This is, you might say, the very salt of psychiatry. This rather extensive group includes syndromes, in which the structure is dominated by delusions and hallucinations-both together and separately. This:

Paranoid syndrome. At the core-the primary systematized delirium;

Hallucinosises. It is based on hallucinations, both true and pseudo. Delirium may be present, but it is secondary, arising from what is heard, seen, felt — in short, it interprets existing hallucinations;

Paranoid syndrome. The basis — a combination of delusions, often persecuting, and hallucinations;

Paraphrenic syndrome. At the core-delirium fantastic, large-scale content (just fantastic and scope-its distinctive features for paraphrenic syndrome), plus all the same hallucinations and phenomena of mental automatism.

The sequence in which the syndromes are given is not random. Except for hallucinosis, which can be considered separately, other syndromes are given in the order in which there is a complication and progressive development of symptoms in the classic case of the same schizophrenia (again-in the classic, this is not a dogma, but rather a General pattern that allows other variants of the beginning and development): paranoid syndrome — paranoid syndrome — Kandinsky syndrome — clerambault — paraphrenic syndrome.

Paranoid syndrome. He’s paranoid. The name comes from the Greek word paránoia, meaning “insanity”. The main, or obligate, symptom of paranoia is delirium. Not obsessive, not super-valuable ideas, but delirium — in all its fantasy and unreality, with the reinforced concrete of the belief in one’s own rightness, with the senselessness and futility of persuasion: “why, in fact, do you climb with your counterarguments? Are you a messenger of the dark forces?” Get out, you infernal bastard!»

If you remember the symptoms of thinking disorders, it will be the primary systematized delirium. That is, this is not an interpretation of what the voices whispered (which, by the way, does not happen with paranoia), and not an attempt to justify their depressive state (“This is me for being so spiritless, incompetent, invertebrate and sometimes arthropod”). This delirium crystallizes by itself: here the person something there to itself thought, suspiciously looked sideways, and suddenly: “Eureka! I know who killed John F. Kennedy and — not to get up twice-Laura Palmer! And about microchips, which stamps the order of masons, too, I know! And who does not know — a sucker. And who is the word of the cross say the Mason chipsaway”.

The content of delusional ideas can be very different-invention, greatness (well, or at least special significance), jealousy, persecution, hypochondriac.

For the first time paranoia was identified as a separate disease in 1863 by K. L. Kalbaum, stressing that this mental disorder primarily affects the mental activity.

It is customary to distinguish between acute and chronic paranoid syndrome.

Acute paranoid syndrome usually occurs in the form of an attack. It dawns on a person: this is it! From this point on, everything that happens around is interpreted in favor of the idea that had the honor to overshadow the patient. “Cars at the entrance? Yes, they did it on purpose: the color scheme, the numbers, and the selection of brands-all to one, all to my intergalactic coronation. The birds out there are also not just flying — rehearsing a festive flight. No, holiday emptying is not included in the script, it is, the cost of rehearsal. The police look clearly with a touch of obsequiousness — well, clear stump, the Emperor is known and appreciated.” The systematization of delusions in acute paranoid syndrome is usually shallow — so, General sketches. That is, the list of vassal planets and peoples, most likely, will not be. As well as a list of personal achievements and special signs confirming the claim to the throne. “The king, just the king. Very pleasant. My dears.” But the mood corresponding to delirium is Yes, it is in abundance.

Chronic paranoid syndrome is characterized by both the duration of the course — months and years — and the nature of delusions. They are more detailed, they are built in a clear delusional system with a lot of details and evidence (albeit on a curved logic, but no less tooth-crushing). If this is delirium of persecution — then with a clear description: who, why, what he did, what he wants. If the delirium of jealousy-with a list of lovers, timing of events and interpretation of each delay in the Elevator, the store or (God forbid) on someone’s birthday, as well as an inventory of underwear: in this she goes to the neighbor below, in this to the commanding lover, and in this gives the homeless as part of humanitarian aid. It is characteristic to encapsulate delirium-by analogy with a splinter or splinter, which used to cause pain, but over time were tightened in a connective tissue capsule and bother less — that is, the delirium itself has not gone away, but the attitude towards it has become much calmer. Emotions are less pronounced, but can periodically accumulate and give affective outbursts. But the activity in the search for evidence in the fight for his innocence, in knocking on the doors and writing letters (if virulently orientation of the delirium, for example) is simply amazing. Another characteristic feature: over time, as a rule, the delusional system expands and includes all new objects. Chased by black realtors? The mayor’s office and the FSB joined them. Did the wife give the neighbor and the boss? Now she took on the service of a working hostel and a Gypsy village. The news anchor was in love and did this with his eyebrows right off the screen? Now two orchestras and a Cossack chorus so eyes and undress, even before the faithful awkward!

