Schizophrenia definition. Who is a schizophrenic? How to recognize a schizophrenic? Famous schizophrenics. What is schizophrenia

- a mental disorder, accompanied by the development of fundamental disorders of perception, thinking and emotional reactions. Differs in significant clinical polymorphism. The most typical manifestations of schizophrenia include fantastic or paranoid delusions, auditory hallucinations, impaired thinking and speech, flattening or inadequacy of affects, and gross violations of social adaptation. The diagnosis is established on the basis of an anamnesis, a survey of the patient and his relatives. Treatment - drug therapy, psychotherapy, social rehabilitation and readaptation.

ICD-10

F20

General information

Causes of schizophrenia

The causes of occurrence have not been precisely established. Most psychiatrists believe that schizophrenia is a multifactorial disease that occurs under the influence of a number of endogenous and exogenous influences. There is a hereditary predisposition. In the presence of close relatives (father, mother, brother or sister) suffering from this disease, the risk of developing schizophrenia increases to 10%, that is, about 20 times compared with the average risk in the population. However, 60% of patients have an uncomplicated family history.

Factors that increase the risk of developing schizophrenia include intrauterine infections, complicated delivery, and time of birth. It has been established that people born in spring or winter are more likely to suffer from this disease. They note a stable correlation between the prevalence of schizophrenia and a number of social factors, including the level of urbanization (urban residents get sick more often than rural residents), poverty, unfavorable living conditions in childhood, and family relocations due to unfavorable social conditions.

Many researchers point to the presence of early traumatic experiences, neglect of vital needs, sexual or physical abuse suffered in childhood. Most experts believe that the risk of schizophrenia does not depend on the style of upbringing, while some psychiatrists point to a possible association of the disease with gross violations of family relationships: neglect, rejection and lack of support.

Schizophrenia, alcoholism, drug addiction and substance abuse are often closely related, but it is not always possible to track the nature of these relationships. There are studies pointing to the connection of exacerbations of schizophrenia with the use of stimulants, hallucinogens and some other psychoactive substances. However, an inverse relationship is also possible. When the first signs of schizophrenia appear, patients sometimes try to eliminate unpleasant sensations (suspicion, mood deterioration and other symptoms) by using drugs, alcohol and drugs with a psychoactive effect, which entails an increased risk of developing drug addiction, alcoholism and other addictions.

Some experts point to a possible connection of schizophrenia with abnormalities in the structure of the brain, in particular, with an increase in the ventricles and a decrease in the activity of the frontal lobe, which is responsible for reasoning, planning and decision-making. Patients with schizophrenia also show differences in the anatomical structure of the hippocampus and temporal lobes. At the same time, the researchers note that the listed disorders could have arisen secondarily, under the influence of pharmacotherapy, since most of the patients who participated in the studies of the structure of the brain had previously received antipsychotic drugs.

There are also a number of neurochemical hypotheses linking the development of schizophrenia with impaired activity of certain neurotransmitters (the dopamine theory, the keturene hypothesis, the hypothesis that the disease is related to disorders in the cholinergic and GABAergic systems). For some time, the dopamine hypothesis was especially popular, but later many experts began to question it, pointing to the simplified nature of this theory, its inability to explain clinical polymorphism and many variants of the course of schizophrenia.

Schizophrenia classification

Based on clinical symptoms, the DSM-4 distinguishes five types of schizophrenia:

• paranoid schizophrenia- there are delusions and hallucinations in the absence of emotional flattening, disorganized behavior and thinking disorders
• Disorganized schizophrenia(hebephrenic schizophrenia) - thinking disorders and emotional flattening are detected
• Catatonic schizophrenia- psychomotor disorders predominate
• Undifferentiated schizophrenia- psychotic symptoms are detected that do not fit into the picture of catatonic, hebephrenic or paranoid schizophrenia
• Residual schizophrenia- there is a mild positive symptomatology.

Along with those listed, two more types of schizophrenia are distinguished in the ICD-10:

• simple schizophrenia- gradual progression of negative symptoms in the absence of acute psychoses is revealed
• Post-schizophrenic depression- occurs after an exacerbation, characterized by a steady decrease in mood against the background of mild residual symptoms of schizophrenia.

Depending on the type of course, domestic psychiatrists traditionally distinguish between paroxysmal-progredient (coat-like), recurrent (periodic), sluggish and continuously ongoing schizophrenia. The division into forms, taking into account the type of course, allows you to more accurately determine the indications for therapy and predict the further development of the disease. Taking into account the stage of the disease, the following stages of the development of schizophrenia are distinguished: premorbid, prodromal, first psychotic episode, remission, exacerbation. The end state of schizophrenia is a defect - persistent deep thinking disorders, reduced needs, apathy and indifference. The severity of the defect can vary significantly.

Symptoms of schizophrenia

Manifestation of schizophrenia

Typically, schizophrenia manifests during adolescence or early adulthood. The first attack is usually preceded by a premorbid period of 2 or more years. During this period, patients experience a number of non-specific symptoms, including irritability, mood disturbances with a tendency to dysphoria, bizarre behavior, sharpening or perversion of certain character traits, and a decrease in the need for contact with other people.

Shortly before the onset of schizophrenia, a period of prodrome begins. Patients are increasingly isolated from society, becoming scattered. Short-term disorders of the psychotic level (transient overvalued or delusional ideas, fragmentary hallucinations) are added to nonspecific symptoms, turning into a full-blown psychosis. The symptoms of schizophrenia are divided into two large groups: positive (something that should not be normal appears) and negative (something that should be normal disappears).

Positive symptoms of schizophrenia

hallucinations. Usually in schizophrenia, auditory hallucinations occur, while the patient may think that the voices sound in his head or come from various external objects. Voices may threaten, command, or comment on the patient's behavior. Sometimes the patient hears two voices at once arguing with each other. Along with auditory, tactile hallucinations are possible, usually of a pretentious nature (for example, frogs in the stomach). Visual hallucinations in schizophrenia are extremely rare.

Delusional disorders. In delusional influence, the patient believes that someone (enemy intelligence, aliens, evil forces) influences him with the help of technical means, telepathy, hypnosis or witchcraft. With delusions of persecution, a schizophrenic patient thinks that someone is constantly watching him. The delusion of jealousy is characterized by an unshakable conviction that the spouse is unfaithful. Dysmorphophobic delirium is manifested by confidence in one's own deformity, in the presence of a gross defect in some part of the body. With delusions of self-blame, the patient considers himself guilty of the misfortunes, illnesses or death of others. In delusions of grandeur, the schizophrenic believes that he occupies an exceptionally high position and / or possesses extraordinary abilities. Hypochondriacal delusions are accompanied by a belief in the presence of an incurable disease.

Obsessions, disorders of movement, thinking and speech. Obsessive ideas - ideas of an abstract nature that arise in the mind of a patient with schizophrenia against his will. As a rule, they are global in nature (for example: “what happens if the Earth collides with a meteorite or deorbits?”). Movement disorders manifest as catatonic stupor or catatonic excitation. Disorders of thinking and speech include obsessive sophistication, reasoning and meaningless reasoning. The speech of patients suffering from schizophrenia is replete with neologisms and overly detailed descriptions. In their reasoning patients randomly jump from one topic to another. With gross defects, schizophasia occurs - incoherent speech, devoid of meaning.

Negative symptoms of schizophrenia

Emotional disorders. social isolation. Emotions of patients with schizophrenia are flattened and impoverished. Often there is hypothymia (sustained decrease in mood). Hyperthymia (sustained increase in mood) occurs less frequently. The number of contacts with others decreases. Patients suffering from schizophrenia are not interested in the feelings and needs of loved ones, stop attending work or school, prefer to spend time alone, being completely absorbed in their experiences.

Disorders of the volitional sphere. Drifting. Drift is manifested by passivity and inability to make decisions. Patients with schizophrenia repeat their habitual behavior or reproduce the behavior of others, including asocial behavior (for example, they drink alcohol or take part in illegal actions), without feeling pleasure and without forming their own attitude to what is happening. Volitional disorders are manifested by hypobulia. Needs disappear or decrease. The range of interests narrows sharply. Decreased sex drive. Patients suffering from schizophrenia begin to neglect the rules of hygiene, refuse to eat. Less often (usually in the initial stages of the disease), hyperbulia is observed, accompanied by an increase in appetite and sexual desire.

Diagnosis and treatment of schizophrenia

The diagnosis is established on the basis of an anamnesis, a survey of the patient, his friends and relatives. The diagnosis of schizophrenia requires the presence of one or more criteria of the first rank and two or more criteria of the second rank, defined by ICD-10. The criteria for the first rank include auditory hallucinations, the sound of thoughts, fanciful delusions and delusional perceptions. The criteria for schizophrenia of the second rank include catatonia, thought interruption, persistent hallucinations (other than auditory), behavioral disturbances, and negative symptoms. Symptoms of the first and second rank should be observed for a month or more. To assess the emotional state, psychological status and other parameters, various tests and scales are used, including the Luscher test, the Leary test, the Carpenter scale, the MMMI test and the PANSS scale.

Treatment for schizophrenia includes psychotherapy and social rehabilitation activities. The basis of pharmacotherapy are drugs with antipsychotic action. Currently, preference is more often given to atypical antipsychotics, which are less likely to cause tardive dyskinesia and, according to experts, can reduce the negative symptoms of schizophrenia. To reduce the severity of side effects, antipsychotics are combined with other drugs, usually mood stabilizers and benzodiazepines. If other methods are ineffective, ECT and insulin coma therapy are prescribed.

After the reduction or disappearance of positive symptoms, a patient with schizophrenia is referred for psychotherapy. Cognitive behavioral therapy is used to train cognitive skills, improve social functioning, help with awareness of the characteristics of one's own condition and adaptation to this condition. Family therapy is used to create a favorable family atmosphere. Conduct training sessions for relatives of patients with schizophrenia, provide psychological support to relatives of patients.

Prognosis for schizophrenia

The prognosis for schizophrenia is determined by a number of factors. Favorable prognostic factors include female sex, late age of onset, acute onset of the first psychotic episode, mild negative symptoms, absence of prolonged or frequent hallucinations, as well as favorable personal relationships, good professional and social adaptation before the onset of schizophrenia. Social attitude plays a certain role – according to research, the absence of stigmatization and the acceptance of others reduces the risk of relapse.

Schizophrenia... For many, if not all people, this disease sounds like a stigma. "Schizophrenic" is a synonym for the finale, the end of existence and uselessness for society. Is it so? Alas, with such an attitude, it will be so. Everything unfamiliar is frightening and perceived as hostile. And a patient suffering from schizophrenia, by definition, becomes an enemy of society (I want to note, unfortunately, it is our society that is not the case in the whole civilized world), because others are afraid and do not understand what kind of "Martian" is nearby. Or, even worse, they mock and mock the unfortunate. Meanwhile, you should not perceive such a patient as an insensitive deck, he feels everything, and very sharply, believe me, and first of all, his attitude towards himself. I hope to interest you and show understanding, and therefore sympathy. In addition, I want to note that among such patients there are many creative (and well-known) personalities, scientists (the presence of a disease does not detract from their merits) and just sometimes people who are close to you.

Let's try together to understand the concepts and definitions of schizophrenia, the features of the course of its symptoms and syndromes, and its possible outcomes. So:

From Greek. Schizis - splitting, phrenus - diaphragm (it was believed that this was where the soul was).
Schizophrenia is the "queen of psychiatry". Today, 45 million people suffer from it, regardless of race, nation and culture, 1% of the world's population suffers from it. To date, there is no clear definition and description of the causes of schizophrenia. The term "schizophrenia" was introduced in 1911 by Erwin Bleuiler. Prior to that, the term "premature dementia" was in use.

