Oneiric syndrome: development, signs and manifestations, diagnosis, treatment

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Oneiroid is a psychopathology characterized by a qualitative clouding of consciousness, which is manifested by plot-related pseudohallucinations, fantastic dreams, daydreams, experiences, delusions, illusions, the appearance of unusual images and fragments, and the patient’s detachment from society. The imagination of patients reaches the level of contemplation. These phenomena in the subconscious are combined with real events and gradually replace them.

The term "oneiroid" translated from ancient Greek means "type of dreams." Oneiric syndrome was first discovered in 1894 by researchers in the field of infectious psychoses. In 1924, the pathology was described in detail by a psychiatrist from England, Mayer-Gross, who observed a patient with schizophrenia. In 1950, the Hungarian psychiatrist L. Meduna identified schizophrenia with oneiric disorder as a separate nosological entity. There have been debates and debates around this disease for a long time, significant disagreements among doctors arose, and there was no uniform terminology. Modern scientists have found that oneiric syndrome is a manifestation of various diseases: psychiatric, infectious, oncological, vascular and others.

Diseases in which oneiroid most often develops:

• Schizophrenia,
• Psychoses,
• Epilepsy,
• Traumatic brain injury,
• Alcohol and drug intoxication.

The syndrome is characterized by a staged course and is accompanied by disturbances in thought processes, speech, emotional and psychomotor state. Persons with oneiroid are characterized by ambivalence of behavior. They experience contradictory and ambivalent experiences. The simultaneous occurrence of two antagonistic feelings in patients is a sign of pathology.

Foxes with oneiroid have impaired or completely absent spatial-temporal orientation. Patients contemplate unknown things that others do not notice. Their perception of the subject changes, their own “I” is transformed by turning into an animal or an inanimate object. Participants in pseudohallucinatory situations include people around them in their fantasies.

Oneiroid is characterized by the alienation of patients from the outside world. An atypical relationship between vivid, sensual fantasies and modern realities arises in their minds. During an attack, the patient's face becomes mask-like, and their gaze becomes absent or frozen. The patients are silent and outwardly indifferent, without contact. In the post-attack period, they easily and in great detail retell their experiences and visions.

The advanced form of oneiric syndrome occurs mainly in adolescents in combination with catatonic stupor. In schoolchildren and preschool children, individual signs of pathology appear, which over time combine and form a full-fledged picture of oneiroid. In elderly people, pathology develops extremely rarely. Based on the expressed clinical picture and anamnestic data, a diagnosis is established. All patients are given pharmacological treatment taking into account the true cause of the syndrome.

Classification

There are different types of oneiroid:

1. 
   Dreamlike

   - patients are completely immersed in their imagination, separating from the outside world, becoming indifferent, detached, non-contact.
2. Fantastic-illusory - an interweaving of fantasies, dreams and illusions with events occurring in real life.
3. Dream-oriented - complete immersion of patients in their dreams with the perception of objects and phenomena that do not really exist, located in subjective mental space and not having the nature of objective reality.
4. Scenic-hallucinatory - the predominance of auditory, visual, tactile and other pseudohallucinations in the clinical picture.
5. Alcoholic – characterized by peculiar symptoms, progresses from delirium and occurs after withdrawal of alcohol or taking a low-quality surrogate.
6. Post-stroke is a complication of acute brain failure.
7. Expansive - admiration of one’s personality, being in the world of fairy-tale dreams and colorful fantasies with romantic plots, friendliness, absence of danger, joy, pleasure.
8. Depressive - low mood, suppression of intellectual activity, motor and volitional inhibition, suppression of instincts, difficulties in concentrating, focusing on painful experiences, low self-esteem, nightmares, constant expectation of danger, predominance of negative emotions - anxiety, fear, despondency, apathy, tearfulness .
9. Manic – activation of the patient, optimistic mood, joy of life, elevated mood, mental arousal, acceleration of thinking and speech, motor excitement.

Classification and stages of development of oneiroid

The modern classification of ailments does not contain the term “oneiroid”, since it is not considered a separate ailment, but is a type of qualitative clouding of consciousness. Oneiroid is included in the concept of “delirium”.

In psychology, oneiroid is considered a special variation of a disorder of consciousness.

