Oneiric syndrome

Description:

Oneiric syndrome (oneiroid) (other - Greek  — a dream,  — a look), a schizophrenic delirium) — the psychopathological syndrome which is characterized by a special type of high-quality disturbance of consciousness (a oneiric, grezopodobny disorientation) with existence of the developed pictures of the fantastic snovidny and pseudo-hallucinatory experiences intertwining with reality. The disorientation in time and space (sometimes and in own personality) at oneiroid differs also from the devocalization (which is characterized by lack of orientation), and from the amentia (which is characterized by constant futile search of orientation) — at oneiroid of the patient is a participant of the endured pseudo-hallucinatory situation. Surrounding people can join the patient in the form of participants in the endured situation. One of signs of oneiroid is the disorientation in the personality hallucinated, change of the subject of perception, transformation I, for example, transformation into a bird or a tree.

Symptoms of the Oneiric syndrome:

Classical oneiroid has the stages of development. According to S. T. Stoyanov  they are the following:

  1. Vegetative and somatic disturbances.
  2. Crazy mood.
  3. Affective and crazy derealization and depersonalization.
  4. Fantastic affective and crazy and illusory derealization and depersonalization.
  5. Oneiric catatonia.

The Russian school of psychiatry allocates very similar stages of expansion of a oneiric syndrome:

  1. Initial. It is characterized by affective frustration. Duration — weeks — months. Note: duration of a stage can considerably will cause a stir depending on a syndrome etiology.
  2. Stage of crazy mood. Duration — hours — days.
  3. Stage of nonsense of a performance, value and intermetamorfoza. Duration — days — weeks.
  4. A stage of an acute fantastic paraphrenia (the oriented oneiroid, the degraded onirizm — H. Baruk, 1938). Duration: hours — several days.
  5. True oneiroid. Duration: hours — several days.

Symptoms are reduced upside-down. Such development classical natural development of oneiroid is characteristic of schizophrenia. It is accepted to call it endogenous oneiroid. Exogenous and organic oneiroid (except senile) develops pristupoobrazno, but its culmination is similar with such at schizophrenia.
Frustration of the emotional sphere.
Oneiroid most often begins with disturbances of emotions. The first lability of emotions appears. Also unilateral change of emotions towards negative or positive is possible. There are frustration of a dream: the sleeplessness which is replaced by bright dreams. There is a fear, fears of the patient to go crazy. Further crazy frustration join.

Depending on dominance of affect distinguish maniacal (expansive) and depressive options of oneiroid. At the first patients feel admiration, affection, penetration and enlightenment, at the second — apathy, alarm, irritability, powerlessness. Frustration of the emotional sphere are followed by vegetative: appetite disturbances, headache, heartache. The maintenance of emotions is displayed on a face of the patient. Frustration of the emotional sphere, together with motive (effector) — constant satellites of oneiroid.
Disorders of thinking and speech. At oneiroid existence of the crazy ideas which maintenance is defined by the maintenance of pseudo-hallucinosis is characteristic. The nonsense develops gradually, after emotional frustration.

The first the so-called crazy mood appears: unsystematized persecution complex, death, hypochiondrial nonsense. There is a partial disorientation.

Following — nonsense of a performance with the symbolism phenomena. Fregoli's syndrome and Kapgr's syndrome are characteristic, transformation can will extend including to things. At this stage there can be affective verbal illusions, mental avtomatizm (ideatorny), seldom verbal hallucinations.

They are succeeded by a paraphrenic stage with the phenomena figurative fantastic retrospective in the beginning, and then — Manichean nonsense. The consciousness of the patient is still kept. Clinical example of this stage:

    The patient … told that he was in the big hall with the floor covered with a marble tile. To the hall conducted steps, one from above, others - from below … From above on steps angels went down, demons from below rose, in the hall grandiose fight which witness was a patient began. He did not take part in fight of the good and evil but only he observed it.

Disturbance of perception of time is possible.

At last, there comes the so-called true oriented oneiroid at which imaginations of the patient coexist with orientation in the surrounding real world. The consciousness is broken: the patient — the full-fledged participant of the events which are taking place in pseudohallucinations. Top of it is gryozopodobny oneiroid. However step-by-step, slow, natural to a nonsense razvita as it was already told, occurs not always.

