Paraphrenic syndrome - an extreme form of delusion with delusions of grandeur

The relevance of the problem of acute paraphrenic states is determined by their special position among psychopathological syndromes with a tendency, on the one hand, to periodic, and on the other hand, to continuous disease processes. Including in their structure most of the spectrum of positive psychopathological disorders in different proportions, they represent a kind of “slice”, “nodal point” [1] of the pathological process, expressing the qualitative features of a progressive disease in a given period of time.

In modern foreign literature, the term “paraphrenia” is used in relation to psychoses of late age and as a synonym for the chronic course of schizophrenia with the presence of systematized delusional symptoms [2-5]. Acute paraphrenic syndrome is not identified as a separate psychopathological definition in foreign literature, which is reflected in the modern classification of mental illnesses.

In the present study, within the framework of the psychopathology of acute paraphrenic syndrome, predominantly positive symptoms were studied, taking into account the characteristics of the course of schizophrenia.

The purpose of the study is to study the clinical and psychopathological structure and dynamics of acute paraphrenic states in various forms and variants of the course of schizophrenia.

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Paraphrenia is a fantastic delirium of “particularly large scope”, combined with increased (rarely decreased) mood. A more severe form of delusion than paranoia and paranoid.

Patients feel like rulers of people, planets and the Universe, centers of the struggle between good and evil, sources or conductors of divine forces. Paraphrenic syndrome is an indicator of a gross disruption of the brain and psyche.

Paraphrenia literally means “beside the mind” in Greek. It was first described by the famous German psychiatrist Emil Kraepelin in 1907 as a separate disease. However, to date, this is not considered a separate disease, but is a syndrome (a combination of several symptoms) that can develop in various mental disorders.

Clinical picture

With paraphrenic syndrome, the following symptoms are observed:

• delusional ideas (persecution, overestimation of one's own importance);
• hallucinations or pseudohallucinations;
• behavior of a fictitious nature (communication with aliens or famous people);
• the patient does not try to convince others of his stories, he sincerely believes in his story;
• sudden mood swings, but rarely being depressed.

In addition, the patient may additionally develop Capgras syndrome, characterized by the presence of a double that replaces it. A person explains the reason for attributing bad deeds to him by the actions of his double or non-existent twin. With this pathology, the patient may not recognize people from his close circle and family, but can see a loved one in a stranger.

In general, symptoms of paraphrenia indicate the progression of mental illness and deterioration of the patient’s condition.

The following painful phenomena are characteristic of paraphrenia:

• A symptom of false recognition, when in unfamiliar people around them they see other, important persons participating in their lives.
• Fantastic delirium of grandeur.
• Increased mood (less often decreased), euphoria.
• Confabulations are false memories. The patient feels that he remembers certain events. However, in reality these events did not happen.

The causes of paraphrenia are gross disturbances of metabolic processes in the brain, overexcitation of subcortical structures.

Classification with clinical features

Depending on the characteristics of the symptoms, it is customary to distinguish several types of paraphrenic syndrome:

1. Hallucinatory
   . The patient hears internal and external voices that instill in him delusional ideas and also distort reality. In this state, the patient rarely enters into dialogue with others, proving that he is right.
2. Systematized
   . Ideas are sustainable. They are orderly, although they are delusional. This type of disease is characterized by pronounced delusions of grandeur, superiority and a negative attitude towards other people. This behavior is accompanied by both auditory and visual hallucinations.
3. Confabulatory
   . The patient has a combination of inflated self-esteem and memories of non-existent events in which he took a heroic part. This type of disorder rarely goes away on its own. It usually occurs as a result of complications of hallucinatory and systematized paraphrenia.
4. Depressed or melancholic
   . The patient unreasonably considers himself guilty of actions that he did not commit. He assures everyone that he deserves punishment and humiliation, and tries to blame himself at every opportunity.
5. Erotic
   . It affects women more often. Usually the cause is problems in family life. It seems to the patient that he is being reproached for immorality (adultery) and is promised to be punished by resorting to sexual violence. The disorder is intermittent and occurs in attacks.
6. Late
   . Diagnosed in people over 70 years of age. Patients feel that their rights are constantly being violated and offended. The pathology relates to senile schizophrenia and is practically untreatable.

Depending on the nature of the disease, acute and chronic forms of paraphrenia are distinguished. In the first situation, the disease occurs suddenly and has a pronounced change in behavior - from euphoria to depression, and vice versa. The delusion in this case is unsystematized and is usually described as particularly important (for example, saving the planet).