From facultative symptoms-as a rule, affective disorders, depending on the content of delirium: light euphoria before the coronation or jitters before the Inquisition.

The inability at this stage in the development of science to objectify hallucinations is not exactly a problem for psychiatry, but certainly a factor that creates discomfort in the sirloin. Again, the flag, the drum and the anchor opponents. Say — and how to verify the authenticity of complaints? What if the patient made a pathognomonic [43] gray gelding error in relation to the truth? Perhaps one day we will objectify hallucinations. The main thing is not to regret what he did.

Hallucinosises. Their main, predominant, obligate symptom is hallucinations. These can be either true or pseudo-hallucinations, with localization in any of the analyzers: visual, auditory, olfactory, tactile-as well as in any combination. The difference between hallucinosis and delirium and oneiroid is that the mind in hallucinosis is not clouded, and the patient is always aware of who he is, where he is and when he is. The difference between hallucinosis and paranoid syndrome is that in hallucinosis, although delirium may be present (secondary, sensual-the psyche must at least somehow justify what the patient sees, hears or smells!), but it does not dominate, but only accompanies hallucinations, being an additional, or optional, symptom. Actually hallucinations as a symptom were already considered above in the section of disorders of perception. As for the classification of hallucinations, they are usually divided as follows.


Acute hallucinations. Occur suddenly, acutely; the influx of hallucinations is accompanied by fear, anxiety; the patient does not find a place, rushes, tries to do something or at least hide.

Chronic hallucinations. As a rule, very long, can stretch for years. They are either continuous or undulating. The emotions that accompany chronic hallucinosis are usually not as vivid as in acute hallucinosis, since the patient has time to get used to hallucinations, but when the hallucinations increase, at their peak, they can be quite intense.

Residual hallucinosis. They in some cases end acute psychosis of any origin, accompanied by delusions and hallucinations. At the stage of residual hallucinosis, delirium stops, there are only auditory (in the vast majority of cases) hallucinations, to which the patient has already formed a criticism, that is, he understands that he hears not neighbors, not Metatron and not devils, but a product of his own psyche. Further, as a General rule you should recovery. Or at least remission.

By the form:

Verbal hallucination. It is based on auditory hallucinations, or “voices”. The voice can be one or several, they can sound from anywhere: from the next apartment, from passing cars, from the moon, from the Kremlin (not to be confused with the new year’s address of the President). If these are pseudo-hallucinations, then the voices are more often heard in the head, felt as induced, made, or resemble sounding thoughts — but voiced so that the usual mental monologue or dialogue that a person conducts quietly with himself, in comparison with them is much more silent, pale and indistinct. Although the patient may often find it difficult — whether he caught his own thought or it was a hallucination.

Visual hallucination. It is manifested by the influx of visual hallucinations — both single, for example Cheburashka in the refrigerator, and multiple, sometimes resembling a separate stage production, only for one viewer and, for his convenience, right around him. In this case, the characters can be so bright that it is impossible to distinguish them from the real ones. Put pressure on the eyeball, you say? Well, at the next visit of the Prince of Darkness with his infernal dance you can do so, it will amuse them very much.

As particular variants, the following types of visual hallucination can be distinguished:

Van Bogart’s visual hallucinosis, which occurs in leukoencephalitis. It is characterized by increased drowsiness, i.e. sleep attacks that can not be fought, and in the intervals between sleep there are colorful visual hallucinations in the form of brightly colored animals, butterflies, fish, and all this-against the background of increasing anxiety, anxiety, they say, what kind of jungle in the ward?!

Peduncular hallucinosis, hallucinosis or Lermitte. It occurs when the brain stem is affected in the area of the third ventricle and legs of the brain (hence the name: pedunculi in Latin — “legs”): hemorrhage, tumor — or due to other causes. In this case, hallucinations usually occur in the evening and have the appearance of something small, kaleidoscopic and nimble-like a dance of cockroaches or a military parade of mice-saboteurs. At the same time, the patient perceives such hallucinations quite calmly and distantly, fully aware that they are more hallucinations than the machinations of imperialism. Other types of visual hallucinations (Pic, Charles bonnet) [44] are mentioned in the section symptoms of perception disorders.

Tactile hallucination. Presented, respectively, tactile, or tactile, hallucinations. One of his private options — the so-called dermatozoic delirium Ekboma, in which the patient (usually elderly) feels crawling on the skin and under the skin of insects, worms, bugs, and further on entomological reference, why it is restless, saddened and obsessed with hatred for oborzevshim arthropods and others like them. It is also found in cocaine and amphetamine intoxication.

