Paranoid syndrome - causes, symptoms, types and treatment of delusional ideas

Paranoia is a severe mental disorder. It is characterized by the emergence of excessive suspicion in a person. With the development of this pathology, patients begin to see evil intent and build conspiracy theories in any random combination of life circumstances. Against this background, they are capable of unpredictable actions.

Pathogenesis of the disorder

Many scientists consider paranoia to be an independent form of mental disorder. The pathology is characterized by gradually developing delusions that occur without visual or auditory hallucinations. But often its appearance is accompanied by false memories. Over time, delirium becomes persistent.

The patient's mood is closely related to obsessions. In certain cases it can be suppressed, expansive or increased. In this case, the pathology is not accompanied by a pronounced change in mental abilities. There is a tendency to detail and thoroughness in thinking. The patient's behavior may remain unchanged for a long time.

Male paranoia of betrayal (jealousy)

The leading sign of the disorder is the conviction that the spouse is unfaithful, and this conviction has no basis and is based on painful ideas, unfounded, often far-fetched “evidence” and beliefs. Sometimes a man sincerely believes that his wife is not only cheating, but is also planning something bad, for example, she wants to poison her, set her up, etc.

This form of male paranoia is also characterized by the following symptoms:

• emotional lability, but gradually the periods of complacent, good mood become shorter and shorter, anxiety, irritation and anger predominate;
• constant search for evidence of the spouse’s infidelity: studying messages, photos, phone call history, examining bedding and underwear, clothes, surveillance (sometimes the patient even resorts to the help of private detectives);
• endless quarrels and conflicts (even to the point of physical violence), and often the wife is forced to admit to cheating just to end the scandal.

At the same time, the “jealous” person usually does not think about the identity of the alleged lover; it is the very fact of adultery that worries him. The literature on psychiatry describes clinical cases where a patient equipped his home with a complex system of security cameras, another patient did not stop at traffic lights, fearing that his wife would become acquainted with the driver of another car during this time, etc.

Provoking factors

Scientists have not yet identified the exact causes of the disease. But experts have identified a number of factors that significantly increase the risk of developing pathology. These include:

• heredity;
• protein metabolism disorder;
• psychological trauma that the patient received in childhood;
• neurological and mental diseases;
• long-term depression;
• neuroses;
• prolonged isolation from society;
• difficult life situations;
• long-term use of medications, drugs or alcohol consumption.

The risk group includes patients suffering from Alzheimer's and Parkinson's diseases.

Many scientists believe that regular consumption of large quantities of strong coffee can provoke the development of paranoid syndrome. The drink negatively affects the quality of sleep, insomnia develops, against the background of which the body is constantly in a depressed state.

Paranoid syndrome and similar disorders

Paranoid syndrome is a mental disorder characterized by the presence of systematic delusions. This condition develops slowly and over time the patient develops a complex system of inferences.

Kraepelin

The disease was described in 1863 by Emil Kraepelin. However, a little later, in 1912, several forms of pathology were identified, such as paranoid delusions and paranoid schizophrenia. In Soviet and Russian psychiatry, it is also customary to separate these concepts, since they differ in development patterns and clinical signs.

Unlike paranoia, paranoid syndrome is characterized by the presence of several delusional ideas. The disease is one of the stages in the development of paranoid schizophrenia, and in rare cases it is observed with the development of various other mental disorders.

Paranoid schizophrenia is a pathology characterized by a predominance of paranoid syndrome. Symptoms increase gradually, but paranoia is not observed.

The disease was identified in 1912 as an independent mental disorder. Before this period, it was believed that paranoid schizophrenia was only a form of paranoia.

In contrast to paranoia, patients retain a sense of the reality of what is happening. There are no hallucinations or systematic delusions. The pathology is characterized by periods of remission and exacerbation.

What is the difference between paranoia and paranoid disorders?

As has already been clarified, paranoia and paranoid disorders are different diseases. What symptoms of paranoia will help distinguish it from other diseases? Here are some examples:

1. With paranoia, there is one obsession and thought. For example, it seems to you that your work colleague wants to set you up. Therefore, all working moments are accompanied by this single thought. When you are upset, it seems that all the people around you want to set you up and deceive you. That is, there is a large-scale manifestation of the disease;
2. The paranoia itself is very logical and consistent. That is, the patient builds a fairly reasoned sequence and cause-and-effect relationships between the delusional idea and the surrounding circumstances. Delusional disorders have no logic and no relationship with events;
3. Paranoia does not imply the occurrence of any hallucinations or real distortions of reality. In disorders, delusions and hallucinations are observed together.

History of diagnosis

Paranoid syndrome began to be studied in more detail after the disease was identified as an independent disease. In 1915, a number of scientists proved that pathology is accompanied by interpretive delusions and that often all the patient’s thoughts are systematized.

