Causes, signs and symptoms of schizophrenia

Schizophrenia is a disease belonging to the group of endogenous psychosisbecause its causes are due to various changes in the functioning of the organism, that is, are not associated with any external factors. This means that the symptoms of schizophrenia do not arise in response to external stimuli (as with neurosis, hysteria, psychological complexes, etc.), but by themselves. This is the fundamental difference between schizophrenia and others. mental disorders.

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

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

For example, human eyes see green leaves of trees. This picture is transmitted to the brain, absorbed by it and transferred to the cortex, where the process of understanding the information received is taking place. As a result, a normal person, having received information about green leaves on a tree, will make sense of it and will conclude that the tree is alive, summer is on the street, there is a shadow under the crown, etc. And with schizophrenia, a person is not able to comprehend information about green leaves on a tree, in accordance with normal laws peculiar to our world. This means that when he sees the green leaves, he will think that someone is painting them, or that this is some kind of signal for aliens, or that you need to rip them all, etc. Thus, it is obvious that in schizophrenia there is a disorder of consciousness, which is not able to form an objective picture from the available information on the basis of the laws of our world. As a result, a person gets a distorted picture of the world, created precisely by his consciousness from the initially correct signals that came to the brain from the sense organs.

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

Schizophrenia - Symptoms and Signs

Pointing out the signs and symptoms of schizophrenia, we will not only enumerate them, but also explain in detail, including examples, what exactly is meant by one or another formulation, since for a person far from psychiatry, it is the correct understanding of specific terms used to denote symptoms, is the cornerstone for gaining an adequate understanding of the subject matter.

First, be aware that symptoms and signs are characteristic of schizophrenia. Symptoms are defined as strictly defined manifestations characteristic of the disease, such as delusions, hallucinations, etc. But signs of schizophrenia consider four areas of activity of the human brain, in which there are violations.

Signs of Schizophrenia

So, the following effects are attributed to the signs of schizophrenia (Bleuler's tetrad, four A):

Associative defect - expressed in the absence of logical thinking in the direction of any final goal of reasoning or dialogue, as well as in the resulting poverty of speech, in which there are no additional, spontaneous components. At present, this effect is called shortly alogia. Consider this effect on an example in order to clearly understand what psychiatrists mean by this term.

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

If the second woman to whom the question was addressed was a schizophrenic, the dialogue would be as follows:
- Where are you driving?
- To Sister.
- What for?
- I want to visit.
- Did she have something happen or just like that?
- It happened.
- What happened? Something serious?
- Sick.

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

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

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

Depending on the nature of ambivalence, there are three varieties of it - emotional, volitional and intellectual. Thus, emotional ambivalence is expressed in the simultaneous presence of the opposite feeling towards people, events or objects (for example, parents can love and hate children, etc.). Willful ambivalence is expressed in the presence of an infinite oscillation, if necessary, to make a choice. Intellectual ambivalence is the presence of diametrically opposed and mutually exclusive ideas.

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

These pathological effects are signs of schizophrenia and cause changes in the personality of a person who becomes unsociable, closed, loses interest in subjects or events that previously disturbed him, makes absurd actions, etc. In addition, a person may have new hobbies that previously were completely atypical for him. As a rule, such new hobbies in schizophrenia become philosophical or orthodox religious teachings, fanaticism in following an idea (for example, vegetarianism, etc.). As a result of the restructuring of the personality, a person’s performance and the degree of his socialization are significantly reduced.

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

  • Positive (productive) symptoms,
  • Negative (deficient) symptoms,
  • Disorganized (cognitive) symptoms,
  • Affective (mood) symptoms.

Positive symptoms of schizophrenia

Positive symptoms include symptoms that previously were not a healthy person and they appeared only with the development of schizophrenia. That is, in this case, the word "positive" is not used in the sense of "good", but reflects only that something new has appeared. That is, there was a certain increase in the qualities inherent in man.

The positive symptoms of schizophrenia include the following:

  • Rave,
  • Hallucinations,
  • Illusions
  • State of arousal
  • Inadequate behavior.

Illusions represent the wrong vision of a truly existing object. For example, instead of a chair, a person sees a cupboard, and perceives a shadow on the wall as a person, etc. Illusions should be distinguished from hallucinations, since the latter have fundamentally different characteristics.

Hallucinations are a violation of the perception of the surrounding reality through the senses. That is, by hallucinations understand some sensations, which in reality do not exist. Depending on which sense organ the hallucinations concern, they are divided into auditory, visual, olfactory, tactile and gustatory. In addition, hallucinations can be simple (individual sounds, noise, phrases, flashes, etc.) or complex (connected speech, certain scenes, etc.).

Auditory hallucinations are most often observed, when a person hears voices in the head or in the outside world, sometimes it seems to him that thoughts were not made by him, but invested in the brain, etc. Voices and thoughts can give commands, advise something, discuss events, speak vulgarities, laugh, etc.

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

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

Rave It is a set of certain beliefs, conclusions or conclusions that are completely untrue. The nonsense can be independent or provoked by hallucinations. Depending on the nature of the beliefs, they distinguish delusions of persecution, influence, power, greatness or attitude.

The most common persecution nonsense is when a person feels that someone is being followed, for example, aliens, parents, children, police, etc.Each insignificant event in the surrounding space seems to be a sign of tracking, for example, tree branches swaying in the wind are perceived as a sign of observers lying in wait. A person with glasses is perceived as a contact, who reports on all his movements, etc.

Nonsense effects are also very common and are characterized by the notion that a person has any negative or positive impact, for example, DNA restructuring, radiation, psychotropic weapons will, medical experiments, etc. In addition, with this form of delirium, a person is sure that someone controls his internal organs, body and thoughts, putting them directly into his head. However, the delusions of impact may not be so bright forms, and disguised as quite similar to the reality of the form. For example, a person each time gives a slice of cut sausage to a cat or dog, because he is sure that they want to poison him.

Dysmorphophobia delirium is a persistent belief in the presence of deficiencies that must be corrected, for example, straightening protruding ribs, etc. The nonsense of reformatorship is a constant invention of some powerful new devices or systems of relationships that are not viable in reality.

Inadequate behavior It is either a naive stupidity, or a strong agitation, or inappropriate manners and appearance inappropriate situations. Depersonalization and derealization are typical variants of inappropriate behavior. Depersonalization is a blurring of the boundaries between I and not I, as a result of which one’s own thoughts, internal organs and body parts do not seem to be his own, but brought from outside, random people are perceived by relatives, etc. For derealization, enhanced perception of any minor details, colors, smells, sounds, etc. is characteristic. Because of this perception, it seems to a person that everything does not happen for real, but people, like in a theater, play roles.

The most difficult option of inappropriate behavior is catatonia in which a person takes awkward poses or randomly moves. Awkward posture is usually taken by a person in a stupor and holds them for a very long time. Any attempt to change his position is useless, because he is resisting, which is almost impossible to overcome, because schizophrenics have incredible muscle strength. A special case of awkward poses is wax flexibility, which is characterized by holding any part of the body in one position for a long time. When excited, a person begins to jump, run, dance and perform other meaningless movements.
Also refer to the option of inappropriate behavior hebephrenia - excessive sillyness, ridicule, etc. A person laughs, jumps, laughs and performs other similar actions regardless of the situation and location.

Negative symptoms of schizophrenia

The negative symptoms of schizophrenia are the disappeared or significantly reduced previously existing functions. That is, before the disease, the person possessed some qualities, and after the development of schizophrenia, they either disappeared or became significantly less pronounced.

In general, the negative symptoms of schizophrenia are described as the loss of energy and motivation, decreased activity, lack of initiative, poverty of thought and speech, physical inactivity, emotional poverty and narrowing of the range of interests. A patient with schizophrenia looks passive, indifferent to what is happening, reticent, immobile, etc.

However, with a more accurate allocation of symptoms to the negative include the following:

  • Passivity,
  • Loss of will
  • Complete indifference to the world (apathy),
  • Autism,
  • Minimal expression of emotions
  • Flattened affect,
  • Inhibited, sluggish and stingy movements,
  • Speech disorders
  • Thinking disorders,
  • Inability to make decisions
  • The inability to maintain a normal coherent dialogue,
  • Low ability to concentrate
  • Rapid exhaustion,
  • Lack of motivation and lack of initiative,
  • Mood swings,
  • The difficulty of building a sequential action algorithm
  • The difficulty of finding a solution to a problem
  • Bad self control
  • The difficulty of switching from one activity to another,
  • Agedonism (inability to have fun).