According to the classification proposed by Academician A. Snezhnevsky, oneiroid is distributed according to the following characteristics, namely: by orientation in the events of reality and by the nature and prevailing affect.

In turn, depending on the orientation in reality, they distinguish: dream-like and fantastic-illusory oneiroid syndrome. The first is characterized by a change in the individual’s self. It is characterized by the patient’s complete detachment from external reality and immersion in events occurring in the imagination. Secondly, fragments of reality are mixed with fantastic unreal figurative pictures.

Depending on the character and dominant affect, depressive oneiroid and expansive oneiroid are distinguished.

According to Demanova’s classification, oneiric states are divided into four variations: dream-like (complete detachment from the outside world, immersion in imaginary events), scenic-hallucinatory (is a consequence of schizophrenic delirium, sometimes senile dementia, fantastic hallucinations are noted), fantastic-illusory (occurs in schizophrenia, accompanied by a kaleidoscopic mixture of delirium and reality), oriented-dream-like (a consequence of psychoses arising due to toxic damage to brain structures).

The classic oneiroid goes through certain stages of development: autonomic dysfunction, general somatic pathologies, delusional disorder, depersonalization and derealization, oneiroid catatonia.

At the initial stage, affective disorders are detected. Its duration can be weeks and even months, due to the etiological factor. It is characterized by an escalation of emotional symptoms.

The period of delusional ideas is quite short - from a couple of hours to several days. The disease at the described stage speaks about itself through paranoid tendencies and through increased emotional intensity.

Delusions of staging can be observed for a longer period of time (up to a month). It manifests itself as illusory phenomena and detachment syndrome.

The stage of oriented oneiroid is characterized by paraphrenic delirium, the duration of which is no more than several days.

True oneiroid is considered the shortest stage. Therefore, it is here that the detailed symptoms of a mental disorder are noted. After which the clinical manifestations of oneiroid are minimized until they disappear.

Etiology

Oneiric syndrome is a nonspecific polyetiological pathology, which is a manifestation of various disorders: psychiatric diseases, severe intoxications, effects of anesthesia, viral and bacterial infections, neurological pathology, somatic non-infectious diseases, autoimmune diseases, endocrinopathies. In addition to psychogenic provocation, heredity plays a great role in the development of the disease.

• Mental illnesses – paroxysmal schizophrenia and manic-depressive psychosis.
• Exogenous intoxication caused by exposure to chemical, medicinal, narcotic and other toxic substances.
• Organic brain damage.
• Use of anesthesia during operations.
• Viral infections - cytomegalovirus, influenza and parainfluenza virus, herpes virus.
• Bacterial infection occurs in the form of sepsis, meningitis, meningoencephalitis.
• Neurological pathology - epilepsy, panic disorders against the background of acute encephalopathy, dyscirculatory disorders.
• Cardiovascular dysfunctions - stroke, myocardial infarction, heart failure, vascular dementia.
• Autoimmune disorders - rheumatism, vasculitis, SLE.
• Metabolic disorders - hypovitaminosis, pellagra.
• Endocrinopathies.
• Neoplasia leading to cachexia, chronic asthenia.
• Injuries accompanied by painful shock and blood loss.

If the cause of the pathology is exogenous intoxication - the use of psychotropic drugs, drugs, medications, the syndrome quickly progresses and has vivid symptoms. The wave-like course of oneiroid is characteristic of discirculatory phenomena and organic diseases of the brain.

Causes of oneiroid

The main factor causing oneiroid is heredity. If someone from the patient’s immediate circle is diagnosed with psychosis with accompanying hallucinations and confusion or schizophrenia, then most likely the cause of the illness in question is heredity. But if the described disturbances are not found in the family, then oneiroid can be provoked by intense emotional experiences that prompt him to escape from reality into an illusory world.

In addition, the syndrome in question can also be provoked by physical factors, for example, head trauma, epileptic seizures, and poisoning with pharmacopoeial drugs.

It should be noted that usually oneiric syndrome is a manifestation of recurrent or catatonic schizophrenia. Therefore, if the cause of the described oneiroid syndrome is a mental disorder, then the manifestations of the disease can last several days or even months.

