Oneirophrenia is a very rare medical disorder characterized by a dreamlike state. It is a state that appears similar to schizophrenia with regard to its symptoms. It can be described as a state where dreams, hallucinations, and reality merge into one. It may be accompanied by motor and catatonic disturbances.
The term was first used in 1950, in order to make a distinction between this state and that of schizophrenia. Extensive research into oneirophrenia was not conducted until the following decade where its relationship to schizophrenia was examined. As a result of the similarities between the two conditions, oneirophrenia is often mistakenly diagnosed as schizophrenia. It is important to note that approximately half all people diagnosed with schizophrenia experience at least one instance of oneirophrenia.
While the two conditions do share certain symptoms, they differ in terms of the disruptions to the senses and disassociation symptoms. Oneirophrenia correlates positively with sleep deprivation as well as sensory deprivation and with the use of certain drugs. Psychiatrists often have a hard time distinguishing oneirophrenia from other disorders without a thorough examination of the patient. The condition is rare enough that mentions in psychiatric textbooks are very infrequent; however, it is still cited in the International Statistical Classification of Diseases and Related Health Problems as well as in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Other terms for oneirophrenia include oneirism, oneiroid state, and oneiroid syndrome.
Manic depressive psychosis was discovered and named by Laszlo J. Meduna, a neurologist and psychiatrist. He also discovered that the condition could be treated with a form of electro convulsive therapy that used the drug Metrazol. Induced oneirophrenia (using ibogaine) would be used later on by psychoanalysts for manipulating the dream state in their patients.
While diagnoses of oneirophrenia are still made, the term is largely out of use these days. Psychiatrists who are focused on the DSM often neglect to diagnose patients with the condition because it related to phenomena as opposed to a clinical approach.
Clouded consciousness is a symptom of oneirophrenia. Consciousness can be defined as the degree to which an individual’s mind is related to the world. Clouded consciousness can be defined as a disturbance of the relationship between the individual’s mind and reality. The individual’s perception diminishes in its intensity and the order within his or her perceptive field breaks down.
Individuals suffering from oneirophrenia are often unable to focus on things, which is typically where the condition begins. This is unlike schizophrenia wherein the condition typically begins with the individual experiencing some form of trauma.
Another factor that differentiates oneirophrenia from true schizophrenia is the fact that information from the patient’s senses will typically be left intact despite the fact that their feelings and emotions are disturbed. A person with oneirophrenia finds themselves in a state of dream-like altered perception. When this altered perception is taken to its extreme, it can cause the individual to experience hallucinations and delusions.
Because of its symptoms, oneirophrenia is considered an acute psychosis that will go into remission. Remission of oneirophrenia occurs in approximately 60 percent of cases and usually happens within a period of roughly 2 years.
One of the factors that distinguish oneirophrenia from schizophrenia has to do with the resistance to insulin. Individuals suffering from oneirophrenia display a resistance to insulin that is not present in people suffering from schizophrenia. The resistance to insulin can be reversed to where the patient has a normal hypoglycemic response with the administration of electroconvulsive therapy. This is one more indication of oneirophrenia’s benign nature in comparison with the more severe effects of true schizophrenia.
In some cases, the changes in perception that characterize oneirophrenia make the patient restless and agitated. Some people with the condition cause harm to themselves or others. Sufferers from oneirophrenia may also exhibit automatic obedience, which means that they will mechanically follow instruction as a result of the unresponsiveness to external stimuli that their condition causes. Echopraxia, which is the repetition of movements, can also be a sign of oneirophrenia. Other symptoms that can occur include echolalia, which is the repetition of speech or other vocalizations. Some patients exhibit garrulousness with rambling speech alternated with mutism.
Fever, accelerated heart rate and elevated blood pressure may also be among the symptoms. Oneirophrenia’s onset may occur within a matter of hours or of days.
As noted above, the factors that cause oneirophrenia include sleep deprivation, which is the condition wherein an individual does not get adequate sleep. Sleep is a human need like eating and drinking. In addition to cases where someone is unable to sleep, sleep deprivation includes cases where an individual does not sleep at the right time of day and instances where they may be getting poor quality sleep.
Each of us has a body clock that follows a pattern called the circadian rhythm. Your circadian rhythm affects how your body works. As a result, sleep deprivation can have serious consequences that affect both physical and mental health.
There is considerable evidence that humans can function for extended periods without sleep. Medical students studying for examinations are examples of humans functioning effectively even without adequate sleep. However, studies have also shown that psychoses (like oneirophrenia) can emerge when people go without sleep beyond 100 hours.