Due to lack of motivation, schizophrenics often cease to leave the house, do not perform hygienic manipulations (do not brush their teeth, do not wash, do not watch clothes, etc.), as a result of which they get a neglected, sloppy and repulsive appearance.

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

  • Constant jumping to various topics
  • The use of new, made-up words that are understandable only to the person himself,
  • The repetition of words, phrases or sentences
  • Rhyming - speaking meaningless rhyming words,
  • Incomplete or abrupt answers to questions
  • Unexpected silence due to blockage of thoughts (sperrung),
  • The influx of thoughts (mentism), expressed in a quick disjointed speech.

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

A variety of disorders of the will, motivation, initiative, memory and attention in general are called depletion of energy potential because a person quickly gets tired, cannot perceive the new, poorly analyzes the totality of events, etc. All this leads to a sharp decrease in the productivity of its activities, as a result, as a rule, the ability to work is lost. In some cases, a person forms a supervaluable idea, consisting in the need to save strength, and manifested in a very careful attitude to his own person.

Emotions in schizophrenia become mild, and their range is very poor, which is usually called flattened affect . At first, a person's responsiveness, compassion, and empathy are lost, so that schizophrenic becomes selfish, indifferent, and cruel. In response to various life situations, a person may react completely atypically and incongruously, for example, to be absolutely indifferent to the death of a child or be offended by an insignificant action, word, glance, etc. Very often, a person may experience deep affection and submit to any one close person.

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

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

A special variant of the violation of thinking is reasoning which consists in constant empty reasoning on abstract topics. Moreover, the ultimate goal of reasoning is completely absent, which makes them meaningless. Severe schizophrenia can develop schizophasia representing the pronunciation of unrelated words. Often these words are combined by patients into sentences, observing the correctness of the cases, but they have no lexical (semantic) connection.

With the prevalence of negative symptoms of willpower, the schizophrenic easily falls under the influence of various sects, criminal groups, and asocial elements, obeying their leaders without question. However, a person may persist the will, which allows him to perform any meaningless action at the expense of normal work and social communication. For example, a schizophrenic can make a detailed plan of a cemetery with the designation of each grave, count the number of any letters in a particular literary work, etc.

Agedonia represents a loss of the ability to enjoy anything. Thus, a person cannot eat, walk through the park with pleasure, etc. That is, against the background of the agedonia, a schizophrenic cannot, in principle, enjoy even those actions, objects or events that have previously delivered him.

Typical syndromes characteristic of schizophrenia

These syndromes are formed only from positive or negative symptoms, and are the most common combinations of schizophrenia manifestations. In other words, each syndrome is a combination of the most frequently combined individual symptoms.

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

  • Hallucinatory-paranoid syndrome - characterized by a combination of unsystematic delusional ideas (most often persecution), verbal hallucinations and mental automatism (repetitive actions, the feeling that someone controls the thoughts and body parts, that everything is unreal, etc.). All symptoms are perceived by the patient as something real. There is no sense of artificial feeling.
  • Kandinsky-Clerambo syndrome - refers to a variety of hallucinatory-paranoid syndrome and is characterized by the feeling that all visions and disorders of a person are violent, that someone created them (for example, aliens, Gods, etc.). That is, it seems to a person that his thoughts are put into his head, with his internal organs, actions, words and other things being controlled. Periodically there are episodes of mentism (an influx of thoughts), alternating with periods of withdrawal of thoughts. As a rule, there is a completely systematized delusion of persecution and influence, in which a person quite convincingly explains why he was chosen, what they want him to do, etc. A schizophrenic with Kandinsky-Klerambo syndrome believes that he does not control himself, but is a puppet in the hands of his pursuers and evil forces.
  • Paraphrenic syndrome - characterized by a combination of persecution delusions, hallucinations, affective disorders, and Kandinsky-Clerambo syndrome. At the same time with the ideas of persecution, a person has a clear conviction in his own power and power over the world, as a result of which he considers himself the ruler of all the Gods, the Solar System, etc. Under the influence of his own delusional ideas, a person can tell others that he will create paradise, change the climate, transfer humanity to another planet, etc. The schizophrenic himself feels himself at the center of a grand, supposedly happening event. Affective disorder consists of constantly elevated mood up to a manic state.
  • Capgra's Syndrome - characterized by the delusional idea that people can change their appearance to achieve any goals.
  • Affective paranoid syndrome - characterized by depression, delusional ideas of persecution, self-accusations and hallucinations with a bright accusatory character. In addition, this syndrome can be characterized by a combination of megalomania, noble origin and hallucinations of a praiseworthy, glorifying and approving character.
  • Catatonic syndrome - it is characterized by solidification in a certain posture (catalepsy), imparting some uncomfortable position to body parts, maintaining it for a long time (waxy mobility), as well as strong resistance to any attempts to change the accepted position. Mutism can also be noted - dumbness with a sound speech apparatus. Any external factors, such as cold, moisture, hunger, thirst, and others, cannot force a person to change an absent facial expression with an almost completely absent facial expression. In contrast to freezing in a certain posture, excitement may appear, characterized by impulsive, meaningless, fanciful and mannered movements.
  • Hebephrenic syndrome - characterized by foolish behavior, ridiculousness, mannerism, making grimaces, lisping, impulsive actions and paradoxical emotional reactions. Perhaps a combination with hallucinatory-paranoid and catatonic syndromes.
  • Depersonalization-derealization syndrome - characterized by feelings of painful and extremely unpleasant experiences about changes in his own personality and the behavior of the surrounding world, which the patient cannot explain.

Manic schizophrenia (manic-depressive psychosis)

The main clinical picture is obsessive ideas and delusions of persecution. Speech becomes verbose and abundant, so that a person can talk for hours about everything that surrounds him. Thinking becomes associative, as a result of which unrealistic interrelations between objects of speech and analysis arise. In general, at present, the manic form of schizophrenia does not exist, since it was isolated in a separate disease - manic-depressive psychosis.

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

Acute schizophrenia (attacks of schizophrenia) - symptoms

The term acute is usually understood as the period of an attack (psychosis) of paroxysmal progredient schizophrenia. In general, as the name implies, this type of course of schizophrenia is characterized by alternating acute seizures and periods of remission. Moreover, each next attack proceeds harder than the previous one, and after it there are irreversible consequences in the form of negative symptoms. The severity of symptoms also increases from one attack to another, and the duration of remission is reduced. In an incomplete remission a person does not leave anxiety, suspicion, delusional interpretation of any actions of other people, including relatives and friends, as well as periodic hallucinations.

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

The oneroid is characterized by unlimited and very vivid hallucinations and delusions, which concern not only the world, but also itself. Thus, a person represents himself as some other object, for example, pockets, a disc player, a dinosaur, a car, fighting with people, etc. That is, a person has complete depersonalization and derealization. At the same time, within the framework of the delusional illusory representation of oneself in someone’s mind or something, whole scenes play out from the life or activity of the person with whom he identified himself.Experienced images cause motor activity, which may be excessive or, conversely, catatonic.

Sluggish (hidden) schizophrenia

This type of schizophrenia has many different names, such as soft, non-psychotic, microprocessing, rudimentary, sanatorium, prephase, slow-flowing, hidden, larvirovanny, amortized, pseudo-neurotic, occult, non-regressive. The disease does not have progression, that is, over time, the severity of symptoms and the degradation of the individual does not increase. The clinical picture of sluggish schizophrenia is significantly different from all other types of the disease, since it contains no delusions and hallucinations, but there are neurotic disorders, asthenia, depersonalization and derealization.

Sluggish schizophrenia has the following steps:

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

Symptomatology manifestations of sluggish schizophrenia can be very variable, as it can occur as an adynamy, neurosis of obsessive states, hysteria, hypochondria, paranoia, etc. However, in any variant of the manifestation of sluggish schizophrenia, a person has any one or two of the following defects:
1.Ferschreiben - Defect, which is expressed in the strangeness of behavior, eccentricities and flimsy. A person makes uncoordinated, angular, childlike movements with very serious facial expressions. The general appearance of a person is sloppy, and the clothes are completely awkward, fancy and ridiculous, for example, shorts and fur coats, etc. The speech is equipped with unusual turns and is replete with descriptions of minor minor details and nuances. The productivity of physical and mental activity is preserved, that is, a person can work or study, despite the oddity.
2.Pseudopsychization - a defect expressed in a huge number of supervaluable ideas with which a person literally gushes. At the same time, the individual is emotionally charged, he is interested in all those around him, whom he is trying to attract to implement countless supervaluable ideas. However, the result of such a stormy activity is negligible or completely absent, therefore the productivity of an individual's activity is zero.
3.Defect of energy potential reduction - expressed in the passivity of a person who is primarily at home, not wanting to do anything.

