Frequent hallucinations will lead to what. Hallucinations in schizophrenia and other mental disorders: similarities and differences. Side effects of drugs

Hallucinations are an important symptom for the diagnosis of various psychotic disorders. Although a number of specific characteristics, such as insulting, commenting, and imperative voices, as well as auditory hallucinations of an extracampal nature (i.e., outside the "sensitive field" of the analyzer), are no longer distinguished in the DSM-5, many clinicians still tend to consider that hallucinations in schizophrenia can be identified based on these characteristics.

However, it is worth considering that there is a growing recognition among scientists that hallucinatory experiences cover a wide range of mental disorders and may even be part of the everyday experience of people who do not meet the criteria for any mental disorder.

In a new study, F. Waters and C. Fernyhough analyzed whether certain characteristics of hallucinations considered specific to schizophrenia are such by conducting a systematic review of scientific papers investigating direct comparisons of the clinical characteristics of auditory and visual hallucinations among 2 or more groups of patients, one of which necessarily included persons with schizophrenia. 43 articles were reviewed, studying hallucinations in 4 main groups: non-clinical conditions; conditions associated with drugs and alcohol; various neurological diseases and other medical conditions, as well as mental disorders.

The authors provide data that hallucinations in mental disorders, in addition to schizophrenia, schizotypal disorder, and schizoaffective disorder, can also occur in bipolar disorder (in manic, depressive and mixed phases), unipolar depression, dissociative disorders, personality disorders, PTSD, anorexia and bulimia nervosa.

Also, hallucinations can be a consequence of the pathology of various physiological systems. For example, acquired deafness is a common cause of auditory hallucinations, and various eye diseases or damage to the afferent visual pathways can cause visual hallucinations (in domestic psychopathology, this type of perceptual deception is referred to as Charles Bonnet's hallucinations). Endocrine-related various metabolic disorders, including thyroid dysfunction and Hashimoto's disease, vitamin D and B12 deficiencies, can also cause hallucinations. Other disorders associated with hallucinations include chromosomal disorders such as Prader-Willi syndrome, various autoimmune diseases, acquired immunodeficiency disorders such as HIV/AIDS, and sleep disorders such as narcolepsy. Neurological diseases such as tumors, traumatic brain injuries, epilepsy, various vascular diseases can also cause hallucinations. Perceptual delusions are also quite common in neurodegenerative diseases such as Parkinson's disease and dementia with Lewy bodies.

Additionally, it is worth paying attention to the fact of hallucinatory experiences in people who do not fall under the criteria for mental disorders. Psychotic experiences occur in about 4-7% of the general population, with 80% of such experiences being transient. In this group, the prevalence of hallucinations depends on the stage of development: for example, in children they occur in 8%, and in the elderly in 1-5% (which again may indicate a connection with the development or involution of the nervous system). Hallucinations can also occur in situations of extreme physiological or psychological stress, such as extreme fatigue, sensory deprivation, bereavement, etc.

The results of this study showed that no hallucinatory characteristic strongly suggests a diagnosis of schizophrenia, except for the age of onset in late adolescence. Among the 21 characteristics of hallucinations in schizophrenia given in the article, 95% were observed in other mental disorders, 85% in various neurological diseases, 66% in drug and alcohol-related conditions, 52% in non-clinical conditions (See Table 1 ).

Tab. 1 Phenomenological features of hallucinations (abbreviated version)

In general, scientists came to the conclusion that when considering hallucinations, it is inappropriate to give weight to certain characteristics of hallucinations in the diagnosis of schizophrenia, because. the results of the study did not confirm that, based on certain features of hallucinations, it is possible to unambiguously diagnose schizophrenia. Moreover, Schneider's first-line symptoms were not specific for schizophrenia, as they occurred in non-clinical conditions - 20-40%, narcolepsy - 10-17%, alcohol withdrawal - 26-60%, affective disorders - 20-55% and dissociative disorders - 80%.

This review provides an important conclusion regarding the diagnostic value of hallucinations. For example, hostile voices that speak in the third person and cause distress may be equally present in a patient with schizophrenia, epilepsy, a brain tumor, or PTSD. However, this finding does not suggest that hallucinations are clinically uninformative.

In general, the authors of the study conclude, hallucinations are a feature of human perception that crosses the boundaries of diagnostic categories and spans the gap between psychopathological and non-clinical experience. Therefore, it is important for the clinician to focus on the combination of hallucinations with other symptoms and clinically relevant findings.

The material was prepared as part of the project ProSchizophrenia - a specialized section of the official website of the Russian Society of Psychiatrists dedicated to schizophrenia, modern approaches to its diagnosis and treatment.

Hallucinations are an image that appears in the mind of an individual without the presence of an external stimulus. They can arise as a result of severe fatigue, with the use of a number of psychotropic drugs and with certain neurological ailments and some mental illnesses. In other words, hallucinations are false perceptions, an image without an object, sensations that arise without stimuli. Images that are not supported by really existing stimuli can be presented as an error in the processes of perception of the sense organs, when the patient feels, sees or hears something that does not really exist.

There are hallucinations that have a sensually bright color, persuasiveness. They can be projected outside, do not differ from true perceptions and are called true. In addition, there are hallucinations perceived by the internal auditory analyzer or visual, localized in the inner sphere of consciousness and felt as a result of the influence of some external force that provokes visions, for example, voices. They are called pseudo-hallucinations.