In domestic psychiatry, schizophrenia is "a chronic endogenous disease, manifested by various negative and positive symptoms, and characterized by specific progressive personality changes."

Here, apparently, we should pause and take a closer look at the elements of the definition. From the definition, we can conclude that the disease proceeds for a long time and carries a certain staging and regularity in the change of symptoms and syndromes. Wherein negative symptoms- this is the "falling out" from the spectrum of mental activity of pre-existing signs characteristic of this person - flattening of emotional response, reduction of energy potential (but more on that later). The positive symptoms- this is the appearance of new signs - delirium, hallucinations.

Signs of schizophrenia

Continuous forms of the disease include cases with a gradual progressive development of the disease process, with varying severity of both positive and negative symptoms. With a continuous course of the disease, its symptoms are observed throughout life from the moment of the disease. Moreover, the main manifestations of psychosis are based on two main components: delusions and hallucinations.

These forms of endogenous disease are accompanied by personality changes. A person becomes strange, withdrawn, commits ridiculous, illogical actions from the point of view of others. The range of his interests changes, new, previously unusual hobbies appear. Sometimes these are philosophical or religious teachings of a dubious nature, or fanatical adherence to the canons of traditional religions. At patients working capacity, social adaptation decreases. In severe cases, the emergence of indifference and passivity, a complete loss of interests is not excluded.

The paroxysmal course (recurrent or periodic form of the disease) is characterized by the occurrence of distinct attacks, combined with a mood disorder, which brings this form of the disease closer to manic-depressive psychosis, especially since mood disorders occupy a significant place in the picture of attacks. In the case of a paroxysmal course of the disease, the manifestations of psychosis are observed in the form of separate episodes, between which there are "bright" intervals of a relatively good mental state (with a high level of social and labor adaptation), which, being sufficiently long, can be accompanied by a complete recovery of working capacity (remission).

An intermediate place between these types of course is occupied by cases of a paroxysmal-progressive form of the disease, when, in the presence of a continuous course of the disease, the appearance of seizures is noted, the clinical picture of which is determined by syndromes similar to attacks of recurrent schizophrenia.

As mentioned earlier, the term "schizophrenia" was introduced by Erwin Bleuler. He believed that the main thing for describing schizophrenia is not the outcome, but the "basic disorder". He also singled out a complex of characteristic signs of schizophrenia, four "A", Bleuler's tetrad:

1. Associative defect - lack of associated purposeful logical thinking (currently called "alology").

2. A symptom of autism ("autos" - Greek - own - distancing from external reality, immersion in one's inner world.

3. Ambivalence - the presence in the patient's psyche of multidirectional affects love / hate at the same time.

4. Affective inadequacy - in a standard situation gives an inadequate affect - laughs when reporting the death of relatives.

Symptoms of schizophrenia

The French psychiatric school proposed a scale of deficient and productive symptoms, arranging them according to the degree of increase. German psychiatrist Kurt Schneider described rank I and rank II symptoms in schizophrenia. The "calling card" of schizophrenia is the symptoms of rank I, and now they are still "in use":

1. Sounding thoughts - thoughts acquire sonority, in fact they are pseudo-hallucinations.
2. "Voices" that argue among themselves.
3. Commentary hallucinations.
4. Somatic passivity (the patient feels that his motor acts are controlled).
5. "Taking out" and "implementation" of thoughts, shperrung - ("blockage" of thoughts), interruption of thoughts.
6. Broadcasting of thoughts (mental broadcasting - as if a radio receiver is turned on in the head).
7. Feeling "made" thoughts, their foreignness - "thoughts are not their own, they were put into the head." The same - with feelings - the patient describes that it is not he who feels hungry, but he is made to feel hungry.
8. Delusions of perception - a person interprets events in his symbolic key.

In schizophrenia, the boundaries between "I" and "not me" are destroyed. A person considers internal events external, and vice versa. Borders are loosened. Of the 8 signs above, 6 speak of this.

Views on schizophrenia as a phenomenon are different:

1. Schizophrenia is a disease - according to Kraepelin.
2. Schizophrenia is a reaction - according to Bangofer - the reasons are different, and the brain responds with a limited set of reactions.
3. Schizophrenia is a specific adaptation disorder (Amer. Laing, Shazh).
4. Schizophrenia is a special personality structure (based on a psychoanalytic approach).

Etiopathogenesis (origin, "origins") of schizophrenia

There are 4 "blocks" of theories:

1. Genetic factors. 1% of the population is stably sick; if one of the parents is sick, the risk that the child will also get sick is 11.8%. If both parents - 25-40% and above. In identical twins, the frequency of manifestation in both at the same time is 85%.
2. Biochemical theories: metabolic disorders of dopamine, serotonin, acetylcholine, glutamate.
3. Stress theory.
4. Psychosocial hypothesis.

Overview of some theories:

Stress (very different) affects the "flawed" personality - most often it is stress associated with the load of adult roles.

The role of parents: The American psychiatrists Bleytseg and Linds described the "schizophrenogenic mother". As a rule, this is a woman: 1. Cold; 2. non-critical; 3. Rigid (with a "freezing", delayed affect; 4. With confused thinking - often "pushing" the child to a severe course of schizophrenia.

There is a virus theory.

The theory that schizophrenia is a slowly progressive encephalitis-type debilitating process. The volume of the brain in patients suffering from schizophrenia is reduced.

In schizophrenia, the filtration of information, the selectivity of mental processes, and the pathopsychological direction are disturbed.

Men and women suffer from schizophrenia equally often, but the city dwellers - more often, the poor - more often (more stress). If the patient is male, the disease has an earlier onset and a more severe course, and vice versa.

The American health care system spends up to 5% of the budget on the treatment of schizophrenia. Schizophrenia is a disabling disease, it shortens the patient's life by 10 years. In terms of the frequency of causes of death in patients, cardiovascular diseases are in the first place, and suicide is in the second place.

Patients with schizophrenia have a large "margin of strength" in front of biological stress and physical exertion - they can withstand up to 80 doses of insulin, are resistant to hypothermia, rarely get ARVI and other viral diseases. It has been reliably calculated that "future patients" are born, as a rule, at the junction of winter-spring (March-April) - either because of the vulnerability of biorhythms, or because of the effects of infections on the mother.

Classification of variants of schizophrenia.

According to the type of flow, there are:

1. Continuously progressive schizophrenia.
2. Paroxysmal
a) paroxysmal-progredient (fur-like)
b) periodic (recurrent).

By stages:

1. The initial stage (from the first signs of the disease (asthenia) to the manifest signs of psychosis (hallucinations, delusions, etc.). There may also be hypomania, subdepression, depersonalization, etc.
2. Manifestation of the disease: a combination of deficient and productive symptoms.
3. Final stage. A pronounced predominance of deficient symptoms over productive ones and the freezing of the clinical picture.

According to the degree of progression (development rate):

1. Rapidly progressive (malignant);
2. Medium progredient (paranoid form);
3. Low-progressive (sluggish).

The exception is recurrent schizophrenia.

Description of some types:

Malignant schizophrenia: manifests itself between the ages of 2 and 16 years. It is characterized by a very short initial stage - up to a year. The manifest period is up to 4 years. Peculiarities:
a) In premorbid (i.e., in a state preceding the disease), a schizoid personality (closed, uncommunicative, fearful of the outside world of a person);
b) Productive symptoms immediately reach a high level;
c) At the 3rd year of the disease, an apathetic-abulic syndrome is formed (vegetabels - "vegetable life" - while this condition can be reversible at the time of severe stress - for example, in a fire);
d) Treatment is symptomatic.

Intermediate type of schizophrenia: The initial period lasts up to 5 years. Strange hobbies, hobbies, religiosity appear. Get sick at the age of 20 to 45 years. In the manifest period - either a hallucinatory form or delusional. This period lasts up to 20 years. At the final stage of the disease - shrapnel delirium, speech is preserved. The treatment is effective, it is possible to achieve drug remissions (temporary improvements in well-being). With continuous-progredient schizophrenia, hallucinatory-delusional symptoms significantly predominate over affective ones (violations of the emotional-volitional sphere); in paroxysmal, affective symptoms predominate. Also, in paroxysmal remissions, they are deeper and can be spontaneous (spontaneous). With a continuously progressive patient, the patient is hospitalized 2-3 times a year, with a paroxysmal - up to 1 time in 3 years.

Sluggish, neurosis-like schizophrenia: Age of onset is 16 to 25 years on average. There is no clear boundary between the initial and manifest periods. Neurosis-like phenomena dominate. Schizophrenic psychopathization is observed, but the patient can work, maintain family and communication ties. At the same time, it is clear that the person is "distorted" by the disease.

What are the negative and positive symptoms?

Let's start with the negatives:

1. Engin Bleiler singled out associative defect;
Stransky - interpsychic ataxia;
Also - schism.

All this is the loss of coherence, the integrity of mental processes -
a) in thinking;
b) in the emotional sphere;
c) in acts of will.

The processes themselves are fragmented, and even within the processes themselves there is a "mess". Schism is an unfiltered product of thinking. Healthy people also have it, but it is controlled by consciousness. In patients, it is observed in the initial stage, but, as a rule, disappears with the advent of hallucinations and delusions.

2. Autism. A patient with schizophrenia experiences anxiety and fear when communicating with the outside world and wants to distance himself from any contact. Autism - flight from contacts.

3. reasoning- the patient speaks, but does not move towards the goal.

4. Apathy- Increasing loss of emotional response - an ever smaller number of situations causes an emotional reaction. At first, rationalization is observed instead of immediate emotions. The first thing that disappears is interests and hobbies. ("Sergey, my aunt is coming" - "we'll come and meet you"). Adolescents behave like little old men - they seem to be reasonably responsible, but behind this "reasonableness" there is a clear impoverishment of emotional reactions; ("Vitalik, brush your teeth" - "why?") I.e. does not refuse or disagree, but tries to rationalize. If you give an argument why you need to brush your teeth, there will be a counterargument, the conviction can drag on indefinitely, because. the patient is not going to discuss anything in fact - he just resonates.

5. Abulia(according to Kraepelin) - the disappearance of the will. In the early stages, it looks like increasing laziness. First - at home, at work, then in self-service. Patients lie more. More often, it is not apathy, but impoverishment; not abulia, but hypobulia. Emotions in patients with schizophrenia are stored in one isolated "reserve zone", which in psychiatry is called parabulia. Parabulia can be the most diverse - one of the patients abandoned work and walked around the cemetery for months, drawing up his plan. "Labor" took up a large volume. Another - counted all the letters "H" in "War and Peace". The third - dropped out of school, walked down the street, collected animal excrement and at home carefully attached them to the stand, as entomologists do with butterflies. Thus, the patient resembles a "mechanism running idle."

Positive or productive symptoms:

1. Auditory pseudohallucinations(the patient hears "voices", but perceives them not as really existing in nature, but accessible only to him, "induced" by someone, or "descent from above"). It is usually described that such "voices" are heard not as usual, by the ear, but by the "head", "brain".

2. Syndrome of mental automatisms(Kandinsky-Clerambault), which includes:
a) Delusions of persecution (patients in this state are dangerous, because they can arm themselves in order to defend themselves from imaginary pursuers, and injure anyone who is considered as such; or attempt suicide in order to "end it");
b) delirium of influence;
c) auditory pseudohallucinations (described above);
d) Mental automatism - associative (feeling that thoughts are "made"); senestopathic (feeling that feelings are "made"); motor (feeling that certain movements that he makes are not his, but imposed on him from the outside, he is forced to do them) .

3. Catatonia, hebephrenia- freezing in one position, often uncomfortable, for long hours, or vice versa - sharp disinhibition, foolishness, antics.

