Mental automatism syndrome: causes, treatment Articles

Kandinsky-Clerambault syndrome is a serious mental illness characterized by pathological changes in the emotional and sensory sphere, disorders of motor and thought processes. Acute obsessive states form the basis of this syndrome. Patients think that their consciousness is influenced by extraneous forces in a wide variety of ways: through hypnosis, damage, the evil eye, alien interventions. Such an effect causes harm to the patient. In extremely rare cases, it is aimed at re-education, strengthening the will, and preparing for the future.

The symptoms of Kandinsky-Clerambault syndrome were first described by the Russian psychiatrist V. Kandinsky. 40 years later, more detailed information about pathology appeared in psychiatry. A psychiatrist from France, M. Clérambault, who suffered from schizophrenia, spoke about his symptoms.

The pathology is manifested by delusions, hallucinations, alienation, “made” movements, unnatural behavior and strange actions. Patients believe that their body and mind are constantly being influenced by strangers. They control thoughts and actions, forcing complete submission. Persons with Kandinsky-Clerambault syndrome lose their own “I”, become helpless, lose control over themselves, and stop performing everyday activities and basic duties.

Types of mental automatisms:

The associative or ideational type is manifested by an endless stream of thoughts, their influx, abduction, “reading” of thoughts by strangers. This type of automatism is based on non-verbal communication with non-existent individuals, often with offenders. Patients believe that their ideas are stolen and other people's thoughts are imposed. The people around them, in their opinion, know what they are thinking about.
Senestopathic or sensory type is manifested by a “made mood”, causeless joy, anger, sadness, fear, delight. Patients experience unpleasant, painful or painful feelings inside: pressure, distension, tension, burning, pulsation, cooling. Sexual arousal, perverted appetite, sense of smell and taste, defecation disorders are the main manifestations of sensory automatism.
The motor type is manifested by psychomotor hallucinations. Patients remain confident in the constant external influence on their movements and actions. Their gestures and facial expressions become unnecessary and involuntary, and stupor often occurs. All movements from turning the head to raising the hand are subject to someone else's will. Intermittent speech is caused by certain difficulties with opening the mouth and moving the tongue. Even blinking the eyes causes many problems for patients.

Kandinsky-Clerambault syndrome can occur at any age. In the evenings, children experience visual hallucinations and an endless stream of thoughts. In young men, the pathology manifests itself in all three components. In textbooks on psychiatry, special attention is paid to the ideational component, which is predominant. In adults, all components of automatism appear with a full set of symptoms characterizing them.

Etiology

Mental automatism syndrome is a manifestation of a number of diseases:

schizophrenia,
psychoses of various origins,
epilepsy,
acute infection and intoxication,
poisoning with amphetamines, methamphetamines, cocaine and other psychostimulants,
addiction,
head injuries,
neoplasms in the brain,
cerebrovascular accident,
alcoholism,
Wilson's disease
prolonged overwork or chronic stress.

Under the influence of negative factors on the psyche, defense mechanisms are activated, manifesting themselves in the form of automatisms. Most often, sensory automatism develops. To justify a traumatic event, the patient interprets them as the result of external influence. Patients experience delusions, hallucinations and other symptoms.

Kandinsky-Konovalov syndrome. Signs, treatment, prognosis

Kandinsky-Konovalov syndrome (Kandinsky-Clerambault) is one of the types of hallucinatory-paranoid syndrome, also called mental automatism syndrome. This is a mental state characterized by alienation or loss of “self”, denial of one’s own mental processes (sensory, motor and mental).

This state is combined with a feeling of the influence of some external force. Thus, Kandinsky-Konovalov syndrome is defined as a delusional state, accompanied by a feeling of physical and mental impact, as well as delusions of persecution. Most often, this syndrome is observed in schizophrenia, but it also occurs as a concomitant symptom, for example, in a disease such as Konovalov-Wilson disease.

Neuropsychiatric manifestations of Wilson's disease include speech disorders, poor facial expressions, tremors, excessive salivation, and impaired motor coordination. In Konovalov-Wilson disease, unlike Konovalov syndrome, intelligence is completely preserved. However, impulsive behavior is observed, accompanied by aggressive reactions and manifestations of numerous phobias.

