Imperative hallucinations are extraneous sounds and noises that the patient hears. They can be quite diverse - jerky fuzzy sounds or whole phrases, scratching sound, knocking, cacophony of voices or a lone voice. The noise level that sounds in the head can be subtle or very loud, familiar or unfamiliar. In most cases, the patient’s sounds are scary. They can threaten him, force them to carry out their orders. Such psychological pressure breaks the victim. He begins to execute commands that sound on his head.
Causes of peremptory hallucinations
With a variety of neuroses, auditory delirium is usually absent. Therefore, when imperative hallucinations occur , this indicates serious violations that can affect certain parts of the brain. Studying the clinical picture in each case, a qualified specialist is trying to determine the source that has become the catalyst for this disease.
At the moment, doctors can name only a few reasons for the development of the disease, but some of them remain beyond the scope of understanding.
The main known causes of peremptory hallucinations are:
- Alcoholism. People suffering from this ailment (especially for a long time) are very prone to auditory hallucinations. They are expressed in the appearance in the alcoholic in the head of voices that appeal to him, cause him to talk. There can be several or one of such voices, they can communicate with each other, discussing the patient, commenting on his actions, and cause a panic in the patient. Against the background of such a mental disorder, it becomes almost impossible to guess the further actions of a person.
- Often there are peremptory hallucinations in schizophrenia, which is a psychotic personality disorder. The auditory transformation in such cases is directed directly to the patient. The voice begins to communicate with him, to give orders.
- Addiction. People taking drugs are in an altered state of consciousness and, accordingly, can hear a variety of noise in the head.
That is why peremptory hallucinations manifest themselves.
Sexually transmitted diseases and paranoia
The above reasons are the most common. However, in essence there are many more. For example, some sexually transmitted diseases (syphilis) can cause similar symptoms. People who use various medicinal substances can also suffer from the strongest auditory cacophonies.
We described the main causes of peremptory hallucinations, but we must not forget that the human body is aging, there are numerous pathological changes that lead to the appearance of senile paranoia, which also causes similar symptoms in people.
Amenia
In the list of root causes of imperative hallucinations it is necessary to note amentia - an extremely difficult kind of stupefaction, which is expressed in a negative change in the speech output of sounds, “distortion” of world perception and thinking. The danger of such a pathological condition is that a multifaceted distortion can lead the patient to suicide.
Imperative hallucinations, experts attribute to deviations of verbal nature. Having established the main cause of these pathological changes, a qualified doctor is able to predict the outcome of therapeutic measures.
Symptomatology
So, imperative hallucinations are what the patient hears, but in reality there are no sounds. Translated from Latin, imperare means “to order”, therefore, the terminology considered means pathological sounds that are perceived by the patient as orders that make him carry out one or another action. In most cases, the symptoms of peremptory hallucinations seem to be when the patient receives orders that are sadistic and criminal in nature, making the patient dangerous not only to his environment, but also to himself. The voice in the patient’s head usually speaks directly to him, giving commands: “take a knife, cut off your hand ...”, “climb onto the windowsill, jump ...”, “find the rope and throw a demon standing next to the neck ...”.
Imperative hallucinations in content may vary.
Fears
Patients who have not completely lost their minds share their fears with a specialist. As a rule, they are afraid that with the next attack of voice they will order to cause physical harm to someone from the environment, because during such an attack a person loses the ability to control his thoughts and actions. His will is suppressed so much that he is not able to resist what is happening to him.
Mostly voices directly refer to the patient, however they do not name him by name. Quite rarely, voice orders can concern abstract or long-term actions, as a rule, such instructions affect exclusively “here and now”.
Voices in silence
Imperative hallucinations - this is when the patient hears similar whisperings with both ears, however, there are cases when sound perception occurred on only one side. In most cases, a person hears voices against the background of absolute silence, more often at night. A very similar clinical picture occurs when the patient is in a state of deep trance, under hypnosis.
We considered that these are imperative hallucinations.
Diagnostic methods for detecting pathology
If there are suspicions surrounding the patient or loved ones that he suffers from the pathology considered in this article, it is necessary to consult a psychiatrist.
Diagnosis of this type of hallucination, as a rule, begins with the fact that the specialist makes sure that the patient suffers from this particular pathology and his conversations and stories do not constitute an illusion or an ordinary fantasy.
Imperative auditory hallucinations or auditory inspiration are specific sound structures that occur in the patient’s mind in the absence of external stimuli. People who have a history of these diseases differ from visionaries in that the latter are easy to convince otherwise, while in the case of patients this is not possible.
During the diagnosis, the psychiatrist suggests that the patient undergo special tests that help determine the presence of peremptory hallucinations.
An important diagnostic technique for this disease is the visual observation by a specialist of patient behavior. Such monitoring allows you to confirm the pathological condition and determine the type of its manifestation.