Later, already in 1934, in the works of V.M. Morozov, it was proven that patients develop persistent delusional thoughts over time. All conclusions have a special system and patients are confident that they are right.

Also in the works of A.B. Smulevich and M.G. Shchirina in 1972 found that in some cases the disease develops like an epiphany, acutely and suddenly.

Classification according to ICD-10

In the international classification of diseases intended for use in Russia, delusional disorders have code F 22.01. It also includes paranoid development.

Also, other delusional personality disorders, including the querulant form, belong to the section coded F28.8 and F28.88. In the official ICD-10, paranoia is not classified as a separate section and corresponds to delusional disorder, code F22.0.

With a mild course of the pathology, they speak of paranoid disorder, the code of which, in accordance with ICD-10, is F60.0. In this case, the term “paranoid” means something similar to paranoia.

In addition, there is another form of personality disorder similar to paranoia. Paranoid schizophrenia. In the ICD, adapted for use in Russia, it belongs to the heading F22.03 - paranoid schizophrenia.

International Classification of Diseases

If you turn to the official international classification ICD-10, you will find that paranoia itself is not a disease. Only paranoid-type disorders that arise in the presence of other mental illnesses are considered. Is this the right approach? Unknown. But previously, paranoia within the framework of classical psychiatry was considered as an independent disease.

Characteristics of a typical patient

Patients suffering from paranoid syndrome are distrustful and suspicious of other people. This manifests itself in systematized delirium. A person always believes that others have bad intentions and are plotting against them. They can talk about their suspicions with a trusted person. But if this person allows himself to doubt that the patient is right, he immediately falls into the circle of conspirators.

In another case, a person imagines a conspiracy in which a group of people participates. The patient tells about this to everyone he meets and can trust. In this way he wants to protect himself and warn others about evil intentions.

A person with paranoid syndrome believes that they are trying to deceive him or take advantage of him for their own purposes. However, there is no evidence. Such relationships permeate not only personal relationships, but also professional ones, regardless of the environment.

Paranoia: its signs

During the course of the disease, it is difficult to identify any clear stages. Sometimes the manifestation of the disease may be preceded by a prodromal period, which is characterized by mood changes. The patient is less and less likely to be in a complacent mood. Suspiciousness, gloominess, self-absorption, pickiness are typical. A person can avoid communication, provoke scandals and conflicts.

With paranoia, symptoms usually appear when what is happening is somehow related to formed delusional ideas. Otherwise, the patient does not give the impression of a mentally unhealthy person, especially during the period of remission. He takes care of his appearance, is neat, is able to maintain a logically coherent conversation, and in some cases his ability to work is preserved.

Clinical picture

Signs of paranoia can manifest themselves in varying degrees of severity, so the main symptoms of paranoid syndrome include:

• decreased mental activity;
• inability to adequately perceive criticism;
• suspicion;
• hostility;
• hallucinations, most often auditory;
• megalomania;
• touchiness;
• jealousy is constant and unfounded;
• tendency to pass off fantasies as reality.

In addition, there is constant anxiety and fear. Patients suffer from depression and prolonged psychosis. Often they begin to file complaints to various authorities against people whom they consider their enemies and involved in the conspiracy.

How is the disease paranoia treated in psychology?

A psychiatrist treats paranoia. The main method of treatment is medication. Groups of drugs that a doctor can use:

• antipsychotics are drugs that block dopamine receptors. In simple words, they inhibit the development of delusional ideas by reducing the chemical activity of the brain;
• tranquilizers - reduce anxiety during persecution paranoia;
• antidepressants - normalize mood if paranoia is accompanied by severe depression.

The doctor prescribes medications individually - each drug has several effects at once, and thanks to experience, a competent psychiatrist can quickly select adequate therapy. Read more about treating paranoia.

The prognosis of the disease depends on the character of the person and his willingness to make contact. Paranoia is a disease that tends to be protracted. But this does not mean that it cannot be dealt with. If you follow the recommendations of your doctor, it is quite possible to reduce the severity of symptoms or get rid of them altogether.

Development of pathology

Paranoid syndrome develops in two stages. The first is characterized by the secrecy of delusional ideas in the patient’s behavior and actions. But the character begins to gradually change, suspicion appears. The patient adjusts his life to his fantasies, taking them for reality.

The second stage is characterized by an improvement in delusional deviations. The patient suffers from auditory hallucinations. The paranoid constantly imagines surveillance, alien voices that call him and impose their truths.

Often such people turn to investigative authorities for help due to wiretapping. The patient begins to be overcome by fear, panic, and anxiety. He feels like he is surrounded by a secret conspiracy. He talks about his plans with caution.

Only a doctor can stop the development of mental disorders, psychosis, depression and constant horror.

Folk remedies for treating paranoia

Alternative therapy should be started after consultation with a doctor. Medicinal plants are used in parallel with medications. But treatment of the disorder using traditional methods is possible only in the initial stages; in advanced cases, hospitalization is indicated for the paranoid.

