Types of manias. What is mania really?

Mania

Mania(from Greek ????? - madness, frenzy) represents the direct opposite of depression. Characteristic features of a manic state (hyperthymia) are increased (expansive) mood, acceleration of the flow of ideas, associations, and motor agitation. This “triad” of basic symptoms, just like the depressive “triad” of affectivity, reveals varying degrees of severity in terms of intensity of manifestations and various combinations of proportions within its individual components. In some cases, elevated mood predominates, in others, acceleration of the associative process comes to the fore, but motor excitation may also predominate.

"Mania without mania" characterized by the fact that the leading symptom is motor excitation without increasing the speed of associations. Concentration is not impaired, but thinking productivity is reduced. Such patients are active, talkative, gesticulate a lot, make acquaintances easily, and make contacts. There is increased activity, which is typical for any mania, but there is clearly an overvalued attitude towards one’s activity. Actually, manic affectivity is characterized by inexpressiveness and lack of brightness. The feeling of complete physical well-being and comfort characteristic of such patients is not accompanied by a feeling of joy and fun; on the contrary, irritability or even anger appears. There is an overestimation of one’s own capabilities, but this is expressed only in some exaggeration of the events taking place. Violations of somatovegetative functions are insignificant, manifested in sleep disturbances (early awakenings, but without a feeling of fatigue and weakness), a slight increase in appetite (M. A. Morozova, 1989).

Mania of the cyclothymic register(hypomania) is characterized by an increase in physical and mental tone, a feeling of cheerfulness, physical and mental well-being, good mood, and optimism. All mental processes (perception, thinking, memorization) proceed easily and smoothly. This feeling of well-being is accompanied by a desire for energetic activity. Patients wake up refreshed (after a deep but short sleep), immediately take up their usual activities or easily start new ones, without experiencing any hesitation or anxiety. In this state, they usually successfully cope with their studies, show enviable initiative in work, in family affairs, in company at the holiday table, willingly joke, have fun and infect others with joy. At the same time, there is always increased self-esteem. Despite the large expenditure of energy, patients do not feel tired, they do not take into account the opinions of others, they can be noisy, and disturb the peace of others. They sleep little, but do not lose their fighting spirit and enthusiasm. Their appetite is increased and their pulse is increased. There is an expression of pleasure on the face (“facial expressions of pleasure”, according to I. Sikorsky, 1910) - the eyes shine, the gaze is sparkling, the skin is pink, sometimes reddish, smooth, the folds are smoothed out, a smile easily appears, the patients look younger.

Simple mania - the next stage in the development of an endogenous manic state. Here all manifestations of mania become completely obvious and distinct. Patients call their health “excellent”, “wonderful”, “wonderful”, “festive”, “magnificent”, their mood is “cheerful”. They sing, joke, dance, feel a surge of inexhaustible energy, and feel a thirst for tireless activity. Self-esteem increases even more - they are talented, they can write poetry, compose music, they can cope with any job, any task. The external manifestations of mania are also quite demonstrative, bright - patients look lively and joyful, festively enthusiastic, expansive, perky, laugh loudly for an insignificant reason, easily make wisecracks, joke, dress up festively, in fashion, talk a lot, gesticulate. They are constantly busy with something, inventing something new, constantly doing something, but never finishing anything. At home, they are actively engaged in rearranging their everyday life, buying new things, furniture, undertaking rearrangements, renovations, buying new clothes, giving gifts, often even to unfamiliar people, showing particular generosity, quickly spending money, easily “getting into” debt, borrowing money from friends, they say that they want to do good to everyone. Although the desire for activity in such cases is significantly increased, productivity is almost always reduced. Distractibility, the easy emergence of new ideas, plans, plans, lack of patience and consistency prevent patients from performing what they intended, and sometimes even their usual duties. The pace of thinking is accelerated, associations arise more often based on external signs - what comes into the field of vision, into the sphere of attention, easily causes a response “burst” of thoughts and statements on the relevant topic. When communicating with people, the previously inherent delicacy and tactfulness noticeably decreases, and a tendency towards familiarity is revealed. Sexuality almost always intensifies, attempts at intimacy sometimes follow one after another, while the wife or girlfriend herself is sometimes forced to consult a sex therapist for advice on correcting sexual behavior. Patients easily enter into love affairs, talk a lot and inappropriately about erotic topics, arrange feasts for an insignificant reason or for no reason, indulge in “spirits”, carousing, many begin to abuse alcohol. Nevertheless, at this stage, the ability to self-control is still largely preserved, and their personal characteristics are quite clearly manifested in the behavior and actions of patients. The statements of patients and their behavior remain within the framework of carelessly optimistic, overvalued nature. There are no crazy statements. Many of the patients continue to be aware (though not constantly) of the unusual nature of the condition and agree to take medications. Manifestations of motor hyperactivity and increased self-esteem with overvalued aspirations are characteristic of the clinical picture in more developed manic states, but then they become more pronounced.

