Imperative hallucinations: main causes, symptoms and treatment. Imperative hallucinations in the clinic of modern forms of schizophrenia Imperative hallucinations

Auditory or as they are also called imperative hallucinations. Specialists more often than others have to meet precisely with such complaints. The sounds and noises that the patient hears are quite diverse. These may be jerky fuzzy sounds or distinct whole phrases, a knock, a scratchy sound, a lone voice, or a cacophony of voices. The level of noise in the head can be subtle or very loud, unfamiliar or familiar. Most often, these sounds frighten the patient. They threaten him, promising to punish him; scare; subjugating themselves, forcing them to obey their orders. Such psychological pressure morally breaks the “victim”. He begins to unconditionally follow the commands that sound in his head.

ICD-10 code

R44.3 Hallucinations, unspecified

Causes of imperative hallucinations

With "banal" neuroses, auditory delirium usually does not manifest itself. Therefore, the appearance of hallucinations in a person indicates serious changes that affect certain parts of the human brain. Analyzing the clinical picture in each individual case, a qualified doctor tries to determine the source that has become the catalyst for the disease.

To date, doctors name only some of the causes of imperative hallucinations, but some of them remain beyond human understanding.

Alcoholism. Persons suffering from this disease (especially for a long time) are quite susceptible to auditory hallucinations. They are expressed in the appearance of a voice “in the head” of an alcoholic, which addresses him, calling him to a conversation. But most often, there are several voices, they communicate with each other, " discussing the patient, commenting on his actions", causing the patient to panic. Against the background of such a mental disorder, it is almost impossible to predict the further actions of such a person.

Schizophrenia is a psychotic personality disorder. Auditory transformation in this case is directed directly to the patient. The voice communicates with him, gives orders.

These are the most common sources. But there are many more. For example, sexually transmitted diseases, such as syphilis, can also provoke similar symptoms.

People who use drugs also suffer from the strongest auditory cacophony.

The body ages, pathological changes occur in it, which can lead to the development of senile paranoia, which can also cause a similar symptom in the victim.

In the list of root causes of the appearance of imperative hallucinations, amentia should also be noted - a very severe form of clouding of consciousness, expressed in the negative transformation of the speech output of sound, the "distortion" of thinking and world perception. The whole danger of this disease lies in the fact that such a multifaceted distortion is quite capable of leading the patient to death.

Symptoms of imperative hallucinations

From Latin imperatum - translates as how to order, therefore the terminology under consideration denotes pathological auditory sounds that are perceived by the patient as orders that force him to perform one or another action. Most often, the symptoms of imperative hallucinations are expressed in the receipt by the patient of such orders that have a criminal-sadistic color, making the patient dangerous both for himself and for the people around him. The voice speaks directly to the person, giving commands: "take an ax, cut off your hand ...", "climb the window, jump ...", "take the rope and throw it around the neck of the demon who is nearby ..."

Patients who have not yet completely lost all reason share their fears with the doctor. They are very afraid that at the next attack, the voices will order him to cause physical harm to someone from his close people. After all, during an attack, a person loses control over his brain, his will is suppressed so much that he cannot resist the voices - it does not even occur to him.

Mostly the voice directly addresses the patient, but he does not call the patient by name. Quite rarely, voice orders relate to abstract or long-term actions, usually such orders affect the situation “here and now”.

Mostly the patient hears such whispers with both ears, but there are cases when sound perception comes from one side. Mostly a person begins to hear voices at night, against the background of absolute silence.

A very similar picture occurs when the patient is under hypnosis, in a state of deep trance.

Diagnosis of imperative hallucinations

If people around and close people suspect that the person next to you is suffering from the pathology discussed in this article, you should seek the advice of a qualified psychiatrist.

His diagnosis of imperative hallucinations usually begins with the fact that he makes sure that the patient suffers precisely from the pathology, and not his conversations and stories are an illusion or a simple fantasy.

After all, auditory windings are sound structures that arise in the mind of a sick patient in the absence of an external stimulus. People with a history of this pathology differ from "dreamers" in that the latter can easily be convinced otherwise. Whereas it is unrealistic to convince the psychiatrist's patients of the unreality of the sound cacophony.

If a person, under the influence of a light effect or other factors, sees how a wardrobe changes, turning into an evil bear, then this is an illusion, a mirage in the desert is an illusion. But if a person is convinced of the presence of a cat in an empty corner, then this is a hallucination. Similar tests are available for detecting imperative hallucinations.

An important method of diagnosing the disease is visual observation by specialists of the patient's behavior. It is this monitoring that allows the doctor to confirm the disease and determine its form of manifestation.

Pathological seizures can occur episodically; in severe forms of mental disorder, a person can completely immerse himself in such a state. It is very important to prevent such a transition.

The psychiatrist very carefully controls the change in facial expressions, since in a sick person, emotional manifestations, expressed by a change in facial expressions, are not commensurate with the situation around him. For example, against the background of complete sorrow, such a patient is able to enjoy life, laugh ... Or against the background of complete calm, for example, a sunny morning, birds sing, and the patient is in a state of panic, fear, anger ...

The most pronounced symptom of auditory hallucinations is the desire of the patient to plug his ears, hide his head under the pillow, so as not to hear the frightening whisper that reaches him. At the same time, the environment does not provide prerequisites for such actions.

Cases have been recorded when sick people, in horror, covering their ears with their hands, rushed headlong to their heels, without dismantling the road, while falling under cars, falling out of windows. Mostly, such manifestations are rarely observed in isolation, more often there are complex changes in which auditory pathology is combined with other symptoms, for example, delusional states.

It happens that healthy people are also subject to illusions, while the appearance of hallucinating sounds is an undoubted indicator of a mental pathology that requires urgent emergency medical care.

Great attentiveness to your close relatives and friends will allow you to recognize the disease in time, because a person, getting into such a situation, afraid of being misunderstood and stopped by the fear of being placed in a psychiatric hospital (or for some reason known to him alone) tries to hide the delusional state, dissimulate it to your everyday life.

The hallucinating face becomes more alert, concentrated, constantly on the alert so as not to betray his condition. But when the early stage of the progression of the disease is missed, the person gradually begins to communicate with his imaginary interlocutor, answering his questions aloud.

Treatment of imperative hallucinations

If a person encounters such a pathological situation for the first time, it plunges him into a stupor and horror. But the main thing to remember is that what happens for a hallucinating person is a manifestation of his reality. Therefore, the first thing that his close relatives need to remember is how to behave correctly in this situation and what help they are able to provide to their neighbor.

