The last stage of schizophrenia symptoms. Stages of occurrence of recurrent schizophrenia. Outwardly they appear

Doctors say that severe physical illnesses occur in three stages:

1. On the first organism mobilizes all resources.
2. On the second, balance occurs, the body adapts to the disease.
3. On the third, exhaustion sets in, the diseased organ (or the whole organism) ceases to cope with the “work”.

The diagnosis and treatment of schizophrenia should be experienced psychiatrist .

The course of schizophrenia resembles the course of serious illnesses of the body. There are three stages of schizophrenia: mastery, adaptation and degradation. The severity and duration of these stages vary significantly.

First stage of schizophrenia: mastery

From the familiar, predictable real world, the patient passes into a distorted, phantasmagoric world of visions, hallucinations, unusual colors and unusual proportions. Not only does his world change, he changes too. With a stormy course of schizophrenia in his eyes, a person becomes a hero or an outcast, a savior of the universe or a victim of the universe.

If changes occur gradually, anxiety, confusion and fear may prevail in the first stage of schizophrenia: something is clearly happening to the outside world, people's motives are not clear, but they do not bode well - you need to prepare either for defense or for flight.

The first stage of schizophrenia can be called a period of discovery and insight. It seems to the patient that he sees the essence of things and the true meaning of events. In this phase, there is no place for routine and tranquility.

The discovery of a new world can be wonderful (for example, when feeling omnipotent) or terrible (when realizing the insidious plans of enemies who allegedly poison the patient, kill him with rays or read his mind), but it is impossible to calmly survive the changes.

It happens that having survived a bright, stormy phase of mastery, the patient returns completely to normal life. And with an unfavorable course of schizophrenia, short, almost imperceptible periods of mastery and adaptation are quickly replaced by a long phase of degradation.

The second stage of schizophrenia: adaptation

The patient gets used to the changes. The sense of novelty is lost. In the second stage of schizophrenia, delusions, hallucinations and other manifestations of the disease become commonplace. The illusory world no longer obscures reality. The two realities coexist more or peacefully in the mind of man.

This stage of schizophrenia is characterized by the so-called "double orientation": the patient can see in a neighbor an evil alien and, at the same time, a well-known Uncle Misha.

Regardless of the variant of the course of schizophrenia, the result of therapy largely depends on what the patient chooses: the real world or the world of illusions. If nothing keeps a person in the real world, he simply does not need to return to reality.

In addition, this stage of schizophrenia is accompanied by the repetition of the same words, gestures and facial expressions that are not related to the current situation, stereotypical behavior - the patient walks in circles around the room, sits and sways with lamentations. The more severe the course of schizophrenia, the more stereotypical behavior becomes.

The third stage of schizophrenia: degradation

In this phase, emotional dullness comes to the fore. The time of onset of the third stage depends on the form and on the variant of the course of schizophrenia. Signs of emotional and then intellectual degradation develop rapidly in hebephrenic and simple forms of the disease.

Patients with the catatonic and paranoid form, especially those with a favorable course of schizophrenia, can remain emotionally and intellectually intact for a long time.

In the third stage, the patient seems to burn out from the inside: hallucinations fade, the expression of emotions becomes even more stereotyped. Space and time lose their significance.

With any type of course of schizophrenia, the third phase is unfavorable in terms of prognosis. However, thoughtful rehabilitation gives patients the opportunity to exist in society. In some cases (usually after severe emotional upheavals), a short-term or sustained return to normal life is possible.

- 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 of the prevalence of schizophrenia with 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 experienced in childhood. Most experts believe that the risk of schizophrenia does not depend on parenting style, 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 these 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 subsequently, 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 flow, domestic psychiatrists traditionally distinguish between paroxysmal-progredient (fur-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 list of criteria for schizophrenia of the second rank includes catatonia, thought interruption, persistent hallucinations (except 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 gender, 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.

The disease of schizophrenia is of royal blood, because she is called the "queen of psychiatry." In its course, the disease goes through several stages, among which early stages of schizophrenia has its own characteristics.

