What is Oneiric syndrome or Journey to fairy-tale worlds

Oneiric syndrome (oneiroid) (ancient Greek ὄνειρος - dream, εἶδος - view), schizophrenic delirium - a psychopathological syndrome characterized by a special type of qualitative disturbance of consciousness (oneiric, dream-like disorientation) with the presence of detailed pictures of fantastic images novel and pseudohallucinatory experiences intertwined with reality. Disorientation in time and space (sometimes in one’s own personality) with oneiroid differs from both stupor (characterized by a lack of orientation) and amentia (characterized by a constant fruitless search for orientation) - with oneiroid the patient is a participant in an experienced pseudohallucinatory situation. People around them can be included by the patient as participants in the situation they are experiencing. One of the signs of oneiroid is disorientation in the personality of the hallucinated person, a change in the subject of perception, transformation of the Self, for example, turning into a bird or a tree.

General information

Oneiroid is a psychopathological syndrome in which a qualitative disturbance and clouding of consciousness of a special type occurs, reminiscent of dream-like disorientation.
With oneiric syndrome, fantastic pictures unfold in a person’s head, dreamlike and pseudo-hallucinatory experiences arise, which can intertwine with reality or completely replace it. A state of disorientation in space and time, clouding of consciousness, and passivity are usually caused by the participation of patients in their pseudohallucinatory situations. This is not amentia since it is a constant fruitless search for orientation and not stupefaction , which is characterized by a lack of orientation. In addition, people nearby can become participants in the situations experienced by oneiroid, so the symptoms often resemble a delirious state .

The main symptom of this pathopsychological condition is disorientation in one’s own personality, its duality, a complete change in perception, transformation of one’s own “I” can go as far as turning into a bird, a plant or even an inanimate object.

Oneiric syndrome usually manifests in adolescents and has features of catatonic stupor. For older people, oneiric delusional experiences are not typical.

Brief historical background

In 1894, E. Regis called the state of psychosis caused by infections and intoxications oneiric delirium, but in 1909 the French psychiatrist G.G. de Clerambault was proposed to call this syndrome oneiric delirium. 15 years later, V. Mayer-Gross published a book in which he described the state of confusion and forms of oneiric experience in patients suffering from psychosis, which is now considered recurrent schizophrenia , which is the most complete form of the disease, occurring in several successive stages.

The term comes from the ancient Greek words oneiros - dream and eidos - view.

Diagnostics

Differential diagnosis

It is first of all necessary to differentiate oneiric syndrome from a concept very close to it - oneirism. It manifests itself in the fact that the patient’s vivid dreams upon awakening cannot be distinguished from reality, but it seems to him that they were in reality. The critical attitude, however, quickly returns. With severe oneiric syndrome, it is enough to simply close your eyes to see dream experiences. At the same time, criticism disappears and motor excitement appears. The content of the experiences is everyday or professional. Delirium is possible, but there are no true hallucinations. Oneirism occurs more often with burn disease, sepsis, and inflammatory diseases.

Pathogenesis

Oneiric syndrome can unfold in several stages. People first experience symptoms of a mood disorder , which can last for weeks or even months. Then comes the stage of delusional mood , which lasts hours or days, and delirium for days or weeks with enactments and false recognitions, meanings and intermetamorphoses. Next, acute fantastic paraphrenia , and only then true oneiroid with stupefaction lasting hours or even days.

If oneiroid is caused by exogenous organic diseases or intoxications, then its development is rapid - it can take only a few minutes and occur against the background of symptoms characteristic of these diseases.

S.T. Stoyanov identifies the following stages of the formation of oneiric syndrome. He believes that pathology begins with vegetative general somatic disorders, then a delusional mood comes, then comes the stage of affective-delusional derealization and depersonalization, which ultimately causes oneiric catatonia .

Symptom reduction occurs in the reverse order. In the classical form, the natural development of oneiroid occurs in people with schizophrenia and is called endogenous. Exogenous-organic oneiroid, not counting senile, is characterized by a paroxysmal course, but the climax is similar to schizophrenic.

general information

The oneiric state refers to qualitative disorders of consciousness. The second name is dream disorder. The disease was described at the end of the 19th century in patients with infectious and intoxicating psychoses. Later, similar disorders were discovered in schizophrenia.

The classic variant of the disease is oneiric catatonia, described in the type of schizophrenia of the same name. For a long time, experts believed that disturbances of consciousness with the appearance of fantastic pictures are characteristic only of schizophrenic disorders. However, at the end of the 20th century it was found that symptoms of oneiric stupefaction are observed in intoxication syndromes and organic brain damage.

