Paranoia - description of the disease and its stage

The word “paranoia” in psychiatry, and in everyday life in general, has been known and used for quite some time. According to its original meaning, this concept implied any form of mental perversion, however, since the eighties, the word “paranoia” was assigned a new meaning, which remains to this day.

Paranoia these days

is a unique form of psychosis that combines illogical and even delusional ideas characteristic of mental disorders and the preservation of normal mental abilities, emotional background and thinking processes.

Symptoms of paranoia

Once they arise, illogical thoughts can be retained in the subconscious, from where it is almost impossible to eliminate them with any beliefs. In addition, they have the ability to reproduce both through logical development and through the emergence of new ideas and thoughts that appear similar to the original ones. Most of the content of their thoughts and delusions is associated with deceptions of the senses, most often with hallucinations. In most cases, the obsessive thought of paranoid people is persecution mania.

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This is especially true for the initial stage of the disease. In later stages, megalomania
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Stages of development and immersion in your fictional world

Persecution mania develops gradually in three stages, each of which has its own symptoms and signs:

The first stage is characterized by the presence of primary signs of the development of paranoia. Closedness, excessive worry, and increased levels of anxiety begin to appear.
In the second stage, symptoms increase. Behavior becomes more restless, the person is unable to interact with others and adapt to society. Fear becomes a constant companion, and open complaints against others begin.
At the third stage , uncontrollable signs of aggression begin and severe depression develops. A special category of patients may attempt suicide due to fears and depression. Behavior becomes suspicious and wary. There is a lack of trust in the people around you. There may be a misinterpretation of current events. The patient does unusual things that are completely inconsistent with everyday habits. It should be especially emphasized that all the thoughts of an individual are concentrated on his exceptional personality and the particularity of his significance for society. Also characteristic is the desire for self-isolation, aimed at limiting the influence of the environment.

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At the initial stage of development, persecution mania looks quite harmless, but already during this period the disorder prevents a person from living a full life. Living in constant fear and tension, the patient provokes the development of other mental and somatic diseases. It is especially difficult for relatives and other people who surround such a person.

Stages of paranoia

Paranoia is a chronic disease in which three stages are clearly monitored:

First stage

Preparatory stage - delirium does not yet manifest itself in the words and actions of the patient and at this stage it is almost impossible to diagnose the disease. Paranoia is revealed only in the future, and at the next stages it becomes obvious that delusional thoughts were nurtured in the patient’s mind for months - they simply did not affect his behavior and other external manifestations. Continuing, at first glance, their ordinary lives (“remaining themselves”), paranoid patients become increasingly distrustful and suspicious. They begin to notice that they are being treated “somehow differently,” their lives and dignity are in danger, they are being pursued by unknown (often fictitious) persons, and so on. Patients begin to take self-defense measures; every day they become more and more hostile towards potential “enemies” - for example, police officers, social workers, and often just all people indiscriminately.

Second stage

The second stage of paranoia can last for many years. It is associated with the active development of delusional ideas and thoughts that arose in the first stage. This stage is the main one. The patient develops an incredibly complex picture of the world, based on delusional thoughts and hallucinations. In it, most often, the paranoid person is surrounded by all sorts of dangers - he is being watched by intelligence agents, their phones are tapped and even their thoughts are read. They see hostile faces and unpleasant scenes, they hear voices and so on. Words and thoughts are imposed on them that can compromise them and in general, in their opinion, this whole world was created to kill them, drive them to despair, suicide, and so on. Having succumbed to these ideas, patients become depressed and nervous, they are very easily angered, they become lethargic and apathetic, losing all interest in everything except their persecution mania
. They are always careful in communication so as not to inadvertently compromise themselves. Noticing that they are considered crazy, they try in every possible way to hide their worldview and isolate themselves even more from society. However, due to fear and anger, a paranoid person is capable of losing self-control and trying to harm potential perpetrators of the conspiracy, up to and including public insults and attempted murder.

