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 starts following the commands in his head.
Causes of imperative hallucinations
With a variety of neuroses, auditory delirium, as a rule, is absent. Therefore, when imperative hallucinations appear, this indicates serious disorders that may affect certain parts of the brain. Studying the clinical picture in each case,a qualified specialist is trying to determine the source that became the catalyst for this disease.
Today, 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:
- 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.
- Compulsory 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.
- Drug 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 occur.
VD and paranoia
The above reasons are the most common. However, in reality there are many more. For example, some sexually transmitted diseases can cause similar symptoms.(syphilis). 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 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 "distortion" 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.
Specialists refer to imperative hallucinations 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.
Symptomatics
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 are presented in the patient receiving such orders, which have a sadistic-criminal effect.character, making the patient a danger not only to his environment, but also to 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 may vary in content.
Fears
Sick, who have not yet completely lost their mind, 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 unable to resist what is happening to him.
Mostly the voices address the patient directly, but they do not call him by name. Quite rarely, voice commands can relate to abstract or long-term actions, as a rule, such instructions affect only the here and now.
Voices against the silence
Imperative hallucinations are when the patient hears such whispers with both ears, but 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 detection methodspathology
If the patient's surroundings or close people suspect that he suffers from the pathology discussed in this article, you should 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 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 otherwise, while this is impossible for patients.
During diagnosis, the psychiatrist 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 imperative to prevent such a transition.
The psychiatrist carefully controls the change in the patient's facial expressions, because the patient has emotional manifestations that are expressedchanges in mimic manifestations are not commensurate with the real situation in which he resides. 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, threw themselves 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 he althy 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 attention to your loved ones will allow you to diagnose the disease in time, because a person, getting into a similar 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 focused and alert, constantlyis on the alert so as not to betray his disease. However, when the early stage of 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 that can also cause the development of imperative hallucinations.
It happens that the patient has painful sensations. 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 prescribed to the patient. Elderly patients who use devices to amplify sounds should 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 a similar situation andhow they can help 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.
During an attack, you should not raise your voice and talk loudly with the patient. During this period, he should create the illusion that others are doing everything possible to help him.
Calm music, a change of scenery, in some cases, medications that should be prescribed only by a qualified specialist will help reduce excitement. But no matter how attentive the relatives are to the patient, he needs medical help.
Today, the therapy of imperative hallucinations is carried out with the help of sever altechniques, and all of them are aimed at eliminating the occurrence of pathological seizures, removing the patient from a delusional state.
Medicines
Treatment is usually with medication, which typically includes the following medications:
- "Tizercin";
- Plegomasin;
- Thorazine;
- Gibanil;
- Largactyl;
- "Aminazine";
- 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 of this disease depends on the causes of the problem. These can be sedatives, antipyretics, anti-inflammatory, neurostimulating drugs, as well as drugs for the treatment of CNS pathologies and mental disorders.
Auxiliary therapies may be prescribed to the patient, for example, electrical stimulation treatment is often used, which specifically affects specific areas.
Surgical treatment
If hallucinations of an imperative nature 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 areall 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.