According to neurogenetic theories, the productive symptomatology of the disease is due to dysfunction of the caudate nucleus system of the brain, the limbic system. Mismatch in the work of the hemispheres, dysfunction of the fronto-cerebellar connections are found. On CT (computed tomography of the brain), you can detect the expansion of the anterior and lateral horns of the ventricular system. With nuclear forms of the disease, the voltage from the frontal leads is reduced on the EEG (electroencephalogram).

Diagnosis of schizophrenia

The diagnosis is made on the basis of the identification of the main productive symptoms of the disease, which are combined with negative emotional and volitional disorders, leading to the loss of interpersonal communications with a total observation period of up to 6 months. The most important in the diagnosis of productive disorders is the identification of symptoms of influence on thoughts, actions and mood, auditory pseudohallucinations, symptoms of openness of thought, gross formal thought disorders in the form of discontinuity, catatonic movement disorders. Among the negative violations, attention is paid to the reduction of energy potential, alienation and coldness, unreasonable hostility and loss of contacts, social decline.

At least one of the following signs must be present:

"Echo of thoughts" (sounding of one's own thoughts), insertion or withdrawal of thoughts, openness of thoughts.
Delusions of influence, motor, sensory, ideational automatisms, delusional perception.
Auditory commentary true and pseudo hallucinations and somatic hallucinations.
Delusional ideas that are culturally inappropriate, ridiculous, and grandiose in content.

Or at least two of the following:

Chronic (more than a month) hallucinations with delusions, but without pronounced affect.
Neologisms, sperrungs, broken speech.
catatonic behavior.
Negative symptoms, including apathy, abulia, impoverishment of speech, emotional inadequacy, including coldness.
Qualitative behavioral changes with loss of interest, lack of focus, autism.

Diagnosis of paranoid schizophrenia is put in the presence of general criteria for schizophrenia, as well as the following signs:

1. dominance of hallucinatory or delusional phenomena (ideas of persecution, relationship, origin, thought transmission, threatening or haunting voices, hallucinations of smell and taste, senesthesia);
2. catatonic symptoms, flattened or inadequate affect, speech rupture may be presented in a mild form, but do not dominate the clinical picture.

Diagnosis of the hebephrenic form is put in the presence of general criteria for schizophrenia and:

one of the following signs;

• distinct and persistent flattening or superficiality of affect,
• a distinct and persistent inadequacy of affect,

one of the other two signs;

• lack of purposefulness, concentration of behavior,
• distinct disturbances of thinking, manifested in incoherent or broken speech;

hallucinatory-delusional phenomena may be present in a mild form, but do not determine the clinical picture.

Diagnosis of the catatonic form is placed if the general criteria for schizophrenia are met, and at least one of the following signs has been present for at least two weeks:

• stupor (a distinct decrease in reaction to the environment, spontaneous mobility and activity) or mutism;
• arousal (outwardly meaningless motor activity not caused by external stimuli);
• stereotypy (voluntary adoption and retention of meaningless and pretentious postures, performance of stereotyped movements);
• negativism (outwardly unmotivated resistance to appeals from the outside, the fulfillment of the opposite of what is required);
• rigidity (maintenance of the posture, despite external attempts to change it);
• waxy flexibility, stiffening of the limbs or body in poses given from the outside);
• automatism (immediate following of instructions).

Photos of patients with catatonic schizophrenia

undifferentiated form is diagnosed when the condition meets the general criteria for schizophrenia but not the specific criteria for individual types, or the symptoms are so numerous that they meet the specific criteria for more than one subtype.

Diagnosis of post-schizophrenic depression set if:

1. the state during the last year of observation met the general criteria for schizophrenia;
2. at least one of them is retained; 3) the depressive syndrome must be so protracted, severe and unfolding as to meet the criteria for at least a mild depressive episode (F32.0).

For diagnosis of residual schizophrenia the condition must in the past meet the criteria common for schizophrenia, not already detected at the time of the examination. In addition, at least 4 of the following negative symptoms must have been present within the last year:

1. psychomotor retardation or reduced activity;
2. distinct flattening of affect;
3. passivity and reduced initiative;
4. impoverishment of the volume and content of speech;
5. decrease in the expressiveness of non-verbal communication, manifested in facial expressions, eye contact, voice modulations, gestures;
6. decrease in social productivity and attention to appearance.

Diagnosis of a simple form of schizophrenia is based on the following criteria:

1. a gradual increase in all three of the following signs for at least a year:

• distinct and persistent changes in some premorbid personality traits, manifested in a decrease in motives and interests, purposefulness and productivity of behavior, withdrawal into oneself and social isolation;
• negative symptoms: apathy, impoverishment of speech, decrease in activity, a distinct flattening of affect, passivity, lack of initiative, decrease in non-verbal characteristics of communication;
• a distinct decrease in productivity at work or school;

1. the state never corresponds to the features common to paranoid, hebephrenic, catatonic and undifferentiated schizophrenia (F20.0-3);
2. there are no signs of dementia or other organic brain damage (FO).

The diagnosis is also confirmed by the data of a pathopsychological study, clinical and genetic data on the burden of schizophrenia in first-degree relatives are of indirect importance.

Pathopsychological tests in schizophrenia.

In Russia, unfortunately, the psychological examination of the mentally ill is not very developed. Although honey. There are psychologists on staff in hospitals.

The main diagnostic method is a conversation. The logical sequence of thinking inherent in a mentally healthy person in a patient with schizophrenia is in most cases upset, and associative processes are violated. As a result of such violations, the patient seems to speak consistently, but his words do not have a semantic connection with each other. For example - the patient says that he is "hunted by the laws of justice of the sages in order to drag lambs with straight noses around the world."

As tests, they are asked to explain the meanings of expressions and sayings. Then you can "dig out" the formality, the earthiness of judgments, the lack of understanding of the figurative meaning. For example, "they cut down the forest, the chips fly" - "well, yes, the tree is made of fibers, they break off when struck with an ax." Another patient, when asked to explain what the expression “This man has a heart of stone” means, says this: “Among the times of growth, there is heart layering, and this is the appearance of human growth.” The above phrases are incomprehensible. This is a typical example of "speech discontinuity". In some cases, speech is reduced to the pronunciation of individual words and phrases without any sequence. For example, "...smoke pouring...there will be no place...the kingdom of heaven...it's wrong to buy water...two without a name...six crowns...cut a lasso and a cross..." - this is the so-called verbal okroshka, or verbal salad. They may be asked to draw the meaning of the phrase "delicious lunch." Where an ordinary person draws a chicken leg, a steaming bowl of soup, or a plate with a fork and knife, a schizophrenic patient draws two parallel lines. To the question - "what is it?" - replies that "lunch is delicious, everything is high, harmony, that's how these lines are" Another test - to exclude the fourth extra - from the list "jackdaw, tit, crow, plane" - may either not exclude the plane (all from the list flies), or to exclude, but relying only on signs known to him ("the first three from the list can land on the wires, but the plane cannot." And not living / non-living, like ordinary people).

Predictions for schizophrenia.

We will reveal four types of forecasts:

1. General prognosis of the disease - refers to the time of onset of the end state and its characteristics.

2. Social and labor forecast.

3. Forecast of the effectiveness of therapy (whether the disease is resistant to treatment).

4. Forecast of the risk of suicide and homicide (suicide and murder).

About 40 factors have been identified that make it possible to determine the prognosis of the course of the disease. Here are some of them:

1. Sex. The male is an unfavorable factor, the female is favorable (nature is designed so that women are the keepers of the population, while men are researchers, they account for more mutations).

2. The presence of concomitant organic pathologies is a poor prognosis.

3. Hereditary burden for schizophrenia - unfavorable prognosis.

4. Schizoid accentuation of character before the onset of the disease.

5. Acute onset is a good prognostic sign; erased, "smeared" - bad.

6. Psychogenic "starting" mechanism - good, spontaneous, not having an obvious reason - bad.

7. The predominance of the hallucinatory component is bad, the affective component is good.

8. Sensitivity to therapy during the first episode - good, no - bad.

9. A large frequency and duration of hospitalizations is a poor prognostic sign.

10. The quality of the first remissions - if the remissions are complete, good (meaning remissions after the first episodes). It is important that there be no or minimal negative and positive symptoms during remission.

40% of patients with schizophrenia commit suicidal acts, 10-12% die from suicide.

List of risk factors for suicide in schizophrenia:

1. Male gender.
2. Young age.
3. Good intelligence.
4. First episode.
5. History of suicide.
6. The predominance of depressive and anxiety symptoms.
7. Imperative hallucinosis (hallucinations ordering to perform certain actions).
8. The use of psychoactive substances (alcohol, drugs).
9. The first three months after discharge.
10. Inadequately small or large doses of drugs.
11. Social problems in connection with the disease.

Risk factors for homicide (attempted murder):

1. History of (previously) criminal assault episodes.
2. Other criminal acts.
3. Male gender.
4. Young age.
5. Use of psychoactive substances.
6. Hallucinatory-delusional symptoms.
7. Impulsivity.

Sluggish schizophrenia

According to statistics, half of patients with schizophrenia "possess" it in a sluggish form. This is a certain category of people that is difficult to outline. Recurrent schizophrenia also occurs. Let's talk about them.

By definition, sluggish schizophrenia is schizophrenia that does not show pronounced progression throughout and does not show manifest psychotic phenomena, the clinical picture is represented by disorders of the light "registers" - neurotic personality disorders, asthenia, depersonalization, derealization.

The names of sluggish schizophrenia accepted in psychiatry: mild schizophrenia (Kronfeld), non-psychotic (Rozenshtein), Current without a change in character (Kerbikov), microprocessual (Goldenberg), rudimentary, sanatorium (Konnaibeh), prephase (Yudin), slow-flowing (Azelenkovsky), larvated , hidden (Snezhnevsky). You can also find the following terms:
failed, amortized, ambulatory, pseudo-neurotic, occult, non-regressive.

Sluggish schizophrenia has certain stages, stages:

1. Latent (debut) - proceeds very covertly, latently. As a rule, at the age of puberty, in adolescents.

2. Active (manifest) period. The manifesto never reaches the psychotic level.

3. Stabilization period (in the first years of the disease, or after several years of the disease).
In this case, the defect is not observed, there may even be a regression of negative symptoms, its reverse development. However, there may be a new push at the age of 45-55 years (involutional age). General characteristics:
Slow, long-term development of the stages of the disease (however, it can stabilize at an early age); long subclinical course in the latent period; gradual reduction of disorders in the period of stabilization.

Forms, variants of low-progressive schizophrenia:

1. Asthenic variant - symptoms are limited by the level of asthenic disorders. This is the softest level.
At the same time, asthenia is atypical, without a "symptom of a match", irritability - in this case, selective exhaustion of mental activity is observed. There are also no objective reasons for asthenic syndrome - somatic disease, organic pathology in premorbidity. The patient gets tired of everyday everyday communication, ordinary affairs, while he is not exhausted by other activities (communication with antisocial personalities, collecting, and often pretentious). This is a kind of hidden schism, a splitting of mental activity.

2. Form with obsession. Similar to obsessive compulsive disorder. However, in schizophrenia, no matter how hard we try, we will not find psychogenesis and personality conflict. Obsessions are monotonous and emotionally not saturated, "not charged". At the same time, these obsessions can be overgrown with a large number of rituals performed without the emotional involvement of a person. Characterized by monoobsessions (monothematic obsession).

3. Form with hysterical manifestations. Characterized by "cold hysteria". This is a very "selfish" schizophrenia, while it is exaggerated, grossly selfish, exceeding the hysteria in a neurotic. The rougher it is, the worse, the deeper the violation.

