Paranoid is acute. Reactive paranoid Reactive delusional psychoses

Psychological Dictionary. A.V. Petrovsky M.G. Yaroshevsky

Dictionary of psychiatric terms. V.M. Bleikher, I.V. Crook

Paranoid (para + Greek poeo - perceive, think, -eides - similar)- a psychopathological syndrome characterized by primary or figurative delusions, often in combination with auditory hallucinations, pseudohallucinations, and phenomena of mental automatism. Synonym: paranoid syndrome, paranoid state.

• Alcoholic paranoid- acute alcoholic psychosis, developing most often with alcoholism of stages II-III. Characterized by delusions of persecution, affect of anxiety, fear, motor agitation, and impulsive actions.
• Alcoholic paranoid acute[Pozdnyakova S.P., 1978] - a form of acute transient alcoholic P., characterized by rapid development in a short period of time, a critical exit from psychosis, the absence of persistent residual phenomena. It develops during periods of exacerbation of alcoholism, with massive alcoholization and, often, with the participation of psychogenic and somatogenic factors. Characterized by an affect of fear, sensory delusions of persecution, ideas of special meaning, rudimentary ideas of physical influence. The delirium is unsystematized and specific. The duration of psychosis ranges from several hours to 2-2.5 days. It is observed mainly in forensic psychiatric practice.
• Paranoid of the external environment[Zhislin S.G., 1940] - acute P., arising from the combination of minor, taken individually, situational hazards and mildly expressed exogeny. Considered as a reaction of pathologically altered soil. Asthenia plays an important role in its genesis (overwork, past physical illnesses, sleep deprivation, consumption of alcoholic beverages). Delusions of persecution and affect of fear are characteristic. Often occurs in special conditions (on the road, in a foreign language environment, etc.). Hence the former name - railway P. Syn.: Situational P.
• Minor paranoid- characterized by delusional ideas of damage, persecution, poisoning, theft, spreading to people directly surrounding the patient - relatives, loved ones, neighbors. Observed in delusional psychoses of late age.
• Paranoid acute- acute transient delusion of persecution, usually close to a specific situation in content, with the presence of verbal illusions, hallucinations, an affect of anxiety, fear. The reasons are different, but most often we are talking about the combination of several pathogenic factors. A variety of P.o. can also be considered a P. external situation. In some cases, the symptoms of P.o. paranoid schizophrenia debuts, especially in the presence of somatic distress, intercurrent infection (for example, the manifestation of paranoid schizophrenia in connection with influenza infection).
• Psychogenic paranoid- a type of reactive psychosis. Pure paranoid is rare; hallucinatory-paranoid states are more often observed, while, as a rule, psychopathological symptoms reflect a psychogenic-traumatic situation and a pronounced affect of fear, which plays an important role in pathogenesis. Characterized by an acute onset, the presence of insufficiently clear, approaching dream-like [Buneev A.N., 1946], consciousness, the persecutory nature of delirium, abundant auditory and visual hallucinations. The phenomena of induced Kandinsky-Clerambault syndrome are not uncommon [Immerman K.L., 1961]. Syn.: P. reactive.

Neurology. Complete explanatory dictionary. Nikiforov A.S.

Paranoid- psychosis, manifested by delusions of persecution, jealousy, litigiousness, etc., as well as verbal hallucinations, illusions and phenomena of mental automatism.

Paranoid involutionary- manifestation of presenile or senile disorder in the form of delusions of ordinary content, aimed at others, with a predominance of delusional ideas of damage, relationships, persecution, jealousy. Auditory verbal hallucinations are possible. The behavior of those around him seems suspicious to the patient; he constantly hears offensive hints and insults. Patients are often withdrawn and inaccessible, but at times they can be active, sometimes even aggressive. Accompanied by a progressive decrease in the level of intellectual and mnestic functions.

Oxford Dictionary of Psychology

no meaning or interpretation of the word

subject area of ​​the term

Alcoholic paranoid (or delusion) ranks third among all alcoholic psychoses, after delirium tremens and hallucinosis. This diagnosis is received by 10-25% of patients admitted to the clinic with psychosis due to alcoholism. For a long time, paranoid was not considered an independent disease. But today it is recognized as a serious disorder that requires immediate hospitalization and long-term rehabilitation therapy.

Alcoholic paranoid - causes and clinical picture

Alcoholic paranoid is one of the types of alcoholic psychosis, the main symptom of which is severe delusions of persecution.

