| Oneiroid syndrome | |
|---|---|
| Pronunciation |
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| Specialty | Psychiatry |
| Symptoms | Vivid scenic hallucinations, pseudohallucinations, catatonic symptoms (mutism, waxy flexibility, negativism), delusions, disorientation in place, time, self, double orientation, stupor or sub-stupor |
| Duration | A few weeks or days |
| Causes | Catatonic schizophrenia |
| Diagnostic method | Based on symptoms |
| Differential diagnosis | Delirium |
Oneiroid syndrome (OS) is a condition involving dream-like disturbances of one's consciousness by vivid scenic hallucinations, accompanied by catatonic symptoms (either catatonic stupor or excitement), delusions, or psychopathological experiences of a kaleidoscopic nature. The term is from Ancient Greek "ὄνειρος" (óneiros, meaning "dream") and "εἶδος" (eîdos, meaning "form, likeness"; literally dream-like / oneiric or oniric, sometimes called "nightmare-like"). It is a common complication of catatonic schizophrenia, although it can also be caused by other mental disorders. The dream-like experiences are vivid enough to seem real to the patient. [1] OS is distinguished from delirium by the fact that the imaginative experiences of patients always have an internal projection. [1] This syndrome is hardly mentioned in standard psychiatric textbooks, possibly because it is not listed in DSM. [2]
The German physician Wilhelm Mayer-Gross first described oneiroid states in 1924. Mayer-Gross's 1924 dissertation "Self-descriptions of Confusional States: the Oneiroid Form of Experience" (German: Selbstschilderungen der Verwirrtheit: die Oneiroide Erlebnisform) is considered to be the first monograph discussing oneiroid states. [3] It is the psychopathological method (known to German psychiatrists as the "phenomenological method" – phänomenologische Methode ). [3]
The term "oneiroid syndrome", while generally known to European and Russian psychiatrists, remains largely unfamiliar in the United States. [2]
Included in the 9th edition of Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death, adapted for the USSR (ICD-9, 1983), were two diagnoses of oneiroid states in section 295.2 (catatonic schizophrenia):
According to Soviet psychiatric research, oneiroid syndrome occurs alongside catatonic schizophrenia in the great majority of cases. The catatonic phenomena in catatonic schizophrenia (code F20.2) may be combined with oneiroid syndrome, as it is written in the current version of the ICD-10.
Oneiroid syndrome is characterized by the extraordinary and fantastical nature of its psychotic experiences. [4] Characteristic to the condition are mixed feelings, conflicted thoughts, contradictory experiences and actions, a sense of dramatic changes in the world, and simultaneous feelings of triumph and catastrophe. [4] Oneiroid syndrome is often accompanied by frequent hallucinations and pseudohallucinations, as well as visual illusions. [4] Patients do not identify the perceived phenomena as belonging to the real world, but rather as belonging to other realms or spheres, which cannot be observed or accessed by ordinary people. [4] Patients often participate mentally in narratives of considerable detail and drama, sometimes with the ability to observe themselves from the outside. [4] Their actual behavior, however, does not typically reflect the richness of their experience at the time in which it is occurring. [4]
A patient with oneiroid syndrome will often experience unusual and colourful pseudohallucinations. [1] The environment may be perceived as having been specially set as for a show. [1] Some patients in an oneiroid state might believe that during such an experience their lives are staged shows; in this case it is similar to the Truman Show delusion.
There is often disorientation regarding place and time, as well as a double-awareness of oneself: a patient might be aware simultaneously that he or she is in the hospital, as well as a participant in a fantastical narrative. [1] Individuals surrounding the patient may also be perceived by the patient as being participants in the same narrative, and might be regarded as either friendly or hostile. [1] The behavior of a patient who is in an oneiroid state sharply contrasts with his or her fantastic pseudohallucinatory symptoms – patients usually lie motionless in bed, with closed eyes, sometimes making "smooth flying" movements with their hands, watching their fantastic adventures as if from the outside. [1] Patients often experience distortions of time of immense proportions: for example, a patient may report that he or she has been flying for several light years, and that during that time, he or she died several times and was raised from the dead by cloning, with each of the clones living for several hundred years. [1] Sometimes, patients do not lie on their bed, but instead wander thoughtfully through the mental institution with an "enchanted smile," withdrawn into themselves. [1] At times, they are capable of directly reporting their fantastical experiences. At their height, single catatonic symptoms can appear in the form of, for example, catalepsy or sub-stupor. The themes of oneiroid experience are derived from the patient's own experiences, from books, fantasy, or films of appropriate content (probably, that is why the story of the experiences is different for all). [1]
Catatonic stupor can be accompanied by a clear consciousness – lucid catatonia – or with a disorder of consciousness – oneiroid catatonia. Oneiroid catatonia combines with dream-like experiences, and a patient only communicates with people after the end of the episode of stupor (contact with a patient actively experiencing oneiroid catatonia is often very difficult and useless).
