Delusional reality: signs and symptoms of paranoid schizophrenia

Paranoid schizophrenia is recognized as the most common form of this disorder.
Moreover, the term “paranoid” is used in everyday circles, while the official concept is paranoid schizophrenia. The disease combines all the main schizophrenia-like symptoms and signs, but delusions and hallucinations come to the fore in the clinical picture.

First manifestations

It should be noted that the negative symptoms of the disorder are changes in the emotional background, apathy, lack of will, etc. in paranoid schizophrenia, they are noticeably less pronounced than productive symptoms. The latter include delusions, hallucinations, and thinking disorders.

At the beginning of the disease, in its initial stage, the patient may experience obsessive ideas or thoughts. For example, the fear that something bad will happen if he doesn’t count to 100 right now. Hypochondriacal thoughts, that is, increased concern about one’s health, the conviction of the presence of some kind of disease, in some cases serious, without reliable reasons, is also present. Senestopathies often appear: unusual, tormenting sensations in the body. They are characterized in a rather pretentious manner: the head is compressed by a hoop; stabbing pain in the heart, as if a needle was sticking out of it and gradually moving into its thickness. Sleep is disturbed, the patient suffers from insomnia.

The emotional background becomes scarce and inflexible, emotions are dulled, and the person is perceived as a rigid, emotionless individual. His circle of interests narrows, but isolation, suspicion and distrust appear. Patients are capable of showing aggression towards loved ones, sharply narrow their social circle, and find it difficult to establish friendly connections.

There may be manifestations of cruelty. For example, a young man suffering from paranoid schizophrenia, before the development of a full-blown clinical picture, experienced cruelty to animals. He tortured and beat cats and dogs, and hung birds by the neck.

Other signs include anxiety, concern, and fear. This makes a person confused. It is difficult for him to navigate a given situation, he hesitates, and cannot make a decision.

Symptoms of excitement and increased activity appear. The initial period of paranoid schizophrenia can last more than 10 years.

Depersonalization in a patient with paranoid schizophrenia is manifested by the feeling that something is happening to the body and thoughts, as if they do not belong to him. He cannot control his actions; he looks at them as if from the outside. Derealization makes the world around us cloudy, without colors, alien and incomprehensible.

The typical age for the onset of the disease is 30 years. Although there are often cases when it begins to manifest itself at an earlier period.

Patient L., 20 years old. He received a head injury and a fractured lower jaw as a result of being beaten by a neighbor in the yard. He underwent treatment that lasted several months. When I returned to work after sick leave, I began to show increased activity and efficiency. He tried to leave home early for work, citing the fact that they couldn’t cope there without him. I approached the mayor of the city with proposals for organizing folk festivals, holidays, and special events. He became especially agitated, lost sleep, and refused to eat. He ran through the streets, handing out invitations to City Day.

I drove to a neighboring town in my father’s car. On the way, he stopped at a store to buy provisions, but he did not have the money to pay for the goods, and he left the documents for the car as collateral. He was driving in the oncoming lane when the police stopped him. I came home by taxi to get money to buy documents. He left for documents and a car, which he left somewhere. But he returned home barefoot, on foot. He couldn't explain what happened to him.

Delusions in paranoid schizophrenia

Delirium, as the main symptom of the disorder, develops in several stages and symbolizes the “heyday” of the disease.

The first stage of its formation is called paranoid. It is characterized by systematized, interpretive delusions. The concept of systematization means that nonsense has a fairly logical, plausible structure. This stage of the disorder is not accompanied by disturbances of perception, such as hallucinations and mental automatisms.

The most common plot (theme) of delusion is the ideas of persecution, greatness and jealousy, invention, and violation of rights. Thus, a patient who lived with his father and became dependent on his sister after the death of his parent began to rave about damage caused to him by his sister. The patient stated that she infringed on him “in everything,” mocked him, took possession of his father’s inheritance and spent his, the patient’s, money.