1. Under no circumstances should one even try to dissuade the patient that everything that happens to him is a reality transformed by the psyche.
2. It is necessary to show tact, patience, and in many ways to show imagination in order, first of all, to calm an excited and shocked person. For example, if he is absolutely sure that werewolves are trying to get into his window at night, do not laugh, just take an active part in finding means and ways to physically protect yourself from the threat (bring an aspen branch from the street, put an icon in the room, give a pectoral cross etc).
3. It is necessary to use such paraphernalia and try to create an atmosphere and environment such that the resulting hallucinations do not cause such horror, that is, if possible, soften the emotional severity and negative color.

• Make fun of the "suffering".
• Show your irritation and dissatisfaction when the patient begins to show any concerns. Rejoice already in the fact that a loved one trusts and seeks help, otherwise, he will simply withdraw into himself, trying to contain the growing inner horror. But such a situation cannot last forever, the moment will come when “an explosion will occur.” And even an experienced psychiatrist is not able to predict how this attack will end.
• Give up a hopeless task to convince the hallucinating person that this is the fruit of his inflamed consciousness.
• You should not focus your and his attention on this problem and try to find out who is talking to him, what is the sound source.
• During an attack, it is especially necessary to monitor your emotions, you should not raise your voice and talk too loudly. During this period, it is necessary for the patient to create the illusion that others are doing everything to help him and “save” him.
• Calm soothing music, a change of scenery, and, in special cases, medications, which should be prescribed only by a certified specialist, can somewhat reduce excitement.

But no matter how attentive the relatives are to the “victim”, he simply needs qualified medical assistance. Turning to a specialist, a diagnosis will be made, recommendations will be given and adequate therapy will be prescribed.

To date, the treatment of imperative hallucinations is carried out by several methods, but all of them are mainly aimed at eliminating pathological seizures, removing the patient from a delusional state.

The protocol of therapeutic therapy usually includes such pharmacological drugs as tizercin, chlorazine, contomin, plegomazine, gibanil, thorazine, chlorpromazine hydrochloride, chlorpromazine, largactyl, chlorpromazine, phenactyl, ampliactyl, hibernal, promactil, propafenine, megafen, clopromane or amplictyl.

The antipsychotic, neuroleptic drug chlorpromazine is usually administered intramuscularly or intravenously.

With intramuscular injection, a single maximum dosage is 0.15 g, during the day - 0.6 g. The recommended intake schedule is usually presented by prescribing from one to five milliliters of a 2.5% solution, but not more than three procedures during the day.

In the event of an acute attack of the disease, the doctor prescribes intravenous administration of the drug. In this case, two to three milliliters of a 2.5% solution are diluted with 20 ml of a 40% glucose solution before injection. With this method of drug delivery to the body, a single maximum dosage is 0.1 g, during the day - 0.25 g.

When stopping an attack at home, a psychiatrist can prescribe drugs of this group in the form of tablets or dragees. Aminazine is taken orally immediately after meals (this will reduce the level of irritation of the mucous membrane of the digestive tract). The starting daily dosage of the drug is 25 - 75 mg, spaced into one - two - three doses.

Contraindications for the use of this drug in the treatment protocol include:

• Individual intolerance by the patient's body of one or more constituent components of the drug.
• As well as a history of cardiovascular decompensation.
• Ulcerative and erosive lesions of the stomach and duodenum.
• Serious pathological changes in the liver and kidneys.
• Severe form of hypotension.
• Disruptions in the work of the stomach.

In parallel, the doctor also prescribes haloperidol, senorm, haloper, trancodol-5 or trisedil.

An antipsychotic, belonging to the derivatives of butyrophenone, haloperidol is administered to the patient orally 30 minutes before the intended meal. To reduce the level of irritation of the mucous membrane of the digestive system, the drug can be drunk together with a sufficient amount of milk.

The starting daily recommended dosage (depending on the clinical picture and the intensity of the attack) is prescribed in the range from 0.5 to 5 mg, divided into two to three doses. Gradually, the dosage increases by 0.5 - 2 mg, until the expected therapeutic effect is achieved. In especially severe cases, the increase in dosage can be from 2 to 4 mg.

The maximum allowable amount of a drug that is allowed in a daily intake is determined by the figure of 100 mg.

In most cases, the therapeutic efficacy of relieving an attack can be achieved at daily dosages of 10-15 mg.

If the patient has a chronic form of schizophrenia, then it is usually possible to stop the problem with daily dosages of 20-40 mg.

In resistant cases, with a special immunity of the patient's body to the drug, the quantitative component of its administration can stop at 50-60 mg.

The maintenance dosage, which is taken by the patient in the intervals between attacks, is from 0.5 to 5 mg per day. These figures are decreasing very carefully and gradually.

The duration of treatment therapy can take an average of two to three months.

If the disease is diagnosed in children from 3 to 12 years old, whose body weight falls within the range of 15 to 40 kg, the dose of the administered drug is calculated from 0.025 to 0.05 mg per kilogram of the weight of a small patient, divided into two to three doses. You can increase the dosage no more than once every five to seven days. The maximum allowable daily administration of the drug should not exceed 0.15 mg per kilogram of the patient's weight.

For elderly people suffering from imperative hallucinations, the amount of drug administered is reduced and half or even a third of the recommended adult dose is administered. The increase in dosage can be carried out no more than once every two to three days.

If necessary, the attending physician may prescribe this drug in another manufactured form: oral drops, solution for intravenous or intramuscular injections.

It is not recommended to use the drug in question in the treatment protocol if the patient suffers from Parkinson's disease, depression of the central nervous system, damage to the basal ganglia, with depressive disorders and if the patient's age is less than three years, as well as in the case when the patient's body shows hypersensitivity to the components of the drug ingredients and derivatives of butyrophenone.

Also, other antipsychotic and atypical antipsychotic drugs, as well as necessary antidepressants, may be included in the therapy protocol.

For example, it can be moclobemide (Aurorix), imipramine (Melipramine), befol, citalopram (Cipramil), amitriptyline, simbalta (Duloxetine), trimipramine (Gerfonal), and many others.

The antidepressant and sedative - amitriptyline - is prescribed to the patient for oral administration, without chewing, immediately after a meal - this will reduce irritation of the mucous membrane of the digestive tract.

The medicine is taken in several doses: the maximum dose is administered immediately before bedtime. For an adult patient, this dosage is 25-50 mg. Gradually, in small amounts, the initial figure increases to 150 - 200 mg daily, spaced into three doses, while the time for which this growth is made is from five to six days.

If the therapeutic effect is not visible for two weeks, the daily amount of the administered drug is increased to 300 mg. If the depressive symptoms disappeared, the prescribed amount of the drug, on the contrary, is gradually reduced to 50-100 mg per day.