Patient's movements often become restricted, becoming catatonic for a short period: stereotypies – body-rocking, head banging, mutism, negativism (failure to cooperate or the active subversion of demands made of the patient), waxy flexibility, impulsive actions. [4] Sometimes the patient's speech is completely incoherent, but sometimes they are able to answer questions, offering an opportunity for a physician to identify the nature of the patient's disorientation. [4] Patients can be disoriented not only with respect to place and time, but also can be disoriented with respect to themselves and their own personality. [4]
Oneiroid syndrome most often occurs as the manifestation of an acute episode of schizophrenia. [4] The duration of the oneiroid period is limited to a few weeks or days. [1] The first signs of the beginning of a psychotic episode are sleep disorders and a growing sense of anxiety. [4] The patient's concerns quickly reaches a level of total bewilderment. [4] Vivid emotions and the phenomena of derealization serves as the basis for fragmentary, unsystematized delusions (acute picturesque delusion). [4]
The initial fear is soon replaced by an affect of amazement or sheer ecstasy. [4] Patients quiet down, looking around with a keen interest in their surroundings, and become excited by colors and sounds. [4] Later, patients develop catatonic stupor or catatonic agitation. [4] The duration of the oneiroid episode is different from patient to patient. Often, spontaneous recovery occurs within a few weeks of onset. [4] The termination of the psychosis is gradual: hallucinations disappear very quickly, but catatonic phenomena and irregular behavior sometimes persist for a long time. [4] After the end of the psychosis, patient can describe some fragments of their psychopathological experiences, but this story is usually inconsistent. [4]
An oneiroid-schizophrenic state also can be induced by the Kandinsky-Clérambault syndrome. [5] This is typical for people with paranoid schizophrenia who also suffer from the oneiroid syndrome.
After leaving the oneiroid state, the patient may remember their fantastic experiences, but suffer amnesia about the real events that occurred in his life during this psychotic episode. Residual delusion may persist for a few days afterward.
Oneiroid catatonia is one of the most favorable schizophrenic psychoses, it poses minimal complications in the aftermath of an episode, and a patient can undergo treatment and recover without significant personality changes. [4]
During extremely strong breaks of consciousness, a patient may very rarely develop hyperthermia, accompanied by an increasing cerebral edema and impaired cardiac activity (known as "febrile schizophrenia" in Russia and "lethal catatonia" in the west). [4] The immediate initiation of intensive therapy can now save most of these patients. [4]
The use of antipsychotics in lethal catatonia is considered ineffective [6] and very dangerous. Instead, psychiatrists recommend the use of benzodiazepines, symptomatic therapy, as well as dantrolene, [7] bromocriptine, [7] ketamine and amantadine [8] for treatments of this condition.
The exact causes of oneiroid syndrome are unknown. However, it is pathologically connected to the following conditions:
Most often, this pathology is noted in schizophrenia (oneiroid catatonia), but sometimes it is described with organic brain lesions and intoxications. [1]
There is no self-consciousness disorder in oneiroid syndrome with exogenous diseases. There are no catatonia phenomena, and the syndrome ends more rapidly. [4] Oneiroid syndrome in exogenous organic diseases is evidence of a severe deterioration in the patient's response to the organic disease, and its transition to amential syndrome or mental fog is an even more unfavorable symptom. [4]
Exogenous organic oneiroid is different from schizophrenic oneiroid. [4] In most cases, the described exogenous psychoses occupy an intermediate position between delirium and oneiroid, with a rapid and dynamic development of symptoms and an increase in psychotic symptoms occurring during the evening (as is typical for delirium). [4] Clinical resolution of such psychoses after deep sleep also points to a case of delirium. [4] All of this allows us to relate these diagnostic categories to have the variants of delirium ("fantastic delirium"). Hallucinogens (LSD, hashish, ketamine) and hormonal preparations (for example, corticosteroids) may cause exogenous oneiroid syndrome. [4]
Later in 1961 the Bulgarian psychiatrist S. T. Stoianov studied the dynamics and the course of the oneiroid syndrome in "periodic", or recurrent schizophrenia. [9] In the ICD-9 was a diagnosis 295.79: recurrent schizophrenia without other specifications (also known as periodic schizophrenia or circular schizophrenia). It was deleted from the ICD-10. In the DSM-5 there is no such diagnosis, either.