At a stage of nonsense of a performance, value and an intermetamorfoza the first alalias in the form of its acceleration or delay develop. The speech contact with the patient at the developed oneiroid is almost always impossible.
Oneiric hallucinations. Oneiric hallucinations — the scenic pseudohallucinations which are observed at oneiric states and differing in singularity and irreality. So-called snovidny, gryozopodobny experiences at oneiroid have no external projection, are developed in consciousness, in subjective mental space therefore are not true hallucinosis (unlike a delirium), and pseudohallucinations (pseudo-hallucinosis). The pictures endured by the patient are bright, is frequent (though it is optional) fantastic contents. More often, stsenopodobna visual objects, are connected with any subject line. So, for example, O. V. Kebrikov describes oneiric hallucinations:

    In this state it seems to patients that they make interplanetary trips, appear among inhabitants of Mars, conduct with them battles, collect gemstones on the moon of an unusual look. Others blow over the unknown cities, are on streets, among their inhabitants, participate in plots and revolts. The third direct sea battles with pirates, pursue "Flying Dutchman". The fourth wander among prehistoric beings, appear in crowd of residents of ancient Rome, get to Heaven or hell. The fifth are present at general accident – destruction of buildings, death of the cities, death of millions of people, eruption of volcanoes, an earthquake, world wars, general cataclysms, collision of planets, disintegration of the globe.

Effector and strong-willed disturbances. In spite of the fact that the patient is a participant of the events endured by him, psychomotor excitement for oneiroid is uncharacteristic (it possibly, but is observed seldom), on the contrary, more often patients lie in catalepsy, are released from surrounding, a mimicry uniform, "stiffened". Catatonic frustration are possible. At the same time there is a dissociation between behavior of the patient in reality and in the fantastic content of oneiroid where he is an active character. It distinguishes a oneiric syndrome from a typical delirium at which the patient is extremely active and can do harm to itself and people around. However modern researches show that the professional delirium is very close to oneiroid.

At a oneiric syndrome disorders of attention are also observed. At fantastic and illusory oneiroid absent-mindedness of attention while at grezopodobny oneiroid the reality does not draw attention in general is characteristic.
Dysmnesias
After an exit from a oneiric state partial amnesia is possible, however it is expressed in much smaller degree, than at deliriums. According to V. L. Gavenko, partial it is held in remembrance only on painful experiences while on real events it amnezirutsya. It is confirmed also in earlier researches of A. V. Snezhnevsky. About what at an exit from oneiroid is held in remembrance, also the neuropathologist academician A. A. Skoromets claims. At improvement of a condition of patients the ecmnesia can be observed.

Reasons of the Oneiric syndrome:

Development of a oneiric syndrome is possible at endogenous and exogenous and organic mental disorders:

  1. Exogenous and organic form: at infectious (encephalitis), intoksikatsionny and other somatopsychoses, presenile and neurosis tardas, vascular dementia, traumatic damage of a brain (ChMT), epilepsy, alcoholic deliriums. Feature of oneiroid at acute intoxication (for example, inhalation of Moment glue for the purpose of drug intoxication) is its fulminant, sometimes within several minutes, development. At other exogenous and organic diseases it begins and comes to an end rather quickly too. Feature of oneiroid at alcoholic deliriums, somatogenic and vascular psychoses and psychoses at ChMT at early stages of development is the pronounced adynamy which is replaced by a delirium or devocalization. At ChMT and epilepsy the adynamy can pass into twilight stupefaction. At Krepelin's disease before the developed oneiroid there comes the azhitirovanno-alarming depression. At all above-mentioned frustration the oneiric syndrome develops without classical pattern, mixing with symptoms of these diseases (is characteristic of it at alcoholic deliriums — zooptichesky hallucinations, motive excitement). There do not come disorders of consciousness. There are no catatonia phenomena. Oneiroid can reach a limit with transitional symptoms Wicca. A oneiric syndrome at exogenous and organic diseases — the evidence of heavy disease, and its transition to an amentia or devocalization — even more adverse sign.
  2. Endogenous — at schizophrenia, is more rare at bipolar affective disorder. In MKB-9 there was a category 295.24295.24 — the Catatonia oneiric as option of shuboobrazny schizophrenia and 295.25295.25 — the Catatonia oneiric as option of periodic schizophrenia. Now they treat F20.220.2 — Catatonic schizophrenia.

Treatment of the Oneiric syndrome:

Acute management is similar to treatment of a delirium.

Hospitalization issues in an insane hospital are resolved in an individual order, depending on weight and character of a basic disease.