The only cause of such psychosis is alcohol abuse. The disorder usually occurs in people only in the second or third stages of alcoholism; the majority of patients are people who have been constantly drinking alcohol for more than 7-8 years.

The greatest risk of developing alcoholic paranoid is in people who drink 0.5-1.5 liters of vodka daily. Delirium begins much less often in alcoholics who drink 200-300 ml per day.

There are also several risk groups - paranoid is more often diagnosed in alcoholics who have suffered a head injury, who have severe heredity, and in patients with epileptoid psychopathy.

The clinic of alcoholic paranoid consists of 3 main phenomena. These are affective disorders (sharp mood swings), sensory (figurative) delusions and inappropriate behavior.

Varieties

Alcohol paranoid is diagnosed exclusively in “experienced” alcoholics. It develops either in a state of intoxication, after a long binge, or during severe withdrawal syndrome. The second case occurs most often - usually delusions of persecution begin precisely during the period of a painful hangover.

The duration of the disease and its course largely depend on the form of psychosis. Scientists identify 3 main types of alcoholic delirium.

Abortive

Lasts from 3 hours to a day, begins mainly in a state of alcohol intoxication. First, affective disorders appear (bad mood, feelings of anxiety, then fear), which sharply develop into delusions of persecution.

Spicy

Lasts from 2 to 25 days and is most often diagnosed. This form of psychosis develops only during a hangover. First, prodromal phenomena appear that last for several days. These are classic withdrawal symptoms - depressed mood, problems with sleep and appetite, arrhythmia, trembling of limbs, feelings of anxiety, confusion, etc. Soon confusion develops into severe fear, delirium begins, and sometimes hallucinations.

Protracted

Such psychosis can drag on from 1.5-2 months to several years. It begins as a typical acute alcoholic paranoid, but over time the feeling of fear weakens and is replaced by a stable low-anxious mood. The specifics of delirium change - the alcoholic’s motives and suspicions become more logical and selective. This form of alcohol use disorder often occurs in periodic relapses that last for several months.

Some narcologists and psychiatrists divide prolonged alcoholic paranoid into subacute (lasts up to 6 months) and chronic (from 6 months to several years).

Symptoms and signs

The signs of alcoholic paranoid are similar for all types of the disease, the only difference is their extension over time. A very long binge or a sharp increase in the dose of alcohol can provoke the first attack of paranoid in an alcoholic.

The very first stage of psychosis is withdrawal symptoms (somatovegetative signs, insomnia and nightmares, bad mood). Then affective disorders take over. A painful melancholy, unreasonable anxiety, fear appears, which quickly develops into panic.

Alcoholic delirium soon develops, which can take different forms:

• delusions of persecution (the most common form);
• delusions of relationship;
• delirium of jealousy;
• delusions of self-blame;
• delirium of poisoning, etc.

At the first stage of psychosis, hallucinations may begin - auditory and visual, they last no longer than 1-2 days. The main symptom of alcoholic paranoia is always delusion, which is based on a single thought - that the patient is in danger of physical harm.

The alcoholic is convinced that they want to kill him, and in a very specific way - by poisoning, stabbing, hanging, shooting, quartering, torture, etc. Sometimes the patient believes that his family members are also in danger.

The source of danger is usually specific people - friends, neighbors, random people met on the street. In delusions of jealousy, this could be a wife who dreams of leaving for her lover; if the delirium of self-condemnation begins, then the patient is sure that he has done a great deal and deserves death.

If the delusion of relationships is involved, then it seems to the person that all people treat him with contempt or hatred in advance, and deliberately arrange various nasty things.

The course of alcoholic delirium is traditionally accompanied by a strong feeling of fear. The patient constantly performs impulsive actions: tries to run away, grabs people by the hands, asks for help, screams loudly, hides in the apartment, in attics, in sewer hatches, etc.

Differential diagnosis

One of the most difficult moments in the treatment of alcoholic paranoid occurs at the diagnostic stage. It is often difficult to distinguish between alcoholic psychosis and paranoid schizophrenia complicated by alcoholism. The most severe cases are when the patient suffers from schizotypal disorder due to alcoholism, in which personality changes are quite minor.

To make a correct diagnosis, it is necessary to collect a complete history of the disease. If a person’s psychosis is not associated with binge drinking, hangover, or appears at an early stage of alcoholism, we are talking about paranoid schizophrenia.

