F20 Schizophrenia. What is paranoid schizophrenia F20 diagnosis decoding

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The course of the paranoid form of schizophrenia and its treatment

Paranoid schizophrenia, according to ICD-10, is a mental pathology that belongs to one of the types of schizophrenia. Its feature is the predominance of delusions and (or) hallucinations. The remaining symptoms are affective flattening, speech rupture is present in a mild form. The disease is the most common of all types of schizophrenia. The syndrome develops after 20 years and can last until the end of days. Forecast: unfavorable.

Diagnosis can only be made by a psychiatrist after conducting clinical examination procedures and confirming the presence of a number of criteria that correspond to the disorder. In the case of anxiety depression, a depressive paranoid form develops.

Differential diagnosis of the disorder

Diagnosis of paranoid schizophrenia implies its distinction from clinically similar mental illnesses. The differential diagnosis allows to exclude alcoholic delirium, jealousy. In this case, the identification of negative personality changes typical of schizophrenia is of decisive importance. The final diagnosis is made after a 12-month observation of the patient.

The cardinal signs of a paranoid syndrome are communication difficulties, peculiar thinking disorders, an increase in emotional impoverishment, and disintegration of the psyche.

When diagnosing, the doctor is guided by the rule: for schizophrenia, "typically everything is atypical." He must take into account such signs as paradoxicality, unusualness, pretentiousness.

Symptoms of the disorder

The depressively paranoid form of schizophrenia develops in stages. The first signs of the disease, according to ICD-10, are the appearance of various obsessions, psychopathic disorders and a distorted perception of one's "I". At the initial stage of the disease, lasting several years, the symptoms appear episodically. Over time, the picture is complemented by the appearance of crazy ideas. Depending on the characteristics of the individual, at this stage, the circle of interests may narrow, and emotional reactions become impoverished.

The next stage in the development of the disease is the formation of a variant of paranoid schizophrenia. In psychiatry, there are 2 main options, each of which has its own symptoms:

delusional;
hallucinatory.

In the case of the development of a delusional variant, the carrier of the disorder has a pronounced systematized continuous delirium. The main ideas of delirium can be jealousy, attitude, invention, persecution, influence, rationalization. With this type of disorder, it is possible to develop a polythematic delirium, characterized by the presence of several interconnected plots.

The symptoms of this form of the disease include false representations. In psychiatry, the concept of "delusion" is interpreted as a set of ideas about the world, born in the mind of the patient as a result of internal processes, without taking into account information coming from the outside world. Such patients not only express ideas, they actively strive to bring them to life. A striking example of such a state is the search for possible lovers of your partner and accusations of discrediting relationships against innocent people.

When making a diagnosis of paranoid schizophrenia, it is important to distinguish delusions from, for example, fixed beliefs. In this case, you should know that delusions do not depend on the information communicated to the patient. He may include it in his inferences, but the very concept that underlies the pathological idea will remain intact.

This form of disorder is characterized by a slight depression of the emotional and volitional spheres. The carrier of the disorder is able to show quite adequate emotional reactions, although quite often they have an aggressive coloring. Symptoms of pathology in this case may include disturbances in the motor sphere and changes in mental activity. Patients often “lose their thoughts” and cannot express their thoughts in a structured way. Senestopathy appears.

The hallucinatory type of disorder is characterized by less systematization and duration of delirium. In this case, the history of the disorder includes verbal hallucinations. Carriers of the disorder hear non-existent speech, as if someone is calling them, swearing at them, commenting on their actions. As a result, patients begin to experience anxiety and fear. Gradually, the hallucinatory-paranoid syndrome takes the form of pseudo-hallucinations, which are characterized by the sound of other people's voices in the head. Depending on the clinical picture of the pathology, the development of the Kandinsky-Clerambault syndrome is possible.

The course of this disorder includes symptoms such as pseudohallucinations, the sounding of one's own thoughts, and delusions of influence. The delusion of influence is expressed in the fact that patients believe that their thoughts are heard by everyone, and someone directs their course. The prognosis in the absence of treatment is unfavorable.

Hallucinations are a phenomenon or product generated by the patient's sense organs. There is a classification of these phenomena, which includes the following types of hallucinations:

The most common are auditory and visual hallucinations. Visual hallucinations have their own classification depending on the images that pop up in the mind of the patient:

Elementary - spots of light, lines, flashes.
Objective - in the mind of the patient, objects appear that can be “taken” from the real world or be the product of a sick mind. The size of these images is significantly different from the real ones. Usually in such cases there are micro- or macrooptical hallucinations.
Autoscopic - the carrier of the disorder sees either his double. Or himself.
Zoopsia is the vision of birds and animals.
Extracampal - the patient sees objects that are located outside the field of view.
Senestopathy is the occurrence of sometimes unpleasant pain sensations in different parts of the body without a somatic basis.

The listed hallucinations can be in motion or remain in place, color or black and white. Auditory hallucinations are much easier. Hallucinatory-paranoid syndrome most often begins precisely with the appearance of auditory hallucinations. Voices begin to sound in the head of the patient long before the diagnosis is made. The votes may belong to several "people" or to one. Often these voices are threatening and tell the patient what to do. Sometimes voices communicate with each other, argue.

Less commonly, olfactory, gustatory, tactile hallucinations are manifested, which are expressed in sensations of an unpleasant taste or smell, which cause refusal of food and non-existent touches.

Senestopathy also belongs to the rare category. This type of hallucination can manifest itself in the form of hard tolerable sensations, a feeling of squeezing, burning, bursting in the head, turning over inside something. Senestopathy can become the basis for delirium.

Options for the course of paranoid schizophrenia

The International Classifier of Diseases defines the following types of the course of the disorder:

F20.00 - continuous.
F20.01 - episodic course with a growing defect.
F20.02 - episodic course with a stable defect.
F20.03 - episodic remitting course.
F20.04 - incomplete remission.
F20.05 - full.

The reasons

A significant history of the study of paranoid schizophrenia does not allow specialists to name unambiguous factors contributing to its occurrence so far. However, possible reasons include:

burdened heredity;
alcoholism, drug addiction, substance abuse;
anomalies of intrauterine development;
neurobiological disorders;
social factors.

Treatment of paranoid schizophrenia

Treatment of the syndrome depends on the medical history and clinical manifestations. At present, thanks to the modern development of pharmacology, the treatment of the disorder has a more favorable prognosis. To achieve a stable remission allows the complex use of the latest groups of neuroleptics. The action of these drugs is aimed at eliminating productive symptoms, but they are not able to eliminate the personality changes that have arisen. The active stage of treatment lasts from 7 to 30 days.

The forecast depends on timeliness of the begun treatment. With the development of a schizophrenic defect, irreversible personality changes occur. The use of antipsychotics can stop their further development, but no drug is able to return them to normal. In this case, the prognosis is considered unfavorable.

Treatment can be carried out on an outpatient basis, but in severe cases, the patient's disorder is placed in a hospital.

Sustained remission is possible only in the case of a timely visit to a psychiatrist, before the development of personality changes. During this period, treatment is applied, the purpose of which is to prevent an exacerbation of the disorder. In especially severe cases, electric shock is used as a stationary method of treatment. The technique is quite complicated, but only with its help it is possible to stop the development of a depressive syndrome.

There is no cure for paranoid syndrome. Close people should know about this and accept the situation as it is. The favorable prognosis of therapy largely depends on the attitude towards the patient of his relatives. In this regard, treatment includes psychological support and training in tactics of communication with the patient of his immediate environment.

F20-F29 Schizophrenia, schizotypal and delusional disorders.

F20 Schizophrenia.

F20.0-F20.3 General criteria for paranoid, hebephrenic, catatonic and undifferentiated schizophrenia:

G1. During most of the psychotic episode lasting at least one month (or for some time on most days), at least one of the signs listed in the list (1), or at least two of the signs from the list (2), must be present.

1) At least one of the following features:

a) “echo” of thought, insertion or withdrawal of thoughts, or openness of thoughts;

b) delusions of influence or influence, distinctly referring to the movement of the body or limbs, or to thoughts, actions or sensations; delusional perception;

d) persistent delusions of a different kind that are culturally inappropriate and completely impossible in content, such as identifying oneself with religious or political figures, claims of superhuman abilities (for example, the ability to control the weather or communication with aliens).

2) or at least two signs from among the following:

a) chronic hallucinations of any kind, if they occur daily for at least one month and are accompanied by delusions (which may be unstable and semi-formal) without a distinct affective content;

b) neologisms, breaks in thinking, leading to fragmentation or inconsistency in speech;

c) catatonic behavior such as agitation, stiffness or waxy flexibility, negativism, mutism and stupor;

d) "negative" symptoms, such as severe apathy, impoverishment of speech, and smoothness or inadequacy of emotional reactions (it should be obvious that these are not due to depression or antipsychotic therapy.

G2. The most commonly used exclusion criteria are:

1) If the case also meets the criteria for a manic episode (F30-) or a depressive episode (F32-), criteria G1.1 and G1.2 above must be met BEFORE the mood disorder develops.

2) The disorder cannot be attributed to an organic brain disease (as set out in F00-F09) or alcohol or drug intoxication (F1x.0), dependence (F1x.2) or withdrawal (F1x.3 and F1x.4).

When identifying the presence of the above anomalous subjective experiences and behavior, one should be especially careful to avoid false-positive assessments, especially where there are culturally or subculturally determined forms of behavior and manners, as well as a subnormal level of mental development.

Given the considerable variation in the course of schizophrenic disorders, it may be appropriate (especially for research purposes) to specify the type of course using the fifth character. The course should be coded for a follow-up period of at least one year (for remission, see note 5 in the introduction).

F20.x0 continuous (during the entire period of observation there are no remissions in psychotic symptoms)

F20.x1 episodic with progressive development of a defect progressive development of "negative" symptoms in the intervals between psychotic episodes

F20.x2 episodic with stable defect persistent but not progressive "negative" symptoms between psychotic episodes

F20.x3 Episodic relapsing with complete or virtually complete remissions between psychotic episodes

F20.x4 incomplete remission

F20.x5 complete remission

F20.x8 different flow type

F20.x9 no current detected, observation period too short

F20.0 Paranoid schizophrenia.

A. The (F20.0-F20.3) general criteria for schizophrenia must be met

B. Delusions and hallucinations (such as delusions of persecution, meaning and relationship, high kinship, special mission, bodily change or jealousy; "voices" of a threatening or imperative nature, olfactory or gustatory hallucinations, sexual or other bodily sensations) must be pronounced.

B. Emotional flatness or inadequacy, catatonic symptoms, or broken speech should not dominate the clinical picture, although they may be mild.

F20.1 Hebephrenic schizophrenia.

B. (1) or (2) must be noted:

1) distinct and prolonged emotional smoothness;

2) a distinct and prolonged emotional inadequacy.

B. (1) or (2) must be noted:

1) behavior that is characterized more by aimlessness and absurdity than purposefulness;

2) a distinct thought disorder, manifested by broken speech

D. The clinical picture should not be dominated by hallucinations or delusions, although they may be present in mild severity.

F20.2 Catatonic schizophrenia

A. The general criteria for schizophrenia (F20.0-F20.3) must be met, although this may not be possible initially due to the patient's inability to communicate.

B. One or more of the following catatonic symptoms are clearly defined for at least two weeks:

1) stupor (a significant decrease in reactivity to external stimuli and a decrease in spontaneous movements and activity) or mutism;

2) excitation (motor activity without a visible goal, which is not influenced by external stimuli);

3) freezing (arbitrary adoption and maintenance of inadequate or bizarre postures);

4) negativism (resistance without apparent motives to all instructions and attempts to budge, or even movement in the opposite direction);

5) rigidity (maintenance of a rigid posture despite attempts to change it);

6) wax flexibility (preservation of body members in the position given to it by other people);

7) automatic subordination (automatic execution of instructions).