Olfactory hallucination. The smells that the patient thinks are overwhelmingly unpleasant, although there are exceptions. But most often it smells of decay, decomposition or perceived as a poison gas. A special variant is Gabek’s olfactory hallucinosis, in which the patient (usually older than 40 years) believes that he does not just smell unpleasant, but actually stinks and reeks, in connection with which attempts are made either of a palliative [45] nature, like deodorants and perfume in megadoses, or radical-like suicidal attempts.

By reason of occurrence, or by etiology:

In General, there can be a lot of reasons, but as a separate unit it is accepted to allocate alcoholic and atherosclerotic hallucinosis.

Alcoholic hallucinosis, in contrast to alcoholic delirium, occurs: a) without clouding of consciousness and b) is exhausted by auditory hallucinations. It lasts for weeks and months and often turns into a chronic form, and this is for years.

Atherosclerotic hallucinosis is more common in women. Hallucinations — both visual and auditory-have long been criticized, and they are perceived as hallucinations, with a degree of fear or irony, depending on the mood. As the atherosclerotic changes deepen, with the increase of dementia, the criticism of hallucinations disappears, and they become an alternative reality for the patient.

In addition to secondary sensory delirium, facultative symptoms in hallucinosis are represented by affective disorders — most often depressive and subdepressive, as well as anxiety and fear.

Paranoid syndrome

Delirium in paranoid syndrome, being a mandatory, obligate symptom, is not as clearly systematized as in paranoid, and is not necessarily represented by any one idea (monoidea). If for a paranoid syndrome with delusions of poisoning, for example, the poisoner-one and uses strictly so-and-so, then for a paranoid number of well-wishers can be represented by all the numerous Medici family.

In most cases when paranoid syndrome delusion is in the nature of persecuting (from lat. persecutio-persecution) – this either brad relations (when seems, that surrounding as something not so look, something not the think and at all are happy would strangle, Yes nurture not allows), either brad special meaning — when all in surrounding environment not simply so, it specifically so rigged, to hint patient. Ah, you understood, about than; either brad impact — on choice, ranging from witchcraft on insidiously stolen hair and ending secret; either delirium of poisoning (you can make a list of poisons yourself), or actually delirium of persecution, when the forces of evil and the government moved from hints to fighting (well, or at least conceived the capture of the patient in order to do something purely unnatural).

Hallucinations under this syndrome-true or false, more often auditory, but can be represented and in the form of smells; or instead of hallucinations can be present senestopatii-there prickled, here gurgled, and here is in this place bites and chomps. The main thing that unites such hallucinations is the correspondence to the content of delirium: if you poison with gas, you will feel the smell, if you are affected by rays or witchcraft — there will be a burning or malaise, and the voices in delirium will not sing “many years” at all. From facultative symptoms — more often affective (of which, again, more often depressive than manic, affect, which is understandable — after all, it is clearly not to give a medal for exemplary behavior, and often poisoned still not laughing gas), anxiety, fear, insomnia.

For — acute, subacute or chronic.

Kandinsky-Clerambault Syndrome

The syndrome got its name from the names of two psychiatrists who described it: V. H. Kandinsky and G. de clerambault. The basis of this syndrome is a triad:

1) hallucinations (and more often-pseudo-hallucinations);

2) delusional ideas (usually-harassment and / or exposure);

3) the phenomena of mental automatism.

What is meant by mental automatism? These are phenomena of mental activity of the person (in this case it is more appropriate to speak-the patient), which he perceives and regards as spontaneous, arising and proceeding in addition to his desire and will, often with the feeling that they were “made” for him from somewhere outside. What is very important, the patient perceives these thoughts, actions, feelings as alien, not belonging to him: not just the hand with the ax twitched-it pulled the devil. Criss-cross. And so thirteen times.

Often, by the way, the basis of delirium lies just an explanation of where such control could come from, the impact. Sources are very different — from representatives of pandemonium to angels and directly to the Creator (in this connection, the statement that someone’s hand was directed by the Lord himself is perceived by a psychiatrist with a lively professional interest), from elementary radio transmitters to the most complex psychotronic emitters with torsion generators and noospheric control.

What greatly disturbs and even frightens the patient is that his ” I ” in connection with such influences and control from the outside is not what it used to be. It is no longer perceived as simple and complete as before. It no longer has those reliable walls, the armor that protected the cozy world from prying eyes and encroachments.

In total it is accepted to allocate three variants of mental automatism:

1) sensory (sensory, senestopathic);

2) associative (ideative);

3) motor (kinesthetic, motor).

