Oneiroid syndrome is a dream-like state of confusion with clouding of consciousness. The sensory delusions, which are perceived as very close to life, are often accompanied by intense emotional experiences, most of which have strong negative connotations. Affected individuals cannot separate what they seem to be experiencing from reality and are difficult to convince of the unreality of the events because of the supposed authenticity of it.
What is oneiroid syndrome?
Oneiroid syndrome is closely related to the concepts of delirium and delusions. Introduced into German psychiatry by Wilhelm Mayer-Gross, a psychopathologist from Heidelberg, in 1924, the term refers to extremely complex dreams in which the experiencer appears to be awake to his or her own condition. The name of the syndrome comes from the Greek word “oneiros” (“dream”) and means something like “dream-like”. The dream event experienced usually triggers strong feelings of fear or anxiety in those affected. Even in retrospect, it is not possible for him to distinguish between dream and reality. For them, the oneiroid was as real as the waking state. Triggers are situations in which the brain is intact and awake, but the person still faces a loss of world or self. Experiences are interpreted delusionally, depersonalization occurs. However, for oneiroid syndrome to occur, the affected person must have had a fantasy-like tendency prior to the precipitating psychosis. In making the diagnosis, it is important for the treating physician to distinguish the syndrome from schizophrenia and other delusional disorders.
Causes
The causes of oneiroid syndrome can be varied. Typically, it occurs when the brain is intact but the affected person is unresponsive for an extended period of time. It particularly affects people with paralyzed bodies who have little or no ability to make independent contact with the outside world. This includes Guillain-Barré syndrome. In this progressive paralysis, the affected persons must be artificially ventilated at some point. They dream more often. In combination with the involvement of the cranial nerves and the deprivation of the outside world, oneiroidal conditions have already occurred in almost every sufferer. In addition, however, even a coma state can trigger oneiroidal syndrome. Other risk factors result from brain injuries, massive starvation states, severe burns and traumatic psychoses. Those who are in a coma for an extended period of time often report events after the fact that did not happen, but were real to them. This also leads to the fact that those affected can hardly remember their actual time in the hospital, for example. Instead, they report fantastic events – the oneiroids.
Symptoms, complaints and signs
For an outsider, especially considering patients at risk, it is not difficult to diagnose oneiroids as such. Individuals report events they have experienced, for example, while lying in a hospital bed. In all cases, the events are strongly negative. In most cases, they are abductions or mistreatment. Often the imaginings are accompanied by a feeling of being completely at the mercy of the underlying illness. The persons are awake during the oneiroid, but experience the events primarily passively. This means that they themselves have no influence on the events and have no possibility of intervening themselves or controlling the development of the dream for themselves. Also the topic death is often taken up. One example is a woman who reported the death of her son after her final awakening and was herself distraught to see him well. Only in rare cases are oneiroids taken as positive. The typical symptomatology also includes the patients’ clinging to their stories. For them, the dream states are real and cannot be separated from reality – even after awakening.
Diagnosis and course of the disease
Oneiroid syndrome is not so much a disease as it is an accompanying symptom of various diseases such as locked-in syndrome, psychoses, encephalitides, brain injuries, and brainstem ischemia. It is not itself dangerous in the strict sense, but it does trigger states of confusion in the affected person. Individuals react irritably when they are not believed or are distressed.A medical doctor will make the diagnosis on the basis of the patient’s descriptions and his or her environment. Before doing so, however, he must clarify whether the affected person is not suffering from delusions or schizophrenia. Oneiroid syndrome is not easily distinguishable from all mental illnesses. More accurate studies on the subject do not exist, which may be due to poor diagnostic delineation. The prognosis is good.
Complications
Due to oneiroid syndrome, affected individuals suffer from various psychological complaints and disorders. These complaints have a very negative effect on the quality of life and reduce it enormously. As a rule, patients with oneiroid syndrome are also dependent on the help of other people in their lives and often can no longer cope with everyday life on their own. Those affected may also appear bizarre and confused to outsiders, potentially causing social discomfort due to the syndrome. The patients themselves are unable to intervene in the events and free themselves from them on their own. Furthermore, this disease can lead to severe psychological discomfort and depression, if the patients possibly see already deceased friends or relatives. In severe cases, this requires the patient to be admitted and treated in a closed hospital. Treatment of oneiroid syndrome is carried out with the help of medication and psychological therapy. As a rule, no particular symptoms occur. However, it is impossible to predict whether there will be a positive course of the disease. In many cases, a long period of time passes before the treatment of oneiroid syndrome actually takes effect.