F20.3 Undifferentiated schizophrenia

A. The general criteria for schizophrenia (F20.0-F20.3) must be met.

1) symptoms are insufficient to meet the criteria for any of the F20.0, F20.1, F20.2, F20.4, or F205 subtypes;

2) there are so many symptoms that criteria for more than one of the subtypes listed in B above (1) are met.

F20.4 Post-schizophrenic depression.

A. During the last 12 months, the general criteria for schizophrenia (F20.0-F20.3) should have been met, but they are not currently available.

B. One of the conditions noted in criterion G1 (2) a), b), c) or d) in sections F20.0-F20.3 must persist.

C. Depressive symptoms must be of sufficient duration, severity and variety to meet the criteria for at least a mild depressive episode (F32.0).

F20.5 Residual schizophrenia

A. The general criteria for schizophrenia (F20.0-F20.3) should have been met at some time in the past, but are not currently available.

B. At least 4 of the following "negative" symptoms must have been present in the previous 12 months:

1) psychomotor retardation or hypoactivity;

2) distinct emotional smoothness;

3) passivity and lack of initiative;

4) impoverishment of speech in terms of volume or content;

5) poverty of non-verbal communication, determined by the mimic expression of the face, contact in the gaze, modulation of the voice or posture;

6) low social productivity or poor self-care.

F20.6 Simple schizophrenia

A. Slow progressive development over at least a year of all three signs:

1) a distinct change in the premorbid personality, manifested by the loss of drives and interests, inactivity and aimless behavior, self-absorption and social autism;

2) the gradual appearance and deepening of "negative" symptoms, such as severe apathy, impoverishment of speech, hypoactivity, emotional smoothness, passivity and lack of initiative and poverty of non-verbal communication (determined by facial expression, contact in the gaze, voice modulation or posture);

3) a distinct decline in social, educational or professional productivity.

B. Absence at any time of the abnormal subjective experiences reported in G1 in F20.0-F20.3, nor of hallucinations or fully formed delusions of any kind, i.e., the clinical case should never respond criteria for any other type of schizophrenia or any other psychotic disorder.

C. No evidence for dementia or other organic mental disorder as presented in sections F00-F09.

F20.8 Other form of schizophrenia

F20.9 Schizophrenia, unspecified

F21 Schizotypal disorder.

A. For a minimum of two years, at least 4 of the following must be present continuously or periodically:

2) oddities, eccentricities or peculiarities in behavior or appearance;

3) impoverishment of contacts and a tendency to social autism;

4) strange views (beliefs) or magical thinking that influence behavior and are not consistent with subcultural norms;

5) suspicion or paranoid ideas;

6) obsessive chewing gum without internal resistance, often with dysmorphophobic, sexual or aggressive content;

7) unusual perceptual phenomena, including somato-sensory (bodily) or other illusions, depersonalization or derealization;

8) amorphous, detailed, metaphorical, hyper-detailed and often stereotyped thinking, manifested by strange speech or in other ways without pronounced discontinuity;

9) rare transient quasi-psychotic episodes with intense delusions, auditory or other hallucinations, and delusional ideas, usually occurring without external provocation.

B. The case must never meet the criteria for any disorder in schizophrenia in F20- (schizophrenia).

F22 Chronic delusional disorders.

F22.0 Delusional disorder

A. Presence of a delusion or a system of interrelated delusions other than those listed as typical schizophrenic under criteria G(1) b) or d) for F20.0-F20.3 (i.e., excluding those that are completely impossible in content or culturally inappropriate). The most common examples are delusions of persecution, grandeur, hypochondria, jealousy, or erotic delusions.

B. Delusions in criterion A must have been present for at least 3 months.

B. The general criteria for schizophrenia (F20.0-F20.3) are not met.

D. There should be no chronic hallucinations of any kind (but there may be transient or rare hearing hallucinations in which the patient is not discussed in the third person and which are not of a commentary nature).

E. Occasional depressive symptoms (or even a depressive episode (F32-)) may be present, but delusions persist even when no mood disturbances are present.

E. Most commonly used exclusion criteria. There must be no evidence for a primary or secondary brain disorder as defined in F00-F09 or for psychotic disorder due to psychoactive substance use (F1x.5).

Hint for highlighting possible subtypes:

If desired, the following types can be distinguished: persecutory type; lingering type; type with relation ideas; type with ideas of greatness; hypochondriacal (somatic) type; type with ideas of jealousy; erotomanic type.

F22.8 Other chronic delusional disorders

This is a residual category for chronic delusional disorders that do not meet the criteria for delusional disorder (F22.0). Disorders in which delusions are accompanied by chronic hallucinatory "voices" or schizophrenic symptoms that do not fully meet the criteria for schizophrenia (F20.-) should be coded here.

Delusional disorders lasting less than 3 months should, however, be coded at least provisionally in F23.-.

F22.9 Chronic delusional disorder, unspecified

F23 Acute and transient psychotic disorders.

G1. Acute development of delusions, hallucinations, incoherent or broken speech, acting in isolation or in any combination. The time interval between the appearance of any psychotic symptom and the development of the full clinical picture of the disorder does not exceed 2 weeks.

G2. If transient states of confusion, false recognitions or disturbances of attention do occur, they do not meet the criteria for an organically conditioned clouding of consciousness as set out in F05.-, criterion A.

G3. The disorder does not meet the symptomatic criteria for manic episode (F30.-), depressive episode (F32.-) or recurrent depressive disorder (F33.-).

G4. There is insufficient evidence of recent psychoactive substance use that would meet the criteria for intoxication (F1x.0), harmful use (F1x.1), dependence (F1x.2) or withdrawal states (F1x.3, F1x.4).

Chronic and largely unchanging use of alcohol or drugs in the amount and frequency to which the patient is accustomed does not in itself preclude the use of F23 This should be decided on the basis of clinical judgement, and depending on the requirements of the particular research project

G5. Most commonly used criticisms of exclusion Absence of organic brain disease (F00-F09) or major metabolic disorder affecting the central nervous system (does not include childbirth)

The fifth character should be used to indicate the association of the acute onset of the disorder with acute stress (which occurs within 2 weeks before the onset of acute psychotic symptoms):

F23.x0 without combination with acute stress

F23.x1 Combined with acute stress

F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia.

A The general criteria for acute and transient psychotic disorders must be met (F23)

B Symptoms change rapidly in both type and intensity from day to day or even within one day

C The presence of any type of hallucination or delusion for at least several hours at any time since the onset of the disorder

D. Symptoms from at least two of the following categories that develop at the same time:

1) emotional turmoil, characterized by intense feelings of happiness or ecstasy, or overwhelming anxiety or marked irritability;

2) confusion or false recognition of people or places;

3) increased or decreased activity, reaching a significant degree.

E. Any of the symptoms listed under schizophrenia (F20.0-F20.3), criteria G1 and G2, if present, for a short time after the onset of the condition, i.e. criterion B in F23.1 is not met .

E. The total duration of the disorder does not exceed 3 months.

F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia.

A. Criteria A, B, C and D must be met for acute polymorphic psychotic disorder

B. Some of the criteria for schizophrenia (F20.0-F20.3) are met for most of the time since the onset of the disorder, but they do not necessarily meet this diagnosis completely, i.e., at least:

1) any of the symptoms in F20, F1.1 a-d or

2) any of the symptoms F20, G1.2 from e) to h)

C. Symptoms of schizophrenia of the previous criterion B are detected for no more than one month.

F23.2 Acute schizophrenia-like psychotic disorder

A. The general criteria for acute and transient psychotic disorders (F23) are met.

B. The criteria for schizophrenia (F20.0-F20.3) are met, with the exception of the duration criterion.

C. The disorder does not meet criteria B, C, and D for acute polymorphic psychotic disorder (F23.0).

D. The total duration of the disorder does not exceed one month.

F23.3 Other acute predominantly delusional psychotic disorders

A. The general criteria for acute and polymorphic psychotic disorders (F23) are identified.

B. Relatively stable delusions and/or hallucinations are noted, but they do not meet the symptomatic criteria for schizophrenia (F20.0-F20.3).

B. The disorder does not meet the criteria for acute polymorphic psychotic disorder (F23.0)

D. The total duration of the disorder does not exceed 3 months.

F23.8 Other acute and transient psychotic disorders

Any other acute psychotic disorders that cannot be classified under other headings in F23 should be coded here (eg, acute psychotic states in which distinct delusions or hallucinations occur, but only for a short time). Here, the states of undifferentiated excitation should also be coded, if it is not possible to obtain information about the mental state of the patient, but only in the absence of data for organic conditioning.

F23.9 Acute and transient psychotic disorder, unspecified

F24 Induced delusional disorder.

A. The developing delusion or delusional system initially occurs in another person with a disorder classified in F20-F23.

B. These two people show an unusually close connection with each other and are relatively isolated from other people.

C Delusions did not occur to the patient before meeting with another person and in the past he did not develop disorders attributable to F20-F23

F25 Schizoaffective disorders.

Note This diagnosis is based on a relative "balance" in the amount of severity and duration of schizophrenic and affective symptoms.

G1. The disorder meets the criteria for one of the moderate or severe mood disorders (F30.-, F31-, F32.-) as defined for each subtype.

G2. For most of the time, at least a two-week period, symptoms of at least one of the following symptom groups are clearly present (which almost coincide with the symptom groups in schizophrenia (F20.0-F20.3):

1) “echo” of thoughts, insertion or withdrawal of thoughts, openness of thoughts (F20.0-F20.3, criterion G1.1 a));

2) delusions of influence or influence, clearly referring to movements of the body or limbs or to certain thoughts, actions or sensations (F20.0-F20.3, criterion G1.1 b));

4) persistent delusions of any kind that are culturally inadequate and completely impossible in content, but are not just ideas of greatness or persecution (F20.0-F20.3, criterion G1.1 d)), for example, that the patient visits other worlds, can control clouds with his breath, communicate with plants or animals without words, etc.;

5) clearly inadequate or broken speech or frequent use of neologisms (expressed form of criterion G1.2 b) in rubric F20.0-F20.3);

6) frequent occurrence of catatonic behaviors such as freezing, waxy flexibility and negativism (F20.0-F20.3, criterion G1.2 b)).

G3. Criteria G1 and G2 must occur during the same episode and at least for some time at the same time. In the clinical picture, the symptoms of both G1 and G2 criteria must be pronounced.

G4. The most commonly used exclusion criteria. The disorder cannot be attributed to an organic psychiatric disorder (in the sense of F00-F09) or to an intoxication, dependence or withdrawal state associated with the use of psychoactive substances (F10-F19).

F25.0 Schizoaffective disorder, manic type.

B. Criteria for manic disorder (F30.1 or F31.1) must be met.

F25.1 Schizoaffective disorder, depressive type.

A. The general criteria for schizoaffective disorder (F25) must be met.

B. The criteria for a depressive disorder, at least of moderate severity, must be met (F31.3, F31.4, F32.1, or F32.2).

F25.2 Schizoaffective disorder, mixed type.

A. The general criteria for schizoaffective disorder (F25) must be met.

B. The criteria for mixed bipolar affective disorder (F31.6) must be met.

F25.8 Other schizoaffective disorders

F25.9 Schizoaffective disorder, unspecified

If desired, the following subtypes of schizoaffective disorder can be distinguished depending on its dynamics:

F25.x0 Only simultaneous development of schizophrenic and affective symptoms. Symptoms are defined in criterion G2 under F25.