Alcoholic schizophrenia - symptoms

As such, alcoholic schizophrenia does not exist, but alcohol abuse can provoke the development of the disease. The condition in which people find themselves after prolonged drinking is called alcoholic psychosis and does not have any relation to schizophrenia. But due to pronounced inadequate behavior, impaired thinking and speech, people call this condition alcohol schizophrenia, since the name of this particular disease and its common essence are known to everyone.

Alcoholic psychosis can occur in three versions:

  • Delirium (delirium tremens) - occurs after the cessation of consumption of alcoholic beverages and is expressed in the fact that a person sees devils, animals, insects and other objects or living beings. In addition, the person does not understand where he is and what happened to him.
  • Hallucinosis - occurs during binge. The person is disturbed by auditory hallucinations of a threatening or accusing nature.
  • Crazy psychosis - Occurs with prolonged, regular and fairly moderate alcohol consumption. It expresses a delusion of jealousy with harassment, attempted poisoning, etc.

What is schizophrenia

The name of the disease comes from two ancient Greek words: "σχίζω", which translated means "splitting or splitting" and "φρήν", which can be translated as "rationality, intelligence, thinking". The etymology of the name has given rise to many disputes and has caused great confusion: schizophrenia is often confused with another mental illness - a split personality.

According to statistics, this disease affects four to six people for every thousand. In this case, both men and women are equally prone to the occurrence of the disease, although male schizophrenia manifests itself at an earlier age than female. The most commonly diagnosed such a mental disorder from sixteen to thirty years. But this does not mean that it is impossible to get sick at another age. The statistics speak for themselves. A peak is considered to be twenty six to thirty two years for women and twenty to twenty eight years for men. Much less common is children's schizophrenia, as well as late or senile schizophrenia, developing in old age.

Often, such a mental illness develops and proceeds slowly, so that the sick person does not even suspect that he has any mental disorder. But there are cases when schizophrenia occurs suddenly and progresses rather quickly. Therefore, it is necessary to know exactly the initial symptoms of the disease in order to recognize them in time and seek medical help.

Many forms and types of the disease, as well as a significant number of different symptoms, have caused doubts that schizophrenia is a separate disease, and many scientists believe that such a diagnosis implies a numerous series of individual syndromes.

Most patients with such a diagnosis do not pose a danger to the people around them, although in some cases they may exhibit unexplained aggression and cruelty. Such people live like everyone else: with their family, independently, or in group homes. In rare cases, in severe cases of illness, compulsory hospitalization of the patient is possible, however, the frequency and duration of the patient’s stay in such an institution is limited and the person, with qualified treatment, soon returns to normal life.

Forms of Schizophrenia

No matter how studied this disease, so far there remains a lot of mysteries. There are various forms and types of mental disorders, but the full clinical picture is absent. In simple words, this means that there is no unambiguous symptomatology in this pathology. Also with this disease it is impossible to give any specific prognosis. One patient will only need one course of powerful drug therapy, the other may be shown long-term hospital treatment. Provide all the options for the development of events with this disease is simply impossible.

The classical classification of schizophrenia identifies four main types of the disease, but several years ago, WHO introduced some amendments to it. The disease has the ICD 10 code F20. DSM-4 and ICD-10 distinguish the following main types of schizophrenia:

  • paranoid,
  • hebephrenic or disorganized,
  • catatonic,
  • residual or residual
  • simple
  • undifferentiated
  • post schizophrenic depression.

Let us dwell in more detail on each of these species.

Paranoid

Paranoid or paranoid schizophrenia is one of the main types of the disease, characterized primarily by the presence of hallucinations and delusions. Depending on the prevalence of one or another variant in which the clinical picture of the disease is expressed, subtypes of paranoid schizophrenia are distinguished.

For delusional paranoid schizophrenia, the following features of development are characteristic:

  • false distorted beliefs that are not amenable to common sense and logic, while perceived by the patient as ingenious,
  • bullshit greatness
  • delusions of ingenuity
  • nonsense jealousy and others.

Depending on the type of delusional changes and human behavior. Most often, this syndrome leads to the fact that the schizophrenic is not able to perform their work and family responsibilities, as well as to complete maladjustment in society.

The hallucinatory subspecies of paranoid schizophrenia is characterized by the presence of visual, tactile, and especially auditory hallucinations in the patient. Patients often hear different voices that threaten him, order, comment and condemn the various actions and actions of the patient. They can sound both outside and in the head of the patient, which is interpreted by the sick person as violent, invested or induced by someone else thoughts. This concept is called pseudohallucinations.

Catatonic

Catatonic schizophrenia is a psychosis in which significant deviations in motor function are manifested, while the patient’s consciousness remains completely clear. Catatonic form is characterized by the sudden and sharp fading of the patient in a ridiculous posture for a long time, muscle spasms and a complete lack of speech. Such a phenomenon is called catatonic stupor.

Catatonic excitement manifests itself almost always spontaneously and impulsively: the patient can suddenly scream or run somewhere, and also show causeless aggression towards himself or the people around him.

In the catatonic form of schizophrenia, there are no symptoms such as delusions and hallucinations. The patient is fully aware of what is happening, soberly reacts to the events and the words addressed to him. Information is perceived by him in full. After stabilization, the schizophrenic remembers everything that happened to him. Thus, it turns out that a person is simply unable to control his movements and actions, while maintaining constant clarity of consciousness.

Gebefrenicheskaya

Hebephrenic, hebephrenic or disorganized schizophrenia is the most unfavorable of all forms in terms of further prognosis. It begins, as a rule, in adolescence, but can manifest itself in both a teenager and an adult. At the same time there is a significant violation of emotional and volitional function. With such a diagnosis, patients are constantly in a silly and cheerful mood, behave inadequately, with all their appearance they resemble children. They have completely no attachment to loved ones and experiences. Negative symptoms of the disease are constantly increasing, and, in the end, the patient ceases to communicate with others, to understand them, becomes incapable of working.

Simple schizophrenia develops gradually, while this type of psychosis is characterized by the absence of bouts of psychopathy. The patient behaves closed, his emotions are noticeably poorer, the features of autism appear, although there are no aggression, hallucinations, delusions, or catatonic effects. It should be noted that the delayed course of the disease does not guarantee a favorable prognosis. In the end, all the same, everything ends with the formation of an emotional-volitional defect characteristic of schizophrenia.

Residual

Residual or residual schizophrenia is a disease in the chronic stage, the essence of which is the manifestation of residual negative symptoms after suffering an attack of psychosis. This form appears in:

  • lack of emotion
  • passivity and apathy,
  • inhibition in psychomotor development,
  • decrease in volitional function,
  • strong violation of speech function.

There are also other as typical types of schizophrenia, and atypical form of the disease, differing among themselves in the type of flow: periodic or recurrent, fur-like, malignant, sluggish. A brief description of each of these species.

Periodic, recurrent, circular schizophrenia or schizoaffective disorder is characterized by sharp flashes of hallucinatory delusions with a bright emotional and expressive color.Moreover, the more pronounced are the emotions against the background of an attack of hallucinations or delusions, the more favorable the prognosis for this type of disease. You can relieve serious symptoms with the help of drugs, and the next attack may be repeated after a rather long time, or not at all.

Fur-like or paroxysmal schizophrenia builds up from an attack to an attack. Even after the necessary treatment, residual symptoms of psychosis, such as hallucinations or delusions, appear. Attacks in this form of the disease occur quite often, and if at the onset of the illness the patient understands that he is frankly delirious and that he is being overwhelmed by hallucinations, then with each new attack he increasingly believes in his undeniable genius and considers delusions to be logical and intelligent thoughts. Such attacks can last from several weeks to several years, and in the intervals between them the disease only progresses. At the same time, the degree of progression and the depth of mental disorder vary significantly: sometimes approaching schizophrenic dementia, and sometimes closer to sluggish schizophrenia.