Psychotic mania. Patients at this stage of the development of mania are very excited, talk incessantly in a hoarse voice, laugh loudly, sing, recite, rhyme, vigorously and loudly greet everyone they meet, and if they are in the hospital, they greet doctors and staff, loudly enthusiastically comment on what is happening around them, at all times. interfere, keep others in suspense. They compose poems, write love letters to doctors, propose the most extraordinary innovations in various areas of life, set out grandiose plans for their actions, are going to become famous scientists, politicians, millionaires, and talk about the possibility of them making discoveries that will turn the whole world upside down. The lack of education and professional training does not bother them at all; everything seems accessible and easily overcome. They consider themselves the happiest, the smartest and the most beautiful, they can make everyone happy, they will force the whole world to talk about themselves. Such boundless optimism is in no way overshadowed by their actual situation and condition (for example, being in a psychiatric hospital, difficult financial situation, somatic diseases, etc.). Ideatorial excitation also becomes sharply expressed, thoughts “run”, “rush like a whirlwind” (fuga idearum), they talk about "leaping thoughts". Associations arise instantly, more and more new ideas constantly “flare up”, in this flow some thoughts overtake others.

Mania – translated from Greek – passion, attraction. This is a disorder of desire, accompanied by an irresistible desire to perform some action. A person is obsessed with the idea of ​​doing something. At this moment, he does not think about the consequences; he can harm himself and others. Having achieved his goal, he calms down for some period, then everything repeats again and again. The list of all manias that occur in humans is quite large - 142 varieties.

Depending on the object of attraction, the following types are distinguished, presented in Table 1.

Table 1. Types of manias

As can be seen from Table 1, manias are conventionally divided into 3 types:

Characteristics of manias

All manias have a common mechanism of action. A certain stage is characteristic:

1. Precursor stage. Before an attack, a person feels strong excitement, finds no place for himself, and experiences an irresistible desire to perform one or another action (depending on the type of mania). He cannot think about anything else, is unable to do ordinary things, or perform his duties. Autonomic symptoms are added - the pulse quickens, the person blushes, experiences trembling throughout the body, sweats, and blood pressure rises.
2. Stage of action. During this period, the patient is insane and does not give an account of what he has done. Actions are impulsive, occur against his will, and he is unable to interrupt them. The patient does not plan anything in advance, the process is chaotic and inconsistent. The fact of performing actions is important, not their meaning. At the same time, the patient experiences an extraordinary “drive”, pleasure, and a surge of energy. Having achieved what he wanted, he feels deep satisfaction and relief.
3. "Awakening" stage. At this stage, the patient seems to “awaken” from sleep, obsession. With horror he discovers the consequences of his behavior, experiences a feeling of remorse, swears to himself and others that this will not happen again. Often falls into depression, which can end in suicide.

But after a while the promises are forgotten, the attack is repeated again and again. Gradually, the interval between attacks decreases, pathological actions occur more often and last longer. In the absence of timely treatment, attacks lead to serious complications that threaten the lives of the patient and others. Some types of mania can lead to the patient committing illegal acts and imprisonment.

Causes of mania

The causes of mania are varied. There are biological, psychological factors, as well as additional reasons characteristic of adolescents.