F25.x1 Simultaneous development of schizophrenic and affective symptoms with subsequent persistence of schizophrenic symptoms outside periods of affective symptoms

F28 Other non-organic psychotic disorders.

Psychotic disorders that do not meet the criteria for schizophrenia (F20.0-F20.3) or psychotic types of (affective) mood disorders (F30-F39) and psychotic disorders that do not meet the symptomatic criteria for chronic delusional disorder (F22.-) should be coded here. ) (an example is chronic hallucinatory disorder). This also includes combinations of symptoms that are not covered by the previous (F20.-categories (F20.-F25), for example, a combination of delusions other than those listed as typical schizophrenic in F20.0-F20.3, criterion G1.1 b) or d) (i.e. other than those who are completely unbelievable in content or culturally inadequate), with catatonia.

What is paranoid schizophrenia

Paranoid schizophrenia is one of the manifestations of a chronic mental disorder. The disease usually makes its debut at a young age: from twenty to thirty, and is the most famous and common type of schizophrenia.

Paranoid schizophrenia: characteristic features of the disease

According to the International Classification of Diseases of the 10th revision of the ICD-10, paranoid schizophrenia has the code F20.0. This form of schizophrenia is characterized by two main distinguishing features - the presence of hallucinatory and delusional disorders. At the same time, affective disorders (fear, anxiety), catatonic or oneiric symptoms, speech and will disturbances can be observed, but they are little or not expressed at all. If certain signs are also found, then experts divide this disease into subtypes:

affective paranoid schizophrenia (with depressive, manic or anxious variant of the course of the disease);
catatonic form of paranoid schizophrenia.

According to the variants of the course of the disease, there are:

with continuous flow F20.00;
episodic with increasing defect F20.01;
episodic c with stable defect F20.02;
with paroxysmal progressive course F20.03.

Incomplete remission has the code F20.04, complete - F20.05.

Thus, the paranoid form can have a diverse clinical picture, which in turn indicates the multicomponent nature of the etiology (origin) of the disease and the difficulties in making a correct diagnosis.

The periods of the formation of the disease

Paranoid schizophrenia can be characterized by both acute and slow onset. With an acute onset, there is a sharp change in behavior: inconsistent thinking, aggressive arousal, unsystematized delusional disorders. There may be increased anxiety, pointless and causeless fear, oddities in behavior.

The slow onset is characterized by the duration of the invariance of external forms of behavior. Only periods are noted cases of strange actions, gestures or grimaces, inadequate suspicion, statements bordering on delusional. There is a loss of initiative, loss of interest in former hobbies, the patient may complain of feelings of emptiness in the head.

Sometimes the disease can begin with slowly but steadily growing pseudo-neurotic symptoms: decreased ability to work, lethargy, the presence of obsessive overvalued desires or thoughts.

The initial initial stage can also be characterized by personality depersonalization (a distorted idea of one's own "I"), confusion, unreasonable fear or anxiety, delusional moods, statements and delusional primary, that is, intellectual perception of the environment.

The development of the initial stage is described by obsessive phenomena (for example, hypochondria) or thoughts, situational or already systematized delusional statements. Often already at this stage of the course of the disease, one can notice personality changes: isolation, scarcity of emotional reactions. After that, against the background of frequently occurring delusional ideas, hallucinations may appear. As a rule, at this stage - verbal (in the form of a hallucinatory dialogue or monologue). This is how a secondary delusional disorder develops.

Then the so-called Kandinsky-Clerambault syndrome begins to prevail with the development of symptoms of pseudohallucinations (that is, without identifying them with real objects or events) and mental automatisms (the perception of one’s own thoughts, movements not as part of one’s mental “I”, but as part of something alien inspired by someone else): associative, motor, senestopathic.

The main symptom at the initialization stage is delusional disorders, which are hallucinatory in nature.

The manifestation of the disease can occur both as an acute paranoid disorder and as Kandinsky-Clerambault syndrome.

Causes of the disease

The exact causes of this disease, like other forms of schizophrenia, have not yet been established in modern science. Studies show that schizophrenia develops to a greater extent against the background of various brain dysfunctions. It really is. But what exactly causes such dysfunctions - a number of genetic factors, environmental, pathological changes caused by a consequence of somatic diseases - is still unknown.

Possible causes of paranoid schizophrenia:

imbalance in the production of the neurotransmitter dopamine or serotonin;
genetic predisposition;
viral infections in the perinatal (intrauterine period), oxygen starvation;
acute stress experienced in childhood or early life;
psychological trauma of childhood;
scientists argue that children born as a result of late pregnancy are at greater risk than children born from young parents;
drug and alcohol abuse.

Symptoms of the disease

The paranoid type of schizophrenia is characterized by leading and secondary symptoms. According to ICD-10, a diagnosis is made when the general criteria for schizophrenia are met and the following symptoms are present:

Affective disorders that manifest themselves in the form of unreasonable fear or anxiety, alienation, emotional detachment, passivity, inadequacy of emotional reactions can be observed.
Catatonic disorders: agitation or stupor.
General changes in behavior: loss of interest in one's own hobbies, awareness of the aimlessness of existence, the manifestation of social autism.
There may be signs of incoherent broken speech, a violation of the sequence of thinking.
Increased aggression, anger.

All secondary signs and negative symptoms in the clinical picture of the paranoid form of schizophrenia are not predominant or pronounced.

Delusional ideas that are accompanied by auditory hallucinations. A person can hear voices in his head that tell him about the possible "dangers" that lie in wait for him.
Visual hallucinations are observed, but much less often auditory and verbal.
Pseudohallucinations are characterized by the perception of hallucinations in the mental subjective space, that is, the objects of hallucinations are not projected onto real objects and are not identified with them.
The presence of different types of psychological automatisms.
Stability and systematicity of paranoid delusions.

Depending on the predominance of the main symptom, two subtypes of the paranoid form of schizophrenia are distinguished: delusional and hallucinatory.

In the delusional form of the disease, the leading symptom is characterized by a long-term progressive systematized delirium.

The main idea of delirium (its plot) can be anything. For example, hypochondria, jealousy, reformism, persecution, etc. Polythematic delusional disorder (with the presence of several different plots) can also be observed.

Patients with a pronounced delusional paranoid disorder not only express false (“true” on their part) thoughts, but also try with all their might to prove their ideas or translate them into reality.

With a hallucinatory variant of the disease, delusional disorders do not have a systematization and duration of manifestations. Such disorders are called paranoid delusions (sensual). There are pronounced verbal hallucinations, auditory. It may seem to patients that someone is calling them, commenting on their actions. Gradually, such voices transform and move from reality to the inside. And the voices are already ringing in my own head. This is how pseudohallucinations appear, Kandinsky's syndrome develops.

Visual and other types of hallucinations are much less common in the paranoid form.

Diagnosis and treatment

The diagnosis of "paranoid schizophrenia" is made on the basis of a complete clinical examination, confirmation of the presence of leading symptoms and a differential diagnosis. It is important to exclude other types of the disease, as well as the induced type of delusional disorder (which is often found in people who were brought up in a family with mental illness), organic delusional disorder (which is not endogenous), etc.

Patients with this diagnosis need systematic treatment even when the symptoms decrease or recede completely. The treatment of this disease is in many ways similar to the treatment of other types of schizophrenia. And the options are selected based on the severity and variety of symptoms, the patient's health status and other factors.

Modern drug therapy includes several stages:

Active - its task is to eliminate productive symptoms. In this case, various types of antipsychotics are prescribed. Therapy lasts from a week to a month. Such drugs are able to quickly stop acute symptoms, but are completely ineffective in changing the patient's personality (the formation of a defect in schizophrenia). New developments in this area in the form of atypical antipsychotics can slow down the development of personality changes.
Stabilizing - at this stage, some types of drugs can completely cancel or reduce their dosages. The stage lasts from several months to six months.
Supportive - its task is to fix the results and prevent the development of relapses or exacerbation of the disease. Cancellation of treatment may lead to the return of acute symptoms.

In order not to take the medicine daily, pharmacologists have developed a deposited form of antipsychotics. An injection of the drug is administered every few weeks. The active substance is released gradually, which allows you to maintain the desired level of the drug in the blood.

Psychological rehabilitation is also carried out with the patient, where professional and social skills are developed.

Paranoid schizophrenia is a chronic disease from which there is no cure. Modern medicine is aimed at eliminating acute symptoms and improving the quality of life of patients.

F20 schizophrenia

ICD-10 diagnosis tree

f00-f99 class v mental and behavioral disorders
f20-f29 schizophrenia, schizotypal and delusional disorders
F20 schizophrenia(Selected ICD-10 diagnosis)
f20.0 paranoid schizophrenia
f20.1 hebephrenic schizophrenia
f20.2 catatonic schizophrenia
f20.4 post-schizophrenic depression
f20.9 schizophrenia, unspecified
f20.5 residual schizophrenia
f22 chronic delusional disorders
f23 acute and transient psychotic disorders
f25 schizoaffective disorders
f28 other non-organic psychotic disorders
f29 Non-organic psychosis, unspecified

Diseases and syndromes related to ICD diagnosis

Titles

Description

Endogenous procedural disorders (DSM heading Schizophrenia, Schizoaffective disorder, Schizotypal disorder) is a group of chronic endogenous mental disorders that have a regular syndromokinesis and syndromotaxis of productive and negative symptoms, occurring with an increase in negative symptoms, pathognomonic signs of which are discordant disorders , intellectual-mnestic and emotional-volitional disorders, the development of which leads to the formation of a specific emotional-volitional defect (progression of autism, apathy, abulia) and operational diagnostics of which is carried out using the criteria of the rubric "Schizophrenia" ISD-10 and DSM-4R.

The history of the study of schizophrenia begins in the second half of the 19th century, when hebephrenia was described by Hecker in 1871, and catatonia was first mentioned by Kahlbaum in 1890. From the end of the 19th century, the era of luminaries of psychiatry begins. Blayer described symptoms pathognomonic for schizophrenia - discordant thought disorder, autism, ambivalence, affective dissociation, ambivalence. In 1924, Bumke identified the nuclear forms of schizophrenia. Continuously progressive schizophrenia is described by Kleist (1953) and Leonhardrm (1960). Later, Kerbikov, Snezhnevsky, Nadzharov, Tiganov, Zharikov and other scientists studied the clinical problem of schizophrenia.

Schizophrenia is a fairly common disease. Morbidity ranges from 1.9 to 10 per 1000 population. The incidence is different, depending on gender: for men 1.98; for women 1.85. It is noted that men suffer from continuous-current schizophrenia to a greater extent. The highest incidence occurs in adolescence and youth, then the incidence rate decreases, but schizophrenia occurs at any age - from the prenatal period to old age.

The reasons

1. Dopamine theory proposed by Carsson. It was determined that in patients with schizophrenia, the synthesis of dopamine is increased and the sensitivity of dopamine receptors is increased. Dopamine-rich structures: nigro-striatal, mesencephalic-cortical, and mesencephalic-limbic-cortical structures. There is hypersensitivity of dopaminergic receptors in the limbic region and striatum. There is a violation of the activity of GABA (gamma-aminobutyric acid), an inhibitory substance that affects these receptors.

2. The etiological role of toxic factors is determined in connection with the similarity of the chemical structures of biogenic amines and psychomimetics. It turned out that the structures of norepinephrine and dopamine have much in common with the structure of mescaline. In the urine of patients, dimethoxyphenylethylamine was isolated, which indicates a violation of the methylation of biogenic amines.