In the chronic course of the disease, delirium is stable and systematized. Delusions of grandeur prevail. There are no sudden changes in behavior. The patient perceives his thoughts as truth and does not enter into arguments.

Paraphrenic syndrome can be observed in the following diseases

• Organic mental disorders.
• Schizophrenia, schizoaffective disorder, other schizophrenia spectrum disorders.
• Atypical bipolar affective disorder.

According to the flow, acute and chronic paraphrenia are distinguished. Acute paraphrenia develops in a relatively short time and can be reversible. Chronic paraphrenia is difficult to treat and can last a lifetime.

To identify and make a diagnosis, the patient must be examined by a psychiatrist. Usually, a single examination by a doctor is enough to clarify the condition.

Treatment of paraphrenia should be carried out in a hospital. Therapy includes antipsychotic effects with drugs with anti-delirium action, and if ineffective, shock treatment methods. Other methods - physical therapy, psychotherapy, diet therapy - have an auxiliary effect.

As a rule, patients with paraphrenia, although not critical of their condition and not aware of their illness, do not resist hospitalization, perceiving what is happening as part of a “game” or performance that is played out around them. But in some cases they can resist and be aggressive. In these cases, involuntary hospitalization is required within the framework of Russian legislation.

If you encounter incorrect behavior in your loved one, do not waste time, contact a psychiatrist and arrange an examination of the patient. You can invite a psychiatrist to your home or go for a consultation yourself.

If you need help during hospitalization, contact us, we will help.

Material and methods

We observed 60 patients with schizophrenia, 29 women and 31 men aged from 20 to 54 years (average - 37 years) with a picture of acute paraphrenic states during an attack of the disease.

The duration of the disease in the studied patients was from 6 months to 35 years, the number of attacks suffered by one patient, including paraphrenic ones, was from 1 to 6. The total number of attacks in 60 patients was 164, of which 113 were acute paraphrenic, and 51 attacks of other types. .

The work used psychopathological, follow-up and statistical research methods.

Stages of schizophrenia (clinical classification)

Features of the treatment of paranoid schizophrenia are determined by the stage of its course. Patients may experience the following stages of mental disorder:

1. premorbid. Isolation from the outside world occurs, and key personality traits change. The person becomes irritable and suspicious;

2. prodromal. The patient strives to isolate himself from any contact with the real world and loved ones. Lack of composure and absent-mindedness are noted;

3. first psychotic episode. Patients experience hallucinations, which are accompanied by delusional thoughts and obsessions;

4. remission.

Symptoms of psychotic disorder

Patients and their relatives should think about the need for treatment for schizophrenia if they detect such alarming signs as:

· auditory pseudohallucinations associated with the appearance of obsessive thoughts;

· delusion of influence, when a person believes that he is under surveillance and is in danger;

Verbal hallucinations in the form of voices appearing in the head;

· delusional ideas, for example, meeting with aliens, representatives of the other world;

· inadequate reactions to what is happening;

· episodes of uncontrollable flow of thoughts, intermittent speech and emotional coldness.

Is it possible to warn?

The main method of prevention is timely diagnosis and treatment of the main provoking disease, as well as preventing the development of complications. The medical literature notes that the use of psychotropic drugs in the treatment of schizophrenia entails a reduction in the number of patients with paraphrenic syndrome.

In addition, the creation of a favorable emotional atmosphere plays a significant role in preventing the occurrence of this pathology. This should include the attention and care of parents for their children, the absence of quarrels in the family, visiting a psychologist, and avoiding conflict situations at work.

The use of psychotropic medications must be agreed upon with the attending physician. In addition, you should not succumb to the negative influence of others with suggestions about using drugs and alcoholic beverages.

First manifestations

In paranoid schizophrenia, positive symptoms are more often observed than negative ones. This means that delusions, hallucinations and thought disorders predominate, and not apathy and lack of will, as happens with other types of pathology before attacks. At the very beginning, the patient begins to have delusional ideas and thoughts. He may say that he expects something bad, scary or destructive. It happens that he is unable to calm down until, for example, he counts to 100.

Along with such thoughts, hypochondria worries me. A person is very concerned about his health and is afraid of getting sick or infected. Senestopathies often occur when there are unusual and unpleasant sensations in the body: a hoop squeezing the head, stabbing pain in the heart, as if a needle was stuck into it, etc.

