NONSENSE — objectively false, caused by the painful reasons judgment arising at the patient without adequate external occasions which is not giving in to a razubezhdeniye and always involving the identity of the patient. B. is one of the most common symptoms of mental disorders and it is observed at the majority of psychoses (schizophrenia, maniac-depressive psychosis, involutional, organic and vascular psychoses, infectious and intoksikatsionny psychoses).
Unlike wrong judgments, B. does not korrigirutsya at a razubezhdeniya or an explanation. B. resists even to the most weighty arguments.
Crazy ideas (greatness, prosecution, self-abasement, hypochiondrial, etc.) remain generally invariable throughout centuries. Influence of an era, cultural level, premorbidal characterologic features of the patient affect generally only in specific contents B.
On B.'s maintenance it is subdivided into three groups: nonsense of greatness, its version — B. of wealth, a high origin, invention, a reformatorstvo, genius, love B.; a persecution complex, its versions — B. of special value, the relation, prosecution, influence, poisoning, charge, a robbery, jealousy; nonsense of self-abasement, its version — B. of sinfulness, self-accusations, guilts, hypochiondrial, nigilistic. However B.'s systematization only according to contents not rather fully reflects its clinical value.
- 1 Forms of nonsense on psychopathological structure and features of development
- 2 Psikhogenno the caused dilirium formation
- 3 Psychopathological structure of nonsense depending on age of patients
- 4 The pathogeny
- 5 The forecast
- 6 The diagnosis
- 7 Treatment
Forms of nonsense on psychopathological structure and features of development
On psychopathological structure and patterns of development of B. divide into three groups: primary, sensual (figurative) and affective.
Primary nonsense across Snell (L. Snell, 1865), a primordialny delirium on Grizingera (W. Griesinger, 1872), true nonsense across Grula (H. Gruhle, 1951), an intellectual monomania across Eskirol (J. E. Es-quirol, 1838) quite often at the beginning of a disease is the only sign of disorder of mental activity and usually corresponds to limited generalization of disease process at its slow progreduated development. Primary B. is interpretive, its starting point are the facts of the outside world — views, smiles, gestures of people around (exogenous interpretations) or internal feelings (endogenous interpretations). In its development distinguish three periods: 1) incubations, 2) manifesto and systematization, 3) terminal.
In the period of an incubation only B.'s harbingers are noted: distrustfulness, various assumptions and guesses, arrogance, revaluation of own personality, secret hopes. B. forms slowly, sometimes for a number of years. The patient is dissatisfied with the situation, «neglect it». The family not so warmly treats it, unfriendly meets. Suspicions, presentiments, prejudice accrue gradually.
Even the insignificant accidental event or a natural phenomenon can be a decisive incitement for the period of manifestation of B.; immediately confidential communications «become clear», the past and the future «opens». In certain cases «inspiration» is connected with false memoirs.
At a stage of systematization there is an expansion of a circle of subjects to crazy interpretation, the crazy system forms, the patient «knows» who pursues it, for what purpose and what means (the systematized B.). The systematized B. often remains for many years — chronic B. It can change due to accession of affective frustration, hallucinations, the phenomena of mental automatism — B. of influence, the ideas of greatness. During this period patients become unsociable, their speech dazzles with symbolical expressions, hints and reservations. The letter contains unusual, often newly created words (neologisms), separate words and phrases are specially underlined. Formation of new crazy judgments stops sooner or later. But time the constructed crazy system remains safe for a long time.
In the terminal period there can be B. Eto's disintegration can be connected with attenuation of disease process or with the advent of symptoms of weak-mindedness. Emotional coloring of the crazy ideas fades, B.'s design becomes simpler, conviction in reality of former crazy concepts disappears. B. regresses, it is fragmented and dies away. In other cases though the crazy ideas also remain, the patient gradually loses the crazy activity, interpretations turn pale, stereotipizirutsya. B. exerts the lesser impact on actions of the patient, pales into insignificance.
Disease process, B. at low-progreduated development, or at the initial stages it is characterized by a number of the features inherent to the supervaluable ideas — supervaluable B. according to Birnbaum (To. Birnbaum, 1915).
Treat these features: affective tension and the dominating character (almost full preoccupation, obsession the crazy ideas) with unilateral, emotionally rich (katatimny) processing of all impressions of surrounding reality — katatimny B., and also features of subject of the crazy ideas. Content of pathological representations has no obviously absurd character, and reflects the nature of «relationship», with to-rymi quite often it is necessary to meet in usual life situations.