Third stage

Treatment of paranoia

The main problem in the treatment of paranoia is that patients themselves do not consider themselves sick, and therefore do not consult a specialist for a long time. In addition, paranoid people exhibit symptoms noticeable to others quite late, since the apparent adequacy persists for a long time. However, no effective method of treating paranoia has yet been developed. One possible method is chemotherapy. However, it is worth noting that the main problem in the treatment of paranoia remains the patient’s social adaptation and restoration of his trust in people.

Advantages of treating paranoia in our clinic

Our staff have extensive experience in treating paranoia.
We use combination therapy
. We select medications individually. We combine medications with a course of psychotherapy, physiotherapy, diet therapy, physical therapy and massage to make the treatment more effective.
We treat complex cases
. We accept patients who perceive treatment as an attempt to restrain them and control their consciousness. We relieve acute thinking disorders, after which we convince the patient of our desire to help and motivate him to agree to treatment.
We are being treated in a hospital
. We help place you in a hospital, even if the patient initially refuses to see a psychiatrist, treatment or hospitalization. We place you in general or individual wards and assign medical staff for constant monitoring. We carefully monitor the mental and physical condition of the patient. We create conditions conducive to recovery.
We provide reports to relatives
. We conduct regular classes with relatives, where we fully inform about the condition, prognosis, teach the correct behavior with the sick person and provide psychological assistance. Upon discharge, we provide a discharge summary indicating all the research results, all treatment performed, recommendations, if necessary, we write out prescriptions and provide a certificate of incapacity for work (“sick leave”).
We do not register
. We treat anonymously, do not report the patient’s place of work, and do not register with a mental health clinic.
We work around the clock .

To make an appointment for a relative with a psychiatrist, or to call a doctor at home, or to carry out hospitalization, call. You can ask your doctor questions by phone or by leaving a request.

Glossary of terms

In this section we have collected all the terms that you might encounter in this article. Gradually, we will collect from these explanations a real dictionary of a narcologist-psychiatrist. If some concepts remain unclear to you, leave your comments under the articles on our site. We will definitely help you figure it out.

Delirium (delusional syndrome)

– a mental disorder that is characterized by erroneous, completely uncontrollable judgments in the patient. These judgments are capable of being formed without any explanation, reason or appropriate conditions for this. This syndrome manifests itself in patients with schizophrenia, as well as in people suffering from diseases of the central nervous system of a vascular and atrophic nature. In addition, patients diagnosed with psychosis are also susceptible to the development of delusional syndrome.

Paranoia

Psychoses

- These are short-term, reversible mental disorders that arise in a person as a result of mental trauma. They are characterized by the severity, severity and depth of the mental harm caused. Productive and negative symptoms arise. German psychologist and psychiatrist Karl Jaspers formulated the concept that reactive psychoses occur due to a conflict between the individual and an intolerable reality. This definition was included in textbooks and, in many ways, became classic.

Reasons for development

Paranoid syndrome most often develops in people around 30 years of age. Its causes have not been fully established, and experts only put forward theories about the occurrence of the pathology. It has been proven that paranoia often has a hereditary connection.

Other factors that can affect a person’s psycho-emotional state and contribute to the development of pathology:

Experienced violence, which often happens in childhood.
High demands of parents towards the child and strict control on their part.
Bad habits that weaken the nervous system.
Conflict situations that cannot be resolved.

Paranoia can be triggered by the personality traits of a particular person. A paranoid person is always a vulnerable person with high self-esteem. The pathological condition is often diagnosed in people with developed thinking and a strong, but unbalanced character. Against the background of this combination, the following features develop:

Mistrust.
Despotism.
Pedantry.

Delirium of jealousy

Symptoms

Taking into account the above, we will further talk about delusions of jealousy in the male version.
To obtain gender inversion, it is enough to change the generic endings. The axial, syndrome-forming symptom of this disorder is the feeling of... well, of course. However, it should also be understood that in the phrase “delirium of jealousy” the key word is the first word, not the second. The rest is nuances, largely determined by the clinical features of the underlying disease. Thus, people with chronic alcoholism, age-related dementing processes or other organic pathologies often take a careless approach to collecting evidence. It is enough for them to “just know, that’s all,” or rely on simple lumpen-proletarian syllogisms like: “All women are harlots. You are a woman. Therefore, you are...” The definitions and accusations that the jealous woman hears against herself in this case would make the most unbridled organism from the gateway blush. In alcoholics and “organic” patients, in addition, for a number of reasons, the threshold beyond which a man ends and a formidable martial artist, fist fighter and severe punisher of unfaithful wives begins is much lower - sometimes impulsive, explosive and easy-going, and sometimes hardworking and conscientious , as a veteran of the witch hunts during the Inquisition.