4. With depersonalization. In human development, depersonalization (violation of the "me - not me" boundaries) may be the norm in adolescence; in schizophrenia, it goes beyond this.

5. With dysmorphic experiences ("my body is ugly, my ribs are too sticky, I'm too thin/fat, my legs are too short, etc.). This also occurs in adolescence, but in schizophrenia there is no emotional involvement in the experience." Defects" frilly - "one side is more frilly than the other." Anorexia nervosa syndrome at an early age also belongs to this group.

6. Hypochondriacal schizophrenia. Non-delusional, non-psychotic level. Typical for adolescence and involutionary age.

7. Paranoid schizophrenia. Reminds me of a paranoid personality disorder.

8. With a predominance of affective disorders. Possible as hypothymic variants (subdepression, but without intellectual retardation). At the same time, a schism is often seen between a reduced background of mood and intellectual, motor activity, a volitional component. Also - hypochondriacal subdepression with an abundance of senestopathies. Subdepression with a tendency to introspection, introspection.
Hyperthymic manifestations: hypomania with a one-sided character of enthusiasm for one activity. "Zigzags" are characteristic - a person works, is full of optimism, then a recession for several days - and works again. Schizis variant - hypomania with simultaneous health complaints.

9. Variant of unproductive disorders. "Easy Option" Symptoms are limited to negative. There is a gradual, increasing defect over the years.

10. Latent sluggish schizophrenia (according to Smulevich) - everything that was listed above, but in the most mild, outpatient form.

Defects in sluggish schizophrenia:

1. A defect of the Verschreuben type (with German strangeness, eccentricity, eccentricity) - described by Krepeleny.
Outwardly - disharmony of movements, angularity, a certain juvenile ("childhood"). The unmotivated seriousness of facial expression is characteristic. There is a certain shift with the acquisition earlier (before the disease) of traits not characteristic of this personality. In clothes - slovenliness, absurdity (short trousers, bright hats, clothes, as from the century before last, randomly selected things, etc.). Speech is unusual, with a selection of peculiar words and turns of speech, "stuck" on minor details is characteristic. There is a preservation of mental and physical activity, despite the eccentricity (there is a schism between social autism and lifestyle - patients walk a lot, communicate, but in a peculiar way).

2. Psychopathic defect (pseudopsychopatization according to Smulevich). The main component is schizoid. An expansive schizoid, active, "gushing" with overvalued ideas, emotionally charged, with "autism inside out", but at the same time flattened, not solving social problems. In addition, there may be a hysterical component.

3. Reduction of the energy potential of a shallow degree of severity (passive, live within the house, do not want and cannot do anything). Similar to the typical reduction in energy potential in schizophrenia, but to a much less pronounced degree.

These people often begin to resort to psychoactive substances, more often to alcohol. At the same time, emotional flatness decreases, the schizophrenic defect decreases. The danger, however, is that alcoholism and drug addiction become uncontrollable, since the stereotype of their response to alcohol is atypical, alcohol often does not bring relief, the forms of intoxication are expansive, with aggression and brutality. However, alcohol is indicated in small doses (old-school psychiatrists prescribed it to their patients with sluggish schizophrenia).

And finally - recurrent, or periodic schizophrenia.

It is rare, in particular due to the fact that it is not always possible to diagnose it in time. In the International Classification of Diseases (ICD), recurrent schizophrenia is designated as schizoaffective disorder. This is the most complex form of schizophrenia in terms of its symptoms and structure.

Stages of occurrence of recurrent schizophrenia:

1. The initial stage of general somatic and affective disorders (subdepression with severe somatization - constipation, anorexia, weakness). The presence of overvalued (ie, based on real, but grotesquely exaggerated) fears (for work, relatives) is characteristic. Lasts from several days to several months (usually 1-3 months). This may be the limit. The beginning is adolescence.

2. Delusional affect. Fuzzy, undeveloped fears of delusional, paranoid content (for oneself, for loved ones) appear. There are few delusions, they are sketchy, but there is a lot of affective charge and motor components - thus, this can be attributed to an acute paranoid syndrome. Beginning changes in self-consciousness are characteristic. There is a certain alienation of one's behavior, depersonalization manifestations of a shallow register. This stage is extremely labile, symptoms may fluctuate.

3. Stage of affective-delusional depersonalization and derealization. Disorders of self-awareness sharply increase, a delusional perception of the environment appears. Delusions of intermetamorphosis - "everything around is rigged." False recognition appears, a symptom of twins, there are automatisms ("I am controlled"), psychomotor agitation, substupor.

4. Stage of fantastic affective-delusional depersonalization and derealization. Perception becomes fantastic, paraphrenization of symptoms takes place ("I'm in the school of space reconnaissance and I'm being tested"). The disorder of self-awareness continues to worsen (“I am a robot, they manage me”; “I manage a hospital, a city”).

5. Illusory-fantastic derealization and depersonalization. The perception of oneself and reality begin to suffer rudely up to illusions and hallucinations. In fact, this is the beginning of a oneiroid stupefaction ("I am me, but now I am a technical device - pockets are special devices for disks"; "a policeman says - I hear him, but this is a voice that controls everything on Earth").

6. Stage of classical, true oneiroid clouding of consciousness. The perception of reality is completely disrupted, it is unrealistic to make contact with the patient (only for a short time - due to the lability of the processes). There may be motor activity dictated by experienced images. Self-consciousness is violated (“I am not me, but an animal of the Mesozoic era”; “I am a machine in the struggle between machines and people”).

7. Stage of amental-like obscuration of consciousness. In contrast to the oneiroid, psychopathological experiences of reality are extremely impoverished. Amnesia of experience and images is complete (with oneiroid - no). Also - confusion, severe catatonic symptoms, fever. This is the pre-phase of the next stage. The prognosis is unfavorable. (There is also a separate form - "Febrile schizophrenia"). The main "psychiatric" remedy in this case is electro-convulsive therapy (ECT) - up to 2-3 sessions per day. This is the only way to break this state. There is a 5% chance of improvement. Without these measures, the prognosis is 99.9% poor.

All of the above levels can be an independent picture of the disease. As a rule, from an attack to an attack, the condition worsens until it “freezes” at some stage. Recurrent schizophrenia is a low-progressive form, therefore there is no complete recovery between attacks, but remissions are long, the manifestations of the disease are hardly noticeable. The most common outcome is a reduction in energy potential, patients become passive, fenced off from the world, while maintaining, nevertheless, often a warm atmosphere for family members. In many patients, through recurrent schizophrenia after 5-6 years, it can turn into a fur coat. In its pure form, recurrent schizophrenia does not lead to a permanent defect.

Treatment of schizophrenia.

General Methods:

I. Biological therapy.

II. Social therapy: a) psychotherapy; b) methods of social rehabilitation.

Biological methods:

I "Shock" methods of therapy:

1. Insulin-coma therapy (introduced by German psychiatrist Zakel in 1933);

2. Convulsive therapy (with the help of camphor oil injected under the skin - the Hungarian psychiatrist Meduna in 1934) - is not used now.

3) electro-convulsive therapy (Cerletti, Beni in 1937). Mood disorders ECT treats very effectively. With schizophrenia - with suicidal behavior, with catatonic stupor, with resistance to drug therapy.

4) Detoxification therapy;

5) Diet-unloading therapy (with sluggish schizophrenia);

6) Deprivation (deprivation) of sleep and phototherapy (for affective disorders);

7) Psychosurgery (in 1907, Bechtrinwa's staff performed a lobotomy; in 1926, the Portuguese Monica performed a prefrontal leucotomy. Monitz was later wounded by a patient with a pistol shot after he performed an operation on him);

8) Pharmacotherapy.

Drug groups:

a) neuroleptics;
b) Anxiolytics (reducing anxiety);
c) Normotimics (regulating the affective sphere);
d) antidepressants;
e) nootropics;
e) psychostimulants.

In the treatment of schizophrenia, all of the above groups of drugs are used, but antipsychotics are in the 1st place.

General principles of drug treatment of schizophrenia:

1. Biopsychosocial approach - any patient suffering from schizophrenia needs biological treatment, psychotherapy and social rehabilitation.

2. Pay special attention to psychological contact with the doctor, because patients with schizophrenia have the lowest interaction with the doctor - they are distrustful, they deny the presence of the disease.

3. Early initiation of therapy - before the onset of the manifest stage.

4. Monotherapy (where you can prescribe 3 or 5 drugs, choose 3, so you can "track" the effect of each of them);

5. Long duration of treatment: relief of symptoms - 2 months, stabilization of the condition - 6 months, formation of remission - a year);

6. The role of prevention - special attention is paid to drug prevention of exacerbations. The more exacerbations, the more severe the disease. In this case, we are talking about secondary prevention of exacerbations.

The use of antipsychotics is based on the dopamine theory of pathogenesis - it was believed that patients with schizophrenia had too much dopamine (a precursor of norepinephrine), and it should be blocked. It turned out that there is not more of it, but the receptors are more sensitive to it. At the same time, violations of serotonergic mediation, acetylcholine, histamine, glutamate were found out, but the dopamine system reacts faster and stronger than the others.

The gold standard for the treatment of schizophrenia is haloperidol. In terms of power, it is not inferior to subsequent drugs. Classic antipsychotics, however, have side effects: they have a high risk of extrapyramidal disorders, and they act very brutally on all dopamine receptors. Recently, atypical antipsychotics have appeared: Clozepine (leponex) - the first atypical antipsychotic to appear; the most famous at present:

1. Respiredon;
2. Alanzepine;
3. Clozepine;
4. Quetiopin (Serroquel);
5. Abilefay.

There is a prolonged version of drugs that allows you to achieve remissions with more rare injections:

1. Moditen Depot;
2. Haloperidol-decanoate;
3. Rispolept-consta (reception 1 time in 2-3 weeks).

As a rule, when prescribing a course, oral drugs are preferable, since the introduction of the drug into a vein, into the muscle is associated with violence and causes peak blood concentrations very quickly. Therefore, they are used mainly for the relief of psychomotor agitation.

Hospitalization.

In schizophrenia, hospitalization is indicated in acute conditions - refusal to eat for a week or more, or leading to a loss of body weight by 20% of the original or more; the presence of imperative (commanding) hallucinosis, suicidal thoughts and tendencies (attempts), aggressive behavior, psychomotor agitation.

Because people with schizophrenia are often unaware that they are ill, it is difficult or even impossible to persuade them to seek treatment. If the patient's condition worsens, and you can neither convince nor force him to be treated, then you may have to resort to hospitalization in a psychiatric hospital without his consent. The primary purpose of both involuntary hospitalization and the laws governing it is to ensure the safety of the acutely ill patient and those around him. In addition, the tasks of hospitalization also include ensuring timely treatment of the patient, even if against his desire. After examining the patient, the district psychiatrist decides under what conditions to treat: the patient's condition requires urgent hospitalization in a psychiatric hospital, or outpatient treatment can be limited.

Article 29 of the Law of the Russian Federation (1992) " On psychiatric care and guarantees of the rights of citizens in its provision" clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

“A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative before the decision of the judge, if his examination or treatment is possible only in hospital conditions, and the mental disorder is severe and causes:

1. his immediate danger to himself or others, or
2. his helplessness, that is, his inability to satisfy the basic needs of life on his own, or
3. significant harm to his health due to the deterioration of his mental state if the person is left without psychiatric care.

Treatment during remission

During the period of remission, maintenance therapy is mandatory; without this, a worsening of the condition is inevitable. As a rule, patients after discharge feel much better, consider that they are cured completely, stop taking drugs, and the vicious circle starts again. This disease is not completely cured, however, with adequate therapy, it is possible to achieve stable remission against the backdrop of maintenance treatment.

