One of the most characteristic symptoms of schizophrenia, which is found in 80% of patients, is delusional ideas. What it is? Delusions are stable conclusions and beliefs that have nothing to do with reality. Delusion in a schizophrenic patient is one of the main manifestations of an exacerbation of the disease, psychosis.
The peculiarity of delirium is that it cannot be explained from the point of view of the mind and it is impossible to prove to a schizophrenic that his ideas are unrealistic. A person with delusional ideas does not listen and does not perceive reasonable arguments, therefore it is extremely difficult to treat him. It is characteristic that delusional ideas in schizophrenia can be very diverse, and differ in content and other features.
The difference between delusions of a schizophrenic and delusions in healthy people
Delusional ideas arise as a result of mental illness, so they are not similar to the erroneous opinions and beliefs that people with a healthy psyche have.
- Crazy ideas are characterized by an erroneous, distorted representation of reality. Delusion is unshakable, that is, the ideas of the patient cannot be corrected. Attempts to enter into a dispute, to argue, to prove only strengthen it.
- The patient is convinced of the reality of delusional experiences.
- Delusions are characterized by initially incorrect grounds (the so-called paralogic).
- Most often (with rare exceptions) delusional ideas arise against the background of clear consciousness.
- Delirium is always accompanied by noticeable changes in the patient’s personality (his attitude towards himself and others changes).
- Against the background of the appearance of crazy ideas, intelligence does not decrease. On the contrary, delusions are more often observed in patients with a high level of IQ.
Different classifications of delusions in schizophrenia
Brad is classified according to different criteria.
I. According to the content, nonsense is conditionally divided into three large groups:
- Persecutory. The underlying motive for all delusions that fall into this category is the patient’s belief that he is being persecuted or intentionally harmed.
- Metaphysical. An example is all the delusional ideas, one way or another connected with the belief of a person that he is influenced by supernatural forces.
- Expansive. The essence of delirium is that the patient unreasonably begins to overestimate his self-esteem, and considers himself a genius, the owner of unique qualities, and an outstanding person.
- Depressive. Its content is opposite to expansive crazy ideas and, on the contrary, is characterized by low self-esteem.
- Other types. There are a lot of them because the content of crazy ideas is often associated not with the disease itself, but with the sociocultural environment in which a person grew and developed.
II. According to the mechanism of appearance, nonsense is distinguished:
- Primary. Occurs as a separate disorder. It may exist alone or be combined with other signs of psychopathology. A characteristic feature of primary delirium: it is not associated with other symptoms by cause-and-effect relationships and exists in parallel.
- Secondary. It follows from other mental disorders, is their consequence. For example, a patient has vocal hallucinations. He hears that someone is talking to him, but does not know how to explain this to himself in terms of reason. Then the patient tries to come up with an accessible interpretation – this is how the crazy idea appears that he is talking with angels, ghosts, etc.
In schizophrenia, both kinds of delusions occur.
There is another classification according to the formation mechanism. According to her, delirium happens:
- Interpretive. The patient interprets real events and phenomena from the point of view of erroneous, “crooked” logic.
- Sensual. The patient does not prove his ideas with logical arguments. He is convinced of their authenticity because he “feels that way.”
- Induced. A person is “infected” with delusional ideas from a mentally ill person.
III. According to the level of systematization, nonsense is distinguished:
- Systematized. Thoughtful, structured, “logical” nonsense with a system of arguments and arguments. More often, he indicates that the patient’s mental disorder has been developing for a long time.
- Sketchy. Separate crazy ideas that may not be related to each other in any way, but can be combined on the go with an invented common theme. This variety is characteristic of the acute onset of delirium.
IV. In terms of scale or unusualness, there is nonsense:
Small scope. Usually, relatives, friends, and neighbors of the patient are involved in it, and the content does not go beyond the scope of everyday issues from the series “Neighbors deliberately heat my apartment every weekend” or “Mom deliberately puts a knife in my bag so that I cut myself.”