Pathological attacks can occur sporadically, with severe mental disorders, people can completely immerse themselves in this condition. It is imperative to prevent such a transition.
The psychiatrist carefully monitors the patient’s facial expressions, since the patient’s emotional manifestations, which are expressed by changes in facial expressions, do not commensurate with the real situation in which he is. For example, against the background of complete grief, the patient is able to have fun, laugh, or against the background of complete calm, he is in a state of fear, panic, and anger.
The most common symptom of auditory hallucinations is the patient’s desire to plug his ears, cover his head with a pillow so as not to hear a frightening whisper or voice. At the same time, reality does not provide the prerequisites for such actions.
There are cases when patients suffering from imperative hallucinations, covering their ears with their hands, in terror rushed to run away, not taking the roads apart, and at the same time fell under cars, were thrown out of windows. Such manifestations are observed, as a rule, in isolation, most often there are complex disorders in which auditory pathologies are combined with other symptoms, for example, a delusional state.
There are healthy people who are prone to illusions, while the occurrence of hallucinating sounds is considered a specific indicator of mental pathologies that require urgent medical attention.
High attentiveness to your loved ones will allow you to diagnose the disease in time, because a person, getting into a similar situation, is afraid to be misunderstood and he is stopped by the fear of being assigned to a psychiatric hospital. He is trying to hide his condition, but sooner or later it again makes itself felt.
The hallucinating patient becomes focused and alert, constantly on the alert, so as not to give out his disease. However, when the early stage of pathology progression is missed, he gradually begins to communicate with an imaginary interlocutor, answering his questions out loud.
When diagnosing, the doctor can prescribe an MRI or CT scan of the brain to identify structural disorders that can also cause the development of peremptory hallucinations.
It happens that the patient has painful sensations. Imperative hallucinations can be their causes, or these reasons are hidden in serious mental disorders or a specific neurological pathology. These symptoms should not be taken lightly. A full and competent comprehensive examination will help establish an accurate diagnosis, after which the doctor will prescribe special medications for hallucinations or therapy for the underlying disease (vascular pathology, brain neoplasm).
To exclude the organic nature of the pathology, laboratory tests of blood, urine, and spinal cord can be prescribed to the patient. Elderly patients who use devices to amplify sounds need to check the correct operation of such an electronic device.
Treatment of imperative hallucinations
If a person is faced with a similar pathological situation for the first time, this plunges him, as a rule, into stupor and horror. However, it should be remembered that what is happening for a hallucinating patient is a manifestation of reality. Therefore, the first thing his close relatives should know is how to behave in a similar situation and what help they can provide to the patient.
In no case should one try to convince a person that everything that happens to him is a reality transformed by the psyche. It is necessary to behave tactfully, show patience, and in many respects imagination, to initially calm a shocked and excited person. For example, if the patient is absolutely sure that werewolves are trying to get into the window, you should not laugh - you just need to take an active part in finding ways and means to physically protect yourself from an illusory threat. It is necessary to try to create such an atmosphere and environment so that imperative hallucinations do not cause horror in the patient, that is, if possible, smooth out the emotional acuteness of the phenomenon. Also, in no case can you convince the hallucinating person that the sounds he hears are the fruit of his sick consciousness. You should not focus on the problem and try to find out who is talking to him and what is the sound source.
During an attack, you should not raise your voice and speak loudly with the patient. During this period, he should create the illusion that others are doing everything possible to help him.
Calm music, a change of scenery, and in some cases medications, which should be prescribed only by a qualified specialist, will help reduce arousal. But no matter how close they are attentive to the patient, he needs the help of doctors.
To date, the therapy of imperative hallucinations is carried out using several methods, and all of them are aimed at eliminating the occurrence of pathological attacks, removing the patient from a delusional state.
Medicines
Treatment is usually carried out with the help of medications, which usually include the following drugs:
- Tizercin;
- "Plegomazin";
- "Thorazin";
- Gibanil
- Largactyl
- "Aminazine";
- Chlorpromazine;
- Ampliaktil;
- Megafen
- Amplictil;
- "Kontamin."
One of the most prescribed medications for imperative hallucinations is Aminazine, which is used for intramuscular or intravenous administration.
Therapy for this disease depends on the cause of the problem. It can be sedative, antipyretic, anti-inflammatory, neurostimulating medications, as well as drugs for the treatment of CNS pathologies and mental disorders.
Ancillary therapy may be prescribed to the patient, for example, treatment with electrostimulation is often used, which specifically targets specific departments.
Surgery
If hallucinations of an imperative nature are provoked by a tumor process in the head, the patient is prescribed surgical treatment. Removing a tumor, cutting off or splitting the auditory nerve, installing a hearing aid or implant, plastic surgery and prosthetics of the ear elements are all possible options for surgical treatment of this pathological condition.
In certain cases, it is enough to eliminate the symptoms of intoxication of the body, restore its activity, stop the use of alcohol, drugs and other substances that have a similar effect.