Do not forget that often the success of treatment depends on how quickly after the exacerbation or initial stage there was an appeal to a psychiatrist. Unfortunately, relatives who have heard about the "horrors" of a psychiatric clinic oppose the hospitalization of such a patient, believing that "everything will pass by itself." Alas... Spontaneous remissions are practically not described. Therefore, they turn later, but in a more difficult situation.

Criteria for remission: the disappearance of delusions, hallucinations (if any), the disappearance of aggression or suicidal attempts, if possible, social adaptation. In any case, the decision on discharge is made by the doctor, as well as on hospitalization. The task of the relatives of such a patient is to cooperate with the doctor, informing him of all the nuances of the patient's behavior, without hiding or embellishing anything. And also - monitor the intake of drugs, since such people do not always fulfill the appointments of a psychiatrist. In addition, success also depends on social rehabilitation, and half the success in this is the creation of a comfortable atmosphere in the family, and not an "exclusion zone". Believe me, patients of this profile very subtly feel the attitude towards themselves and react accordingly.

If you take into account the cost of treatment, disability payments and sick leave, then schizophrenia can be called the most expensive of all mental illnesses.

Psychiatrist A.V. Khodorkovsky

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

General characteristics of schizophrenia

At its core, it is a chronic disease in which a disorder of thinking and perception of any phenomena of the surrounding world develops against the background of a preserved level of intelligence. That is, a person with schizophrenia is not necessarily mentally retarded, his intelligence, like that of all other people, can be low, medium, high, and even very high. Moreover, in history there are many examples of brilliant people who suffered from schizophrenia, for example, Bobby Fischer - world chess champion, mathematician John Nash, who received the Nobel Prize, etc. The story of John Nash's life and illness was brilliantly told in A Beautiful Mind.

That is, schizophrenia is not dementia and a simple abnormality, but a specific, very special disorder of thinking and perception. The term "schizophrenia" itself consists of two words: schizo - split and phrenia - mind, reason. The final translation of the term into Russian may sound like "split consciousness" or "split consciousness". That is, schizophrenia is when a person has a normal memory and intellect, all his senses (vision, hearing, smell, taste and touch) work correctly, even the brain perceives all information about the environment as it should, but consciousness (the cortex brain) processes all this data incorrectly.

For example, human eyes see the green leaves of trees. This picture is transmitted to the brain, assimilated by it and transmitted to the cortex, where the process of comprehending the received information takes place. As a result, a normal person, having received information about green leaves on a tree, comprehends it and concludes that the tree is alive, it is summer outside, there is a shadow under the crown, etc. And with schizophrenia, a person is not able to comprehend information about green leaves on a tree, in accordance with the normal laws inherent in our world. This means that when he sees green leaves, he will think that someone is painting them, or that this is some kind of signal for aliens, or that he needs to pick them all, etc. Thus, it is obvious that in schizophrenia there is a disorder of consciousness, which is not able to form an objective picture from the available information based on the laws of our world. As a result, a person has a distorted picture of the world, created precisely by his consciousness from the initially correct signals received by the brain from the senses.

It is because of such a specific disturbance of consciousness, when a person has both knowledge, and ideas, and correct information from the senses, but the final conclusion is made with the chaotic use of their functionals, the disease was called schizophrenia, that is, the splitting of consciousness.

Schizophrenia - symptoms and signs

First, you should know that schizophrenia is characterized by symptoms and signs. Symptoms are understood as strictly defined manifestations characteristic of the disease, such as delusions, hallucinations, etc. And signs of schizophrenia are four areas of human brain activity in which there are violations.

Signs of schizophrenia

Associative defect - is expressed in the absence of logical thinking in the direction of any ultimate goal of reasoning or dialogue, as well as in the resulting poverty of speech, in which there are no additional, spontaneous components. Currently, this effect is called briefly - alogia. Let's consider this effect with an example in order to clearly understand what psychiatrists mean by this term.

So, imagine that a woman is riding a trolley bus and her friend enters at one of the stops. A conversation ensues. One of the women asks the other: "Where are you going?" The second replies: "I want to visit my sister, she is a little sick, I'm going to visit her." This is an example of the response of a normal person who does not suffer from schizophrenia. In this case, in the response of the second woman, the phrases “I want to visit my sister” and “she is a little sick” are examples of additional spontaneous speech components that were said in accordance with the logic of the discussion. That is, the only answer to the question of where she is going is the "to her sister" part. But the woman, logically thinking of other questions of the discussion, immediately answers why she is going to her sister (“I want to visit because she is sick”).

If the second woman to whom the question was addressed was a schizophrenic, then the dialogue would be as follows:
- Where are you driving?
- To Sister.
- For what?
- I want to visit.
Did something happen to her or just like that?
- It happened.
- What's happened? Something serious?
- Got sick.

Such a dialogue with monosyllabic and non-expanded answers is typical for the participants in the discussion, among whom one is ill with schizophrenia. That is, with schizophrenia, a person does not think out the following possible questions in accordance with the logic of the discussion and does not answer them immediately in one sentence, as if ahead of them, but gives monosyllabic answers that require further numerous clarifications.

Autism- is expressed in distraction from the real world around and immersion in one's inner world. A person's interests are sharply limited, he performs the same actions and does not respond to various stimuli from the outside world. In addition, a person does not interact with others and is not able to build normal communication.

Ambivalence - is expressed in the presence of completely opposite opinions, experiences and feelings regarding the same object or object. For example, in schizophrenia, a person may simultaneously love and hate ice cream, running, etc.

Depending on the nature of ambivalence, there are three types of it - emotional, volitional and intellectual. So, emotional ambivalence is expressed in the simultaneous presence of opposite feelings towards people, events or objects (for example, parents can love and hate children, etc.). Volitional ambivalence is expressed in the presence of endless hesitation when it is necessary to make a choice. Intellectual ambivalence consists in the presence of diametrically opposed and mutually exclusive ideas.

affective inadequacy - is expressed in a completely inadequate reaction to various events and actions. For example, when a person sees a drowning person, he laughs, and when he receives some kind of good news, he cries, etc. In general, affect is an external expression of an internal experience of mood. Accordingly, affective disorders are external manifestations that do not correspond to internal sensory experiences (fear, joy, sadness, pain, happiness, etc.), such as: laughter in response to the experience of fear, fun in grief, etc.

These pathological effects are signs of schizophrenia and cause changes in the personality of a person who becomes unsociable, withdrawn, loses interest in objects or events that previously worried him, commits ridiculous acts, etc. In addition, a person may have new hobbies that were previously completely atypical for him. As a rule, philosophical or orthodox religious teachings, fanaticism in following an idea (for example, vegetarianism, etc.) become such new hobbies in schizophrenia. As a result of the restructuring of a person's personality, the working capacity and the degree of his socialization are significantly reduced.

In addition to these signs, there are also symptoms of schizophrenia, which include single manifestations of the disease. The whole set of symptoms of schizophrenia is divided into the following large groups:

• Positive (productive) symptoms;
• Negative (deficiency) symptoms;
• Disorganized (cognitive) symptoms;
• Affective (mood) symptoms.

Positive symptoms of schizophrenia

Positive symptoms of schizophrenia include:

• Rave;
• hallucinations;
• Illusions;
• A state of arousal;
• Inappropriate behaviour.

Hallucinations are a violation of the perception of the surrounding reality with the help of the senses. That is, hallucinations are understood as certain sensations that do not exist in reality. Hallucinations are divided into auditory, visual, olfactory, tactile and gustatory depending on which sense organ they affect. In addition, hallucinations can be simple (individual sounds, noise, phrases, flashes, etc.) or complex (coherent speech, certain scenes, etc.).

The most common are auditory hallucinations, when a person hears voices in his head or in the world around him, sometimes it seems to him that the thoughts were not produced by him, but put into the brain, etc. Voices and thoughts can give commands, advise something, discuss events, speak vulgarities, make you laugh, etc.

Visual hallucinations develop less frequently and, as a rule, in combination with hallucinations of other types - tactile, gustatory, etc. It is the combination of several types of hallucinations that gives a person a substrate for their subsequent delusional interpretation. So, some discomfort in the genital area is interpreted as a sign of rape, pregnancy or illness.

It should be understood that for a patient with schizophrenia, his hallucinations are not a figment of the imagination, but he really feels it all. That is, he sees aliens, atmospheric control threads, smells of roses from the cat litter and other non-existent things.

Rave is a collection of certain beliefs, conclusions or conclusions that are completely untrue. Delusions can be independent or provoked by hallucinations. Depending on the nature of beliefs, delusions of persecution, influence, power, greatness or attitude are distinguished.

Delusions of persecution most often develop, in which it seems to a person that someone is following him, for example, aliens, parents, children, policemen, etc. Every minor event in the surrounding space seems to be a sign of surveillance, for example, tree branches swaying in the wind are perceived as a sign of observers sitting in ambush. The met person in glasses is perceived as a messenger who goes to report on all his movements, etc.

Delusions of influence are also very common and are characterized by the idea that a person is being affected in some way, negatively or positively, for example, DNA rearrangement, radiation, suppression of the will by psychotropic weapons, medical experiments, etc. In addition, with this form of delusion, a person is sure that someone controls his internal organs, body and thoughts, putting them directly into the head. However, the delirium of influence may not have such vivid forms, but disguise itself as forms that are quite similar to reality. For example, a person each time gives a piece of cut sausage to a cat or dog, because he is sure that they want to poison him.

The delusion of dysmorphophobia is a strong belief in the presence of shortcomings that need to be corrected, for example, to straighten protruding ribs, etc. The delusion of reformism is the constant invention of some new powerful devices or systems of relationships that in reality are not viable.

Inappropriate behavior represents either naive stupidity, or strong agitation, or manners and appearance inappropriate for the situation. Typical variants of inappropriate behavior include depersonalization and derealization. Depersonalization is a blurring of the boundaries between self and non-self, as a result of which one’s own thoughts, internal organs and body parts seem to a person not their own, but brought from outside, random people are perceived by relatives, etc. Derealization is characterized by an increased perception of any minor details, colors, smells, sounds, etc. Because of this perception, it seems to a person that everything is not happening for real, and people, like in a theater, play roles.

The most severe variant of inappropriate behavior is catatonia, in which a person takes awkward postures or randomly moves. Clumsy poses are usually taken by a person in a stupor and hold them for a very long time. Any attempt to change his position is useless, because he has a resistance that is almost impossible to overcome, because schizophrenics have incredible muscle strength. A special case of awkward postures is wax flexibility, which is characterized by holding any part of the body in one position for a long time. When excited, a person begins to jump, run, dance and make other meaningless movements.
Also referred to as inappropriate behavior hebephrenia- excessive foolishness, laughter, etc. A person laughs, jumps, laughs and performs other similar actions, regardless of the situation and location.

Negative symptoms of schizophrenia

In general, the negative symptoms of schizophrenia are described as loss of energy and motivation, reduced activity, lack of initiative, poverty of thought and speech, physical passivity, emotional poverty, and narrowing of interests. A patient with schizophrenia appears passive, indifferent to what is happening, taciturn, motionless, etc.

However, with a more accurate selection of symptoms, the following are considered negative:

• Passivity;
• Loss of will;
• Complete indifference to the outside world (apathy);
• Autism;
• Minimal expression of emotions;
• Flattened affect;
• Inhibited, sluggish and mean movements;
• Speech disorders;
• Disorders of thought;
• Inability to make decisions;
• Inability to maintain a normal coherent dialogue;
• Low ability to concentrate;
• Rapid exhaustion;
• Lack of motivation and lack of initiative;
• mood swings;
• Difficulty in constructing an algorithm for sequential actions;
• Difficulty in finding a solution to the problem;
• Poor self-control;
• Difficulty switching from one activity to another;
• Ahedonism (inability to experience pleasure).