There are several other signs that can clearly distinguish between the two disorders:

Treatment

Treatment of alcoholic paranoid is carried out exclusively in inpatient settings. In mild forms of psychosis, after hospitalization and the removal of the first symptoms, the patient can be observed and treated on an outpatient basis. In severe cases, the patient is left in the hospital for several days.

Drug treatment is carried out by several groups of drugs:

• neuroleptics;
• tranquilizers;
• antidepressants;
• vitamins, etc.

Immediately after hospitalization, intravenous administration of antipsychotic drugs is required to relieve fear and eliminate behavior disorders (chlorpromazine, haloperidol, diazepam). If attacks of delirium are combined with depressed mood, antidepressants are prescribed. Discharge from the hospital is possible only after the complete disappearance of delusional ideas and signs of aggression.

After eliminating the main symptoms of psychosis, a comprehensive treatment is necessary to prevent relapses. This includes working with a psychotherapist, Alcoholics Anonymous groups, etc.

Alcohol paranoid usually does not have serious consequences and does not provoke personality changes - provided that the course of treatment has been completed completely and the patient no longer abuses alcohol. If the patient continues to drink alcohol regularly, hallucinosis and prolonged psychosis may develop against the background of paranoia.

– a group of psychoses with quite diverse symptoms that arise under the influence of mental trauma (staying in an alien environment, under conditions of severe stress). Accompanied by the formation of overvalued or delusional ideas, auditory and visual hallucinations are possible. There is anxiety, suspicion and constant psychological tension. A depressive component of varying severity is often detected. The diagnosis of “reactive paranoid” is made taking into account the history and clinical manifestations. Treatment – ​​elimination of the traumatic situation, pharmacotherapy, psychotherapy after the disappearance of psychotic level disorders.

General information

Reactive paranoid is a psychosis that occurs under the influence of traumatic circumstances: being in a situation of severe conflict, in an alien social environment, in a war zone, in conditions of imprisonment, etc. It develops acutely. Symptoms usually disappear after eliminating the traumatic situation; sometimes a subacute or protracted course of reactive paranoid is observed, resulting in pathological personality development. Detailed studies of this pathology were carried out in the first half of the 20th century by famous Soviet psychiatrists: P.B. Gannushkin, V.A. Gilyarovsky, A.N. Molokhov, E.A. Popov, A.V. Snezhnevsky and others. Subsequently, these studies were supplemented with new data, but views on the causes of development, course and methods of treatment of reactive paranoid have not undergone significant changes since then. Diagnosis and treatment are carried out by specialists in the field of psychiatry.

Causes and classification of reactive paranoid

As the immediate causes of the development of reactive paranoid, experts indicate acute psychotraumatic circumstances, usually associated with a risk to the life, health and future of the patient, or having great subjective significance for the patient. Constant elements of traumatic circumstances that provoke the emergence of reactive paranoid are a high level of uncertainty, lack of information, the inability to assess what is happening from the point of view of usual standards and build a line of behavior that ensures the best outcome in a given situation.

Of great importance are the characteristics of the patient’s character and personality, his somatic condition, as well as the specific conditions of the situation (foreign language environment, imprisonment, etc.). The likelihood of developing reactive paranoid increases with increased sensitivity, anxiety, suspiciousness, suspicion, rigidity of internal attitudes and insufficient flexibility of thinking. Factors contributing to the emergence of reactive paranoid are physical and mental fatigue, exhaustion, poor nutrition, lack of sleep, trauma and somatic illnesses.

Domestic researchers identify the following variants of reactive paranoid:

• Reactive delusional psychosis

The group of reactive delusional psychoses includes wartime paranoids, prison paranoids, railway paranoids, paranoids when entering a foreign language environment and other types of reactive paranoid that have common clinical symptoms, but differ slightly in external manifestations depending on specific environmental conditions.

Reactive paranoid delusions

The leading symptom of reactive paranoid is the formation of overvalued or delusional ideas directly related to traumatic circumstances. Commonly observed hypochondriacal delusions, litigious delusions, delusions of jealousy, delusions of persecution, or delusions of invention. A characteristic feature of this form of reactive paranoid is the preservation of external adequacy and orderly behavior in other areas of life. The subject of delusional ideas is well understood by others, since they can trace the connection between these ideas and the patient’s current problems.