The effect of therapy is enhanced by the following herbal raw materials:

• Geranium. Grind 200 g of young shoots of the plant, place in a teapot with a spout and put a rubber tube on this spout. Then place the dish on the stove, lowering the tube into the glass. Keep the kettle on low heat for 3 hours. Dilute a couple of drops of the resulting product in a glass of water, take 2 times a day.
• Ginger. Grind the tubers of the plant. The resulting powder is taken as follows: dilute 10 g in boiled milk, drink 3 times a day.
• Plant complex. Mix dried hawthorn, oregano, hops, St. John's wort, lilac and cucumber. Boil 30 g of the mixture in half a liter of water, and leave the resulting mixture for 12 hours. In the morning, drink 100 ml of infusion. The course of treatment lasts 60 days.

Exotic plants also used include ashwagandha (Indian ginseng, an adaptogen that fights stress) and brahmi (a brain tonic that improves memory).

Character of the current

In medicine, there are several types of paranoia, which differ in signs and causes, these include:

1. Alcoholic . Occurs due to prolonged use of alcoholic beverages. One of the signs is pathological jealousy. The mania of persecution also manifests itself.
2. Involutionary . Characterized by delusions of persecution, grandeur, and jealousy. Occurs at the age of 45-60 years.
3. Megalomaniac . Systematized delusions of grandeur. Often the patient feels like a pioneer or reformer.
4. Delirium of jealousy . The patient always thinks that his spouse is unfaithful to him.
5. Religious . Delusional ideas of religious content.
6. Persecute . Systematized ideas of persecution.
7. Erotic . It develops more often in women 40-50 years old. Characterized by a predominance of erotic delirium.
8. Senile . Occurs in old age.
9. Spicy . Manifested by sudden, figurative delusions of grandeur, relationships, or persecution.
10. expansive paranoia is also distinguished Images of delirium also appear suddenly. Most often they are of a religious nature.

FAQ

To study the issue in this article in more detail, it is necessary to consider the most common questions that arise in relation to paranoid disorder. Let's look at the answers to these popular questions.

What to do if paranoia strikes suddenly

When paranoia appears suddenly, the following questions need to be answered:

1. Did she really appear suddenly?
2. What are the causes of paranoia?
3. Is this situation a transition from a mild to an acute form?

In any case, the best decision would be to consult a psychiatrist for help. It is he who will be able to accurately diagnose this disease and offer you a treatment path.

However, if by surprise you mean being discovered and somewhat surprised by it, then you can try to deal with paranoia on your own. But it is important to remember that when self-medicating, you take responsibility for the fact that the disease can be neglected.

What to do if paranoia develops in a child or teenager

In the case of children, it is most important to see a doctor immediately. Due to the fact that children and adolescents have an unstable and weak psyche, they cannot properly assess the situation. Moreover, they are unlikely to suspect they are paranoid. As a parent, you need to explain to your child that medical help is necessary. Do not pressure or threaten under any circumstances. Try to make contact, show empathy and love. You need to become a helper and protector in the eyes of your child.

Is it possible to remove the problem with medication?

Yes, medications solve problems of paranoia. This has already been discussed. However, this decision is made by the attending physician. He will write out special antipsychotics according to your prescription. Therefore, you still have to see a doctor.

There are different treatment options for paranoia

Development of paranoia

In general, we have already talked about how exactly paranoia develops. But let's list these stages again:

1. The emergence of an idea;
2. The idea develops into an obsessive and manic thought;
3. Under its influence, thinking and perception of reality changes;
4. It develops into delirium that haunts a person constantly;
5. The worldview, human behavior, and character change.

What are the main ways to treat paranoia?

There are two main methods of treatment:

Medication

Therapy

The specific method of treatment is determined by the doctor. These two methods can be combined. This increases the effectiveness of treatment.

Complex of therapeutic measures

Treatment can be carried out either inpatient or outpatient, depending on the patient’s condition. Therapy involves taking antipsychotics, sedatives and antidepressants. Medicines are prescribed only by a doctor after examination and all psychological tests.

There are also ongoing conversations with the patient in order to change his thinking. To treat the disease, the main directions are used: family psychotherapy, cognitive behavioral psychotherapy, individual and group work. Thanks to this approach, patients can manage their emotions. Support and understanding from loved ones is also important.

It is difficult to completely get rid of paranoia, since the patient’s suspicions also extend to the attending physician, and the prescribed psychotherapy is perceived as an attempt to keep his thoughts and actions under control.

If left untreated, long-term depression occurs. Patients constantly feel fear and anxiety. This condition leads to suicidal thoughts. Often patients become aggressive and dangerous to others.