Causes of hallucinations

Imaginary images, not supported by really present stimuli and associated with the visual system, are characterized by the contemplation of patients of various objects or events that do not really exist in reality, in which they can take part.

These hallucinations in humans arise as a result of poisoning with alcohol-containing substances (that is, it is one of the manifestations of alcohol), with the use of narcotic drugs, as well as psychostimulants such as LSD, cocaine, etc., medicines with an M-anticholinergic effect (for example, antidepressants), some organic structures of tin. In addition, visual imaginary images, as well as auditory hallucinations, characteristic of some ailments (peduncular hallucinosis).

Visual hallucinations, therefore, are the so-called visual illusion, a disturbed perception of reality. With this ailment, the patient cannot separate real objects from imaginary images.

Orders given by a "voice from above", words of praise from invisible friends, shouts - refer to hallucinations from the auditory system. They are often observed in schizophrenic disorders, simple partial seizures, occur with alcoholic hallucinosis, are the result of various poisonings.

The sensation of imaginary odors is characteristic of olfactory erroneous perceptions, which also occur when patients often feel extremely unpleasant "aromas" of rot, rancidity, etc. In addition, olfactory hallucinations can provoke brain defects, namely, lesions of the temporal lobe. Partial seizures and encephalitis caused by the herpes virus, along with olfactory imaginary perceptions, also cause gustatory hallucinations, characterized by patients feeling a pleasant or disgusting taste in the mouth.

Verbal hallucinations of a threatening nature are expressed in the patients' persistent perception of verbal threats against themselves, for example, it seems to them that they are going to be hacked to death, castrated, or forced to drink poison.

Contrasting imaginary perceptions have the character of a collective dialogue - one set of voices furiously condemns the patient, demands to subject him to sophisticated torture or put him to death, and the other group defends him uncertainly, timidly asks for a delay in torture, assures that the patient will improve, stop drinking alcoholic beverages, become kinder . Characteristic of this type of disorder is that the group of voices does not address the patient directly, but communicate with each other. Often they give the patient exactly the opposite orders (to fall asleep and dance at the same time).

Speech-motor hallucinations are characterized by the patient's conviction that someone takes possession of his own speech apparatus, by influencing the muscles of the tongue and mouth. Sometimes the articulatory apparatus pronounces voices that are not heard by others. Many researchers attribute the described imaginary perceptions to variations of pseudohallucinatory disorders.

Visual hallucinations in individuals in terms of their prevalence occupy the second position in psychopathology after auditory ones. They can also be elementary (for example, a person sees smoke, fog, flashes of light), that is, with incomplete objectivity and the presence of subject content, namely zoopsy (visions of animals), polyopic (multiple images of illusory objects), demonomaniac (visions of mythological characters , devils, aliens), diplopic (visions of doubled illusory images), panoramic (visions of colorful landscapes), endoscopic (visions of objects inside one's body), scene-like (visions of plot-related imaginary scenes), autovisceroscopic (contemplation of one's internal organs).

Autoscopic imaginary perceptions consist in the observation by the patient of one or more of his doubles, completely copying his behavioral movements and mannerisms. There are negative autoscopic misperceptions where the patient is unable to see their own reflection in a mirror surface.

Autoscopies are observed in organic disorders in the temporal lobe and parietal region of the brain, in alcoholism, in postoperative hypoxia, due to the presence of pronounced psychotraumatic events.

Microscopic hallucinations are expressed in perceptual delusions, representing an illusory decrease in the size of people. Such hallucinations are most often found in psychoses of infectious origin, alcoholism, chloroform poisoning, and ether intoxication.

Macroscopic illusions of perception - the patient sees enlarged living beings. Polyopic imaginary perceptions consist in the patient's vision of many identical imaginary images, as if created as a carbon copy.

Adelomorphic hallucinations are visual distortions, devoid of distinctness of forms, brightness of colors and volumetric configuration. Many scientists attribute this type of disorder to a special type of pseudohallucination, which is characteristic of schizophrenia.

Extracampal hallucinations consist in the patient's vision with angular vision (that is, outside the normal field of view) of some phenomena or people. When the patient turns his head towards a non-existent object, such visions instantly disappear. Hemianopsic hallucinations are characterized by the loss of one half of the vision, are observed in organic disorders occurring in the human central nervous system.

Hallucinations of Charles Bonnet are true distortions of perception, observed when one of the analyzers is damaged. So, for example, with retinal detachment or glaucoma, visual hallucinations are noted, and with otitis media - auditory illusions.

Olfactory hallucinations are a deceptive perception of very unpleasant, sometimes disgusting and even suffocating odors (for example, the patient smells a decaying corpse, which in reality does not exist). Often, olfactory-type hallucinations cannot be differentiated from olfactory illusions. It happens that one patient may have both disorders, as a result of which such a patient refuses food. Deceptive perceptions of the olfactory type can arise as a result of various mental ailments, but they are predominantly characteristic of organic defects of the brain and are localized in the temporal region.

Taste hallucinations are often observed in combination with olfactory deceptive perceptions, manifested in the sensation of a taste of rot, pus, etc.

Tactile hallucinations consist in the patient feeling the appearance of some liquid on the body (hygric), touching something high or low temperature (thermal hallucinations), grasping from the back of the body (haptic), an illusory sensation of the presence of insects or under the skin (intrinsic zoopathy), crawling of insects or other small creatures on the skin (external zoopathy).