It’s a different matter when delusions of jealousy develop within the framework of schizophrenia, especially if the patient has high intelligence or, God forbid, is related to power structures, which often remains possible for a long time due to the façade preservation of social and professional skills. In some cases, the collection of “evidence” is carried out using such technical means and, most importantly, with such inexhaustible ingenuity, in comparison with which the CIA would seem like a petty squabble at a keyhole.

A more or less universal, etiologically independent tendency can be considered humiliating and, more often, disgusting tests to which victims are regularly subjected. After each separation - it doesn’t matter whether it lasted three months, three hours or three minutes - the jealous person is obliged to present her handbag, clothes, hair, underwear, oral cavity, breasts, and genitals for detailed examination. At the same time, affective pressure, delusional induction and blackmail (“If nothing happened, just prove it!”) can be so powerful that the victim, with a literally paralyzed will, fulfills all demands. And then, after some time, most often it is difficult to explain: why, in fact, did she endure all this, if long before the resolution (of one or another) of this unbearable situation for her, she already “guessed that he was sick.” However, psychiatrists and pathopsychologists usually do not ask such questions: by that time the victim often has to be treated rather than questioned. And again, it’s a fact: our women, unlike Western women, under the influence of a number of reasons, peculiarities of mentality, internal motives and values, are much more likely to endure and hope to the end, stubbornly whispering with lips clotted with blood: “This is a woman’s lot,” or “I won’t leave him, he’s sick”, or “Everyone lives like this”, or the immortal “He hits - means he loves”, or even “It’s her own fault”, or even “He’s still my beloved and only one”. Often beyond the psychic capabilities of the victim there is a need to admit and tell himself: this is not jealousy, this is a disease, it is merciless and inexorable, it destroys, it is a poisoner; she killed the man whom I loved, whom I married and from whom I gave birth to children, he is no more and will never be, and if I drag out time a little more, tearing my pillow with my teeth at night, mourning and begging to come back, then me too it won't either...

Children who grow up in such families are one of the most difficult and intractable aspects of the problem. These scenes are not intended, in fact, for adult eyes, but they simply disfigure the child’s psyche, sometimes irreversibly. The worst thing begins when the child becomes a psychological, financial hostage (“If you file for divorce, I won’t give you the money, but alimony will be minimal, according to the official salary”) or a direct, in the most literal sense of the word, instrument of blackmail. Such situations are especially difficult for the victim in cases where the husband and father for a long time manage to maintain the same purely external, façade appearance of an ordinary, strong, friendly, healthy family (“No one will believe you anyway”). Fortunately, in most cases, the patient verbally declares his love and inability to live without his son/daughter/children, but as the negative apathetic-abulic symptoms increase, he gradually loses all interest in them, without forgetting to declare that the children are not his, but “brought in the lap” and “feasted on from lovers.”