Paranoid syndrome is a chronic disease that is characterized by mental disorder and the occurrence of delusional ideas. The causes of the pathology have not been established to date. There are a number of factors that increase the risk of developing paranoia. Treatment consists of constant monitoring of the patient and changing his consciousness.

As we saw in the chapters on schizophrenia and paraphrenia, the position of paranoia has always been unclear. In a certain period of development of psychiatry, mainly before Kraepelin, it was understood very broadly, and it included many cases that later came to be regarded as a paranoid form of dementia praecox. Due to the fact that the latter soon grew to very large proportions, and cases that were quite diverse in symptoms and course began to be included in it, Kraepelin proposed to identify some cases with long-term preservation of mental alertness and a certain height of intelligence under the name paraphrenia. It must be said, however, that the position of this group turned out to be as precarious as the paranoia of the pre-Kraepelin period or its paranoid form of schizophrenia. It turned out that many cases of paraphrenia essentially belong to schizophrenia, some should probably be attributed to protracted forms of a manic state of circular psychosis; Finally, there are cases that occupy a special position and constitute a relatively small group that deserves the name of paranoia. According to Kraepelin’s definition, it is characterized by the fact that, on the basis of a peculiar predisposition, with full preservation of meaningfulness and correctness in thinking, feeling and behavior, a persistent system of delusions slowly develops, representing the processing of life experiences. Despite the sometimes quite significant similarity with the paranoid form of schizophrenia and paraphrenia in the paranoia group, we are talking about completely different essentially pictures with a different genesis and different mental mechanisms. There is always a certain, although very slowly growing, weakening process, and in the genesis of delirium the main role is played by altered organic sensations and hallucinations. Delirium is established due to the fact that the perception of the surrounding world changes, and the degrading intellect cannot cope with new sensations and hallucinations and makes errors of judgment. For paranoid forms of schizophrenia, cathethetic delusional formation is typical, suggesting the presence of a weakening of the intellect. What is significant here is that the delusion of a schizophrenic is not organically united with his entire personality, appears to be some kind of heterogeneous formation, and often appears to the patient himself as something alien, parasitic. With paranoia, pictures of delusions similar in content develop as a kind of reaction of a painfully sensitive personality to actual events. The driving force in this case is not changes in the world of sensations, but the needs of feeling, due to which the very genesis of delirium can be called catathymic.

The question of the genesis of delusions in paranoia and related questions about the scope of the concept itself and the delimitation of paranoia from other diseases have received a lot of attention in recent years. Kehrer and Kretschmer attach the most importance to emotional moments and think that the conflicts underlying paranoia differ from hysterical ones only in their great depth and affect the vital layer of the personality, while hysterical ones proceed more superficially. Kehrer also talks about disorders in the area of ​​personality drives, the dynamics of which are determined by contrasting experiences, and social aspects play a role. Schultze strives to further clarify the concept of “conflict,” which plays a role in the genesis of paranoia. According to his formulation, the paranoid constitutes his delusion from the contradictions between the desire for social inclusion of himself in society and for the recognition of the value of the individual, on the one hand, and from the insufficiency caused by a painful predisposition that has been revealed in life, on the other.