The average duration of treatment is at least three months.

Elderly people, with a mild degree of disorder, are prescribed dosages that fall within the range of 30 to 100 mg daily, and after achieving therapeutic efficacy, the amount of the drug administered is reduced to 25–50 mg daily.

If necessary, it is allowed to use other forms of release of the drug in question.

Amitriptyline can be administered as a solution intravenously or intramuscularly. The rate of drug delivery is slow. The starting amount is 20-40 mg four times a day. Injections are gradually being replaced by tablets.

The duration of the treatment course is no more than six to eight months.

The dosage for children from six to twelve is - 10 - 30 mg, or calculated as 1 - 5 mg daily per kilogram of the weight of a small patient, divided into several doses.

For adolescents over 12 years old - 10 mg three times a day. In case of medical necessity, the amount of the administered drug can be increased to 100 mg per day.

Contraindications for use are the acute phase or recovery period after a myocardial infarction, angle-closure glaucoma, acute alcohol poisoning, the presence of intraventricular conduction in the patient's body, simultaneous treatment with MAO inhibitors, as well as hypersensitivity to the components of the drug and amitriptyline.

Any hallucinations, including auditory ones, are treated according to a purely individual scheme, because the source of pathological abnormalities in each person can be different and can be made up of many different factors.

If it turns out that the cause of abnormal noises is a malfunction of the hearing aid, then, naturally, you should contact an audiologist, check the device and, if necessary, replace it with a working one.

Prevention of imperative hallucinations

• Stick to a healthy lifestyle.
• Learn to avoid stressful situations.
• Avoid strong physical and mental stress, exhaustion.
• Give up bad habits, especially those associated with hallucinogens.

Strange as it may seem, but such simple tips will reduce the risk of developing a lesion, which is called imperative hallucinations in medicine, by several times.

Prediction of imperative hallucinations

If, during the development of a mental illness, hallucinations also join the pathological symptoms, doctors state that the patient's condition worsens and the clinical picture of the disease becomes more complicated. Imperative are auditory hallucinations that sound in the ears of a sick person as an order. Quite often, voices heard have a criminal-sadistic color, prompting them to act, which poses a danger either to the person himself or to those around him. If timely measures are not taken and the patient is not subsequently kept on maintenance therapy, the prognosis of imperative hallucinations is very deplorable.

If measures are taken belatedly or the symptoms were ignored, then for the patient everything can end in death. Often the disease under consideration is observed in people prone to suicidal or homicidal actions.

Even a healthy person, having heard a whisper and not finding its source, feels very uncomfortable with the seed in such a situation, and what can we say about a sick person. Auditory deceptive sensations that have an aggressive imperative character - imperative hallucinations - are a rather serious and dangerous disease, which can only be stopped by a highly qualified specialist. Therefore, if you have even the slightest suspicion about yourself or your loved one, it is better to consult a doctor. The main thing is not to miss the onset of the disorder, when it can still be controlled with fairly gentle drugs. Such a patient, against the background of drug therapy, is able to lead a fairly high-quality social life. But if the moment is missed and the disease progresses, it is necessary to treat the disease, but now you will have to apply much more strength and patience, and the result is quite difficult to predict.

So take care of yourself and your family and friends!

Visceral(entero- and interoceptive, somatic, bodily, etc.). This kind of hallucinatory phenomena has many names. More often they occur in the form of pseudohallucinations. Visceral hallucinations are the sensation of foreign objects in the internal organs of a person, more often living creatures: snakes, frogs, cockroaches, rats, worms, nails, ball bearings, radio transmitters, microphones, etc. An attempt by psychiatrists to dissuade a patient from secondary sensual hallucinatory delusions is associated with visceral hallucination. This famous action was carried out in the thirties of the last century.

The patient, who claimed that a snake lives in her stomach, was given an imitation of surgery. After a laparotomy performed under anesthesia, she was shown a snake allegedly removed from her stomach. The relief lasted a couple of days. Then the patient began to say that the snake was removed, but the kites remained, and she feels them.

In Magnan we find one of the most brilliant examples of visceral pseudohallucination:

“One patient we saw a few years ago said that he was “temporalized”: his bride allegedly slipped into his body through a hole in the temporal (temporal) region and all her organs overlapped his own: eye to eye, ear to ear , navel to navel. Since he was in the men's section, the duality of his persona, consisting of both a man and a girl, put him in the most difficult position. When he got up or went to bed, with the bashfulness of a young girl, he hurried to put on his shirt or lie down as soon as possible; during the day, he constantly crossed his legs, thus protecting his virginity.

Haptic hallucinations- a kind of tactile hallucinations - a feeling of pressure on the surface of the skin, embracing, a sharp touch.

Many years ago, a patient with hysterical psychosis was treated in the women's department. In addition to true psychogenic visual hallucinations, she had haptic hallucinations as part of complex hallucinations. Every night, in the diffused light of a night lamp, she saw a big green Viy grabbing her hands and feet. Viy "touched" her with his furry limbs, while, as the patient said, "he strove to grab her breasts or buttocks."

Hypnagogic and hypnopompic hallucinations- visual and auditory hallucinations that occur when falling asleep and waking up, in an intermediate state between sleep and wakefulness. For a moment, let's digress from perceptual disturbances and recall from the course of physiology that sleep, like wakefulness does not come instantly. There is a certain intermediate phase of incompletely clear consciousness, the brain structures take time to switch the consciousness toggle switch: on / off. It is at this time that hallucinatory experiences may arise, which the patient, despite the incomplete clarity of consciousness, nevertheless evaluates not as dreams, but precisely as hallucinations.

An elderly man with alcoholic encephalopathy (alcohol-related dementia) in a state of regular withdrawal when falling asleep with his eyes closed sees three coffins with relatives in them. He opens his eyes, finds nothing, but believes that he really saw three coffins, runs to his wife and asks where they have gone.

Understanding the essence and scientific definition of hallucinations was made during the study of this problem within the framework of the general development of psychiatry. Thus, the translation of the Latin word "allucinacio" means "unfulfilled dreams", "idle chatter" or "nonsense", which is quite far from the modern meaning of the term "hallucinations". And the term "hallucinations" acquired its modern meaning only in the 17th century in the work of the Swiss physician Plater. But the final formulation of the concept of "hallucination", which is still relevant today, was given only in the 19th century by Jean Esquirol.

• A hallucination is a “vision” of a non-existent object on an object that actually exists in the surrounding space.
• Pseudo-hallucination is the "seeing" of a non-existent object inside one's own body.
• An illusion is a “vision” of real-life objects distorted, with characteristics that do not actually exist in them (a coat is perceived as a lurking person, a chair is seen as a gallows, etc.).