Some scientists refer to hallucinations of the tactile type as a symptom of the sensation of a foreign object in the mouth, for example, thread, hair, thin wire, observed in tetraethyl lead delirium. This symptom, in fact, is an expression of the so-called oropharyngeal imaginary perceptions. Tactile illusory representations are characteristic of cocaine psychosis, delirious clouding of consciousness of various etiologies, and schizophrenia. Often, tactile hallucinations in schizophrenia are localized in the genitourinary region.

Functional hallucinations originate against the background of a real-life stimulus and live until the end of the stimulus. For example, against the background of a piano melody, the patient can simultaneously hear the sound of the piano and the voice. At the end of the melody, the illusory voice also disappears. Simply put, the patient perceives at the same time a real stimulus (piano) and a commanding voice.

Functional hallucinations are also divided depending on the analyzer. Reflex hallucinations are similar to functional ones, they are expressed in the appearance of imaginary perceptions of one analyzer, when exposed to another, and exist exclusively during stimulation of the first analyzer. For example, the patient may feel the touch of something wet on the skin (reflex hygro hallucinations) when viewing a certain picture. As soon as the patient stops looking at the picture, the discomfort disappears.

Kinesthetic (psychomotor) erroneous perceptions are manifested in the sensation by patients of the movements of certain parts of the body, which occur against their will, but in reality there are no movements.

Ecstatic hallucinations in a person are detected when he is in a state of ecstasy. They are distinguished by their colorfulness, imagery, influence on the emotional sphere. Often characterized by religious, mystical content. There are visual and auditory, as well as complex. Many drugs provoke hallucinations, but they are not always accompanied by positive emotions.

Hallucinosis is a psychopathological syndrome characterized by the presence of pronounced multiple hallucinations against the background of clear awareness.

Delusions, hallucinations form Plaut's hallucinosis, which is verbal (less often olfactory and visual) imaginary perceptions in combination with delusions of persecution with clear consciousness. This form of hallucinosis occurs with a disease such as syphilis of the brain.

Atherosclerotic hallucinosis is observed more often in the female part of the population. At the same time, at first, deceptive perceptions are fenced off, as atherosclerosis develops, an exacerbation of characteristic signs is noted, such as weakening of memory, a decrease in intellectual activity,. The content of distorted perceptions is often neutral and concerns simple everyday activities. With the deepening of atherosclerosis, deceptive perceptions can become more and more fantastic.

Hallucinations in children are often confused with illusions, which are children's inadequate perception of real-life objects. In addition, for little crumbs, the vision of illusions is considered a physiological norm, since with their help fantasy develops.

Hallucinations, on the other hand, are spontaneously appearing types of various objects, characterized by brilliance, the perception of objects that do not exist in reality, actions.

Hallucinations in children are a constant subject of study by scientists. Recent studies indicate that approximately 10% of primary school students develop auditory hallucinations. The emergence of imaginary perceptions in children does not depend on their gender.

Treatment of hallucinations

For effective treatment of perceptual disorders, it is necessary to find out the cause that provoked the appearance of this condition.

Hallucinations, what to do? Today, many methods have been developed to treat different types of hallucinations. But with a number of ailments, therapy is aimed at curing the disease that caused the hallucinations, and at eliminating or alleviating the symptoms. Since in an isolated form hallucinations are quite rare. Often they are an integral part of a number of psychopathic syndromes, often combined with different variations of delusions. Often the appearance of imaginary perceptions, especially at the beginning of the course of the disease, usually affects the patient and is accompanied by excitement, feeling, anxiety.

Until now, the issue of effective therapy for hallucinations is controversial, but almost all healers agree on one thing, that treatment should be individually directed.

First of all, it is necessary to exclude various diseases and intoxications, which are often factors provoking the appearance of this condition. Then you should pay attention to the drugs used by the patient. Since in clinical practice there have been many cases when, for the treatment of errors in the perception of various analyzers, it was sufficient to stop taking certain drugs.

People suffering from the appearance of hallucinations may be characterized by a critical attitude towards imaginary ideas that arise in the mind, and not critical. The individual may be aware that the voices he hears or the scenes he observes do not exist in reality, or he may think that they are true. Often, patients can see quite real scenes that correspond to reality, for example, observe events involving relatives.

Some patients suffering from this condition are able to distinguish imaginary perceptions from reality, while others are not able, some may feel changes in the body, which are harbingers of imminent hallucinations. The close environment may notice the appearance of this disorder in an individual by his behavior, namely, by observing his gestures, facial expressions, actions, listening to the words uttered by him, which do not correspond to the surrounding reality. This is very important, since quite often patients, afraid of being placed in a "psychiatric hospital" or due to their delusional considerations, try to hide their symptoms, dissimulate hallucinatory experiences.

A patient suffering from hallucinations is characterized by concentration and alertness. He can peer into the surrounding space with a gaze, listen intently to something, or move his lips silently, answering his unreal interlocutors. It happens that this condition in individuals occurs periodically. In such cases, it is characterized by a short course, so it is important not to miss an episode of hallucination. The facial expressions of patients often correspond to the content of imaginary perceptions, as a result of which they reflect surprise, fear, anger, less often joy, delight.

With hallucinations, characterized by the brightness of perception, they can respond to the voices they hear aloud, plug their ears, pinch their noses with their hands, close their eyes, fight off non-existent monsters.

Hallucinations, what to do? At the pre-medical stage, the main thing is the safety of the sick individual and his environment. Therefore, possible dangerous and injurious actions must be prevented.

Responsibility for the treatment of individuals suffering from an erroneous perception of reality, in the first turn, falls on their closest environment - on relatives.