Lange, developing the concept of his teacher Kraepelin, accepts the presence of a unique, constitutionally determined nature of reaction, the same for all cases of paranoia. The role of constitutional aspects, however, is not denied by other authors, but still the main one should be considered a special paranoid development of the individual with a change in attitudes towards everything around him: the delusion itself is not a central, axial disorder, but only a regional one and to a certain extent optional, so how with a change in life situation it can smooth out or even disappear. In the above definition of Kraepelin, it is undoubtedly necessary to make a significant amendment, namely by rejecting the criteria of persistence, the inaccessibility of delirium for correction, in view of the fact that, as Kronfeld and V. Shterring rightly point out, this persistence, although it is a commonly observed clinical fact, does not indicate the very essence of delirium. In general, delusions with paranoia develop in the presence of two factors: a peculiar inclination towards paranoid attitudes of the individual and an unfavorable situation. As for the first point, here we have people who, from their youth, have revealed certain features of their mental makeup in the sense of great pride, egocentrism, increased self-esteem, a tendency to fantasy and the search for truth, for whom not everything is smooth in their sexual life and who do not adapt well to surrounding life. These features, which distinguish the patient from those around him, themselves create a situation in which the patient becomes in a special position in relation to others, which, with his increased self-esteem and sensitivity, gives him reason to somewhat overestimate himself in comparison with others and assume that he is not being given due, they envy him, strive in one way or another to belittle his dignity. In the presence of such mental characteristics, if life circumstances are not particularly favorable, the patient may develop distrust, suspicion, a tendency to interpret everything in a special way, see injustice everywhere, a conscious intention to harm him, humiliate him, and insult him as permanent character traits. Very often, painful phenomena remain throughout life at this stage of a paranoid nature, the manifestations of which, depending on life circumstances, either become aggravated or are largely smoothed out. Sometimes, in a particularly unfavorable situation, things can lead to painful shifts in the patient’s thinking with the formation of delusional concepts. The starting point is always some kind of conflict in life, a failure at work, an unsuccessful marriage, an unfavorable outcome for the patient in some legal case. The emotional reaction, which is an inevitable consequence of an unpleasant experience in every person, in this case is usually especially emphasized due to increased sensitivity and leads to an intensification in the patient’s character of those features that prevent him from giving a correct objective assessment of the case. Morbid resentment and conceit often push the patient to various wrong actions, aimed at eliminating the unfavorable consequences of the case for him, but usually leading to even more significant misunderstandings and grief for him. As a result, the suspicions that arose from the very beginning not only do not dissipate, but are increasingly strengthened, and even the most insignificant events and in no way affecting the interests or pride of the patient begin to be regarded as delusional. In this way, persistent delirium develops, which, under circumstances unfavorable for the patient, grows like a snowball. Hallucinations usually do not occur in such cases, and they cannot play any role in the formation of delusions, but the illusory nature of perception is of a certain importance. It often seems to the patient that the persons whom he suspects of having an incorrect attitude towards him are making some signs to each other, whispering to each other. On the other hand, false memories and memory errors are of great importance, due to which the past is distorted in the direction that corresponds to the patient’s delusional attitudes. For example, it seems to him that the facts that he himself reported at one time are distorted by his opponents, that the protocol on which his own signature is, is forged, etc. The development of delirium undoubtedly requires intellectual changes for itself, often original, but in in any case, not of the nature of dementia in the usual sense. The formal abilities of the intellect, memory, consideration, criticism remain at the same height, just as the external correctness of the patient’s behavior is preserved. Thanks to all this, the patient, at least up to a certain point, gives the impression of a completely sane person to everyone around him. In the views of a paranoid, however, it is always possible to state that the judgment is erroneous, and, moreover, in the most basic points. Some kind of shift in mental mechanisms that makes the patient’s logic crooked, does not give him the opportunity to see the true state of affairs and pushes everyone to new erroneous conclusions. This is facilitated by the special gullibility of patients and the weakness of criticism that they reveal when they encounter facts related to I'm delirious about them. It matters that such patients always find people who sympathize and are convinced of the validity of their complaints about the injustices caused. These are usually the people closest to the patient, members of his family, who often, together with the patient, became victims of an unfavorable life situation. Sometimes in such cases we can definitely talk about induced delirium. Such people who sympathize and assent to the patient often themselves look for various facts that confirm the assumption of the patient, who in this case shows special gullibility, accepting these facts without any criticism. Since delirium always develops as a reaction to painful experiences, the source of which can be the life situation itself, sometimes one has to take into account such moments that for some reason put the patient in a particularly disadvantageous position for him. Dependence on others and a low position may be important, as a result of which paranoia can more easily develop in people of certain professions. According to pre-revolutionary data, paintings of this kind were relatively often owned by governesses. Specht includes here folk teachers whose increased sense of self-esteem, if observed as a constitutional feature, does not find sufficient satisfaction in the attitudes of those around them (we are talking about Germany).

To get acquainted with the essence of paranoia and the mechanisms of delusion formation during it, it is very interesting to get acquainted with the history of one typical case described by Gaupp and known to all psychiatrists under the name Fall Wagner.

At about 5 o'clock in the morning on September 4, 1913, the senior teacher in the village of Degerloch, Ernst Wagner, killed his wife and four children, stabbing them to death with a dagger while they were asleep. Covering the corpses with blankets. Wagner washed, got dressed, took with him three revolvers and over 500 cartridges and set off by rail to the place of his former service - the village of Mühlhausen. There he set fire to several buildings, and then ran out into the street and, holding a revolver in each hand, began shooting at all the residents he encountered. As a result, 8 people were killed by him, and 12 were seriously wounded. Only when he had shot all the cartridges he had at the ready and the revolvers were empty, they managed to disarm him in a difficult struggle, and he received such serious injuries that at first he seemed dead. Due to the strangeness of the motives put forward by him to explain this bloody crime, a psychiatric test was carried out on him, which gave the following results.