Typically, the paranoid delusional stage is accompanied by increased activity. That is, if a person shows delusional ideas of jealousy, then he tries hard to expose his lovers, find his rival and deal with him. In the case of delusions of reformism, the patient turns to all sorts of authorities and looks for resources to implement his ideas.

Delusional themes in paranoid schizophrenia can develop gradually, subacutely or acutely.

Its acute development is accompanied by suddenness and unexpectedness in the patient’s behavior. Unreasonable aggressiveness and motor agitation appear. Thinking is disorganized, torn, or the patient develops fear of something, suspicion, anxiety, he literally becomes numb with horror.

The gradual development of delusional ideas does not cause sharp dissonance in behavior. Oddities in the patient's actions and judgments, inappropriate gestures and grimaces, and changes in interests are periodically observed. A person may complain of confusion of thoughts, emptiness in the head, and inability to concentrate.

A delusional thought, before “settling down” in the mind of a paranoid person, goes through several stages:

• expectation - the patient feels internal anxiety, tension. It is accompanied by the feeling that something big is about to happen, shedding light and dispelling darkness;
• insight - suddenly to the patient “everything becomes clear” in his unrealistic ideas. He begins to look at the world with different eyes, and he himself transforms into a different personality. The true, crazy truth is born, shedding light on the previously incomprehensible;
• systematization - this process is similar to making a mosaic. When individual pieces come together and create a complete picture. Delusional themes completely cover a person, filling his thoughts, past, future and present.

Paranoid delusions can persist for quite a long time. In this case, a diagnosis of paranoid schizophrenia is made.

PsyAndNeuro.ru

Paranoid delusions are a typical symptom of psychotic disorders. Cross-cultural studies show that this type of delusion is more common than others, and is observed not only in schizophrenia, but also in bipolar affective and unipolar depressive disorders. Its formation is associated with a wide range of psychological mechanisms, such as a tendency to jump to conclusions, difficulties in understanding the mental states of other people (i.e., violation of the model of mind), increased threat anticipation and features of the attributional style in combination with low self-esteem. At the same time, persons with paranoid delusions show relatively intact logical and heuristic thinking, as well as the ability to test hypotheses.

In their study, Bentall et al. examined the psychological mechanisms that contribute to the emergence of paranoia and examined the structure of connections between them. The sample consisted of 237 participants: 137 were diagnosed with schizophrenia, major depressive disorder or late-onset schizophrenia-like psychosis (divided into groups with and without delusions), 64 people constituted the control group. The first step of the study was aimed at identifying adequate constructs (factors) that explain the obtained measurement results. Thus, the subjects were assumed to have the following groups of factors: paranoid beliefs, threat anticipation, affective disorders (anxiety, depression), self-esteem, attributional style, tendency to rush to conclusions, mental model and cognitive abilities (intelligence, working memory). To identify and test them, multivariate analysis was used using structural equation modeling techniques with latent variables (factors). The model obtained by the authors confirmed the presence of the above factors, and at the same time demonstrated the presence of “second order” factors, uniting them into three main groups: cognitive functioning, paranoia and depressive thinking style.

The results showed that the paranoia factor (which included delusional ideas and threat anticipation) was associated with a combination of factors of depressive thinking style (which included low self-esteem, stability and globalization of negative judgments and affective disorders) and impaired cognitive functioning (including executive (regulatory) ) functions, tendency to jump to conclusions and disturbances in model of mind). Depressive thinking was highly correlated with paranoia even after controlling for cognitive functioning (r = 0.65, p < .001), and conversely, cognitive functioning was associated with paranoia independent of depressive thinking (r = −0.34, p < .001). In summary, the study showed that paranoid delusions involve both cognitive and affective mechanisms, which supports the selection of both types of processes as targets for treatment.

Author of the translation: Syrokvashina A.D.