3. Dysfunction of neuropeptides. Neuropeptides are the basis of intercellular interaction. These include neurohormones, neurotransmitters, neuromodulators, chemical carriers of specific information.

There are violations in 3 groups of neuropeptides:

A) violation of neurohumoral function (vasopressin, oxytocin, thyrotropin - releasing hormone);

B) the neurotransmitter function of neuropeptides is to change membrane potentials (substance P);

C) neuromodulatory function: endorphins and enkephalins, similar in structure to opiates, affect specific receptors and have a psychotropic effect.

There are specific indications of genetic aspects in the inheritance of schizophrenia. An important role in this is played by the phenomenon of the assortative funnel of marriages, which consists in the following: persons with a similar genotype experience a strong sexual attraction to each other, which ultimately leads to the accumulation of homozygous offspring in 3-4 generations. Schizophrenia is characterized by a polylocus (polygenetic) model of inheritance with a predominance of recessive genes. Characterized by incomplete penetrance, translocations of 3 and 8 pairs of chromosomes, the concentration of pathological genes in the 5th pair of chromosomes.

The contribution of genetic factors in the development of schizophrenia reaches 87%, and the type of course and syndrome are mainly inherited.

The risk of getting schizophrenic in a relative of the proband (a person with schizophrenia):

Parents - 14%, brothers and sisters - 15-16%, children 10-12%, aunts and uncles - 5-6%. However, in addition to the risk of getting schizophrenia, relatives have an increased risk of other mental anomalies.

Risk factors for schizophrenia:

1. Factor X (possibly a perinatal pathology), which causes brain damage with the expansion of the lateral ventricles in puberty. It is believed that if factor X did not act in this period, then schizophrenia does not develop after puberty.

2. Perinatal pathology.

3. Schizoid personality type.

4. Schizophrenogenic family (conformal father is suppressed by a sthenic and despotic mother).

5. Intoxication with cannabinoids.

6. Conceiving a child during the winter months.

There are also etiological factors that model the causes of schizophrenia:

1. Sex. It is noted that men are more likely to suffer from a continuously progressive form of schizophrenia.

2. Age. There is a concept of an age crisis in the development of schizophrenia:

1 age crisis: from early childhood to 3 years (development of early childhood autism);

2 age crisis: preschool and early school age (the presence of children's fear and delusional fantasy);

3 age crisis: adolescence (the beginning of low-progressive and hebephrenic schizophrenia);

4 age crisis: youthful age (beginning of juvenile malignant schizophrenia);

5 age crisis: 25 - 30 years (paranoid schizophrenia);

6 age crisis: age involution -years (schizoaffective disorders);

7 age crisis: pathological menopause (involutional paranoid, involutional melancholy);

8 age crisis: late age - after 65 years (Ekbom's syndrome, verbal hallucinosis of fantastic content).

3. It is noted that schizophrenia has a more severe course in people with low education, qualifications, material level.

Pathogenesis

The pathogenesis of schizophrenia is presented in the form of the following interrelated stages:

1. Violation of brain development. The marker is internal hydrocephalus (dilation of the lateral ventricles).

2. Violation of the metabolism of serotonin and methionine with the formation of indoles, which leads to autointoxication.

3. Violation in the dopaminergic system (increased sensitivity to dopaminergic receptors). These disorders cause positive symptoms in schizophrenia.

4. Serotonergic disorders are manifested in a deficiency of serotonin, a violation of the sensitivity of serotonergic receptors. Cause discordant disorders and negative symptoms.

5. Autoimmune pathology. During exacerbations of schizophrenia, there is an increase in the concentration of autoantibodies and a violation of the protective function of the blood-brain barrier.

6. Pathological activation of the left hemisphere of the brain contributes to the development of hallucinatory-paranoid symptoms and discordant disorders. Pathological activation of the diencephalic parts of the right hemisphere contributes to the emergence of schizoaffective symptoms and, on the other hand, neurosis-like and psychopathic disorders (with low-progressive schizophrenia).

Symptoms

Increased sensitivity in the premorbid period, before the development of obvious clinical signs of the disease, consists in a very subtle perception of how other people treat a person, but he, in turn, cannot feel the state of the interlocutor.

Types of pathological personalities found in the premorbid period of schizophrenia:

1. Without features.

2. Sensitive schizoids - vulnerable, reactive-labile, with neurotic reactions, "mimosa-like."

3. Emotionally cold and expansive schizoids - emotionally reduced, with monotonous rigid, overvalued activity, expansiveness.

4. Exemplary - sluggish, passive, obedient, reasonable, with sluggish instincts.

5. With the presence of a disproportion between high intelligence and motor awkwardness.

6. Unstable, excitable, with disinhibited drives and motor skills.

8. Hysterical personalities.

9. Psychasthenic personalities - anxious and suspicious, with reflection, a tendency to introspection, uncertainty.

10. Asthenic personalities with sensitivity, weakness, increased fatigue.

11. Pedintic-rigid (anancaste) personalities.

12. Paranoid and psychopathic personalities - expansive, sensitive, sluggish fanatics, "fighters for justice."

13. Infantile personalities with a long-lasting childish style.

14. People characterized by strange behavior.

Productive disorders in schizophrenia.

1. Neurosis-like disorders:

A) with a predominance of asthenic disorders (lethargy, fatigue, irritability), the creation of a special sparing regimen, hypothymia;

B) inadequate fears are stereotyped and ridiculous (in children);

C) with a predominance of obsessive phenomena, a feeling of timidity, hypothymia, phobias, later - a system of rituals and mentism with fear of going crazy;

D) with a predominance of depersonalization and derealization;

E) non-delusional dysmorphophobic and dysmorphomanic ideas;

E) hypochondriacal-senestopathic conditions;

G) episodic ideas of relation, calls, separate and unstable mental automatisms.

2. Psychopathic disorders:

A) increased affective lability;

B) a state with hypersthenicity, monotonous activity, a tendency to paranoid reactions and unstable overvalued education;

C) psychopathic states with increased sensitivity, a tendency to unstable individual ideas of attitude;

D) conditions with a predominance of hysterical disorders, which are characterized by tearfulness, capriciousness, a tendency to quarrel, vaso-vegetative lability;

E) psychopathological conditions with increased excitability and heboid disorders;

E) states, including episodic ideas of attitude, calls, individual mental automatisms.

3. Overvalued formations:

A) unusual autistic interests and games, autistic fantasies of an overvalued nature (in children). Ridiculous collecting, stereotyped solo play, devoid of practical value;

B) the phenomena of metaphysical intoxication - rudimentary paranoia with a passion for abstract philosophical teachings and modernist trends. This hobby is not productive;

C) overvalued dysformophobia and mental anorexia. Confidence in the presence of a defect in appearance or completeness, sensitive ideas of attitude, subdepression, the desire to correct the identified defect.

4. Mild affective disorders:

A) subdepression of a cyclothymium-like level with diurnal mood swings;

B) adynamic (apathetic) subdepression;

C) hypomania of a cyclothymogenic nature with an increase in mood, motor and intellectual activity, rudeness, harshness, disinhibition;

D) hypomania with psychopathic behavior;

E) repeated subdepressions with brief remissions;

E) frequent change of hypomanic and sub-depressive states with brief remissions;

G) continuous change of hypomanic and subdepressive states.

5. Affective syndromes:

A) depression with obsessions;

B) depression of the endogenous type, including anesthetic with ideas of self-accusation and condemnation;

C) depression with anxiety and agitation;

D) manic states of a circular type - the level of psychotic mania;

E) mixed non-delusional affective states.

6. Affective-delusional syndromes:

A) endogenous depression with delusions of persecution and / or hypochondriacal delusions;

B) depression with hallucinations and pseudo-hallucinations;

C) manic-delusional states;

D) mania with hallucinations and pseudo-hallucinations;

E) depressive-paranoid states with intermetamorphosis;

E) acute paraphrenic conditions.

7. Affective-catatonic states:

A) depressive-catatonic state;

B) manic-catatonic state;

C) manic-hebephrenic symptoms.

8. Oneiric states:

A) reduced oneiroid states with lability of affect, fear, mania with confusion, figurative and sensual delirium without a definite plot;

B) oneiroid-affective states (oriented oneiroid, a combination of true and fantastic orientation);

C) oneiroid-catatonic states (true oneiroid);

D) fibril-catatonic states.

9. Acute delusional syndromes:

A) acute sensual delirium;

B) acute paranoid state;

C) acute Kandinsky-Clerambault syndrome;

10. Paranoid states:

A) delusions of pretension, overvalued delusions, dysmorphomania of a paranoid nature. There is a monothematic affective delusion. Patients are obsessed with the idea of psychological comprehensibility of the delusion. Possible delusions of reformism, litigious delusions, hypochondriacal, dysphoromanic, jealousy, sensitive delusions of attitude, erotomanic;

B) paranoid delirium with affective fluctuations;

C) persistent paranoid delusions.

11. Chronic paranoid states.

12. Paraphrenic states.

13. Other delusional states.

14. Catatonic-paranoid states.

15. Catatonic states:

A) catatonic and catatonic hebephrenic stimulation;

B) catatonic stupor.

16. End states:

A) accompanied by underdeveloped or intermittent catatonic symptoms of the catatonic circle. Microcatatonic symptoms are characteristic;

B) the state of a catatonic akinetic circle;

C) states such as hyperkinetic-catatonic circle;

D) with a predominance of fantastic delirium;

E) a state of hallucinatory-delusional type;

E) states of catatonic-delusional and catatonic-hallucinatory type.

Treatment

Schizophrenia is a disease with a fundamentally favorable course, that is, with proper treatment, the vast majority of patients experience a long-term and high-quality remission. Therapy of schizophrenia is a complex of drug, psychotherapeutic, intensive and other methods of influencing the etiopathogenesis of the disease.

The main group of drugs used in schizophrenia are called antipsychotics. According to the classification, 9 classes of antipsychotics are distinguished:

1. Phenothiazides (chlorpromazine, neuleptil, mozheptil, teralen).

2. Xanthenes and thiaxanthenes (chlorproxen, clopixol, fluanxol).

3. Buterophenones (haloperidol, trisedil, droperidol).

4. Piperidine derivatives (Imap, Orap, Semap).

5. Bicyclic derivatives (rispolept).

6. Atypical tricyclic derivatives (leponex).

7. Derivatives of benzodiazepines (olanzapine).

8. Indole and naphthol derivatives (moban).

9. Benzamide derivatives (sulpiride, metoclopramide, amisulpride, tiapride).

Antipsychotics (antipsychotics) affect the dopamine system and are dopamine receptor antagonists. Their action leads to an antipsychotic effect. Violations in the serotonergic system, causing negative symptoms, are also stopped by antipsychotics. The action of neuroleptics causes side effects, primarily exrapyramidal disorders. The newest antipsychotics, or atypical antipsychotics (risperidone, olanzapine) have equal affinity for dopamine and serotonin receptors, are comparable in effectiveness to classical antipsychotics, and are much better tolerated. Each of the neuroleptics has individual features of pharmacodynamic activity. Antipsychotics in small doses eliminate affective, anxiety-phobic, obsessive-compulsive, somatoform disorders and compensation for personality anomalies, primarily of an endogenous procedural nature. In high doses, antipsychotics reduce psychomotor activity and have an antipsychotic effect. They also have an antiemetic effect. Neurotropic action of neuroleptics causes extrapyramidal and vegetative symptoms.