At the medical stage, an anamnesis is first collected, the nature of the visible, audible, felt is specified, a laboratory examination is carried out in order to accurately diagnose and prescribe therapy, methods of care and observation of the patient.

Treatment is focused on the relief of arousal attacks and is aimed at eliminating symptoms such as delusions, hallucinations. For this purpose, intramuscular injections of Tizercin or Aminazine can be used in combination with Haloperidol or Trisedil. The patient is hospitalized in a psychiatric clinic in the presence of a serious mental illness that provoked the appearance of hallucinations.

Failure to provide assistance to patients is dangerous because this disorder can progress and can become chronic (hallucinosis), especially in the presence of aggravating factors, such as alcoholism. The patient is unable to distinguish all his hallucinations from reality, and after a while he begins to think that this is the norm.

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This pathological symptom refers to disorders of perception of the surrounding reality. Depending on the analyzer in which the disturbance in the perception of the surrounding reality occurs, hallucinations are divided into auditory, visual, olfactory, tactile, gustatory, visceral, speech and motor hallucinations.

Hallucinations of any nature can be caused by mental illness, as well as brain damage (traumatic brain injury, meningitis, encephalitis, etc.) or severe pathologies of internal organs. Hallucinations in severe somatic diseases (internal organs) or brain damage are not a sign of a person's mental illness. That is, a person suffering, for example, from heart failure or having suffered a traumatic brain injury, may experience hallucinations, but at the same time he is completely mentally healthy, and a violation of the perception of the surrounding reality occurred due to a serious illness.

In addition, hallucinations can also appear in perfectly healthy people under the influence of substances that affect the functioning of the central nervous system, such as alcohol, drugs, psychotropic drugs, toxic substances, etc.

Brief description and essence of the symptom

So, Esquirol gave the following definition of hallucinations: "a person is deeply convinced that he has some kind of sensory perception at the current moment, and there are no objects within reach." This definition is relevant to this day, because it reflects the main essence of this psychiatric symptom- a violation of the sphere of perception of the surrounding reality, in which a person feels objects that are absent in reality and at the same time is completely convinced that he is right.

In short, hallucinations are the perception of something that is actually missing at the moment. That is, when a person feels smells that do not exist in reality, hears sounds that also do not exist in reality, sees objects that are absent in the surrounding space, etc., then these are hallucinations.

At the same time, mirages do not belong to hallucinations, since this phenomenon is not a consequence of a violation of mental activity, but a natural phenomenon, the development of which is based on the laws of physics.

Hallucinations must be distinguished from pseudo-hallucinations and illusions, which also relate to disturbances in the sphere of perception of the surrounding world that occur in severe mental disorders.

So, the main difference between hallucinations and pseudo-hallucinations is their pronounced outward orientation and connection with objects that really exist in the surrounding space. For example, a hallucination is that a person sees a spot sitting on a real-life chair, or hears sounds from behind a real existing door, or smells coming out of a ventilation that is in reality, etc. And pseudo-hallucinations, on the contrary, are directed inward, that is, on the perception of various non-existent objects inside the human body. This means that during pseudohallucinations, a person feels non-existent objects in his body, for example, voices in the head, cockroaches in the brain, a beam of radiation in the liver, the smell of blood in the vessels, etc. Pseudohallucinations are very intrusive, often have a threatening, imperative or accusatory character. and little dependent on the thoughts of the person himself.

Illusions, unlike hallucinations, are a distorted perception of real-life objects and objects. Illusions are characteristic of all people of any age and gender, and they are due to the peculiarities of the work of the sense organs and the laws of physics. An example of a typical illusion is a hanging coat, which in low light conditions appears to be a figure of a lurking person. The illusion also includes the distinct hearing of the voice of a familiar person in the rustle of leaves, etc.

That is, summing up, we can briefly say that:

• Hallucination- this is a "vision" of a non-existent object on an object that actually exists in the surrounding space.
• Pseudo-hallucination- this is a "vision" of a non-existent object inside one's own body.
• Illusion- this is a "vision" of real-life objects distorted, with characteristics that they actually lack (a coat is perceived as a lurking person, a chair is seen as a gallows, etc.).

What are hallucinations?

So, depending on the nature and the analyzer involved, hallucinations are divided into 4 following types:

1. Associated hallucinations. They are characterized by the appearance of images with a certain logical sequence, for example, a stain on a chair predicts the appearance of flies from a faucet if a person tries to turn on the water.
2. Imperative hallucinations. They are characterized by the appearance of an orderly tone emanating from any surrounding objects. Usually such an orderly tone commands a person to perform some action.
3. Reflex hallucinations. They are characterized by the appearance of hallucinations in another analyzer in response to the impact of a real stimulus on any analyzer (auditory, visual, etc.). For example, turning on the light (an irritant for the visual analyzer) causes an auditory hallucination in the form of voices, orders, the noise of the installation for guiding laser beams, etc.
4. Extracampal hallucinations. They are characterized by going beyond the field of this analyzer. For example, a person sees visual images that are hallucinations behind a wall, etc.

In addition, there is a historically established and most commonly used classification of hallucinations according to the sense organs in the field of activity of which they occur. So, according to the analyzers of feelings available to a person, hallucinations are divided into the following types:

Besides, hallucinations are divided into the following types depending on their complexity:

True hallucinations - video

Pseudo-hallucinations - video

Hallucinations - Causes

1. Mental illnesses:

• Hallucinosis (alcoholic, prison, etc.);
• Hallucinatory-delusional syndromes (paranoid, paraphrenic, paranoid, Kandinsky-Clerambault).

