Kandinsky-Clerambault syndrome or mental automatism

There are a huge number of myths and misconceptions about psychiatry among people. As a practicing doctor, I encounter this phenomenon all the time. You can hear so many ideas and suggestions for treatment from patients and their loved ones!

Just a few days ago, the mother of a patient suffering from schizophrenia suggested that her daughter undergo an “intestinal drainage” in order to “get rid of the sludge that leads to hallucinations.” Another mother of a mentally ill patient insisted on massage of the prostate gland for approximately the same purpose. I am even afraid to count how many proposals I have listened to regarding the treatment of mentally ill patients with urine therapy, honey, mud, physical activity and diets.

More than once I was asked to “scare the patient more strongly” - “because stress will make the disease go away,” they insisted on immersing the patient in ice water on the feast of Epiphany. And the rituals of reprimand or exorcism of the most varied scale... I think that if I followed the lead of these well-wishers, I would risk ending up in the hospital or, what’s the best, behind bars. It would be difficult to explain to “competent comrades” why I immersed a sick person in wormwood against his will... A lot of myths and misconceptions are associated with schizophrenia. As often as not, “in the world” our patients are called “crazy”, “fools”, “seizures” - without even imagining the essence of the changes happening to them, and therefore without understanding the peculiarities of their behavior, views on life, the world around them. This is called stigmatization: in essence, people deny patients the same rights as others - only due to a lack of understanding of their illness.

I will try to lift the veil of misunderstanding a little and tell you what actually happens to mentally ill people, using the example of one of the most common and severe phenomena in psychiatry.

Kandinsky-Clerambault syndrome (mental automatism syndrome; external influence syndrome, influence syndrome, alienation syndrome, mastery syndrome) is a psychopathological symptom complex manifested by alienation or loss of belonging to one’s own mental processes (mental, sensory, motor) in combination with a feeling of influence some outside force; accompanied by delusions of mental and physical influence and (or) delusions of persecution, perceptual disorders. Mental automatism syndrome can be observed in various mental illnesses: alcoholic, traumatic, vascular, infectious psychoses. It is most characteristic of schizophrenia, especially its paranoid form, and almost always indicates an unfavorable prognosis for the course of the disease.

"Hunters" and victims

The first comprehensive description of the symptoms of this disorder belongs to the Russian psychiatrist Viktor Khrisanfovich Kandinsky (1849–1889), who in 1880 published a chronicle of his own illness, “On the Doctrine of Hallucinations,” where he gave a detailed description of the observed mental disorders. In 1881, a German translation of the book was published, which quickly received responses in Germany and France.

Almost 40 years later, Gaëtan Henri Alfred Eduouard Léon Marie Gatian de Clérambault (1872–1934), a French psychiatrist, compiled a classification of the symptoms identified by Kandinsky and combined them into a syndrome, which he received name: Kandinsky-Clerambault syndrome.

Thus, Kandinsky and Clerambault independently described the syndrome of mental automatism. It is noteworthy that both psychiatrists analyzed and described their own painful experiences. They were both sick, and both eventually led to suicide.

Features of the course of the disease

Kandinsky Clerambault's mental automatism syndrome, like other mental illnesses, develops in several stages, which are characterized by certain symptoms and severity.

During the syndrome, there are two forms: acute and chronic:

1. In the acute course of the disease, all the patient’s symptoms manifest clearly. In this case, the patient is quite active, talkative, but at the same time easily irritable and aggressive. Some patients experience a very strong feeling of fear. This form lasts up to three months, and is accompanied by pseudohallucinations with attacks of delusional ideas. Such ideas completely embrace the patient, which completely takes the person out of normal life. In such patients, symptoms often change, obsessive states or pain changes its location.
2. The development of the chronic form occurs over several years. Clinical manifestations begin to gradually increase: signs of ideational automatism appear first, followed by phenomena of motor or sensory automatism. The manifestations of this form of the disease are so vague that it is difficult to diagnose.

Note. Often, delusional states occur in a mild degree of severity, which is difficult to determine when examining such a patient.

Symptoms of Kandinsky-Clerambault syndrome

This is a feeling of alienation from one’s own mental processes, of mastery by someone from the outside. Arises as a result of delusional ideas about the imaginary impact on the patient (for example, radiation or ultrasound).

Ideatorial, or associative, automatisms are the result of an imaginary influence on thinking processes and other forms of mental activity.

These include:

Mentism is a violent influx of thoughts and images beyond the patient's control.