The speech of a person suffering from schizophrenia is characterized by the following features:

• Constant jumping on various topics;
• The use of new, invented words that are understandable only to the person himself;
• Repetition of words, phrases or sentences;
• Rhyming - speaking in meaningless rhyming words;
• Incomplete or jerky responses to questions;
• Sudden silences due to blockage of thoughts (sperrung);
• The influx of thoughts (mentism), expressed in rapid incoherent speech.

Autism is a detachment of a person from the outside world and immersion in his own little world. In this state, the schizophrenic seeks to withdraw from contact with other people and live in solitude.

Various disorders of will, motivation, initiative, memory and attention are collectively referred to as depletion of energy potential , since a person quickly gets tired, cannot perceive a new one, analyzes the totality of events poorly, etc. All this leads to a sharp decrease in the productivity of his activity, as a result of which, as a rule, his ability to work is lost. In some cases, a super-valuable idea is formed in a person, which consists in the need to preserve strength, and manifests itself in a very careful attitude towards one's own person.

Emotions in schizophrenia become weakly expressed, and their spectrum is very poor, which is usually called flattened affect . First, a person loses responsiveness, compassion and the ability to empathize, as a result of which the schizophrenic becomes selfish, indifferent and cruel. In response to various life situations, a person can react in a completely atypical and incongruous way, for example, be absolutely indifferent to the death of a child or take offense at an insignificant action, word, look, etc. Very often, a person can experience deep affection and obey any one close person.

With the progression of schizophrenia, a flattened affect can take on peculiar forms. For example, a person can become eccentric, explosive, unrestrained, conflictual, spiteful and aggressive, or, on the contrary, acquire complaisance, euphoric high spirits, stupidity, lack of criticism of actions, etc. With any variant of a flattened affect, a person becomes sloppy and prone to gluttony and masturbation.

Violations of thinking are manifested by illogical reasoning, incorrect interpretation of everyday things. Descriptions and reasoning are characterized by the so-called symbolism, in which real concepts are replaced by completely different ones. However, in the understanding of patients with schizophrenia, it is these concepts that do not correspond to reality that are symbols of some real things. For example, a person walks naked, but explains it this way - nudity is needed to remove a person’s stupid thoughts. That is, in his thinking and consciousness, nudity is a symbol of liberation from stupid thoughts.

A special variant of thought disorder is reasoning, which consists in constant empty reasoning on abstract topics. Moreover, the ultimate goal of reasoning is completely absent, which makes them meaningless. In severe schizophrenia, it can develop schizophasia, representing the pronunciation of unrelated words. Often these words are combined by patients into sentences, observing the correctness of cases, but they do not have any lexical (semantic) connection.

With the predominance of negative symptoms of depression of the will, the schizophrenic easily falls under the influence of various sects, criminal groups, asocial elements, obeying their leaders implicitly. However, a person may retain a will that allows him to perform some senseless action to the detriment of normal work and social intercourse. For example, a schizophrenic can draw up a detailed plan of a cemetery with the designation of each grave, count the number of any letters in a particular literary work, etc.

Anhedonia represents the loss of the ability to enjoy anything. So, a person cannot eat with pleasure, take a walk in the park, etc. That is, against the background of anhedonia, a schizophrenic, in principle, cannot enjoy even those actions, objects or events that previously gave him it.

Disorganized symptoms

affective symptoms

Typical syndromes characteristic of schizophrenia

So, The typical positive syndromes of schizophrenia include the following:

• hallucinatory-paranoid syndrome - characterized by a combination of unsystematic delusions (most often persecution), verbal hallucinations and mental automatism (repetitive actions, a feeling that someone controls thoughts and body parts, that everything is not real, etc.). All symptoms are perceived by the patient as something real. There is no sense of artificiality.
• Kandinsky-Clerambault Syndrome - refers to a variety of hallucinatory-paranoid syndrome and is characterized by the feeling that all visions and disorders of a person are violent, that someone created them for him (for example, aliens, Gods, etc.). That is, it seems to a person that thoughts are put into his head, internal organs, actions, words and other things are controlled. Periodically there are episodes of mentism (an influx of thoughts), alternating with periods of withdrawal of thoughts. As a rule, there is a completely systematized delusion of persecution and influence, in which a person explains with complete conviction why he was chosen, what they want to do to him, etc. A schizophrenic with the Kandinsky-Clerambault syndrome believes that he does not control himself, but is a puppet in the hands of persecutors and evil forces.
• paraphrenic syndrome - characterized by a combination of delusions of persecution, hallucinations, affective disorders and the Kandinsky-Clerambault syndrome. Along with the ideas of persecution, a person has a clear conviction of his own power and power over the world, as a result of which he considers himself the ruler of all the Gods, the solar system, etc. Under the influence of his own delusional ideas, a person can tell others that he will create a paradise, change the climate, transfer humanity to another planet, etc. The schizophrenic himself feels himself in the center of grandiose, supposedly ongoing events. An affective disorder consists in a constantly high mood up to a manic state.
• Capgras syndrome- is characterized by the delusional idea that people can change their appearance to achieve any goals.
• Affective paranoid syndrome - characterized by depression, delusional ideas of persecution, self-accusations and hallucinations with a vivid accusatory character. In addition, this syndrome can be characterized by a combination of megalomania, noble birth and hallucinations of a laudatory, glorifying and approving character.
• catatonic syndrome - characterized by freezing in a certain position (catalepsy), giving parts of the body some uncomfortable position and maintaining it for a long time (waxy mobility), as well as strong resistance to any attempts to change the adopted position. Mutism can also be noted - dumbness with a preserved speech apparatus. Any external factors, such as cold, humidity, hunger, thirst and others, cannot force a person to change the absent facial expression with almost completely absent facial expressions. In contrast to being frozen in a certain position, arousal may appear, characterized by impulsive, senseless, frivolous and campy movements.
• hebephrenic syndrome - characterized by foolish behavior, laughter, mannerisms, making faces, lisping, impulsive actions and paradoxical emotional reactions. Perhaps a combination with hallucinatory-paranoid and catatonic syndromes.
• Depersonalization-derealization syndrome - is characterized by feelings of painful and extremely unpleasant experience about changes in one's own personality and the behavior of the surrounding world, which the patient cannot explain.

Typical negative syndromes of schizophrenia are as follows:

• Thinking Disorder Syndrome - manifested by diversity, fragmentation, symbolism, blockage of thinking and reasoning. The diversity of thinking is manifested by the fact that insignificant features of things and events are perceived by a person as the most important. At the same time, the speech is detailed with a description of the details, but vague and unclear in relation to the general main idea of ​​the patient's monologue. The fragmentation of speech is manifested by the fact that a person builds sentences from words and phrases that are unrelated in meaning, which, however, are grammatically connected by correct cases, prepositions, etc. A person cannot complete a thought, because he constantly deviates from a given topic by associations, jumps to other topics, or begins to compare something incomparable. In severe cases, the fragmentation of thinking is manifested by a stream of unrelated words (verbal okroshka). Symbolism is the use of a term as a symbolic designation of a completely different concept, thing or event. For example, with the word stool, the patient symbolically denotes his legs, etc. Blockage of thinking is a sharp break in the thread of thought or loss of the topic of conversation. In speech, this is manifested by the fact that a person begins to say something, but abruptly stops, without even finishing a sentence or phrase. Reasoning is fruitless, lengthy, empty, but numerous reasoning. In speech, a patient with schizophrenia can use his own invented words.
• Syndrome of emotional disorders - characterized by the extinction of reactions and coldness, as well as the appearance of ambivalence. People lose emotional ties with loved ones, losing compassion, pity and other similar manifestations, becoming cold, cruel and insensitive. Gradually, as the disease develops, emotions disappear completely. However, not always in a patient with schizophrenia, who does not show emotions in any way, those are completely absent. In some cases, a person has a rich emotional spectrum and is extremely burdened by the fact that he is not able to express it fully. Ambivalence is the simultaneous presence of opposite thoughts and emotions in relation to the same object. The consequence of ambivalence is the inability to make a final decision and make a choice from the possible options.
• Will disorder syndrome (aboulia or hypobulia) - characterized by apathy, lethargy and lack of energy. Such disorders of the will cause a person to be fenced off from the outside world and become isolated in himself. With strong violations of the will, a person becomes passive, indifferent, without initiative, etc. Most often, will disorders are combined with those in the emotional sphere, so they are often combined into one group and are called emotional-volitional disorders. In each individual person, volitional or emotional disturbances may predominate in the clinical picture of schizophrenia.
• Personality Change Syndrome is the result of the progression and deepening of all negative symptoms. A person becomes mannered, absurd, cold, withdrawn, uncommunicative and paradoxical.

Symptoms of schizophrenia in men, women, children and adolescents

The first symptoms of schizophrenia (initial, early)

• Speech disorders. As a rule, a person begins to answer any questions in monosyllables, even those where a detailed answer is required. In other cases, it cannot exhaustively answer the question posed. It is rare that a person is able to answer a question in full, but he speaks slowly at the same time.
• Anhedonia- the inability to enjoy any activities that previously fascinated a person. For example, before the onset of schizophrenia, a person liked to embroider, but after the onset of the disease, this activity does not fascinate him at all and does not give pleasure.
• Weak expression or complete absence of emotions. The person does not look into the eyes of the interlocutor, the face is expressionless, it does not reflect any emotions and feelings.
• Failure to complete any task because the person does not see the point in it. For example, a schizophrenic does not brush his teeth because he does not see the point in it, because they will get dirty again, etc.
• Weak focus on any subject.

Symptoms of different types of schizophrenia

Paranoid (paranoid) schizophrenia

Catatonic schizophrenia

Hebephrenic schizophrenia

Simple (mild) schizophrenia

Undifferentiated schizophrenia

Residual schizophrenia

Post-schizophrenic depression

In addition to the above, some doctors additionally distinguish manic schizophrenia.

Manic schizophrenia (manic-depressive psychosis)

Depending on the nature of the course, continuous and paroxysmal-progressive forms of schizophrenia are distinguished. In addition, in modern Russia and the former USSR, recurrent and sluggish types of schizophrenia were distinguished, which in modern classifications correspond to the terms schizoaffective and schizotypal disorder. Consider the symptoms of acute (stage of psychosis paroxysmal-progredient form), continuous and sluggish schizophrenia.

Acute schizophrenia (attacks of schizophrenia) - symptoms

An attack of acute schizophrenia can occur in the form of psychosis or oneiroid. Psychosis is characterized by vivid hallucinations and delusions, a complete detachment from reality, persecution mania or depressive detachment and self-absorption. Any mood swings cause changes in the nature of hallucinations and delusions.

Oneiroid is characterized by unlimited and very vivid hallucinations and delusions, which concern not only the surrounding world, but also oneself. Thus, a person imagines himself as some other object, for example, pockets, a disc player, a dinosaur, a machine that is at war with people, etc. That is, a person experiences complete depersonalization and derealization. At the same time, within the framework of the delusional-illusory representation of oneself as someone or something that has arisen in the head, whole scenes from the life or activity of that with which the person has identified himself are played out. Experienced images cause motor activity, which can be excessive or, on the contrary, catatonic.

Continuous schizophrenia

Sluggish (hidden) schizophrenia

Sluggish schizophrenia has the following stages:

• Debut- proceeds inconspicuously, as a rule, at puberty;
• Manifest period - characterized by clinical manifestations, the intensity of which never reaches the level of psychosis with delusions and hallucinations;
• Stabilization- complete elimination of manifest symptoms for a long period of time.