Characteristics of the initial stage of the disease

Experts distinguish four stages (stages) of the development of schizophrenia. The initial stage, which lasts from several months to several years, is called the initial stage, which is characterized by the following symptoms.

Symptoms of the initial stage of schizophrenia

Symptoms of the disease may appear suddenly, or develop over a long period of time, completely unnoticed. At the initial stage of the disease, those deviations are manifested that are inherent in many mental illnesses, for example, depression.

Experts note two main productive symptoms characteristic of the primary stage of schizophrenia - delusions and hallucinations. They appear in patients regardless of gender. In addition to the main ones, there are secondary symptoms of the disease:

1. violations associated with speech, when there are jerky answers, there is no ability to transmit detailed information;

2. loss of "taste" for life - previously favorite activities do not give pleasure;

3. lack of emotions, or their weak manifestation;

4. unwillingness and inability to do work, study;

5. Attention disorders, inability to focus on anything, inability to process the information received.

Delirium at this stage of the disease is very diverse in content. The patient speaks of possible persecution, love, jealousy, his own physical defects, ugly and abnormal structure of the body and individual organs. In addition, they have alertness, suspicion, they become tense.

Often early stages of schizophrenia accompanied by the appearance of obsessions, figurative, sensual or abstract.

Medical care at the initial stage of the disease

The success in treatment is the greater, the earlier the patient seeks medical help.

Until recently, it was believed that even at the initial stage of schizophrenia, the patient should be isolated, placed in a hospital for a long time. But, observing the patients, the opinion of doctors changed - it was revealed that a long stay in a medical institution leads to negative consequences. It has been proven that with social support, when the mental state of the patient is not dangerous for himself and others, outpatient treatment gives more positive results.

This is especially true for women, who find it more difficult to experience even a temporary excommunication from the family.

At the initial stage of the disease, the patient is examined by a psychotherapist, who, based on the results obtained, develops an individual method of treatment. Usually, an integrated approach is used, which includes drugs to help get rid of delusions and hallucinations, psychotherapeutic procedures and rehabilitation measures.

Summary

If the patient is diagnosed early stages of schizophrenia It doesn't mean his life is over. The help of loved ones, love and a sensitive attitude can work a miracle - the disease will recede. Good luck.

Most severe physical illnesses occur in three stages. The first stage is characterized by the fact that the body mobilizes all its resources. On the second, balance appears, the body begins to adapt to the disease. And as a result, at the third stage, exhaustion occurs, the diseased organ no longer copes with its “work”.

The course of schizophrenia is similar to the course of severe bodily ailments. Three stages of the course of this disease can be distinguished: mastery, adaptation and degradation. The duration and severity of these stages can vary considerably.

Mastery: the first stage of schizophrenia

From the real, familiar, predictable world, the patient passes into a phantasmagoric, distorted world of hallucinations, visions, unusual proportions and unusual colors. Not only does his world change, he changes too. With the rapid course of schizophrenia in their eyes, a person becomes an outcast or a hero, a victim of the universe or the savior of the universe.

If changes gradually occur, anxiety, fear and confusion can prevail in the first stage of schizophrenia: something is clearly wrong with the surrounding reality, the motives of people are unclear, but they do not bode well, in general, it is necessary to prepare either for flight or for defense .

The first stage of the disease can also be called the time of insights and discoveries. A schizophrenic patient believes that he sees the essence of things and the real meaning of events. In this phase, there is no place for calmness and routine. The discovery of a completely new world can be wonderful (for example, when feeling omnipotent) or terrible (when revealing the insidious plans of enemies who seem to poison the patient, read his thoughts or kill him with rays), but it is absolutely impossible to survive such changes calmly.

It happens that having survived a stormy, bright phase of mastery, a person returns completely to normal life. And in the case of an unfavorable course of schizophrenia, short, almost imperceptible periods of adaptation and mastery are quickly replaced by a long phase of degradation.

