influence of delusional ideas, the patient’s personality changes — his self-consciousness, value system, attitude to the environment and to himself. Well, judge for yourself: what might be the attitude of the Emperor of the Galaxy to itself and to its surroundings? A little different than what is expected from the seemingly ordinary unemployed.
  7. Delusions are not due to intellectual decline. On the contrary, delusions, especially complex and systematic, tend to indicate that the intellect is all right. And on the contrary — the less intelligent, the less common nonsense. But if she is, then it is easier and not so relevant for the patient. In addition, if dementia increases in a person who had delusional production, the delirium itself becomes simpler, takes up less space in the patient’s experiences, until its complete disappearance. And understandably so — there is nothing to produce.

Delirium is classified by stages of development:

A) delusional mood and delusional belief in changing the, of the inevitability of impending catastrophe, danger: “Oh, that, Oh, my heart feels”;

B) delusional perception delusional interpretation of the values of certain phenomena of reality in view of the looming concern: “These views for a reason, and a handful of citizens is clearly with a purpose, and a car drove up, and with special rooms, not otherwise encrypted»;

C) delusional interpretation — delusional explanation of the perceived phenomena: “It is something they bad started: staring accusingly, whispering with a view to developing an action plan, and the details of the plan are encoded in the rooms and the car drove up”;

G) crystallization of delirium — a certain vitality and the content of delusions, their completeness and logical sequence: “I understand. This community is black transplant! I’m about to be kidnapped and disassembled for parts that will be shipped to America and exchanged for cocaine!»;

D) a stage of attenuation of delirium with the emergence of a critical attitude: “Fuhhh carried by… Well, time in the hospital. And yet, what was it? It couldn’t have been like this, all of a sudden. Or could it?”; e) residual (residual) brad: “And transplant all the same bastards!»

The mechanism of occurrence of isolated nonsense:

1) the primary caused directly by thought disorder in the form of insight, feelings, views, perceptions, beliefs, delusional intuition, delusional interpretation of the recollections and observations of reality (Yes, even about the same black transplant);

2) secondary, sensitive, caused by the hallucinatory, illusionary, affective and other’s experiences: hear from the outlet of the “voices” that threaten to kill, believes that the neighbors banded together in a criminal syndicate;

3) holodilny (option of secondary nonsense), resulting in emotional disorders. So, with a depressive syndrome, the patient can declare that it’s all for a reason, it’s all for his sins (and the list on five sheets can provide), and that in General he is a worm and a mastday. And in the manic — almost Batman, only more serious mission;

4) katatelny, he’s sensitive delirium of attitude arising from the exciting and important for that specific individual emotional experiences from value-added sensitive and psychopathic people (delirium relations, persecution, arising from a paranoid psychopath, delusions of jealousy psychopath epileptic);

5) Arising on the basis of sensations from the internal organs: burning in the chest is deadly neighbours is irradiated with light; became mysteriously gurgle in my stomach — it special agents poisoned the water, and only in my apartment;

6) induced-induced, induced by another person, most often mentally ill. How does it work? Here’s a recipe for the average man in the street: run around the Mall with bulging eyes and ask everyone where they sell salt, matches and cereals. We ship all this in bulk quantities in a shopping cart. To complete the picture, connect a couple of like-minded people. I think the result will not be slow to wait;

7) delirium of the deaf, when a person thinks out what he does not hear. The content is often nonsense attitudes or delusions of persecution.

Since gelatinoso have been listed by the resale nonsense.

The content of delusions can be divided into:

  1. Persecutory (from lat. persecutio — chase) nonsense, he is delusions of persecution, which may also include: delusions of influence (rays, radio, hypnotism, telepathy, witchcraft); attitude (usually negative, but there are exceptions), poisoning, jealousy, antagonistic, or Manichaean delirium (when the person believes that it is in the center of confrontation between the forces of good and evil, light and darkness, or when he believes that he fighting two or more competing groups, even States or worlds); nonsense double (when a patient believes that he has a twin that lives beyond his life and committing acts that the patient a disgrace or embarrassing); the delusion of metamorphosis (when the patient believes that under the impact of external influences is he in some turns — into an animal, a tree, piece of furniture); the delirium of obsession (when the patient believes that he possesses someone who controls them).

2) Depressive delusion (delusions low self-esteem) involves the delusion of self-accusation, self-abasement, nihilistic (I’m terminally ill, I have syphilis, AIDS, leprosy, all my organs rotted-withered-scattered in the dust, my misery is eternal and infinite), hypochondriac (I have cancer-sarcoma-another incurable disease, but no one sees and I am here right now will die), dysmorphogenesis (I’m ugly, I stink worse than three-day corpse in the heat, exhalation can be killed on the spot, and emitted gases has long been prohibited by the International Convention on weapons of mass destruction).

3) The group of delirium with higher self-esteem (megalomaniacal nonsense) — delusions of grandeur (from the representative of the President and ending with the Emperor of all galaxies), high birth (really the king, just lost one), invention (Yes, the cure for cancer and the regular teleport also put it on my bill), claim (the theory of relativity, remember? Einstein, bitch, I stole), reformism (well as reorganize rabkrin, not for me to explain), altruistic, or Messianic nonsense — you sit here, the fifth Procurator, at the reception, and lead to person…

4) Mixed forms of delirium include the delirium patronage (we love you prepare for a new crusade, so do not be afraid and never hesitate), brad benevolent influence (here’s five points of charisma, mana, twenty, thirty health and the usual things — agility, resistance to magic), brad staging (the whole world — specifically for this sick theater, all the people in it are actors, and stuff like put that the author would say a few kind), verwandte (litigation), nonsense charges (the patient believe that others look askance at him and despise for what he did not commit at all).

The structure of delirium is divided into systematic and unsystematic.

Systematic nonsense is quite structured externally, it has its own special logic, a system of evidence and arguments in its favor.

Unsystematic nonsense is just a painful statement, devoid of a system of evidence and complex logical constructions: it is so because I know it is so. This is usually secondary to delirium, resulting from patients experiencing hallucinations, senestopatii, either due to depression or mania.

Strictly speaking, the varieties and names of delirium are much more than already given, which is not surprising — because the object on which thinking is directed is the whole world, in all its diversity. But the overall impression is received.

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