Neurosis-like schizophrenia

Alcoholic schizophrenia - symptoms

Alcoholic psychosis can occur in three ways:

• Delirium (delirium tremens) - occurs after the cessation of consumption of alcoholic beverages and is expressed in the fact that a person sees devils, animals, insects and other objects or living beings. In addition, a person does not understand where he is and what is happening to him.
• Hallucinosis- occurs during drinking. A person is disturbed by auditory hallucinations of a threatening or accusatory nature.
• delusional psychosis- occurs with prolonged, regular and fairly moderate alcohol consumption. It is expressed by delusions of jealousy with persecution, attempts at poisoning, etc.

Symptoms of hebephrenic, paranoid, catatonic and other types of schizophrenia - video

Schizophrenia: causes and predisposing factors, signs, symptoms and manifestations of the disease - video

Causes and symptoms of schizophrenia - video

Signs of schizophrenia (how to recognize the disease, diagnosis of schizophrenia) - video

The judgment about the incurability of schizophrenia is widespread. However, with proper therapy, it is possible to reduce, eliminate symptoms, achieve sustainable remission and socialization.

What is schizophrenia and how does it manifest itself?

Schizophrenia- a mental disorder associated with the activity of the brain, which is accompanied by violations of the emotional sphere, perception, thinking. The disease manifests itself in a variety of ways. It is distinguished by multifaceted symptoms, a variety of laboratory, personal manifestations.

Typical manifestations of the disease

Schizophrenia is:

Reasoning about mental retardation erroneous in schizophrenia. Intelligence can vary from low to very high.

For example, schizophrenia world chess champion B. Fischer, writer N. Gogol, mathematician D. Nash, a lot others.

People suffering from this disease, perceiving information adequately, are not able to accurately process it in the brain regions. When a focus of excitation occurs in it, hallucinations are born, to feed which the brain takes energy from other areas. This affects the quality of memory, attention, emotional state.

Symptoms and signs of schizophrenia appear in men and women similarly, only in men at an earlier age (20-28 years). Women, as a rule, get sick from 25 to 32 years.

Causes of the disease

The nature of the causes of pathology has not yet been unambiguously established.

More common are:

• hereditary predisposition (the risk of occurrence increases by 10%);
• intrauterine infections, complications during childbirth;
• viruses, toxic substances, bacteria that cause brain abnormalities;
• oxygen starvation of the brain.

Symptoms and signs of schizophrenia in women may occur after childbirth and are considered postpartum psychosis. Childbirth can become a trigger if there is a predisposition .

Classification ICD 10

In the International Classification of Diseases, schizophrenia refers to a group of chronic processes accompanied by the breakdown of mental functions and emotional reactions. There is a preservation of consciousness and intellect. However, cognitive abilities may decline. In the ICD-10 classification, various types are distinguished.

Types of schizophrenia according to the clinical picture

Each type is characterized by specific symptoms.

simple schizophrenia

Changes in speech, facial expressions, decreased activity. Indifference, apathy, lack of interest and purpose.

Delirium, feeling of persecution, fears, irritability, motor disturbances. May lead to personality changes, depression.

Catatonic

Motor changes: excitement, stupor. Unsystematic and meaningless movements.

hebephrenic

Increased activity, excitability, rapid speech, mood swings, mannerisms, importunity. There are strange behaviors. It is rare, usually in adolescence.

Residual (residual)

Lethargy, lack of will, detachment from society, lack of attention to hygiene.

Types according to the course of the disease

continuously current

There is an increase and progression of negative symptoms leading to a personality defect. It is characterized by lethargy, lack of will, deterioration of thinking.

Paroxysmal (coat-like schizophrenia)

One of the commonly used species. The name comes from the German word "fur coat", meaning shift. Each attack is accompanied by the appearance of new symptoms. The cause can be stress, toxic substances, infections, genetics. Male schizophrenia of this type is distinguished by more aggressive manifestations. Often turns into dementia. Attacks with delusions and hallucinations are longer (up to a year) than the intervals between them. The patient distances himself from others, becomes suspicious. The condition is characterized by depression and tantrums. The first episodes can occur from 11 years of age.

Sluggish

The slow progress of the disease is fixed. Symptoms are mild. Decreased activity and emotionality for many years with the manifestation of shallow depression.

Sometimes diagnosed mixed a type of illness, the course of which becomes either sluggish or paroxysmal.

General signs and symptoms

Pronounced clinical manifestations, as a rule, appear in adolescence. The previous disease state lasts from 2 years.

First signs

They appear gradually, progress, are supplemented:

• monosyllabic answers, slowness of speech;
  
• impoverishment of emotions, avoidance by the eyes of the interlocutor;
• weakening of attention and concentration;
• apathy, lack of interest in anything, suspicion;
• delusional ideas, initial manifestations of hallucinations (which later transform into psychosis).

Signs and symptoms vary.

Signs - 4 directions of the brain (Bleyler's tetrad)

1. association defect. Inability to logical thinking, dialogue. Scarcity of speech. Monosyllabic answers without building a logical chain.
2. The presence of autism. Immersion in your own created world with the monotony of actions and interests. Template thinking, lack of a sense of humor.
3. affective inadequacy to ongoing events. Laughter or tears "inopportunely." For example, laughter in a stressful situation.
4. Ambivalence. Contradictory feelings (a person loves and hates at the same time, for example, birdsong). Moreover, contradictions can be emotional, intellectual, strong-willed.

With a combination of signs, there is a loss of interest in the environment, a closure in oneself. Sometimes new hobbies arise, for example, religion, philosophy, fanaticism appears.

Symptoms are concrete expressions. They are positive And negative .

Symptoms are positive

• Hallucinations (usually auditory: voices, threats, orders, comments). As well as tactile, olfactory, gustatory, visual deceptions.
  
• Rave. Feeling the impact of hypnosis, witchcraft (intelligence, aliens).
• Delusions of persecution, jealousy, own defectiveness, self-accusation, greatness, incurability.
• Violation of motor coordination (stupor, agitation).
• Disorders of speech (sometimes to incoherence, deprivation of meaning), thinking, obsessions.

Symptoms are negative

• Emotional imbalance (depletion of emotions).
• Social disorganization, apathy, thirst for solitude. Dissatisfaction with life.
• Volitional disorders. Lethargy, repetition of actions after others without the efforts of one's own will (including the commission of unlawful acts).
• Narrowing the range of interests, lack of sexual desire, neglect of hygiene, refusal to eat.
• The manifestation of anger, selfishness, cruelty.

Symptoms and signs of schizophrenia in children and adolescents

If problems arise in a child, his exclusion from the life of the team, solitude, loss of interest are immediately noticeable.

Signs of schizophrenia in a child

• personality disorders;
• change in ideals, behavior, interests;
• non-contact, gloominess, low self-esteem;
• whimsical ideas;
• excessive shyness, loss of interest in any activity;
• violations in the areas: emotional, motor, figurative.

Teenage symptoms

• speech disorders: slowing down or speeding up, reticence, abruptness, stuttering;
• emotional emptiness, inactivity;
• violations of thinking, inconsistency of judgments, decrease in intelligence;
• communication difficulties, learning difficulties;
• manifestations of rudeness, pride, discontent.

Sick children tend to realize themselves in unrealizable fantasies. Childhood schizophrenia diagnosed 5 times less often than teenage. Treated quite successfully.

Diagnostics

Diagnostic procedures include taking an anamnesis, interviewing patients, their relatives, and observing for six months. There are diagnostic criteria of the first, second rank. To confirm the diagnosis, at least one criterion from the first rank and two criteria from the second rank are required, which are observed for at least a month.

Criteria for diagnosis of the first rank

• hallucinations, often auditory;
• the presence of crazy ideas;
• perception of a delusional character;
• the sound of your own thoughts.

Criteria for diagnosis of the second rank

• intermittent thoughts;
• movement disorders;
• non-auditory hallucinations;
• behavior pathology.

Methodology for using tests

For psycho-emotional assessment, special scales (Carpenter, PANSS) and tests (Lucher (testing with different colors), MMMI, Leary, etc.) are used.

Test for schizophrenia "Chaplin mask"

The originality of the test is in stating the state of a healthy psyche, for which self-deception and distortion of reality are normal factors.

Provided to attention Charlie Chaplin rotating mask A. A healthy person sees a strange face, as it is convex on both sides. For a schizophrenic patient, the mask is always concave , which is associated with a special processing of information by the brain.

Test for schizophrenia "Cow"

It is proposed to answer what is shown in the picture. For a healthy person, the image is something incomprehensible and blurry. And patients identify a cow because of their detachment from reality.

In the complexity of the diagnostic process help picture tests for schizophrenia as additional research. Test data alone is not enough to clarify the diagnosis. They are only accompanying the main diagnostic measures.

Fundamentals of treatment

The main goal of treatment– achievement of the process of remission (weakening, disappearance of symptoms), prevention of negative forms, psychosis, complications. Treatment depends on age, personality, nature and duration of the disease. In the phase of exacerbation (psychosis, attack), hospitalization is recommended.

Specialized care is provided in psychoneurology by psychiatric specialists. Brain-improving drugs are used. It is recommended to cleanse the body, special diets, laser therapy, electrotherapy, neuroleptic drugs.

Basic Treatments

Therapy is carried out in the following areas: medication, electroshock, psychotherapy, social adaptation, non-standard methods .

Medical therapy

It is based on psychotropic drugs, antidepressants, neuroleptics.
Their goal is to reduce negative symptoms. Drugs are used only on the recommendation of a doctor and in the absence of contraindications.

Effective pills for schizophrenia: Azaleptin, Zyprexa, Solian, Carbamazepine, Cyclodol, Fluanxol,.

Antidepressants: , Ixel, Venlafxin. Antipsychotics:, Aminazine, Tizercin, others.

Agonists: Ziprasidone, Aripiprazole.

Physiotherapy

Most commonly practiced procedures :

• the implementation of the impact on the hemispheres of the brain through certain areas of the skin;
• exposure to light pulses on the retina in order to get rid of phobias, anxiety, neuroses;
• blood purification with laser radiation.

Various methods of increasing immunity are also used using such means: Echinacea, Timolin, Vilazone, Erbisol, Timogen, Splenin.

Psychotherapy

It aims to improve cognitive and functional skills. Creating a positive atmosphere is of great importance. Psychological support of relatives and friends is used.

The treatment prognosis is more favorable for the female sex and for the disease that began at a later age with little negative symptoms. A good social and professional adaptation before the onset of the disease gives a positive effect. Recently, non-standard methods of treatment have been actively used.

Treatment with creativity

Research confirms the connection of the disease with creativity. The brain of patients with schizophrenia is capable of reproducing non-standard associations. No wonder many creative people suffered from this disease. Creativity helps to restore balance, open up in a new way, switch attention.

Treatment with creativity(poetry, drawing) allows you to minimize depressive and stressful moments, concentrate attention, improve mood. In addition, it promotes adaptation in society by creating a sense of need.

Treatment at home

supportive or homemade treatment for several months (up to two years) is aimed at preventing relapse. It is carried out when the acute period passes.
Close people participate in the rehabilitation phase. Occupational therapy, special trainings are practiced, and the recommended medications are continued.

Important for remission trusting relationships. Relatives are taught the rules of communication with patients of this kind. We must try not to argue with them, not to ask unnecessary questions, to calm them down, to protect them from emotional experiences. Eliminate all factors that irritate them, do not raise your voice. It is necessary to show patience, friendliness, tolerance.

After inpatient treatment annual examination, correction.

Full disease cannot be cured. However, with a qualitative approach, the ability to work, social activity is restored, psychosis is prevented, and remission is achieved.

Modern people often have mental illness. One of the most common is schizophrenia. It is still unexplored, despite the active development of psychiatry. However, at the moment there is already a lot of information about it.