Malignant schizophrenia has a constant current. It can be in childhood and adolescence, but most often its beginning falls on adolescence, but because it is also called juvenile schizophrenia. With this form of the disease, the patient is not able to be in society, loses all social skills, shows aggression towards himself and the people around him. Such patients are not able to work and even independently serve themselves. Remissions for this disease are quite rare and short-lived, and therefore patients with this form of mental disorder are almost always in specialized clinics, as they can be dangerous for themselves and other people.

Sluggish schizophrenia or schizotypal disorder has many other names: neurosis-like, latent, pseudo-neurotic, psychopathic and others. The symptoms of such a disorder are present in a mild and mild person, the disease proceeds in a form that is not dangerous for other people, but it is this disorder that ultimately leads to rather serious consequences.

Febrile schizophrenia or lethal catatonia is a severe form of mental disorder, accompanied by various phantasmagoric visions, movement disorders, febrile syndrome, stupefaction, hyperthermia, bruising and increased body temperature. Such conditions are dangerous for the patient's life, as they can lead to swelling of the brain and failure of other internal organs. Therefore, febrile schizophrenia always requires emergency care.

There are also other types of schizophrenia:

  • depressive and manic, which must be distinguished from diseases such as bipolar affective disorder,
  • post-traumatic or post-traumatic stress disorder,
  • juvenile
  • nuclear

Causes

The exact causes of the onset and development of such a disease are still unknown. Recently, however, thanks to neurobiology, the etiology of the disease is beginning to clear up a little, but it still remains confusing and largely unclear. The main factors of the disease is considered to be:

  • heredity and genetic predisposition,
  • psychological interactions
  • social factor
  • living conditions in early childhood,
  • neurobiological disorders.

Conventionally, all causes can be divided into biological, psychological and social.

Biological include:

  • maternal infectious diseases during pregnancy: measles, rubella, influenza, herpes, enterovirus, cytomegalovirus and others,
  • autoimmune diseases that occurred in the prenatal period,
  • genetic heredity,
  • intoxication with various chemicals.

The psychological factors for the development of schizophrenia include:

  • isolation, immersion in your own world,
  • reasoning on abstract invented and incomprehensible topics
  • difficulties in communication and socialization,
  • difficulties in articulating thoughts,
  • suspiciousness and perseverance
  • inability to withstand stressful situations
  • strong vulnerability and impressionability,
  • behavioral oddities in informal situations
  • lack of personal hygiene and tidiness.

Certainly, on the basis of only these factors, no diagnosis is made, however, the relatives and friends of such a person should be alerted even if only some of them are present.

The social causes of mental disorders include:

  • urban factors, according to which people living in large cities are subject to the disease much more,
  • family relationships
  • stressful and conflict situations
  • strong negative emotions
  • hormonal changes in adolescence.

Still, a single cause of schizophrenia does not exist. Scientists are inclined to believe that the development of such a disease is influenced by a combination of various factors: both psychological and social, biological and even neuronal mechanisms.

Symptoms of Schizophrenia

The clinical signs of schizophrenia can be divided into three groups:

  • negative symptoms
  • productive symptoms
  • cognitive symptoms.

The productive symptoms include delirium and hallucinations, negative ones are expressed in lack of will, abulia, apathy, and cognitive signs reveal deviations in thinking, perception, and attention.

Often the harbingers of such a disorder are irritability, alienation, and mood disturbance.

The first initial symptoms indicating the possible occurrence and progression of the disease can be expressed in:

  • impaired speech function, slow speech or its complete lack,
  • low concentration of attention
  • absent-mindedness and inattention,
  • the inability and unwillingness to perform simple tasks, which is associated with a complete lack of understanding of logic and meaning in these tasks,
  • emotional rigidity and poverty
  • the emergence of new strange interests or their complete absence.

Other common signs of any type of schizophrenia include:

  • disorganization of thought processes
  • speech disorder
  • auditory, visual and tactile hallucinations,
  • social isolation
  • the emergence of delusions,
  • catatonic reactions: freezing in absurd poses, followed by acute excitation.

The most characteristic signs of schizophrenia are auditory hallucinations and pseudo-hallucinations, manifested in voices in the head, commanding something to the patient, threatening him, as well as delusions.

Thinking and perception of schizophrenic

Patients with schizophrenia often have a distorted perception of reality. Such people often deny obvious things and facts, and give quite ordinary events a certain special meaning. Most often this is expressed in delusional ideas that the potential patient considers ingenious. Typical delusional ideas for schizophrenia are:

  • delusions of pursuit
  • megalomania,
  • delusion of perception
  • raving jealousy
  • loss of control.

With such a disease, fragmented and torn thinking is also observed. Most often this is reflected in the speech of patients. It is very difficult for such people to concentrate on the subject of conversation, they jump from topic to topic, answer questions out of place, speak incoherently and illogically. The schizophrenic mindset is random, there is no logic in it. It is difficult for sick people to connect even two simple facts.

Prodromal stage

Initial or mild schizophrenia. This early stage of the disease is characterized by the presence of atypical signs, that is, at this stage it is rather difficult to diagnose schizophrenia until it enters the active phase. Often it is also referred to as the latent stage, since such symptoms are also characteristic of people with other mental illnesses, for example, depression.

Patients in such a state stop communicating with relatives and friends, can spend time for a long time, locking themselves in their room, lose interest in various kinds of entertainment, show signs of mental suffering, dull emotions and low motivation. They do not want to attend school or go to work.

The onset of the disease often occurs in childhood or adolescence. So kiddies tend to be lonely, they show apathy to watching movies or cartoons. They are characterized by complete apathy and indifference to the world around them. It turns out that the symptoms of schizophrenia may be present long before the appearance of characteristic signs of the disease.

Stage of psychosis

The second stage of schizophrenia is the stage of psychosis, which is characterized by exacerbation of the disease. The acute or active stages of the disease are characterized by the presence of delusions, hallucinations, unmotivated aggression and serious cognitive impairments. At this degree of mental disorder is the full development.

Often this most severe stage of the disease requires hospitalization in the hospital, since the patient can be dangerous for himself and for those around him. In the hospital, this disease is treated with antipsychotics, and without treatment, this stage can have serious consequences, even death.

Residual stage

The third and last stage of schizophrenia is the final stage of the disease. Symptoms at this stage are very similar to the prodromal stage of the disease. Attacks of psychosis at this stage, as a rule, are absent or are sporadic. But even without acute psychosis, patients experience various negative symptoms: lack of emotion, low energy, depression, and stress. Hallucinations and delusions at the residual stage of the disease are also absent.

Diagnostics

The diagnosis of schizophrenia is made by a psychiatrist based on the patient's complaints and analysis of his behavior. Diagnostic criteria take into account the possible pathogenesis of the disease, as well as symptoms and signs typical for the clinical picture of the disease, as well as their duration and severity. However, you should be aware that such signs are inherent not only in this disease, but also in many other mental disorders: bipolar affective disorder, borderline syndrome, major depressive disorder, schizoaffective disorder and others.

Diagnosis of the disease often includes a medical and neurological examination, which make it possible to exclude the presence of somatic diseases leading to mental disorder, similar to schizophrenia. Such diseases include: syphilis, HIV, metabolic disorders, injuries and brain damage, overdose with psychotropic drugs, epilepsy and systemic infections.

It is mandatory to exclude delirium that has arisen on the basis of alcoholism, in which there are also hallucinations, deviations in the intellectual and emotional level, and for which there is also a sharp and acute onset of the attack.

Differential diagnosis can only be made on the basis of a full medical examination, which includes:

  • examination of the patient
  • laboratory tests: biochemical and clinical blood analysis, urinalysis,
  • pregnancy test,
  • ECG, EEG and MRI of the brain,
  • screening for the presence of psychotropic or narcotic substances in the blood.

Two methods are widely used to diagnose schizophrenia: DSM-5, which is published by the American Psychiatric Association, and ICD-10, developed by WHO. The latter is used in Europe, and the former is typical for the United States and other countries of the world.

To make a correct diagnosis, a patient should have at least two of the listed symptoms:

  • catatonic behavior
  • disturbances in thought processes and speech,
  • crazy states
  • presence of any types of hallucinations,
  • regular negative symptoms that do not go away within a month.

The presence of such signs must be present for six months or more.