A symptom of openness of thoughts is the feeling that thoughts are known to others.

“Thought withdrawal,” in which the patient’s thoughts “disappear” from the head.

“Made thoughts” is the belief that his thoughts belong to strangers, most often his persecutors, and are put into the patient’s head.

“Unwinding of memories”: patients, against their will and desire, as if under the influence of an outside force, are forced to remember certain events of their life; Often, at the same time, the patient is “showed pictures” illustrating memories.

The phenomenon of “made moods, feelings, dreams”: patients claim that their moods, feelings, likes and dislikes are the result of external influences. For example, there is a feeling that emotions do not arise independently, but under the influence of an outside force (“they laugh at me,” “they cry at me”).

Sensory or sensory automatisms usually include unpleasant sensations that also arise as a result of the imaginary influence of an outside force. They manifest themselves as a feeling of sudden heat or cold, painful sensations in the internal organs, head, and limbs. Most often they are unusual, pretentious: patients talk about extremely peculiar sensations in the form of twisting, pulsation, bursting of internal organs and body parts. For example, I heard from patients that “from radiation, the heart swells and buzzes like a bell” or “a plasticity has formed in the head... the brain has frozen, hardened...”; “My intestines are tied in knots - this is causing constipation...” The intestines were turned off, the brain was preserved, stopped - violence! In this case, there may be no real problems from the authorities at all.

Motor, or motor, automatisms include the feeling of external imposition of the movements performed by the patient. Patients believe that their actions are controlled, they move their limbs, tongue, cause a feeling of immobility, numbness, and deprive them of the ability to voluntarily move. Motor automatisms also include speech motor automatisms: patients claim that their language is spoken; the words they utter belong to strangers. So, a patient who has just scolded the doctor with the last words sharply begins to apologize: “Sorry, it’s not me... You are a good doctor, but your tongue moves in your mouth by itself...

Chronic fatigue syndrome is a biological disease

June 17, 2015

Researchers from the Center for the Study of Infectious Diseases and Immunity at Columbia University's Mailman School of Public Health have discovered a variety of unusual immune changes in patients diagnosed with chronic fatigue syndrome, medically known as myalgic encephalomyelitis (ME/CFS), or "systemic stress intolerance disease."

.
The findings could help improve diagnosis and tailor treatment
for the disorder,
symptoms
range from extreme fatigue and inability to concentrate to headaches and muscle pain.

These immunosignatures provide the first reliable evidence that myalgic encephalomyelitis

is a biological disease, not a psychological disorder, and the first evidence that the disease has different stages. The results are published online in the new journal Science Advances, published by the American Association for the Advancement of Science (AAAS, pronounced “Triple-AS”).

The researchers used immunoassay techniques to determine levels of 51 immune markers in plasma samples taken from 298 ME/CFS patients and 348 healthy controls. They found specific structures in patients who had been ill for less than three years. These structures were not present in controls or in patients whose illness lasted more than three years. Patients with a short duration of illness had increased amounts of different types of immune molecules called cytokines. The study found that the disease was unusually strongly associated with the cytokine Interferon gamma, which in turn is associated with the fatigue that accompanies many viral infections, including the Epstein-Barr virus (the cause of infectious mononucleosis). Cytokine levels were not explained by disease severity.

“We now have evidence to show that millions of people with this disease, known as myalgic encephalomyelitis/chronic fatigue syndrome

, are not psychologically ill,” said lead study author Madi Hornig, MD, PhD, international research director at the Center for Infection and Immunity and assistant professor of epidemiology at the Johns School of Public Health Administration.
Mailman at Columbia University (Columbia's Mailman School). “Our results should speed up the process of diagnosis in individuals with early signs of the disease, as well as open up new treatments for chronic fatigue
based on blood markers characteristic of the early stages of the disease.”

There are already human monoclonal antibodies on the market that can lower levels of the cytokine interleukin-17A, which the study found were elevated in patients early in the disease. Before any drugs are tested in clinical trials, Dr. Hornig and his colleagues hope to replicate the study findings with a new long-term study that follows patients for a year. This is to see how levels of cytokines, including interleukin-17A, begin to change in individual patients over time, depending on how long they have been sick.