According to this research the syndrome has six stages in its course:
In most of the cases of the oneiroid syndrome, there were crude pathological changes in the electroencephalography (EEG). [11]
Catatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. It has historically been related to schizophrenia, but catatonia is most often seen in mood disorders. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. Catatonia is now a stand-alone diagnosis, and the term is used to describe a feature of the underlying disorder.
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.
A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."
A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek σύνδρομον, meaning "concurrence". When a syndrome is paired with a definite cause this becomes a disease. In some instances, a syndrome is so closely linked with a pathogenesis or cause that the words syndrome, disease, and disorder end up being used interchangeably for them. This substitution of terminology often confuses the reality and meaning of medical diagnoses. This is especially true of inherited syndromes. About one third of all phenotypes that are listed in OMIM are described as dysmorphic, which usually refers to the facial gestalt. For example, Down syndrome, Wolf–Hirschhorn syndrome, and Andersen–Tawil syndrome are disorders with known pathogeneses, so each is more than just a set of signs and symptoms, despite the syndrome nomenclature. In other instances, a syndrome is not specific to only one disease. For example, toxic shock syndrome can be caused by various toxins; another medical syndrome named as premotor syndrome can be caused by various brain lesions; and premenstrual syndrome is not a disease but simply a set of symptoms.
Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis.
Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in the DSM 5, published in 2013. The disorder is no longer listed in the 11th revision of the International Classification of Diseases (ICD-11).
Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.
This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.
Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.
Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.
Karl Leonhard was a German psychiatrist who was a student and collaborator of Karl Kleist, who himself stood in the tradition of Carl Wernicke. With Kleist, he created a complex nosology of psychotic illnesses. His work covered psychology, psychotherapy, biological psychiatry and biological psychology. Moreover, he created a classification of nonverbal communication.
Waxy flexibility is one of the twelve symptoms that can lead to the diagnosis of catatonia. It is a psychomotor symptom that results in a decreased response to stimuli and a tendency to remain in an immobile posture. If one were to move the arm of someone with waxy flexibility, the patient would keep that arm where it had been positioned until moved again as if positioning malleable wax. Attempts to reposition the patient are met by "slight, even resistance".
Brief psychotic disorder—according to the classifications of mental disorders DSM-IV-TR and DSM-5—is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.
Postpartum psychosis (PPP), also known as puerperal psychosis or peripartum psychosis, involves the abrupt onset of psychotic symptoms shortly following childbirth, typically within two weeks of delivery but less than 4 weeks postpartum. PPP is a condition currently represented under "Brief Psychotic Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Volume V (DSM-V). Symptoms may include delusions, hallucinations, disorganized speech, and/or abnormal motor behavior. Other symptoms frequently associated with PPP include confusion, disorganized thought, severe difficulty sleeping, variations of mood disorders, as well as cognitive features such as consciousness that comes and goes or disorientation.
Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.
The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.
Simple-type schizophrenia is a sub-type of schizophrenia included in the International Classification of Diseases (ICD-10), in which it is classified as a mental and behaviour disorder. It is not included in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the upcoming ICD-11, effective 1 January 2022. Simple-type schizophrenia is characterized by negative ("deficit") symptoms, such as avolition, apathy, anhedonia, reduced affect display, lack of initiative, lack of motivation, low activity; with absence of hallucinations or delusions of any kind.
Bouffée délirante (BD) is an acute and transient psychotic disorder. It is a uniquely French psychiatric diagnostic term with a long history in France and various French speaking nations: Caribbean, e.g., Haiti, Guadeloupe, Antilles and Francophone Africa. The term BD was originally coined and described by Valentin Magnan (1835–1916), fell into relative disuse and was later revived by Henri Ey (1900–1977).
Autistic catatonia is a term used to describe the occurrence of catatonia in autistic people. Catatonia occurs in roughly 10 percent of people diagnosed with an autism spectrum disorder. In addition to the common sign of catatonia, autistic people with catatonia are more likely to stim and self-harm.
Bell's mania, also known as delirious mania, refers to an acute neurobehavioral syndrome. This is usually characterized by an expeditious onset of delirium, mania, psychosis, followed by grandiosity, emotional lability, altered consciousness, hyperthermia, and in extreme cases, death. It is sometimes misdiagnosed as excited delirium (EXD) or catatonia due to the presence of overlapping symptoms. Pathophysiology studies reveal elevated dopamine levels in the neural circuit as the underlying mechanism. Psychostimulant users as well as individuals experiencing severe manic episodes are more prone to the manifestation of this condition. Management solutions such as sedation and ketamine injections have been discussed for medical professionals and individuals with the condition. Bell's mania cases are commonly reported in countries like the United States and Canada and are commonly associated with psychostimulant use and abuse.