In addition to antipsychotics, antidepressants, thymostabilizers, tranquilizers and other groups of drugs are used to treat schizophrenia.

An important role is played by psychotherapeutic work, various kinds of trainings. Physiotherapy.

Paranoid schizophrenia is a fairly debilitating mental illness.

It is also called paranoid schizophrenic disorder.

The main feature of this disease is the loss of connection with the outside world and reality, as a result of which any ability to function and live a full life is lost.

Paranoid schizophrenia can be really debilitating

A disease such as paranoid schizophrenia is classified as a psychotic disorder.

Among its main symptoms, it is most often encountered with auditory hallucinations, as well as deformed thinking.

Often a person suffering from such an ailment is sure that he is being persecuted and conspiracies are made against him. At the same time, he does not lose the ability to concentrate on certain important things, his memory does not deteriorate, and he does not have to deal with emotional apathy.

According to the descriptions of patients, the course of paranoid schizophrenia appears to them as a struggle against a dark and divided world .

Such a life is dominated by feelings of suspicion, doubt, and isolation. Every day you have to listen to the voices inside you even visions are possible.

Here are some symptoms and signs in men and women that can suggest a paranoid form of the disease:

hearing impairment - a person hears something that is not real;
development of inexplicable anger;
incoherence of emotions;
increased anxiety;
causeless excitement;
aggression and desire to contradict(argue);
emergence of violent tendencies;
suicidal tendencies;
delusions of grandeur, inflated conceit.

However, many of these signs can be observed in other species.

And only auditory disorders and paranoid delusions (hallucinatory-paranoid syndrome) are encountered in the treatment of paranoid schizophrenia.

If you do not start timely treatment of paranoid syndrome in schizophrenia, over time, the violation of the thought process will only intensify. There is aggression in the behavior of the patient: he may even consider it self-defense, since "the whole world is against him" and "you need to defend yourself somehow".

Sometimes the paranoid schizophrenic begins to think that he has some special talents, powers or abilities (for example, breathing underwater or flying in the sky).

Either he sincerely considers himself to be some kind of celebrity, and no matter what evidence that refutes such an opinion is presented to him, the patient continues to remain convinced that he is right.

Negative impact on the human psyche.

One can only imagine how difficult and unpleasant it is to hear voices that others do not hear. These voices are often tuned in to criticism, cruel bullying, ridiculing shortcomings .

Causes and factors

While the symptoms of paranoid schizophrenia are reliably known, researchers are still arguing about its causes.

True, many agree on the huge role that brain dysfunction plays in this pathology. But what factor contributes to this has not yet been disclosed.

As a specific risk factor, as well as environmental triggers. However, no theory has strong enough evidence to be proven.

Genetic predisposition most often serves as a kind of "switch", which is activated by some event, emotional experience, or some other factor.

Here are some factors that increase the likelihood of such a diagnosis as paranoid schizophrenia:

the presence of psychotic disorders in one of the relatives;
viral exposure in the womb;
lack of nutrients for the fetus;
receiving stress in childhood;
result of violence;
late conception of a child;
the use of psychotropic substances (especially by adolescents).

And here are the symptoms of the paranoid form of schizophrenic disorder:

persecution mania;
a sense of fulfillment of a special mission;
manifestation of aggressive behavior;
suicidal tendencies;
the appearance in the head of hallucinatory voices (including imperative ones);
the possibility of tactile or visual hallucinations.

Paranoids develop suicidal tendencies

The criteria for diagnosing the disease must correspond to this schizophrenic subtype.

Only the presence of obvious hallucinations and pronounced delusions allows the doctor to diagnose the described disorder, moreover, that:

practically does not appear;
emotions and speech are almost not disturbed.

Among the delusional states, the most characteristic are all kinds of persecutory beliefs.

But the development of drug-induced, as well as epileptic psychoses, as a rule, is excluded.

Interestingly, there is a certain relationship between the nature of the delusion, as one of the symptoms of paranoid schizophrenia, and the level of a person's culture, and even its origin.

Features of treatment

What is it - paranoid schizophrenia, and how is it treated?

Essentially, this is a lifetime commitment, not a temporary treatment course. Although the forecast is not the most joyful, this should be taken into account from the very beginning.

In general, the doctor prescribes therapy based on:

type of disorder;
intensity of symptoms;
individual characteristics of the patient;
medical history;
age characteristics;
other significant factors.

Not only qualified psychotherapists and other medical specialists, but also relatives of the patient, as well as social workers, take an active part in the treatment process.

The therapeutic strategy is usually built on:

taking antipsychotics (traditional and atypical);
psychotherapeutic procedures;
electroconvulsive treatment;
social learning skills.

Often, treatment for paranoid schizophrenia is required.

Non-drug, as well as psychotherapeutic intervention is aimed primarily at the relief of symptoms.

The diagnosis of the described disease can only be made by a qualified doctor. Accordingly, the prescription of drugs is carried out by a medical specialist - the same applies to the schedule of use of drugs and the correct dosage.

If you do not follow the doctor's instructions, the treatment process will not be as effective as we would like, and recovery will not be achieved.

Quite a lot of people stop taking medication after the first few months and continue to debilitate the patient with symptoms.

What will happen if you start the disease?

Signs will regularly worsen, and contact with the outside world will be lost. Suicidal thoughts are also intensifying, which can lead.

Electroconvulsive therapy is one treatment option for paranoid schizophrenia

Often the patient himself does not notice the strange behavior behind him, and even takes hallucinations and delusional states for things that really happen.

But the people around him (especially those close to him) will surely notice the changes and they will most likely have certain suspicions of mental abnormalities - accordingly, they should convince the person to see a doctor.

Disease in ICD-10

Paranoid schizophrenia - what is it in the ICD?

The International Classification of Diseases lists this disorder under the code F20.0.

Along with hallucinations and delusional disorders, the possible presence of affective disorders (anxiety and phobias), catatonic symptoms and speech disorders is suggested.

The following options for the course of the disease are also offered:

continuous flow - code F20.00;
episodic course with a growing defect - code F20.01;
episodic course with a stable defect - code F20.02;
progredient course, having a paroxysmal character - code F20.03.

In the case of incomplete remission, a code is given F20.04, and with full - F20.05.

That is, the clinical picture of the described disease can be varied.

This directly indicates the multicomponent nature of the origin of such a schizophrenic disorder and explains the difficulties associated with making a diagnosis.

Aggressive arousal may be one of the first symptoms.

How does the disease begin?

The onset of the disease is both slow and sudden.

If schizophrenia begins abruptly, the patient's behavior changes rapidly:

the thought process becomes inconsistent;
aggressive excitement appears;
delusional states develop, characterized by inconsistency;
the development of phobias, that is, unreasonable fear, is possible;
behavior becomes more and more strange (inappropriate).

When the onset of the disease turns out to be slow, the forms of behavior also change, but not immediately.

From time to time, the patient performs isolated inappropriate actions, makes strange statements, builds strange grimaces.

Gradually, he loses interest in what he previously thought interesting. Often you can hear complaints about the feeling of inner emptiness.

Slowly, but steadily, pseudoneurotic symptoms also increase:

reduced work capacity;
the person becomes lethargic and lethargic;
obsessive desires appear.

The conclusion of the diagnostician confirms pseudohallucinations, as well as mental automatism (when a person does not perceive his own thoughts and movements as his own).

But it is delusional states that are considered as the main symptom at this stage of the disease.

Prevention

What about the prevention of paranoid schizophrenia?

Of course, it is always said that preventive measures are a smarter approach than curative procedures: it is better to prevent than to cure.

But in this case it should be noted inability to somehow prevent the development of schizophrenic disorder.

Even if the genetic theory is right, any life event can become the “lever” that will trigger the disease.

The sooner treatment is started, the greater the chance of success.

The only thing to remember is the need to start a therapeutic course without delaying it, and as early as possible. This will help bring the disease under control, helping to improve the long-term outlook.

Paranoid schizophrenia: characteristic features of the disease

According to the International Classification of Diseases of the 10th revision of the ICD-10, paranoid schizophrenia has the code F20.0. This form of schizophrenia is characterized by two main distinguishing features - the presence of hallucinatory and delusional disorders. At the same time, affective disorders (fear, anxiety), catatonic or oneiric symptoms, speech and will disturbances can be observed, but they are little or not expressed at all. If certain signs are also found, then experts divide this disease into subtypes:

affective paranoid schizophrenia (with depressive, manic or anxious variant of the course of the disease);
catatonic form of paranoid schizophrenia.

According to the variants of the course of the disease, there are:

with continuous flow F20.00;
episodic with increasing defect F20.01;
episodic c with stable defect F20.02;
with paroxysmal progressive course F20.03.

Incomplete remission has the code F20.04, complete - F20.05.

The periods of the formation of the disease

Sometimes the disease can begin with slowly but steadily growing pseudo-neurotic symptoms: decreased ability to work, lethargy, the presence of obsessive overvalued desires or thoughts.

The main symptom at the initialization stage is delusional disorders, which are hallucinatory in nature.

The manifestation of the disease can occur both as an acute paranoid disorder and as Kandinsky-Clerambault syndrome.

Causes of the disease

Possible causes of paranoid schizophrenia:

imbalance in the production of the neurotransmitter dopamine or serotonin;
genetic predisposition;
viral infections in the perinatal (intrauterine period), oxygen starvation;
acute stress experienced in childhood or early life;
psychological trauma of childhood;
scientists argue that children born as a result of late pregnancy are at greater risk than children born from young parents;
drug and alcohol abuse.

Symptoms of the disease

Secondary symptoms:

Affective disorders that manifest themselves in the form of unreasonable fear or anxiety, alienation, emotional detachment, passivity, inadequacy of emotional reactions can be observed.
Catatonic disorders: agitation or stupor.
General changes in behavior: loss of interest in one's own hobbies, awareness of the aimlessness of existence, the manifestation of social autism.
There may be signs of incoherent broken speech, a violation of the sequence of thinking.
Increased aggression, anger.

All secondary signs and negative symptoms in the clinical picture of the paranoid form of schizophrenia are not predominant or pronounced.

Main symptoms:

Delusional ideas that are accompanied by auditory hallucinations. A person can hear voices in his head that tell him about the possible "dangers" that lie in wait for him.
Visual hallucinations are observed, but much less often auditory and verbal.
Pseudohallucinations are characterized by the perception of hallucinations in the mental subjective space, that is, the objects of hallucinations are not projected onto real objects and are not identified with them.
The presence of different types of psychological automatisms.
Stability and systematicity of paranoid delusions.

Depending on the predominance of the main symptom, two subtypes of the paranoid form of schizophrenia are distinguished: delusional and hallucinatory.

In the delusional form of the disease, the leading symptom is characterized by a long-term progressive systematized delirium.

Visual and other types of hallucinations are much less common in the paranoid form.

Diagnosis and treatment

Modern drug therapy includes several stages:

Active - its task is to eliminate productive symptoms. In this case, various types of antipsychotics are prescribed. Therapy lasts from a week to a month. Such drugs are able to quickly stop acute symptoms, but are completely ineffective in changing the patient's personality (the formation of a defect in schizophrenia). New developments in this area in the form of atypical antipsychotics can slow down the development of personality changes.
Stabilizing - at this stage, some types of drugs can completely cancel or reduce their dosages. The stage lasts from several months to six months.
Supportive - its task is to fix the results and prevent the development of relapses or exacerbation of the disease. Cancellation of treatment may lead to the return of acute symptoms.

Psychological rehabilitation is also carried out with the patient, where professional and social skills are developed.

