Treatment of low-grade schizophrenia. Symptoms and signs

Mental ill-being, an endogenous disease of the schizophrenia spectrum, a severe chronic illness leading to a disorder of mental activity - schizophrenia has been known to mankind throughout the history of existence. Despite this, diagnosis remains challenging. Not every psychotherapist is able to recognize the illness. The disease is characterized by significant clinical polymorphism. Schizophrenia changes a person’s behavior - that’s a fact. Worldwide, 1% of people are diagnosed, regardless of gender, race or continent. The rate may be higher due to true morbidity with mild or erased forms, which are not taken into account in official statistics.

Manifestation of symptoms

Schizophrenia symptoms and signs have three types: positive, negative and cognitive. They appear equally in both women and men. Some symptoms may be difficult to recognize as signs of mental illness. They look like laziness, depression, psychosis. If you look in more detail, the state of psychosis is indeed typical for people with this disease. Schizophrenia in women or men manifests itself at different ages. Schizophrenia in men from 15 to 35 years, and in women from 27 to 37 years.

Transformation of consciousness

Delusions and hallucinatory experiences are integral manifestations of schizophrenia. These also include pseudohallucinations. These are false auditory perceptions of a strange nature. The voices that the patient hears, in his opinion, can come either from the head or from any other organ - arms, legs or stomach.

A schizophrenic cannot escape the feeling of the presence in the body of something unpleasant, forcefully imposed. He can engage in a discussion, ask questions, or argue about anything with this voice. At the same time, the audible voice, as the patient claims, does the same. The continued development of the disease is characterized by the addition of delusional ideas to hallucinations.

Delusional formation comes in various directions:

• delusion of persecution - the belief that someone is following a person or is constantly watching him;
• delusion of relationships - a strong belief that everything happening around them is directly related to the patient;
• delusion of influence - a person thinks that someone is directing his thoughts, and he cannot control them on his own;
• delusion of special meaning - a belief in one’s own greatness, power, or possession of unique abilities.

As schizophrenia develops, a condition called emotional-volitional defect occurs. It gives rise to a lack of strong-willed qualities and complete indifference to the world around us. Habitual everyday tasks that every person performs every day, without even thinking, are a real feat for a schizophrenic. He cannot bring himself to do such simple things as:

• brush your teeth;
• wash your hair;
• cook food;
• go to the shop;
• do basic cleaning of the apartment.

The emotional sphere of the patient suffers. This is expressed by the loss of the ability to show tenderness, affection, sympathy, affection, tact, and frugality. Such a person changes noticeably, he becomes tough, indifferent and cold, and sometimes even cruel. Sometimes this can even manifest itself in aggressive attacks. Relationships with loved ones change for the worse because they do not understand his condition.

Description of positive symptoms

Abnormal judgments and obsessions are noted at this stage. Schizophrenia causes a disorder of this kind against the will of the sick person. He can philosophize too much and conduct meaningless discussions on topics of an immense and global nature. The topic of conversation is often not only devoid of meaning, but also disordered in the style of narration, and there is a constant jumping from topic to topic. Positive signs of schizophrenia in women and men are accompanied by delusional states, motor and thinking disorders, and hallucinations.

Diagnostic criteria

The requirement for a diagnosis of paranoid schizophrenia is the presence of at least 1 clear manifestation or 2 subtle manifestations from the following group:

• statements about putting in or taking away thoughts;
• delusional beliefs that relate to motor activity, sensations, or actions;
• hallucinations of an audio nature - usually a voice commenting on the patient’s behavior or discussing his actions;
• persistent overvalued delusional ideas - beliefs in superpowers, communication with alien beings, etc.

To make a diagnosis, the following list of symptoms is also used, of which at least 2 manifestations must be present:

• overvalued beliefs that arise every day for a week or month, hallucinatory phenomena of any type;
• disruption of speech and thought processes;
• catatonic syndrome, overexcitation or freezing, stupor;
• symptoms of the negative subgroup - apathy, poor speech, inadequate emotional reactions, problems in social adaptation (signs should not be caused by depression or treatment with antipsychotics);
• behavioral disorders, loss of interests, non-targeted actions, self-absorption like autism.

In many types of schizophrenia, symptoms persist for at least 30 days. To be diagnosed with f25 episodic schizoaffective disorder, a patient must have at least one of the following symptoms for 14 days:

• audio hallucinations;
• delusions of control or influence;
• beliefs about telepathy - a person indicates the reception or transmission of a thought process;
• speech is broken, there are neologisms;
• there are delusional ideas that are not characteristic of any subculture of the patient;
• catatonic type symptoms.

During the diagnostic process, symptoms of a mood disorder must be present. The diagnosis is established if a person does not have organic disorders in the functioning of the brain.

Clinical manifestations

Additional symptoms are divided into positive and negative. Positive psychopathological syndromes:

• Asthenic - weakness, increased fatigue, lethargy.
• Psychopathic-like - increased affective lability, increased sensitivity and excitability, hypomanic behavior, overvalued formations.
• Affective - daily sharp mood swings, depression or mania, oneiroid.
• Hallucinatory - hallucinations, voices in the head, pseudohallucinations.
• Delusional - sensual delirium, paranoia, Kandinsky-Clerambault syndrome.
• Catatonic is a pathology that includes decreased (state of stupor) or increased (excitement) psychomotor activity.