In addition to the listed factors, the development of oneiroid can be provoked by:

– acute intoxication processes caused by the abuse of psychoactive drugs or narcotic drugs, as well as substances similar in purpose to drugs (glue, acetone);

– exposure to certain drugs used for general anesthesia;

– various infectious processes of bacterial etiology or viral origin, occurring with hyperthermia and intoxication;

– poisoning with alcohol-containing liquids;

– encephalitis of various nature;

– epilepsy, accompanied by the development of psychoses or mental convulsive attacks equivalent to epileptic seizures;

– non-infectious origin of organ pathologies, accompanied by serious vascular disorders or changes in metabolic processes (myocardial infarction, renal-hepatic lesions with the formation of functional insufficiency);

– immune disorders (lupus erythematosus);

– endocrine dysfunction (diabetes, adrenogenital syndrome, Addison’s disease);

– severe pellagra;

– malignant neoplasms of various localizations, if they lead to intoxication and cachexia.

Often oneiric syndrome is a sign of somatogenic psychoses. It occurs as a result of the formation of encephalopathy of vascular origin or intoxication etiology with a variety of severe somatic ailments. In an infectious process, the cause of a disorder of consciousness is often diffuse damage to neurons, the occurrence of toxic swelling of nerve structures, or disruptions in brain microcirculation.

Symptoms

Oneiric stupefaction develops in five stages, each of which has specific clinical symptoms. The stages have very blurry outlines and smoothly flow into each other.

1. Initial stage: unstable mood - increased or decreased, sleep disturbances - insomnia or colorful dreams, neurovegetative signs - cardialgia, impotence, cephalgia, loss of appetite, hyperhidrosis, facial flushing. Patients suffer from fear of insanity.
2. The stage of the appearance of delusional ideas - delusions of death, incurable illness or persecution are often combined with hallucinosis, illusory ideas, increased tension, paranoia, disorder of thinking processes, expressed in incorrect perception of the surrounding world.
3. The stage of emotionally charged delirium of staging, during which patients develop derealization and depersonalization, illusions and mental automatisms appear. The surrounding objects change externally, and faces also internally. Living people are replaced by doubles, faces and characters are transformed. Patients consider themselves heroes of myths and works of art, aliens and strangers.
4. Paraphrenia with fantastic or megalomanic delusions is a stage of pathology in which patients become the center of the Universe. They communicate with angels and demons, are in the midst of the struggle between good and evil, and consider themselves significant and great. In their subconscious, terrible hallucinations arise about disasters, mass deaths, and the end of the world. Often a person does not realize where he is, gets lost in time and space, and becomes dangerous to others.
5. The stage of expanded oneiroid - the world of dreams and fantasies exceeds real life. Patients participate in their own pseudo-hallucinations, they are immersed in fairy-tale scenes and implausible plots. They actively fight the otherworldly world of spirits and become participants in global disasters. The patient subconsciously goes through all stages of the development of pathology: from the spectator and the main character to the victim of the unfolding events. This is the climax of the attack. Clinical signs of this stage are disorientation, confusion, and illusory-hallucinatory fantasies. Patients become self-absorbed and stop contacting others. With total pseudohallucinosis, painful experiences overtake a person who no longer perceives real events. During an attack, patients become numb, do not make contact, their gaze is fixed at one point.
6. The reverse development of pathology, in which patients clearly remember and colorfully describe their painful experiences.

Main clinical manifestations of the syndrome

Emotional stress is the first manifestation of the syndrome. The lability of emotions, their changes in a negative or positive direction lead to sleep disorders, manifested by insomnia or vivid dreams. Constant fear drives patients crazy. Signs of manic oneiroid are that patients are hyperactive, they admire and are touched, they perceive current events favorably and joyfully. Depressive oneiroid is manifested by apathy, anxiety, irritation, and asthenia. Patients often experience changeable feelings: from lethargy, lack of initiative, frustration to excessive ambition and soulfulness.