• Tumors and brain injuries;
• Infectious diseases affecting the brain (meningitis, encephalitis, temporal arteritis, etc.);
• Diseases that occur with severe fever (for example, typhus and typhoid fever, malaria, pneumonia, etc.);
• Syphilis of the brain;
• Cerebral atherosclerosis (atherosclerosis of cerebral vessels);
• Cardiovascular diseases in the stage of decompensation (decompensated heart failure, decompensated heart defects, etc.);
• Rheumatic diseases of the heart and joints;
• Tumors localized in the brain;
• Metastases of tumors in the brain;
• Poisoning by various substances (for example, tetraethyl lead - a component of leaded gasoline).

• Alcohol (hallucinations are especially pronounced in alcoholic psychosis, called "white tremens");
• Drugs (all opium derivatives, mescaline, crack, LSD, PCP, psilobicine, cocaine, methamphetamine);
• Medications (Atropine, drugs for the treatment of Parkinson's disease, anticonvulsants, antibiotics and antivirals, sulfonamides, anti-tuberculosis drugs, antidepressants, histamine blockers, antihypertensives, psychostimulants, tranquilizers);
• Plants containing toxic substances that act on the central nervous system (belladonna, dope, pale grebe, fly agaric, etc.).

5. Chronic prolonged sleep deprivation.

Hallucinations: causes, types and nature of the symptom, description of cases of hallucinations, connection with schizophrenia, psychosis, delirium and depression, similarity with a dream - video

Treatment

How to induce hallucinations?

The safest way to induce hallucinations is through forced sleep deprivation. In this case, a person will only face the consequences of lack of sleep, hallucinations will appear, but there will be no poisoning of the body with toxic substances.

Semantic hallucinations

There is an opinion that they are inherent only to persons suffering from mental illness. In the same category of people include those who often abuse alcohol or use drugs. To a certain extent, this is true. That is, people of this circle really belong to the risk group. But in general, it cannot be argued that healthy people are not prone to hallucinations. Scientists have conducted experiments that have brought very interesting results. Nineteen people who did not have any diseases became participants.

Each of the participants was alone for some time in a specially equipped room, which cannot be penetrated by extraneous sounds or images from outside. After that, the scientists asked the volunteers about the sensations. Five subjects reported that they “noticed” human faces, and six people said that they “fixed” the movement of incomprehensible creatures. The other six participants "heard" strange sounds that had no explanation. Two people "observed" the presence of monsters in the empty room. According to the organizers of this experiment, a number of such hallucinations are explained by such a circumstance that the brain suddenly fell into conditions of an absolute absence of information, while it was used to receiving it constantly.

Also, psychiatrists argue that for the occurrence of hallucinations it is not at all necessary to be in a dark room. It is known that prisoners placed in solitary confinement also often experience similar phenomena. Being in the conditions of complete absence of any information, the brain is able to independently create various impressions. The cause of hallucinations is often pronounced states of affect, severe fright, certain chemicals. Influenced by the stress that develops in the event of the death of relatives, or in other tragic circumstances. In any case, the reason must be global. There are examples when hallucinations are provoked by strong love, excessive passion.

Very often, the occurrence of this disorder is due to severe injuries, or diseases of the brain. Hallucinations occur in the presence of tumors, can be the result of a severe injury. Among the diseases that cause hallucinations, experts call an aneurysm, olfactory gland meningioma, syphilis, temporal arteritis, migraine, certain cardiovascular problems,. Scientists assign a special role in the development of hallucinations to eye diseases. It has been established that visual hallucinations occur in glaucoma, cataracts, and some other diseases. Moreover, hallucinations have been found to occur in otosclerosis.

Some people believe that hallucinations are the same false perception. But their difference is that false perception is observed when the object itself is absent. Healthy people see hallucinations much more often than you might think. For example, when making a long journey through the desert, languishing from excruciating thirst, it may seem that a settlement, an oasis, is visible ahead. In reality, such objects are nothing more than an optical illusion. But still, it is worth noting that in most cases people with mental illness are prone to hallucinations. Along with visual hallucinations, auditory hallucinations are also observed.

For example, the patient claims to hear the sound of the wind, an approaching car, the knock of a door, and so on - although in reality, nothing of the kind happens in their environment. It happens that hallucinations are verbal in nature, when it seems to people that someone is calling them, and fragments of a non-existent conversation are also heard. If auditory hallucinations are commanding in nature, then a mentally ill person often obeys unquestioningly, thereby sometimes causing significant harm to himself or others. It is known that hallucinations are not only visual, and habitual auditory, but also gustatory, and even olfactory. Often all these phenomena are combined.

Regardless of the cause, hallucinations are of a different nature and affect the patient in different ways. They can be neutral in color, or completely devoid of emotionality. Patients treat them calmly, sometimes even indifferently. But there are exceptions when hallucinations are emotionally expressed very clearly. Thus, a case from clinical practice is described, when a mother who lost her son did not get out of a depressive state. In her hallucinations, she often saw the deceased, and these "meetings" brought her great joy.