Negative psychopathological syndromes:

• Autism is social isolation, inability to experience empathy, lack of spiritual connection with people and lack of interest in social life.
• A reduction in energy potential or a drop in mental activity - lack of productivity, difficulties in using existing knowledge, problems with the mobility of mental processes.
• Emotional changes - impoverishment of emotional reactions, lack of clear differentiation of emotions.
• The phenomena of drift are increasing passivity, the impossibility of building a “life line.” Patients give an analogy of their life to a “boat” that is sailing in an unknown direction.
• Thinking disorders/speech features - thinking is not purposeful, there is no sequence of thoughts and speech, there is no logic. Thinking is fragmented. Sometimes there is an “influx of ideas”, the content of which is difficult for the patient to articulate.

Dementia of the schizophrenic type is a separate negative syndrome. It occurs at the final stage of schizophrenia. To identify it, tests are used to assess cognitive abilities.

With dementia, there is a significant drop in intelligence. The “core of personality” is destroyed. There is a gross violation of the higher intellectual functions involved in the formation of judgments and conclusions. The patient is not able to adequately comprehend what is happening. He does not know how to apply concepts correctly. His thinking cannot analyze, synthesize, generalize information. Stereotyped statements are noticeable in speech. The stock of knowledge and skills suffers.

It is worth addressing the issue of the appearance of a person with schizophrenia. Patients often neglect hygiene and personal care. This is noticeable in sloppy, wrinkled clothes. The facial expression and gaze are sad, wary or “radiant.” Facial expressions are poor or inappropriate to the situation. In schizotypal disorder, patients' appearance is described as “eccentric,” ostentatious, or strange. Facial expressions are meager and restrained.

Description of negative symptoms

This group includes signs of schizophrenia with deeper emotional disorders. A person loses the ability to enjoy life. He falls into a depressed state or simply tries to protect himself from society. A neutral or bad mood is observed, but in rare cases the opposite manifestation occurs with an increase in mood. People with emotional disorders are not interested in the feelings of others. And they feel much more comfortable spending time alone. Schizophrenia manifests symptoms and signs of a negative type in the aspect of decreased sexual desire, ignoring hygiene rules, as well as alcohol consumption.

Description of cognitive symptoms

Cognitive signs are characterized by impairments in concentration and certain types of memory. A person cannot adequately plan, organize his own life, or make decisions. Schizophrenia exhibits symptoms and signs in the same way in women and men, but they are not always recognized as a medical history. It is possible to understand that these are disorders only with the help of neuropsychological tests. Schizophrenia can disguise symptoms as depression and psychosis. Tests allow you to find the truth.

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Sluggish schizophrenia in adolescents

Sluggish schizophrenia in adolescents manifests itself during the onset of puberty – 11–12 years. People around him notice increased emotionality, a tendency toward depression, and paranoid thoughts in the teenager. Other characteristic features:

• Change in speech style. A teenager cannot express thoughts correctly and logically; he often throws out meaningless phrases that are generally not appropriate in a particular conversation.
• Problems in studies. The disease prevents you from performing your duties efficiently, solving important tasks, moving towards goals, and overcoming obstacles.
• Problems concentrating. The teenager is constantly distracted, inhibited, and inadequate.
• Problems with socialization. The guy or girl avoids direct gaze, is reluctant to make contact, and cannot fully express their thoughts.

What are the reasons for development

Schizophrenia does not occur due to one factor. We can say unequivocally that the disease is transmitted by heredity. If one of your close relatives has had such a diagnosis, it will most likely pass on to your children. And for this, the gender of the carriers does not matter. Having second-degree relatives (aunts, uncles, cousins, and grandparents) also increases the risk of receiving a diagnosis. In medical practice, identical twins are also monitored, where one of them has mental disorders. The risk for the second is 65%. In addition to the fact that schizophrenia is inherited by close relatives, it is necessary to take into account the influence of other factors. They can provoke a trigger in the body for the development of mental pathology:

• viral infections;
• stressful situations;
• social factors;
• antenatal infections;
• lack of vitamins.

Signs of schizophrenia

Official medicine finds it difficult to determine the exact causes that cause the development of schizophrenia. Long-term study of the mechanisms of the disease has not made it possible to identify specific stimuli for the deterioration of mental health. Somatic manifestations of the disease in childhood, adulthood and adolescence have significant differences. Therefore, a final diagnosis is possible only during the onset of puberty.

Among the most likely prerequisites for the development of a mental disorder, there are several main ones.

• Genetic predisposition.

The disease can be inherited from a close relative; approximately 10% of children in adolescence are diagnosed with this diagnosis if their mother or father has it.

• Hormonal dysfunction.

Schizophrenia is associated with impaired dopamine production. This hormone is a neurotransmitter that is responsible for the state of a person’s emotional sphere. If there is a pathology of the central nervous system, dopamine is produced in excess. At the physiological level, this causes intense mental overexcitation, in which a person constantly remains. The result is delusions, paranoid ideas, obsession, psychosis or hallucinations.

• The impact of viruses on the human body.