Wilson's disease is hereditary and is caused by a violation of the normal distribution of copper in the body, which leads to its accumulation in the body. This, in turn, causes both liver damage (cirrhosis) and damage to the cerebellum, cerebral cortex and basal ganglia. The disease is accompanied mainly by damage to the liver and central nervous system, involving the kidneys and eyes in the pathological process.

Kandinsky syndrome. Clinical picture

There are two main types of Kandinsky syndrome, according to the detection of symptoms of a certain type:

- with a predominance of delusions of influence (mental automatism), caused, as a rule, by a greater severity of the pathology of the sphere of thinking;

- with a predominance of neuro-hallucinatory disorders.

It is noteworthy that this syndrome occurs only in humans. Delusions of persecution and pseudohallucinations are realized in the patient’s imagination in a wide variety of ways: from hypnosis and witchcraft, to the technogenic influence of modern devices. For example, atomic energy or “electromagnetic radiation” emanating from a computer monitor screen.

The prognosis for overcoming such a condition as Kandinsky-Konovalov syndrome is extremely unfavorable.

In psychiatry, there are three types of mental automatism:

- associative or ideational;

- sensory, or senestopathic;

- kinesthetic or motor.

Associative or ideational automatisms are the result of an imaginary influence on mental processes, as well as other types of mental activity. The simplest type of manifestation of associative automatisms is mentism, that is, an involuntary train of thoughts and ideas, accompanied by the patient’s feeling that his thoughts are known to everyone around him.

Sensory (senestopathic) automatisms include unpleasant sensations that also arise in patients, allegedly as a result of external influences. They can be very different. For example, they may manifest themselves as a feeling of sudden cold or heat, a feeling of pain “somewhere inside”, in the head or in the limbs.

Motor (kinesthetic) automatisms include disorders in which patients are convinced that the movements they perform are not performed by themselves, but against their will. Visual pseudohallucinations include visions: faces, images, panoramic pictures shown to the patient, as a rule, by his pursuers using certain technogenic devices.

Treatment of Kandinsky-Konovalov syndrome

To treat periods of exacerbation of the syndrome, a complex of antipsychotic medications such as triftazine and haloperidol is used. In addition, if psychotropic drugs have a positive effect, the patient must be treated by a psychotherapist with subsequent rehabilitation.

Unlike such a condition as Kandinsky-Konovalov syndrome, treatment of Konovalov-Wilson disease is symptomatic. Its goal is to reduce the amount of copper entering the body and reduce existing reserves of this substance. For this purpose, the patient is prescribed a diet for life that involves a complete abstinence from foods rich in copper: legumes, coffee, chocolate, nuts, and so on.

Drug treatment of Konovalov-Wilson disease is carried out using drugs that remove copper from the body. For example, D-penicillamine, as well as zinc salts. In this case, treatment is prescribed strictly individually for each patient, but subject to a gradual increase in drug doses.

Whatever the causes of various disorders in human behavior, the main reason causing the transition of any mental disorder into a chronic form is the lack of proper attention to the person from loved ones. In any case, late diagnosis and lack of appropriate treatment can lead to death for the patient.

Clinical picture

Symptoms of the disease are: obsessive pain, hallucinations, forced pronunciation of words and phrases. Someone controls the body and thoughts of patients. Patients experience various phenomena, including a burning sensation throughout the body and “fluid overflowing inside.”

The acute course of the pathology is characterized by a vivid manifestation of feelings. Patients become overly talkative, active, often aggressive and irritable. They develop delusional fantasies, complaints become fragmented and paradoxical. During attacks, patients show excessive alertness and suspicion, are afraid of everyone and often panic. The acute period lasts two to three months. Patients fall out of the normal rhythm of life, they are completely absorbed in delirium.

The chronic course of the pathology is characterized by long and slow development. Signs of associative automatism are replaced by symptoms of sensory or motor automatism. The main symptoms become vague and difficult to diagnose.

Sudden mood swings make the patient believe that his emotions are “made up.” Timely treatment of the pathology by a psychotherapist and taking sedatives can stop the further development of the pathological process. If the next stage does occur, motor, associative or sensory self-awareness appears. Patients withdraw into themselves and no longer hide their subordination to “external forces.” In this case, the prognosis of the disease is extremely unfavorable.