At more severe defeat of mental activity (progrediyentno the developing crazy psychoses) there is a formation of the complex crazy system deprived of former affective coloring. B.'s maintenance, in Krom the ideas of prosecution and poisoning prevail, it is deprived even of external communication with reality.
The initial maintenance of the idea of prosecution is exhausted by threat to social standing of the patient (the plagiarism, stealing of inventions for the purpose of espionage discrediting rumors, attempts to provoke and compromise with the purpose to deprive of the place). As Yu. V. Kannabikh (1911) specified, at the first stage the feeling of public self-preservation owns the patient, and on the second — there is a feeling of physical self-preservation. There are fears that the food is poisoned that in pans poison is poured. Then there is a fear of poisoning of the atmosphere by means of, e.g., bacteria, gases, etc. «Enemies» trap the patient during the escaping of the house, try to arrange accident or road accident. The patient alerted, avoids meetings and communication with imaginary persecutors. Sometimes tries to disappear from them, changes the residence, work (migration) — the so-called passive pursued persecutors. In the subsequent transition to active protection is possible: the patient himself attacks «enemies» (the active pursued persecutors) that sometimes leads to acts of aggression. Various violent acts and serious crimes are most often observed at B. of prosecution, hypochiondrial B. and B. of jealousy.
At B. patients demand claim and in every possible way try to obtain protection of own interests, implementation of the desires and aspirations, showing at the same time the activity reaching sometimes crazy actions. If claim is shown in the form of barratry — B. of barratry (or B. of kverulyant), patients are at infinite law, have legal proceedings, convicting the enemies; address in the press, write infinite complaints, undertake «conducting» others affairs or develop various projects, offer own educational system of children, the new principles of transport connections, etc. — B. of a reformatorstvo.
At B. of invention sick, aiming at achievement of a goal (creation of new aircraft, the perpetual motion machine, remedies etc.), throw all other affairs; without reckoning with time, conduct infinite number of experiments and experiments, until late at night sit up over the schemes and designs.
When a subject B. are the ideas of jealousy — B. of jealousy, patients find all new signs of incorrectness of the spouse (too careful toilet of the wife, too big dent on a pillow — two heads, etc. lay). One secretly check whom the wife meets whether is home after hours, demand recognition in treason, lack of the facts charge to sophisticated conspiracy of lovers.
At love B. patients «notice» how persons of other floor at their presence redden, become excited, pant, i.e. find unconditional signs of desire and persistently try to obtain a meeting with the elects.
At hypochiondrial B. the patients assured available at them this or that disease constantly compare «facts», specify details, with indisputable reliability testimonial that, despite dissuasions of doctors, they are sick with a heavy illness. For fight against the disease existing allegedly the specific mode of food is created, methods of self-treatment are developed.
One of often found hypochiondrial B.'s options is B. of disfiguration — dysmorphophobia. Patients consider that they have the shameful defect (the person or other body parts) drawing general attention. Peculiar I break a set
hypochiondrial B.'s novidnost also B. of obsession is, at Krom at the patient the belief is available his body of some being.
At sensitive B. of the relation patients believe that all people around, knowing about their hidden «defects», condemn, despise and sneer at them.
Primary interpretive B. is observed most often at schizophrenia with a continuous and progreduated developmental character of process, paranoia, and also at some forms of protragirovanny alcoholic psychoses (alcoholic B. of jealousy).
The sensual (figurative) nonsense
Sensual (figurative) nonsense (in literature is defined as secondary), unlike interpretive, from the very beginning develops within a difficult syndrome along with other symptoms of a mental disorder — with hallucinations (hallucinatory B.), affective disorders, false sensations, disturbance of consciousness.
Sensual B. has acute B.'s character more often, in most cases has evident and figurative character; there is no isolated crazy system, statements of patients are not a product of intellectual processing, a consecutive number of representations. The crazy ideas are changeable, are sometimes fragmentary. Patients do not try to find it explanations, in one cases they are especially real, in others — have fantastic character.
B.'s formation is preceded in some cases by a condition of uncertain alarm, not clear fears which are followed by feeling of internal tension — crazy mood: «something shall happen». At height of this state perhaps sudden emergence of the crazy ideas (comprehension of sense of oppressive uncertainty) which is followed by sense of relief — B.'s crystallization across Balinsky. In other cases of fear gradually gain more specific character, everything becomes «clearer» and «is more certain», establishment «bonds without cause» begins. There is a crazy perception. The patient begins to notice that everything has relation to it, and «all throw stones into its kitchen garden». Especially for it some things are put, for it some objects are established, laugh at it — B. of the relation. At last, all events around (changes of a situation, etc.) it begins to be perceived as something arranged, everything is dramatized, some comedy — B. of a performance is played.