The line between all these psychiatric terms is quite thin, but very significant from the point of view of the mechanisms of their development and the degree of mental disorders, to which each variant of the disturbance in the perception of the surrounding world corresponds.

What are hallucinations?

Currently, there are several classifications of hallucinations, which subdivide them into types depending on the various characteristics of the symptom. Let us consider the classifications that are most important for understanding the characteristics of hallucinations.

1. Associated hallucinations. They are characterized by the appearance of images with a certain logical sequence, for example, a stain on a chair predicts the appearance of flies from a water tap if a person tries to turn on the water.

2. Imperative hallucinations. They are characterized by the appearance of an orderly tone emanating from any surrounding objects. Usually such an orderly tone commands a person to perform some action.

3. Reflex hallucinations. They are characterized by the appearance of a hallucination in another analyzer in response to the impact of a real stimulus on any analyzer (auditory, visual, etc.). For example, turning on the light (an irritant for the visual analyzer) causes an auditory hallucination in the form of voices, orders, the noise of the installation for guiding laser beams, etc.

4. Extracampal hallucinations. They are characterized by going beyond the field of this analyzer. For example, a person sees visual images that are hallucinations behind a wall, etc.

• Auditory hallucinations (for example, a person hears voices, speech, or just individual sounds). Sounds can be loud or quiet, episodic or constant, slurred or clear, belong to familiar or unfamiliar people or objects, in nature - narrative, accusatory, imperative, in form - monologues, dialogues in different languages, and in localization - in front, behind, above, below the person.

Visual hallucinations (a person sees something simple, such as spots, zigzags, flashes of light, or complex images, such as people, unknown non-existent creatures, as well as entire scenes and panoramas unfolding before his eyes, like in a movie). Visual hallucinations can be black and white, multicolored, single color, transparent or colorless, moving or frozen, kaleidoscopic, panoramic or portrait, large, small or normal, threatening, accusatory or neutral.

Taste hallucinations (a person feels a non-existent taste, for example, sweetness from chewing rubber, etc.).

Olfactory hallucinations (a person feels smells that do not exist in reality, for example, rotten meat, beautiful perfumes of a woman, etc.).

Tactile (tactile) hallucinations (sensation of any touch to the skin, heat, cold, etc.). These hallucinations can be localized on the surface of the skin or under it, a person can feel objects, insects, animals, ropes, heat, cold, touch, moisture or grasping.

Visceral hallucinations (a person feels certain objects inside his body, for example, some kind of implanted chip, worms, some kind of tool, etc.). With these hallucinations, a person can see his own internal organs in a normal or altered form, feel their movement inside the body, feel manipulations with the genitals (masturbation, rape, etc.), and also feel animate and inanimate objects inside the body.

Proprioceptive hallucinations (feeling of movement that does not exist in reality in the legs, arms and any other parts of the body).

Vestibular hallucinations (feeling of a position of the body in space that does not correspond to reality, for example, a feeling of flight, constant rotation around its axis, etc.).

Complex hallucinations (sensations concerning several analyzers at the same time, for example, a feeling of sweet taste from a spot sitting on a chair, etc.).

In addition, hallucinations are divided into the following types depending on their complexity:

• The simplest hallucinations. Characterized by the incompleteness of an erroneously perceived image. For example, visual simplest hallucinations include seeing spots, sparks, circles, rays, etc.; to auditory - unclear rustles, creaking, the sound of steps, inarticulate sounds, syllables, shouts, pronouns, etc.
• Object hallucinations. They are characterized by the completeness of an erroneously perceived image that affects only one analyzer. For example, visual object hallucinations are animals, people, body parts, any objects, etc.; auditory are words, commands, sentences, or even monologues or texts.
• Complex hallucinations. They are characterized by the fact that several analyzers are involved in their formation, as a result of which a person sees entire scenes or panoramas, like in a movie. For example, a person can see mythical aliens and hear their speech, etc.

True hallucinations - video

Pseudo-hallucinations - video

Hallucinations - Causes

The causes of hallucinations can be the following conditions and diseases:

• Schizophrenia;
• Epilepsy;
• Psychosis;
• Hallucinosis (alcoholic, prison, etc.);
• Hallucinatory-delusional syndromes (paranoid, paraphrenic, paranoid, Kandinsky-Clerambault).

2. Somatic diseases:

• Tumors and brain injuries;
• Infectious diseases affecting the brain (meningitis, encephalitis, temporal arteritis, etc.);
• Diseases that occur with severe fever (for example, typhus and typhoid fever, malaria, pneumonia, etc.);
• Stroke;
• Syphilis of the brain;
• Cerebral atherosclerosis (atherosclerosis of cerebral vessels);
• Cardiovascular diseases in the stage of decompensation (decompensated heart failure, decompensated heart defects, etc.);
• Rheumatic diseases of the heart and joints;
• Tumors localized in the brain;
• Metastases of tumors in the brain;
• Poisoning by various substances (for example, tetraethyl lead - a component of leaded gasoline).

3. The use of substances that affect the central nervous system:

• Alcohol (hallucinations are especially pronounced in alcoholic psychosis, called "delirious tremens");
• Drugs (all opium derivatives, mescaline, crack, LSD, PCP, psilobicine, cocaine, methamphetamine);
• Medications (Atropine, drugs for the treatment of Parkinson's disease, anticonvulsants, antibiotics and antivirals, sulfonamides, anti-tuberculosis drugs, antidepressants, histamine blockers, antihypertensives, psychostimulants, tranquilizers);
• Plants containing toxic substances that act on the central nervous system (belladonna, dope, pale grebe, fly agaric, etc.).

Hallucinations: causes, types and nature of the symptom, description of cases of hallucinations, connection with schizophrenia, psychosis, delirium and depression, similarity with a dream - video

Treatment

The treatment of hallucinations is based on the elimination of the causative factor that provoked their appearance. In addition, in addition to therapy aimed at eliminating the causative factor, drug relief of hallucinations with psychotropic drugs is carried out. Antipsychotics are most effective for stopping hallucinations (for example, Olanzapine, Amisulpride, Risperidone, Quetiapine, Mazheptil, Trisedil, Haloperidol, Triftazin, Aminazin, etc.). The choice of a specific drug for the relief of hallucinations is carried out by the doctor in each case individually, based on the characteristics of the patient, the combination of hallucinations with other symptoms of a mental disorder, previously used therapy, etc.

How to induce hallucinations?

To cause hallucinations, it is enough to eat hallucinogenic mushrooms (pale toadstool, fly agaric) or plants (belladonna, dope). You can also take drugs, alcohol in large quantities, or drugs that have a hallucinogenic effect in large doses. All this will cause hallucinations. But simultaneously with the appearance of hallucinations, the body will be poisoned, which may require urgent medical care up to resuscitation. In severe poisoning, death is also likely.