Disorders of mental and speech functions are manifested by delirium, dual orientation, and disturbed sequence of thoughts. A delusional mood is manifested by unsystematized delusions of persecution, death, and hypochondria. The delusion of staging is accompanied by verbal illusory-hallucinatory phenomena, transformation of images and objects, a feeling of alienation, unnaturalness, “made-up” of one’s own movements, acceleration or deceleration of speech. The paraphrenic stage is a fantastic retrospective and Manichaean delirium with preservation of self-awareness. Patients tell how they saw a staircase in a large hall, along which angels descended and demons ascended. They first become witnesses to a grandiose battle, and as the pathology develops, they become participants in the events. The self-awareness of patients is gradually impaired. They are completely immersed in pseudo-hallucinations. Verbal contact with patients is impossible because they speak slowly and slurred.

A disorder of the volitional sphere is a sign of a developed pathology. Patients rarely experience psychomotor agitation. Usually they experience numbness and detachment, their facial expressions are monotonous and “frozen.” Phenomena of catatonia are possible - stupor or hyperactivity, absent-mindedness and inability to concentrate on a specific object, amnestic symptoms - remembering and accurately reproducing painful experiences with loss of memory for real events.

Hallucinations - patients travel between planets, communicate with Martians, go to the Moon and perform a certain mission there; on the streets of the city they organize uprisings, lead naval battles, fight with pirates, experience the end of the world, become sites of destructive actions - cities perish under their leadership, millions of people die, volcanoes erupt, earthquakes occur, planets collide. Fantasies become more and more colorful and fabulous. The patient answers questions evasively, speaks in short phrases, often incomprehensible to the interlocutor, he is confused and indistinctly addresses himself mostly to himself. At the same time, facial expressions are not thematic or are completely absent. Gradually he goes into the world of dreams and falls into his dreamlike state, not noticing the real dangers. After emerging from oneiroid, patients remain convinced of the truth of their visions for a long time.

What is oneiric syndrome

Oneiric syndrome is a special state of mental disorder. It can develop with other mental illnesses (schizophrenia, etc.) or exposure to chemicals on the brain. It is characterized by dreamlike images, pseudohallucinations, and disorientation of the patient in time and space. A person completely falls out of reality, evaluates events inadequately, and behaves according to his perception.

The syndrome has been known to science since 1894 thanks to research into infectious and intoxication psychoses. In the 20s of the twentieth century, oneiric syndrome accompanying schizophrenia was described, and until the 1960s it was considered a manifestation of mental illness. However, later scientists came to the conclusion that there were multiple reasons for the origin of the oneiroid. The syndrome can occur as an endogenous symptom of mental disorders, the result of organic brain disorders, or under the influence of exogenous (external) causes: toxins, other chemicals.

In the modern international classification, oneiroid is classified as a type of delirium, but these conditions have their differences.

Oneiroid is classified according to several criteria. One of the criteria is orientation:

1. The dream-like oneiroid resembles a dream in the form of an event in which the patient is fascinated; at the same time, he is alienated from the world around him.
2. With fantastic-illusory oneiroid, mixed orientation is observed (simultaneity of reality and fantasy experiences).

Oneiroids also differ in the causes of their occurrence. The most important of them:

Alcoholic oneiroid is a syndrome that progresses from delirium. This type of oneiroid differs from other types due to differences in the perception of reality by the brain of an alcoholic.

Oneiroid after a stroke is a syndrome of organic nature, which sometimes develops as a complication after severe conditions.

In addition, oneiroids are divided according to the nature of affect:

An expansive oneiroid is a person who is completely captivated by the world of his fantasies and is in a state of admiration.

Depressive oneiroid - a person does not want to do anything, he is constrained, immobilized and depressed.

Manic oneiroid – occurs less frequently than others; the patient behaves overactively, actively, guided by his fantasies.

Psychiatrists are involved in the diagnosis and treatment of oneiric syndrome.

Diagnostic measures

Diagnosis of the oneiric state is quite complex. Sometimes patients do not have any complaints, except for an increase in internal tension, inhibited reaction, insomnia, and depression. These manifestations are nonspecific. They do not allow one to suspect this disorder. Psychiatrists talk with the patient and his relatives, collect a life history, and observe manners and behavior. All this data is extremely important for making a diagnosis. In addition, a comprehensive analysis of somatic and neurological status is required. The results of laboratory and instrumental diagnostics are often decisive.

• Patients need to donate blood for general clinical and biochemical tests, cerebrospinal fluid for cytological, histological and microbiological studies.
• Instrumental diagnostic methods - tomographic and x-ray examinations of the skull.
• The psychological state of the patient is determined using special tests and scales.

