Among other psychosensory disorders, hallucinosis of an organic nature is a disorder in which the patient is prone to hallucinations. Visions can haunt constantly, an alternative option is periodic relapses. More often these are visual pictures or auditory phenomena. A person at the moment of an attack maintains clarity of consciousness. Some understand the essence of what is seen and heard, some do not realize that this is a hallucination. In a number of cases, a delusional interpretation of the phenomenon is observed, although the possibility of critical thinking is more often retained.
Differential Diagnosis
Clarifying the syndrome of hallucinosis, it is important to make a correct diagnosis. The criteria for classifying a case are described in the international classifier ICD in column F06. When checking the conformity of the signs observed in the patient, it is also necessary to note how frequent the hallucinations are, whether they are constant, and 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, which is observed most of the time. No delusional disorder. If the patient is able to identify any of the indicated symptoms, a diagnosis different from the pathological condition in question should be made.
About the nuances of diagnostics
Based on the current ICD classification system, organic hallucinosis includes the non-alcoholic state and dermatozoic delusions.
Shizophrenia or hallucinations under the influence of alcohol should not be included in this diagnosis. They belong to groups of diagnoses coded as F20 and F10.52.
Diagnoses and codes
There are several subcategories in column F06. Each of the cases is assigned to a specific subgroup, based on the symptoms of hallucinosis, the causes that provoked it and the characteristics of the course.
The zero subgroup includes pathology caused by brain injury, the first - cerebrovascular diseases, the second - epilepsy. The third subgroup includes cases due to tumor processes in the brain, the fourth - HIV, the fifth - syphilis that affected the nervous system. The sixth group includes cases associated with other viruses and bacteria that have infected the nervous system. The seventh category is organic hallucinosis due to diseases other than those mentioned above, the eighth category is mixed diseases, and the ninth category is unspecified pathologies.
Nuances of the case
In organic hallucinosis, the most pronounced feature of the clinical picture is deceptive perception. In addition to impaired 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 an unpredictably long time - based on the characteristics of the manifestations of the pathology.
To reduce the manifestations of the disorder, it is recommended to use antipsychotic medications. The most popular antipsychotics are amisulpiride and haloperidol. In clinical practice, zuclopenthixol and risperidone are quite widely used. The dosage must be selected in such a way that the patient's body tolerated the drug, while a pronounced effect was observed. Volumes should be kept to a minimum. To choose the most suitable remedy, monotherapy is practiced, successively trying different drug options until the optimal one can be determined.
About treatment
Why has the problem of organic hallucinosis become so acute lately? Life expectancy in the elderly is getting longer, and scientists attribute this to an increase in the incidence of mental disorders. The abundance of stress and deterioration of the nervous system, exhaustion of the brain and a number of other negative factors lead to the fact that by old age the probability of getting a mental disorder increases significantly, and the older the person, the greater these risks. Additional challenges include the difficulty of choosing drugs that older people can tolerate.
In some cases, combination therapy may be prescribed, using two drugs at the same time. Usually this is driven by chronic hallucinosis, in which three successively used drugs did not show a pronounced effect. It is taken into account that the dosage should be adequate, and the tried options themselves should belong to different groups of drugs. The experimental period is no less important - each of the means must be used for at least three weeks, so that it is possible to correctly draw conclusions about its effect or lack of it.
How to combine?
If organic hallucinosis requires a combination of different drugs, you should, if possible, resort to such means for which the likelihood of developing extrapyramidal effects is assessed as quite low. These include preparations containing clozapine and risperidone. The medical practice of using amisulpride and sertindole in combination therapy is quite widespread. Olanzapine is also a fairly safe remedy (as far as it is possible in principle for the group of medicines under consideration).
The antipsychotics used in organic hallucinosis lower the antiepileptic barrier, which creates additional difficulties if it is necessary to correct the condition of persons suffering from epilepsy. Clozapine, combined with phenothiazine compounds, lowers the barrier more than others.
Nuances of the combination
Do not use typical long-acting antipsychotics whenever possible.
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. Zuclopenthixol is prescribed in an amount of 2-10 mg per day, in rare and especially severe cases - 20 mg.
Acceptable volumes of trifluoperazine 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, 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 limit is higher - from 75 to 80 years. The disease belongs to the 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 organ. Such medical practice is needed both at the stage of an acute condition and during maintenance therapy.
Most often organic hallucinosis appears on the background of epilepsy. If seizures bother a person for a decade or more, the likelihood of developing hallucinosis is estimated to be very high. However, epilepsy is not the only reason that can provoke such a pathological condition. Cases are known whenorganic 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. Prolonged manganese poisoning can play a role.
State Clinic
Against the background of organic hallucinosis, the patient is usually somewhat slower than a he althy individual, comprehends what is happening around. It has a fairly poor associative array. Such people are not inclined to talk and show emotional dryness, callousness. Often they are rather 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 impulses, nature becomes impulsive. You can notice hallucinosis by certain behavioral traits: such a person speaks stereotypically and jokes monotonously.
As the condition progresses, the patient becomes lethargic, memory deteriorates, and it becomes more difficult to reproduce information. Sooner or later, this can provoke dementia. If you start treatment in a timely manner, the prognosis is generally favorable, but much depends on the individual characteristics of the patient and the success of the selection of a therapeutic course. Medication and medical care during the support period are no less important than at the stage of acute psychosis.
Hallucinosis: what is it?
This term is used to denotea state where 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 in schizophrenia, epilepsy, and may be of a somatic nature. Hallucinosis is possible with bipolar disorders, malignant diseases, impaired functioning of the sense organs. There are cases of hallucinosis in migraine, due to the abuse of alcohol, narcotic compounds, surrogates.
Certain forms of hallucinosis are possible in violation of the functionality of the heart, blood vessels, thyroid gland.
Hallucinosis: is it only organic?
In addition to the variant discussed above, there is atherosclerotic, alcoholic hallucinosis. The first is diagnosed if its development is explained by atherosclerosis. It 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. Slightly less common during drinking. The patient is oriented in space, his own personality, and the hallucinations are predominantly verbal. Sounds and words are heard, at first neutral. Due to the lack of critical perception of the patienttries to find the source of sounds, which is accompanied by increased anxiety and horror. The hallucinations become stronger, several voices are heard communicating with each other regarding the identity of the patient. Polyphonic scenes are possible (for example, a court). Since there is no critical attitude to the condition, the patient is haunted by delusional ideas related to the plot of a particular vision.