There is a category of pathogenic microorganisms that can destroy nerve cells. One of the most known pathological agents to science is the herpes virus. With good immunity, it can stay in the body for years without causing harm. If the patient suffers from various diseases of a chronic or infectious nature, viruses can manifest themselves, causing the manifestation of schizophrenia.

• Toxoplasmosis.

This is an indirect cause of the development of schizophrenia, but rather one of the risk factors. It is especially dangerous if a pregnant woman is infected: the fetus can develop pathologies, including diseases of the nervous system.

Common causes of schizophrenia include:

• alcohol, drug and other types of addiction;
• pathologies of intrauterine development;
• brain injuries that occurred during childbirth or throughout life;
• heredity;
• severe emotional shock;
• prolonged stay in a state of stress, prolonged depression.

Scientists believe that specific family attitudes are also the trigger for the development of the disease. Parents force the child to react to certain situations according to one scenario, while they themselves perform completely different actions. The dualistic attitude cannot be analyzed by a small child due to his age. Contradictions grow inside him, with which he is left alone. The constant search for answers to one's questions causes intrapersonal conflict, which over time can develop into a mental disorder.

Risk factors and complications

Signs of schizophrenia in men and women at different stages may not appear or periodically disappear. This is especially possible if treatment is followed. There are patients who lead normal professional and social lives, although this diagnosis is characterized by a desire to isolate themselves from society. Schizophrenia develops gradually in women and men over several years. Risk factors include the following conditions:

• suicide attempts (5-6% of patients commit suicide);
• alcohol abuse;
• outbursts of aggression;
• addiction.

Causes of mental illness

The exact cause of schizophrenia has not yet been identified. It is believed that this is a multifactorial disease that develops under the influence of a number of provoking and predisposing factors:

• Burdened heredity. If you have close relatives with schizophrenia, the risk of developing it in your offspring increases by about 20 times.
• Unfavorable social conditions such as poverty and family instability.
• Bad habits. Smoking, drug addiction, substance abuse and alcoholism do not so much cause the disease as accompany schizophrenia, complicating its course.
• Complicated pregnancy (prematurity, intrauterine hypoxia or infections).
• Emotional turmoil, especially in childhood. It has been proven that people who have experienced physical or sexual violence are more likely to develop schizophrenia.
• Anomalies in the development of central nervous system structures. Autopsies of dead patients showed that most of them had dilation of the cerebral ventricles, a decrease in the volume of the frontal lobe, and organic changes in the temporal gyri and hippocampus.

There are other theories of the development of schizophrenia that are not so popular and widespread.

Main types of disease

In the medical classification, the main types of schizophrenia include 9 positions. Some of them have subtypes. Experts identify several of them, which occur most often. Paranoid schizophrenia manifests itself in increased suspicion of others. A person is haunted by the feeling that he is constantly being watched, he has delusions and hallucinations. In the catatonic form of the disease there are movement disorders. And this can be either complete immobilization or chaotic disorderly excitement. Simple schizophrenia does not have a history of acute psychosis, but negative symptoms increase over time. The hebephrenic form manifests itself in the form of dementia and foolishness.

Publications in the media

Schizophrenia is a mental illness of a continuous or paroxysmal course, begins mainly at a young age, is accompanied by characteristic personality changes (autization, emotional-volitional disorders, inappropriate behavior), thought disorders and various psychotic manifestations. Frequency - 0.5% of the population. 50% of beds in psychiatric hospitals are occupied by patients with schizophrenia.

Genetic aspects . A priori, polygenic inheritance seems most likely. Non-scientific application of a broader definition of schizophrenia leads to an increase in population frequency estimates to 3%. The existence of several loci that contribute to the development of schizophrenia has been proven or suggested ( • SCZD1, 181510, 5q11.2‑q13.3; • amyloid b A4 precursor protein, AAA, CVAP, AD1, 104760, 21q21.3‑q22.05; • DRD3 , 126451, 3q13.3; SCZD3, 600511, 6p23; SCZD4, 600850, 22q11‑q13; EMX2, 600035, 10q26.1.

CLINICAL PICTURE

Clinical manifestations of schizophrenia are polymorphic. Various combinations of symptoms and syndromes are observed.

Negative symptoms . In psychiatry, the term “negative” means the absence of certain manifestations inherent in a healthy person, i.e. loss or distortion of mental functions (for example, impoverishment of emotional reactions). Negative symptoms are decisive in diagnosis.

• Thinking disorders. Patients with schizophrenia rarely have only one type of impaired thinking; usually a combination of different types of thought disorder is noted • • Diversity. Minor features of everyday things seem more significant than the object as a whole or the general situation. Manifested by ambiguity, vagueness, and thoroughness of speech • • Discontinuity. There is no semantic connection between concepts while the grammatical structure of speech is preserved. Speech loses its communication properties, ceases to be a means of communication between people, retaining only its external form. Characterized by a gradual or sudden deviation in the thought process towards random associations, a tendency towards symbolic thinking, characterized by the coexistence of the direct and figurative meaning of concepts. There are sudden and incomprehensible transitions from one topic to another, a comparison of the incomparable. In extreme cases, speech is devoid of semantic meaning and is inaccessible to understanding if it is constructed outwardly correctly. In severe cases of disrupted thinking, the patient spews out a sequence of completely unrelated words, and pronounces them as one sentence (verbal okroshka) • • Sperrung (blockage of thinking) - an unexpected break in the train of thought or a long delay in the thought process, loss of the thread of conversation. The disorder occurs with clear consciousness, which is different from absence seizure. The patient begins his thought or answer and suddenly stops, often in the middle of a sentence. • • Reasoning - thinking with a predominance of florid, unsubstantial, empty and fruitless reasoning, devoid of cognitive meaning • • Neologisms - new words invented by the patient, often by combining syllables taken from different words; the meaning of neologisms is understandable only to the patient himself (for example, the neologism “tabushka” is created from the words “stool” and “cabinet”). To the listener they sound like absolute nonsense, but to the speaker these neologisms are a kind of reaction to the inability to find the right words.