Disease treatment

Although schizophrenia is an incurable disease, with proper and timely treatment, complete remission can occur and patients can live a normal life.

The treatment of such a disease involves complex therapy, which includes the following methods:

  1. Drug treatment. For these purposes, antipsychotics, antipsychotics, anticonvulsants, antidepressants and tranquilizers are most often used.
  2. Psychotherapy, including family therapy, cognitive-behavioral, methods of psychoanalysis and cognitive training.
  3. Social therapy.

Alternative treatments for schizophrenia include:

  • insulin therapy,
  • electroconvulsive therapy
  • treatment of folk remedies
  • fasting treatment
  • physiotherapy combined with balneotherapy,
  • acupuncture and others.

Typically, schizophrenia is treated on an outpatient basis at home, but the advanced stage of the disease requires that the patient be hospitalized in a hospital or a specialized psychiatric clinic. This may be necessary in cases where the patient is a danger to himself and others as a result of unmotivated aggression.

How to avoid schizophrenia

Prevention of this disease helps prevent the occurrence of this disease, prevent a possible relapse, avoid exacerbations of schizophrenia, and also suspend and slow its progression.

Primary prevention aimed at preventing the possible onset of the disease is limited to medical genetic screening. To determine whether a child can develop congenital or acquired schizophrenia, doctors assess the mental state of the parents and their heredity. Based on this assessment, it is possible to calculate the risk of disease in a future generation. However, medicine cannot influence the transfer of genes responsible for the development of schizophrenia.

Maintenance therapy, in which it is necessary to constantly take drugs in a small dose, significantly slows down the progress of the disease and reduces the manifestation of negative symptoms and the risk of recurrence of psychosis.

People with schizophrenia should stop taking drugs and alcohol, avoid any mental-emotional load.

An important factor in the prevention of the disease is the social rehabilitation of the patient. It is necessary to lead an active lifestyle, engage in creativity and your favorite interests, constantly learn something new, communicate with other people, develop yourself. All these activities impede cycling on one's own experiences, promote mental development and improve the prognosis of the disease.

What is dangerous disease

Without proper and qualified treatment, schizophrenia can be dangerous. Such a mental disorder, after which serious and serious complications can occur. This can lead to the development of dementia, irreversible mental disorders. The patient may die due to a suicide or febrile form of the disease.

Also, such a disease is fraught with complete personal change of the patient, which is also irreversible.

Lifespan

Life expectancy with this disease is eighty-eighty-five percent of the average reading. Women with this diagnosis live longer than men, and patients die mainly during suicide attempts. This is largely influenced by the long-term use of antipsychotic drugs and neuroleptics, as this can lead to cardiovascular diseases and lung pathologies. The statistics are also aggravated by poor nutrition, lack of physical activity and smoking.

How to treat a person with schizophrenia

It is very difficult to live with a schizophrenic, but it is necessary to make every effort to help a loved one to cope with this serious illness. It is also worth remembering that help will be needed for yourself.

During periods of exacerbation of the disease should pay attention to the behavior of the patient, in time to notice changes in mental state and seek medical help. Also, close relatives may insist on compulsory treatment in a psychiatric clinic, if the patient in the state of affect can cause harm to himself or others.

During remission, the patient’s diet should be monitored. Properly selected special diet for schizophrenia will significantly prolong the interictal period and reduce negative symptoms. Products with this disease should not contain gluten and casein and be saturated with vitamins, microelements, antidepressants and various enzymes. Such products include: fermented milk products, low-fat varieties of fish and meat, fresh vegetables, almonds, bananas, fruits, dried fruits and others. Drink should be natural fresh juices and homemade compotes.

Relatives of the patient should provide him with full care immediately after discharge from the hospital, or do everything possible so that he does not get there. Firstly, it is necessary to strictly monitor the medication with maintenance therapy. Secondly, the patient should be interested in something, take him some work. In this case, it is necessary that the work necessarily had a meaning and was useful to someone. It is necessary for relatives and friends of schizophrenic to understand that many people consider such people strange and wonderful. Therefore, they should learn to live with these oddities, try not to notice them, treat their quirks with patience, and in no case do not make fun of them and scoff.

Definition of the disease. Causes of disease

Schizophrenia - This is one of the most common (on average, about 1% of the population is sick) and severe mental disorders that are known today. This disease affects both the social and the professional sphere of the life of the patient and his relatives. Schizophrenia as a nosology includes positive symptoms (delirium, hallucinations), negative symptoms (apathy, reduced social functioning, decreased emotional expressiveness, etc.), cognitive impairment (impaired thinking, planning, specific memory impairment, thought speed, etc. .), as well as a violation of social interactions, which, in turn, may alter the manifestations of other symptoms.

Modern studies show that schizophrenia is distributed approximately equally among the sexes, but in men this disease usually begins earlier (at the age of 18-25) and is more severe. The manifestation of schizophrenia in women usually occurs between the ages of 25-30. According to the American Psychiatric Association, these figures are the same in all ethnic groups around the world.

There is still no consensus about the etiopathogenesis of this disease. One of the theories of schizophrenia argues that the central cause of some cases of the disease is the interaction of the developing fetus with pathogens, such as viruses, or with mother’s antibodies, which are formed in response to these pathogens (in particular, Interleukin-8). There are studies showing that exposure to certain fetuses (for example, influenza) to the fetus (especially at the end of the second trimester) causes defects in the development of the nervous system, which can occur as factors predisposing to schizophrenia.

Today, it is known that the genetic factor plays a crucial role in the onset and development of schizophrenia. Heritability rate ranges from 70 to 85 percent. However, the question of how this disease is inherited is still not fully understood. Nowadays, more than 100 genes are being claimed for a role in the development of schizophrenia, most of which are responsible for the regulation of autoimmune processes. Most geneticists agree that it is unlikely that one gene of schizophrenia will be found, that is, this disease is multifactorial in nature.

The influence of environmental factors on the development of schizophrenia is also being investigated. Until the beginning of the 21st century, most of the research in these issues was based on epidemiological data, and it was only thanks to modern neuroscience and the possibilities of neuroimaging and neurochemistry that new models of the emergence and development of schizophrenia were put forward. It became known that the prefrontal region of the frontal and temporal lobes are the two cortical regions most affected by the pathological process. Subcortical structures such as the thalamus, hippocampus and cerebellum are also involved.

The ventricles of the brain in normal and schizophrenia

There is also a lot of evidence that for the onset of schizophrenia, a special premorbid is needed - schizophrenic diathesis (which can be up to 40% of people), as well as a specific stress trigger factor. This theory is called stress diathesis.

Pathogenesis of schizophrenia

The processes of neurotransmitter regulation in the brain in patients with this disease are being actively studied. Traditional schizophrenia models take dopaminergic dysfunction as a basis. The dopamine hypothesis of schizophrenia was first proposed in the 1960s, when it was first discovered that the antipsychotic effect of chlorpromazine successfully treats positive symptoms in patients with schizophrenia. It was then that the study of new antipsychotic drugs began, the mechanism of action of which suggested the inhibition of increased dopaminergic activity. Such drugs were antagonists of the dopamine D2 receptor. The dopamine D2 receptor is a receptor associated with protein G, which is a common target for antipsychotic drugs. In the treatment of psychotic symptoms, it was believed that dopamine D2 receptor antagonism occurs mainly in the mesolimbic pathway. However, the dopamine receptor antagonist is not clinically effective in the treatment of negative symptoms in schizophrenia. Although the exact mechanism underlying these cognitive deficiencies remains largely unknown, factors such as cortical dopamine function deficiency, dysfunction at NMDA receptors, or impaired synaptic elimination probably play an important role in the pathogenesis of the disease. Molecular studies have confirmed the association of elevated levels of subcortical dopamine with the occurrence of positive symptoms of schizophrenia, but with the proviso that this discovery is not pathognomonic due to the neurochemical heterogeneity of the populations of patients with schizophrenia. Although hyperactivity in the subcortical dopaminergic system is largely an important condition explaining the emergence of productive symptoms, the dopamine hypothesis requires further study and expansion, in particular, it is necessary to investigate the role of other neurotransmitter systems in the pathophysiology of the disease.