Source: The Cognitive and Affective Structure of Paranoid Delusions: A Transdiagnostic Investigation of Patients With Schizophrenia Spectrum Disorders and Depression

Paranoid delusions

After the paranoid stage, the paranoid stage develops. It is characterized by the formation of unsystematized delirium with various themes. Several unrealistic ideas of different directions appear at once.

Unlike the paranoid delusional concept, which can acquire a logical coloring, paranoid delusion is completely devoid of logic. It is fragmented, episodic, abstract.

Here is the story of a guy suffering from paranoid schizophrenia. The illness made itself felt through delusions of attitude. It seemed to him that they were watching him and collecting information about him of various kinds. At work, the team talks about his personal life, on the street all people look at him.

Then the idea was added that the neighbors below (of Caucasian nationality) wanted to take over his apartment, so the young man quit his job in order to protect his home. He believed that the Caucasians had already installed wiretapping and were watching him. He claimed that they had taken possession of his will, putting pressure on him, inclining him to communicate. If I found a small object, a button or a paper clip in the room, I assumed that the neighbors had installed a bug.

Even a year after the Caucasians moved out, the delirium persisted. The guy was sure that they continued to live secretly in the same apartment. He explained that they went to the magician and showed him his photo. Now this magician guides his thoughts, actions, and instills in him a model of behavior.

The patient treated the head of the Caucasian family with respect. He said that he was a worthy man and even went to his homeland and cut off his finger there as a sign of respect for him. This is a kind of request so that the patient does not resist and gives them the apartment.

Now the guy must also deprive himself of some part of his body as a sign of solidarity. To do this, he tied his big toe with thread, bringing it to gangrene. The organ had to be amputated. The patient thought that the effect on him would stop. However, this did not help. And he decided that, probably, it was too small and insufficient a sacrifice and the left hand needed to be removed. During examination in a psychiatric hospital, a strangulation groove was discovered on his wrist.

The emergence of paranoid delusions indicates a deep damage to the psyche, covering all its layers. Its themes are also varied. Ideas of persecution prevail. There are also delusions of relationships, influence, etc.

In men and women, the disorder has no clear distinctions. But the delusional theme may differ. Thus, women are more likely to obsess over their appearance, family and fertility, while men are more obsessed with thoughts about career, love affairs, spies and criminals.

The paranoid stage of the disease is characterized by impaired perception, manifested by hallucinations, pseudohallucinations, and illusions. Thus, delusional, hallucinatory and delusional-hallucinatory course of the disease is distinguished. The presence of hallucinations softens the severity of the condition and has a more favorable outcome. In this case, delirium develops quickly, and after it is systematized, the patient experiences relief.

Hallucinations at this stage of the disease are mainly auditory. The patient hears voices that call him by name or make unpleasant remarks in his direction, use foul language, and comment on his actions. Then pseudohallucinations occur. They are characterized by the feeling that someone else's thoughts have been introduced into the head. Patients hear silent voices, echoes of thoughts, voice streams from any part of the body or from another planet.

Another symptom of the paranoid stage of the disease is mental automatisms. There are the following types:

• motor – patients are sure that someone is directing their movements. They happen by someone else's will. A person walks, talks, smiles under external influence;
• ideational – thoughts are put into a paranoid person’s head. Either there is a certainty that his own thoughts are stealing from his head;
• sensory - any sensations in the body, natural and unnatural, appear under the influence of magical forces.

Quite often, according to patients, actions, thoughts, and sensations are “imposed” on them by aliens, magicians and sorcerers, or by introducing X-rays or other devices.

Pseudohallucinations, delusions of influence and mental automatisms are combined into one syndrome called Kandinsky-Clerambault. The syndrome is often diagnosed during the course of the disease.

Paranoid syndrome. Paranoid syndrome

Paranoid syndrome. Primary systematized delirium of interpretation of various contents (jealousy, invention, persecution, reformism, etc.), occasionally existing as a monosymptom in the complete absence of other productive disorders. If the latter arise, they are located on the periphery of the paranoid structure and are subordinated to it. Characterized by a paralogical structure of thinking (“crooked thinking”) and delusional detailing.