Medical history of schizophrenia

The very first mention of the disease falls on the 17th century BC on the ancient Egyptian papyrus in the Book of Hearts. This indicates that even ancient people were studying issues related to mental disorders. The description of the disease schizophrenia was also put forward in the Middle Ages. This is evidenced by ancient medical texts.

In 1880, the Russian psychiatrist Viktor Khrisanfovich Kandinsky first described the disease, giving it the name "ideophrenia". The disease was described by Emil Kraepelin in 1893 as an independent disorder of the human soul. What kind of Kraepelin was the first to divide it into early dementia and manic depression. This observation plays a significant role in the scientific community so far. Now outpatient medical histories are started for people suffering from this pathology. Schizophrenia in 1908 was named an independent disease. Eigen Bleuler, a Swiss psychiatrist, introduces the concept to the scientific community. According to his research, the deviation can appear both in adolescence and in an adult. The most significant statement of the scientist indicates that schizophrenia is a malfunction in the work of associative thinking. Eigen proposed several types of illness:

• Strong-willed. Difficulties in choosing any meaningful decision. Since a person cannot make a choice, this forces him to refuse to make decisions in general.
• Emotional. Thinking, which is characterized by a positive and neutral attitude towards objects from the surrounding reality (people, objects, events).
• Intellectual. Conflicts of diverse ideas and reasoning in the mind. They often conflict and are mutually exclusive.

After a short period of time, psychiatrists recognized this concept. What kind of disease schizophrenia is now established. However, the question of occurrence, treatment and signs for which it is necessary to make a diagnosis is still unknown.

What is an ailment

According to statistics, about 3% of the world's population is affected by this disease. What is schizophrenia disease? This is characterized by a variety of hallucinations and distortions of thinking. Some people believe that schizophrenia is a split personality, but this is not true. A sick person does not understand what is happening around him. A complete confusion is going on in the head: thoughts, events, imaginary incidents are mixed with each other. Everything that a person perceives from the surrounding world is a chaotic set of various pictures, images and sounding phrases. One of the severe forms is continuous paranoid schizophrenia. Often patients completely deny their disease and consider themselves healthy people. Sometimes there are patients who build their own separate reality in addition to the one that exists in the world.

Also, schizophrenia is characterized by its combination with other deviations. These include various depressions and anxiety disorders. Often among schizophrenics you can meet alcoholics and drug addicts. Patients are suicidal. As a result, a person may lose their home, work and contacts with people.

Causes of the disease

At the moment, scientists do not have exact statements, which is why the disease appeared. Is schizophrenia hereditary or not? Experts answer this question that it can appear not only because of the genetic factor. There are many possible causes of schizophrenia:

• Heredity. This assumption appeared in the last century, when people believed that schizophrenia could only manifest itself by inheritance. The likelihood of the disease increases with the proximity of a relative with schizophrenia. Modern research states that the risk of transmission of a deviation from one schizophrenic parent is 12%, and from two - 20%.
• Developmental disorders of the brain. This assumption is based on various pathologies of the brain. The bottom line is that the deviations do not progress and are mild. However, in the future, because of them, the disease can develop.
• Psychological aspects. This theory was proposed by Sigmund Freud. Its meaning is to restore the patient to his former state, which was lost.
• body intoxication. Psychiatrists believe that unsplit products of protein metabolism can be the causes of the disease. It is believed that the brain undergoes oxygen starvation.
• Cognitive impairment. In this case, schizophrenia appears due to the fact that a person tries to describe his feelings to relatives. As soon as the patient begins to hear voices, he tells loved ones. However, they do not understand it and deny it. As a result, schizophrenia develops.

Science is only getting closer to describing the causes of the disease, but at the moment there is not enough information. It is known that patients have impaired perception and sensory feelings.

Signs of the disease

Often, people with schizophrenia have many disorders that can be used to identify the disease. What kind of disease is schizophrenia and how does the patient behave? Such a person may have different thoughts from speech, sound hallucinations, delirium may appear. Often patients are socially isolated due to the resulting paranoia, hallucinations, delusions and apathy. Very rarely, schizophrenics can remain silent and stand still. Also, patients stop doing normal activities, such as washing their hair or brushing their teeth. A person expresses little emotion, sometimes it will be difficult to understand what he feels. However, these signs are not enough to diagnose a mental disorder.

Stages of the disease

Each period of the course of the disease is characterized by different signs and symptoms. There are 4 stages in total:

• premorbid stage. During it, a person's basic personality traits change. The person begins to behave suspiciously and inadequately. Also, the patient begins to strangely express his emotions.
• prodromal stage. A person begins to withdraw from society and his family. The patient is isolated from the outside world. The traits of an absent-minded person also appear.
• First psychotic episode. During it, the schizophrenic develops auditory hallucinations, obsessions and delusions.
• remission stage. The characteristic features of this period are the disappearance or weakening of all symptoms. This is followed by a strong aggravation.

Also, patients may develop a defect, an incurable stage of the disease. Psychiatrists believe that this is the last stage of mental illness. They are called deviations in the personality and psyche of a schizophrenic. In patients, all needs are reduced, apathy, indifference and serious disturbances in thinking appear.

Symptoms of schizophrenia

In patients with this, disorders of thinking and perception, as well as emotional disturbances, are observed. Also in schizophrenia, the stages of the disease play a significant role in the symptoms. Often, their duration should be about a month, and for a more accurate diagnosis, a specialist should observe a person for six months. Distinguish between positive and negative symptoms. The former include signs that were not observed in a person before, but they appeared at the stage of development of schizophrenia. The word "positive" means the appearance of new symptoms:

• Rave.
• The appearance of hallucinations.
• Excited state.
• Strange behavior.
• Illusions.

The negative symptoms of schizophrenia are the absence of a normal manifestation of emotions and character traits. The personality of the patient is erased due to violations of the mental state and processes in the body. The most common negative symptoms:

• Decreased volitional activity. A schizophrenic patient ignores elementary hygiene standards. It also reduces appetite and food cravings. Attraction to the opposite sex completely disappears. In severe cases, schizophrenia can lead to a complete loss of interest in life and apathy.
• Isolation from society. Such a sign may appear very late. A person strives not to be in a team, stops communicating with relatives and friends.
• Depressed state. Patients feel a state close to depression. They develop apathy and indifference to the world around them.

Also, patients with schizophrenia become very passive, it is difficult for them to make decisions. Most do not respond to difficulties and believe that nothing can be changed in difficult situations.

Diagnosis of the disease

The diagnosis can only be made by a specialist who relies on a complete psychiatric diagnosis. It includes a general assessment of the patient's condition by questioning. As we have already found out, even specialists cannot give an exact answer to the question: is schizophrenia a congenital or acquired disease? After all, it can appear both due to a genetic factor, and as a result of brain dysfunctions throughout life. Family data is also collected, because very often this disease is caused by genetics. Another specialist conducts a complete medical diagnosis to rule out other diseases. After all, some diseases have similar symptoms. To make a diagnosis, you need to determine the symptoms that persist for a month:

• Auditory or visual hallucinations.
• apathy, depression, silence.
• Deviations from the usual behavior in the family, at work, in educational institutions.
• Speech and thinking disorders.
• Delusional states.

Schizophrenia is characterized by loss of connection with reality for a long time. However, there are many similar mental disorders, such as short psychotic episodes, mania and depression. Also, the patient's symptoms may occur due to the use of psychoactive substances: alcohol, heroin, amphetamine, cocaine.

Differences in women and men

Representatives of the stronger sex, suffering from a disease, may lose all their cravings and interest in life. Sometimes schizophrenia can wax and wane. The most basic signs in men:

• The appearance of hallucinations.
• Delusional state.
• Low level of critical attitude to life.

Men mystify all occurring events or objects. An inadequate reaction to what is happening may appear: tears or laughter. It also increases anxiety and arousal.

In women, the very first manifestations of the disease can appear at the age of 20, less often at 30. What is the first sign of schizophrenia in women? Behavior that becomes antisocial. They often lose their hobbies and jobs due to behavioral problems. Also, women often have apathy and indifference to the world around them. Main features:

• Aggressive behavior.
• Irritability.
• auditory hallucinations.
• Obsession.

Women may cry often and try to draw a lot of attention to themselves. Also, many complain of non-existent pain. behavior changes dramatically. The symptoms of schizophrenia in women do not differ much from the symptoms in men.

Manifestations at an early age

Schizophrenia is one of the most common diseases in adolescents. It occurs in every fifth patient with mental disorders. Symptoms and signs of schizophrenia in adolescents are similar to those in older people, but have their own characteristics. The disease may appear due to factors:

• genetic predisposition.
• Deviations of the nervous system.
• The impact of infections on the fetus during gestation by the mother.
• Substance use and childhood alcoholism.
• Many quarrels, scandals and conflicts in the family.
• Insufficient attention to the teenager.

In children, unlike adults, negative symptoms are more pronounced than positive ones. The symptoms and signs of schizophrenia in adolescents include thinking disorders, mood disorders, apathy. Some may be rude to their parents and relatives. Sometimes there are symptoms of depression. Some parents believe that this is teenage maximalism that will pass. However, under this mask, a serious mental disorder can be hidden. Positive symptoms appear in the form of:

• Brainy ideas. The teenager believes that he has many flaws in appearance. These ideas can develop into anorexia, harm to the body, and in rare cases, it can lead to suicide.
• hallucinations. Often manifested in sound forms. It seems to a teenager that the voices inside him criticize, condemn and scold.
• Passion for psychoactive substances. Sometimes a teenager can show a strong attention to drugs and alcohol, which will only harm his mind.

Treatment is the same as for adults. Consultation with a specialist and action is necessary. Diagnosis is similar to that of an adult. for treatment, a course of psychotherapy and medication is often prescribed. Separate work is also underway with parents so that they understand the reasons for the appearance of the diagnosis and know what kind of help the child needs.

International classification

The tenth revision of diseases since 2007 is the current generally accepted classification of diagnoses. Schizophrenia is assigned the F20 code according to the ICD-10. The disease is a disorder characterized by a distortion of thinking, perception. According to modern data, the patient can retain his consciousness and intellect abilities, however, as the diagnosis develops, they may worsen.

Also, patients diagnosed with schizophrenia (ICD-10 code F20) think that their thoughts can be reflected and transmitted over distances. The disorder is characterized by manifestations of visual or auditory hallucinations, delusional states, erratic thoughts. Schizophrenia can occur both long-term and episodic. In some cases, symptoms of depression or mania are present.

Treatment of the diagnosis of schizophrenia

Scientists still consider this mental disorder the most mysterious and unexplored. However, it is possible to cure and reduce the symptoms of schizophrenia with the help of existing therapies. Diagnosis of schizophrenia includes the necessary examinations. If patients have attacks of hallucinations or delusions, then this must be treated in a hospital setting. Medications (antidepressants and neuroleptics) can successfully cope with various symptoms and manifestations of a mental disorder.

A person with such a diagnosis will need to constantly take medication and be under the supervision of doctors. And after the completed course of psychotherapeutic treatment and rehabilitation, the patient will be able to return to a normal lifestyle.

One of the most important parts of recovery is psychotherapy. Doctors give a complete description of the disease schizophrenia. Specialists also work with people and explain to them how to act during attacks, as well as what to do to reduce their number.

Psychotherapists conduct conversations with relatives of patients. After all, for effective treatment, patients must be provided with the necessary moral support and understanding. Group sessions are popular among specialists, where patients share their experiences and successes in recovery with each other. Such procedures are especially effective during the illness of sluggish schizophrenia. This has a positive effect on the emotional background of patients, which helps to reduce symptoms.

Thanks to the development of modern medicine, it is possible to allow patients with schizophrenia to live like ordinary people. However, a complete cure is not possible.