Megalomanic scope. This is fantastic nonsense of grandiose proportions with the participation of unreal beings, and people. The patient can imagine how he saves the Universe and manages the world. Or, on the contrary, he may be convinced that he is the cause of all the troubles on the planet.
Now you are familiar with the main classifications of delusions. Let us dwell in more detail on certain types of delusional ideas that are most common in schizophrenia.
Delusions of Relationship
One of the most characteristic and frequent in schizophrenics. This is a type of persecutory or paranoid delusion. Delusions of attitude can manifest themselves in the following ideas. The patient is convinced that everything that happens around him is directly related to him and that the attention of others is focused only on him. It seems to such patients that everyone is discussing them, in the grin of a bystander they find a threat to themselves, some take even the news broadcast on TV personally.
Delusions of attitude in schizophrenics often develop into delusions of meaning. At this stage, the patient is not only sure that “the world revolves around him”, but he can also explain why.
Delusional Ideas of Persecution
Another common symptom of schizophrenia. With this type of delusion, the patient becomes paranoid. He is convinced that he is being followed. More often with a negative goal – to recruit, harm, kill, and evict from home. Less often, schizophrenics think that the purpose of the persecution is positive (for example, to protect them from enemies).
Delusional ideas of this type can be dangerous to others. Being confident in persecution, a schizophrenic may show aggression towards imaginary persecutors. Therefore, it is necessary to begin treatment at the very first symptoms – increased suspiciousness and suspicion, from which delusions of persecution always begin.
Other Types of Paranoid Delusions
Delusional ideas based on paranoia can manifest themselves in other variations. In the delusion of poisoning, the patient is afraid that he will be poisoned or, worse, that he has already been poisoned. Many even take tests to confirm poisoning. At the same time, negative results by no means dissuade schizophrenics, but only strengthen them in their conviction, forcing them to look for more and more poisoners in their environment.
With delusions of jealousy, it seems to the patient that his partner is unfaithful. At the same time, illogical and unreliable arguments are presented as evidence. Unfortunately, often the delirium of jealousy is accompanied by violence against the “unfaithful” partner.
In this group, there is also the nonsense of litigation. The patient may be convinced that someone is intentionally violating his legal rights. Hence the desire to write complaints about different instances, to sue on various occasions.
Delusional ideas of influence are characterized by the patient’s persistent conviction that his psyche or physical health is influenced by the outside. Any object of influence can be present in the beliefs of a schizophrenic – hypnosis, psychotropic substances.
Varieties of Metaphysical Delirium
In schizophrenics, it is not as common as paranoid delusions, but it also has a place to be.
Two delusional ideas are close in meaning – archaic and delusional obsession. In the first case, the patient is sure that he is being influenced by witchcraft and magical powers. In the second – that something lives inside him that causes suffering, that is, he is possessed by supernatural power.
A subspecies of the delusion of possession can be considered the so-called dermatologic delusion, which is often accompanied by hallucinations from the field of tactile sensations. With such a crazy idea, the patient is sure that worms, beetles, or other small parasites live under his skin. Similar in sensations and delirium of internal zoopathy. Only in this case, the “beast” or “parasite” does not live under the skin, but directly in the internal organs. This category also includes religious delusions, when the patient considers himself a god, a prophet, or, conversely, the devil.
From the same series, eschatological delusions (belief in one’s own ability to predict the end of the world) and delusions of reincarnation (the patient’s stories about who he was in his “past life”).
Variations of Expansive Delusions
The second most common among schizophrenics is the delusion of greatness, power, and possession of power. Such patients appoint themselves as kings, gods, possessors of superhuman abilities, and exalt themselves above other people.
According to the delusional idea of immortality, human life can be endless or last for centuries. But this requires certain external conditions.