The ability to make correct judgments and conclusions on issues that do not affect delusional beliefs is not noticeably impaired, which indicates catathymic (that is, associated with an unconscious complex of affectively colored ideas, and not a general change in mood) mechanisms of delusion formation. Memory disturbances in the form of delusional confabulations (“memory hallucinations”) may occur. In addition, there are hallucinations of the imagination, the content of which is associated with dominant experiences. As delirium expands, an ever wider range of phenomena becomes the object of pathological interpretations. There is also a delusional interpretation of past events. Paranoid syndrome usually occurs against the background of somewhat elevated mood (expansive delusions) or subdepression (sensitive, hypochondriacal delusions).

The content of delusions at distant stages of development can acquire a metallomaniac character. Unlike paraphrenia, delusion continues to be interpretive and in its scope does not go beyond the scope of what is fundamentally possible in reality (“prophets, outstanding discoverers, brilliant scientists and writers, great reformers”, etc.). There are chronic, existing for a number or even decades, and acute versions of paranoid syndrome. Chronic paranoid delusions are most often observed in relatively slowly developing delusional schizophrenia. Delirium in such cases is usually monothematic. The possibility cannot be ruled out that there is an independent form of the disease - paranoia.

Acute, usually less systematized paranoid states are more common in the structure of attacks of fur-like schizophrenia. The delusional concept is loose, unstable and can have several different themes or centers of crystallization of false judgments.

Some authors consider it justified to distinguish between paranoid and paranoid syndromes (Zavilyansky et al., 1989). Chronic, systematized, overvalued delusions (beginning with overvalued ideas) that arise under the influence of a key psychotraumatic situation for the patient are called paranoid. Paranoid and epileptoid features of the premorbid personality of constitutional, post-processual or organic origin contribute to the development of delusions. The mechanisms of delusion formation are associated with psychological rather than biological disorders - “psychogenic-reactive” delusion formation. Paranoid syndrome in this interpretation is appropriate to consider within the framework of pathological personality development.

Paranoid or hallucinatory-paranoid syndrome. Includes delusional ideas of persecutory content, hallucinations, pseudohallucinations and other phenomena of mental automatism, affective disorders. There are acute and chronic hallucinatory-paranoid syndromes.

Acute paranoid is an acute sensory delusion of persecution (in the form of delusions of perception) of a specific orientation, accompanied by verbal illusions, hallucinations, fear, anxiety, confusion, and abnormal behavior reflecting the content of delusional ideas. It is observed in schizophrenia, intoxication, and epileptic psychoses. Acute paranoid states can also occur in special situations (long journeys associated with insomnia, alcohol intoxication, emotional stress, somatogenies) - road or situational paranoids, described by S.G. Zhislin.

Acute hallucinatory-paranoid syndrome is an acute sensory delusion of persecutory content, arising against a background of fear, confusion and combined with pseudohallucinations and other phenomena of mental automatism. It is more common in the structure of attacks of fur-like schizophrenia, with atypical alcoholic psychoses. Chronic hallucinatory-paranoid syndrome (synonyms: Kandinsky-Clerambault syndrome, other eponyms, mental automatism syndrome, invasion syndrome, deposition syndrome, xenopathic syndrome, parasitism syndrome, influence syndrome, external influence syndrome, alienation syndrome, mastery syndrome, polyphrenia, nuclear syndrome) — the difference in names reflects the difference in the opinions of their authors regarding which disorders should be considered determining the structure of the syndrome: mental automatisms, disorders of self-awareness, the experience of openness or delusional ideas of physical and mental influence.

Mental automatisms in their completed form represent the experience of violence, invasion, the doneness of one’s own mental processes, behavior, and physiological acts. The following types of mental automatisms are distinguished.