Semantic hallucinations

Semantic hallucinations is the name of a popular musical group. There is no such thing in medical terminology.

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IMPERATIVE HALLUCINATIONS IN THE CLINIC OF MODERN FORMS OF SCHIZOPHRENIA

L. V. Khomenko

Kharkov Regional Clinical Psychiatric Hospital No. 3 (Saburova Dacha), Kharkov

Khomenko L. V. Imperative hallucinations in the clinic of modern forms of schizophrenia [Electronic resource] // Topical issues of modern psychiatry and narcology: Collection of scientific works of the Institute of Neurology, Psychiatry and Narcology of the Academy of Medical Sciences of Ukraine and Kharkiv Regional Clinical Psychiatric Hospital No. 3 (Saburova dacha), dedicated to 210th anniversary of the Saburova dacha / Ed. ed. P. T. Petryuk, A. N. Bacherikov. - Kyiv-Kharkov, 2010. - V. 5. - Access mode: http://www.psychiatry.ua/books/actual/paper116.htm.

Perceptual disturbances in the form of hallucinations (imaginary perception, perception without an object), while continuing to be a key psychopathological sign of the schizophrenic process, have at the same time undergone a certain phenomenological evolution over the past decades. The rubricification of hallucinatory experiences in accordance with the sense organs (visual, auditory, tactile, olfactory, kinesthetic, visceral, muscular, gustatory, complex) was more concretized in the direction of expansion. The division of hallucinations according to the level of complexity has become more complicated: 1) elementary (visual analyzer: photopsies - sparks, lightning, shiny lines; auditory analyzer: acoasms - elementary sounds (knocking, whistling, noise); phonemes - verbal hallucinations (calls); 2) simple - visual hallucinations that occur against the background of clouded consciousness, and auditory - against the background of altered consciousness (visual analyzer: panoramic hallucinations (scene-like phenomena); auditory analyzer: commentary or imperative voices); 3) complex (combined) hallucinations (for example, the patient simultaneously experiences visual, auditory, tactile and olfactory hallucinations).

It is known (M. V. Korkina, N. D. Lakosina, A. E. Lichko, 1995) that all hallucinations, regardless of whether they are visual, auditory or other deceptions of the senses, are divided into true and pseudo-hallucinations. True hallucinations are always projected outwards, are associated with a real, concretely existing situation, most often do not cause any doubts in patients about their actual existence, they are just as vivid and natural for a hallucinator as real things. True hallucinations are sometimes perceived by patients even more vividly and distinctly than really existing objects and phenomena. Pseudo-hallucinations more often than true hallucinations are characterized by the following distinctive features. Most often they are projected inside the patient’s body, mainly in his head (“the voice” sounds inside the head, inside the head the patient sees a business card with obscene words written on it, etc.). Pseudo-hallucinations, first described by V. Kandinsky, resemble representations, but differ from them, as V. Kandinsky himself emphasized, in the following features: 1) independence from the will of a person; 2) obsession, violence; 3) completeness, formalization of pseudo-hallucinatory images; 4) even if pseudo-hallucinatory disorders are projected outside one's own body (which happens much less often), then they are devoid of the nature of objective reality inherent in true hallucinations, and are completely unrelated to the real situation. Moreover, at the moment of hallucination, this situation seems to disappear somewhere, the patient at this time perceives only his own hallucinatory image. The appearance of pseudo-hallucinations, without causing the patient any doubts about their reality, is always accompanied by a feeling of being made, tuned in, directed by these voices or visions. Pseudo-hallucinations are, in particular, an integral part of the Kandinsky-Clerambault syndrome, which also includes delusions of influence, which is why patients are convinced that they were “made with the help of special devices”, “voices are directed directly to the head by transistors”.

Auditory hallucinations are most often expressed in the pathological perception by the patient of some words, speeches, conversations (phonemes), as well as individual sounds or noises (acoasma). Verbal (verbal) hallucinations can be very diverse in content: from the so-called hails (the patient “hears” a voice calling his name or surname) to whole phrases or even long speeches delivered by one or more voices.

The object of our study was the most dangerous for the patient's condition imperative hallucinations (from Latin imperatum - to order), the content of which is imperative. According to our long-term observations, these are imperative orders to do something or prohibitions on actions. Patients more often attribute the orders of votes to their own account. Rarely "forward" them to others. Voices may demand actions that are directly contrary to the patient's intentions - to hit or kill someone, insult, commit theft, attempt suicide or self-harm, refuse to eat, take medicine, or talk with a doctor, turn away from the interlocutor, close your eyes, squeeze teeth, standing still, walking without any purpose, rearranging objects, moving from one place to another. Patients with this kind of painful experiences can be very dangerous both for themselves and for others, and therefore need special supervision and care.

Sometimes the orders of "voices" are "reasonable". Under the influence of hallucinations, some patients turn to psychiatrists for help, without being aware of the fact of a mental disorder. Some patients point to a clear intellectual superiority of the "voices" over them.

The content of imperative deceptions and the degree of their influence on behavior are different, so the clinical significance of this type of deception may be different. So, "orders" of a destructive, absurd, negativistic nature indicate a level of personality disorganization close to catatonic. Such orders, like catatonic impulses, are realized automatically, unconsciously. Commands with a sense of compulsion are also carried out, but at the same time the patient tries to resist or at least realizes their unnaturalness. The content of such orders is no longer always destructive or absurd. Orders of persecutory content are observed. Contradictory, ambiguous orders of voices are encountered, when, along with absurd ones, quite reasonable orders are also heard. Sometimes orders are heard that are consonant with the patient's conscious attitudes.

Hallucinatory orders, as you know, are not always implemented. Sometimes patients do not attach importance to them, or consider them ridiculous, meaningless. Others find the strength to hold themselves back or “in spite of the voices” to do the opposite. More often, however, imperative hallucinations have an irresistible influence. Patients do not even try to oppose themselves to them, following the most ridiculous orders. According to patients, at this time they feel "paralysis" of their will, act like "machine guns, zombies, puppets." The irresistible imperativeness of hallucinations testifies to their proximity to catatonia and phenomena of psychic automatism. According to V. Milev (1979), imperative orders can be classified as schizophrenic symptoms of the first rank.

Hallucinations that contain not orders, but persuasions, exhortations, false information, which acquire great persuasive power for patients, show similarities with imperative hallucinations. Often imperative hallucinations are observed with suicidal or homicidal behavior.