Adaptation: the second stage of schizophrenia

No matter how violent the course of schizophrenia is, at some point a person gets used to the changes taking place. The feeling of novelty is lost almost completely. In the second stage of schizophrenia, hallucinations, delusions and other manifestations of the disease become commonplace. Illusory reality no longer obscures reality. The two worlds coexist in the patient's mind more or less peacefully.

This stage of schizophrenia is characterized by the appearance of the so-called "double orientation": a person can see an evil alien in a neighbor, and, at the same time, an old comrade.

In addition, this stage of schizophrenia is accompanied by preseveration (repetition of the same gestures, words and facial expressions that are not related to the current situation), as well as stereotypical behavior. The more severe the course of schizophrenia, the more typical the person's behavior becomes.

Degradation: the third stage of schizophrenia

In this phase, emotional dullness comes to the fore. The time of onset of the third stage will depend on both the form and the variant of the course of schizophrenia. Signs of emotional, and then - and intellectual degradation develop quickly with simple and hebephrenic forms of the disease. Our patients with paranoid and catatonic forms, especially those with a favorable course of schizophrenia, remain intellectually and emotionally intact for a long time.

At the third stage, the patient seems to burn out from the inside: hallucinations fade, the expression of emotions becomes completely stereotyped. Time and space lose their significance.

It should be noted that for any type of schizophrenia, the third phase is unfavorable in terms of prognosis. But be that as it may, our clinic provides an opportunity for thoughtful rehabilitation, which gives patients the opportunity to live in society. In some situations (usually after a pronounced emotional shock), a short-term or quite stable return to normal life is likely.

Regardless of the variant of the course, the result of the treatment of schizophrenia will largely depend on what the patient prefers: the real world or the world of illusions. If nothing keeps the patient in the present reality, there is simply no need for him to return to reality. However, our psychiatrist of the first category Ivanov, in turn, will do everything possible to return a person to the real world and keep him there as long as possible.

If you are looking for a doctor for the treatment of schizophrenia, please contact our clinic. Our psychiatrists have extensive experience in managing patients with schizophrenia.

Schizophrenia is a mental disorder that is very difficult to diagnose because it manifests itself in different ways in patients. In some, the disease begins acutely, auditory hallucinations and delusions, disorganization of speech and thinking, in others, the symptoms come gradually, one after another at certain intervals. A person begins to quickly get tired, malaise, weakness and, as a result, irritability, irascibility. However, by themselves, these signs do not mean anything, and they are often attributed to overexertion and depression, but these are the first "bells" for urgent medical attention.

Stages and symptoms of schizophrenia:

Closedness in oneself, inability to open normally to the outside world. Inability to adequately express feelings. The schizophrenic was engaged in his studies and tried to display himself in them. This perception is called "simple schizophrenia". It seems that the individual lacks the energy to release his feelings. But feelings accumulate in him, and this is called the inability to correctly understand and express them.

A nervous breakdown occurs in a certain period. There is a reflection of their feelings in other people who barely know the individual. He sees the opposite in a mirror. Incorrectly assigned values ​​appear. The smallest detail is given meaning that does not really exist. Such an exaggerated assessment of significance, a reflection of feelings is called "paranoid".

• 3 stage

The third stage of schizophrenia occurs with bouts of extreme rage, possibly permanent stupor. A person is unpredictable and becomes dangerous to others. There is an emotional disaster. This condition is called catatonic.

• 4 stage

At this stage, a person becomes the personification of a deity, correctness, a person without which no one in life can do. It divides it into pieces, and each piece lives on its own. Patients in this state seem possessed. The patient's feelings are not related to himself. He does not react to possible rapprochement with people who know him well.

Types of schizophrenia

1. A person shows an inability to form attachment to people, and he wanders from one individual to another. Such people can be vagabonds, various prostitutes. But this does not mean that every vagrant is a schizophrenic.
2. Paranoid schizophrenic. Such people hear other people's voices, they exaggerate their importance.
3. The third type is catatonic. Characteristics - accompanied by changes in muscle function and a sudden manifestation of rage.
4. The patient exhibits strange behavior. He says that he is the center of the universe. He loves everyone, and often this takes a religious
coloring.