Associative or ideational automatism - disorders of mental activity, memory, perception, affective sphere, occurring with the experience of alienation and violence: influxes of thoughts, non-stop flow of thoughts, states of blockade of mental activity, symptoms of investing, reading thoughts, symptom of unwinding memories, pseudohallucinatory pseudomemories, sudden delays memories, the phenomenon of figurative mentalism, etc.

Manifestations of ideational automatism also include auditory and visual pseudohallucinations, as well as a number of affective disorders: “induced” mood, “induced” fear, anger, ecstasy, “induced” sadness or indifference, etc. This group of automatisms includes “ made” dreams. The inclusion of auditory verbal and visual pseudohallucinations in the group of ideational automatisms is due to their close connection with thinking processes: verbal pseudohallucinations with verbal ones, and visual ones with figurative forms of thinking.

Senestopathic or sensory automatism is a variety of senestopathic sensations, the appearance of which patients associate with the influence of external forces. In addition, this includes olfactory, gustatory, tactile and endosomatic pseudohallucinations. Sensory automatism includes various changes in appetite, taste, smell, sexual desire and physiological needs, as well as sleep disturbances, autonomic disorders (tachycardia, excessive sweating, vomiting, diarrhea, etc.), “caused,” according to patients, from the outside.

Kinesthetic or motor automatism - impulses to activity, individual movements, actions, deeds, expressive acts, hyperkinesis that arise with the experience of violence. Receptive processes can also occur with the phenomena of being made: “They force you to look, listen, smell, look with my eyes...”, etc.

Speech motor automatism - phenomena of forced speaking, writing, as well as kinesthetic verbal and graphic hallucinations.

The formation of mental automatisms occurs in a certain sequence. At the first stage of development of ideatorial automatism, “strange, unexpected, wild, parallel, intersecting” thoughts appear, alien in content to the entire structure of the personality: “I never think like that...” At the same time, sudden interruptions of necessary thoughts may occur. Alienation concerns the content of thoughts, but not the process of thinking itself (“my thoughts, but very strange ones”).

Then the feeling of one’s own thinking activity is lost: “Thoughts float, go on their own, flow non-stop...” or states of blockade of mental activity arise. Subsequently, the alienation becomes total - the sense of belonging to one’s own thoughts is completely lost: “Thoughts are not mine, someone is thinking in me, other people’s thoughts are in my head...” Finally, a feeling arises as if thoughts “come from the outside, are introduced into the head, are invested... “Telepathic contacts with other people arise, the ability to directly read the thoughts of others and mentally communicate with others appears. At the same time, patients may claim that at times they are deprived of the ability to think or that they are “pulled out of thoughts” or “stolen.”

The development of verbal pseudohallucinations can occur as follows. First, the phenomenon of the sound of one’s own thoughts arises: “Thoughts rustle and sound in the head.” Then your own voice begins to be heard in your head, “voicing”, and sometimes like an “echo”, repeating your thoughts. This can be called inner speech hallucinations. The content of statements gradually expands (statements, comments, advice, orders, etc.), while the voice “doubles, multiplies.”

Then “other people’s voices” are heard in my head. The content of their statements is becoming more and more diverse, divorced from the reality and personality of the patients. In other words, the alienation of the process of internal speaking also increases in a certain sequence. Finally, the phenomenon of “made, induced voices” arises. The voices speak on a variety of topics, often abstracted from personal experiences, sometimes reporting absurd and fantastic information: “The voices behind the ears speak about local topics, but in the head they speak about national ones.” The degree of alienation of what is said by voices can therefore be different.

The dynamics of kinesthetic automatism generally correspond to those described above. At first, previously unusual impulses to action and impulsive desires appear, and strange and unexpected actions and actions are performed for the patients themselves. Subjectively, they are perceived as belonging to one’s own personality, although unusual in content. There may be short stops of action. Subsequently, actions and deeds are performed without a sense of one’s own activity, involuntarily: “I do it without noticing it, and when I notice it, it’s hard to stop.” Conditions of blockade or “paralysis” of impulses to action arise.