At the initial stage of paranoid schizophrenia, a person’s sleep is disturbed, which affects his daytime state. His emotional background is characterized by scarcity and inflexibility, emotions are dulled. He looks like a rigid and uninterested individual who absolutely does not care what happens around him. In this case, aggression towards loved ones is possible. Your social circle is narrowing, and it becomes more difficult to establish relationships with people.

Symptoms depend on each specific case. Some patients, although few, can be violent in the initial stages. They have sadistic tendencies. They abuse animals, especially cats and dogs.

Almost all patients experience increasing fear and anxiety. Because of this, the patient turns into a confused person who cannot fully navigate the new situation. He has difficulty making decisions.

Sometimes the listed signs appear 10 or even 25 years after some injury.

This stage can continue for several years. Gradually, the number of symptoms increases as the pathology continues to progress.

External signs

There are several signs by which relatives of a sick person may suspect he has schizophrenia:

• He is isolated from society, sees friends less often, becomes increasingly withdrawn and does not share his experiences with family members.
• A person abandons his studies, stops showing up at the university or at work.
• Gradually, he begins to take less care of himself, does not shave, rarely washes and does not monitor the condition of his clothes.
• The patient is obsessed with various kinds of ideas, is interested in mystical and religious teachings, studies paranormal topics, etc.
• The person begins to hear worse, constantly asks again or does not respond to questions.

The difficulty is that the patient does not consider himself sick, so persuading him to undergo examination is not easy. This can often be done when the symptoms become more severe.

Diagnosis and differentiation from similar disorders

The main task when examining a patient with suspected development of paraphrenic syndrome is to establish differences between similar disorders that indicate mental disorders. Paraphrenia is considered the most complex form of delusional state.

Therefore, special attention in this situation is paid to differential diagnosis.

The symptoms of paranoid, paranoid and paraphrenic syndrome are similar. Therefore, they can be distinguished from each other only after identifying all the pathological symptoms in the patient.

Thus, with paranoid syndrome, delusional ideas often arise against the background of a disturbance in the state of mind. With paranoid syndrome, a person exhibits suspicion and mistrust, which can subsequently cause persecution mania.

Paraphrenia should be distinguished from delusional states in adolescent psychosis or mental disorders as a result of taking psychotropic and narcotic drugs. Therefore, it is important to establish the duration and nature of the symptoms that occur.

With paraphrenia, real things are replaced by fantastic ideas, while brain functions are not impaired. Therefore, this pathology is excluded from the doctor’s consideration if problems are detected during a neurological examination of the brain.

Paraphrenic syndrome is not classified as a separate painful condition.

For this reason, it is necessary to establish the disease that accompanies the corresponding symptoms and treat it, and not individual manifestations of paraphrenia.

Kandinsky-Clerambault syndrome

The third stage of paranoid schizophrenia is Kandinsky-Clerambault syndrome, named after the Russian psychiatrist and French doctor. It is characterized by the development of several types of automatisms in the patient:

• Ideatorial (associative). The patient feels as if someone is putting thoughts into his head. He also suspects that others can hear his thought process. Mentism is observed - a symptom of an influx of thoughts and memories. Often the patient believes that certain events are forcing him to remember outside forces.
• Sensory (senestopathic). At this stage, automatisms concern bodily sensations. It seems to a person that they are caused from the outside. Feelings of cold, warmth or excitement, the sources of which, in fact, do not exist.
• Motor (kinesthetic). These automatisms are associated with physical activity. Now the patient believes that all his actions are performed not by him, but by someone else, as if any movement is performed without the participation of his will. This especially applies to speech motor movements.

Wizards, aliens, hypnotists, etc. can act as an extraneous force that forces a person to think, feel and act.

At this stage, if hallucinations occur, they are auditory. The patient hears swearing in his direction, comments and commands.

With Kandinsky-Clerambault syndrome, pseudohallucinations are possible, when patients distinguish hallucinations from real objects. Both familiar and unknown people, pictures, voices, etc. appear in visions.

Symptoms in women

There are no significant differences between the signs of paranoid schizophrenia in women and men. However, for the former, family, health and appearance always come first, so delusional ideas are associated with this. Concern with such problems also determines the nature of hallucinations.

Women are afraid that the child will be harmed, that she is aging quickly, etc. According to her, there are ill-wishers all around. Sometimes they name specific names and surnames of real people, for example, neighbors, work colleagues or relatives.