Today, schizophrenia is curable. This kind of disease often appears with age, when a person becomes lonely and unable to succeed with the rapid development of technology in society.

Stages of schizophrenia



Researchers have identified three stages of schizophrenia: prodromal, acute, residual.

Prodromal stage of schizophrenia

People in the prodromal stage of schizophrenia often isolate themselves, stay in their room for long periods, and stop spending time with family or friends. These people cannot safely go to work or school because they are mentally ill, and may show signs of decreased motivation, loss of interest in entertainment, and dullness of emotions.

The course of schizophrenia with signs of the prodromal stage is not typical. That is, someone experiencing this behavior may have depression or some other problem. This is why it is difficult to identify the prodromal stage until the active phase is reached.

The development of schizophrenia often manifests itself in childhood. This conclusion was reached by scientists who studied this disease. The bottom line is that when watching movies, children behave in a completely different way than healthy ones. They are characterized by apathy for watching cartoons, they love loneliness, indifference to the world is manifested. Thus, signs of schizophrenia may be present years before the onset of psychotic symptoms. This is the first stage of schizophrenia.

Family members can be a positive influence when it comes to identifying a schizophrenia prodrome and immediate treatment follows.

Signs and symptoms

Although the prodromal signs differ from each other, almost always a sick person withdraws into himself, isolates himself from society. There are some symptoms of the prodromal stage of schizophrenia:

• Unreasonable aggression, irascibility, nervousness.
• Slurred, strange speech.
• Imitated laughter, sharp crying.
• Bad dream.
• A distortion of reality.
• Persecution mania.
• Isolation from society and even relatives.
• hallucinations.

Acute stage of schizophrenia

The second stage of schizophrenia is acute. When someone experiences psychotic symptoms such as hallucinations, delusions, or grossly disorganized behavior, it is an indication that they are in an acute or active stage. The active phase indicates the full development of the disorder.

The behavior of patients may become so extreme or strange that hospitalization is necessary. Once a patient sees a doctor, the first thing the psychiatrist will do is observe, question, and question the patient's family members. The purpose of the conversation is to find out when strange acts began, how long they lasted.

Patients with psychotic disorders are treated with antipsychotics. With the help of medicines, many manifestations disappear. Without treatment, the active phase can last a lifetime. In very rare cases, the active phase is eliminated and the symptoms disappear without treatment.

Residual stage of schizophrenia

The last stage of schizophrenia is residual. The final stage of schizophrenia is called the residual stage. The features of the residual phase are very similar to the prodromal stage. Patients at this stage do not show psychosis, but may experience some negative symptoms such as lack of emotional expression or low energy. Although the residual stage often does not have delusions or hallucinations, patients in it continue to experience stress.

recovery process

Timely treatment of schizophrenia significantly increases the chances of a full recovery. The process of treatment is long, complicated, but quite real. The first step towards recovery will be overcome when the patient realizes that his fictional world is just a figment of the imagination.

The next stage of treatment is the awareness and perception of the disease, which will serve as a sign of effective therapy. Then drug treatment is prescribed, often accompanied by psychotherapy. By following the recommendations of a doctor, a person can literally control his mind, and return to normal life.

What are the stages of schizophrenia?

When it comes to a patient with schizophrenia, many people imagine the image of a mentally ill person dangerous to others. It is also widely believed that such individuals should be isolated and treated forcibly. Indeed, there are patients who need to be treated in a hospital, but in general, it all depends on the stage of the disease. In any case, it is believed that society is focused on providing assistance and support to such patients. The inner world of a schizophrenic patient is extremely complex, and it is impossible for a healthy person to understand it. Scientists say that every hundredth person in the world is affected by this disease, regardless of age.

