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Hallucinations

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Hallucinations - perceptions that arise without a real object, deceptions of feelings; the patient sees or hears that in reality at the moment does not exist. Hallucinations are divided by analyzers (visual, tactile, auditory, etc.) and by the nature of occurrence. The most important in practical terms are the following. Hypnagogic - visual and auditory hallucinations that occur when falling asleep (with eyes closed!) And often serve as a precursor to the developing alcoholic delirium. Visual hallucinations are most common in acute exogenous psychosis and impaired consciousness. They are observed mainly in the evening and at night. Microptic - visual hallucinations in the form of images of people or animals that differ in very small sizes (often with alcoholic delirium). Imperative - auditory hallucinations, “voices”, ordering to perform certain actions, often dangerous for the patient or others; sometimes they prohibit the patient to talk, force him to resist examination or examination, etc. The danger of these hallucinations is that patients are often unable to resist the “order”. Auditory hallucinations occur more often in silence when the patient is alone and not distracted. Auditory hallucinations are particularly common in schizophrenia and alcoholic hallucinosis. Olfactory hallucinations are expressed by various imaginary smells, often unpleasant; usually found in schizophrenia and presenile paranoids; their appearance in the clinical picture of schizophrenia usually means a tendency towards an unfavorable course of the disease with resistance to treatment. With tactile hallucinations, the patient experiences a feeling of crawling under the skin of insects, chills, and small objects (with alcoholic delirium, cocaine intoxication). With taste hallucinations, patients experience an unusual taste not characteristic of this food or the appearance of unpleasant taste sensations in the mouth without eating.

There are true hallucinations and false (pseudohallucinations). A patient with true hallucinations is convinced of the reality of their existence, since for him they are projected in the surrounding space, not differing from ordinary sounds, voices and visual images.

Pseudo-hallucinations are localized within the patient’s own body and are accompanied by a feeling of alienity and accomplishment (they hear voices in their head that are transmitted to them from space; they are “made to see”; they are convinced of an extraneous influence on their thoughts and feelings, often expressing their thoughts about the nature of such effects - “hypnosis”, “laser”, etc.). Pseudo-hallucinations are usually combined with delusions of impact. If true hallucinations are more characteristic of alcoholic, traumatic and organic psychoses, then pseudo-hallucinations are only for schizophrenia.

Hallucinosis is a psychopathological syndrome characterized by pronounced, abundant (of various types) hallucinations that dominate the clinical picture. Hallucinosis is often accompanied by delusions, the content of which depends on “voices” or visions (hallucinatory delusions). Acute hallucinosis develops usually in infectious or intoxicating (usually alcoholic) psychosis. With an unfavorable course or inadequate treatment against the background of organic or vascular diseases of the brain, acute hallucinosis becomes chronic, in which auditory hallmarks and less frequently tactile hallucinations prevail. With him, the behavior of patients is more orderly, perhaps a critical attitude to the “voices”, patients can even remain able to work.

The appearance of hallucinations indicates a significant severity of mental disorders; in patients with neurosis, they usually do not exist. Studying the characteristics of hallucinations in each case can help establish the diagnosis of mental illness and predict its outcome. For example, in schizophrenia, the voices that the patient hears often refer to him, comment on his actions or order him to do something. In case of alcoholic hallucinosis, voices speak of the patient in the third person and usually curse or condemn for drunkenness.

With the appearance of hallucinations, the behavior of patients usually changes, so the presence of deceptions can be learned not only from the patient's story, but also from the objective signs of hallucinations: the patient talks to someone, shakes off invisible objects from himself, plugs his nose with cotton, etc.

The occurrence of hallucinations is an indication for hospitalization (with the obligatory accompaniment of such patients by a paramedic) and active therapy with neuroleptics (haloperidol, triftazin, epotarazin, leponex, etc.). Chronic hallucinatory conditions in schizophrenia and other mental illnesses require constant maintenance therapy with psychotropic drugs and dynamic monitoring by a psychiatrist. It should be borne in mind that in a number of cases, when talking to a doctor, patients can hide their hallucinations (dissimulation), and in the presence of paramedical personnel, “forget” and demonstrate objective signs of experiencing hallucinations. Personnel should be required to inform the doctor about the presence of hallucinatory disorders in the patient.