Over the past 20 years, it has become clear that this theory does not fully explain the pathogenesis of schizophrenia; therefore, the development of alternative models was required. Glutamatergic models of schizophrenia is based on the observation that psychotomimetic agents such as phencyclidine (PCP) and ketamine provoke psychotic symptoms and neurocognitive disorders, symptoms similar to schizophrenia by blocking neurotransmission of glutamate receptors in N-methyl-D-aspartate (NMDA). Since glutamate / NMDA receptors are located throughout the entire brain, glutamatergic models explain common cortical dysfunction involving NMDA receptors. In addition, NMDA receptors are located on the brain structures that regulate dopamine release, which suggests that dopaminergic deficiency in schizophrenia may also be secondary to underlying glutamatergic dysfunction. Drugs that stimulate neurotransmission mediated by NMDA receptors, including inhibitors of glycine transport, have shown encouraging results in preclinical studies and are currently undergoing clinical trials.Overall, these data suggest that glutamatergic theories may lead to new treatment approaches that would not be possible based on only dopaminergic models.

Classification and developmental stages of schizophrenia

Used in psychiatry two classification systemsICD-10 (more common in Eurasia) and DSM-V (more commonly used in America). Despite the exclusion of clinical forms from the DSM-V classification, in Russian psychiatry and in ICD-10 the rule of division of the disease is preserved in forms that differ from each other in some features of the course and manifestation. At present, the dominant view is that with the next revision of the ICD, the division of schizophrenia into forms will be removed, since in practice the forms are not clearly delimited from each other.

1. Paranoid form disease occurs most often, the main manifestation is relatively stable, usually paranoid delusions, which, as a rule, accompany auditory hallucinations and other disorders of perception. Pathologies in the field of emotions, will, speech, and catatonic symptoms are most often absent or relatively mild.

2. Hebephrenic schizophrenia - With this form of the disease, affective disturbances in the form of pretentious and unpredictable behavior and mannerism (mannered) come to the fore in the clinic. In this case, delusions and hallucinations are mild. The mood in patients is labile, inadequate, thinking is rudely broken. The level of social functioning in patients with a hebephrenic form of schizophrenia is seriously affected. Due to the rapid growth of the defect in the emotional-volitional sphere, the prognosis for patients is unfavorable.

3. Catatonic schizophrenia manifested pronounced alternating bouts of psychomotor disorders: fluctuations between hyperkinesis (psychomotor agitation) and stupor or passive submission and negativity. Against the background of a long-standing forged posture, sudden states of psychomotor arousal occur, which is very characteristic of this form of the disease.

4. Simple form of schizophrenia - characterized by the absence of delirium and hallucinations with a pronounced inability to function in society, autism, emotional inadequacy, ambivalence. As a rule, this variant of the disease is very slow, and the malignant course is extremely rare.

Complications of Schizophrenia

Possible complications of schizophrenia

  • 20% shorter life expectancy
  • 50-60% increase in mortality,
  • 6% death from suicide (10 times higher),
  • decrease in social activity and level of personal functioning, which leads to disability,
  • in febrile schizophrenia (an attack of a disease with central fever and multiple organ failure), death from this disease can be observed.

General information

Schizophrenia is a polymorphic mental disorder characterized by a breakdown of affects, thought and perception processes. Earlier in the specialized literature indicated that about 1% of the population suffers from schizophrenia, but recent large-scale studies have shown a lower figure - 0.4-0.6% of the population. Men and women are equally affected, but women usually develop schizophrenia later. In men, the peak incidence occurs at the age of 20-28 years, in women - at the age of 26-32 years. The disorder rarely develops in early childhood, middle and old age.

Schizophrenia is often combined with depression, anxiety disorders, drug addiction and alcoholism. Significantly increases the risk of suicide. It is the third most common cause of disability after dementia and tetraplegia. Often entails pronounced social maladjustment, resulting in unemployment, poverty and homelessness. City dwellers suffer from schizophrenia more often than people living in rural areas, but the causes of this phenomenon are still unclear. Schizophrenia treatment is carried out by experts in the field of psychiatry.

Causes of Schizophrenia

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

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

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

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

Some experts point to a possible connection between schizophrenia and anomalies in the structure of the brain, in particular with an increase in the ventricles and a decrease in the activity of the frontal lobe, which is responsible for reasoning, planning and decision-making. In patients with schizophrenia, differences in the anatomical structure of the hippocampus and temporal lobes are also detected. At the same time, the researchers note that the violations listed could have occurred for the second time, under the influence of pharmacotherapy, since the majority of patients who participated in brain structure studies had previously received antipsychotic drugs.

There are also a number of neurochemical hypotheses linking the development of schizophrenia with impaired activity of certain neurotransmitters (dopamine theory, keturen hypothesis, hypothesis about the connection of the disease with disorders in the cholinergic and GABArgic systems). The dopamine hypothesis was especially popular for some time, but later many experts began to question it, pointing out the simplified nature of this theory, its inability to explain clinical polymorphism and many options for schizophrenia.

Schizophrenia classification

Given the clinical symptoms in DSM-4, there are five types of schizophrenia:

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

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

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

Depending on the type of course, domestic psychiatrists traditionally distinguish paroxysmal-progressive (fur-like), recurrent (periodic), sluggish and continuously ongoing schizophrenia. The division into forms based on the type of flow allows you to more accurately determine the indications for therapy and predict the further development of the disease. Given the stage of the disease, the following stages of schizophrenia development are distinguished: premorbid, prodromal, first psychotic episode, remission, exacerbation. The final state of schizophrenia is a defect - persistent, deeply disturbed thinking, reduced needs, apathy and indifference. The severity of the defect can vary considerably.

The manifestation of schizophrenia

Schizophrenia usually manifests during adolescence or early adulthood. The first attack is usually preceded by a premorbid period of 2 years or more. During this period, patients experience a number of nonspecific symptoms, including irritability, mood disorders with a tendency to dysphoria, freakish behavior, sharpening or distortion of certain character traits and a decrease in the need for contacts with other people.

Shortly before the debut of schizophrenia, the prodroma period begins. Patients are increasingly isolated from society, becoming dispersed. Short-term frustration of a psychotic level (transient overvalued or delusional ideas, fragmentary hallucinations), turning into a developed psychosis, join non-specific symptoms. The symptoms of schizophrenia are divided into two large groups: positive (something appears that should not be normal) and negative (something disappears that should be normal).

Prognosis for schizophrenia

The prognosis for schizophrenia is determined by a number of factors. The prognostically favorable factors include the female sex, the late age of onset, the acute onset of the first psychotic episode, a slight severity of negative symptoms, the absence of prolonged or frequent hallucinations, as well as favorable personal relationships, good professional and social adaptation before the onset of schizophrenia. A certain role is played by the attitude of society - according to research, the absence of stigmatization and acceptance of those around it reduces the risk of recurrence.

What is schizophrenia?

Schizophrenia is a mental illness characterized by a distortion of thinking (in the form of delusions) and perception (in the form of hallucinations). The term "schizophrenia" literally means "cleavage of the mind", which does not quite correctly reflect the essence of this disease, because many people confuse it with dissociative personality disorder (among people - a split personality).

The schizophrenic does not realize the reality of what is happening around. Thoughts arising in his imagination, and all those events that occur in reality, are mixed up in my head.

Information penetrated into the consciousness of such a person is a chaotic set of colored pictures, all sorts of sounds and meaningless images.It often happens that the schizophrenic completely denies the existing reality - he lives life in his illusory world.

Schizophrenia is often combined with depression, anxiety disorders, drug addiction and alcoholism. Significantly increases the risk of suicide. It is the third most common cause of disability after dementia and tetraplegia. Often entails pronounced social maladjustment, resulting in unemployment, poverty and homelessness.

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

  • genetic predisposition
  • prenatal factors (for example, development of abnormalities as a result of problems with abnormal fetal development),
  • social factors (the background of urbanization contributes to the growth of mental disorders),
  • experiences from early childhood can cause schizophrenia,
  • environmental factors
  • brain injury during childbirth or immediately after it,
  • social isolation
  • alcoholism causes schizophrenia and man, and contributes to gene mutations, due to which the disease can develop in his children,
  • drug addiction leads to the development of schizophrenia and gene mutation, similar to alcohol.

Note the group of stressful conditions caused by external factors, which, in turn, can play a role in the formation of schizophrenia:

  • Viral infection that struck the brain during childbirth
  • Fetal hypoxia
  • Birth of a child before the end of the full term of pregnancy
  • The impact of the virus in infancy
  • Loss of parents or separation from family
  • Physical and Mental Injuries from Domestic Violence

The first signs of schizophrenia

Like any other disease, schizophrenia has the first signs that you need to pay attention to and contact a psychiatrist.