Stalled at maximum speed

Research supports the idea that ME/CFS

may reflect an infectious escape run.
Patients often report that CFS became concomitant with infectious mononucleosis (Epstein-Barr virus) and have not been able to fully recover since then. New research suggests that due to these infections, the immune system loses the ability to self-regulate and stabilize after experiencing an acute infection, to restore homeostasis; the immune response becomes like a car stalled at top speed. “Patients with ME/CFS appear to have sudden spikes in cytokine levels over approximately three years, causing the immune system to become depleted and cytokine levels to drop,” says Dr. Hornig. “Early diagnosis may provide unique treatment options for chronic fatigue syndrome
that are likely to be different from what would be appropriate to do in the later stages of the disease.”

The researchers carefully screened the participants to ensure that they actually had the disease being studied. The researchers also recruited a larger number of patients who were more recently diagnosed. The patients' resistance to stress was normal; Before each blood draw, patients were asked to fill out standard paperwork, in part to induce fatigue. The scientists also took into account factors that influence the immune system, including time of day, season and geographic location of where the blood samples were taken, as well as age, gender and ethnicity/race.

In 2012, V. Ian Lipkin, MD, director of the Center for the Study of Infectious Diseases and Immunity, and colleagues reported the results of a multicenter study that definitively dispelled speculation that two viruses were involved in chronic fatigue syndrome.

: XMRV (xenotropic murine leukemia virus-related virus) and pMLV (polytropic murine leukemia virus).

At the medical center, you can undergo a full diagnosis of infections caused by the Epstein-Barr virus, as well as get a consultation with an immunologist. Services are provided inpatient and at home.

Our address: St. Petersburg, 11th line of Vasilyevsky Island, building 36

Phone numbers for appointments and consultations and (911) 227-12-90

Pseudohallucinations

These phenomena are characteristic specifically of Kandinsky-Clerambault syndrome. These are visual, auditory, olfactory, gustatory and other deceptions of perception, distinguished by patients from real objects (i.e., the patient seems to “see them with his inner eye” or “hears them inside his body”) and have the nature of being made, artificial.

For example, the patient “sees” “made images”: faces, entire panoramas (similar to watching a movie), which are “showed” to the patient by his “persecutors” with the help of certain “apparatuses”. Auditory pseudohallucinations - noises, words, phrases “transmitted” by radio, through various equipment; they are most often localized in the head and body; have an imperative and commentary nature, belong to familiar and unfamiliar persons; can be men's, women's, children's.

For example, one of the patients very colorfully (at the peak of an acute condition) described to me “pictures of the future” that “alien angels” were “transmitting” into his brain. It looked, he said, like a filmstrip or slides that were shown to his inner “brain” eye. He described the contents of the “pictures” in detail, but due to other thinking disorders, he could not complete the description to the end, slipping into other topics.

We also constantly have to ask patients - where exactly do they hear “voices”? If a person reports that orders or swearing are heard inside the head, even in complete silence around, this is a serious sign of our syndrome.

General information

Kandinsky-Clerambault syndrome belongs to the paranoid-hallucinatory type and is a severe type of psychotic disorder with personality transformation. A patient suffering from a similar disease experiences signs of obsessive states, as if someone outside is manipulating his psyche.

Among the complaints there are complaints about the existence of a certain subject or force that controls the patient’s thoughts and requires his unquestioning submission. As a result, the patient does not consider himself responsible for his own actions, actions, and thoughts.

The establishment of unnatural behavior (mental automatism) is accompanied by hallucinations with the subsequent development of paranoia, which results in alienation of the individual. As the mastery syndrome progresses, the appearance of other mental problems cannot be ruled out.

The first doctor to describe in detail the symptom complex of a pathological disorder was the Russian psychiatrist V. Kh. Kandinsky. The scientist was engaged in the study of automatisms, the results of his work were published in 1880. Almost 40 years later, the French psychiatrist de Clerambault, who studied the same problem, proposed a classification of the complex of symptoms recorded by Kandinsky.

As a result, the mental illness was named after two scientists who studied the pathology comprehensively.

Patients with schizophrenia (up to 60%) more often suffer from alienation or influence syndrome; in this case, one should not expect comforting prognoses. Both doctors after whom the disorder is named suffered from its symptoms, and in their studies described their own observations. Kandinsky's death, like Clerambault's, was the result of suicide.

Review of reasons

The main cause of the pathological condition is considered to be schizophrenia. Mental automatisms can also accompany the pre-manifest period with subsequent complication as the pathology develops. High-risk patients include people with unstable mental health, suffering from imaginary fears and anxieties, and frequent depression.

Kandinsky-Clerambault syndrome is an obsessive state of controlling one’s own consciousness from the outside. In rare cases, signs of automatisms can be observed in other mental problems.