Clinical signs of motor automatism:

Video: examples of interviewing patients with Kandinsky-Clerambault syndrome

Mental automatism syndrome

Mental automatism syndrome (Kandinsky-Clerambault syndrome) is a type of hallucinatory-paranoid syndrome in which the patient has pseudohallucinations, delusional ideas of influence of both a mental and physical nature, and the phenomenon of mental automatism. The patient loses his own thinking, emotional, sensory and motor processes, the patient seems to be under the influence of some extraneous forces, sometimes indicating who is controlling him. To the patient, his own thoughts and actions seem made by someone else and unnatural.

With the development of mental automatism syndrome, three types of automatisms appear: ideational, senestopathic, and motor.

Ideatorial automatisms - the patient believes that his thoughts do not belong to him, that they are “put into” his head, there may be a feeling that the people around him know what he is thinking about. Such a patient will also consider any dream to be “put into his head.” The symptom of “echo thoughts” is clearly expressed - the patient is sure that the people around him are speaking his thoughts out loud. Patients tend to mentally communicate with people, especially if they believe that these people “invest” their thoughts and memories.
Senestopathic automatisms - the patient is bothered by senestopathies (unpleasant sensations on the surface of the body or in some organ) or natural sensations in the body, which, in his opinion, are “caused by someone”; sometimes patients talk about cosmic rays and magic. This includes pseudohallucinations (gustatory, olfactory).
Motor automatisms - patients believe that walking, speaking and facial expressions are beyond their control, everything is controlled by someone else, telling them what to do.

This syndrome usually develops in schizophrenia and psychosis (alcoholic, epileptic, traumatic).

The syndrome can develop in two forms: acute and chronic. With the development of an acute form of the disease, the patient develops figurative delusions with a strong emotional state: there may be hostility, wariness, distrust, and fear. The patient also has contradictory symptoms, they change quickly, and the patient is in a state of agitation. The chronic form can develop for years, including all of the above types of automatisms, which reach incredible proportions (the patient may accuse doctors of removing organs, look for traces of extraterrestrial civilizations commanding the patient’s actions).

The chronic form is considered more dangerous, because the hallucinatory-paranoid picture worsens over time, which is more conducive to personality changes.

It is possible to prevent the development of this syndrome in patients by ensuring proper treatment of the diseases that caused this condition (schizophrenia, alcoholic psychosis, etc.). Diagnosis of the developed Kandinsky-Clerambault syndrome is carried out by a psychiatrist; differential diagnosis is carried out with hallucinatory-delusional syndrome, in which true hallucinations are present, but the very idea of extraneous influence of external conditions on the patient’s thoughts, actions and feelings is absent.

Treatment must be carried out in a psychiatric hospital. The doctor prescribes neuroleptics, psychotropic drugs, antidepressants, tranquilizers. Psychotherapy may be used.

Source: N. G. Neznanov. Psychiatry.

Treatment

Treatment of patients with Kandinsky-Clerambault syndrome is complex. It consists of drug therapy, psychotherapy, and rehabilitation measures. If the syndrome occurs during schizophrenia or psychosis, patients are hospitalized in psychoneurology.

Psychotropic drugs:

Neuroleptics that inhibit nervous processes in the central nervous system - Aminazine, Sonapax, Leponex.
Antidepressants that promote the production of substances that improve mood - Amitriptyline, Prozac, Imipramine.
Tranquilizers that relieve anxiety, fear, restlessness and asthenia, as well as normalize sleep - Phenazepam, Clozepid, Amizil.
Sedatives of plant origin – “Novopassit”, “Persen”, “Sedasen”.

In addition to drug therapy, patients are recommended psychotherapy. Cachexic patients are prescribed brewer's yeast, iron supplements, vitamins and other tonic agents. Regular visits to a psychotherapist are combined with exercise therapy and strict adherence to a diet that limits copper-containing products. Long walking and swimming are recommended for all patients. Morning exercises, hardening procedures, and fighting bad habits help delay or prevent relapse of the pathology. A calm environment in the family, the attention of relatives and the support of friends are necessary for patients with paranoid Kandinsky-Clerambault syndrome.

Traditional treatment:

Peony root tincture has a pronounced sedative effect on the patient’s body.
A decoction of thyme, hops, oregano and mint relieves nervous tension and saves from insomnia.
Fragrant mignonette is infused with vegetable oil and rubbed into whiskey.
An infusion of blackberry leaves and hop cones strengthens the nervous system.
Henbane, datura and belladonna have a positive effect on the psycho-emotional state of a person.