At the next stage, activity proceeds with a clear experience of alienation of one’s own activity and violence: “Something is pushing from within, prompting, not a voice, but some kind of internal force...” Episodes of interruption of action are also experienced with a tinge of violence. At the final stage of development of motor automatisms, a feeling appears that motor acts are done from the outside: “My body is controlled... Someone controls my hands... One hand belongs to my wife, the other belongs to my stepfather, my legs belong to me... They look with my eyes...” The states of blockade occur with a feeling of external influence. incentives to action.

The sequence of development of speech motor automatisms may be similar. At first, individual words or phrases are broken out, alien to the direction of the patient’s thoughts, absurd in content. Often individual words are suddenly forgotten or the formulation of thoughts is disrupted. Then the feeling of one’s own activity that accompanies speech is lost: “The tongue speaks on its own, I’ll say it, and then the meaning of what was said comes through... Sometimes I start talking...” Or the tongue stops for a short time and does not listen. Next, a feeling of alienation and violence arises in relation to one’s own speech:

“It’s as if it’s not me who speaks, but something in me... My double is using the language, and I’m not able to stop the speech...” Episodes of mutism are experienced as violent. Finally, a feeling of external mastery of speech arises: “Strangers speak my language... They give lectures on international topics in my language, and at this time I don’t think about anything at all...” Conditions of loss of spontaneous speech are also associated with external phenomena. The development of speech motor automatisms can begin with the appearance of kinesthetic verbal hallucinations: there is a feeling of movement of the articulatory apparatus corresponding to speech, and the idea of ​​involuntary mental pronunciation of words. Subsequently, the internal monologue acquires a verbal-acoustic connotation, and a slight movement of the tongue and lips appears. At the final stage, true articulatory movements arise with the actual pronunciation of words out loud.

Senestopathic automatism usually develops immediately, bypassing certain intermediate stages. Only in some cases, before its appearance, can one state the phenomenon of alienation of senestopathic sensations: “Terrible headaches, and at the same time it seems that this is not happening to me, but to someone else...”

In the structure of mental automatisms, Clerambault distinguished two types of polar phenomena: positive and negative. The content of the former is the pathological activity of any functional system, the latter is the suspension or blockade of the activity of the corresponding system. Positive automatisms in the field of ideation disorders are a violent flow of thoughts, a symptom of investing thoughts, a symptom of unwinding memories, made emotions, induced dreams, verbal and visual pseudohallucinations, etc.

Their antipode, that is, negative automatisms, can be states of blockage of mental activity, a symptom of withdrawal, pulling out thoughts, sudden loss of memory, emotional reactions, negative auditory and visual hallucinations that arise with a feeling of accomplishment, forced deprivation of dreams, etc. In the field of senestopathic Automatism will be, respectively, sensations made and an externally caused loss of sensitivity; in kinesthetic automatism - violent actions and states of delayed motor reactions, taking away the ability to make decisions, blocking impulses for activity. In speech motor automatism, the polar phenomena will be forced speaking and sudden speech delays.

According to Clerambault, schizophrenia is more characterized by negative phenomena, especially if the disease begins at a young age. In fact, positive and negative automatisms can be combined. Thus, forced speaking is usually accompanied by a state of blockade of mental activity: “The tongue speaks, but at this time I am not thinking about anything, there are no thoughts.”

Disorders of self-awareness that arise in the syndrome of mental automatism are expressed by the phenomena of alienation of one’s own mental processes, the experience of the violence of their course, dual personality and the consciousness of an internal antagonistic double, and subsequently - a feeling of mastery by external forces. Despite the seemingly obvious nature of the disorder, patients usually lack a critical attitude towards the disease, which, in turn, may also indicate a gross pathology of self-awareness. Simultaneously with the increase in the phenomena of alienation, the devastation of the sphere of the personal Self progresses.

