DELIRIOUS SYNDROME (Latin delirare to rave, rave; synonym: delirium, feverish nonsense, fever) — one of stages of development of intoksikatsionny or infectious (symptomatic) psychoses, in some cases one can exhaust all psychosis (delirium tremens — delirium tremens); the most frequent form of exogenous type of reaction. Psychopathological D. the page represents hallucinatory stupefaction with dominance of true visual hallucinations and illusions, figurative nonsense, motive excitement and safety of consciousness.
In France the term «delirium» is applied to designation of crazy syndromes of various structure and nozol, accessories. The delirium of the somatic nature since the time of Regis (E. Regis, 1894) is designated as delire onirique (oneiric nonsense). In domestic psychiatry the term «delirium» means one of kinds of exogenous type of reaction of Bongeffer (see. Bongeffera exogenous types of reactions ).
The clinical picture
Most often precedes D.'s development by page emergence of the somatogenic adynamy depending on a basic disease (see. Symptomatic psychoses ). Less often than D. the page arises before its emergence, however and in these cases at the diseased signs of a constitutional adynamy usually come to light. D.'s manifestations by the village usually accrue gradually that allows to allocate several its stages described for the first time internisty by Libermeyster (S. of Liebermeister, 1866). The first stage — in the late afternoon or by the night appears the general excitability, speech, motor and mimic reactions quicken and accelerated. Patients are talkative, in their statements the inconsistency reaching times of degree of incoherence is noted: there are flows figurative, sensual and evident, in some cases the stsenopodobny memoirs relating to the remote or recent past. Patients are restless, their movements gain the exaggerated expressiveness; the hyperesthesia of various degrees is constant. They shudder at insignificant sounds, usual lighting is unpleasant to them and forces to blink, the usual food has an intensive smell and taste. Various external events, sometimes the most insignificant, draw for a short time attention. The mood is changeable: unreasonable joy with a shade of enthusiasm, affection or impetuous fun easily is replaced by depression, concern, an irritable capriciousness. Complaints to a headache, feeling physical are frequent. weakness.
In the second stage against the background of strengthening of a hyperesthesia, the raised otvlekayemost, changeable mood and speech motor concern there are visual illusions. In one cases they are ordinary according to contents and are not numerous, in others — are multiple and take the form of pareydoliya (see Illusions). There can incidentally be a disorder of orientation in the place and time. Before backfilling at the closed eyes there are separate or multiple kaleidoscopically replacing each other gipnagogichesky hallucinations (see). In the latter case tell about gipnagogichesky deliriums. The dream in the first and second stages of development of D. of page superficial, is followed by multiple bright, quite often alarming or dreadful dreams. During frequent awakenings patients realize not at once what was a dream and that is reality.
In the third stage of development of D. of page along with illusions there are true visual hallucinations soon beginning to define a wedge, a picture. At D. of page separate fragments of surrounding are a part of hallucinatory frustration or are the cause for their change. Hallucinations can be single and multiple, static and mobile, colourless and color, reduced, usual or oversizes. Visual hallucinations at D. of page arise in real space. In one cases in their contents it is impossible to reveal any certain situation and vision replace each other without any communication, in others — there are scenes which are consistently changing, connected according to contents. Depending on etiol, a factor visual hallucinations can have the distinctive features. E.g., zooptichesky (the patient sees animals) hallucinations are characteristic of alcoholic and kokainny D. of page; mikropsichesky (the small size of hallucinatory images) hallucinations — for D. of the page arising at poisoning with opiates. At D. the page of the patient always is the interested viewer of everything that occurs before his eyes. Its affect and acts correspond to the maintenance of seen. It is captured by curiosity, bewilderment, delight, fear, despair, horror; with interest or entrancement looks, runs, defends, attacks. The mimicry corresponds to the dominating affect and actions. In this stage there can be also auditory, tactile, olfactory hallucinations, sketchy figurative nonsense. Speech excitement usually confines to separate phrases, words, shouts. When stsenopodobny visual hallucinations acquire the unusual contents — scenes of war, death and revival, unusual travel or adventures — say about fantastic deliriums. In these cases patients often feel feelings of movement in space up to flight. In the third stage orientation in surrounding is usually broken. Most often patients are in a false manner oriented in the place and surrounding persons. The consciousness is usually kept. Memories of the frustration determining D. by page in the third stage, as a rule, are fragmentary; about occurring around memoirs does not remain.