Discussing the causes of hallucinations of various types, scientists always emphasize that today this process is poorly understood, and the selective disorders that occur during x and hallucinations are not clear enough. Scientists single out hallucinations inherent in healthy people as a separate topic. For example, hallucinations of a mass nature. When they occur, the phenomenon of mass suggestion is observed, when people “turn on” each other, while the crowd becomes a single organism. It has long been established that a person is easily suggestible. When alone, he is able to behave like a critical thinker.

hallucinations(from Latin Hallucination - delirium, visions) - imaginary images of objects and situations perceived as real, but absent in reality, arising spontaneously, without sensory stimulation. Caused by internal mental factors (as opposed to illusion, which is a distorted perception of external stimuli).

Back in the 7th c. The Indian philosopher Kumarilla Bhatta expressed consonant modern guesses about the deceptions of human perception. The illusory nature of the image, he argued, is determined by the perversion of the relationship between the external object and the organ.

The causes may be defects in the sense organs, as well as such disorders when images of memory are projected into the outside world and become hallucinations. Some hallucinations can have a bright sensual coloring, persuasiveness and be projected outside and be indistinguishable from real perceptions. Such hallucinations are called true.

Others are perceived by internal hearing or vision, localized in the internal field of consciousness and felt as the result of the influence of some external force that causes visions, voices, etc. This phenomenon was described at the end of the 19th century. Russian psychiatrist V.Kh. Kandinsky, is called pseudohallucinations.

A hallucinating patient, along with false images, can adequately perceive reality. At the same time, his attention is distributed unevenly, often shifting towards deceptions of perception. For the most part, there is no understanding of the pain of hallucinations, the patient behaves in exactly the same way as if what seemed to him were actually happening.

Often, hallucinations, no matter how irrational their content, are more relevant for the patient than reality, and patients treat them the same way as the corresponding real phenomena. Patients stare at something, turn away, close their eyes, look around, wave away, defend themselves, try to touch or grab something with their hands, listen, plug their ears, sniff, drop something from their body, etc.

Under the influence of hallucinations, various actions are performed that reflect the content of perceptual deceptions: patients hide, look for something, catch, attack others, sometimes try to kill themselves, destroy objects, defend themselves, flee, complain, etc. With auditory hallucinations, they talk aloud with "voices".

As a rule, patients believe that others perceive the same things that they perceive in their hallucinations - they hear the same voices, experience the same visions, and smell. Emotional reactions are clearly expressed, the nature of which reflects the content of perceptual deceptions: fear, rage, disgust, enthusiasm.

The patient finds himself in great difficulty if imaginary and real images enter into a relationship of antagonism and have an equal power of influence on behavior. With such a "split" personality, the patient seems to exist in two "dimensions" at once, in a situation of conflict between the conscious and the unconscious.

Types and symptoms of hallucinations

The mentally ill, especially those suffering from schizophrenia or manic depression, may believe that they are a messenger from heaven and constantly hear the voice of God speaking to them. He can feel the gentle touch of an angelic hand. These sensory impressions, which come from within the psyche, are perceived as genuine, really existing stimuli coming from outside.

The recurring hallucinations of a mentally ill person can create an entire fantasy world designed to accommodate internal emotional conflict to reality. Less severe cases include hallucinations, usually auditory or visual, that occur in healthy people during periods of deep emotional distress.

Hallucinations can be a delusion of any of the five basic senses, i.e. they are visual, auditory, olfactory, gustatory, tactile and hallucinations of a general feeling (experiencing unusual processes occurring inside the body, sensations from the presence of foreign objects in the body, etc.).

If the patient hears voices, these are auditory hallucinations; if he sees the dead - visual. A patient with paranoia, constantly feeling that the room smells of poisonous gases penetrating through the wall, suffers from olfactory hallucinations. A person who complains of being electrocuted by his pursuers experiences tactile hallucinations.

A patient who feels that poison has been mixed into his food has taste hallucinations. Hallucinations that occur outside of a particular sensory field are also possible. Thus, it may seem to the patient that water is pouring out of some point on his head.

Tactile (tactile) hallucinations are associated with the sensation of touch, usually unpleasant. For example, cocaine users often complain of the sensation of insects running under their skin.

In a state of delirium, usually due to alcohol poisoning, patients often see various small creatures. In this case, the patient describes a normal object reduced to microscopic proportions. When a patient complains that some parts of the body are not where they should be, but in some other place, they speak of psychomotor hallucinations.

Hypnagogic hallucinations occur in mentally healthy people between wakefulness and sleep. Thus, a late-night driver who falls asleep at the wheel may suddenly apply the brakes sharply, because it seems to him with complete distinctness that he sees a person running out into the road in front of the car.

Causes of hallucinations

Very often, the occurrence of this disorder is due to severe injuries, or diseases of the brain. Hallucinations occur in the presence of tumors, can be the result of a severe injury.

Among the diseases that cause hallucinations, experts call the following:

• aneurysm
• meningioma of the olfactory gland,
• syphilis,
• temporal arteritis,
• migraine,
• certain cardiovascular problems
• chorea of ​​Huntington.

Scientists assign a special role in the development of hallucinations to eye diseases. It has been established that visual hallucinations occur in glaucoma, cataracts, and some other diseases. Moreover, hallucinations have been found to occur in otosclerosis.

Some people believe that illusions and hallucinations are the same false perception. But their difference is that false perception is observed when the object itself is absent.

Healthy people see hallucinations much more often than you might think. For example, when making a long journey through the desert, languishing from excruciating thirst, it may seem that a settlement, an oasis, is visible ahead.

In reality, such objects are nothing more than an optical illusion. But still, it is worth noting that in most cases people with mental illness are prone to hallucinations. Along with visual hallucinations, auditory hallucinations are also observed.