  1. Inability to perform familiar actions, since the patient does not see in them the obvious meaning. For example, she does not wash her hair, as her hair will get dirty again,
  2. Speech disorders, which are expressed mainly in monosyllabic answers to questions posed. If the patient is still forced to give a detailed answer, he will speak slowly,
  3. Low emotional component. The face of the patient is incomprehensible, it is impossible to understand his thoughts, he avoids meeting his eyes with the interlocutor,
  4. Low concentration on any subject or object of action,
  5. Anhedonia also belongs to the early signs of the disease. At the same time, even the classes that previously attracted a person gave him moments of joy, now become completely uninteresting.
  6. Affective inadequacy - expressed in a completely inadequate response to various events and actions. For example, when he sees a drowning person, he laughs, and when he receives some good news, he cries, etc.

Think about the disease is in the following cases:

  • drastic changes in character
  • the appearance of neurotic symptoms - persistent fatigue, increased anxiety, constant
  • rechecking decisions and actions
  • insomnia,
  • nightmares
  • vague sensations in the body.

A person prone to the development of schizophrenia loses interest in life, family, notes a depressive state, suddenly takes a great interest in alcohol, draws gloomy pictures.

It is worth noting that such symptoms in one way or another can appear in every person, therefore a qualified specialist should diagnose signs of schizophrenia.

Negative symptoms and signs of schizophrenia

  • Inhibition - the patient loses the ability to quickly respond and make decisions, is not able to support the conversation.
  • Emotional coldness - the edge in mimic and voice expression of feelings is erased.The monotony of speech and "frozen" facial expressions are characteristic.
  • Asociality - it becomes difficult for a person to dwell in society. He goes bad on contact and makes acquaintances.
  • Low concentration of attention, which leads to the inability to lead a normal life, go to work, do favorite things. Even the handwriting is distorted.
  • Loss of interest in what is happening. In contrast, obsessive ideas appear, on which a person becomes obsessed. Productive life becomes unreal.

Due to lack of motivation, schizophrenics often cease to leave the house, do not perform hygienic manipulations (do not brush their teeth, do not wash, do not watch clothes, etc.), as a result of which they get a neglected, sloppy and repulsive appearance.

With the course of the disease, the symptoms of the emotional manifestations of schizophrenia weaken to the point of emotional dullness.

  • Emotional decline affects the entire appearance of the patient, facial expressions and behavior.
  • His voice becomes monotonous, expressionless.
  • A person loses expressiveness and becomes motionless (sometimes a mask-like face, monotony of voice, angular movements, their stiffness are a manifestation of side effects of drugs, this should be taken into account).

How does the disease of schizophrenia manifest: hallucinations, delusions and aggression

Before you determine schizophrenia in humans, it is recommended to observe him. In patients with this pathology, a distorted picture of the environment appears, created by their own consciousness based on the original correct signals.

The onset of the disease (manifest period) is characterized by:

  1. Nonsense of persecution, relationships, values, high origin, endowed with a special purpose and absurd nonsense of jealousy, as well as nonsense impact.
  2. Hearing true, as well as pseudo-hallucinations of the commentator, contradictory condemning.
  3. Sexual, olfactory, taste, and somatic hallucinations.

Hallucinations

Hallucinations are disorders of perception and the occurrence of phenomena (objects, sensations) where they are not. They can be visual, auditory, tactile, and so on. Auditory hallucinations of various contents are characteristic of schizophrenia. Auditory hallucinations, or “voices,” occur in a person inside the head or out of objects.

There are four types of hallucinatory disorders:

  1. hearing impairment is most common in schizophrenia. A voice appears in the head of a patient or from surrounding objects that comments, criticizes a person’s actions, or instructs him how to live correctly and what to do,
  2. tactile - develop less auditory. The patient may feel that boiling water is poured on his skin or, conversely, ice water. Also, patients can complain about the feeling that someone lives inside them (fish swim through the veins, a snake crawls in the stomach)
  3. olfactory - the most inexpressive hallucinations. A person complains of smells that no one but him feels
  4. visual - extremely rarely appear in schizophrenia.

Auditory and visual hallucinations in schizophrenia manifest as follows:

  • self-talk, reminiscent of a conversation or replies to someone's questions (of course, except for comments like "Where did I put the keys?")
  • laughter for no apparent reason
  • the impression that a person sees and hears something that no one else perceives,
  • a sudden silence, as if he was listening to something,
  • preoccupied or alarmed
  • inability to focus on the topic of conversation or a specific task.

Delusions are cumulative beliefs, conclusions and conclusions that differ from reality. Before the acute form of schizophrenia manifests, the patient is delirious and suffers from hallucinations.

There are several tips on how to recognize schizophrenia with manifestations of delusions.This is indicated by the following main features:

  • changes in behavior, the emergence of unmotivated aggression,
  • constant stories of implausible character, like vivid color dreams,
  • baseless fear for your life and health,
  • manifestation of fear in the form of voluntary imprisonment at home, fear of people,
  • constant annoying complaints to the authorities for no reason.

With the progression of the disease the patient becomes conflicted and explosive. During the course of the disease, the doctor pays special attention to reasoning - a hollow reasoning of a permanent nature. In this case, there is no ultimate goal of reasoning. Under an agedonia, the ability to receive pleasure from something is lost.

Exacerbation of schizophrenia

Recurrence or exacerbation of schizophrenia is the development of the acute phase in which the disorder takes an active course, productive symptoms manifest, an adequate assessment of one’s condition diminishes or is completely lost. Such a patient's condition can lead to adverse consequences, both for the carrier of the disease, and for others. In this regard, the early recognition of signs of acute illness is of particular importance.

Factors contributing to the exacerbation of schizophrenia are:

  • Canceling drugs is one of the most frequent reasons for which decommissioning remission occurs.
  • Somatic pathology - also provokes exacerbations. Most often it is a cardiovascular, respiratory or kidney disease.
  • Infections are often accompanied by the development of arousal.
  • Stress - also leads to decompensation of the patient. Conflicts in the family, among friends, at work, are inducers of psychotic states.

When the first signs of psychosis appear, you should contact your doctor. Native carriers of the disorder and the patient himself are already familiar with the manifestations of the disease, so even minor changes should alert them, especially in spring and autumn.

Treatment methods

Treatment of schizophrenia is carried out primarily to reduce severe symptoms, reduce the chances of recurrence of the disease, as well as the return of symptoms after improvement.

Among the methods of treatment of schizophrenia used are the following:

  • drug therapy,
  • electroconvulsive therapy (used with the ineffectiveness of drug therapy, involves the transmission of electrical impulses through the brain),
  • social therapy (involves the improvement of the patient’s living conditions, the long-term implementation of such measures ensures appropriate efficacy),
  • psychotherapy (used as a supportive method of treatment, for example, in combination with drug therapy, helps to alleviate the patient’s general condition).

During remission, maintenance therapy is obligatory, without this inevitably deterioration. As a rule, patients after discharge feel much better, they believe that they have fully recovered, they stop taking the drugs, and the vicious circle starts again.

This disease is not completely cured, but with adequate therapy it is possible to achieve stable remission against the background of supportive treatment.

According to experts, people who suffer from schizophrenia, in some cases represent a danger, first of all, to themselves. Therefore, suicide cases are quite often recorded among such patients. It is also possible the manifestation of cruel behavior in those patients who use alcohol or drugs. Therefore, periodic treatment of schizophrenia is mandatory.

Whether disability is given in schizophrenia

In schizophrenia, disability is given, but not all and not always. With this disease, it is laid in the following cases:

  • the duration of the disease is more than three years,
  • the presence of frequent bouts of psychosis and continuous hospital treatment,
  • loss of ability to work and self-service,
  • bouts of aggression and auto-aggression,
  • social fenced off.

Disability group depends on the severity of the disease.

Can people with schizophrenia work

Work with schizophrenia patients is not only possible but necessary. This is a good prevention of relapse of this disease. But there are some positions that schizophrenics are not allowed to: specialties with high responsibility, work where there is access to weapons, work requiring nervous, psychological and emotional stress, driving specialties, working at height, working with dangerous equipment and toxic substances.

A good option for schizophrenia would be remote work at home, since communication with outsiders is minimized.