Another common feature stems from the very essence of delusional disorder. The suspicions put forward, as well as “accusations”, “evidence” and especially “logical evidence” can be amazingly, fantastically absurd, but for the patient himself they are as real as, say, the weather outside the window or the amount of cash in his wallet is real for a healthy person . Therefore, to prove anything, to exhort, to make excuses, to appeal to common sense, to involve people who are authoritative for the patient as witnesses is not only absolutely pointless, but is also fraught with retaliatory aggression, auto-aggression, or some other reaction of this kind. The expected result from these conversations has never been seen before in history, anywhere in the world and by no one - unless, of course, this is really a delusional disorder, psychotic, and not neurotic or personal. Victims, friends and relatives who are aware of what is happening most often “understand this with their minds” and “intuitively feel it,” but cannot “believe it in their hearts and imagine how this is even possible.” Therefore, in different families, the same mistake is repeated again and again, the same desperate attempts to solve the problem peacefully, with persuasion, flattery, humility, joint efforts, endless patience - just not to wash dirty linen in public (what will people say?! ..) and do not take this rubbish to a psychiatric hospital, to the police, to the outside world. This mistake, alas, can be fatal for the patient himself, for the jealous woman or, in rare cases, for the alleged rival. And even if the opponent is physically stronger, that is, he tries to cure the jealous person with his fists (what else can an average man, even an intelligent one, come up with, if he is stronger and the same rigid archetypal programs speak in him?), the situation will not fundamentally change. The only difference is that in the eyes of a patient with delusions of jealousy, betrayal will be absolutely and unequivocally proven - and extrapolated to all other situations, which, however, did not raise doubts before and did not need proof. What is there to prove, if everything is already clear: today is Tuesday and an even date, so the plane over there in the window flew from right to left, and although she was sitting with her back to the window, she still finished her tea first and even sneezed on purpose. , to make fun of her further, then she put on a jacket and went to take out the trash, having received some kind of sign known to her (the lovers deliberately did not ring either the door or the phone - in order to deceive vigilance), and in three minutes at the entrance, wow, how much You can make it, she’s so tired, she’s back, and she doesn’t want to answer, she just cries, and even then it’s somehow unnatural...

There is an unofficial but quite apt jargon in psychiatry: “weave into delirium.” So, sometimes the most unexpected person, for example, a doctor, can be “woven” into the structure of monothematic delusional experiences by the patient. But here the logic is at least clear: he conspired with his cheating wife to “put him in a mental hospital, and only then”... (options - received a bribe, conducts a scientific experiment, persuaded or intimidated relatives, wants to take away not only his wife, but also apartment, etc., etc.).

Often, a divorce with a move does not change anything much: the patient, using already well-developed detective skills honed over many years, sooner or later finds out the new address and the entrance lock code, and an endless crowd at the door begins, endless conversations about the same things, nightly silences into the telephone receiver, streams of messages into email and social networks, broken windows (if the floor allows), and again attempts to “track and prove.” Again and again. Again and again…

If this is a delusion of jealousy, the patient will find irrefutable evidence of betrayal even in space, having lived together with the jealous woman for a year and a half on a space station and there letting her out of sight for five minutes.

And even if the delusion is realized, i.e. the patient observes adultery being objectively committed in reality, with his own eyes, or receives truly indisputable evidence - for example, from the victim herself, driven to the last degree of despair and “rising to a high degree of madness” - the process continues to progress at its own pace, thinking remains delusional, and the situation still unpredictable.

Who is right and who is wrong, and whether these wives actually cheat, and if so, why, and how strong are the reasons to be jealous in each case... all this has nothing to do with the topic of the article, believe me, not the slightest connection. These are redundant details, unimportant details that a professional wouldn’t even think of being interested in. It’s all somewhere out there, in the zone of conventional norms, conflict management, psychology of family relationships, and, in extreme cases, neurosology.

Delusions of jealousy are exclusively within the competence of the psychiatrist.

And really anything can happen.

When you work in a clinic for more than a quarter of a century, the law of large numbers comes into play. What was once a line in a textbook turns into human destiny. And there are more and more such lines every year.

Patient ***, 82 years old, is admitted with a severe traumatic brain injury, which was inflicted on him with a bayonet shovel by a jealous neighbor in the country (two years older, the jealous woman is four years older).