Classification

There are several classifications of oneiroid. When taking into account the orientation of events in the surrounding world, oneiric syndrome occurs:

• dream-like appearance - in this case, one’s own “I” turns out to be modified against the background of complete detachment from the outside world and immersion in their imaginary pictures;
• fantastic-illusory coloring - in patients the real world is mixed with fantastic fragments.

If we take into account such a factor as the predominance of affect, then oneiroid can be expansive or depressive . The first is manic and is distinguished by the occurrence of admiration, tenderness, penetration and insight, while the depressive causes in the patient apathy , a feeling of anxiety, irritability and powerlessness.

Disorder of the “I” and neurosis can manifest itself in the form of loss of activity, simplicity and vitality of a person. More complex identity disorders include feelings of impenetrability, loss of stability and boundaries of one’s own “I,” its modification, reincarnation, fragmentation, dissolution, and in some cases, patients feel that they are inanimate, divided, or even upset personalities.

Treatment

The diagnosis of “twilight disorder of consciousness” is made by a psychiatrist, studying the clinical picture and based on a conversation with the patient and his relatives. You will also need a consultation with a neurologist and a number of specialized specialists, as well as studies such as MRI and CT of the brain, EEG, etc.

If during the process of darkening the patient committed a crime: caused damage to property, harm to health or murder, then a forensic psychiatric examination is carried out. It, among other things, involves the study of documents compiled by law enforcement officers, forensic reports, and witness statements.

Treatment is carried out in the psychiatric department of the hospital with the help of antipsychotics and tranquilizers. The psychotic type of disorder will require individual psychotherapy. It is necessary in the event of a crime committed by a patient.

If the twilight state is of a non-psychotic type, then the underlying disease is treated.

Naturally, individual treatment tactics are selected for each patient, depending on the above factors.

Causes

The causes of oneiric syndrome are endogenous and exogenous organic lesions and disorders, including:

• infectious encephalitis ;
• meningitis;
• intoxication, postpartum and other types of somatogenic psychosis ;
• senile psychosis;
• Kraepelin's disease , with oneiroid usually occurring after agitated-anxious depression;
• vascular dementia ;
• traumatic brain injuries;
• epilepsy;
• alcoholism;
• acute intoxication , for example, through inhalation of Moment glue;
• catatonic or paranoid schizophrenia, which is more often found in combination with mental automatism syndrome;
• bipolar affective disorder.

Recovery period

Rehabilitation after oneiroid is an important part of restoring social and professional life. During the recovery period, the patient should adhere to the following recommendations:

1. When using antipsychotics in the acute period of oneiric syndrome, their use continues. The dosage is reduced by 2 or 4 times. The doctor’s task is to select a dosage regimen that ensures no relapses with minimal risk of side effects.
2. Individual psychotherapy is provided. The specialist helps to cope with residual manifestations of the disease, as well as normalize social activity. It is possible to conduct group sessions of psychotherapeutic assistance.
3. If the patient had organic brain damage, motor rehabilitation is carried out, which consists of physical therapy, massage and kinesiotherapy.

During the rehabilitation period, a person needs a positive emotional environment in the family and at work. Stressful situations can lead to a relapse of oneiroid symptoms.

Symptoms

Oneiroid as a clouding of consciousness affects various cognitive, psychological and physiological functions, causing disorders of speech, emotional component, memory, etc.:

• emotions - their lability arises and a shift in a positive or negative direction is possible, an unbridled fear of going crazy;
• detachment from the outside world;
• sleep disorders such as insomnia , vivid dreams are possible;
• loss of appetite;
• headache;
• heartache;
• asthenia;
• various vegetative visceral disorders, including tachycardia , blood pressure fluctuations, hyperthermia , paresthesia , greasiness of the skin, dyspeptic disorders and anorexia ;
• effector (motor) disorders, possible numbness in a lying position;
• gradual development of delusional ideas caused by the content of pseudohallucinations;
• different types of delusional mood - delusions of persecution, death, illness, staging, reincarnation of things, Fregoli syndrome , Capgras and at the stage of paraphrenia - Manichaeism;
• partial disorientation ;
• a sense of exclusivity of one’s own personality and fulfillment of a saving mission;
• violation of the sequence of thinking;
• disturbances in time perception;
• verbal affective illusions or, in rare cases, hallucinations ;
• mental (ideational) automatisms;
• speech disturbances, its acceleration or deceleration;
• lack of opportunity to establish a dialogue;
• attention disorder;
• monotony of facial expressions or even a “frozen facial expression.”