• Emotional disorders •• Emotional disorders in schizophrenia are manifested primarily by the extinction of emotional reactions, emotional coldness. Due to decreased emotionality, patients lose their sense of affection and compassion for loved ones. Patients become unable to express any emotions. This makes it difficult to communicate with patients, causing them to withdraw even more into themselves. Patients in the later stages of schizophrenia do not have strong emotions; if they appear, one should doubt whether the diagnosis of schizophrenia was correctly made. Emotional coldness manifests itself first and to the greatest extent in feelings towards parents (usually the patient responds to the care of parents with irritation; the warmer the attitude of the parents, the more obvious the patient’s hostility towards them). As the disease progresses, such dulling or atrophy of emotions becomes more and more noticeable: patients become indifferent and indifferent to their surroundings . great caution. People with schizophrenia exhibit both positive and negative emotions, although not as strongly as healthy people. Some people with schizophrenia, who appear to have no emotions, actually live a rich emotional inner life and have a hard time experiencing their inability to express emotions • • Ambivalence. The coexistence of two opposing tendencies (thoughts, emotions, actions) towards the same object in the same person at the same time. It manifests itself as the inability to complete certain actions or make a decision.

• Volitional disorders. Emotional disorders are often associated with decreased activity, apathy, lethargy and lack of energy. A similar picture is often observed in patients who have suffered from schizophrenia for many years. Severe volitional disorders lead to an unconscious withdrawal from the outside world, a preference for the world of one’s own thoughts and fantasies, divorced from reality (autism). Patients with severe volitional disorders look inactive, passive, and lacking initiative. As a rule, emotional and volitional disorders are combined with each other; they are designated by the same term “emotional-volitional disorders.” Each patient has an individual relationship between emotional and volitional disorders in the clinical picture. The severity of emotional-volitional disorders correlates with the progression of the disease.

• Personality changes result from the progression of negative symptoms. They manifest themselves in pretentiousness, mannerism, absurdity of behavior and actions, emotional coldness, paradox, and unsociability.

Positive ( psychotic ) manifestations . The term “positive” (“productive”) in psychiatry means the appearance of states that are not characteristic of a healthy psyche (for example, hallucinations, delusions). Positive symptoms are not specific to schizophrenia, because also occur in other psychotic conditions (for example, organic psychoses, temporal lobe epilepsy). The predominance of positive symptoms in the clinical picture indicates an exacerbation of the disease.

• Hallucinatory-paranoid syndrome is manifested by a combination of poorly systematized, inconsistent delusional ideas, often persecution, with a syndrome of mental automatism and/or verbal hallucinations • • For the patient, apparent images are as real as objectively existing ones. Patients actually see, hear, smell, and do not imagine. For patients, their subjective sensory sensations are as valid as those emanating from the objective world • • The behavior of a patient experiencing hallucinations seems crazy only from the point of view of an outside observer; to the patient himself it seems quite logical and clear • • Delusions and hallucinations are considered one of the most important and common symptoms of schizophrenia, but one symptom is not enough to diagnose this disease. Many patients with schizophrenia with a whole range of other symptoms, such as thought disorders, emotional and volitional disorders, have never observed delusions or hallucinations. It must also be remembered that delusions and hallucinations are inherent not only in schizophrenia, but also in other mental illnesses, so their presence does not necessarily indicate that the patient has schizophrenia.

• Mental automatism syndrome (Kandinsky–Clerambault syndrome) is the most typical type of hallucinatory-paranoid syndrome for schizophrenia. The essence of the syndrome is the feeling of the violent origin of disorders, their “madeness” • • Alienation or loss of belonging to one’s “I” of one’s own mental processes (thoughts, emotions, physiological functions of the body, movements and actions performed), the experience of their involuntary, madeness, imposition from the outside. Characteristic symptoms of openness, withdrawal of thoughts and mentism (an involuntary influx of thoughts) • • Pseudo-hallucinations (sensations and images that arise involuntarily without a real stimulus, differing from hallucinations in the patient’s lack of a sense of the objective reality of these images) • • Mental automatism syndrome usually accompanies systematized delusions of persecution and impact. Patients no longer belong to themselves - they are at the mercy of their persecutors, they are puppets, toys in their hands (sense of mastery), they are under the constant influence of organizations, agents, research institutes, etc.