When determining the stage of schizophrenia, it was found that the disease process has several stages. Initially, there is a pre-morbid stage, when the manifestations of schizophrenia are not pronounced. This is followed by the height of the disease, which has periodic relief, or in other words, remissions, when the symptoms subside for an indefinite time. This is followed by the final stage, which has residual symptoms, which are characterized by a certain degree of severity, which may be different. When treatment is started without delay, the severity of symptoms, as well as their duration, can be largely corrected. Very often it is possible to achieve, if not absolute recovery, then at least relief of symptoms for a long time.

As clinical practice shows, approximately one third of all patients with schizophrenia experience the need for psychiatric help during their lifetime. In fact, schizophrenia is a group of prefabricated symptoms that have different prognosis and consequences. There is a first list of signs of the disease, and it is rather big. However, even taking into account such an abundance, it is not certain individual symptoms that are important, but their duration, combinations, social consequences, that is, their impact on a person’s ability to work and his behavior. If a person leads a strange way of life, has a special worldview, then this does not mean at all that he is mentally ill. Especially if he is perfectly adapted to life and successful in business.

Features of the three stages of schizophrenia

According to doctors, the course of severe physical illnesses always has three stages, and schizophrenia is no exception in this regard. Features of the first stage of schizophrenia is that at this time the body is mobilizing all its resources. Further, the second stage is characterized by the onset of exhaustion, since the diseased organ is no longer able to fully perform its usual functions. Schizophrenia is in this respect no different from severe somatic diseases. Many scientists distinguish such stages of schizophrenia as mastery, adaptation, and degradation. Researchers have proven that the duration of each such stage can vary, just as the severity is not the same.

Basically, the main attention is paid to a change in character, neurotic symptoms. They are expressed in chronic fatigue that has no reason, incomprehensible fears, constant anxiety. Also, obsessions arise when a person constantly double-checks whether he turned off the gas, returns home several times to make sure he has not forgotten to lock the door. In addition, it seems to the patient that he has true premonitions, at night he has nightmares, vivid dreams. The patient falls into a depressed state, and complains that there are no thoughts in his head. What used to bring him pleasure and joy, aroused keen interest, becomes indifferent. The own family is no exception, concerning family members of the event.

A person can become addicted to alcohol, start drawing gloomy drawings. All this confirms that a person develops a mental illness. Among the common signs of various stages of schizophrenia, delusions are noted in the first place, hallucinations are also often noted. They are expressed in crazy ideas, when the patient is sure that they want to mix poison into his food, that someone is watching him, and so on. And it makes no sense to prove the opposite to a person, since this is impossible. Almost any stage of schizophrenia is characterized by the fact that the patient cannot critically perceive his morbid worldview. If the patient sees or hears hallucinations, he does not distinguish them from reality.

Manifestations of different stages

It is known that even in the case of a violent course of schizophrenia, the patient eventually gets used to the changes that have arisen, and the feeling of novelty disappears. The second stage of schizophrenia, characterized by hallucinations and similar phenomena, becomes to a certain extent a common occurrence for the patient. The presence of an illusory world no longer interferes with reality, and two realities coexist in his mind. At this stage, schizophrenia is characterized by a kind of dual orientation, when in the same neighbor the patient sees an insidious alien scout, and an old friend, Uncle Kolya. In this case, the success of therapy is determined by which world the patient prefers. If nothing keeps him in the real world, then he may not want to return to reality.

The third stage is degradation, when emotional dullness is in the foreground. When the third phase occurs, it is impossible to determine, since it is due to the form of schizophrenia, as well as the variant of the course. With a simple form of schizophrenia and with a hebephrenic form, signs of degradation appear earlier. If the patient suffers from a paranoid and catatonic form, then for quite a long time he remains emotionally and intellectually intact. This is especially observed if the course of schizophrenia is favorable. During the third stage, the patient burns out from the inside. His hallucinations grow fainter, his emotions flatten. For him, neither space nor time indicators matter.