In one of our patients (at the time of the examination, a student of the 11th grade), the debut of imperative hallucinations began at the age of 10, which was visually manifested in “fading”: while walking, he stopped “like a stone” for 2–3 minutes. Initially, the frequency of such episodes of "fading" was 1-2 times a week, then "fading" was observed daily. It turned out that the “freezes” were due to orders from the voice to stop (“after a step or several steps, I stop at the order of the voice that follows me from behind”). Sometimes the patient disobeyed these orders, but this was not for long. Subsequently, by the age of 15, "the voice became rough ... terrible ... I asked my mother to help me get rid of it"). Imperative hallucinations were accompanied by a low mood background, anxiety, suspicion, panic, because a male voice threatened: “If you don’t stop coughing, then the boys will strangle me. Get out quickly." Occasionally, the "voice" ordered to go somewhere, check something, hit someone.

The study of the mental sphere in this patient revealed a violation of purposefulness and criticality, disorganization of thinking, and a distortion of the generalization process. Judgments are varied. Notes many specific, formal and casual connections. For example, a “broom” is added to the “furniture” group, since it is also wooden, “bed” is combined with a “thermometer” by a situational connection. And a number of associations do not have any logical justification at all. For example, "butterfly" + plane "+" ship "; "bird" + "fish" + "boot". Due to his intellectual abilities, the patient cannot cope with many tasks, and, as a rule, cannot explain his decisions.

As a result of treatment (Senorm, Trifen, Cytahexal), the patient's condition improved, imperative auditory hallucinations lost their significance. Became calmer and more adequate. Willingly included in the treatment and rehabilitation labor processes. Used the free exit mode. Discharged from the hospital in remission.

Consequently, in the studied patient, imperative hallucinations were observed against the background of disintegration of thinking, distortion of the generalization process, violations of purposefulness and criticality, and a general decrease in intellectual productivity, which is characteristic of the paranoid form of schizophrenia.

Causes, signs, types and treatment of hallucinations

Hallucinations are various perceptual disorders that appear as an image that occurs without any stimulus. There are many varieties of this phenomenon and it is important to be able to distinguish between true hallucinations and pseudo hallucinations.

Etiology

Various hallucinations can be caused by both mental and somatic diseases. Also, the influence of various medications, alcohol, narcotic and toxic substances, and the consequences of injuries should not be excluded.

Visual hallucinations often appear under the influence of alcohol, especially in a state of alcoholic delirium. Many substances can also affect the brain in a similar way, causing hallucinations: various psychostimulants (opium derivatives, LSD, cocaine, amphetamines), atropine, antiparkinsonian drugs, some muscle relaxants, toxic plants (belladonna, dope, pale toadstool).

Also, the cause of hallucinations can be stress, a state of chronic lack of sleep.

Various vascular diseases can also "force" the human brain to form a non-existent image. Often, patients after a stroke may complain of tactile or olfactory hallucinations that accompanies delirium or senestopathy.

Mental illnesses that are accompanied by various types of hallucinations include reactive psychosis, schizophrenia (auditory hallucinations), and various “borderline” states. Also in this group can be attributed hallucinatory-delusional syndromes: paranoid, parphrenic, Kandinsky-Clerambault, paranoid.

Tumor diseases, epilepsy, infectious diseases (syphilis, meningitis, temporal arteritis) and other somatic conditions may be accompanied by hallucinations.

Classifications

Hallucinations can be divided into several categories and grouped according to common criteria.

First of all, it is worth distinguishing true hallucinations from pseudo hallucinations. The former are characterized by the fact that an imaginary image is formed in the surrounding space in the absence of an external irritating or stimulating factor. Also, this type of hallucination "interacts" with the real world, and the patient is not critical of it.

Pseudohallucinations are less vivid images that are most often projected inside the patient's body (voices in the head, "worms crawl under the skin") and have a more subjective coloring. These images are distinguished by obsession, a sense of "doneness" and little depend on the thoughts and desires of the patient. They are often threatening or accusing.

Hallucinations can be classified according to the type of analyzer that is involved:

• Imperative - have an imperative character, carry certain orders, most often of a violent nature;

Auditory hallucinations are a type of productive pathology in psychiatry, in which the patient hears various sounds in the absence of their real source. An important characteristic of what is heard is precisely as hallucinations - the patient is convinced of their truth. He will never characterize imaginary sounds with the word "it seemed."

Types of auditory hallucinations

What is directly audible can be different - the sound of the wind, the sound of a car, the singing of birds, and most characteristically - voices. The characteristics of the voices are also different:

• Voices commenting on the behavior of the patient. In most cases, commentary hallucinations are distinguished by a sarcastic tone, which causes discontent and aggression. In an unfortunate combination of circumstances, this aggression can spill out on the relatives of the patient.
• Voices talking to each other on topics not related to the patient. This is a relatively safe type of auditory hallucinations, in most cases perceived by the patient as a kind of radio.
• Voices that repeat the patient's thoughts or confirm his ideas. This is a rather dangerous type of hallucination, it can provoke aggressive behavior. In the case of repetition of thoughts, it seems to the patient that all his thoughts, even impartial or intimate, are disclosed to all. He may have a desire to eliminate the "witnesses" of the mind reading. And in the case of confirmation by the voices of thoughts, any, even the most incredible, ideas, with a long repetition, seem to the patient a reality. The flashing thought that his wife can cheat on him, under the influence of hallucinations, turns into a fait accompli. And the fact may be followed by retribution, also invented under the influence of hallucinations.
• Commanding (imperative) voices. The most dangerous type of auditory hallucinations, since the patient lacks criticality. He believes everything he hears in hallucinations, and therefore carries out all their orders. And the orders can be very different - from cleaning the apartment to going and killing your grandmother. Combined delusions and hallucinations of an imperative nature are most often a symptom of a severe mental illness, such as schizophrenia.

Causes of auditory hallucinations

When deciding how to treat hallucinations, it is extremely important to find out their cause in each case. It is she who plays a decisive role in the choice of treatment tactics. The causes of hallucinations can be divided into several main groups:

1. Hearing aid malfunction. this is a fairly common reason. If an elderly person using a hearing aid complains about voices, first of all, you need to check the quality of his work.
2. Side effects of drugs. Some psychotropic drugs in overdose or as side effects can cause hallucinations. Also, hallucinations are possible with an illiterate combination of drugs. Especially often this happens with self-medication. When addressing a doctor about the symptoms of hallucinations, be sure to present a complete list of drugs taken by the patient.
3. Alcohol intoxication and delirium. In this case, the recognition of the cause is not difficult. It is necessary to distinguish between hallucinations in alcohol intoxication and delirium. When intoxicated, they develop at the height of intoxication, especially when using surrogate alcohol, and are neutral in nature. With delirium, hallucinations of a threatening nature occur when alcohol is withdrawn after prolonged use. How to treat auditory hallucinations in this case is quite understandable.
4. Auditory hallucinations as a symptom of mental illness. The most common and most difficult to treat option. It is in this case that all the variety of auditory hallucinations occurs. They can be a manifestation of schizophrenia, manic-depressive psychosis, Alzheimer's disease and other diseases.