Sensory deprivation occurs when an individual is completely cut off from sensory input. The loss of vision, hearing or taste are common effects of strokes and other brain injuries. Sensory deprivation and the resulting oneirophrenia can occur in cases where an individual’s vision is damaged. Sensory deprivation (and oneirophrenia) can also be produced deliberately. Examples of cases where this has been done include studies on the effects of sensory deprivation. Subjects in one such study at McGill University began exhibiting symptoms of oneirophrenia such as hallucinations after a short time. The hallucinations ranged from abstract patterns to complex scenes. One subject in the McGill study saw pre historic animals while another saw only dogs. Some of the hallucinations were auditory, with one subject being able to hear someone in their hallucination talking, others felt the sensation of touch. Researchers believe that the hallucinations are caused by normal brain activity that is usually kept in check by sensory stimuli. When the stimuli are removed, the hallucinations occur.
The use of certain drugs is also known to cause oneirophrenia. Ibogaine is one such drug. Ibogaine is derived from the Iboga shrub that originates in Central West Africa. The drug is used to minimize the effects of withdrawal from narcotics, but the shrub from which it comes has a longer history of use in shamanic rituals associated with the Bwiti (a tribal religion from Gabon) long before that. Ibogaine induces oneirophrenia and is, therefore, referred to as being oneirogenic. In the Bwiti rituals, it is used to create a hallucinatory state for rites for assisting an adolescent’s transition to adulthood. Ibogaine’s oneirogenic effects are also believed to stimulate the user’s long-term memory.
Harmaline is another hallucinogen found in several plants and is used as a medication for stimulating the central nervous system. Harmaline is an alkaloid that has been isolated from the Peganum harmala family of plants. Effects of harmaline include the ability to induce internal hallucination as well as create visual effects like opaque trails left behind moving objects. Vibrating vision has also been listed as one of harmaline’s effects.
Acute onset of oneirophrenia often results in clinicians searching for drug intoxication and seizure disorder. The effects on speech may result in the diagnosis of schizophrenia being considered, while delusions may cause some doctors to recognize mania. Stupor without a clear cause may result in the diagnosis of oneirophrenia.
In an emergency room, the mania associated with oneirophrenia may cause a physician to prescribe antipsychotic medicines. In most cases, the drug prescribed will be haloperidol. Unfortunately, haloperidol can induce malignant catatonia. A better option is to administer benzodiazepines which will sedate the patient but allow for them to be examined for common causes of delirium. Lorazepam administered intramuscularly can result in rapid improvement.
Patients suffering from oneirophrenia are resistant to insulin when they are injected with glucose. They take between 30 and 50 percent longer to return to normal glycemia. While the reason for this is not known, one theory is that there is an insulin antagonist present in the blood during psychosis.
Oneirophrenia responds to electroconvulsive therapy. Electroconvulsive therapy is also known as electroshock therapy or can be shortened to ECT. Electroconvulsive therapy is viewed as an effective and safe treatment for people with severe, persistent emotional disorders and is safe for patients of all ages. It is an especially important solution given the potential harm from neuroleptic drugs. Furthermore, it provides relief from symptoms in less time than do psychotropic medications. The administration of electroconvulsive therapy for oneirophrenia along with deep insulin therapy has been shown to result in eosinopenia along with an improvement in clinical status. Patients who did not display a rise in eosinophil count did not show an alteration in mental state.
Meduna found that 64 percent of cases in which full remissions were achieved involved the use of electroconvulsive therapy. In those cases, the condition remitted within 6 months. Only in a few cases were the patients resistant to insulin for long periods after onset. There have been chronic cases where the patients continued to be insulin resistant after a long period.
The electroconvulsive therapy used by Meduna was accompanied by administration of the drug Metrazol, which is also known by other names including pentylenetetrazol and pentylenetetrazole. This drug’s approval by the US Food and Drug Administration was revoked in 1982.
The fact that oneirophrenia responds to electroconvulsive therapy is an indicator that it is a manifestation of the syndrome of catatonia along with other conditions like benign stupor and catatonic excitement.
Currently, there is no direct treatment specifically for oneirophrenia.
Given that the causes of oneirophrenia include long periods without sleep, avoidance of excessive sleep deprivation can be considered a primary preventive measure. Effective ways to prevent the sleep deprivation that can result in oneirophrenia include good sleep hygiene practices. Good sleep hygiene includes maintaining a regular sleeping schedule as well as sleep retraining. Cognitive behavioral therapy has also been used effectively to treat sleep problems.
Medication may also be useful for avoiding sleep deprivation. In some cases, it may be possible to treat both sleep deprivation and other psychological issues with a single medication. For example, the use of selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) may be used in place of selective serotonin reuptake inhibitors (SSRIs). Unlike SSRIs, SSNRIs do not affect an individual’s ability to sleep.
In cases where sleep deprivation is the product of stimulant use such as the use of medications for treating attention deficit and hyperactivity disorder, changing the schedule by which those drugs are administered may help. Sleep problems may be relieved by administering Ritalin and other drugs earlier in the day or with the use of time-release formulations.
In many of the instances where oneirophrenia occurs, such as perceptual isolation as a result of damage to sensory organs, it may be impossible to prevent.