Biological:

Psychological:

• prolonged stress;
• conflict situation, pressure at school, at work, at home;
• Personal characteristics - emotional instability, lack of strong-willed qualities, hysterical traits.

Additional factors in adolescents:

• hormonal changes;
• communication with antisocial elements;
• lack of impressions, boredom;
• the impression of films and books, the desire to experience it yourself.

Forms and varieties of manias

Clinical manifestations of mania include:

Social manias

One of the most common encountered in medical practice is mania for cleanliness and order (ripophobia). The disorder is characterized by pathological tidying up the house (continuous cleaning, scrubbing, washing) and/or constant hand washing and showering. Gradually, washing hands from an impulsive action becomes a ritual obsessive action; the patient (usually women) cannot be torn away from this activity under any circumstances.

The procedure continues for hours. This can happen during the arrival of guests (the hostess suddenly gets up, goes to the bathroom and disappears there for a long time), or an important meeting. Over time, ripophobia can develop into paranoia; the patient feels that dirt accompanies her everywhere, and disgust appears. The patient wears gloves, does not eat outside the home, and wears closed clothes even in summer. She terrorizes her family with demands to keep them clean and displays aggression.

Dermatillomania and trichotillomania are manifested by self-harm of the skin and scalp. The obsessive desire to harm oneself in any way leads to disastrous consequences. The patient has to resort to the help of a dermatologist and undergo plastic surgery.

Oniomania (an uncontrollable urge to buy) can end in ruin if treatment is not carried out in time. A person buys everything, completely unnecessary things and products, without thinking about the consequences. The patient may lose his family if his spouse does not want to live in poverty.

Bibliomania (passion for reading), onomamania (obsessive urge to remember names, dates, titles), melomania (passion for music), clinomania (desire to lie in bed), arithmomania (unhealthy fascination with numbers), choriomania (pathological craving for dancing) are the most harmless types of mania. But continuous reading, dancing, listening to music, and counting gradually exhaust the patient, leading him to physical exhaustion.

Timbromania (pathological passion for collecting stamps), pygmalionism (craving for sculptures, statues of women), hippomania (mad passion for horses) to an extreme degree can lead to the commission of illegal actions by patients. In order to obtain a rare stamp for a collection, a thoroughbred horse, or an ancient sculpture, a maniac is capable of stealing, committing robbery, and even committing murder.

Graphomaniacs (pathological craving for writing) are a threat to the editorial offices of magazines and newspapers! These people can drive editors into a tizzy by demanding that they publish their “works.”

Ergomaniacs - pathological workaholics - are a gift for their superiors. But for the patient himself, this is fraught with physical exhaustion and conflicts in the family (does not devote time to home).

Nymphomaniacs, zoomaniacs, flagellomaniacs and erotomaniacs are obsessed with pathological sexual desire. Consequences can manifest themselves in sexually transmitted diseases, the breakdown of patients' families, loss of work, and respect in society. The climax may be the infliction of bodily harm or even the murder of the object of desire (if there are no reciprocal feelings).

Antisocial mania

Antisocial mania is the most dangerous condition. Thus, homicidal addicts suffering from a pathological desire to kill should be kept in a special closed hospital under the supervision of a psychiatrist.

Drug addicts and substance abusers must be registered at a drug treatment clinic. In a state of drug or toxicological intoxication, they are capable of harming both themselves and others. In search of a dose, they can resort to theft and murder.

Kleptomaniacs, gambling addicts, plutomaniacs who commit thefts and even murders (for the sake of obtaining funds for the next gambling game or simply due to a pathological attraction to money during plutomania) are also subject to vigilant supervision.

The relatively harmless ones from this group are dromomaniacs, suffering from an uncontrollable desire for vagrancy. But long-term wandering can result in serious consequences both for the patient himself (infectious diseases in unsanitary conditions, physical exhaustion due to starvation) and for those around him (theft and murder by a hungry patient).

Suicidomania is a condition that is dangerous for the patient himself. Such patients should also be constantly monitored by a psychiatrist.

Manias accompanied by psychotic deviations

This group of manias occurs against the background of mental disorders - schizophrenia, psychosis, organic brain damage.