• Paraphrenic syndrome is a combination of expansive delusions with delusions of persecution, auditory hallucinations and (or) mental automatisms. In this state, along with complaints about persecution and influence, the patient expresses ideas about his world power, cosmic power, calls himself the god of all gods, the ruler of the Earth; promises the creation of heaven on earth, the transformation of the laws of nature, radical climate change. Delusional statements are characterized by absurdity, grotesqueness, statements are given without evidence. The patient is always at the center of unusual and sometimes grandiose events. Various manifestations of mental automatism and verbal hallucinosis are observed. Affective disorders manifest themselves in the form of elevated mood, which can reach the level of mania. Paraphrenic syndrome, as a rule, indicates the age of onset of schizophrenia.

• Capgras syndrome (a delusional belief that people around them are capable of changing their appearance for a specific purpose).

• Affective-paranoid syndrome •• Depressive-paranoid syndrome is manifested by a combination of depressive syndrome, delusions of persecution, self-blame, verbal hallucinations of an accusing nature • • Manic-paranoid syndrome is manifested by a combination of manic syndrome, delusions of grandeur, noble origin, verbal hallucinations of an approving, praising nature .

• Catatonic syndrome •• Catatonic stupor. Characterized by increased muscle tone, catalepsy (freezing for a long time in a certain position), negativism (unreasonable refusal, resistance, opposition to any outside influence), mutism (lack of speech with a intact speech apparatus). Cold, uncomfortable posture, wet bed, thirst, hunger, danger (for example, a fire in a hospital) are not reflected in any way on their frozen, amicable face. Patients remain in the same position for a long time; all their muscles are tense. A transition from catatonic stupor to excitement and vice versa is possible • • Catatonic excitement. Characterized by an acute onset, suddenness, chaoticity, lack of focus, impulsiveness of movements and actions, senseless pretentiousness and mannerisms of movements, absurd unmotivated exaltation, aggression.

• Hebephrenic syndrome. Characterized by silly, ridiculous behavior, mannerisms, grimacing, lisping speech, paradoxical emotions, impulsive actions. May be accompanied by hallucinatory-paranoid and catatonic syndromes.

• Depersonalization-derealization syndrome is characterized by a painful experience of changes in one’s own personality and the surrounding world that cannot be described.

Depression in schizophrenia

Depressive symptoms in schizophrenia (both during exacerbation and in remission) are often observed. Depression is one of the most common causes of suicidal behavior in patients with schizophrenia. It should be remembered that 50% of patients with schizophrenia make suicide attempts (15% are fatal). In most cases, depression is due to three reasons.

• Depressive symptoms may be an integral part of the schizophrenic process (for example, when depressive-paranoid syndrome predominates in the clinical picture).

• Depression can be caused by awareness of the severity of their illness and the social problems that patients face (narrowing of their social circle, misunderstanding on the part of loved ones, being labeled as “crazy,” work maladjustment, etc.). In this case, depression is a normal personality reaction to a serious illness.

• Depression often occurs as a side effect of antipsychotic medications.

CLASSIFICATION

The division of schizophrenia according to its clinical forms is carried out according to the predominance of a particular syndrome in the clinical picture. This division is conditional, because only a small number of patients can be confidently classified as one type or another. Patients with schizophrenia are characterized by significant changes in the clinical picture during the course of the disease, for example, at the beginning of the disease the patient is noted to have a catatonic form, and after a few years he also experiences symptoms of the hebephrenic form.

Forms of schizophrenia

• The simple form is characterized by a predominance of negative symptoms without psychotic episodes. A simple form of schizophrenia begins with the loss of previous motivations for life and interests, idle and meaningless behavior, and isolation from real events. It progresses slowly, and the negative manifestations of the disease gradually deepen: decreased activity, emotional flatness, poor speech and other means of communication (facial expressions, eye contact, gestures). Efficiency in study and work decreases until they stop completely. Hallucinations and delusions are absent or occupy a small place in the picture of the disease.

• Paranoid form is the most common form; The clinical picture is dominated by hallucinatory-paranoid syndrome and mental automatism syndrome. The paranoid form is characterized by the predominance in the picture of the disease of delusional and hallucinatory disorders, forming paranoid, paranoid syndromes, Kandinsky-Clerambault syndrome of mental automatism and paraphrenic syndrome. At first, they note a tendency towards systematization of nonsense, but later it becomes more and more fragmentary, absurd and fantastic. As the disease progresses, negative symptoms appear and intensify, creating a picture of an emotional-volitional defect.

• The hebephrenic form is characterized by the predominance of hebephrenic syndrome. This form differs from the simple one in the patients’ greater mobility, fussiness with a touch of foolishness and mannerisms, and instability of mood is characteristic. Patients are verbose, prone to reasoning, stereotypical statements, their thinking is poor and monotonous. Hallucinatory and delusional experiences are fragmentary and striking in their absurdity. According to E. Kraepelin, only 8% of patients experience favorable remissions, but in general the course of the disease is characterized by malignancy.

• The catatonic form is characterized by the predominance of the catatonic syndrome in the clinical picture of the disease. This form manifests itself as a catatonic stupor or agitation. These two states can alternate with each other. Catatonic disorders are usually combined with hallucinatory-delusional syndrome, and in the case of an acute paroxysmal course of the disease - with oneiric syndrome.