Treatment of aggravated forms of Kandinsky-Clerambault syndrome (paranoid, schizoid) should take place in a specialized clinic. To recognize psychosis or schizophrenia, a number of special tests are necessary.

In addition, it is important to differentiate the syndrome from the state of hallucinatory-delusional type (HBD), since the disorders have similar symptoms. The main difference between GBS is true hallucinations, not accompanied by alienation of the individual.

Risk factors

Factors that can cause the appearance of mental abnormalities include addictions such as alcohol, toxic, and narcotic addictions. The development of Kandinsky-Clerambault syndrome can start from a traumatic brain injury that causes cerebral hypoxia. In this situation, mental disorder becomes a defensive reaction to traumatic actions.

Signs of automatisms are characteristic of the post-stroke period; they can also be the result of a tumor process or hemorrhage in the brain.

Paranoid delusions with hallucinations are characteristic of Wilson's disease, which progresses due to the accumulation of copper in the body. If the element is incorrectly distributed among organs (liver, kidneys, brain), the process of irreversible changes in them begins. However, it happens that the causes of automatisms are genetically determined.

Delusions of influence or persecution

The patient can explain his painful sensations by influencing him using a variety of methods - from witchcraft and hypnosis to modern means (electricity, UHF waves, radio waves, radiation, atomic energy, laser beams). The influence is carried out by both individuals and organizations, often with the goal of causing harm to the patient. For example, in my practice, which began in the late 90s of the last century, the most common complaints were about the “mafia or racketeers” (everyone remembers the dashing 90s !), as well as aliens from other planets and psychic sorcerers (remember the craze for parapsychology and ufology in the 80s and 90s!).

It is Kandinsky syndrome within schizophrenia that is characterized by delusions of persecution, interpretation, and influence. Other types of delusions are also inherent in other mental illnesses.

It is possible to develop an inverted version of Kandinsky-Clerambault syndrome: the patient himself supposedly has the ability to influence others, recognize their thoughts, influence their mood, feelings, and actions. These phenomena are usually combined with ideas of overestimation of one's personality or delusions of grandeur.

One of my regular patients, a fairly young girl, at the height of a schizophrenic attack, believed in “enormous magical power” emanating from her. She felt like “an all-powerful healer, connected by energy fields to the entire world,” and was unstoppable in her attempt to heal literally everyone who came into her sight. I must disappoint lovers of mysticism and energy therapy. The patient only seemed to be “guessing” the diagnosis, and she could not help anyone. But she made an excellent recovery and is now practically healthy.

Classification and characteristic features

In psychiatry, there are several varieties of the Kandinsky-Clerambault symptom, each of which, along with the general picture, is characterized by specific symptoms.

Flow

Hallucinatory-paranoid syndrome within the framework of schizophrenia can develop acutely or become chronic. The acute form develops quickly, is characterized by a paroxysmal course, vivid, figurative, but poorly systematized delusions; variability, inconsistency of symptoms, intensity of emotions (not only fear, suspicion, hostility, but also high spirits), severity of mental automatisms.

The chronic form develops gradually, sometimes unnoticeably; can last for years. Usually the clinical picture becomes more complicated due to the accumulation of various automatisms. Delusional ideas are often systematized and directed. The patients’ sensations and imaginary sources of influence take on fantastic content (for example, their stomach was taken out, their intestines were blocked: they are being influenced from other continents with the participation of CIA employees, aliens).

Delusional – hallucinatory type of course

In this case, several options for the course of the disease are provided: delusional and hallucinatory:

• with the delusional variant of the course, a person develops various kinds of delusional ideas of persecution, influence, and pseudohallucinatory disorders, in turn, manifest themselves to a lesser extent or may be completely absent;
• whereas in the hallucinatory course , pseudohallucinations are observed, and there are practically no delusional disorders.

Diagnostics

The presence of Kandinsky-Clerambault syndrome is determined by signs of the unconscious emergence and development of mental disorders with an ever-increasing feeling of alienation and awareness of their violence.

In addition, as part of the diagnosis of schizophrenia, we pay attention to other mental disorders that are characteristic of the disease itself. Indeed, with schizophrenia, specific disorders of the emotional-volitional sphere, behavioral disorders, memory and intellectual disorders occur. Of great importance is the history of the development of the disease process, its stages, the role of heredity and the premorbid personality of the patient.

All this allows the psychiatrist to separate Kandinsky syndrome from other externally similar mental phenomena.