For example, the patient claims to hear the sound of the wind, an approaching car, the knock of a door, and so on - although in reality, nothing like this happens in their environment. It happens that hallucinations are verbal in nature, when it seems to people that someone is calling them, and fragments of a non-existent conversation are also heard.

If auditory hallucinations are commanding in nature, then a mentally ill person often obeys unquestioningly, thereby sometimes causing significant harm to himself or others. It is known that hallucinations are not only visual, and habitual auditory, but also gustatory, and even olfactory. Often all these phenomena are combined.

Regardless of the cause, hallucinations are of a different nature and affect the patient in different ways. They can be neutral in color, or completely devoid of emotionality. Patients treat them calmly, sometimes even indifferently. But there are exceptions when hallucinations are emotionally expressed very clearly. Thus, a case from clinical practice is described, when a mother who lost her son did not get out of a depressive state. In her hallucinations, she often saw the deceased, and these "meetings" brought her great joy.

Discussing the causes of hallucinations of various types, scientists always emphasize that to date this process has been poorly studied, and the selective disorders that occur during illusions and hallucinations are not clear enough. Scientists single out hallucinations inherent in healthy people as a separate topic.

For example, hallucinations of a mass nature. When they occur, the phenomenon of mass suggestion is observed, when people “turn on” each other, while the crowd becomes a single organism. It has long been established that a person is easily suggestible. When alone, he is able to behave like a critical thinker.

Treatment of hallucinations

Urgent Care

Emergency care is based on the general principles of stopping arousal and treating hallucinatory-delusional states. At the same time, it is necessary to take into account the nature of the disease in which hallucinations develop. Thus, visual hallucinations during a feverish state or during delirium tremens require different therapeutic tactics aimed at treating the disease as a whole.

First aid should ensure the safety of the patient and others, prevent dangerous actions caused by fear, anxiety, excitement. Therefore, measures for the supervision of patients are of paramount importance, especially in an acute hallucinatory state. They do not differ significantly from alcoholic measures in delirium.

Medical assistance

Treatment of hallucinations is aimed at reducing arousal and affective disorders: chlorpromazine is administered 2-4 ml of a 2.5% solution or tizercin - 2-4 ml of a 2.5% solution intramuscularly or the same drugs orally at 100-200 mg / day. With continued use of chlorpromazine or tisercin, the doses of which can be increased to 300-400 mg / day, they are combined with drugs that selectively act on hallucinations: triftazine up to 20-40 mg / day or haloperidol up to 15-25 mg / day or trisedil up to 10-15 mg / day intramuscularly or orally in the same or slightly higher doses or etaperazine up to 60-70 mg / day.

Hospitalization in psychiatric institutions is necessary in cases where the hallucinatory (hallucinatory-delusional) syndrome is not caused by a serious physical illness. In the latter case, treatment in compliance with all precautionary measures should be carried out with the participation of a psychiatrist on the spot or with transfer to a psychosomatic department. Transportation of patients is carried out in accordance with the basic principles of transportation of patients with mental disorders.

Questions and answers on the topic "Hallucinations"

Question:Hello. My great-grandmother is 87 years old. Her blood pressure is over 200. Her refrigerator sings songs, then the river flows, then someone steals money. Generally glitches. He does not sleep at night, but sleeps during the day. Please tell me what to do. And what medicine to give. Thank you. I am hope for your help.

Answer: Very often, hallucinatory disorders arise from a lack of real communication. If they are caused by diseases characteristic of the elderly, then it is impossible to cope with hallucinations at home. It is necessary immediately, at the first negative manifestations, to contact a psychologist, psychiatrist, neurologist.

Question:Hello, my grandmother is 79 years old and I began to notice that she smears food on herself, eats porridge and smears it on her face at the same time, she can spread jam, sugar, salt, and anything. In some places it eats its own skin, tears it off and eats it. At the beginning there were hallucinations, but there were no new ones for the last six months. In general, the behavior is calm, balanced, easily and quickly irritated, sometimes memory fails (but this is more likely to age). There was no history of chronic diseases and pathology, except for iron deficiency anemia. It is somehow unusual to see this and at the same time I worry about her. I didn’t find a similar description of the situation on the Internet, it scares ignorance what it is? And with what it is connected. Thanks for the answer.

Answer: In this description, I do not see anything else than developing senile dementia (senile dementia) with psychotic symptoms (hallucinations, auto-aggression are obviously associated with some pronounced delusional motives). Consultation of a psychiatrist-gerontologist is required, in his absence - just a psychiatrist. Proper treatment can reduce the severity of inappropriate behavior, slow down the decay of the personality, but is unlikely to stop it completely. Most likely, in the future it will be necessary to resolve the issue of permanent care, observation or placement in a special institution.

Question:Hello, my father had 3 heart attacks, after that a stroke, a little over a month ago, he paralyzed the left side of the body, there was a speech disorder, now he is recovering a little, he is starting to walk more or less. He had heart attacks due to alcohol, he had been abusing it regularly for the last 10 years, before that partially. The pressure is dropping. After the second heart attack, she underwent bypass surgery and aortic valve replacement. The whole problem is that lately he has been sleeping very badly at night, and some sounds constantly seem to him - steps around the apartment, someone opens the lock on the door, they say there are conversations in the next room (which is why he searches the whole apartment in the middle of the night) . Could these be hallucinations? Or maybe it's some kind of fantasy that he wants in reality? What could have caused this? How to deal with it?