At the initial stage of reactive paranoid, overvalued and delusional ideas can be corrected. Subsequently, the delirium deepens, the patient becomes less susceptible to the opinions of other people. The duration of the disorder depends on the characteristics and duration of the traumatic situation. When the problem is resolved, reactive paranoid usually quickly reduces and disappears. If the patient remains in an unfavorable psychological atmosphere for a long time and cannot solve the problem, a protracted course may result in pathological paranoid development.

Reactive delusional psychoses

This form of reactive paranoid develops in extreme circumstances that require rapid adaptation to unusual and often extremely unfavorable conditions: when entering a war zone, during arrest, isolation from the usual environment (when entering a foreign language environment), absolute isolation (when collapsed during an earthquake , in a mine or in a cave). According to P.B. Gannushkin, there are two circumstances that most contribute to the development of reactive paranoid: the first is suspicion of committing a crime, the second is being in a completely alien environment.

Predisposing factors that increase the likelihood of reactive paranoid occurrence are secrecy, anxiety, self-doubt, increased sensitivity, as well as objective circumstances due to which a person hides certain facts and fears exposure. The listed factors create an unfavorable emotional background and sharply increase psychological stress. As a result, a patient suffering from reactive paranoid begins to interpret any neutral events (the behavior and views of others, their conversations among themselves) as evidence of eavesdropping, spying, condemnation or exposure.

Acute or subacute development of reactive paranoid is possible. The first manifestation of psychosis is increasing anxiety and anticipation of an inevitable catastrophe, combined with false recognitions and derealization. Patients with reactive paranoid feel that everything that happens has some kind of secret meaning, that other people are planning something, whispering and exchanging glances. The culmination is a feeling of mortal danger. Those around them turn into attackers who are preparing to deal with the patient, taking his life.

Against the background of extremely intense emotional reactions (confusion, anxiety, anxiety and fear), delusions and visual and auditory hallucinations occur. The patient suffering from reactive paranoid “sees” someone sneaking towards him to attack him, “hears” voices threatening or reporting enemy plans. Psychosis without hallucinatory disorders is extremely rare. Delusions of special significance, delusions of influence, delusions of relation, or delusions of persecution usually develop. The theme of delusions in reactive paranoid is directly related to traumatic circumstances. When there is a threat to life, the theme of sudden death dominates; when there is a threat to the future and reputation, the theme of moral damage, humiliation, injustice, etc. dominates.

The elements of delusion are determined by the situation that provoked the development of reactive paranoid. With railway paranoia, the patient may see the neighbors as a gang of thieves planning a robbery and turn to the conductor or police for help. With wartime paranoia, he may consider those around him to be enemies, and himself to be a deserter, traitor or spy. The main manifestations of reactive paranoid usually disappear within a few days after the start of treatment. For 2-3 weeks, asthenia is observed, sometimes with elements of residual delirium.

Induced reactive paranoid

Induced reactive paranoid develops as a result of close, usually long-term, contact with a patient suffering from a mental disorder. Factors contributing to the development of induced paranoid are high emotional intensity during communication between the inductor and the recipient, a lack of other sources of information and external stimuli, a too narrow circle of communication, as well as the high authority of the inductor in the eyes of the recipient.

Induced reactive paranoid more often occurs with self-doubt, anxiety, increased suggestibility, psychopathy and mental retardation. The theme of the recipient's delusions reflects the inducer's delusional ideas. Possible delusions of poisoning, delusions of persecution, litigious delusions, etc. There is no criticism of one’s own state and the state of the inductor. When contact with the inducer is stopped, the symptoms of reactive paranoid are reduced and disappear.

Treatment and prognosis for reactive paranoid

Treatment is carried out in a psychiatric hospital. In the acute phase of reactive paranoid, antipsychotics, anti-anxiety and sedative drugs are used. After eliminating psychotic manifestations, it is possible to use various psychotherapeutic techniques to identify the causes of the development of reactive paranoid, process traumatic experiences and develop new, more adaptive ways of responding. Individual therapy is used.

The prognosis is usually favorable. When the traumatic situation is resolved and a favorable psychological atmosphere is created, the manifestations of reactive paranoid stop within a few days or weeks. After the elimination of psychotic symptoms, asthenia of varying severity is observed, possibly with residual elements of delusion or paranoid experiences. Subsequently, all pathological manifestations disappear, and the outcome of reactive paranoid is complete recovery. Rarely (usually in the presence of defects in the mental constitution) pathological development of personality is observed.