Wagner turned out to be extremely burdened by heredity on both his father's and mother's sides. As a child, he was a very sensitive, O5ID and proud boy. Extreme truthfulness did not leave him even if he was threatened with punishment for telling the truth. He was scrupulously true to his word. Very early on, he developed an attraction to women, a rich and indomitable imagination, and a passion for reading. At the teacher's seminary where he studied, he was distinguished by spiritual independence, increased self-esteem, love of literature and extreme conscientiousness in relation to his duties. Early on, he acquired a hopeless outlook on life: “The best thing in this life is never to be born,” he writes as a 17-year-old boy in the album of one of his comrades, “but if you are born, you must persistently strive for the goal.” At the age of 18, Wagner fell into the grip of a vice that turned out to be fatal to his fate - under the influence of increased sexual excitability, he began to engage in masturbation. The stubborn struggle he waged against his weakness was unsuccessful. From that time on, his self-esteem and his frank truthfulness received a severe blow, and pessimism and a tendency towards hypochondriacal thoughts provided fertile ground for development. For the first time, his personality experienced a deep internal discord between the feeling of guilt and self-contempt that had now gained dominance in his soul and his former aestheticism, attraction to women and high opinion of himself. He began to suspect that his comrades noticed his secret vice and mocked him. However, this mental conflict did not have a noticeable impact on his successes and external relationships with people. He passed his first teacher's exam with flying colors and entered the service as a teacher's assistant. He established good relations with his fellow officers: they considered him a good-natured, although somewhat arrogant and too touchy young man. However, due to his conceit, he soon had a clash with the senior teacher, as a result of which he was transferred to another place - the village of Mühlhausen. He began to have relationships with women quite early. Nevertheless, despite all his struggle with this vice and attempts to be treated, he could not give up masturbation even at the age of 26-27 years. More than 10 years before the crime, under the influence of wine fumes - and at this time, in order to drown out the remorse of his conscience, he began to drink heavily - he, returning home from the tavern, committed sodomistic acts several times. Since then, the main content of his thoughts and feelings has been remorse for these disgusting acts. How did he, a man with artistic taste, with high moral aspirations, with his ambition and contempt for everything ignoble, succumb to such a wild unnatural attraction! The fear that his sodomy would be discovered again made him extremely suspicious, forcing him to fearfully, distrustfully look closely and listen to the faces and conversations of those around him. Already having this sin on his conscience, Wagner passed his second teacher's exam, and, fearing to be arrested, he always carried a revolver in his pocket - upon arrest he was going to shoot himself. The further he went, the more and more his suspicion grew. The thought that his relations with animals had been spied on began to haunt him. It began to seem to him that everything was already known and that he was under special surveillance. If they talked or laughed in front of him, then a cautious question immediately arose in his mind whether they were talking about him or whether they were laughing at him. Checking his daily observations and pondering their smallest details, he became more and more convinced of the validity of such thoughts, despite the fact that, according to his own words, he had never been able to hear a single phrase that would fully prove his suspicions. Only by comparing the views, facial expressions and individual movements of his fellow citizens or interpreting them in a special sense of the word, did he come to the conviction that all this undoubtedly relates to himself. What seemed most terrible to him was that while he himself was tormented by cruel self-accusations, cursing and executing himself, those around him mercilessly turned him exclusively into an object of universal ridicule. From that time on, the whole picture of life began to appear to him in a completely distorted form; The behavior of the peaceful inhabitants of Mühlhausen, who were not at all aware of Wagner’s spiritual drama, in his mind takes on the character of deliberate mockery of him. The further development of delirium is interrupted by Wagner's transfer to another village. Having accepted the transfer as a punishment, he still initially felt relief from the thought that no one would know him in his new place. Indeed, although even there deep darkness and melancholy dominated his soul, for 5 years he did not notice any ridicule of himself. During this time, he married a girl with whom he accidentally met, he married solely because he considered it impossible to refuse a marriage with a woman who became pregnant from him. Despite the fact that Wagner was now living a completely normal sex life, suspicion still demanded food, and gradually the old fears awoke again. Comparing the innocent remarks of friends and acquaintances, he began to come to the conclusion that rumors about his vices had reached here too. Of course, the culprits for this were the Mülchausens, who were not content with mocking the unfortunate man themselves, but needed to make him an object of ridicule in a new place. A feeling of deep indignation and anger began to grow in his soul. There were moments when he reached extreme levels of angry excitement, and only the thought of revenge, which began to mature in him from that time on, kept him from direct reprisal. His favorite subject of dreams now became a detailed discussion of his planned business. He developed the crime plan in great detail already 4 years before it was carried out. Wagner wanted to achieve two goals at the same time. The first of them was the complete destruction of his family - a family of degenerates, burdened with the shame of the most disgusting vice: “Everything that bears the name Wagner is born for misfortune. All Wagners must be destroyed, all of them must be freed from the fate that weighs on them,” he later told the investigator. Hence the idea of ​​killing all his children, his brother’s family and himself. The second goal was revenge - he was going to burn the entire village of Mühlhausen and shoot all its male inhabitants for their cruel mockery of him. The bloody deed conceived by Wagner at first frightened him. To cheer himself up, he kindled his imagination and dreamed of the greatness of the task facing him, which now turned into a great mission for him, “the work of his whole life.” He armed himself with reliable weapons, learned to shoot in the forest, prepared a dagger to kill his wife and children, and yet, every time. Just as he was thinking of starting to carry out his plan, an irresistible horror seized him and paralyzed his will. After the murder, he told how often at night he stood at the bedside of his children, trying to overcome internal resistance, and how the moral impossibility of this matter scared him away every time. Gradually life became an unbearable torment for him. But the deeper the melancholy and despair become in Wagner’s soul, the greater the number of his enemies seems to him and the greater the task at hand. (The medical history in this part is taken from the translation given in the book by P. M. Zinoviev “Mental illnesses in pictures and images.”)