Treatment of auditory hallucinations

Treatment approaches can vary greatly depending on the cause of the hallucinations. Consider how to treat auditory hallucinations according to the reasons listed above.

1. Hallucinations due to malfunction of the hearing aid. The most favorable variant of diagnostic results. It is treated by replacing or repairing the device. Depending on the type of hearing aid, they can independently imitate noise or reproduce voices due to the fact that the device tunes in to a radio wave and broadcasts it to the patient.
2. Only a specialized specialist can recognize hallucinations that are a side effect of the action of drugs or their combinations. Not always such a specialist is your local therapist. You may need to contact a psychiatrist, cardiologist, narcologist or other doctor on the profile of diseases and medications taken. Be sure to keep a record of all medications you take - names, doses and frequency of administration per day. This is especially important in the case of elderly patients who may mix up the medicine or take it repeatedly. It is convenient to make a special "appointment calendar" in which to mark the drugs taken. When visiting a doctor, be sure to show him this "calendar" or just a list of drugs.
   The occurrence of hallucinations due to medication indicates a pronounced overdose or prolonged use of incompatible drugs. Not always this condition can be eliminated only by the abolition of drugs or a change in combinations. Intoxication may be required to accelerate the elimination of substances that caused hallucinations. Treatment in this case takes place in stationary conditions. In the future, the patient is discharged for follow-up care at home and the appropriate regimen and combinations of drugs are recommended to continue treatment.
3. Auditory hallucinations in alcohol intoxication or delirium occur acutely, combined with delusional ideas, visual hallucinations, persecution mania. In this case, the treatment should be immediate and very active. The patient must be hospitalized. Active detoxification therapy, infusions of nutrient and saline solutions are prescribed for the speedy removal of toxic substances from the patient's body. With severe aggressiveness, motor agitation, obsessive ideas of persecution, it is possible to prescribe tranquilizers and neuroleptics. In the future, a full-fledged psychosocial rehabilitation of the patient, his involvement in work, and preventive work with the family are necessary.
4. Auditory hallucinations in mental illness are part of an extensive symptom complex called productive symptoms. In addition to auditory hallucinations, it includes other types of them (visual, tactile, pseudo-hallucinations), delusions of various kinds, and obsessive states. Hallucinations in combination with these symptoms are an alarm signal indicating the presence of a severe pathology from the psyche. In young people, they may primarily indicate schizophrenia. In the elderly, it may be a manifestation of Alzheimer's disease or senile dementia. Specific nosology can be clarified only with a thorough examination. The choice of treatment tactics also depends on the final diagnosis. In most cases, treatment for such severe symptoms occurs in a hospital. For the relief of hallucinatory phenomena, antipsychotics are used, in particular atypical antipsychotics of the new generation. With severe psychomotor agitation, the appointment of tranquilizers is necessary. In the case of pathology in the elderly, the treatment for the relief of acute hallucinosis is the same as in the young. In the future, therapy depends on the nosology - there are specific drugs for, nootropics for dementia, etc.

The goal of primary treatment is to reduce the severity or eliminate hallucinations altogether. At home, there is an aftercare with a planned intake of drugs. In most cases, these patients require lifelong treatment. It is very important to teach relatives to recognize the symptoms of an exacerbation and control the patient's condition.

Imperative hallucinations are extraneous sounds and noises that the patient hears. They can be quite varied - jerky fuzzy sounds or whole phrases, scratching sound, knocking, cacophony of voices or a lonely voice. The level of noise that sounds in the head can be subtle or very loud, familiar or unfamiliar. In most cases, such sounds frighten the patient. They can threaten him, force him to follow their orders. Such psychological pressure breaks the victim. He begins to follow the commands that sound in his head.

Causes of imperative hallucinations

With a variety of neuroses, auditory delirium, as a rule, is absent. Therefore, when imperative ones appear, it speaks of serious disorders that can affect certain parts of the brain. Studying the clinical picture in each case, a qualified specialist tries to determine the source that has become the catalyst for this disease.

At the moment, doctors can name only some of the causes of the development of the disease, but some of them remain beyond understanding.

The main known causes of imperative hallucinations are:

1. Alcoholism. People suffering from such a disease (especially for a long time) are highly susceptible to the occurrence of auditory hallucinations. They are expressed in the appearance of voices in the head of the alcoholic, which appeal to him, cause him to talk. There may be several or one such voices, they can communicate with each other, discussing the patient, commenting on his actions, and causing the patient to panic. Against the background of such a mental disorder, it becomes almost impossible to guess the further actions of a person.
2. Imperative hallucinations often occur in schizophrenia, which is a psychotic personality disorder. Auditory transformation in such cases is directed directly to the patient. The voice begins to communicate with him, to give orders.
3. Addiction. People who take drugs are in an altered state of consciousness and, accordingly, can hear a variety of noises in their heads.

This is why imperative hallucinations appear.

Venereal disease and paranoia

The above reasons are the most common. However, in reality there are many more. For example, some sexually transmitted diseases (syphilis) can cause similar symptoms. People who use various medicinal substances can also suffer from the strongest auditory cacophonies.

We have described the main causes of imperative hallucinations, but we must not forget that the human body ages, numerous pathological changes occur in it, leading to the emergence of senile paranoia, which also causes similar symptoms in people.

amentia

In the list of root causes of imperative hallucinations, it is necessary to note amentia - an extremely severe kind of clouding of consciousness, which is expressed in a negative change in the speech production of sounds, a "curvature" of world perception and thinking. The danger of such a pathological condition lies in the fact that a multifaceted distortion can lead the patient to suicide.

Imperative hallucinations are classified by specialists as deviations of a verbal nature. Having established the main cause of these pathological changes, a qualified doctor is able to predict the outcome of therapeutic measures.

Symptoms

So, imperative hallucinations are what the patient hears, but in reality these sounds do not exist. Translated from Latin, imperare means “to order”, therefore the terminology under consideration means pathological sounds that are perceived by the patient as orders that force him to carry out one or another action. In most cases, the symptoms of imperative hallucinations appear in the patient receiving such orders that are sadistic-criminal in nature, making the patient dangerous not only for his environment, but also for himself. The voice in the patient’s head, as a rule, addresses him directly, giving commands: “take a knife, cut off your hand ...”, “climb onto the windowsill, jump ...”, “find a rope and throw it around the neck of the demon who is standing nearby ...”.