Paranoid schizophrenia is a chronic disease from which there is no cure. Modern medicine is aimed at eliminating acute symptoms and improving the quality of life of patients.

Schizophrenic disorders are usually characterized by significant and characteristic distortions of thought and perception, as well as inappropriate affects. Clear consciousness and intellectual ability are usually preserved, although there may be some decline in cognitive ability over time.

The most important psychopathological symptoms include a feeling of reflection of thoughts (echo), insertion of someone else's or theft of one's own thoughts, transmission of thoughts over a distance; delusional perception and delusions of control from the outside; inertia; auditory hallucinations commenting on or discussing the patient in the third person; disordered thought and symptoms of negativism.

The course of schizophrenic disorders may be prolonged or episodic, with progression or stability of disturbances; it may be one or more episodes of the disease with complete or incomplete remission. In the presence of extensive depressive or manic symptoms, the diagnosis of schizophrenia should not be made until it is clear that the schizophrenic symptoms preceded the affective disturbances. Schizophrenia should not be diagnosed in the presence of obvious brain disease, as well as during drug intoxication or withdrawal. Similar disorders developing in epilepsy or other brain diseases should be coded under F06.2, and if their occurrence is associated with the use of psychoactive substances, under F10-F19 with a common fourth character.5.

A paranoid form of schizophrenia in which the clinical picture is dominated by a relatively stable, often paranoid delusion, usually accompanied by hallucinations, especially auditory, and perceptual disturbances. Disorders of emotions, will, speech and catatonic symptoms are absent or relatively mild.

Excluded:

involutional paranoid state (F22.8)
paranoia (F22.0)

A form of schizophrenia in which affective changes dominate. Delusions and hallucinations are superficial and fragmentary, the behavior is ridiculous and unpredictable, usually mannerisms. The mood is changeable and inadequate, thinking is disorganized, speech is incoherent. There is a tendency towards social isolation. The prognosis is usually unfavorable due to the rapid increase in "negative" symptoms, especially affective flattening and loss of will. Hebephrenia should be diagnosed only in adolescence and early adulthood.

The clinical picture of catatonic schizophrenia is dominated by alternating psychomotor disturbances of a polar nature, such as fluctuations between hyperkinesia and stupor or automatic submission and negativism. Shackled postures can be maintained for a long time. A notable feature of the condition may be cases of sudden excitement. Catatonic manifestations can be combined with a dream-like (oneiric) state with vivid stage hallucinations.

Schizophrenic:

catalepsy
catatonia
wax flexibility

A psychotic condition that meets the essential diagnostic criteria for schizophrenia, but does not correspond to any of the forms classified in F20.0-F20.2, or that exhibits features of more than one of the above forms, without a marked predominance of a specific set of diagnostic characteristics.

Excluded:

acute schizophrenia-like psychotic disorder (F23.2)
chronic undifferentiated schizophrenia (F20.5)
post-schizophrenic depression (F20.4)

A depressive episode, which may be prolonged, occurring as a consequence of schizophrenia. Some symptoms of schizophrenia ("positive" or "negative") should still be present, but they no longer dominate the clinical picture. These depressive states are associated with an increased risk of suicide. If the patient no longer exhibits any symptoms of schizophrenia, the diagnosis of a depressive episode (F32.-) should be made. If the symptoms of schizophrenia are still vivid and clear, the diagnosis of the appropriate type of schizophrenia (F20.0-F20.3) should be made.

A chronic stage in the development of schizophrenia in which there has been a clear transition from an early stage to a late stage characterized by prolonged (though not necessarily irreversible) "negative" symptoms, such as psychomotor retardation; low activity; emotional dullness; passivity and lack of initiative; poverty of speech content; the poverty of non-verbal interactions through facial expressions, eye expressions, intonations and postures; reduced self-care and scarcity of social activities.

Chronic undifferentiated schizophrenia

Residual schizophrenic condition

A disorder in which there is a subtle but progressive development of bizarre behavior, an inability to meet the demands of society, and a decline in all activities. The characteristic negative features of residual schizophrenia (eg, flattening of affect and loss of will) develop without any overt prior psychotic symptoms.

Schizophreniform:

disorder NOS
psychosis NOS

Excludes: brief schizophreniform disorder (F23.2)

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

F20 Schizophrenia

What is Schizophrenia -

The risk of developing schizophrenia is 1%, and the incidence is 1 case per 1000 population per year. The risk of developing schizophrenia increases with consanguineous marriages, with a burden of the disease in families with first-degree relatives (mother, father, brothers, sisters). The ratio of women and men is the same, although the detection of the disease in men is higher. The birth and death rates of patients do not differ from the average population. The highest risk of developing the disease for increasing age.

What causes Schizophrenia:

(A) The most recognized is the genetic nature of schizophrenia, which is substantiated by research on the risk of developing the disease in mono- and dizygotic twins, in siblings, parents and children, as well as in the study of adopted children from parents with schizophrenia. However, there is equally strong evidence that schizophrenia is due to a single gene (monogenic theory) with varying expressivity and incomplete penetrance, few genes (oligogenic theory), many genes (polygenic theory), or multiple mutations. Hopes are pinned on the study of translocations in the 5th chromosome and the pseudoautosomal region of the X chromosome. Therefore, the most popular hypothesis is the genetic heterogeneity of schizophrenia, in which, among others, there may also be sex-linked variants. It is likely that patients with schizophrenia have a number of advantages in natural selection, in particular, they are more resistant to pain, temperature and histamine shock, as well as to radiation. In addition, the average intelligence of healthy children of parents with schizophrenia is higher than the population intelligence for similar ages. It is likely that schizophrenia is based on a schizotype - a carrier of schizotaxy markers, which, being a neutral integrative defect, manifests itself under the influence of environmental factors as a pathological process. One of the markers of schizotaxia is a violation of slow eye movements when observing a pendulum, as well as special forms of evoked potentials of the brain.

(B) Constitutional factors take part in shaping the severity and reactivity of the process. So, in women and men-gynecomorphs, schizophrenia proceeds more favorably and with a tendency to periodicity; after the age of 40, the course of the disease is also more favorable. In men of an asthenic constitution, the disease often proceeds continuously, and in women of a pycnic constitution, more often periodically. However, the constitution itself does not determine susceptibility to disease. Morphological dysplasia usually indicates a possible atypia of the process, and such patients respond less well to treatment.

(C) 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, dilatation of the anterior and lateral horns of the ventricular system can be seen. With nuclear forms of the disease, the voltage from the frontal leads is reduced on the EEG.

(D) Of rather historical interest are attempts to link schizophrenia with infectious (streptococcus, staphylococcus, tuberculosis, E. coli) and viral (slow infections) pathology. However, in patients with schizophrenia, there is a distinct distortion in immune responses during the development of infectious pathology.

(E) Biochemical studies have linked schizophrenia to excess dopamine. Blocking dopamine with productive symptoms with antipsychotics helps to relax the patient. However, with a defect, there is a deficiency not only of dopamine, but also of other neurohormones (norepinephrine, serotonin), and with productive symptoms, not only the amount of dopamine increases, but also cholecystokinin, somatostatin, and vasopressin. A variety of changes are noted in carbohydrate, protein metabolism, as well as in the metabolism of lipoproteins. Indirect evidence of metabolic disorders in schizophrenia is the presence of a specific smell in the nuclear forms of the disease, chondrolysis (destruction and deformation in the case of a defect in the cartilage of the auricle), earlier puberty with a rapid increase in loss of libido.

(E) Theories of psychology explain the development of the disease in terms of the revival of archaic (Paleolithic, mythopoetic) thinking, the impact of a deprivation situation, selectively split information that causes semantic aphasia. Pathopsychologists detect in patients: a) diversity and ambivalence of judgments, b) egocentric fixation, in which judgments are made on the basis of their own motives, c) "latent" signs in judgments.

(G) Psychoanalytic theories attribute the disease to childhood events: exposure to a schizophrenogenic, emotionally cold and abusive mother, a situation of emotional dissociation in the family, fixation or regression to narcissism, or covert homosexuality.

(3) Ecological theories explain the fact of the predominant birth of schizophrenic patients in the cold season by the impact of prenatal vitamin deficiency, mutagenic exposure during the spring conception of a child.

(ii) Evolutionary theories consider the genesis of schizophrenia within the evolutionary process either as a "price" for increasing the average population intelligence and technological progress, or as a "hidden potential" of progress that has not yet found its niche. The biological model of disease is the freeze-flight response. Patients suffering from the disease have a number of selective advantages, they are more resistant to radiation, pain, temperature shock. The average intelligence of healthy children of parents with schizophrenia is higher.

Symptoms of Schizophrenia:

The diagnostic group as a whole is characterized by a combination of disorders of thinking, perception, and emotional-volitional disorders that last at least a month, but a more accurate diagnosis can be made only for 6 months. observations. Usually, the first step is a diagnosis of acute transient psychotic disorder with symptoms of schizophrenia or a schizophrenia-like disorder.

Stages of the disease: initial, manifest, remission, recurrent psychosis, deficient. In 10% of cases, spontaneous exit and long-term remission (up to 10 years) are possible. The reasons for the differences in prognosis are predominantly endogenous. In particular, the prognosis is better in women with a picnic physique, high intelligence, life in a complete family, as well as a short (less than 1 month) initial period, a short manifest period (less than 2 weeks), the absence of an abnormal premorbid background, the absence of dysplasia, low resistance to psychotropic drugs.

According to E. Bleuler, the axial disorders of schizophrenia include thinking disorders (discontinuity, reasoning, paralogicality, autism, symbolic thinking, narrowing of concepts and manticism, perseveration and poverty of thoughts) and specific emotional-volitional disorders (stupefaction of affect, coldness, parathymia, hypertrophy of emotions, ambivalence and ambivalence, apathy and abulia). M. Bleuler believed that axial disorders should be outlined by the presence of manifest manifestations, the absence of syndromes of exogenous type of reactions (amentia, delirium, quantitative changes in consciousness, seizures, amnesia), the presence of fragmented thinking, splitting in the sphere of emotions, facial expressions, motor skills, depersonalization, mental automatisms, catatonia and hallucinations. V. Meyer-Gross attributed thinking disorders, passivity with a sense of influence, primary delusions with ideas of relation, emotional flattening, sounding thoughts and catatonic behavior to the primary symptoms.

The most recognized in diagnostics were symptoms of the first rank according to K. Schneider, which include: the sounding of one's own thoughts, auditory contradictory and mutually exclusive hallucinations, auditory commentary hallucinations, somatic hallucinations, influence on thoughts, influence on feelings, influence on motives, influence on actions, a symptom of openness of thoughts, sperring and delusional perception, close to acute sensual delirium. The symptoms of the second rank include catatonia, pathological expression in speech, emotions and experiences. Most of these symptoms are taken into account in the modern classification thanks to the International Schizophrenia Study in 9 countries.

According to ICD 10, at least one of the following signs must be noted:

1. "Echo of thoughts" (sounding of one's own thoughts), insertion or withdrawal of thoughts, openness of thoughts.
2. Delusions of influence, motor, sensory, ideational automatisms, delusional perception. Such a combination in domestic psychiatry is referred to as the Kandinsky-Clerambault syndrome.
3. Auditory commentary true and pseudohallucinations and somatic hallucinations.
4. Delusions that are culturally inappropriate, ridiculous, and grandiose in content.

Or at least two of the following:

1. Chronic (more than a month) hallucinations with delusions, but without pronounced affect.
2. Neologisms, sperrings, broken speech.
3. Catatonic behavior.
4. Negative symptoms, including apathy, abulia, impoverishment of speech, emotional inadequacy, including coldness.
5. Qualitative changes in behavior with loss of interests, lack of focus, autism.