Patient ***, 32 years old, gathers the whole family in front of the screen to finally witness the fact of his wife’s infidelity (24 years old), allegedly recorded by a recording from a hidden video camera. According to the patient, his wife is cheating on him with his own brother (later it turns out that the patient’s first marriage broke up for the same reason, after several episodes of clearly inappropriate behavior), and the only people he, the patient, will trust is his mother with grandmother: “Now you’ll see everything for yourself, and as you say, so it will be!” The whole family lives in a large private house. The wife knew about the installed DVR. The patient is described by relatives as gentle, naturally intelligent, very neat, “boring,” but a caring family man and loving husband. The relationship with my brother is consistently good (!), family and, moreover, business-like - the brothers are partners in a small business. Absolutely nothing happens on the screen: an empty room and occasional distortions of a clearly technical nature (the day before the patient spent the entire night at the computer, supposedly clearing the recording of interference in a non-linear video editing program). Pointing to those present at the screen, the patient repeatedly exclaims with triumphant intonation and facial expressions: “Did you see? Well, are you finally convinced?” Neither mother, nor grandmother, nor brother, nor the “cheater” herself sees anything. At the time when the filming was taking place, the brothers were at work, and the wife and three-month-old son (a breastfed child) were at home, almost constantly in front of the patient’s mother and his grandmother, which they informed the patient about in a harsh manner. After viewing, the patient, even not particularly annoyed by the “blindness” or “collusion” of his closest relatives (he did not express either one or the other out loud), looks at his wife with a mysterious grin - and remains with his own opinion, because “saw everything he needed,” and will provide the rest with “a better recording next time.” It is known that during the year before the events described, the patient began to drink in the evenings in order to “drown out the unbearable mental and heart pain from his wife’s constant infidelities” (his wife was hospitalized several times during that period with the threat of miscarriage). Three months after the “viewing”, the patient is admitted to the hospital with a clinic of cerebral edema, and the available anamnestic information does not exclude a true suicide attempt [the word “true” is used here as an antonym to the much more common demonstrative and blackmail attempts - approx. Lakhta Clinic]. After a day of being in a comatose state - exitus letalis.

Nurse ***, 54 years old, who was present at a collegial discussion of a case of delusions of jealousy: “Rare? Yes, where I come from, every third woman lives like this, and everyone is silent; one over there hanged herself a month ago, her mother wrote to me, and another one went missing last year and is still being searched for, and her hubby in the end, they say, completely drank himself to death”...

Patient ***, 38 years old, serving in one of the control structures of the executive branch of government, is in a specialized department of the Forensic Psychiatric Examination - approx. Lakhta Clinic]. For many years he reproached his “too young and beautiful wife” (according to the patient’s own wording) for frivolous behavior, incessant flirting “with everything that moves,” and then for adultery. In the last 2-3 years, he somehow tapped the phone, installed a service beacon (subscriber location tracker), looked at all SMS messages, hacked an email account, then installed a wiretap and a security camera in his wife’s office (private notary, 34 of the year). In one of the filmed fragments, he allegedly saw, in the words of “a glimpse of a bare back, clearly a man’s, since his wife’s tattoo is different and in the wrong place.” On other videos I also saw a VAZ-2103 car not far from the garage, from which I concluded that the wife was making love to her “ex” in the garage, because He also “used to have a Zhigul” (the patient does not know which model). At home, he repeatedly stated that he felt close attention and, apparently, surveillance at work, but each time he rationalized his experiences by saying that “in fact, checks came later.” He began to drink, but practically did not get drunk [an atypical reaction to alcohol and other psychoactive substances is often found in schizophrenia - approx. Lakhta Clinic]. He continued to work right up to his hospitalization; According to his job description, he was distinguished by conscientiousness, balance, diligence, a high sense of responsibility, and often stayed late at work in order to meet deadlines for submitting documentation and avoid mistakes. At the same time, he turned to a family psychologist, a neurologist, a “psychic” for help, and then was even hospitalized in a private rehabilitation center for people with drug addiction, because... there was a psychotic episode with hallucinatory experiences and psychomotor agitation: he “saw” through the fence how his wife was having sex with two Caucasians in a park area, tried to break the fence, called his relatives (sister and her husband) - who, fortunately, happened to be passing nearby and managed to take the patient away before the police showed up. The next day I was discharged from the rehabilitation center, because there, in the words, “they wanted to turn me into a vegetable with injections, and I didn’t like being treated with drug addicts at all.” Three months later, he went to a private clinic to see a psychotherapist and insisted on an immediate examination of his wife, citing the fact that “it had become unbearable to live with her because of the constant lies and betrayals”; demonstrated a receipt found in her car from a hairdressing salon, in which the wife “should not have been at that time and on that day.” He expressed sincere bewilderment that his wife was going to move with her son to her parents because of “some kind of right to personal space.” At the reception, at the same time, he was quite calm, beyond the delusional plot, adequate, comprehensively oriented and even formally critical of his own condition, which he described as painful and in need of medical correction. He promised to “think about” the recommendation of the psychotherapist, who cautiously suggested hospitalization and promised assistance. Two weeks later, neighbors, alarmed by the noise and screams, called the police, whose employees, in turn, called an ambulance. As it turned out, the patient saw his wife’s car approaching the entrance, and by the latter’s gait he “suddenly realized” [describes the so-called “aha phenomenon” that occurs in schizophrenia - approx. Lakhta Clinic] that now she will cheat on him in the elevator in a perverted form. While my wife was going up in the elevator to the twelfth floor, I imagined in every detail, heard and even “almost saw” how this was happening. A murder was committed, the method of which...