Summing up

Schizophrenia is a severe and incurable mental illness, but with timely therapy you can achieve stable and prolonged remission, allowing the patient to live a normal life, work and start a family. There are many types and forms of this disorder, but almost all of them are amenable to treatment, subject to timely medical attention, correct and qualified diagnosis of the disease, as well as subsequent prevention of the disease.

Schizophrenia treatment

The goals of treating patients with schizophrenia are:

  • increase the level of social functioning
  • increasing patient compliance and ensuring safety of therapy;
  • improving the quality of life
  • reducing the frequency of exacerbations and increasing the duration of improvement of the mental state in this disease,

When choosing a treatment, it is necessary to take into account the pharmacogenomics (the patients' genetic predisposition to certain drugs), side effects and the cost of the drugs, the patient's readiness for therapy, as well as the risk assessment of the therapy taking into account comorbid conditions.

The modern approach to the treatment of schizophrenia as a biopsychosocial disease involves a complex therapy using both biological (drug and non-drug) and psychosocial methods.

Psychopharmacotherapy is aimed at stopping the exacerbation of the disease (stopping therapy) and further treatment in order to stabilize the mental state. This is the first stage of schizophrenia therapy. In the second stage, drugs are used to maintain the achieved improvement and prevent possible attacks (anti-relapse effect of drugs). First of all, antipsychotic drugs are used. The first generation of these drugs included chlorpromazine, fluphenazine, haloperidol, perphenazine. The second generation of antipsychotics: clozapine, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone, etc. The choice of drug depends primarily on the existing psychopathological characteristics of the symptoms. Possible side effects and complications of therapy are manifested in the form of extrapyramidal symptoms (acute dystonia, akathisia, drug parkinsonism, tardive dyskinesia), neuroleptic malignant syndrome, metabolic syndrome, etc. Along with antipsychotics, tranquilizers and normochemicals are quite widely used in the treatment of schizophrenia.

Non-drug treatments include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). These methods are used in cases where the disease can not be conservative medical treatment. Usually, after ECT and TMS, patients experience significant improvement and a long period without exacerbations of psychotic symptoms. It should be noted that the effectiveness of TMS is not yet fully proven.

An important place is occupied by psychosocial rehabilitation of patients with schizophrenia. Her goal is to restore the social and communication skills of patients and increase their level of functioning.

Forecast. Prevention

Scientific studies have shown that there are some factors that influence the improvement of prognosis in schizophrenia. These include:

  • female,
  • acute onset of the disease compared with the long-term ongoing process,
  • later manifestation age,
  • the prevalence of productive, rather than negative symptoms in the clinic of the disease,
  • high level of social functioning and personal autonomy in the premorbid period.

However, most of the studies performed on this issue are of a correlation nature, and it is difficult to establish a clear causal relationship. It has also been proven that negative attitudes towards people with schizophrenia can have a significant adverse effect on these patients. In particular, it was found that criticism, hostility, and authoritarianism of family members of schizophrenic patients correlate with a higher risk of disease recurrence in different cultures.

Bibliography

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Introduction

Patient P., 28 years old, applied for medical care in a psychiatric hospital at the insistence of her parents.

On admission she complained about the feeling of influence from the people around her, anxiety, restless sleep, confusion of thoughts, “voices” in her head and stomach.

It turned out that the patient’s heredity is psychopathologically burdened by the mother’s grandfather’s schizophrenia.

According to the parents and according to medical records, the girl fell ill at the age of 23 years. It was then that distinct changes in personal qualities began to appear in the form of a gradually increasing closure, a decline in social interests and activity.

Around January 2014, well-being has changed dramatically: fear, anxiety, and the feeling that certain faces affect the brain and control it have appeared. Parents seemed "strangers". Later, conviction arose in the presence of love relationships with a famous artist. The girl said that she was mentally talking to him about love. She was sure of reciprocity on his part. The patient describes her condition at that time as being close to ecstasy. She had a feeling of her “holiness”, a special closeness to God (“God's chosen people”). The perception of the world has changed, but how exactly, the girl could not explain and describe.

At the same time, the patient began to feel that she had "extrasensory" abilities. "Inside the head" surfaced events of the future, for example, how parents die in a plane crash and tsunami. A certain "divine" inner voice instructed and instructed her. The girl talked with imaginary people, performed obscure actions ("some manipulations with her hands"). Under the influence of voices she applied a quill pen to her heart, poured holy water on her head, fought against "evil spirits" with the help of "reading books on astronomy." I didn’t sleep, tried to run away from home, resisted my relatives. In this regard, at the insistence of parents was hospitalized in a psychiatric hospital.

From medical information it is known that the patient had previously been treated in psychiatric hospitals with a diagnosis of paranoid schizophrenia.

The patient was born in the city of Murmansk. Pregnancy and childbirth from the mother were uneventful. The girl is the only child in the family. Early development took place without features, the character was formed quite sociable, prone to reverie. Up to 12 years old she was raised in a complete family, then her parents divorced. Mother describes as quick-tempered and irritable, he calls his father more good-natured and easy-going.

After the 11th grade, she entered the university for a biotechnologist, then worked in her specialty. Currently, the patient is not married, has no children and is under the care of parents. Lives in the mother's family in satisfactory material and living conditions.

From past illnesses - only children's infections without complications and colds. Allergic history is not burdened. Tuberculosis, hepatitis, sexually transmitted diseases denies.

Survey

Somatic status: the general condition is satisfactory. Patient normostenicheskoy physique, satisfactory nutrition. The skin and visible mucous regular color, clean. Peripheral lymph nodes are not enlarged. Breathing in the lungs is vesicular, wheezing is not heard. Pulse 77 beats per minute, rhythmic, satisfactory filling, not tense. Blood pressure 110/70 mm RT. Art. Heart sounds loud, rhythmic. The abdomen is soft, painless on palpation in all departments. Panging on the back painless on both sides. Urination and stools are normal.

Neurological status: The eye slits are equal. Pupils are rounded, equal in size. Photoreactions are live, symmetrical. The convergence reaction (the ability of the eyes to turn towards each other) on both sides is preserved. The movement of the eyeballs occurs in full. Double eyes and nystagmus (involuntary oscillatory eye movement) no. The face is symmetrical. Language in the middle line. Tendon reflexes of medium vitality, the same on both sides. Abdominal reflexes are low, identical to the right and left. Sensitive disorders are not. In the Romberg position (standing with the feet shifted together, eyes closed, and arms stretched straight ahead in front of her), the patient is stable. Coordination tests are performed satisfactorily. Meningeal signs that occur during irritation of the meninges are not identified.

Clinical blood tests, general urinalysis, biochemical blood tests were performed. No pathologies detected. The results of the blood test for viral hepatitis B and C, HIV infection, and syphilis are negative.

Radiography of the chest and ultrasound of the abdominal organs without pathology.

According to ECG, the average frequency of ventricular contractions is 76 beats per minute. Sinus rhythm. The normal position of the electrical axis of the heart in the frontal plane.

According to the EEG results, moderate disturbances in the bioelectrical activity of the brain are observed, indicating diffuse irritation of the cortex (stimulation of brain regions), diencephalic (hypothalamic) structures dysfunction with a decrease in the stability of the general functional state of the brain.

The patient was referred for consultations to a general practitioner and a neurologist: there were no data for acute therapeutic and organic pathology.

F20.0 Paranoid schizophrenia

On the background of treatment with neuroleptics, the patient's condition improved somewhat: the girl became more contactable, more sociable, the number of deceptions of perception decreased, the level of anxiety decreased, sleep improved, behavior became more orderly.

Symptomatology of the disease was moderately cropped.

The patient was discharged in satisfactory condition under the supervision of a psychiatrist at the place of residence. Before discharge, a psychotherapeutic conversation was conducted with the patient, recommendations were given, and prescriptions for antipsychotics were written out. Further treatment of the patient was held in a day hospital at a neuropsychiatric dispensary.

Conclusion

The girl suffers from mental illness for about five years. The presence of hallucinatory-delusional symptoms, inadequacy, reduction of will and inclinations, lack of emotions, as well as the results of the conducted examinations point to paranoid schizophrenia. The effectiveness of the treatment chosen suggests that in such a disorder, the use of antipsychotics is the best solution.

Watch the video: Schizophrenia Overview. Clinical Presentation (January 2020).