To understand the essence of changes in paranoia, the further fate of the patient is very interesting. After being declared mentally ill and insane by the court, he spent 6 years in a psychiatric hospital when he was again examined by Gaupp. It turned out that he retained mental alertness and correctness of behavior and did not show any signs of dementia or dullness. By all indications, the diagnosis of schizophrenia had to be rejected in the most decisive manner. There was no further development of delirium and, on the contrary, one could state a certain weakening of it and an awareness of the painfulness of at least some of one’s experiences. He told the doctor: “My criminal actions stemmed from mental illness... perhaps no one regrets the Mühlhausen victims more than me.” In this way, a significant part of the delirium, which arose on the basis of difficult experiences associated with life conflicts, was corrected in such a way that with a superficial acquaintance with the patient one could think of a complete recovery. In reality, the delusional attitudes remained the same, just as the personality retained its previous paranoid structure. The imprisonment and subsequent stay in a psychiatric hospital undoubtedly contributed to the calming of the patient and the paling of his delirium. During this time, he worked a lot, continued his previous literary and poetic experiments, and in particular wrote dramatic works, in one of which he made himself the hero; he also wrote a long autobiography. For understanding the genesis of delirium, it is important that the main role was played by a painful interpretation of actual facts that did not have the meaning that the patient attributed to them. His following statements are typical: “I could understand some conversations as if they were talking about me, for there are accidents and unrelated things that, taking into account certain circumstances, may seem to have meaning and a specific purpose; thoughts with which your head is full, you willingly place in the heads of others.” With such a seemingly critical attitude towards his most vivid delusional ideas, he retained his former suspicion and, at the slightest reason, began to think that those around him were making fun of him.

In the genesis of painful phenomena in this case, as is generally the case with paranoia, there was a combined effect of heavy heredity, relatively high talent, and mental influences associated with failures in life, which had a particularly strong effect on the young and proud teacher. In this case, the presence of proud ideas of greatness also deserves attention. In the descriptions of paranoia in the old sense, which can be found in old manuals on psychiatry, there are indications of the transformation of delusions of persecution into delusions of grandeur, which always seems to occur at a certain period of development. This transformation in the form of some kind of turning point in the disease, timed to a certain time, hardly ever takes place, but there is a grain of truth in the observations of old psychiatrists. Delusions of grandeur sometimes genetically seem to follow from delusions of persecution. The same Wagner speaks very clearly about this: “The delusion of grandeur that appears in my works represents a natural reaction to my depression.”

Paranoia in the sense that we now understand it is not a common disease. According to Kraepelin, 40% of all diseases characterized by paranoid symptoms are classified as schizophrenia, slightly more than this are paraphrenia, and only a small remainder is paranoia. According to Bumka, this remainder is estimated at 3-4% of all psychoses in this group. Bumke classifies the entire group of paraphrenia (in the textbook published in 1930) without any reservations as schizophrenia. The following table, taken from the monograph by K. Kolle (Die primère Verrücktheit, 1932), can give an idea of ​​the relative frequency of paranoia and its position among other diseases. During the period 1904-1922, when Kraepelin was the director of the Munich clinic, for approximately 30 thousand patients admitted there were diagnoses:

The majority, approximately three quarters of the diseases, occur in men. The onset of the disease usually falls after 30 years of age.

Collet's 66 cases in this regard are distributed as follows:

As a rule, there is a severe hereditary burden. It is natural, therefore, that in the neuropsychic organization of a subject who subsequently develops paranoia, from the very beginning traits are discovered that give the right to talk about the presence of psychopathy. Relatively often, certain sexual perversions are observed.

The course of paranoia, as we saw in the example of Wagner, is chronic, partly gradual, but largely characterized by individual outbreaks associated with life conflicts.

In some cases, the emphasis has to be placed either on constitutional features, or on reactive changes, or on the painful development of the entire personality. Since situational aspects, which naturally can be very diverse, play a role in constructing the picture of the disease, the clinic of paranoia, understanding it even within the relatively limited framework in which paranoia is now understood, is quite diverse. Kehrer schematically reduces various paranoid pictures to the following groups:

1) habitual paranoid attitudes (other names—paranoid psychopaths or constitutions);

2) chronic, non-progressive paranoia;

3) paranoid reactions (paranoid situational psychoses and phases);

4) chronic, paranoid development.

The features of these forms are clear from the names themselves. Only two groups need explanation. Chronic, non-progressive paranoia occupies an intermediate position between constitution and development. In these cases, delirium, without further development, but also without correction, remains as something persistent for a long period of life.