At the accruing aggravation of symptoms everything surrounding begins to gain special and quite certain value. The ashtray on a desk means that life shall die away; five oranges in a vase — the certificate of that the patient — the fifth wheel in the cart (B. of value). The special sense is made by a mimicry, gestures, the speech, a physical touch. Associations, on the Crimea other value is perceived, can arise in the most various way: on sense, by analogy, by contrast, on external similarity etc. At the same time instability of new «value» is characteristic. Other sense of the surrounding phenomena, objects and actions is not fixed for a long time. Through a nek-swarm they can waste time for the patient the singularity.
Sensual B. from the very beginning can gain fantastic character with big polymorphism and variability of contents and a magnificent religious and mystical, erotic, fantastic or space plot — B. fantastic, B. of imagination. Patients say that before them the unprecedented horizons revealed, they live under laws of a new era, are going to the planet Mars where their meeting with a number of outstanding persons is scheduled. At the heart of figurative, unusual on the irreality and fabulousness of the crazy ideas false memoirs — konfabulyatorny B quite often lie. A big variety of constantly replaced «facts» and «events» «remembered» by patients is characteristic of a crazy plot in these cases. At initial stages of formation of B.
false recognitions can already be observed. Patients begin to notice an izmenennost, fancifulness of all surrounding. Objects, persons, the taking place events seem some mysterious. Unusual beauty of a landscape, «curve» signs on houses, too bystry change of passersby is evident. In all surrounding something unnatural is covered, people as though were replaced.
At emergence of so-called illusions of doubles [Kapgra (J. Capgras, 1909)] seems to patients that around them not real people, but their doubles externally similar to those people for whom they give themselves. In one cases relatives and friends find lines of a neznakomost, the gestures and acts unusual for them remind foreign people (a symptom of the negative double). In other cases among unfamiliar on a look, gait, a manner to behave begin to know earlier well persons familiar to them — a symptom of the positive double (see. Kapgra symptom ).
At the further complication of symptomatology connected with an aggravation of symptoms of the patient B. of an intermetamorfoza is observed, at Krom it is not about change of appearance, not about transformation of one person into another any more, and about the full both physical, and spiritual transformation (metamorphosis) having multiple character.
Irrespective of a specific plot of B. in the center of all events as the main character costs the identity of the patient. He directs all course of «fight», stops and renews it voluntarily. It is found already at antagonistic B. (Manichean nonsense), contents to-rogo is fight of forces benevolent and hostile to the patient. Characters of that and other party (persecutors and patrons) are very various: neighbors, employees, armies and governments of various states, god or devil. The result of fight quite often gains nation-wide or world value (prevention of atomic accident, the crash of the whole social systems).
At expansive B. the ideas of greatness act into the forefront and carry the fantastic, deprived of any logical explanation character. Patients are convinced of the power, high purpose, a special mission. They have the gift of anticipation, ingenious abilities, no obstacles for implementation of their ideas exist. They call themselves immortal, «appropriate» to relatives or acquaintances high ranks and awards.
Sensual (figurative) B. is observed most often at schizophrenia, is preferential with pristupoobrazny and with a pristupoobrazno-progreduated current, at organic, infectious, alcoholic and epileptic psychoses, at a general paralysis.
The affective (golotimny) nonsense
Affective (golotimny) nonsense according to contents usually corresponds to the dominating affect. At the same time, however, the crazy ideas cannot be considered as clear reaction to the ground affective state, napr as attempt of an explanation by the patient of the melancholy. Affective B. costs in the same row with others, the symptoms of a depression which are not brought the friend out of the friend (vital melancholy, ideatorny and motor braking, etc.) and manias.
Most often at depressive B. the ideas of sinfulness, guilt, self-abasement are observed (B. of self-accusation). A subject B. in most cases is the repentance of the serious crimes which are allegedly committed by the patient. The maintenance of the crazy ideas quite often joins the real, but long ago occurred and lost the value facts (an onanism, marital infidelity, office and other offenses). Patients speak about the unrecoverable mistakes made by them all the time, accuse themselves of simulation: they are not sick, deceived doctors, shall be forwarded from hospital in prison. Some, on the contrary, with alarm wait for punishment for made — arrest, tortures, execution.