Delusions of grandeur (megalomania) and persecution occur as part of delusions in schizophrenia, in the manic stage of bipolar disorder, which occurs with a psychotic component, against the background of brain intoxication.

A person with megalomania thinks that he is the center of the Universe, omnipotent. Behavior becomes consistent with mania - he treats people arrogantly, exaggerates his capabilities, and is in his own imaginary world. Delusions of grandeur to the extreme (paraphrenic, fantastic delusions) can drive a person to any crazy actions.

With persecution mania, a person becomes suspicious, loses peace, and enemies seem to be everywhere. Under the influence of delirium, he is able to “take revenge” on his pursuers - to kill them. The patient is extremely exhausted and requires urgent hospitalization.

Patients with “Plyushkin syndrome” love to collect trash and walk around courtyards and landfills with numerous bags. These are patients with organic brain damage suffering from dementia. Being in unsanitary conditions can cause infectious diseases.

Pathological self-deprecation (micromania) occurs against the background of the depressive stage of bipolar disorder and depression of other etiologies. A patient obsessed with micromania is capable of driving himself to suicide (guided by thoughts of his own worthlessness).

Necromania (craving for desecration of corpses) and copromania (obsession with feces) are perversions inherent in patients with organic brain lesions (mental retardation, schizophrenia).

Conclusion

All patients with antisocial mania and mania with a psychotic component are subject to vigilant supervision by a narcologist. Basically, treatment should be carried out in a hospital.

For patients with social mania in an unadvanced form, it is enough to take a course of treatment on an outpatient basis and undergo psychotherapy.

Mania

(Greek mania – passion, madness, attraction).

1. Syn.: manic syndrome;

2. An outdated, historical name for psychopathological conditions occurring with psychomotor agitation;

3. The term is used unprofessionally to denote delusions, for example, delusions of persecution, grandeur. This use of the term is unlawful.

M. akinetic (Greek a - not, kinesis - movement). See M. inhibited.

M. atonic. See Manic stupor.

M. no nonsense. Manic syndrome that does not include delusional ideas.

M. Bella. See Delirium acute.

M. is cheerful. A type of mixed states. A hypomanic state characterized by an increased cheerful mood without pronounced psychomotor agitation.

M. is angry. Manic syndrome, characterized by irritability, short temper, a tendency to easily arise conflicts with others, and aggressiveness.

M. inhibited. A type of mixed states (see). A combination of elevated mood, speech excitation and motor retardation up to stupor. Sometimes the acceleration of mental processes reaches the level of a leap of ideas.

Syn.: M. akinetic.

M. is frantic. See M. furibunda.

M. unproductive. A type of mixed states. Elevated mood and motor arousal occur without acceleration of mental processes, with a paucity of mental production, monotony and unproductive statements. Often observed in schizophrenia, which occurs with manioform symptoms.

M. oneiroid. At the height of the development of manic syndrome, disturbances of consciousness of the oneiric type with fantastic hallucinatory experiences are noted.

M. periodic. Manic states occur periodically, in paroxysms, and do not alternate with depressive states. Refers to the atypical monopolar course of MDP or phasic psychoses.

M. sadness. A rarely observed form of psychogenic-reactive onset of mania that occurs directly in connection with severe mental trauma.

M. resonating. (French raisonner – to reason, to reason). Manic, often hypomanic, syndrome with speech excitation, occurring with empty, fruitless philosophizing, lengthy reasoning.

M. senile (Mayer-Gross W.). A manic state that occurs in old age, most often - angry, confused or unproductive M. There is no dementia.

M. confused (Bostroem A., 1926). Manic syndrome, in which the acceleration of mental processes reaches great severity, incoherence of thinking and speech, impaired consciousness, and confusion are observed. At first it gives the impression of acute endogenous psychosis, and then a typical manic symptom complex is formed with an outcome in recovery or transition to depression. Exogenous harmfulness seems to provoke endogenous psychosis (in the presence of a circular predisposition)

M. transient. Transient short-term manic syndrome (over several hours or days).

M. is anxious. A type of mixed states. Psychomotor agitation is combined with an anxious-depressive mood.

M. chronic. A hypomanic state that lasts for years often occurs with anger.

Synonym: chronic hypomania (Kraepelin E.).

