ONEIRIC SYNDROME (Greek oneiros dream + eidos look; syndrome; synonym: oneiroid, onirizm, oneyrofreniya, snovidny extremely crazy stupefaction, syndrome of a snopodobny oglushennost) — a special form of stupefaction with flow of involuntarily arising fantastic crazy representations containing the dramatized fragments seen, read, heard, endured, isolated, fancifully intertwining with it is changed by the perceived details of surrounding; form of fantastic experiences. The arising pictures dreams similar to dreams follow usually one by one in a certain sequence so one event as if follows from another. The lake of page is followed by partial or full detachment from surrounding, disorder of consciousness in various degree, depressive or maniacal affect, motive, including catatonic, symptoms.
For the first time O. page under the name «oneiric nonsense» was described by E. Begis in 1894 at infectious and intoksikatsionny psychoses. Fr. psychiatrists combined oneiric nonsense and a delirium (see. Delirious syndrome ) in one psikhopatol, a state — an onirizm. The term «Oneiric Nonsense» offered G. de Clerambault in 1909 was not widely adopted in France. In domestic it is also mute. psychiatry the first descriptions of O. of the page arising at schizophrenia belong to L. M. Rosenstein (1923) and V. Maier-Gross (1924), considering his special form stupefactions. Their point of view gained further development and confirmation, especially in researches of the Soviet psychiatrists.
The clinical picture
O. of page in the most finished form arises during an attack of recurrent schizophrenia (see). At the same time O.'s development by page takes place a number of stages. The initial stage proceeding several weeks or months is presented by affective frustration. Depressions with slackness, powerlessness, a capriciousness, irritability, unmotivated alarm are more often observed (see. Depressive syndromes ). Hypomaniacal states (see. Maniacal syndromes ) are always characterized by enthusiasm, an umilennost, feeling of enlightenment. Disturbances of affect are expressed in different degree, are followed by frustration of a dream and appetite, headaches, unpleasant feelings in heart, locks.
The initial stage is replaced by a stage of crazy mood. Surrounding it seems to the patient changed and unclear, executed ominous sense. The patient feels either sharp unaccountable fear, or a presentiment of the threatening accident. There are crazy ideas of prosecution, a robbery, death, a disease, unsystematized, different in intensity. Emergence of episodes is characteristic confusions (see), crazy orientation in surrounding and crazy behavior (the SI. Nonsense ), that several hours or can proceed days.
Then there is a stage of nonsense of a performance, value and an intermetamor-foza. Patients claim that around them there is some action as in a performance, and they are its participants, passive observers; surrounding objects symbolize unusual situations or matter not inherent to them; from time to time there is a transformation of one persons in others, sometimes such transformation extends to surrounding objects.
In addition to the various crazy ideas, contents to-rykh reflects the prevailing affective background, there are mental avtomatizm, first of all, ideatorny (see. Kandinsky — Klerambo a syndrome ), false recognitions (see. Kapgra symptom ), affective verbal illusions (see), in some cases verbal hallucinations (see). Intensity of affective and motive disturbances, duration of crazy orientation and confusion increases. These frustration can continue several days of a pla of weeks.
The stage of an acute fantastic paraphrenia, or the oriented oneiroid (the degraded onirizm), is followed by fantastic modification of the previous mental disorders — nonsense, including nonsense of a performance and nonsense of value, mental avtomatizm, false recognitions. The fantastic contents is acquired by the events which are taking place around the patient and also former knowledge and memoirs — the fantastic retrospective nonsense develops. Depending on the prevailing affect allocate expansive type of oneiroid when there is an expansive delirium (nonsense of greatness, a high origin, etc.), or depressive type — various displays of a Cotard delusion (see. Kotara syndrome ), often there is an antagonistic nonsense, there can be stsenopodobny visual hallucinations of frightening contents (pantofobichesky). In perception and consciousness of the patient along with right orientation in the personality and the place the fantastic crazy concept of the world around and the situation in it is at the same time created; the situation is perceived as the historical past or an extraordinary situation of the present, as scenes from fairy tales or from science-fiction literature; surrounding people turn into characters of unusual events. At the same time the consciousness remains. Fantastic crazy constructions easily change under the influence of changes surrounding, and also affect, dreams, corporal feelings. In this state confusion can alternate load. Either confused and pathetic excitement or a substruporous state prevails (see. Catatonic syndrome ), to-rye are followed by an alarming depression, fear or ecstatic affect. The time sense is broken: it is slowed down, accelerates or there is a feeling of its disappearance. This stage can proceed several days.