Charge of commission of imaginary crimes can proceed also from people around — B. of condemnation. In all events patients see instructions on the fault, immoral behavior in the past; some believe that the hostile attitude of people around towards them is quite deserved, others are convinced of falsehood of charges and guilty persons of do not consider.
At the weighting of a state which is followed by complication of a clinical picture of a depression B.'s emergence denials is possible (see. Kotara syndrome ).
B. denials, being closely connected with B. of guilt, can have fantastic character. At the same time the ideas of immortality and hugeness can concern both the identity of the patient, and all surrounding.
Affective B. most often arises within attacks or phases of endogenous psychoses (maniac-depressive psychosis, periodic schizophrenia, an involutional depression), is observed also at situational and vascular depressions.
Psikhogenno the caused dilirium formation
the Special place on patterns of development and a clinical picture occupies psikhogenno the caused dilirium formation. Most often it is about B. of prosecution and B. otnoshen and I. B. in these cases has figurative character, it is emotionally rich, is followed by affect of fear or alarming mood, also hallucinatory frustration are quite often observed. B.'s maintenance reflects the injuring situation in a direct or negative look. — B. innocence and B. of pardon. In one cases it is threat to physical existence, punishment, in others — moral and ethical damage, destiny of the family. Psychogenic B.'s development can carry both acute, and Protragirovannye! character. The most acute state is observed at so-called railway paranoids, paranoids of an external situation (S. G. Zhislin) in which genesis along with an unusual external situation the great value gets a factor of overfatigue and a long sleep deprivation. The ideas of prosecution in these cases develop very quickly, within several hours — acute B. Patients begin to notice suspects who watch them, are going to rob, throw out from the car, to kill. All events around — in the car, at the station — have a direct bearing on the preparing plot. For the sake of rescue of the life patients try to jump out on the run of the train, begin to battle against imaginary persecutors, in fear of the forthcoming punishment make suicide attempts.
Are very close on origins of B. in a foreign-language environment and B. hard of hearing. II is in that, and in other case pathological interpretation unavailable (either in connection with ignorance, or in connection with deafness) speeches of people around and after this, in process of strengthening of alarm and fear, their mimicry, gestures and, at last, all taking place events takes place.
At relatives and at the persons which are in direct long communication with mentally sick including willows conditions of relative social isolation, emergence of the induced B. (the induced B.) is possible. Such B., the subject to-rogo is usually closely connected with the phenomena and events of ordinary life, is similar according to contents to psychosis of the inductor, and in certain cases almost completely copies it. One person is usually induced (folie a deux — insanity together), two are more rare — three — four; the bigger number of accomplices (kodelirant) meets seldom.
Psychopathological structure of nonsense depending on age of patients
figurative B. Interpretativny B. is characteristic Of children's age (B. is usually observed at children 10 years are more senior) arises in rudimentary forms. B. of fantastic contents, and also infantile reformatory plans and the ideas of invention, a little different from bredopodobny imaginations, is characteristic. Also crazy ideas of hypochiondrial contents, the ideas of the attitude towards parents outgrowing then in B. «foreign parents», and crazy proceeding with senesthopathias are typical dysmorphophobia (see), more often observed at girls.
At late age prevails or interpretive B. (the crazy ideas of jealousy and prosecution are most often observed), or B. with dominance of a fabulirovaniye — konfabulyatorny B. Harakterna concreteness, the ordinary of maintenance of B., the narrow circle of «persecutors» including persons, with to-rymi patients meet in everyday life — B. of small scope. The leading place in the maintenance of the crazy ideas of prosecution is taken by ideas of causing moral (cavils, gossips, mockeries, insults) and material damage (damage of property, theft). At the same time large number and extreme detailing of the crazy illusions connected with an arrangement and outward of the objects surrounding the patient is characteristic (B. of damage). The crazy ideas at late age meet character of a reformatorstvo and invention seldom. The ideas of greatness and revaluation of own personality usually have konfabulyatorny character.