Chronic alcoholism often leads to the development of severe forms of psychosis. 10–20% of people who drink are diagnosed with alcoholic paranoid. The pathology is characterized by the appearance of auditory and visual hallucinations and delusions. The patient behaves inappropriately, commits impulsive actions, and becomes aggressive. With timely treatment and complete abstinence from alcohol, no irreversible changes in the psyche occur, and a complete recovery is possible.

Delusion of persecution (alcoholic paranoid) is a type of psychosis that is accompanied by hallucinogenic-paranoid syndrome. The disease progresses in alcoholics during binges or during a hangover after prolonged drinking (the first 3 days).

The appearance of delirium may be preceded by a sharp increase in the dose of alcoholic beverages. The first attacks are observed in people who have been drinking ethanol for many years.

Alcohol psychosis develops in a normal environment, sometimes exacerbation can be triggered by visiting public places. For example, traveling on a bus or staying at the airport leads to delusions of persecution, verbal illusions, and unreasonable anxiety. The clinical picture of acute paranoid develops over several hours or days and lasts up to 1–2 weeks; with a protracted form of the disease, the delusional state lasts for months.

Causes and symptoms of the disease

During psychosis, an alcoholic has the feeling that someone is pursuing him or wants to cause physical harm. In every passerby and person nearby, the patient sees a potential enemy. Begins to listen carefully to the words, monitor the opponent’s gestures and facial expressions. During attacks of alcoholic paranoia, patients are convinced that they “see” a weapon that they allegedly want to use against them. Visual hallucinations are complemented by auditory ones.

Delusions of persecution are accompanied by severe fear, anxiety, and depressed mood. A person tries to run away, hide, or asks for help from passers-by, law enforcement officers, and may cause physical harm to himself. In some cases, alcoholics decide to go on the defensive and attack the “persecutor” themselves. Sometimes the patient feels that he is unable to hide from the enemy, this pushes him to attempt suicide.

Delusional ideas are obsessive, specific, logically justified, most often associated with close people (wife, work colleague, neighbor, etc.), but can be directed at all persons within the field of view. Patients usually correctly orient themselves in time and space, remember who they are and what they do, and after normalization of the condition, they perceive their obsessive thoughts with humor.

According to the nature of the course, several types of alcoholic delusions of persecution are classified:

• abortive;
• spicy;
• prolonged psychosis;
• chronic paranoid.

Classification of alcoholic paranoid

In the abortive form of the disease, the clinical picture of psychosis is observed for no more than a day, after which mild delirium may remain. Acute alcoholic paranoid lasts up to 3–4 weeks. In addition to thoughts of constant persecution, a person suffers from insomnia, he loses his appetite and interest in household chores. Fear and anxiety intensify in the evening, panic attacks are accompanied by malaise and rapid heartbeat.

Protracted paranoid in an alcoholic begins in the same way as acute paranoid. Later, the fear weakens or disappears completely, and a feeling of anxiety and emotional depression prevails. Patients blame themselves for the current situation, try to limit their social circle, and behave inappropriately. This form of the disease lasts up to 2–3 months. Signs of chronic paranoid are diagnosed for 3 months or longer. Drinking alcoholic beverages and binge drinking contribute to an increase in fear.

Signs of alcoholic delusions of jealousy

A similar type of pathology (metalcohol psychosis) occurs in people with a paranoid character, against the background of personality degradation at the age of 40–50 years. Patients suspect their other half of adultery. At first, delusional ideas arise in a state of intoxication or a hangover; later, suspicions do not leave the person constantly. Men pester their wives with questions, force them to confess to a sinful act, can carry out surveillance, and are even firmly confident in the identity of their “lover.”

Against the background of alcoholic paranoia, the patient often accuses the woman of wasting the family budget, failing to fulfill household duties, committing witchcraft, and attempting poisoning. He may develop visual hallucinosis in the form of scenes of betrayal. In such cases, the alcoholic becomes aggressive and, in a state of passion, is capable of using physical force and killing a person.

Delusions of jealousy have a chronic course, do not change in content, but manifest themselves with varying degrees of aggressiveness. After drinking alcohol, paranoid symptoms progress. Among the patients, people who have been drinking alcohol for many years predominate, with clear signs of personality degradation.