Some patients even “forget” what it is, their own Self; the old Self-concept no longer exists. There are no mental acts emanating from the name of one’s Self at all; this is a total alienation that has spread to all aspects of the inner Self. At the same time, thanks to appropriation, a person can “acquire” new abilities and characteristics that were not previously inherent in him. Sometimes the phenomenon of transitivism is observed - not only the patient, but also others (or mostly others) are the object of external influence and various kinds of violent manipulation, their own feelings are projected onto others. Unlike the projection itself, the patient is not subjectively freed from painful experiences.

The experience of openness occurs with the appearance of various echo symptoms. A symptom of echo thoughts - those around him, according to the patient, repeat out loud what he was just thinking about. Hallucinatory echo - voices from outside repeat, “duplicate” the patient’s thoughts. A symptom of the sound of one’s own thoughts is that thoughts are immediately repeated, they clearly “rustle, sound in the head, and are heard by others.” Anticipatory echo - voices warn the patient what he will hear, see, feel or do after some time. Echo of actions - voices state the actions, intentions of the patient: “I am being photographed, my actions are being recorded...” It happens that the voices are read for the patient, but he only sees the text.

Voices can repeat and comment on motives and behavior, give them one or another assessment, which is also accompanied by the experience of openness: “Everyone knows about me, nothing remains to myself.” Echo of writing - voices repeat what the patient is writing. Echo of speech - voices repeat everything the patient said out loud to someone. Sometimes the voices force or ask the patient to repeat for them what he told others, or, on the contrary, to mentally or out loud say again what he heard from someone, and the patient, like an echo, repeats this. The “hallucinatory personality” here seems to be deprived of contact with the outside world, establishing it with the help of the patient.

There is no name for this symptom, but we will conditionally call it the echo-patient phenomenon. The above echo phenomena can be iterative in the form of multiple repetitions. Thus, a patient (he is 11 years old) has episodes that last two to three hours, when what was said by other people three to five times in someone else’s voice is repeated in his head. One word is repeated more often. During repetitions, he perceives what is happening worse and cannot watch TV. Other echophenomena occur. Thus, the speech of others can be repeated by voices from outside or in the head - a symptom of echo-alien speech.

Voices with external projection are sometimes duplicated by internal ones - a symptom of echovoices. The experience of openness can also be observed in the absence of echo symptoms, arising in the most direct way: “I feel that my thoughts are known to everyone... There is a feeling that God knows everything about me - I am in front of him like an open book... The voices are silent, which means they are eavesdropping on what I think "

Delusion of physical and mental influence - a belief in the influence on the body, somatic and mental processes of various external forces: hypnosis, witchcraft, rays, biofields, etc.

In addition to the above-described phenomena of alienation, in the syndrome of mental automatism, opposite phenomena may occur - the phenomena of appropriation, which constitute an active or inverted version of the Kandinsky-Clerambault syndrome. In this case, patients express the belief that they themselves have a hypnotic effect on others, control their behavior, are able to read the thoughts of other people, the latter have turned into an instrument of their power, behave like dolls, puppets, parsleys, etc. Combination of alienation phenomena and assignments V.I. Akkerman (1936) considered a sign characteristic of schizophrenia.

There are hallucinatory and delusional variants of mental automatism syndrome.
In the first of them, various pseudohallucinations predominate, which is observed mainly during acute hallucinatory-delusional states in schizophrenia, in the second - delusional phenomena that dominate in chronically ongoing paranoid schizophrenia. In chronic schizophrenic delusions of the interpretative type, associative automatisms come to the fore over time. Senestopathic automatisms may predominate in the structure of attacks of fur-like schizophrenia. In lucid-catatonic states, kinesthetic automatisms occupy a significant place. In addition to schizophrenia, phenomena of mental automatism can occur in exogenous-organic, acute and chronic epileptic psychoses. Back to contents