At development of a stage of true oneiroid flows of the visualized fantastic figurative representations (grezopodobny nonsense) dominate, to-rye are connected not with the sphere of perception any more, and with inner world of the patient, the basis them is made by visual pseudo-hallucinosis (see. Hallucinations ). In this state before «an internal eye» of the patient scenes of grandiose and drama situations are played, in to-rykh the patient happens at the same time or consecutive the viewer, the main character, the victim or responsible for the made events, i.e. opposition of the personality to the endured situations disappears and there is a disorder of the consciousness «I». At the same time there is always a dissociation between the maintenance of consciousness and the motive sphere, in a cut the phenomena of a substupor and a stupor, changeable on intensity, with wax flexibility prevail or excitement is preferential with lines of pathetics. Patients look the released, speech communication with them almost always it is impossible. Appearance of patients is characteristic: they are silent, bezdeyatelna, are almost not mobile, only the look expresses painful affect of grief, fear, ecstasy or the amazement turned in itself. True oneiroid at recurrent schizophrenia is the culmination in development of an attack of disease. It can last several hours or days and to alternate with the oriented oneiroid. The reduction of symptoms of O. of page at recovery occurs gradually, as it should be, the return to their emergence. Patients reproduce rather in detail the content of oneiroid, at the same time surrounding events amnezirutsya considerably.
The lake of page of exogenous and organic genesis most often meets at alcoholic psychoses (see), at traumatic, vascular and acute symptomatic psychoses (see), and also at epilepsies (see). In these cases the basic disease proceeds attacks, and O. of page is, as well as at schizophrenia, a culmination stage in development of psychosis. The pages of frustration preceding O. reflect features corresponding nozol, forms. So, at delirium tremens, symptomatic and vascular psychoses, and also at the psychoses arising in the acute period of a craniocereberal injury, initial frustration are the adynamy, a delirium and easy somnolence (see. Devocalization ); at alcoholic hallucinosis and nek-ry symptomatic psychoses — an adynamy and verbal hallucinosis; at the psychoses arising in the remote period of a craniocereberal injury at epilepsy — an adynamy and twilight stupefaction (see) with nonsense and hallucinations. Lakes of page at these diseases are inherent the following common features. The plot of oneiroid has more often incomplete character; e.g., there is only one some episode relating to a space travel. The island of page is fragmentary, and also is deprived of consecutive development. Events of fantastic contents alternate with events of ordinary life. In a wedge, a picture O. of page there are symptoms of the previous stage which are quite often «through» throughout all disease (visual and auditory hallucinations at deliriums and gallyutsinoza). Disorder of the consciousness «I» usually does not arise; mental avtomatizm, excepting visual pseudo-hallucinosis, are fragmentary, tranzitorna, often are absent at all; conditions of block or excitement are deprived of catatonic fig.
of O. of page often is replaced by transitional syndromes in the form of an adynamy (see. Asthenic syndrome ), konfabuleza (see), residual nonsense, an organic psychosyndrome (see. Psychoorganic syndrome ). Memories of O. of page are more often fragmentary and can be extremely poor, and in the subsequent retardirovanny amnesia is quite often observed, at a cut of the patient remembers the maintenance of psychosis in the beginning, and then forgets. O.'s duration of page in these cases fluctuates from 1 hour to several days. O.'s reduction of page occurs critically more often.
Pathogeny it is connected with a pathogeny of those diseases, at to-rykh O. the page arises.
The diagnosis is established on the basis of dominance in a wedge, a picture of grezopodobny nonsense. The differential diagnosis is carried out with a delirium (see. Delirious syndrome ) and an amentia (see. Amental syndrome ).
Treatment is directed to therapy of a basic disease.
O.'s development by page at schizophrenia always demonstrates the subsequent pristupoobrazny disease. O.'s development by page at an exogenous pathopsyhosis often is a sign of an aggravation of symptoms of the patient. During the change or O.'s complication of page by conditions of devocalization or an amentsna the forecast adverse.
Bibliography: Papadopoulos T. F. Acute endogenous psychoses, M., 1975; Rosen JI matte. M. K of psychopathology and clinic of delirious (amentsial-ny) states, Zhurn, psikhol., nevrol, and psikhiat., t. 3, page 163, 1923; Stoyanov S. T. A oneiric syndrome during periodic schizophrenia, the lane with bolg., Sofia, 1968, bibliogr.; Sh N of e y-d e r V. G. K to a question of the differential diagnosis of oneiric stupefaction at acute alcoholic psychoses and pristupoobrazny schizophrenia, in book: A pathogeny and clinic of alcoholic diseases, under the editorship of I. I. Lukomsky, page 292, M., 1970; Shumsky N. G. Features of some types of conditions of the dulled consciousness at vascular diseases at late age, in book: Probl, the organizations psikhiat, the help, clinic and epidemiol, mental diseases, under the editorship of E. Ya. Shternberg, etc., p.1, page 117, M., 1970; Faust C. Die psychischen Storungen nach Hirntraumen, in book: Psychiat, d. Gegenwart, hrsg. v. K. P. Kisner u. a., Bd 2, T. 2, S. 147, B. u. a., 1972, Bibliogr.; Mayer-Gross W. Selbstschilderungen der Ver-wirrtheit, Die oneiroide Erlebnisform, psy-chopathologisch-klinische Untersuchungen, B., 1924.
H. G. Shumsky.