And two more options:

hallucinatory and delusional.

And, a little apart — Capgras syndrome.

Now more about each of them.

Sensory automatism. He’s senestopathic. Why? But because of the unusual sensations (remember the definition of a senestopatii) that someone deliberately causes the patient. And this peristaltic wave, from the esophagus to the rectum and back, is all of THEM. And the delay of the chair-too, customs did not miss THEM. And this burning sensation on the skin is special. And cold. And the skin tightens — this is THEIR special device.

Associative, or ideational, automatism. Here moderation and all sorts of other enemy manipulations concern thoughts and images, as well as emotions. This is an influx of thoughts, or mentalism — when no one asked them, and did not want to think about it at all, but they will rush, as they begin to think!

• An open thoughts, it is a blockage, or sperrung: thought and thought — and all plugging, then I do not think even through enormous effort of will and incentive autopedia;

  • putting thoughts in your head. Do not delude yourself, useful, as a rule, do not invest;
  • extracting thoughts from the head, weaning them from the patient, robbing him: “what did I want to think about? Damn, I already thought, but these scoundrels again all far-fetched stolen»;
  • symptom of “openness of thought”: “Everyone knows what I’m thinking, all my thoughts are open, like a book, that’s just the plot is pumped up and the presentation is such that the teacher of literature would be suicidal on the second paragraph»;

• a symptom of “the echo of thoughts”. “That’s why you repeated what I thought? On purpose? Mimicking? Or can you just repeat my thoughts aloud after me?»;

  • imposed, evoked emotions: “it Is not I who laugh or cry, but I who Express myself in this way, an anonymous vile person»;
  • “unwinding of memories”: “I do not want to, but they are read from me, and I become an involuntary witness to it.”

Motor, aka motor, or kinesthetic, automatism. It concerns actions and movements that the patient does not perceive as his own, taking the role of a doll, a puppet, a robot. It is not he who walks, moves his arms and legs — it is he who is controlled. Even if you can’t see the threads going up, you can’t see the control hand from an obscene place, you can’t see the operator with the remote control-that doesn’t mean anything! It means that they manage more subtly and imperceptibly. Yes, and someone else speaks for him, too. Yes, and someone else said that, too, so please, no offense.

The hallucinatory version of the Kandinsky-clerambault syndrome implies that the leading symptom in it is hallucinations. They are the main part of all the symptoms in this case, and the delirium and phenomena of mental automatism only complement and color the picture.

In the delusional version, respectively, in the first place and in importance, and in terms of symptoms is delirium: persecution, possession or possession, exposure. Hallucinations and elements of mental automatism are not so pronounced, but they are present.

Capgras. The main symptom is a violation of recognition of people: relatives, friends, relatives, just well-known. No, no, the fact that you did not recognize a classmate, so that he was already rich-this in itself is not a symptom, you could just forget it for a few years. It’s a little different: you are sure that you know perfectly well what the real ones look like, and these are duplicates, and not extra — class. “What are you saying? It’s not them — it’s just disguised doppelgangers. Yes, the actors were picked up. And the one over there does not play well at all, you can immediately see that there are not enough personnel in the bodies. But this is worse: physically it is he, and the spiritual stuffing was taken out and instilled some demon. Get out, you bastard.” The opposite happens when the patient begins to “recognize” strangers. “Yes, Yes, this one owes me and hasn’t given it back for a month. Yes, and don’t pretend you don’t know me! And that beauty over there… you know. And also sees as if for the first time, here after all this… as it… from a family of sturgeon, here!”There is a symptom of Fregoli, when, according to the patient, he is pursued by the same people who constantly change their appearance so that he does not recognize them. They say they have a whole Arsenal in store – from false mustaches to inflatable busts of number five, plus plastic surgeons-virtuosos in the van escort, so figs relax…

Paraphrenic syndrome

Paraphrenic syndrome is a kind of culmination in the progress of all hallucinatory-delusional symptoms in the patient. Of all the series of hallucinatory-delusional syndromes, the most vivid and memorable. It was first described in 1913 by Emil Kraepelin [48], giving it the name paraphrenia (from Greek. para — in this context “without”, and phren-mind) and highlighting several of its variants.

What does paraphrenic syndrome include? Almost everything that was found in previous hallucinatory-delusional syndromes:

• hallucinations; of the phenomena of mental automatism; delusions.