At the stage of culmination - a true oriented oneiroid, the patient’s fantasies are oriented towards the surrounding real world and disturbances of self-awareness, that is, he can become a full-fledged participant in the events of pseudohallucinations, achieving a dream-like oneiroid. However, it must be taken into account that the natural development of gradual, slow delirium does not always occur.

Features of dream-like experiences in oneiroid

Pseudohallucinations of patients are usually of a scenic nature and are distinguished by their non-standard and fantastic nature. They are somewhat reminiscent of dreams, but due to the lack of external projection, all events occur within consciousness, filling the subjective mental space. This distinguishes dream-like experiences from a true hallucinatory syndrome.

Pictures with oneiroid are bright, with outlandish content, and can have a plot line of various scenes connected to each other. The themes can be cosmic, urban, medieval, religious, apocalyptic, etc., there is a dissociation in behavior between reality and fantasy, in which the patient plays the main role. In contrast to delirium (delirium from Latin - madness) - patients are often in a calm state, numb, in their dreams, their attention cannot be attracted, while delirious syndrome forces people to be extremely active, capable of harming themselves and others. But, there are scientists who believe that occupational delirium has many similarities with oneiroid.

The state after experiencing oneiroid delirium is often characterized by a feeling of bewilderment and confusion, as well as the development of partial amnesia, but not to such a significant extent as with delirium. In this case, memory is usually preserved regarding painful experiences, while real events are forgotten. As a result of severe organic lesions, the condition may worsen and develop into amentia or stunning .

Clinical picture

Oneiroid refers to disorders of consciousness. However, the first symptoms are manifested by changes in mood. Its lability is noted, which increases with time. During this period, the patient begins to see colorful dreams of various contents. Such changes lead to fear of madness. The sufferer does not share his feelings with others because he is afraid of visiting a psychiatrist. Symptoms of autonomic dysfunction gradually appear: frequent headaches, discomfort in the body, increased sweating, etc.

Mood disorders are progressing. Delusional ideas begin to form. At first they have the character of unsystematized delusions of death, persecution or hypochondria. Specific symptoms for oneiroid are Fregoli syndrome and Capgras. Capgras syndrome is called delusion of the negative twin. The patient believes that his friend or relative has been replaced by a double. In Fregoli's disorder, delusions of a positive double are noted - strangers are regarded by the patient as close people who have changed their appearance.

Gradually the delirium changes its content. It is filled with fantastic thoughts with apocalyptic or mystical ideas. Positive and negative hallucinations occur. During this period, a person becomes dangerous to others and himself.

In the absence of therapy, fantasies begin to displace reality. Contact with reality remains partially preserved. The patient tries to interact with her, but the level of activity is low. With oneiric-catatonic syndrome, contact is completely lost. A person stops responding to any external influences.

In children

In children 3-7 years old, initial manifestations of oneiroid (preoneiroid) are most often observed: motor restlessness, confusion, anxiety, fears, episodic visual and auditory illusions, phenomena of false recognition - a strange woman may seem like a mother or nanny to the child. In such cases, orientation is not yet disrupted.

Symptoms of oneiric syndrome in younger children are rudimentary, fragmentary, and difficult to determine due to the limited ability to self-report and describe painful experiences.

In older schoolchildren, the syndrome may manifest itself fragmentarily and for a short period of time.

Consequences for yourself and others

People suffering from oneiric syndrome are not always dangerous to others.
However, at the first sign of a problem, you should immediately contact a specialist. Having lost orientation in time and space, a person can become dangerous not so much for his environment as for himself.

Hallucinations can cause him to act accordingly. Having received an “order” from the forces of light, the patient may try to destroy his relative, in whom he will see an enemy.

Diet for oneiroid (oneiric syndrome)

Detox diet

• Efficacy: therapeutic effect after 7 days
• Terms: from 3 to 10 days
• Cost of products: 1200-1300 rubles. in Week

Eating as healthy as possible can help reduce the symptoms of psychological disorders. It is important that it is aimed at reducing the amount of consumed saturated fatty acids, fast carbohydrates and white refined sugar. It is recommended to regularly carry out detox fasting days, and also to give up caffeine, energy drinks and alcohol, which increase a person’s emotional lability and aggressiveness.

Due to the increased risk of bulimia , anorexia , or, on the contrary, gluttony , it is best to weigh out portions and create a pre-balanced menu that can fully provide the body with proteins, fats, carbohydrates and vitamins. When choosing foods, you should give preference to dietary meats, moderately fatty dairy products, fresh fruits and vegetables, whole grain baked goods and cereals, and also do not forget about the variety of seafood.