Answer: The symptoms you describe are indeed hallucinations, which, in your father's case, may be the result of damage to the brain tissue. You should show your father to a psychiatrist to clarify the diagnosis and prescribe treatment. consultation with a psychiatrist is strictly necessary, so do not delay a visit to the doctor.

Question:Woman aged 86 years. Tactile, auditory and visual hallucinations (insects in bed; bound, tangled, glued legs; foreign objects in the legs; once "men came." She sleeps badly at night, sometimes screams all night that she is being eaten and bitten, someone walks, crawling.Grandma lies with a fracture of the femoral neck.There were pressure surges, at the end of February the doctor said that vascular changes in the brain were occurring, such as microstrokes (she spoke very poorly, almost did not move, did not see, refused to eat, was constantly sleepy, eyes almost did not open.) What to do?

Answer: For psychiatric diagnosis, a personal consultation with a psychiatrist is necessary. Depending on the general state of health and the severity of hallucinations, the attending psychiatrist will prescribe treatment and select an individual dosage of the drugs used. As part of the Internet consultation, we do not have the opportunity to prescribe psychotropic drugs (these drugs are dispensed in pharmacies only by special prescription).

Question:My husband is 28 years old, he is a drinker, but he didn’t go into drinking binges before, and didn’t get a hangover! But a year ago I was hungover and didn’t drink, and fainted, there was foam and convulsions, everything lasted no more than 5 minutes, then I woke up and didn’t remember anything. I didn’t drink for 2 months, then the same thing happened again. After that, it all started! If he drinks for 3-4 days and nurses, he does not sleep at night: it seems to him that someone is walking at home, they breathe in the back of his head, someone whispers, he jumps up and starts looking. Everyone has to leave the house, because someone in the apartment will do something to us now, but during the day everything is fine, but he does not sleep again, so day 3. Then everything is fine. Recently I have been giving him fenozepam and all the visions stop and he sleeps peacefully. I understand that drinking is strictly forbidden. I would like to know the diagnosis and how to treat! Thank you.

Answer: To clarify the diagnosis and prescribe timely and adequate treatment, it is recommended to consult a neurologist and conduct a comprehensive examination: EEG and Echo-EG of the brain, if necessary, MRI of the brain, only after receiving all the results of the examination, the doctor will make an accurate diagnosis and prescribe adequate treatment. Epilepsy and delirium must be ruled out.

Question:My mother is 80 years old. A perfectly adequate elderly person, but recently I began to notice that she sleeps a lot during the day. Constant desire to sleep. I thought it was spring beriberi, I drank it with vitamins, but daytime sleepiness is still present. And the other day, my mother told me that when she wakes up in the middle of the night she sees strangers in her room, and she understands that this cannot be, she immediately turns on the pile - the vision disappears. He treats it with humor, but it's not funny at all to me. I really look forward to your advice.

Answer: Hello! You need to see a psychiatrist. This happens in old age. Perhaps, against the background of the normalization of sleep and medication, this will pass.

Question:My mother is 72 years old. A normal, socially active person who writes poetry, works with people, but is visually impaired. The following problems appeared. At the moment of waking up, incomprehensible phenomena occur: when you look at the walls and ceiling, color pictures appear, which may contain flowers, geometric shapes, animal heads, etc. Sometimes it is as if children, girls, of an absolutely normal natural appearance are sitting on the bed, sometimes the pictures are very unpleasant. When looking at a bright light, the pictures disappear. Last 5-10 minutes. Doctors do not say anything definite, but they do not find any connection with vision. The result was a fear of nightfall. During the day, during sleep, this does not happen. Please advise what to do.

Answer: Hello! If ophthalmologists have ruled out eye pathology, then you need to contact a neurologist and a psychiatrist for examination and selection of therapy.

Question:The woman is 82 years old. Nchyu does not sleep, sees non-existent people, talks to them, feels fear, falls asleep in the morning. Is it curable, and if so, how can it be helped?

Answer: It is curable to a certain extent. Address to the doctor-psychiatrist, it is better to the gerontologist.

Question:Good afternoon I will try to explain the picture of what is happening - my son is 10 years old very rarely, but such phenomena occur at night - he wakes up and jumps up and cries, does not know where to stick his head, because his sound is amplified - as he explains that the sound comes with great force , th kind of like speakers growing from him put to his ears! At the same time, he runs around the apartment in great tension - his arms and legs are "ice". 5-10 minutes and that's it - I can put him to sleep. It was during a high temperature, and now, after an absolutely calm day, he received a lot of positive emotions from long-awaited gifts - and again at night! He doesn't remember anything in the morning!

Answer: Hello! You need to do an electroencephalogram. Perhaps this is a manifestation of convulsive activity. Consultation of the neurologist is necessary.

Question:Please advise how you can help my mother, who is 88 years old. She began to "hear" various extraneous sounds: either the neighbors' child is crying, then their washing machine makes noise at night, then conversations behind the wall. And all this despite the fact that she has poor hearing, even uses a hearing aid. She asks not to let her adult granddaughter go to her alone, because. gangsters gather in a neighboring apartment, one of whom wants to marry this granddaughter. Otherwise, she is quite adequate: she lives alone, serves herself on her own, goes to the store, cooks, even enjoys crossword puzzles. Mom refuses to go to the doctor, even to the local therapist. Maybe try giving her some light medicine under the guise of vitamins?

Answer: Yes, of course, a light modern neuroleptic. But it should be prescribed by a psychiatrist after an internal examination.