This also includes the nonsense of creativity, which can be expressed by the ideas of reformism, and invention. The bottom line is that supposedly the patient made a great discovery, and invented something unique that could affect the lives of all mankind.
There are delusional ideas about their high origin, according to which the patient was allegedly born to famous parents. But for some reason, they do not recognize their relationship with him. Erotic delirium is also similar in content, only in this case it is not the parents who hide their true attitude towards the patient, but the person allegedly in love with him. As a rule, this is a famous person. From the same series, delusional ideas of beauty (confidence in their unearthly attractiveness), health (confidence in perfect health), and wealth (the patient considers himself the owner of countless treasures).
Experts note that delusional ideas of an expansive type are much more likely to develop in those people who initially had very high self-esteem. During her illness, she manifested herself as a megalomaniac. It is also interesting that delusions of grandeur occur several times more often in people with secondary and higher education than in poorly educated patients.
Early signs of the beginning delusions of grandeur may be the loss of the ability to adequately perceive criticism, and advice, listen to other people’s opinions, obsession with one’s person, aggressiveness, isolation, and breaking social ties. Of course, a patient with delusions of grandeur does not recognize the presence of a medical problem.
The task of relatives is not to argue with a schizophrenic, not to convince them so as not to provoke aggression, but to seek help from a psychiatrist as soon as possible. Delirium is treated not by persuasion, but by properly selected medications as part of an integrated approach.
Varieties of Depressive Delusions
The complete opposite of the previous category. The patient’s self-esteem is greatly reduced. Against this background, he expresses depressive delusional ideas:
- Self-blame (accuses himself of crimes, bad deeds in the past, demands punishment for himself);
- Hypochondria (confidence of the patient that he is terminally ill);
- Denial (the schizophrenic believes that he does not have any part of the body or even the personality as a whole);
- Death (the patient considers himself dead).
What other crazy ideas do schizophrenics have?
Sometimes there is a delusion of a positive or negative twin. The patient is sure that someone has taken possession of the body of his loved one or, conversely, takes a stranger for his relative. Sometimes a similar idea extends to oneself. With schizophrenia, there is also Fregoli syndrome – a kind of delirium in which the patient sees a friend in all the people around him, constantly changing his appearance. May be combined with persecution mania.
The delusional idea of reduplication is based on the belief of the schizophrenic in the existence of his copies, repeating his actions. The essence of the idea of staging is that the surrounding reality is only a kind of production, especially played out for the patient.
Features of Schizophrenic Delusion
Delusional ideas arise not only in schizophrenia but also in other mental disorders. Experts identify several features that can be considered characteristic of schizophrenic delirium.
- Delusions are almost always combined with hallucinations.
- There is often ambiguity and inconsistency in the patient’s beliefs.
- A flash of delusional experience. The schizophrenic is suddenly “overshadowed” by a delusional thought.
- An absurd idea. As a rule, the patient formulates his thought in a very abstract, vague way. Separate fragments of thoughts are difficult to link into a single whole.
- The delirium gradually becomes vaguer and vaguer, the patient withdraws into himself, breaks off all social contacts, and lives in the world of his fantasies.
How are they treated?
Treatment of delirium as a symptom of schizophrenia is complex. Methods of therapy are selected for each patient individually, taking into account the clinical picture, and the stage of the disease. Treatment is usually carried out in several stages. First, in a hospital, an acute attack is stopped and the patient’s condition is stabilized. Then they prepare him for discharge and return to everyday life. The next stages are rehabilitation, which takes about a year, and prevention, which can take decades.
People with schizophrenia need the support of loved ones. It is the relatives who should ensure that the patient does not violate the doctor’s recommendations, takes medication strictly according to the schedule, and helps control behavior.
The emergence of delusional ideas may be one of the first symptoms of schizophrenia. And if you pay attention to the changed behavior of a loved one in time, immediately go to the doctor, and start treatment early, you can maintain a decent quality of life for the patient for many years.