Kandinsky-Clerambault syndrome is a complex and serious disease. Timely diagnosis and adequate treatment of the acute form of the pathology allow patients to fully recover and make the prognosis of the disease favorable. In such cases, the disease undergoes reverse development and ends with recovery. The chronic form is prone to long-term progression, complications of the clinical picture and personality degradation.

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Great Medical Encyclopedia Author: Anufriev A.K.

Kandinsky-Clerambault syndrome is a symptom complex manifested by alienation, or loss of belonging to one’s own mental processes (ideational, sensory, motor) with simultaneous awareness of the extraneous influence of an uncertain or specific force; accompanied by delusions of mental and physical influence and persecution.

Synonyms of Kandinsky-Clerambault syndrome: mental automatism syndrome, external influence syndrome, influence syndrome, invasion syndrome, alienation syndrome, “S” syndrome, mastery syndrome.

For the first time in all its diversity, the syndrome was described by the Russian psychiatrist BX Kandinsky (1849-1889), but 40 years later it was named after the French psychiatrist MGG de Clerambault, (1873-1934), who gave a classification of phenomena related to this psychopathological symptom complex. Domestic psychiatrists studied psychopathology and the clinic of Kandinsky-Clerambault syndrome in various mental illnesses.

In the structure of Kandinsky-Clerambault syndrome, three types of mental automatisms are distinguished:

associative (ideational, or higher mental)
senestopathic (sensory or sensual);
kinesthetic (motor, or motor).

Clinical picture

Associative automatism (according to Clerambault) develops as follows. At first, sudden stops and delays of thoughts or their acceleration occur involuntarily. Then strange syllables, absurd thoughts, unusual desires or impulses appear in the patient’s mind. Gradually, the process of thinking is more and more complicated by spontaneously arising “parallel”, “intersecting:) thoughts that are alien to the entire make-up of the personality. They either quickly disappear and reappear in an influx, or acquire (sometimes together with visual ideas) a non-stop flow (mentism). Involuntary memories are of the same nature, having an intrusive connotation with a vague feeling of unconscious compulsion (“retrieval of old memories,” a symptom of unwinding memories). Subsequently, the patient feels that his own mental manifestations come as if from outside (anticipating thoughts, ideas, desires, etc.).

The central link of associative automatism is designated as a symptom of “echo of thoughts” - the assumption gradually arises, and then the confidence of patients that their thoughts, innermost desires seem to be reflected and become known to outsiders.

As a result of further progression of the disorder, associative automatisms manifest themselves in the form of mental dialogues: according to patients, “telepathic” or “hypnotic” contacts with other people arise. There is a mental exchange of opinions, a “conversation with the mind”, a silent conversation at a distance “in the language of the soul”, which certainly touches on something from the intimate personal experience of the patients, positive or negative (“encouraging” or “praising” phrases, intimate revelations, “sensational revelations” ").

These phenomena, devoid of sensorial-acoustic nuance, are called “psychic” or “incomplete hallucinations” by Baillarger (1846) or “autochthonous ideas” by Wernicke (1898). Alienated-violent thoughts gradually acquire a verbal-acoustic connotation, and at first patients feel like a “rustling”, “rustling of thoughts”, which then turn into a whisper and, finally, begin to sound.

Involuntary thinking, alienated inner speech are transformed into sonorous thoughts, internal “voices”. From this moment the hallucinatory-paranoid period of associative automatism , that is, the Kandinsky-Clerambault syndrome itself, a characteristic feature of which, in addition to delusions of persecution or external influence, are verbal pseudohallucinations. Associative automatism also includes involuntary, violently occurring visual phenomena, which, with further progression of the pathological process, turn into visual pseudohallucinations.

The latter appear in the form of distinct visions, stage pictures, perceived as extremely vivid images before the “spiritual” gaze. And although they are sometimes projected into external space, they are not identified with real objects, but are recognized as a subjective internal phenomenon, forcibly caused from the outside.

A number of affective disorders are also classified as associative automatism: induced mood, excitement, induced fear, anger, sadness or joy, induced voluptuousness, disgust, inspired inspiration or indifference, emotional devastation or ecstasy. These disorders, to a certain extent, are already adjacent to sensory (senestopathic) automatism .

Senestopathic automatism consists of spontaneously occurring, vague, but extremely unpleasant, sensory painful sensations, which patients often attribute to internal organs and systems: a feeling of a rush of heat or cold, distension or compression of the brain, stomach, twisting of the intestines, movement of one or another internal organ, “fluttering and freezing” of the heart, constriction of the throat, piercing, like an electric current, inside the skull or spine, tingling in the limbs, goosebumps crawling under the skin, etc.