The prognosis for schizophrenia depends on a complex of factors that are listed in the table.

Prognostic factors in schizophrenia

cold season

Asymmetric and incomplete family

Polymorphic and acute with productive disorders, up to 14 days

Monomorphic, lingering, negative disorders, more than 2 months

High quality, more than 3 years

With residual symptoms, less than a year

The course of schizophrenia can be established already in the period of the manifesto, but more precisely after the third attack. With a tendency to remissions of good quality, seizures are usually polymorphic, include the affect of anxiety, fear. There is a continuous course, which means the absence of remission for more than a year, episodic with a growing defect, when negative symptoms progrediently (continuously) increase between psychotic episodes, episodic with a stable defect, when persistent negative symptoms are noted between psychotic episodes. The episodic course corresponds to the symptoms of a paroxysmal course accepted in domestic psychiatry. Episodic remitting, when there are complete remissions between episodes. This variant of the course corresponds to the symptoms of a periodic course accepted in domestic psychiatry. After an attack, incomplete remission is also possible. Earlier in domestic psychiatry, this concept corresponded to remissions "B" and "C" according to M.Ya. Sereisky, in which behavioral disorders, affective disorders, an encapsulated psychosis clinic or neurotic symptoms are found in the remission clinic. Complete remission corresponds to remission "A" according to M.Ya. Sereisky.

Persistent negative symptoms during the period of remission (defect) include in its clinic erased symptoms of productive symptoms (encapsulation), behavioral disorders, low mood against the background of apathic-abulic syndrome, loss of communications, decreased energy potential, autism and isolation, loss of understanding, instinctive regression.

In childhood, this diagnosis can be accurately made only after 2 years; from 2 to 10 years, nuclear forms predominate, which manifest themselves in a slightly different form. Paranoid forms have been described since the age of 9 years. The characteristic symptoms of childhood schizophrenia are regression, in particular regression of speech, behavior (symptom of arena, ballet walking, choice of non-game items, neophobia), emotional-volitional disorders and developmental delay. Overvalued fears, delusional fantasies act as equivalents of delirium.

Paranoid (F20.0).

The premorbid background is often without features. The initial period is short - from several days to several months. In the clinic of this period - symptoms of anxiety, confusion, individual hallucinatory inclusions (calls), impaired concentration. The onset may also be reactive paranoid or acute sensory delusions, which are initially regarded as acute transient psychotic disorder with schizophrenic symptoms or schizophrenia-like. The manifest period is from 16 to 45 years of age.

Variants of paranoid schizophrenia are: paraphrenic with symptoms of predominantly systematized paraphrenia; hypochondriacal variant, in which the delusion of infection is clearly associated with the content of auditory, olfactory, somatic hallucinations; hallucinatory-paranoid variant, proceeding with the Kandinsky-Clerambault syndrome. Special variants of paranoid schizophrenia are affective-delusional variants characteristic of a relapsing course. These include depressive-paranoid and expansive-paranoid variants. The depressive-paranoid variant usually begins as a hypochondriacal delusion, which grows to a degree of enormity, the depressive affect is secondary. The expansive-paranoid variant proceeds with the clinic of expansive paraphrenia, however, the expansion continues less than the ideas of grandeur. Classical paranoid schizophrenia is accompanied by polythematic delusions in which it is difficult to separate the ideas of persecution, attitude, meaning.

In paranoid schizophrenia, all variants of the course are possible (continuous, episodic and remitting), and negative disorders during remission include sharpening of character traits, fixation of apathetic-abulic symptoms, "encapsulation", in which individual symptoms of hallucinations and delusions are found in the remission clinic.

Clinical example: patient O., 33 years old. In premorbid without features. After graduating from school and serving in the army, he entered and successfully graduated from a law school, worked as an investigator in a seaside town. He was distinguished by service zeal and highly appreciated the attention of his superiors. Married and has a child. During the period of active work on the investigation of a banal domestic offense, he noticed that he was being watched in the toilet and in the bathroom. When he bathes, “special gases are released”, from which he fell asleep, and under this pretext they steal official documentation. Trying to connect the events, I realized that it is beneficial to one of the bosses in order to hide their "deeds".

He himself began to follow him, but “it turned out that he could not oppose anything to“ high patronage ”. As a result, "bugs" were installed in his apartment, including on the TV, which controlled his thoughts, included desires. Thanks to such “operational work”, his every action and thought became the property of the Main Directorate. I wrote a report "to the top", but was not understood, "since everyone is interconnected." In turn, he began to install listening equipment in the chief's office, was detained at that moment and subjected to a special investigation. In psychomotor agitation, he was taken to a psychiatric clinic. During hospitalization, he was silent, and later said that he could not speak due to the constant monitoring of speech by equipment. After coming out of psychosis, after 10 days, he was commissioned and got a job as a legal consultant, but he still felt surveillance and control of thoughts. He became indifferent to his relatives, and usually did nothing at home, constructing anti-surveillance equipment for hours. He went out in a special beret, in which he built microcircuits for the “thought screen”. He hears the voice of the pursuer, who sometimes continues to expose him and his family to radiation exposure using special methods.

In the manifest period and the further course of the disease, the following are characteristic:

1. Delusions of persecution, relationship, significance, high origin, special purpose or ridiculous delusions of jealousy, delusions of influence.

2. Auditory true and pseudo-hallucinations of a commentary, contradictory, judgmental and imperative nature

3. Olfactory, gustatory and somatic, including sexual, hallucinations.

The classical logic of the development of delirium, described by V. Magnan, corresponds to the sequence: paranoid (monothematic delirium without hallucinations) - paranoid (polythematic delirium with the addition of auditory hallucinations) - paraphrenic. However, this logic is not always noted, the development of acute paraphrenia and the absence of a paranoid stage are possible.

At the first stages, it is necessary to differentiate with acute transient psychotic disorders, and then with chronic delusional and schizoaffective disorders, as well as organic delusional disorders.

Acute transient psychotic disorders can occur with productive and negative symptoms of schizophrenia, however, these states are short-term and limited to a period of about two weeks with a high probability of spontaneous release and good sensitivity to antipsychotics. This rubric, meanwhile, can be considered as "cosmetic" at the stage of overt psychosis in paranoid schizophrenia.

Chronic delusional disorders include monothematic delusions, if auditory hallucinations occur, they are more often true. This group includes those variants of delirium that used to be called paranoid (love delirium, delirium of reformism, invention, persecution).

In schizoaffective disorders, delusional disturbances are secondary to affect, and the affect (manic, expansive, depressive) continues more than the delusion.

In organic delusional disorders, exogenous symptoms are often present, and neurologically, neuropsychologically, and with the help of objective research methods, it is possible to identify the underlying organic brain disease. In addition, personality changes in such disorders have a specific organic coloring.

Until now, it is believed that the treatment of acute overt psychosis in paranoid schizophrenia is best started with detoxification therapy, as well as antipsychotics. The presence of a depressive affect in the structure of psychosis forces the use of antidepressants, but an expansive affect can be stopped not only by tizercin, but also by both carbamazepine and beta-blockers (propranolol, inderal). The onset of paranoid schizophrenia in adolescence is usually accompanied by an unfavorable course, so the increase in negative disorders can be prevented by insulin coma therapy, small doses of rispolept (up to 2 mg) and other neuroleptic drugs. In acute psychosis, doses of rispolept are increased to 8 mg. As a maintenance therapy, antipsychotics are used - prolongs, and if there is an affect in the structure of psychosis - lithium carbonate. The therapy is based either on the principle of influencing the leading syndrome, which is chosen as the “target” of therapy, or on the principle of a complex effect on the amount of symptoms. The initiation of therapy should be cautious to avoid dyskinetic complications. With resistance to antipsychotic therapy, monolateral ECT is used, while the placement of electrodes depends on the structure of the leading syndrome. Supportive therapy is carried out depending on the characteristics of the attack clinic, either with antipsychotic prolongs (haloperidol-depot, lioradin-depot), or with neuroleptics in combination with lithium carbonate.

Hebephrenic (F20.1).

In premorbid behavioral disorders are not uncommon: antidisciplinary, asocial and criminal behavior. Frequent dissociative personality traits, early puberty and homosexual excesses. This is often perceived as a distortion of the puberty crisis. The onset most often covers age, although manifestation of later hebephrenia is also possible. Later, in the manifest period, a triad is characteristic, including the phenomenon of inaction of thoughts, unproductive euphoria and grimacing, reminiscent of uncontrolled tics. The style of behavior is characterized by regression in speech (obscene language), sexuality (casual and abnormal sexual relations) and in other instinctive forms of behavior (eating inedible, aimless dromomania, slovenliness).

Clinical example: Patient L., 20 years old. In adolescence, he was characterized by unbearable behavior. Suddenly and for no apparent reason, he came into conflict with friends and parents, spent the night in basements, used hashish and alcohol, and began to steal. Having hardly finished 9 classes, he moved to a school, which he could not finish, because he was put on trial for hooliganism. After returning home, he decided to come to his senses, went to work. But his attention was attracted by a certain girl, who began to show strange signs of attention. She worked in a large supermarket, and L. began to visit her in the evenings. Meeting her, he spoke loudly and used obscene expressions, spat and thereby compromised her, but when she pointed it out to him, he broke the window and scattered goods in the store. In addition, he became slovenly and did not wash at all, spoke a lot, but without any sense and without a central idea, his speech was interspersed with tirades of “fashionable expressions” that he drew from the “new Russians”. He turned to the policeman with a request to accompany him to the restaurant, for protection, and when he refused, he entered into a fight. He abandoned his job and lived in a landfill not far from his beloved's store. But this did not bother him at all, since he was in constant euphoria. During this time, he committed several thefts, and was caught stealing a bag of candy from a child. During hospitalization, he laughed foolishly, grimaced, in his speech - thematic slipping.

In the structure of the hebephrenic syndrome, the following are revealed:

1. Motor-volitional changes in the form of grimacing, foolishness, regression of instincts, unmotivated euphoria, aimlessness and lack of focus.

2. Emotional inadequacy.

3. Formal paralogical disorders of thinking - reasoning and fragmentation.

4. Non-expanded delusions and hallucinations that do not come to the fore and are in the nature of inclusions.

The course is often continuous or episodic with a growing defect. In the structure of the defect, the formation of dissocial and schizoid personality traits.

Hebephrenic schizophrenia should be differentiated from tumors of the frontal lobes and dementia in Pick and Huntington's disease. With tumors, cerebral symptoms, changes in the fundus, EEG and CT can be detected. Pick's disease is noted at a much later age, and with Huntington's disease, hyperkinesis of thinking, facial expressions, gesture, and posture is specific. On CT scans in patients with schizophrenia who have taken antipsychotics for a long time, there may be changes similar to Huntington's disease.

Treatment includes the use of insulin therapy, hypervitamin therapy, tranquilizers and large antipsychotics (chlorpromazine, mazheptil, trisedil, haloperidol, Zeprex, rispolept in doses of about 4 mg per day). Maintenance therapy is carried out with combinations of antipsychotics-prolongs and lithium carbonate, which allow you to control impulses, in particular aggression.

Catatonic (F20.2).

The premorbid background is characterized by schizoid personality disorder, although development is also possible against a premorbidly unaltered background. In the initial period, depressive episodes, simplex syndrome with isolation, loss of initiative and interests. Manifestation is likely as an acute reactive stupor, after traumatic brain injury, influenza, although more often psychosis develops for no apparent reason.