Imperative hallucinations can vary in content.

fears

Patients who have not yet completely lost their minds share their fears with a specialist. As a rule, they are afraid that during the next attack, the voices will order to cause physical harm to someone from the environment, since during such an attack a person loses the ability to control his thoughts and actions. His will is suppressed so much that he is not able to resist what is happening to him.

Predominantly, the voices directly address the patient, but they do not call him by name. Quite rarely, voice orders can relate to abstract or long-term actions, as a rule, such instructions affect only the “here and now”.

Voices in the silence

Imperative hallucinations are when the patient hears such whispers with both ears, however, there are cases when sound perception occurred only on one side. In most cases, a person hears voices against the background of absolute silence, more often at night. A very similar clinical picture occurs when the patient is in a state of deep trance, under hypnosis.

We have considered that these are imperative hallucinations.

Diagnostic methods for detecting pathology

If the surrounding patient or close people have suspicions that he suffers from the pathology considered in this article, it is necessary to seek the advice of a psychiatrist.

Diagnosis of this type of hallucination, as a rule, begins with the fact that the specialist makes sure that the patient suffers from this particular pathology and that his conversations and stories are not an illusion or an ordinary fantasy.

Imperative auditory hallucinations or auditory induction are specific sound structures that occur in the patient's mind in the absence of external stimuli. People who have a history of such diseases differ from dreamers in that the latter are easy to convince of the opposite, while this is impossible in relation to patients.

The psychiatrist in the diagnosis offers the patient to undergo special tests that help determine the presence of imperative hallucinations.

An important diagnostic technique for this disease is visual observation by a specialist of the patient's behavior. Such monitoring allows you to confirm the pathological condition and determine the type of its manifestation.

Pathological seizures can occur sporadically, with severe mental disorders, people can completely immerse themselves in this state. It is extremely important to prevent such a transition.

The psychiatrist carefully controls the change in the patient's facial expressions, since the patient's emotional manifestations, which are expressed by a change in facial expressions, are not commensurate with the real situation in which he is. For example, against the background of complete grief, the patient is able to have fun, laugh, or against the background of complete calm, he is in a state of fear, panic, anger.

The most common symptom of auditory hallucinations is the desire of the patient to plug his ears, cover his head with a pillow so as not to hear a frightening whisper or voice. At the same time, reality does not give prerequisites for such actions.

There are cases when patients suffering from imperative hallucinations, covering their ears with their hands, rushed to run away in horror, not understanding the road, and at the same time fell under cars, were thrown out of windows. Such manifestations are observed, as a rule, in isolation, but more often there are complex disorders in which auditory pathologies are combined with other symptoms, such as a delusional state.

There are also healthy people who are subject to illusions, while the occurrence of hallucinatory sounds is considered a specific indicator of mental pathologies that require urgent medical attention.

High attentiveness to your loved ones will allow you to diagnose the disease in time, because a person, getting into such a situation, is afraid of being misunderstood and he is stopped by the fear that he will be sent to a psychiatric hospital. He tries to hide his condition, but sooner or later it makes itself felt again.

The hallucinating patient becomes concentrated and alert, constantly on the alert so as not to betray his illness. However, when the early stage of the progression of the pathology is missed, he gradually begins to communicate with the imaginary interlocutor, answering his questions aloud.

When diagnosing, the doctor may prescribe an MRI or CT scan of the brain to identify structural disorders, which can also cause the development of imperative hallucinations.

It happens that the patient experiences pain. Imperative hallucinations may be the causes of them, or these causes are hidden in serious mental disorders or certain neurological pathologies. These symptoms should not be taken lightly. A complete and competent comprehensive examination will help establish an accurate diagnosis, after which the doctor will prescribe special medications for hallucinations or therapy for the underlying disease (vascular pathology, brain neoplasm).

To exclude the organic nature of the pathology, laboratory tests of blood, urine, and spinal cord can be assigned to the patient. Elderly patients who use devices to amplify sounds need to check the correct operation of such an electronic device.

Treatment of imperative hallucinations

If a person encounters such a pathological situation for the first time, it plunges him, as a rule, into a stupor and horror. However, it should be remembered that what is happening for a hallucinating patient is a manifestation of reality. Therefore, the first thing that his close relatives should know is how to behave in such a situation and what help they can provide to the patient.

In no case should you try to convince a person that everything that happens to him is a reality transformed by the psyche. It is necessary to behave tactfully, show patience, and in many ways fantasy, in order to initially calm down a shocked and excited person. For example, if the patient is absolutely sure that werewolves are trying to get into his window, you should not laugh - you just need to take an active part in finding ways and means to physically protect yourself from an illusory threat. It is necessary to try to create such an atmosphere and environment so that imperative hallucinations do not cause horror in the patient, that is, if possible, smooth out the emotional severity of the phenomenon. Also, in no case should one convince a hallucinator that the sounds he hears are the fruit of his sick consciousness. You should not focus on the problem and try to find out who is talking to him and what is the sound source.

Calm music, a change of scenery, and in some cases, medications that should be prescribed only by a qualified specialist will help reduce arousal. But no matter how attentive the relatives are to the patient, he needs the help of doctors.

To date, the therapy of imperative hallucinations is carried out using several techniques, and all of them are aimed at eliminating the occurrence of pathological seizures, removing the patient from a delusional state.

Medicines

Treatment is usually carried out with the help of medications, which usually include the following drugs:

• "Tizercin";
• "Plegomasin";
• "Thorazine";
• "Gibanil";
• "Largactil";
• "Aminazin";
• "Chlorpromazine";
• "Ampliaktil";
• "Megafen";
• "Ampliktil";
• "Contamine".

One of the most prescribed drugs for imperative hallucinations is Aminazin, which is used for intramuscular or intravenous administration.

Therapy for this disease depends on the causes of the problem. These can be sedatives, antipyretics, anti-inflammatory, neurostimulating medications, as well as drugs for the treatment of CNS pathologies and mental disorders.

The patient may be prescribed ancillary therapy, for example, electrical stimulation treatment is often used, which specifically affects specific departments.

Surgery

If hallucinations are provoked by a tumor process in the head, the patient is prescribed surgical treatment. Removal of a tumor, cutting off or splitting the auditory nerve, installing a hearing aid or implant, plastic and prosthetic ear elements - these are all possible options for surgical treatment of this pathological condition.

In certain cases, it is enough to eliminate the symptoms of intoxication of the body, restore its activity, stop drinking alcohol, drugs and other substances that have a similar effect.