Previously never experienced sensations are difficult to describe - patients resort to comparisons and auxiliary words (“as if”, “as if”, “like ...”). In the presence of a delusional interpretation, pathological sensations are regarded by patients as forcibly caused by others (delusions of physical influence). In some cases, sensations acquire a visual-figurative connotation and patients associate them with specific external objects or living beings (delirium of obsession). As a result, they are classified as endosomatic pseudohallucinations , or hallucinations of the general sense.

The hallucinatory-paranoid complication of this disorder sometimes takes on a bizarre and grotesque form, designated by P. Schroder (1926) as “fantastic hallucinosis.” Sensory automatism also includes various changes or perversions of appetite, taste, smell, sexual desire, and the need for physiological functions, assessed by patients as specially created, caused in a special way.

Kinesthetic automatism in the initial stage represents fleeting periods of immobility, involuntary motor impulses to action, impulsive-like gestures, spontaneous facial expressions, accompanied by a feeling of alienation and violence of motor acts.

The subsequent progression of the pathological process is accompanied by the delusional conviction of patients that all their actions are performed as a result of the influence of some extraneous energy, while they themselves turn into puppets of their persecutors (a feeling of mastery).

The development of ideation-motor disorders is known under the name “ psychomotor hallucinations ” by Segla (1914), who divided them into 3 forms, representing different stages of the same pathological phenomenon.

At the first stage, patients experience a sensation of movement of lips and tongue that remain motionless, with a simultaneous idea of involuntary mental pronunciation of words.
In the second, the internal monologue acquires a verbal-acoustic connotation, and the sensation of impulses to move is accompanied by a slight movement of the lips and tongue.
The third stage is characterized by the emergence of true articulatory movements, accompanied by the patient actually pronouncing words out loud.

Psychomotor hallucinations represent a model that reveals a close relationship between different forms of mental automatism: motor and associative, on the one hand, senestopathic and motor, on the other. Thus, the central element of the Kandinsky-Clerambault syndrome are pseudohallucinations, which are “very vivid, sensual, extremely definite subjective perceptions,” differing from true hallucinations only in the absence of the nature of objective reality.

This classic definition of BX pseudohallucinations by Kandinsky has received worldwide recognition. In general and in a more condensed form, the development of mental automatism is as follows:

At the very beginning of the disease, subjective psychophysical phenomena are perceived by patients with the consciousness of belonging to their “I”, but with a feeling of some loss of freedom and their spontaneity.
Then there is a feeling of involuntariness of one’s own ideational, sensory and motor acts with a gradual increase in the feeling of alienation of one’s own personality. Next, ideas arise about the forcible alienation of mental manifestations (the “possession” syndrome), about interference in them from the outside, with a delusional conviction of someone else’s activity (xenopathy). Claude’s syndrome of “external influence” gradually forms , which, with the development of pseudohallucinations, gives a complete picture of the Kandinsky-Clerambault syndrome.

Subsequent modification of this state is often accompanied by transitivism - the pathological conviction of patients that not only they experience various influences that interfere with their inner world, but also those around them, to whom they sometimes even attribute their illness. In such cases, we are usually talking about a paraphrenic modification of Kandinsky-Clerambault syndrome, which is characterized by pseudohallucinatory pseudomemories - a phenomenon first noted by BX Kandinsky (1885). In more acute cases of the pathological process, this transformation continues until oneiric stupefaction , also described by Kandinsky.

Kandinsky-Clerambault syndrome occurs during acute and chronic hallucinatory-delusional states in schizophrenia . In the first case, the hallucinatory variant of Kandinsky-Clerambault syndrome is mainly detected, in the second - delusional (depending on the predominance of delusions or pseudohallucinations).

In the chronic schizophrenic formation of delusions of the interpretive type, associative automatisms dominate from the very beginning and in the future. With paroxysmal delusional development, senestopathic automatisms often predominate (ideas of influence with hypochondriacal themes, delusions of metamorphosis).

In lucid-catatonic pictures, kinesthetic automatisms occupy a greater share. In cyclothymic-like (depressive, manic or mixed) states of schizophrenic origin, mental automatisms are only part of the clinical picture or occur sporadically, during exacerbations of the disease. Moreover, they are, as a rule, found in the structure of undeveloped delusional ideas that have shades of exposure or, conversely, beneficial influence (delusions of benevolent influence).