Flow and types of flow

There are continuous and paroxysmal-progressive types of schizophrenia. Before the advent of ICD-10, there were two more types of progression in Russian psychiatry: recurrent and sluggish. In ICD-10 (as well as in DSM-IV), there are no diagnoses of recurrent schizophrenia and sluggish schizophrenia. Currently, these disorders are identified as separate nosological units - schizoaffective disorder and schizotypal disorder, respectively (see Schizoaffective disorder, Schizotypal disorder).

• The continuous type of course is characterized by the absence of clear remissions during treatment and the steady progression of negative symptoms. Spontaneous (without treatment) remissions are not observed with this type of course. Subsequently, the severity of productive symptoms decreases, while negative symptoms become more and more pronounced, and in the absence of treatment effect, it comes to the complete disappearance of positive symptoms and pronounced negative symptoms. A continuous type of course is observed in all forms of schizophrenia, but it is exceptional for simple and hebephrenic forms.

• The paroxysmal-progressive type of course is characterized by complete remissions between attacks of the disease against the background of progression of negative symptoms. This type of schizophrenia in adulthood is the most common (according to various authors, it is observed in 54–72% of patients). Attacks vary in severity, clinical manifestations and duration. The appearance of delusions and hallucinations is preceded by a period of severe affective disorders - depressive or manic, often replacing each other. Mood fluctuations are reflected in the content of hallucinations and delusions. With each subsequent attack, the intervals between attacks become shorter and the negative symptoms worsen. During the period of incomplete remission, patients retain anxiety, suspicion, a tendency to delusionally interpret any actions of others, and hallucinations occasionally occur. Particularly characteristic are persistent subdepressive states with decreased activity and a hypochondriacal orientation of experiences.

Research methods . There is no effective test to diagnose schizophrenia. All studies are aimed mainly at excluding an organic factor that could cause the disorder • Laboratory research methods: •• CBC and OAM •• biochemical blood test •• study of thyroid function •• blood test for vitamin B12 and folic acid •• analysis blood for the content of heavy metals, drugs, psychoactive drugs, alcohol • Special methods •• CT and MRI: exclude intracranial hypertension, brain tumors •• EEG: exclude temporal lobe epilepsy • Psychological methods (personality questionnaires, tests [for example, Rorschach tests, MMPI ]).

Differential diagnosis

• Psychotic disorders caused by somatic and neurological diseases. Symptoms similar to those of schizophrenia are observed in many neurological and somatic diseases. Mental disorders in these diseases usually appear at the onset of the disease and precede the development of other symptoms. Patients with neurological disorders tend to be more critical of their illness and more concerned about the onset of symptoms of mental illness than those with schizophrenia. When evaluating a patient with psychotic symptoms, an organic etiological factor is always excluded, especially if the patient exhibits unusual or rare symptoms. The possibility of superimposed organic disease should always be kept in mind, especially when a patient with schizophrenia has been in remission for a long time or when the quality of symptoms changes.

• Simulation. Schizophrenic symptoms can be invented by the patient or for the purpose of obtaining “secondary benefit” (simulation). Schizophrenia can be simulated, because The diagnosis is largely based on the patient's statements. Patients who actually suffer from schizophrenia sometimes make false complaints about their supposed symptoms in order to receive some benefits (for example, a transfer from disability group 3 to disability group 2).

• Mood disorder. Psychotic symptoms are observed in both manic and depressive states. If a mood disorder is accompanied by hallucinations and delusions, their development occurs after pathological changes in mood occur, and they are not stable.

• Schizoaffective disorder. In some patients, symptoms of mood disorders and symptoms of schizophrenia develop simultaneously and are expressed equally; Therefore, it is extremely difficult to determine which disorder is primary - schizophrenia or a mood disorder. In these cases, a diagnosis of schizoaffective disorder is made.

• Chronic delusional disorder. The diagnosis of delusional disorder is valid for systematized delusions of non-bizarre content, lasting at least 6 months, with the preservation of normal, relatively high personality functioning without pronounced hallucinations, mood disorders and the absence of negative symptoms. The disorder occurs in adulthood and old age.

• Personality disorders. Personality disorders can be combined with manifestations characteristic of schizophrenia. Personality disorders are stable characteristics that determine behavior; the time of their appearance is more difficult to determine than the moment of onset of schizophrenia. As a rule, there are no psychotic symptoms, and if they are present, they are transient and unexpressed.

• Reactive psychosis (brief psychotic disorder). Symptoms last less than 1 month and occur after a clearly defined stressful situation.

TREATMENT

Social and psychological support in combination with drug therapy can reduce the frequency of exacerbations by 25–30% compared to the results of treatment with antipsychotics alone. Psychotherapy for schizophrenia is ineffective, so this treatment method is rarely used.

The nature of the disease is explained to the patient, they are reassured, and their problems are discussed with him. They try to form an adequate attitude towards the disease and treatment in the patient, and the skills to timely recognize signs of an impending relapse. An excessive emotional reaction of the patient’s relatives to his illness leads to frequent stressful situations in the family and provokes exacerbations of the disease. Therefore, the patient’s relatives must be explained the nature of the disease, treatment methods and side effects (the side effects of antipsychotics often frighten relatives).

Basic principles of drug therapy

• Drugs, doses, and duration of treatment are selected individually, strictly according to indications, depending on the symptoms, severity of the disorder and stage of the disease.

• Preference should be given to a drug that has previously been effective in a given patient.