D.'s symptoms of page are subject to big variability (of an hour by an o'clock and even of a minute to a minute). At night full sleeplessness can be observed or the superficial discontinuous dream arises only at daybreak. In the second and third stages periodically there are so-called lyutsidny intervals — short (minutes, hour) the periods during which disappear completely or almost all mental disorders, the correct orientation in surrounding and consciousness of a disease, up to the full critical relation to it appears.
D.'s development by page is more often limited to the described three stages. In some cases emergence of symptoms only of the first or second stage is possible. In other cases there is more rapid development of symptoms and the first stage is replaced by the third, napr, at poisoning with atropine, tetraethyllead, antifreeze at once. Sometimes there is a weighting of symptoms of the third stage and there is a picture of a professional or mussitans delirium.
Professional delirium (a delirium of employment, nonsense of occupation) — a delirium with dominance of uniform motive excitement in the form of the usual, performed in everyday life operations: food, drink, cleaning, etc. or the actions having a direct bearing on a profession of the diseased — issue of goods, sewing, control of car. Motive excitement at professional deliriums is followed or pronouncing separate words or is «mute». Hallucinations and nonsense either are absent, or are rudimentary. Lyutsidny intervals usually do not happen. There is no memories left of the maintenance of the former psychosis.
Mussitans delirium (a delirium with mutter, muttering delirium) — the delirium with in-coordinate, deprived of the nature of complete actions, uniform and poor (within a bed) motive excitement, a cut is proved removal, a stryakhivaniye, palpation, a hvataniye of nonexistent objects. Speech excitement represents silent and muffled pronouncing separate sounds, syllables and interjections.
The professional delirium can arise without the previous stages of a usual delirium, being replaced then a mussitans delirium. Sometimes D. of page arises not initially, and replaces other form of stupefaction (an amentia, devocalization), and sometimes, on the contrary, precedes it. Of page can be combined with oneiroid or an amentia — delirious and oneiric or delirious and amental syndromes. Depending on circumstances of emergence of a delirium E. Krepelin (1912) distinguished his following types: initial delirium, feverish delirium, infectious collapse delirium.
Of page in all cases arises or considerably amplifies in evening and night time. In the afternoon D.'s signs of page weaken, and in some cases are replaced by other mental disorders. Various manifestations of an adynamy are characteristic of D. of page in the first and second stage in the afternoon, it is frequent in combination with the lowered mood (see. Asthenic syndrome ). Often professional and mussitans delirium, and sometimes and a usual delirium are replaced by conditions of devocalization or an amentia, various on depth, in the afternoon.
Depending on etiol, D.'s factor of page can be followed vegetative and nevrol, the disturbances which are especially expressed in the third stage and also at professional and mussitans deliriums. Perspiration, tachycardia, a tachypnea, fluctuations of level of the ABP, a hyperthermia is noted. Nevrol, frustration depending on D.'s etiology of page are shown by changes of size of pupils, disturbances of convergence of eyeglobes, different types of a nystagmus, emergence of reflexes of oral automatism, a limited or general tremor, a hypomyotonia, a hyperreflexia.
D.'s duration of page usually fluctuates from 3 to 7 days. Disappearance of frustration happens critically, after a long dream, more rare lytically more often. Deviations from average duration are possible both towards shortening, and towards considerable lengthening of existence of the frustration determining D. by page. When D. the page is shown by the frustration inherent to the first and second stages and proceeding apprx. days, tell about abortal deliriums. If the visual hallucinations, nonsense, alarming and timid mood amplifying usually at night exist within weeks and even months, tell about protragirovanny deliriums.