M. attonita (lat. attonitus - stunned). See M. inhibited.

M. furibunda (Latin furibundus - mad, frantic). A manic state with a predominance of pronounced psychomotor agitation with aggressive and destructive tendencies, a predominance of the affect of anger.

Explanatory dictionary of psychiatric terms. V. M. Bleikher, I. V. Kruk. 1995 .

See what “Mania” is in other dictionaries:

MANIA- (Greek mania, from mainomai to be crazy). 1) a mental disorder based on the predominance of one persistently pursuing idea. 2) a strong addiction to something. Dictionary of foreign words included in the Russian language.... ...

mania- See love... See... Synonym dictionary

MANIA- (mania med.), mania, female. (Greek: mania). A painful mental state with sharp transitions from excitement to depression and concentration of consciousness and feelings in any one direction, on any one idea (med.). Mania... ... Ushakov's Explanatory Dictionary

MANIA- (from the Greek mania, madness, frenzy), along with melancholy, is one of the oldest psychiatric concepts. with the help of which a painfully elevated mood, combined with motor excitement, was indicated, sometimes... ... Great Medical Encyclopedia

MANIA- (from the Greek mania, madness, enthusiasm, passion), 1) a mental disorder characterized by elevated mood, motor agitation, accelerated thinking, and talkativeness. 2) Pathological desire, attraction, passion... ... Modern encyclopedia

MANIA- (from the Greek mania, madness, enthusiasm, passion), 1) a mental disorder characterized by high mood, motor agitation, accelerated thinking, talkativeness. 2) Pathological desire, attraction, passion (for example, ... ... Big Encyclopedic Dictionary

...mania- (gr. mania madness, passion, attraction) the second component of complex words, denoting love, strong addiction, painful attraction to what is expressed in the first part of the word, for example: graphomania, kleptomania. New dictionary of foreign words.... ... Dictionary of foreign words of the Russian language

Mania- (mania). This word in colloquial language is often used to denote one-sided attraction, passion directed towards a specific object or activity. As a scientific term, M. has long been used to designate a certain form of mental... ... Encyclopedia of Brockhaus and Efron

Mania- (from the Greek mania madness, enthusiasm, passion) 1) a synonym for the word “delirium” (for example, megalomania); 2) pathological desire, attraction, passion (for example, thirst for power); 3) a mental disorder characterized by elevated mood,... ... Political science. Dictionary.

mania- and, f. manie f. gr. mania madness; passion, attraction. A strong, irresistible addiction or attraction to something. BAS 1. The rest of his bourgeois books are false and sweet. Des fadeurs! But you can’t get mania like the flu if... ... Historical Dictionary of Gallicisms of the Russian Language

Megalomania- this is a type of behavior or self-awareness of an individual, expressed in an extreme degree of overestimation of one’s fame, importance, popularity, genius, political influence, wealth, power, even omnipotence. Megalomania synonyms - delusions of grandeur and megalomania, translated from Greek μεγαλο means exaggerated or very large, and μανία - madness, passion.

In everyday life, non-professional people often mistakenly use the term “delusions of grandeur”, and understand by it an elevated, inadequate mood, marked by increased motor activity, accelerated speech and thinking. This is how mania is viewed in psychiatry.

In modern psychiatry, megalomania is not classified as a separate mental disorder, but is considered as a manifestation of one of the mental disorders. For example, as a component of a manic syndrome or symptom complex, in which delusional ideas are possible when mania reaches a severe degree with psychotic symptoms.

What is megalomania? This condition in psychiatry is considered not as an independent disease, but as a symptom of another pathological condition that is associated with a mental disorder.

Megalomania often appears with paranoid disorders and an inferiority complex. Signs of megalomania manifest themselves in the fact that they concentrate all their thoughts on personal exclusivity and importance to society. As a result, all conversations and actions of a sick person are aimed at alerting others about their own genius and uniqueness.

Causes of megalomania

The reasons lie in the symptoms of paranoid disorder or manic-depressive psychosis. Often this condition occurs due to various and affective conditions. A similar disorder can manifest itself after a traumatic brain injury and complications of progressive paralysis.