Paraphrenic delirium has several important differences. For all its diversity it has characteristic features:

• it is, as a rule, delirium of greatness, it is fantastic, bright, magnificent and monumental. The vast majority of Napoleons, emperors of countries and galaxies, illegitimate children of oligarchs and secret owners of oil rigs in addition to the average drug cartel-just such patients. Minus Bonaparte himself, the emperors of the countries and further down the list — but only on presentation of strong evidence (oil in a three-liter jar and poppy-hemp bouquet are not considered). This may be the nonsense of reformation, and only on a global scale-like exclusive rights to know the last word of the Lord, which all in this world will end. This may be the delirium of persecution — but such that it must be at least a wild hunt. Well, Goblin counterintelligence would do, too. But to chase, plot, complete and final Apocalypse for a couple of regions and millions of victims!

These are retrospective interpretations: the patient explains all the facts from his own life based on his delirium. Why was I born on such and such a date? At the behest of the intergalactic Imperial Alliance. Why in Big Hangovers? For the purpose of conspiracy-hidden from the galactic lumpen proletariat. Why did the Scion of the Imperial family allow a morganatic marriage with a person from a neighboring village? Not morganatic, but very dynastic, you don’t understand anything. She also actually of the Imperial kind, just the fall from the star to the barn her lost memory;

  • these are confabulations, or false memories, subject to the same delusional ideas. “What kind of construction battalion? No, I spent two years on the far reaches of the constellation Cancer. No, I didn’t winter and didn’t freeze anything. Kept watch, protected the Galaxy from the invasion of the red intelligent mold. Even the order has received, in all wall, only it is impossible to see to the simple person in any way»;
  • this is false recognition. “Are you sure you know your companion well? Really? And that she runs an underground brothel for alien minorities? That’s it. Oh, and there’s one of them going. He’s just a customs officer encrypted, so it’s easier to smuggle contraband.”

Downstream distinguish:

  • acute paraphrenia;
  • chronic paraphrenia.

For acute paraphrenia, in addition to acute development and relatively rapid flow, is characterized by affect-bright, pronounced, ranging from anxiety-depressive to manic, with a touch of euphoria and even episodes of ecstasy. Delirium is unsystematic, its plot arises suddenly, under the influence of the current moment, and can easily change. As one of the variants of false recognition, which, by the way, in acute paraphrenia is more common than in chronic, may take place delirium intermetamorphosis: the patient will assure you that a whole group of friends (not one, not two, as in the symptom of Fregoli, but many) – this is not who they say they are. They are changelings. Or parasites in other people’s bodies. Or astral universes and masters are expelled. In short, humanity is in danger. Delirium of special significance — “the sun is slightly dimmed for me today, thank you” – is also more common in acute paraphrenia.

For chronic paraphrenia is characterized by a more systematic and stable, without any noticeable changes in the plot delirium. More often-greatness. The affect is more scanty and even: “Well, I am the king, the king. Very pleasant. My dears. You don’t have to bend the knee.” The relevance of experiences is much less pronounced than in acute course.

Variants of paraphrenic syndrome were described by Kraepelin. This:

  • systematized paraphrenia, when systematized ideas of greatness, ideas of persecution, antagonistic delirium prevail (two opposing camps-say, angels and devils-fight to the death for the possession of his immortal soul. And a recipe for hopless moonshine);
  • unsystematic paraphrenia-corresponding to acute paraphrenia;
  • hallucinatory paraphrenia — when it is in the foreground there is an influx of verbal hallucinations or pseudo-hallucinations. They can praise, sing Hosanna, and carry the good news that there is no Fig to wait for, the Messiah is already here — and then the patient is most reasonable to expect delirium of greatness. They can divide into groups and call each to itself (not to be confused with election platforms), then, most likely, delirium will be antagonistic. They can and a lot of nasty things to say and to promise, then it makes sense to expect the patient has delusions of persecution;
  • confabulatory paraphrenia. With it, the leading symptom will be confabulations, and the patient will suddenly remember where he buried a Golden woman (mother-in-law does not count) or lost an oil rig. And yet-tormented by stories of titled relatives who sleep and see him, dear, on the carpet arm in arm with the Princess. And screams, screams in his sleep…

In addition, the group of paraphrenic syndromes can be attributed to the syndrome (aka delirium) Cotard, described by the French psychiatrist J. Cotard in 1880. Its other name is melancholic paraphrenia. It is characterized by nihilistic-hypochondriacal delirium (especially for the hypochondriac version of this syndrome) and depressive delirium with ideas of the destruction of the world (for the depressive version). In both cases, the patient himself becomes the center of all events: this is his spinal dryness, continuous scabies, gangrene of all the viscera and complete replacement of the brain with alveococcus. This is because of him in the world of financial crisis, global warming, smoothly passing into the ice age, nuclear war and the flood – so, polirnut for sure, so that certainly no one survived. Well, in General, the mood is not to hell.