Diseases characterized by the syndrome

The development of oneiric syndrome is possible with endogenous and exogenous-organic mental disorders:

1. Exogenous-organic form: with infectious (encephalitis), intoxication and other somatogenic psychoses, presenile and senile psychoses (see F - Dementia, unspecified (more often with the so-called Kraepelin's disease - F03.33)), vascular dementia, traumatic brain injury ( TBI), epilepsy, delirium delirium. A feature of oneiroid in acute intoxication (for example, inhalation of Moment glue for the purpose of drug intoxication) is its lightning-fast development, sometimes within several minutes. With other exogenous-organic diseases, it also begins and ends relatively quickly. A feature of oneiroid in alcoholic delirium, somatogenic and vascular psychoses and psychoses in TBI in the early stages of development is pronounced asthenia, followed by delirium or stunning. With TBI and epilepsy, asthenia can turn into twilight stupefaction. In Kraepelin's disease, agitated-anxious depression occurs before full-blown oneiroid. With all of the above disorders, oneiric syndrome develops without a classical pattern; it is characterized by confusion with the symptoms of these diseases (in alcoholic delirium - zooptic hallucinations, motor agitation). Self-awareness disorders do not occur. There are no symptoms of catatonia. Oneiroid may end with transitional symptoms of Wicca. Oneiric syndrome in exogenous organic diseases is evidence of a severe course of the disease, and its transition to amentia or stunning is an even more unfavorable sign.
2. Endogenous - in schizophrenia, less often in bipolar affective disorder. In ICD-9 there was a category 295.24 - Oneiric catatonia as a variant of fur-like schizophrenia and 295.25 - Oneiric catatonia as a variant of periodic schizophrenia. Now they are classified as F2 - Catatonic schizophrenia.

Healing procedures

Patients with oneiric syndrome are treated in a psychiatric clinic under the supervision of medical personnel. The treatment regimen is drawn up by a psychiatrist taking into account the cause of the pathology.

General therapeutic measures include:

1. Detoxification – intravenous administration of saline solutions, glucose, “Reopoliglucin”, oral administration of “Rehydron”, “Atoxil”, “Enterol”,
2. Diuretics - Mannitol, Lasix,
3. Neuroleptics - “Azaleptin”, “Haloperidol”, “Aminosin”, “Tizercin”,
4. Antidepressants - Prozac, Coaxil, Amitriptyline,
5. Sedatives – “Afobazol”, “Persen”, “Novopassit”,
6. Nootropic drugs – “Pantogam”, “Semax”, “Piracetam”,
7. Cytoprotectors – “Actovegin”, “Riboxin”, “Trimetazidine”,
8. Antioxidants – “Mexidol”, “Glutamic acid”, “Glycine”,
9. Vascular drugs – “Trental”, “Vinpocetine”, “Cinnarizine”,
10. Neuroprotectors - Phezam, Thiocetam,
11. Tranquilizers – “Sibazon”, “Relanium”,
12. Antispasmodics – “Papaverine”, “Drotaverine”, “Spazmalgon”,
13. Broad spectrum antibiotics for infectious diseases,
14. Electroconvulsive therapy is performed in severe cases.

With severe psychomotor agitation, patients require physical restraint. However, in most cases, calming psychotherapy is sufficient.

The prognosis of oneiroid is determined by the course of the underlying disease. After quality psychiatric treatment, patients may require consultation with specialists.

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.

Story

The concept of “oneiric delirium” (see onirism) was first used by E. Regis in 1894 when describing psychoses due to infections and intoxications. The term “oneiric delirium” was proposed by the French psychiatrist G. G. de Clérambault in 1909. In 1924, oneiroid as a syndrome was first described by W. Mayer-Gross in the book “Description of Confusion. A form of oneiric experience" (German: "Selbstschilderungen der Verwirrtheit. Die oneroide Erlebnisform"). In 1961, the Bulgarian psychiatrist S. T. Stoyanov studied the dynamics of the process. Oneiroid was described mainly in psychoses, now classified as recurrent schizophrenia. With it, it appears in the most complete form, and its development goes through a number of successive stages.