The following reasons for the development of this condition are identified:

• hereditary predisposition. If one of the parents has a similar disease, then it is most likely that the child will also have it;
• drug and alcohol addiction, previous syphilis;

Symptoms of megalomania

There are several stages of development of this condition. The initial stage of formation is characterized by primary symptoms that are little noticeable to people around. Over time, there is a further progression of the megalomania syndrome, which leads to vivid clinical manifestations and to, as well as the development of dementia.

Such a state is characterized by the individual’s denial of the irrationality of his behavior. The patient is truly confident that his judgments are the only correct ones and all other individuals should enthusiastically agree with him. But the symptoms of megalomania do not always manifest themselves with concomitant delusional disorder and obsessive attempts to instill in others their point of view. Often this disorder manifests itself with increased activity. This condition is typical for, in which phases alternate with episodes of mania. In the manic phase, the individual is completely confident in his own exclusivity, remains full of strength and energy, practically does not feel tired, and his level of energy increases. A person in this state not only extols his own ideas and thoughts, but also demands from those around him a similar attitude that elevates his personality.

The symptoms of this disorder are characterized by emotional instability, vigorous activity can be abruptly replaced by passivity, and a joyful mood by depression. Such mood swings in most cases cannot be controlled. Patients have a sharply negative attitude towards any criticism. Sometimes the patient ignores any comments addressed to him, and sometimes he responds to them and categorically refuses to accept other people’s opinions and help.

People with this mania experience sleep disturbances. Due to constant nervous arousal and increased activity, symptoms of the disorder often include insomnia, restless and shallow sleep. In severe cases, patients experience symptoms of depression, thoughts of, and even attempts to commit suicide. Individuals often experience severe exhaustion, both physical and mental.

Separately, it is necessary to consider the following variant of the course of the disease - severe depressive disorder with suicidal tendencies. There may be several reasons for the development of depression. If we are talking about a patient with bipolar disorder, then with such a disorder, mania is replaced by depression. This is a characteristic course of the disease. Often, severe depression can arise as a result of a person’s loss of reasons to consider himself better than everyone else. The moment of collapse of ideas about personal exclusivity, as a rule, is extremely difficult for patients to bear. A depressed mood can appear as a consequence of physical and nervous exhaustion of the body.

Delusions of grandeur often manifest themselves not just by not accepting criticism, but also by denying, as such, someone else’s point of view. Patients with such a mental disorder are often prone to committing completely irrational and dangerous acts, without reacting at all and without listening to the advice of others and loved ones.

It should be noted that megalomania is detected much less frequently in women than in men, and this disorder also occurs more aggressively in the male population. Often, it is a matter of trying to convey your ideas to those around you and convince them that you are right, which can lead to physical violence.

In women, the disease often takes the form of erotomania and is much milder. Typically, representatives of the fair sex are convinced that they are the object of someone’s ardent love and passion. Their mania extends to a well-known and public object.

Often, certain types of these disorders include signs of various delusional states, which are classified in clinical practice into separate forms.

Megalomania with paraphrenic delusions has pronounced fantastic features and is often combined with depersonalization personality disorder and persecution mania. The clinical picture can be supplemented by the patient’s pathological fantasies related to his uniqueness.

For example, a patient talks about his great deeds, which often take on completely fantastic forms. A person may claim that he must save the world or that he is constantly being watched from space, etc.

A megalomaniac may turn out to be a famous person, as in the case of the eminent mathematician John Nash, who refused a prestigious academic post on the grounds that he was to be enthroned as Emperor of Antarctica.

A less common type of delusional disorder, which is accompanied by delusions of grandeur and is the so-called messianic delusion. A person in this state imagines himself to be Jesus or appears to be his follower. There have been cases in history where individuals with a similar disorder became famous and gathered followers of their own cult.

The greatest danger to people around them are patients who suffer from Manichaean delusional disorder. Megalomania in this case is expressed in the fact that the sick person imagines himself as a defender of the world from the forces of good and evil. This is often observed in schizophrenia.