Treatment

Treatment of patients with Kandinsky-Clerambault syndrome is complex. It consists of drug therapy, psychotherapy, and rehabilitation measures. If the syndrome occurs during schizophrenia or psychosis, patients are hospitalized in psychoneurology.

Psychotropic drugs:

1. Neuroleptics that inhibit nervous processes in the central nervous system - Aminazine, Sonapax, Leponex.
2. Antidepressants that promote the production of substances that improve mood - Amitriptyline, Prozac, Imipramine.
3. Tranquilizers that relieve anxiety, fear, restlessness and asthenia, as well as normalize sleep - Phenazepam, Clozepid, Amizil.
4. Sedatives of plant origin – “Novopassit”, “Persen”, “Sedasen”.

In addition to drug therapy, patients are recommended psychotherapy. Cachexic patients are prescribed brewer's yeast, iron supplements, vitamins and other tonic agents. Regular visits to a psychotherapist are combined with exercise therapy and strict adherence to a diet that limits copper-containing products. Long walking and swimming are recommended for all patients. Morning exercises, hardening procedures, and fighting bad habits help delay or prevent relapse of the pathology. A calm environment in the family, the attention of relatives and the support of friends are necessary for patients with paranoid Kandinsky-Clerambault syndrome.

Traditional treatment:

• Peony root tincture has a pronounced sedative effect on the patient’s body.
• A decoction of thyme, hops, oregano and mint relieves nervous tension and saves from insomnia.
• Fragrant mignonette is infused with vegetable oil and rubbed into whiskey.
• An infusion of blackberry leaves and hop cones strengthens the nervous system.
• Henbane, datura and belladonna have a positive effect on the psycho-emotional state of a person.

Kandinsky-Clerambault syndrome is a complex and serious disease. Timely diagnosis and adequate treatment of the acute form of the pathology allow patients to fully recover and make the prognosis of the disease favorable. In such cases, the disease undergoes reverse development and ends with recovery. The chronic form is prone to long-term progression, complications of the clinical picture and personality degradation.

Treatment and prevention of mental automatism syndrome

To prevent the development of Kandinsky-Clerambault syndrome, timely treatment is necessary, usually in a psychiatric hospital. Complex therapy, as part of the treatment of the underlying disease - schizophrenia:

• medicinal (neuroleptics: haloperidol, trifluoperazine, clozapine, olanzapine, risperidone and other drugs);
• biological therapy - electroconvulsive, insulin comatose;
• psychotherapy (with the positive effect of psychotropic drugs) followed by social rehabilitation (at the stage of recovery and awareness of the disease).

Treatment methods

The key to success in the treatment of external influence or alienation syndrome is an integrated approach, involving psychotherapeutic and medicinal interventions with subsequent monitoring and a rehabilitation period.

1. Drug treatment with psychotropic medications is primarily prescribed to achieve emotional stability. Most often, experts give preference to such modern antipsychotics as Triftazin and Haloperidol in combination with antidepressants and antipsychotics.
2. A little later, it is important to prescribe psychotherapy if the medications give a positive result and the patient is more conscious of the processes that are happening to him.
3. The rehabilitation period, in turn, involves the following measures.

• physical therapy classes;
• following a diet without legumes, nuts, chocolate and other copper-rich foods;
• attending group psychotherapy sessions in addition to ongoing individual ones.

Each case requires an individual approach to provide the most effective treatment. The attending physician develops a general strategy only after a complete examination of the patient and analysis of his behavior.

Preventive measures require appropriate and necessarily timely treatment of the underlying mental illness that may accompany the syndrome in question.

Stages of development

Delusional-hallucinatory Kandinsky-Clerambault syndrome usually develops according to one of two scenarios:

• in the case of the delusional variant, mental automatisms dominate in combination with delusional symptoms, but with the extremely rare occurrence of hallucinations;
• in the hallucinatory type, pseudohallucinations predominate, automatisms with signs of delusional phenomena are absent or completely minimal.

Taking into account the nature of the course, the pathological state of the psyche progresses in stages.

Kandinsky-Clerambault syndrome is a type of schizophrenia

It is important to note that the spectrum of the main signs of the chronic course of Kandinsky-Clerambault syndrome is difficult to diagnose precisely because the episodic picture is blurred. Therefore, in the acute phase, it is necessary to begin treatment with sedatives as early as possible to avoid the onset of the chronic stage. Then the patient will withdraw into himself and hide his subordination to “external influence.”