B. is a psychopathological symptom which at some diseases (schizophrenia, paranoia) has a certain communication with so-called prepsikhotichesky features of the personality. At B. prosecutions and its versions such lines as sensitivity, vigilance, small or selective sociability, a causticity, a capriciousness, unsociability are noted; tendency to disputes, conviction in the unfair relation. Expansive forms B. (reformatorstvo, kverulyantstvo, etc.) are more often observed at the persons differing in activity, persistence, determination, the linearity aggravated by intolerance to injustice, aspiration to independence, sense of superiority over people around. Sensitive B. of the relation arises most often at persons vulnerable, diffident, inclined to introspection and at the same time ambitious, with the raised self-assessment.
Along with personal features sensitive B.'s formation of the relation, litigious B., nonsense of jealousy and some other forms of interpretive primary B. is promoted also by existence of a certain situation and the related long experiences which are closely injuring this personality. At sensitive B.'s formation the relations matter so-called key experiences [Krechmer (E. Kretschmer)]; the feeling of shamefulness of own inferiority is their cornerstone.
As starting point for psychogenic B.'s development, in addition to a personal factor, serve these or those intensive and sharply arising vital conflicts, in particular a situation of mental isolation (the stay in others, hostile environment which is aggravated with impossibility of communication with people around in connection with ignorance of language, imprisonment etc.).
Emergence of hypochiondrial nonsense and nonsense of physical impact is connected with pathology of functioning of iiterotseptivny systems (L. A. Orbeli, V. A. Gilyarovsky).
According to I. P. Pavlov's researches and his schools a basis of pathophysiological mechanisms B. can be phase states, pathological inertness of irritable process, disturbance of relationship of alarm systems.
the Forecast depends on patterns of development of a basic disease. B., observed at continuously progreduated course of process, it is resistant, rezistenten to the majority of therapeutic actions, in most cases finds a tendency to further systematization and complication due to accession of the ideas of greatness and hallucinatory frustration.
At the acute crazy psychoses proceeding as within pristupoobrazny schizophrenia, and exogenous, organic and other diseases, perhaps total disappearance of B. Odnako in some cases at involution of psychosis is possible the preservation of residual crazy symptomatology leading to residual B. Sokhranyaetsya's formation former system B., conviction in reality of last prosecutions. Patients rationalize to the former crazy behavior, however at the same time do not see threat from people around any more, remember last fears reluctantly, say that «persecutors» left them alone. The residual B. which is observed in remissions at patients with schizophrenia forms in the presence of the changes of the personality expressed already, can remain for a long time. The residual B. remaining as a monosymptom on a minovaniya of exogenous psychoses, conditions of the dulled consciousness has figurative character, is unstable, disappears in some cases suddenly.
B. needs to be differentiated from bredopodobny imaginations (unstable, changeable, sometimes the improbable or fantastic bredopodobny ideas) which contents changes depending on the external moments, a talk of people around, questions of the doctor. B. differs also from the supervaluable idea. At the supervaluable idea the central place is taken by the considerable events which really were the cause for its emergence at B. it is about painful interpretation of the real phenomena.
by the Main method of therapy of the diseases which are followed by B. is treatment psychotropic drugs. The choice of neuroleptics is defined by structure B. At primary interpretive B. with the expressed systematization drugs with the selective nature of action (Triphtazinum, a haloperidol) are most effective. At sensual and affective B. also neuroleptics of a broad spectrum of activity (aminazine, Frenolonum, melleril) are shown.
Treatment of crazy states is in most cases performed in the conditions of a hospital with the subsequent out-patient maintenance therapy.
Out-patient treatment can be carried out when B. is not followed by aggressive tendencies, is reduced (residual B.) or is from the very beginning shown in rudimentary forms, without defining entirely behavior of patients.
Bibliography: Akkerman V. I. Mechanisms of schizophrenic primary nonsense, Irkutsk, 1936, bibliogr.; And with - l and S. G's N. Sketches of clinical psychiatry, M., 1965, bibliogr.; Kameneva Ε. N. Shizofreniya, clinic and mechanisms of schizophrenic nonsense, M., 1957, bibliogr.; Smulevich A. B. look for-rina M. G. Problem of paranoia, M., 1972, bibliogr.; Snezhnevskiya. B. General psychopathology, Valdai, 1970; Huber G. Wahn, Fortschr. Neurol. Psychiat., S. 429, 1964; To about 1 1 e K. Der Wah-nkranke im Lichte alter und neuer Psycho-pathologie, Stuttgart, 1957; K ran z H. Das Thema des Wahns im Wandel der Zeit, Fortschr. Neurol. Psychiat., S. 58, 1955; S yo r i-eux P. et Capgras J. Les folies raisonnantes, P., 1909.
A. B. Smulevich.