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Schizophrenia

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 to many) personalities, scientists (the presence of the 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 located).
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 Russian 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" of 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 - delusions, 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 quite long, can be accompanied by a full 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 "underlying 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 rank I symptoms, 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. The feeling of "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 disorder of adaptation (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 a "flawed" personality - most often it is stress associated with the load of adult roles.

- The role of parents: American psychiatrists Bleitseg 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 "pushes" the child to a severe course of schizophrenia.

— There is a virus theory.

— The theory that schizophrenia is a slowly progressive debilitating process like encephalitis. 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 a 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" before biological stress and physical exertion - they can withstand up to 80 doses of insulin, are resistant to hypothermia, and 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).

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 - fragmentation delirium, speech is preserved. The treatment is effective, it is possible to achieve drug remissions (temporary improvements in well-being). With continuous-progressive schizophrenia, hallucinatory-delusional symptoms significantly predominate over affective ones (violations of the emotional-volitional sphere); in paroxysmal, affective symptoms predominate. Also, in the paroxysmal form, remissions are deeper and can be spontaneous (spontaneous). With continuously progressive disease, the patient is hospitalized 2-3 times a year, with 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 scattered, and even within the processes themselves there is a “mess”. Schisis is the unfiltered product of thought. 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 is an avoidance of contacts.

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

4. Apathy Increasing loss of emotional response - fewer situations trigger an emotional response. At first, rationalization is observed instead of immediate emotions. The first thing that disappears is interests and hobbies. (“Sergey, my aunt is coming” - “we will 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 really going to discuss anything - 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 very diverse - one of the patients abandoned work and walked around the cemetery for months, drawing up his plan. "Labor" took up a large volume. The other one counted all the letters "H" in "War and Peace". The third one left 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 identifying 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 follow-up 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.

The diagnosis of paranoid schizophrenia is based on the presence of general criteria for schizophrenia, as well as the following features:

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

The diagnosis of the hebephrenic form is made 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.



Photo of a patient with hebephrenic form of schizophrenia

The diagnosis of the catatonic form is made when 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

The 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.

Post-schizophrenic depression is diagnosed if:

• the state during the last year of observation met the general criteria for schizophrenia;
• 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 the diagnosis of residual schizophrenia, the condition must have met the general criteria for schizophrenia in the past, 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:

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

The diagnosis of simple schizophrenia is based on the following criteria:

• 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 all over 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, ". spill smoke. will not be anywhere. Kingdom of heaven. buying water is wrong. tes of two without a name. six crowns. cut the lasso and the 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 “the dinner is delicious, everything is high, harmony, that's how these lines are” Another test - to exclude the fourth extra - 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).



Drawings of a patient with schizophrenia

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 is some of them:

1. Sex. The male is an unfavorable factor, the female is favorable (nature is designed so that women are the guardians 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. A psychogenic “triggering” mechanism is good, a spontaneous one that does not have an obvious cause is 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 lung "registers" - neurotic personality disorders, asthenia, depersonalization, derealization.

The names of sluggish schizophrenia accepted in psychiatry: mild schizophrenia (Kronfeld), non-psychotic (Rozenstein), 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 the premorbid. 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, but goes beyond this in schizophrenia.

5. With dysmorphic experiences (“my body is ugly, my ribs are too sticky, I am too thin/fat, my legs are too short, etc.”) This also occurs in adolescence, but in schizophrenia there is no emotional involvement in experiences. "Defects" are frilly - "one side is more frilly than the other." The syndrome of anorexia nervosa 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. The delusion 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 am in the school of space reconnaissance and I am being tested”). The disorder of self-consciousness continues to worsen (“I am a robot, they manage me”; “I manage the hospital, the 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-awareness 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 experiencing and images is complete (with oneiroid - not). 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 attack to 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, Behtrinva'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);

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 neuroleptics 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 for it are more sensitive. 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 treatment for 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 the 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 anything or embellishing. And also - monitor the intake of drugs, since such people do not always fulfill the prescriptions 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.

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