Among other psychosensory disorders, hallucinosis of an organic nature is a disorder in which the patient is prone to hallucinations. Visions can haunt all the time, an alternative is periodic relapses. Most often these are visual pictures or auditory phenomena. A person at the time of the attack maintains clarity of consciousness. Some understand the essence of the visible and audible, some do not realize that this is a hallucination. In some cases, a delusional interpretation of the phenomenon is observed, although the possibility of critical thinking often remains.
Differential diagnosis
Clarifying the hallucinosis syndrome, it is important to correctly diagnose. Case criteria are described in the international classifier ICD in column F06. Checking the correspondence of the signs observed in the patient, it is also necessary to note how frequent hallucinations, whether they are constant, whether there is a tendency to relapse. Creation must be clear. When clarifying the state, it is necessary to assess the level of intelligence - there should not be a significant decrease.
According to ICD 10, organic hallucinosis is not accompanied by some specific mood disorder observed most of the time. There is no delusional disorder. If the patient manages to identify any of the indicated symptoms, a diagnosis should be made that is different from the pathological condition in question.
About the nuances of diagnosis
Based on the current ICD classification system, organic hallucinosis includes a non-alcoholic state and dermatozoic delirium.
Cases of schizophrenia or hallucinations due to alcohol should not be included in this diagnosis. They belong to the diagnosis groups, encrypted as F20 and F10.52.
Diagnoses and Codes
There are several subcategories in column F06. Each of the cases is assigned to a certain subgroup, based on the symptoms of hallucinosis, the causes that provoked it and the features of the course.
The zero subgroup includes pathology due to brain injury, in the first - vascular brain diseases, and the second - epilepsy. The third subgroup includes cases due to tumor processes in the brain, the fourth is HIV, the fifth is syphilis, which affects the nervous system. The sixth group includes cases associated with other viruses and bacteria that infect the nervous system. The seventh category is organic hallucinosis, due to diseases other than those indicated above, the eighth - mixed diseases, and the ninth - unspecified pathologies.
Case Nuances
With organic hallucinosis, the most pronounced feature of the clinical picture is fraudulent perception. In addition to the disorder in the ability to see and hear, there is a risk of a tactile form of hallucinosis. The therapeutic course must be chosen immediately, as soon as an accurate diagnosis is made. Treatment of organic hallucinosis lasts unpredictably for a long time - proceed from the features of the manifestations of pathology.
To weaken the manifestations of the violation, it is recommended to use antipsychotic medications. The most popular antipsychotics are amisulpiride and haloperidol. In clinical practice, zuclopentixol, risperidone are quite widespread. The dosage must be selected so that the patient's body tolerates the drug, while there is a pronounced effectiveness. Volumes should be minimal. To choose the most suitable remedy, they practice monotherapy, successively trying different types of drugs, until it is possible to determine the optimal one.
About treatment
Why has the problem of organic hallucinosis become so acute lately? The life expectancy of the elderly is becoming more and more, and scientists attribute this to an increase in the incidence of mental disorders. The abundance of stress and deterioration of the nervous system, brain depletion, and a number of other negative factors lead to the fact that the probability of getting a mental disorder increases significantly at an advanced age, and the older the person, the greater these risks. Additional problems are associated with the complexity of the choice of drugs that could be tolerated by the elderly.
In some cases, combination therapy may be prescribed while using two drugs at the same time. Usually, chronic hallucinosis pushes this, in which three consecutively used drugs did not show a pronounced effect. Take into account that the dosage should be adequate, and the tried and tested options themselves should belong to different groups of drugs. The experimental period is no less important - each of the funds must be used for at least three weeks in order to correctly draw conclusions about its effect or lack thereof.
How to combine?
If organic hallucinosis requires a combination of different drugs, one should resort to such means as possible for which the likelihood of extrapyramidal effects is estimated to be quite low. These include drugs containing clozapine and risperidone. The medical practice of using amisulpride, sertindole in combination therapy is quite widespread. Also quite safe (as far as this is possible in principle for the considered group of medicines) is olanzapine.