How to communicate with a person with delusions of grandeur? This question interests relatives and immediate circles. When communicating with such an individual, you should demonstrate your interest. It is wise to show the person that their opinion is valued. When talking with a patient, you should devote enough time and attention to this conversation. At the end of the conversation, regardless of the personal relationship, you need to thank for the thoughts expressed. It would be right to demonstrate trust in such a person. If the patient sees that they trust him, then this can confirm his sense of self-worth and gain self-confidence, and the interlocutor can avoid aggressive behavior towards him.

Treatment of delusions of grandeur

Mental disorder with delusions of grandeur should be treated promptly to prevent a depressive episode from developing.

How to get rid of delusions of grandeur? This disorder cannot be completely cured, but therapy for the underlying disease is very important, which is individually selected in each case and helps to slightly reduce the symptoms that appear.

Depending on the reason that caused mania in a person, antipsychotics, tranquilizers, sedatives are prescribed, and specific psychotherapy is carried out.

Since the patient is unable to recognize the seriousness of his condition, involuntary therapy may be required. If necessary, the patient is placed in a psychoneurological dispensary and treated in a hospital setting.

In clinical psychiatry, megalomania is defined as a form of psychopathological condition or one of the varieties of affective syndrome in which a person has a false belief that he has outstanding qualities, is omnipotent and famous. Often possessed by delusions of grandeur - in the complete absence of any objective grounds - he so overestimates the importance and significance of his personality that he considers himself an unrecognized genius.

In addition, there may be illusions of having close relationships with famous people or fantasies about receiving a special message and a special mission from higher powers, the meaning of which no one understands...

Epidemiology

According to international studies, megalomania in drug addiction and substance abuse occurs in 30% of cases, in patients with depression - in 21%.

With bipolar mental disorder, this pathology develops in patients under 20 years of age in 75% of cases, equally in men and women, and in people 30 years of age and older (at the time of onset) – in 40%.

In addition, delusions of grandeur develop much more often in people who have a higher level of education, who are more emotional and prone to affectation.

Causes of megalomania

Psychiatrists admit that it is difficult to determine the specific causes of megalomania. Some consider this mental disorder to be an extreme manifestation of the narcissism syndrome; others associate it with bipolar affective disorders (in the stage of increased excitability) and argue that most often megalomania is a symptom of the paranoid type of schizophrenia.

Obviously, this is close to the truth, since almost half (49%) of people suffering from this form of schizophrenia are obsessed with delusions of grandeur. In addition, comorbidity (i.e., a combination of pathogenetically interrelated diseases) of the syndrome of narcissism and bipolar disorder is noted: approximately 5% of patients with bipolar disorder have narcissistic personality disorder. Moreover, both diseases potentiate each other, and then megalomania can be diagnosed (59%).

Among the main causes of megalomania are also:

Lesions or anatomical abnormalities of the brain, particularly in the frontal lobe, amygdala, temporal lobe, or parietal cortex.

A genetically determined increase in the concentration of neurotransmitters or a change in the density of dopaminergic receptors in the brain. That is, the pathogenesis of mental pathology is associated with the fact that in some areas of the brain there is an excess of dopamine neurotransmitters with a simultaneous deficiency of its receptors, and this leads to overactivation or inadequate activation of a particular hemisphere (as studies have shown, most often this is the left hemisphere). Among the causes of megalomania, 70-80% are genetic factors.

Neurodegenerative diseases (Alzheimer's disease, Huntington's disease, Parkinson's disease, Wilson's disease), although the percentage of patients who, with these diagnoses, may develop a mental disorder in the form of secondary megalomania is relatively small.

Drug addiction, since narcotic substances cause drug-induced psychosis (very often with delusions of superiority and omnipotence).

Use of certain medications. In particular, this applies to Levodopa (L-dopa), used to treat cognitive impairment in Parkinson's disease; withdrawal of this drug changes the monoaminergic function of dopamine mediators.

Risk factors

The following psychological and emotional risk factors for the occurrence of this pathological mental state are called:

Severe depressive disorders (in which megalomania becomes a protective mechanism of the psyche);
-obsession with achieving the highest educational development and socio-economic status;
-living alone for a long time, lack of family relationships.