Treatment and psychotherapeutic correction

Therapeutic measures for mental automatism are complex. In addition to drug treatment based on the use of antidepressants and drugs from the antipsychotic group, various psychotherapeutic practices are used

It is important to note that after treatment, the patient will face long-term rehabilitation

It is worth noting that the duration of rehabilitation may vary. The basis of the rehabilitation period is psychotherapeutic correction, physical therapy sessions and adherence to the correct diet. The patient must follow a strict diet throughout the entire recovery period, excluding from the daily diet all products that contain copper.

To reduce the likelihood of relapse, the patient should pay great attention to his physical activity. Moderate exercise, walks in the fresh air and visiting the pool can improve your well-being

Relatives of a person with a mental disorder should be aware of the importance of understanding and support during this difficult period. Caring for a loved one can not only have a beneficial effect on their emotional state, but also reduce the time required for recovery

Treatment and rehabilitation measures

Treatment of alienation syndrome and external influence includes an integrated approach: drug therapy, psychotherapeutic intervention and a rehabilitation period are necessary. The patient is hospitalized in an inpatient psychoneurological department, where a whole range of therapeutic measures is carried out with him.

Among the medications, those that contribute to the emotional stabilization of the patient are selected. Usually these are psychotropic substances, neuroleptics, antidepressants - medications that inhibit certain nervous processes (Haloperidol, Clozapine, Triftazine).

As soon as there is an improvement in the patient’s condition and he begins to realize what is happening, psychotherapeutic measures are carried out.

The rehabilitation period is a mandatory stage of the general treatment tactics, and it turns out to be the longest. At this time, the patient is recommended to:

• attending both individual and group psychotherapy sessions;
• following a special diet that does not contain food containing copper;
• physical activity, physical therapy classes.

If the external influence syndrome is complicated by various psychoses, long-term adaptation of the patient is required under constant medical supervision.

Traditional medicine is unable to cope with the disease on its own. They are effective only when used in combination as maintenance therapy.

An individual approach is required in treating the disease and preventing relapses. The course is selected by the doctor after making an accurate diagnosis and examining the patient.

Clinical picture

Symptoms of the disease are: obsessive pain, hallucinations, forced pronunciation of words and phrases. Someone controls the body and thoughts of patients. Patients experience various phenomena, including a burning sensation throughout the body and “fluid overflowing inside.”

The acute course of the pathology is characterized by a vivid manifestation of feelings. Patients become overly talkative, active, often aggressive and irritable. They develop delusional fantasies, complaints become fragmented and paradoxical. During attacks, patients show excessive alertness and suspicion, are afraid of everyone and often panic. The acute period lasts two to three months. Patients fall out of the normal rhythm of life, they are completely absorbed in delirium.

The chronic course of the pathology is characterized by long and slow development. Signs of associative automatism are replaced by symptoms of sensory or motor automatism. The main symptoms become vague and difficult to diagnose.

Sudden mood swings make the patient believe that his emotions are “made up.” Timely treatment of the pathology by a psychotherapist and taking sedatives can stop the further development of the pathological process. If the next stage does occur, motor, associative or sensory self-awareness appears. Patients withdraw into themselves and no longer hide their subordination to “external forces.” In this case, the prognosis of the disease is extremely unfavorable.

Clinical signs of motor automatism:

• fleeting periods of stillness,
• stiffness of movements,
• slurred speech
• unnatural facial expressions and gestures,
• altered gait
• insulting others
• influence of strangers on the behavior of patients,
• involuntary motor impulses to action,
• impulsive-like gestures
• performing motor acts “without the participation” of patients.

Symptoms of associative automatism:

1. auditory hallucinations,
2. spontaneous emergence of “parallel” and “overlapping” thoughts,
3. non-stop flow of thoughts and visual ideas - mentism,
4. loss of control over your actions and feelings,
5. “echo of thoughts” – the thoughts and innermost desires of patients become known to outsiders,
6. the emergence of “telepathic” and “hypnotic” contacts,
7. “rustle” and “rustle of thoughts” turns into a whisper and begins to sound,
8. delusions of persecution and outside influence.

Sensory automatism is manifested by symptoms of a pseudohallucinatory nature. At the same time, patients complain of:

• causeless pain
• feeling of tingling, burning, fullness, compression,
• pretentious and difficult to describe sensations - senestopathy,
• compression of the brain or stomach,
• "fluttering" of the heart,
• suffocation,
• paresthenia of the limbs,
• changes in taste and olfactory preferences.

Video: examples of interviewing patients with Kandinsky-Clerambault syndrome