...and all other details we leave for impartial analysis to forensic experts. There is an excellent saying that all mass media should adopt: “There are frames for television, and there are for a forensic expert, and one should not be confused with the other.”

And you can’t add anything significant to the above.

Classification of persecution mania

By origin, delusions of persecution can be primary and secondary. The primary option is called interpretive; it is based on a disorder of thinking. The secondary – figurative and sensory – is formed on the basis of hallucinations. According to the content (plot), there are many types of persecutory delusions:

Delirium of damage. The patient is convinced that they are trying to steal or damage his property.
Delirium of poisoning. Confidence that pursuers add poison to food and water.
Delusional relationship. Objects, people and events take on special meaning.
Delirium of influence. The idea of using physical or mental influence to control behavior.
Nonsense of queralism. Thoughts about intentional infringement of rights. A craving for complaints, litigation, and the fight for justice.
Delirium of jealousy. Ideas about cheating, betrayal of a partner.
Nonsense of staging. All events that occur are perceived and interpreted by the patient as part of a performance, an experiment on him.
Delirium of obsession. The patient believes that another creature has possessed him and is controlling him.
Delirium of a double. With the positive option, strangers are perceived as friends and relatives. If negative, close people are strangers with good makeup.
Delirium of metamorphosis. The idea of magical transformation into an animate being or object.
Bullshit of accusations. It seems to the patient that people are constantly accusing him, out loud or mentally, of crimes, troubles, and tragedies.

Use of psychological methods

The use of psychological methods can completely help get rid of phobias and anxiety disorders accompanied by fear of persecution, and significantly reduce the severity of symptoms in the case of delirium. The main psychological method for treating persecutory delusions is cognitive behavioral therapy. Delusion of persecution is a destructive mental state in which a person is pathologically convinced that he is being watched and they want to harm him.

How to behave to others?

First of all, it is necessary to help a sick person understand his problem and convince him to see a psychotherapist. It is very important to find a specialist who will find an approach to such a patient. The success of treatment and the emotional state of the patient largely depend on the level of trust in psychotherapists and psychiatrists.

You should also monitor the intake and dosage of medications prescribed by your doctor.

It is necessary to be patient and try to provide a favorable psycho-emotional atmosphere. There is no need to show excessive anxiety and negative reactions; all these actions encourage retaliatory attacks of aggression.

Relatives of a patient diagnosed with persecution mania should put themselves in the patient’s shoes, so if a person believes that some secret organization wants to kill him, then there is no need to convince him of the opposite.

Diagnosis of the disease

Only a psychiatrist can accurately determine persecution mania by conducting psychological and instrumental procedures.

The doctor will carefully examine the patient’s symptoms and medical history and communicate with his relatives. Particular attention is paid to the presence of a genetic predisposition to diseases of the brain and mental health, bad habits. It is important to find out the nature of the delirium and how the patient himself relates to his problem.

Testing is used as additional information to determine the patient’s current state of mind: characteristics of his emotional sphere, memory, mental activity, etc. Instrumental studies imply:

CT or MRI of the brain (will reveal a tumor or vascular pathology);
electroencephalography - it will allow you to assess the functioning of the brain by the degree of its activity.