Of page most often is replaced by the adynamy sometimes accompanied with a superficial tearful depression. Much more rare, especially at lytic disappearance of symptoms of D. of page, can remain residual nonsense (see). In some cases D. page is replaced by one or several transitional syndromes (see. Symptomatic psychoses ); more often than others arises Korsakovsky syndrome (see).
Arises D. of page at various infectious and other somatopathies, intoxications; much more rare, usually in the form of a professional and mussitans delirium — at vascular damages of a brain, senile dementia (in the presence of the accompanying somatic frustration). Of page develops more often at children and persons 50 years, and also against the background of hron are more senior, than a somatopathy at the persons having alcoholism or drug addiction in the anamnesis. At alcoholism and D.'s drug addiction of page arises after development of acute somatopathies. Among the additional reasons promoting D.'s emergence by the village at patients of advanced and senile age including and with psychoses, use of high doses of medicines, napr, diuretic means, vitamin B matters 12 , Melipraminum.
As D. of page arises usually at bystry development of the disease process which caused it, O. V. Kerbikov (1937) considers that it more svoystven to a healthy brain. L. M. Rosenstein (1923), V. Maier-Gross (1924), I. G. Ravkin (1937) regard D. page as defense reaction of an organism. Its emergence depends not on direct impact of the toxic or connected with infectious process other substances on a brain, and is caused by the disturbances of metabolic processes happening under their influence with formation of the so-called intermediate link influencing a brain (see. Intoksikatsionny psychoses ). Most this situation was confirmed by cases of a tremens (see. Alcoholic psychoses ).
the Diagnosis is made on the basis of dominance in a wedge, a picture of flow of the plentiful true visual hallucinations accompanied with safety of consciousness, speech and motive excitement and strengthening of mental disorders in evening and night time.
The delirium, especially in the third stage of development, in some cases demands a differentiation with oneiric syndrome (see), twilight stupefaction (see). The mussitans delirium needs to be differentiated with amental syndrome (see).
Is necessary treatment of a basic disease. Treatment actually of D. of page comes down to stopping of excitement and sleeplessness, and also maintenance of activity of cardiovascular system. It is reached by use of psychotropic drugs — aminazine, a haloperidol, Seduxenum, etc., and also subcutaneous injections of Cordiaminum or intravenous injections of a korglyukon. At hard proceeding D. the village needs to carry out the therapy reducing a hypoxia of a brain and warning its hypostasis — methylene blue intravenously, drop intravenous administration of urea, Mannitolum.
concerning life and an absolute recovery adverse in cases of a professional mussitans delirium less often in the third stage of development of D. of page, especially when conditions of devocalization and an amentia develop in the afternoon or these forms of stupefaction in general replace D. of page. An indicator of weight of D. of page are also expressed vegetative nevrol. frustration. In other cases forecast favorable.
Bibliography: Kerbikov O. V. To structure and genesis of delirious and amental states, Works psikhiat, a wedge. 1st Mosk. medical in-that, t. 1, century 6, page 60, 1937; Kerbikov O. V., etc. Psychiatry, M., 1968; P about p about in E. A. Materials to clinic and a pathogeny of hallucinations, Kharkiv, 1941, bibliogr.; P and in to and I. G N. Classification and types of a course of delirious disorders of consciousness, in book: Neuroloony. frustration of the exogenous and organic nature, under the editorship of R. G. Golodets, page 19, M., 1975; In 1 e u 1 e of M., Willi J. u. B u h 1 e of H. R. Akute psychische Beglei-terscheinungen korperlicher Krankheiten, Stuttgart, 1966; E at H., Bernard P. et Brisset Ch. Manuel de psychiat-rie, P., 1970; Jaspers K. Allgemeine Psychopathologie, B., 1965; Scharfet-t e r Ch. Allgemeine Psychopathologie, S. 25, Stuttgart, 1976.
H. G. Shumsky.