• Treatment usually begins with small doses of drugs, gradually increasing them until the optimal effect is obtained. In case of acute development of an attack with severe psychomotor agitation, the drug is administered parenterally; if necessary, injections are repeated until the excitement is completely relieved, and subsequently the treatment method is determined by the dynamics of the psychopathological syndrome.

• The most common mistake is prescribing more antipsychotics to patients than necessary. Studies have shown that smaller amounts of antipsychotics usually produce the same effect. When a clinic increases a patient’s dose of antipsychotic medications every day, creating the impression that this is intensifying treatment and reducing psychotic symptoms, in fact, this effect depends only on the duration of exposure to the drug. Long-term administration of antipsychotics in large doses often leads to the development of side effects.

• Subjective severe sensations after the first dose of the drug (usually associated with side effects) increase the risk of a negative treatment outcome and patient evasion from treatment. In such cases, you need to think about changing the drug.

• The duration of treatment is 4–6 weeks, then, if there is no effect, the treatment regimen is changed.

• When incomplete and unstable remission occurs, the dose of drugs is reduced to a level that ensures the maintenance of remission, but does not cause depression of mental activity and pronounced side effects. This maintenance therapy is prescribed for a long time on an outpatient basis.

Basic drugs

Neuroleptics - chlorpromazine, levomepromazine, clozapine, haloperidol, trifluoperazine, flupentixol, pipothiazine, zuclopenthixol, sulpiride, quetiapine, risperidone, olanzapine.

Antidepressants and tranquilizers are prescribed for depression and anxiety, respectively. When the depressive effect is combined with anxiety and motor restlessness, antidepressants with a sedative effect, such as amitriptyline, are used. For depression with lethargy and decreased behavioral energy, antidepressants with a stimulating effect, such as imipramine, or without a sedative effect, such as fluoxetine, paroxetine, citalopram, are used. Tranquilizers (eg, diazepam, bromodihydrochlorophenylbenzodiazepine) are used short-term to treat anxiety.

Complications during treatment with neuroleptics

Long-term therapy with antipsychotics can lead to the development of persistent complications. Therefore, it is important to avoid unnecessary treatment by varying doses depending on the patient's condition. Anticholinergic drugs prescribed to relieve adverse extrapyramidal symptoms, with long-term continuous use, increase the risk of tardive dyskinesia. Therefore, anticholinergic drugs not used constantly and for prophylactic purposes , but are prescribed only in case of adverse extrapyramidal symptoms.

• Akineto-hypertensive syndrome •• Clinical picture: mask-like face, rare blinking, stiffness of movements •• Treatment: trihexyphenidyl, biperiden.

• Hyperkinetic-hypertensive syndrome •• Clinical picture: akathisia (restlessness, feeling of restlessness in the legs), tasykinesia (restlessness, desire to constantly move, change position), hyperkinesis (choreiform, athetoid, oral) •• Treatment: trihexyphenidyl, biperiden.

• Dyskinetic syndrome •• Clinical picture: oral dyskinesia (tension of the masticatory, swallowing, tongue muscles, an irresistible desire to stick out the tongue), oculogyric crises (painful rolling of the eyes) •• Treatment: trihexyphenidyl (6–12 mg/day), 20% caffeine solution 2 ml s.c., chlorpromazine 25–50 mg i.m.

• Chronic dyskinetic syndrome •• Clinical picture: hypokinesia, increased muscle tone, hypomimia in combination with local hyperkinesis (complex oral automatisms, tics), decreased motivation and activity, acairia (intrusiveness), emotional instability •• Treatment: nootropics (piracetam 1200– 2400 mg/day for 2–3 months), multivitamins, tranquilizers.

• Malignant neuroleptic syndrome •• Clinical picture: dry skin, acrocyanosis, sebaceous hyperemic face, forced posture - on the back, oliguria, increased blood clotting time, increased residual nitrogen in the blood, renal failure, decreased blood pressure, increased body temperature •• Treatment: infusion therapy (reopolyglucin, hemodez, crystalloids), parenteral nutrition (proteins, carbohydrates).

• Intoxication delirium develops more often in men over 40 years of age (with a combination of chlorpromazine, haloperidol, amitriptyline. Treatment is detoxification.

Prognosis for 20 years: recovery - 25%, improvement - 30%, care and/or hospitalization required - 20% • 50% of patients with schizophrenia attempt suicide (15% with a fatal outcome) • The older the age of onset, the more favorable the prognosis • The more pronounced the affective component of the disorder, the more acute and shorter the attack, the better it responds to treatment, and the greater the chance of achieving complete and sustainable remission.

Synonyms . Bleuler's disease, Dementia praecox, Discordant psychosis, Dementia praecox

ICD-10 • F20 Schizophrenia

Notes.

• pfropfschizophrenia (from German Pfropfung - vaccination) - schizophrenia developing in an oligophrenic "oligoschizophrenia" pfropfhebephrenia "vaccinated schizophrenia

• Huber's senesthetic schizophrenia - schizophrenia with a predominance of senestopathies in the form of burning sensations, constriction, tearing, turning over, etc.

• schizophrenia-like psychosis (pseudoschizophrenia) is a psychosis similar or identical in clinical picture to schizophrenia.