Classical catatonic schizophrenia occurs in the form of lucid catatonia, catatonic-paranoid states and oneiroid catatonia, as well as febrile catatonia. The motor component in catatonia is expressed in the form of stupor and excitation. Currently, classical catatonia has been replaced by microcatatonic states.

Catatonic stupor includes mutism, negativism, catalepsy, rigidity, freezing, automatic obedience. Common symptoms of stupor include Pavlov's sign (patient responds to whispered speech but does not respond to normal speech), cogwheel sign (bending and unbending resistance is observed), airbag sign (head remains elevated when pillow is removed), hood sign ( the patient tends to cover his head or covers his head with clothes).

Catatonic excitation proceeds with the phenomena of chaos, lack of purposefulness, perseverations and fragmentation of thinking. The whole clinic can be expressed either in a change of excitation and stupor, or in the form of repeated stupor (excitations).

In prilucid catatonia, a purely motor psychosis is noted, and no productive disturbances are noted behind the façade of motor disorders. The catatonic-paranoid variant suggests that delusion lies behind the catatonia. Often such productive disorders can be indirectly identified as a result of observing the patient's facial expressions: he shifts his gaze, the facial expression changes, regardless of the context of the doctor's questions. With oneiroid catatonia, behind the facade of catatonia, there is an influx of fantastic visual images of a cosmic, apocalyptic nature. The patient visits other worlds, heaven and hell. There is no amnesia after leaving this state. Febrile catatonia as a variant of catatonic schizophrenia is recognized only by some psychiatrists, most believe that the addition of temperature to stupor is due either to additional somatic pathology, or unrecognized stem encephalitis, or neuroleptic malignant syndrome. In the clinic, there are discrepancies in the pulse rate and temperature, a petechial rash appears on the lower extremities, a gray film appears on the mucous membrane of the lips, and muscle tone gradually increases.

Signs of microcatatonia include increased tone of the muscles of the shoulder girdle, increased activity of the oral zone, stereotyping of facial expressions, posture, gesture, gait, speech stereotypes, mutism, stereotyped finger play, postural hypokinesia, reduced mobility of the hand with increased finger activity, lack of blinking. Sometimes catatonic stupor manifests itself only in the form of mutism.

All flow options are possible. The defect is usually expressed in apathetic-abulic states.

Clinical example: Patient P., 28 years old. In premorbid active and alive. After graduating from the Agricultural Institute, he was assigned to the forestry department and got married. During the year, the wife noticed changes in behavior: she became withdrawn, answered questions in monosyllables. Once he did not return from work on time, his wife found him sitting on a bench - he stared senselessly into space and did not answer questions. In the department, being presented to himself, he looks into space, resists a change in posture. There is no catalepsy. Mutism and negativism remain persistent and the only symptoms for the next two weeks. After administration of small doses of neuroleptics (risperidone and haloperidol), he recovered from his stupor. He could not explain his condition, “did not know how to speak”, “did not want to answer questions”. For two years there were no psychopathological disorders, he continued to work. Again he fell ill acutely and for no apparent reason. There were accelerated and broken speech, psychomotor agitation, which was replaced by a stupor. However, in the clinic of stupor, along with mutism and negativism, catalepsy was noted. At the station, he stood silently in the center of the hall for several hours, such unusual behavior was noticed by the police, and was taken to the clinic. The exit from the stupor was longer.

The diagnosis is based on the identification of:

2) chaotic, non-purposeful excitation;

3) catalepsy and negativism;

5) subordination and stereotypy (perseveration).

Catatonic schizophrenia should be distinguished from organic catatonic disorders as a result of epilepsy, systemic diseases, tumors, encephalitis, and depressive stupor.

With organic catatonia, atypical movement disorders are noticeable. For example, against the background of catalepsy - tremor of the fingers, choreoathetoid movements, the difference in the symptoms of rigidity and catalepsy in the upper and lower extremities, muscle hypotension. Data from CT, EEG and neurological examination help clarify the diagnosis.

Depressive stupor is accompanied by a characteristic facial expression of depression with Veragut's fold. Depression comes to light in the anamnesis.

The symptoms of microcatatonia resemble both the signs of neuroleptic intoxication and the behavioral signs of a defect in schizophrenia, such as apathico-abulic. In the latter case, they speak of secondary catatonia. For differential diagnosis, it is useful to prescribe detoxification therapy, tremblex, parkopan, cyclodol, or akineton. The use of this course usually reduces the signs of neuroleptic intoxication.

Catatonic mutism must be distinguished from selective (selective) mutism in children and adults with schizoid personality disorders.

Medium and high doses of neuroleptic drugs in catatonia can lead to fixation of symptoms and their transfer to a chronic course. Therefore, in stupor, therapy should be prescribed with intravenous administration of tranquilizers in increasing doses, sodium oxybutyrate, droperidol, nootropics, with careful monitoring of the patient's somatic condition. A good effect is given by 5-6 sessions of ECT with bilateral electrodes. The occurrence of a febrile state in the absence of contraindications forces ECT or transfer to the intensive care unit. Catatonic excitation is stopped by chlorpromazine, haloperidol, tizercin.

Undifferentiated (F20.3).

The clinic includes signs of paranoid, catatonic and hebephrenic schizophrenia in a state of psychosis. Such high polymorphism within a single psychosis usually suggests an episodic relapsing course. However, with the development of symptoms from one typology to another in a sequential chain of psychoses, the course can be continuous, for example, when a transition from paranoid to nuclear syndromes is noted in dynamics. The lack of differentiation of symptoms is sometimes associated with the fact that the disease occurs against the background of drug or alcohol addiction, against the background of the immediate and long-term consequences of a traumatic brain injury.

The diagnosis is based on the identification of symptoms of paranoid, catatonic and hebephrenic schizophrenia.

High polymorphism of psychosis is also characteristic of schizoaffective disorders, however, in them, affective disorders last longer than those characteristic of schizophrenia.

The complexity of therapy lies in the choice of a "target" of exposure and a complex of maintenance therapy. For this purpose, it is important to select axial symptoms, which are almost always visible in the dynamics of the disease.

Postschizophrenic depression (F20.4).

After a previous typical episode with productive and negative symptoms of schizophrenia, a prolonged depressive episode develops, which can be considered as a consequence of schizophrenic psychosis. Usually such an episode is characterized by atypia. That is, there is no typical daily dynamics of mood disorders, for example, mood worsens in the evening, like asthenic depression. Complex senestopathies, apathy, reduction of energy potential, aggressiveness may be present. Some patients interpret their condition as the result of a previous psychosis. If the level of depression corresponds to a mild and moderate depressive episode, it can be considered as a special remission clinic, and if negative disorders predominate, as a defect dynamics.

Clinical example: Patient V., 30 years old. Not working, doing housework. From the anamnesis and according to the medical history, it is known that two years ago she was in the clinic with the following condition. She experienced fears, believed that conspiracies were being arranged around her and a film was being made about her in order to compromise, setting up strange situations, eavesdropping on conversations, “stealing thoughts”, controlling her voice, which is forwarded to another voice. They made a double that always behaves the other way around. Was in the clinic for 2 months. A diagnosis of acute transient psychotic disorder with symptoms of schizophrenia was made, and moditen-depot was prescribed as maintenance therapy. However, she refused therapy and after discharge returned home without psychotic disorders. Nevertheless, she could hardly cope with housework, she could stay in bed all day long, not paying attention to the children. She periodically felt a transfusion in her stomach, which she explained by the fact that "the drugs continue to work." Sometimes the condition improved in the evening, but more often it changed during the day, becoming fussy and anxious. No delusions or hallucinations were found. The husband notes that he has to do almost all the houses himself. If she starts washing, she usually does not finish, sometimes she refuses to eat for a whole day, and he is forced to feed her "almost out of hand." She was again hospitalized. He explains his condition by the “lack of energy”, but he is not at all burdened by it. Facial expressions of depression, posture of submission.

The diagnosis is based on the identification of:

1) an episode of schizophrenic psychosis in history;

2) depressive symptoms, combined with negative symptoms of schizophrenia.

At the onset of the disease after 50 years, it is necessary to differentiate these disorders with the initial period of Alzheimer's disease, more precisely with its variant - Lewy body disease. In this case, additional neuropsychological and neurophysiological studies are needed to distinguish.

Treatment includes a combination of tricyclic antidepressants and antipsychotics. It is possible to use disinhibition with nitrous oxide, as well as ECT with electrodes placed on the non-dominant hemisphere.

Residual (F20.5).

This diagnosis can be considered as a delayed (for more than a year after psychosis) diagnosis of a typical defect in the emotional-volitional sphere after suffering a psychosis.

The cardinal signs of a paranoid syndrome are communication difficulties, peculiar thinking disorders, an increase in emotional impoverishment, and disintegration of the psyche.

When diagnosing, the doctor is guided by the rule: for schizophrenia, "typically everything is atypical." He must take into account such signs as paradoxicality, unusualness, pretentiousness.

Symptoms of the disorder

The next stage in the development of the disease is the formation of a variant of paranoid schizophrenia. In psychiatry, there are 2 main options, each of which has its own symptoms:

delusional;
hallucinatory.

The most common type of delusion is the idea of persecution. Such patients believe that they are being followed by agents of the special services, all their conversations are monitored and recorded. Often at this stage, a depressively paranoid form is formed.

The course of this disorder includes symptoms such as pseudohallucinations, the sounding of one's own thoughts, and delusions of influence. The delusion of influence is expressed in the fact that patients believe that their thoughts are heard by everyone, and someone directs their course. The prognosis in the absence of treatment is unfavorable.

Hallucinations are a phenomenon or product generated by the patient's sense organs. There is a classification of these phenomena, which includes the following types of hallucinations:

visual;
auditory;
taste;
olfactory.

The most common are auditory and visual hallucinations. Visual hallucinations have their own classification depending on the images that pop up in the mind of the patient:

Elementary- spots of light, lines, flashes.
subject- in the mind of the patient, objects appear that can be “taken” from the real world or be the product of a sick mind. The size of these images is significantly different from the real ones. Usually in such cases there are micro- or macrooptical hallucinations.
Autoscopic- the carrier of the disorder sees either his double. Or himself.
Zoopsia- vision of birds and animals.
Extracampine- the patient sees objects that are located outside the field of view.
Senestopathy- the occurrence of sometimes unpleasant pain in different parts of the body without a somatic basis.

Less commonly, olfactory, gustatory, tactile hallucinations are manifested, which are expressed in sensations of an unpleasant taste or smell, which cause refusal of food and non-existent touches.

Options for the course of paranoid schizophrenia

The International Classifier of Diseases defines the following types of the course of the disorder:

F20.00 is continuous.
F20.01 - episodic course with a growing defect.
F20.02 - episodic course with a stable defect.
F20.03 - episodic remitting course.
F20.04 - incomplete remission.
F20.05 - full.

The reasons

A significant history of the study of paranoid schizophrenia does not allow specialists to name unambiguous factors contributing to its occurrence so far. However, possible reasons include:

burdened heredity;
alcoholism, drug addiction, substance abuse;
anomalies of intrauterine development;
neurobiological disorders;
social factors.

Treatment of paranoid schizophrenia

The forecast depends on timeliness of the begun treatment. With the development of a schizophrenic defect, irreversible personality changes occur. The use of antipsychotics can stop their further development, but no drug is able to return them to normal. In this case, the prognosis is considered unfavorable.

Treatment can be carried out on an outpatient basis, but in severe cases, the patient's disorder is placed in a hospital.