In addition, foreign psychiatrists associate risk factors for the development of secondary megalomania with vitamin B12 deficiency, thyrotoxicosis and carcinoid syndrome in the presence of neuroendocrine (catecholamine-producing) tumors.

Symptoms of megalomania

Some symptoms of megalomania were named at the very beginning of the publication. It remains to add that - in addition to the conviction of his extraordinary abilities and deep knowledge - a person believes in his own invulnerability and believes that he does not need other people.

The first signs may manifest themselves in the form of a constant desire to be the center of everyone's attention, the need for admiration, as well as recognition and assertion of one's superiority over others. That is, the ability for objective self-esteem disappears and emotional egocentrism begins to develop.

In most cases, megalomaniacs are pathologically boastful and behave in a pretentious and effusive manner. Their mood changes very often and for no reason, energy gives way to irritability and outbursts of anger. There is a decrease in the need for sleep and rest, disturbance of appetite (overeating or refusal of food), as well as tachypsychia - jumping from one thought to another, accelerating the rate of speech.

Conflicts with others are perceived by patients as the reluctance of others to recognize the unique qualities of their own personality (which exist only in the patient’s imagination). Some patients believe that they are kings, great generals or inventors, or direct descendants of famous people. Compared with narcissism syndrome, patients with megalomania tend to be more active and aggressive.

Stages

As the symptoms of megalomania progress, three stages of this psychopathological condition are distinguished:

Initial (its first signs were listed above);
-progressive stage (accompanied by auditory hallucinations and confabulation);
- stage of extreme severity - paranoid delusions of grandeur or psychosis with fantastic hallucinosis, attacks of aggressiveness, decreased mental abilities.

Complications and consequences

Consequences and complications are associated with disruption of human behavior and functioning in society. At the same time, according to most psychiatrists, patients suffering from delusions of grandeur have a lower risk of suicidal thoughts and attempts.

Diagnosis of megalomania

The main diagnosis of megalomania involves identifying this pathology using a special Young test, which was developed by a group of foreign psychiatrists.

In the so-called Young Mania Rating Scale (YMRS) eleven five-choice questions included.
Questions concern:
- level of mood, motor activity and energy level;
-sexual interests;
-duration and quality of sleep;
-degree of irritability;
-assessment of speech, thinking disorders and the content of the patient’s conversations;
-explosive or aggressive behavior;
- features of appearance (neatness or carelessness in clothing, etc.), as well as the degree of awareness of the presence of the disease or complete denial of any changes in behavior (in most cases, such conditions are characterized by egosyntonicity, that is, the patient perceives his behavior from the point of view of his own standards).

The psychiatrist compares the test results (and, as practice has shown, it has a fairly high level of false assessments) with the symptoms that the patient or (most often) his relatives complain about, as well as with those clinical signs that appeared and were identified by the doctor during the conversation with the patient.

Differential diagnosis

In psychiatry, differential diagnosis is very important, since both schizophrenia and bipolar disorder are mental disorders with loss of contact with reality and psychotic behavior. And it is necessary to clearly identify maladaptive personality traits in order to avoid misdiagnosis and find specific approaches necessary for treatment.

Treatment of delusions of grandeur

Treatment of megalomania is carried out to improve the patient’s condition, since it is impossible to cure this mental pathology.

Some patients may benefit from individual sessions of cognitive behavioral therapy, which is aimed at correcting irrational thinking and inappropriate behavior. Others are more helped by interpersonal or interpersonal therapy, aimed at developing algorithms for resolving conflict situations in which the patient finds himself.

For circadian rhythm disturbances associated with bipolar disorder, social rhythm therapy, a type of behavioral therapy, is used.

For patients suffering from severe megalomania, psychotropic drugs are needed - neuroleptics and antipsychotics that stabilize the mental state.

Also, in the treatment of this pathology, the patient’s conscious adherence to all medical prescriptions (complex therapy) is of great importance.

The prognosis depends on the severity of the disease and the intensity of its manifestation. In any case, megalomania is a sign of abnormal, inadequate mental activity of a person.