• schizophrenia-like syndrome is the general name for psychopathological syndromes similar in manifestations to schizophrenia, but occurring in other psychoses.

• nuclear schizophrenia (galloping) - rapid development of emotional devastation with the disintegration of pre-existing positive symptoms (end state).

Diagnostics

At different stages, schizophrenia manifests symptoms in a range of emotions from baby talk and delusions with hallucinations to suicide attempts. It is necessary to conduct a medical examination to determine the exact clinical picture. Anamnesis is collected based on detailed questions about the patient and his relatives. The doctor will conduct a test for schizophrenia to determine the diagnosis. We are talking about a neurotest that shows immune blood parameters. Based on them, a decision is made on the final diagnosis and its severity. If necessary, the patient may be prescribed an MRI of the brain. Correctly selected treatment for schizophrenia has good results. In 50% it is possible to achieve remission, and 25% of patients completely get rid of the diagnosis, provided that the forms of schizophrenia can be corrected.

Treatment

The first signs of schizophrenia are the ideal time to start therapy. In most cases, this does not work out because the symptoms are ignored or mistaken for other pathological conditions. If the test for schizophrenia confirms the diagnosis, the doctor will prescribe appropriate treatment. If acute symptoms occur, drug correction is recommended. This mainly applies to the following conditions: depression, anxiety, sleep problems, severe apathy, thinking disorders. Schizophrenia in men and women, if the treatment plan is followed, has a positive prognosis. For this purpose, psychotherapy is also used and social rehabilitation is carried out. In the process of treatment, it is necessary to ensure that the signs of schizophrenia in the negative group decrease in severity. In the future, it is important to maintain the condition to avoid relapses.

Special cases

The signs listed earlier refer to typical cases of the development of schizophrenia. However, doctors have to deal with particulars. Moreover, each case is so individual that you can write a dissertation on any of them.

Thus, a woman with signs of schizophrenia can become emotionally cold and abandon her children. She does not clean the house, collects garbage, joins a sect and has no contact with her family.

A typical sign of the first stage is a passion for religion, mysticism, or a complex scientific topic about which the patient knows nothing.

With schizophrenia of the hebephrenic type, which usually occurs in adolescents, a child from an obedient and approximately excellent student can turn into a “bad guy”, and in just 1-2 years. He starts smoking and drinking, shocks passers-by by walking down the street without clothes, defecates in the middle of the room, masturbates in front of his parents, or persuades his own mother to cohabitate.

The surprising thing is that even the presence of such symptoms does not always motivate people to take their loved one to the doctor. It’s often easier for people to think that he’s taking drugs or hanging out with bad company, but he’s not a schizophrenic. Because of this, time is lost that could be spent on treatment.

Myths and misconceptions

Behavior reveals signs of schizophrenia openly if you understand the specific manifestations of the disease. People with this diagnosis are considered non-violent and safe for society. This is not a myth, but we must take into account possible outbursts of rage and aggression, and unpredictable actions.

Personal failure and stupid behavior - this is also what others often say. Yes, certain stages of schizophrenia lead to this condition. A person can even behave like a child. There are forms of schizophrenia with not very pronounced symptoms. People in such cases are no more stupid than others in society. It is interesting that among people diagnosed with schizophrenia, there are many talented artists and musicians. A striking example is Vincent Van Gogh.

Sluggish schizophrenia in children

Sluggish schizophrenia in children can begin to manifest itself from the age of 7. The child begins to behave inappropriately, is afraid of everything, and talks to an invisible interlocutor. Other manifestations of the disease:

• Paranoia. It seems to the child that every person, even those close to him, wants to offend and humiliate him.
• Unreasonable fear. Children begin to panic fear even of ordinary things, and their fears gradually worsen.
• Insulation. Against the background of schizophrenic disorder, the child ceases to show interest in toys and entertainment. He refuses to communicate with other children and cannot build friendly relationships.
• Excessive moodiness. Children with indolent schizophrenia experience sudden and unreasonable mood changes.
• Speech problems. A progressive disease leads to problems with the ability to logically and consistently express one's thoughts. Such children often conduct conversations inappropriately, uttering phrases that have nothing to do with the topic being discussed.

Ways to prevent disease

Schizophrenia provokes a disorder of normal life not only in the person diagnosed, but also in his family and close people. The disease is inherited, so prevention is aimed at leveling this aspect. It is necessary to reduce the risk of stress, maintain hormonal balance, not drink alcohol, and not take drugs. All possible risk factors must be addressed for the diagnosis of schizophrenia to become a reality. It is recommended to do things that help stabilize the psyche: physical labor, drawing and other manual creativity. It is better to understand the risks and carry out prevention than to then undergo treatment for schizophrenia.

How to make an appointment with a psychiatrist at JSC “Medicine” (clinic of academician Roitberg)

Anyone who has been diagnosed with schizophrenia needs psychological help. This is a normal human need to strive to return to normal life. Our clinic treats the delicate problems of patients with understanding. At the appointment, a psychiatrist will help you understand the essence of schizophrenia, find a way out of the situation and support you on the path to recovery.

You can make an appointment with a doctor on the website using a special form or by calling +7 (495) 775-73-60. The clinic is located within walking distance from the Mayakovskaya metro station in the center of Moscow: 2nd Tverskoy-Yamskaya lane, 10.