Etiology and pathogenesis

Since Kandinsky-Clerambault syndrome is detected primarily in schizophrenia, much less often in exogenous-organic psychoses, and even less often in epilepsy, the cause of its occurrence is associated with the etiology of these diseases.

The psychogenetic point of view on Kandinsky-Clerambault syndrome, shared by some French and domestic psychiatrists, was refuted by BX Kandinsky and M. Clerambault and continues to be the subject of debate.

The modern explanation of the mechanism of mental automatisms is based on the teachings of P. P. Pavlov about pathodynamic changes in higher nervous activity. According to him, the entire hallucinatory-paranoid picture with the phenomena of alienation, violence, phenomena of influence and mastery is regarded as a reflection of a pathologically inert irritable process in the central nervous system, which either, according to the law of generalization, concentrates everything abnormal around itself, then, according to the law of induction, repels everything that is normal physiological and psychological .

From this follows the hypothesis of A. A. Mehrabyan (1972) about the violation of gnostic feelings in the general structure of thinking, speech, activity and self-awareness, leading to the functional disintegration of the psyche - from deautomatization to depersonalization.

Diagnostics

The diagnosis is made based on the typical signs of Kandinsky-Clerambault syndrome of involuntary emergence and subsequent development of mental disorders with a growing sense of alienation and awareness of their violence.

The syndrome should be distinguished from similar hallucinatory-delusional states (paranoid with hallucinations of the imagination, exotoxic hallucinosis with delusions, reactive paranoids) by the presence in the latter of truly hallucinatory phenomena, the absence of pseudohallucinatory signs and a sense of alienation of one’s own psychomotor processes.

It is fundamentally incorrect to identify Kandinsky-Clerambault syndrome with depersonalization, which has no sign of violence. Depersonalization, experienced by patients as a global consciousness of their own change, occurs secondary to mental automatisms and increases as they progress. Fleeting symptoms of mental automatism, especially senestopathic and kinesthetic, must be differentiated from phenomenologically similar disorders of consciousness during aura, if it does not develop into a full-blown epileptic seizure. Thematically similar to automatisms, neurotic obsessions are devoid of the feeling of violent occurrence.

Treatment

In addition to treatment of the underlying disease, symptomatic treatment is carried out depending on the proportion of affective, delusional or pseudohallucinatory phenomena in its structure. For the delusional version of the syndrome, general-action neuroleptics are prescribed; for the hallucinatory version, in combination with depressive symptoms, preference is given to combinations of neuroleptics with antidepressants and tranquilizers.

Forecast

Acute cases of Kandinsky-Clerambault syndrome partially or completely undergo reverse development, chronic cases show a tendency to progress over many years, causing major personality changes and complicating the hallucinatory-paranoid picture itself.

Prevention

Prevention of the development of Kandinsky-Clerambault syndrome - timely and correct treatment of initial disorders of the underlying mental illness.

Great Medical Encyclopedia 1979

Development mechanism

The syndrome of mental automatism develops as follows.

Due to the wide amplitude of the so-called mood swings, the patient is confident that his emotions are controlled from the outside. At this stage, it is important to treat with sedatives and regularly visit a psychotherapist. At the initial stages, affective disorders are observed.

depressive despondency gives way to exalted inspiration;
anger, voluptuousness or fear are too exaggerated and feigned;
a state of rapturous ecstasy or emotional devastation.

At the next stage, symptoms are represented by pathological sensory, associative and motor self-perceptions. The patient suffers from an obsession that his movements, feelings and thoughts are influenced by unknown things. If at this stage the patient withdraws into himself and begins to fearfully hide his own subordination to someone or something from the outside, the third stage begins.
The third stage of development of the syndrome is characterized by the inability to control any imaginary influence.
with motor automatism, a person unexpectedly causes pain to himself, makes sudden movements, grabs his hair or shouts out words;
with senestopathic syndrome, delirium of physical influence is observed in the form of a state of suffocation, irresistible trembling from the cold, piercing with electric current and a feeling of constriction of one or another organ (brain, stomach, etc.);
sensory automatism provokes distortion of color, light, taste perception and a feeling of pain. This subtype is characterized by pseudohallucinations of lack of hearing, vision, or being inside a rainbow.