According to our observations, paranoid pictures (paranoische Zustände Kehrer), in general with essentially the same genesis, i.e., reduced to a personal reaction to life experiences and to its unique development, can be observed against the background of other constitutions. It is especially easy to imagine the development of paranoid pictures against the background of an epileptic or epileptoid psyche with its sthenicity and egocentric attitudes. and with a tendency to get stuck on individual thoughts, especially from the category of overvalued ones. The same conditions can be found in cycloid individuals in old age. In the presence of a traumatic situation, we have seen several striking cases of both types.

In the past, when paranoia was understood very broadly, several separate forms were distinguished—typical delusions of persecution, religious insanity, erotic insanity, delusions of invention, etc. Genealogical study indicates their relationship with paraphrenia and, consequently, with schizophrenia. Typical delusions of persecution and clinical picture correspond to the so-called systematic paraphrenia. On the other hand, not so much according to the clinical picture, but rather according to the mechanism of development, delusions of litigiousness, or delusions of querulants, can be classified as paranoia. In this case, the matter begins with the fact that the patient very painfully perceives some kind of injustice actually caused to him, sometimes recorded by a court order. He considers it necessary to achieve justice, files complaints in court, seeks a trial of the case and, dissatisfied with its outcome, transfers it to a higher authority. He begins to think that the unfavorable turn of the matter for him is not accidental, but is explained by the machinations of his ill-wishers and direct enemies, who conspired among themselves, formed a whole gang, bribed judges, acted on them with threats and tried in every possible way to drown the patient. Increasingly worried by failures and suffering from his painful sensitivity from injections of pride, he loses his balance, he himself makes various injustices and mistakes, which further complicate his situation. All the time he is busy with his court affairs, carries with him a whole pile of papers, complaints, copies of court verdicts, certificates. It is natural, therefore, that his financial situation suffers more and more, since he is not able to engage in any productive work. This is how your whole life usually goes, and only physical weakening and loss of energy that comes with age bring a certain calm. However, if your life situation changes, for example when you move to another city, significant, albeit temporary, improvements are possible.

Recognizing Paranoia

When distinguishing paranoia from diseases that are similar in external form, one must remember the main symptom in this case—the development of delusions on the basis of painful personality development as a result of some painful collisions for the patient. If new delusional ideas arise that have no connection with the original conflict, then the diagnosis of paranoia becomes doubtful and one has to think about the paranoid form of schizophrenia or paraphrenia. The same doubts should arise in the presence of clearly expressed hallucinations, especially if they provide material for the development of delusions. The preservation of mental alertness and correctness of behavior should also be considered characteristic of paranoia, since delusional attitudes are not involved here. It is especially typical for paranoids that, despite the complex and extensive patterns of delusion, they usually turn out to be quite good practitioners and are very good at managing their personal affairs. This, of course, also speaks about the safety of their intelligence. It may present certain difficulties in distinguishing from some cases when delusional ideas also reactively arise in psychopathic individuals. Friedman and Gaupp talk about special mild, abortive and treatable forms of paranoia. In these cases, delusional ideas of persecution, sometimes with a hypochondriacal tinge, arise in persons with endogenous nervousness under the influence of external factors. Since in this case the matter is limited to individual ideas and, moreover, related more likely to the type of uberwertige Ideen, and not to delirium, and in relation to them a complete correction soon occurs, then one can hardly talk about paranoia here. It is also possible to differentiate from the delusional imaginations of degenerates. Litigative delirium must sometimes be distinguished from psychopathic debaters and so-called pseudo-queerulants. In these cases, in the presence of querulant inclinations, there is actually no delusion. The presence of a certain amount of excitement and increased emotionality in the delusions of querulants sometimes makes one think about distinguishing it from chronic mania, especially since Specht is inclined to see an internal affinity between both diseases. The roots of paranoid illness are seen in mistrust as a kind of mixed state of manic and depressive moments. Taking into account the conditions for the development of delirium, delimitation is generally possible. In relation to the delusions of querulyants, the most difficulties arise due to the fact that its individual components are simultaneously associated with different diseases. It is not surprising that not all psychiatrists accept its attribution specifically to paranoia. Kraepelin at one time considered it the only typical form of paranoia. Lately he attributed it to psychogenic reactions. It seems to us that Kraepelin’s original point of view, which is also supported by Bumke, is more correct, especially since we associate paranoia in general with psychogenic reactions on psychopathic grounds.

We can talk about treatment only in the sense of some kind of palliative measures. Changing your living situation, changing your job and place of residence can be helpful. Hospitalization, which is sometimes necessary due to a tendency to commit antisocial acts, usually worsens the course, contributing to the strengthening and development of delusions. Of the 66 cases carefully monitored by Collet, only 16 turned out to require long-term hospitalization.