Treatment methods

Acute alcoholic paranoid is differentiated from schizotypal disorders. In the first case, there is no split personality, logical thinking is preserved, hallucinations are rare and the patient is able to logically explain them. With schizophrenia, the patient does not show emotions, treats others coldly, and with delusions of persecution, he expresses aggression, suspicion or fear.

Treatment for paranoid symptoms begins with detoxification of the body and cessation of alcohol consumption. Neuroleptics, B vitamins, colloidal solutions are administered intravenously, and antidepressants and tranquilizers are prescribed. In case of deep delirium, the patient is immersed in a hypoglycemic coma or therapeutic sleep (a combination of sleeping pills and neurotropic drugs) with high doses of insulin. The patient is in a state of shock or sleeps 18–20 hours a day for 1–2 weeks.

After the delirium disappears, patients are prescribed tranquilizers and a visit to a psychotherapist. Alcoholics should be registered at a dispensary and regularly observed by their attending physician. During periods of exacerbation, voluntary or compulsory hospitalization is carried out.

Alcohol paranoid develops with chronic alcohol consumption over many years. Timely treatment and complete abstinence from fortified drinks leads to recovery in half the cases. The effectiveness of treatment depends on the degree of alcoholism, general health, genetic predisposition and the severity of damage to brain cells.

What's wrong with you, how do you feel?
- Fine.
- Is everything gone?
- It's gone.
- What happened to you?
- I was driving from the village and boarding the train in Bologoye. At first I was driving and everything was fine, and then some guys began to find fault and conspire.
- For what purpose did they do this?

- Don't know.
- What do you think?
- I don't know what they wanted to do with me.
- What did you do when the train stopped?
- I decided to get off the carriage, went out onto the platform, and there was a policeman there. I say: this way and that, I’m afraid to ride in the carriage, they find fault. - Do you have things? - I say, there is. - He says: “Well, let’s go, take your things and move to another carriage.” I walked along the carriage with him, took my things, a suitcase and a briefcase, they took me to another compartment carriage, I rode in another carriage to Moscow, I was afraid all the way.
- So that someone doesn't come in?
- Yes.
-Did you pull the compartment door?
- They pulled.
- Who? For what purpose?
- Who, I didn’t see.
- When did you arrive in Moscow?
- I came to Moscow, I’m afraid to go, I was scared, I’m afraid to go. And the old man and the guide went and called a doctor, then they sent me here.
- Was it also scary here?
- The first day I was afraid. And on the second day I calmed down a little.
- Has it become better?
- Yes.
- Is this the first time in your life that this has happened to you?
- Yes.
- Did you really want to harm you now or did you just imagine?
- There were guys.
- But they had nothing to do with you, did not want to harm you?
- Don't know.
- For what purpose did they want to attack you?
- Don't know.
- Or maybe you didn’t want to, but you were just scared?
- It can't be.
- Was your fear strong?
- Strong, I was scared.
- And ran out of the carriage?
- I ran out at the bus stop, I didn’t jump, but at the bus stop.
- And when did you get into the other carriage?
- They shouted: “Open up”, we’ll come in. We won’t touch you” open... But I held on, held on.
- What did they need from you?
- Don't know.
-Have you thought about this?
- Certainly.
- And what did you come to? What assumptions did you have?
“I thought they would beat me up and the child would be left an orphan.”
- What does it mean that the child will remain an orphan? Not only will they kill you?
- I don’t know, but of course I was scared.
- Did all this happen for the first time in your life? And you didn't drink before?
- I drank in the 19th.
- When did you go?
- 25th.
- Did you sleep last night or not?
- No.
- Why didn’t you sleep?
- I arrived in Bologoye at 1 am and sat until the morning.
- When did the whole event occur?
- In the evening.
- And you didn’t sleep the whole next day again?
- Yes.
- Were you sick before the trip?
- Yes, in October I was in a hospital near Smolensk.
- What happened?
- Appendicitis.
- Are you staying here due to illness?
- I don’t know (the patient leaves).
As you can see, the patient suffered an acute delusional outbreak or, as S.G. Zhislin says, acute paranoid. The delirium in its manifestations was sensual delirium, it arose without logical premises, immediately: the “guys” should “attack” him, “kill” him, “the child will remain an orphan.” Fear gripped him, and fear did not leave him even when the policeman transferred him to another carriage. The delusion was accompanied by an affective illusion; in the everyday conversation of those around him, the patient perceived a conspiracy, a plan to attack him, to kill him.