Antipsychotics used in organic hallucinosis lower the antiepileptic barrier, which creates additional difficulties if it is necessary to correct the condition of people suffering from epilepsy. Clozapine, combined with phenothiazine compounds, reduces the barrier more strongly than others.
The nuances of the combination
If possible, do not use typical antipsychotic drugs in the form of a long-acting.
When choosing haloperidol per day, the patient is prescribed 5-15 mg, for risperidone, the optimal dose is from 2 mg to twice the volume. Zuclopentixol is prescribed in an amount of 2-10 mg per day, in rare and especially severe cases - 20 mg.
Permissible volumes of trifluoperazin vary between 5-15 mg, clozapine - 50-200 mg. When prescribing amisulpride, the doctor usually recommends that the patient take 400-800 mg daily. When choosing olanzapine in favor, the optimal dosage is 510 mg for one day.
About the disease: some features
On average, organic hallucinosis is diagnosed in women 10% more often than among men. The risk group is men aged 55 to 60 years, for women the border is higher - from 75 to 80 years. The disease belongs to a class of disorders for which social danger is assessed as low or completely absent. Pathogenesis requires the use of drugs that stabilize blood flow in the brain, metabolic processes in this body. Such medical practice is necessary both at the stage of an acute condition, and during maintenance therapy.
Most often, organic hallucinosis appears against the background of epilepsy. If seizures have bothered a person for a decade or more, the likelihood of developing hallucinosis is estimated as very high. However, epilepsy is not the only reason that can provoke such a pathological condition. There are cases when organic hallucinosis was observed after trauma, encephalitis, under the influence of neoplasm, sclerosis. Organic hallucinosis can occur with prolonged and unjustified use of steroids, hallucinogens and other compounds that affect the mental state of a person. Long-term poisoning of the body with manganese can play its role.
State Clinic
Against the background of organic hallucinosis, the patient is usually somewhat slower than a healthy individual, comprehends what is happening around. It is inherent in a rather poor associative series. Such people are not inclined to talk and show emotional dryness, callousness. Often they are quite lethargic, while they may be characterized by dysphoria, euphoria.
There are cases when patients with organic hallucinosis were aggressive for no reason. It is difficult for them to control their motives, nature becomes impulsive. You can notice hallucinosis on certain lines of behavior: such a person speaks stereotypically and jokes in the same way.
As the condition progresses, the patient becomes apathetic, memory worsens, and it becomes more difficult to reproduce information. Sooner or later, this can trigger dementia. If treatment is started in a timely manner, the prognosis is generally favorable, but much depends on the individual characteristics of the patient and the success of choosing a therapeutic course. Medical and medical assistance in the support period is no less important than at the stage of acute psychosis.
Hallucinosis: what is it?
This term is used to denote a condition when a person suffers from hallucinations, while consciousness is preserved. In the predominant percentage of cases, hallucinations always belong to the same type. A pathological condition accompanies a person for many years and can cause delirium.
At the moment, it is difficult to say for sure whether all the causes of hallucinosis are known. They can appear with schizophrenia, epilepsy, can be somatic in nature. Hallucinosis is possible with bipolar disorders, malignant diseases, impaired functioning of the senses. There are known cases of hallucinosis with migraine, due to abuse of alcohol, narcotic compounds, surrogates.
Certain forms of hallucinosis are possible with impaired functionality of the heart, blood vessels, thyroid gland.
Hallucinosis: is it only organic?
In addition to the above option, atherosclerotic, alcoholic hallucinosis occurs. The first is diagnosed if its development is due to atherosclerosis. This is always a chronic pathology, the symptoms of which gradually increase in accordance with the progress of the underlying disease.
Alcoholic hallucinosis is more characteristic of the period of refusal of alcohol and is accompanied by somatic disorders. It occurs somewhat less often during binge. The patient is oriented in space, his own personality, and hallucinations are mainly verbal. Sounds, words, initially neutral, are heard. Due to the lack of critical perception, the patient is trying to find the source of sounds, which is accompanied by increased anxiety and horror. Hallucinations become stronger, several voices are heard, communicating among themselves regarding the personality of the patient. Polyphonic scenes (for example, court) are possible. Since there is no critical attitude to the condition, the patient is haunted by delusions related to the plot of a specific vision.