When should you see a doctor?
People who notice signs of oneiroid syndrome in another person should go to the doctor with that person. States of confusion or aggression indicate a corresponding condition and must be medically clarified in any case before serious complications occur. It is advisable to see a doctor at the first sign of an illness so that it can be treated before the affected person injures himself or herself in an accident or fall. Since oneiroid syndrome occurs very rarely, there is a high probability that another condition underlies the symptoms. In any case, the typical dream-like state of confusion must be examined by a physician. If side effects or interactions occur during therapy due to the prescribed medication, medical advice is also required. People who already suffer from a mental illness or have a corresponding family history are particularly at risk. People who use drugs or are exposed to psychological stress for other reasons also belong to the risk groups and should be presented to a doctor if oneiroid syndrome is suspected. In addition to the family doctor, a neurologist or a specialist in mental illness must be consulted. Therapeutic counseling is always necessary to accompany drug therapy.
Treatment and therapy
Treatment of oneiroid syndrome is primarily by treating the underlying cause, if possible. Important for patients suffering from oneiroids is the psychological support of their peers or close confidants. Patience is especially needed. The affected persons believe that they have experienced real events. People around them must be aware of this. Annoyed or even aggressive reactions to the stories told to them are counterproductive and trigger incomprehension and defensive reactions in those affected. Psychopharmacologically, a doctor will treat with neuroleptics, for example. However, the focus should always be on the underlying condition. For supplementary treatment, stabilization of the patient’s fluid and vitamin balance is important.
Outlook and prognosis
In oneiroid syndrome, physicians can only make a prognosis to a limited extent. It is not always a disease. It involves very intense dreams in which the dream state is not perceived as a dream state. Rather, those affected consider it to be reality because of the intense sensation. They perceive themselves as awake. This can lead to considerable confusion. In oneiroid syndrome, the boundaries between reality and waking consciousness become blurred with dream sequences during sleep.It often affects people suffering from psychosis or brain injury, encephalitides, or locked-in syndrome. Such conditions can be misunderstood as schizophrenia. They resemble some mental illnesses. Therefore, the diagnosis ultimately determines the prognosis. Overall, the prognosis for oneiroid syndrome is positive. The only problem is that some patients are so confused by the dream sequences that appear real that they develop mental abnormalities. In severe cases, admission to a psychiatric hospital must be considered. In this case, there is an illness value. This worsens the prognosis. Usually, oneiroid syndrome is treated with medication, and if necessary with psychotherapy. In this process, part of the patients experience a clarification of perception. Another part remains stuck for a long time in the oneiroid syndrome, which cannot be influenced at will. It takes time for symptomatic treatment to take effect.
Prevention
To date, there are no reliable studies reporting effective prevention of oneiroid syndrome. Prophylaxis is questionable.
Follow-up
In most cases, very few measures or options for follow-up are available to the affected person with oneiroid syndrome. However, the affected person should see a doctor at an early stage to avoid further complications or other complaints. An early diagnosis always has a very positive effect on the further course of the disease, so that the affected person should see a doctor at the first signs or symptoms of the disease. Most of those affected are dependent on the help and support of close friends or family. Especially loving and intensive conversations have a very positive effect on the further course of the disease and can also prevent depression or other psychological complaints and upsets. In many cases, oneiroid syndrome is also treated by taking various medications. In this case, the affected person should always pay attention to a correct dosage and also to a regular intake of the medication. In general, a lot should be drunk to compensate for the loss of fluid. Supplements can also be taken to restore the body’s vitamin balance. In general, oneiroid syndrome does not reduce the patient’s life expectancy.
Here’s what you can do yourself
Individuals suffering from oneiroid syndrome are unresponsive during the dream-like states. The most important action is to care for the ill person after awakening. The relatives and friends should talk a lot with the ill person and thereby help him or her to come to terms with the often traumatic experiences. At the same time, the patient must take care of himself. In consultation with the doctor, it may be possible to do some light sport. This can alleviate the psychological suffering and weaken the dream-like conditions. Depending on the clinical picture, a change in diet may also be useful. Since oneiroid syndrome can occur in connection with a wide variety of diseases, self-help measures must always be worked out together with the physician and with regard to the symptom picture. Basically, the relatives should inform themselves about the syndrome so that the necessary steps can be taken in case of an attack. It is advisable to read books about the syndrome and, if necessary, to visit a sleep laboratory in order to better understand the oneiroid syndrome. The sufferer should also be educated about the condition and talk to others affected as part of a support group.
